Citation Nr: 19166352 Decision Date: 08/27/19 Archive Date: 08/27/19 DOCKET NO. 18-36 052 DATE: August 27, 2019 ORDER Entitlement to a rating in excess of 40 percent for service-connected degenerative joint disease (DJD) of the lumbar spine is denied. Entitlement to an initial rating in excess of 30 percent for service-connected acquired psychiatric disorder, initially rated as anxiety disorder and later as posttraumatic stress disorder (PTSD), prior to December 4, 2012 is denied. Entitlement to more than a 50 percent rating for service-connected acquired psychiatric disorder from December 4, 2012 to November 2, 2015 is denied. Entitlement to more than a 70 percent rating for service-connected acquired psychiatric disorder from November 2, 2015 is denied. Entitlement to more than a 10 percent rating for service-connected right lower extremity (RLE) radiculopathy prior to July 19, 2016 is denied. Entitlement to a 20 percent rating (but no higher) for service-connected RLE radiculopathy is granted from July 19, 2016. Entitlement to a 40 percent rating (but not higher) for service-connected RLE radiculopathy is granted from October 11, 2016. Entitlement to an initial compensable rating for hypertension (HTN) is denied. Entitlement to TDIU prior to September 12, 2016 (on a schedular and extraschedular basis) is granted. Entitlement to an effective date earlier than December 8, 2009 for the grant of service connection for an acquired psychiatric disorder is denied. Entitlement to an effective date earlier than November 8, 2010, for the grant of service connection for HTN is denied. Entitlement to an effective date earlier than July 12, 2012 for the grant of service connection for RLE radiculopathy is denied. Entitlement to an earlier effective date of December 8, 2009 for the award of Dependents’ Education Assistance (DEA) benefits under 38 U.S.C. Chapter 35 is granted. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran’s lumbosacral spine has demonstrated at worst 30 degrees of forward flexion, with no additional limitation of motion demonstrated on repetitive motion and no evidence of thoracolumbar spine ankylosis or its functional equivalent. 2. Prior to December 4, 2012, the Veteran’s acquired psychiatric disorder is not shown to cause occupational and social impairment with more than occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal. 3. From December 4, 2012 to November 2, 2015, the Veteran’s service-connected acquired psychiatric disorder is not shown to cause occupational impairment with more than reduced reliability and productivity. 4. From November 15, 2015, the Veteran’s service-connected acquired psychiatric disability is not shown to cause occupational and social impairment with more than deficiencies in most areas of functioning, and at no point during the periods on appeal is such disability productive of pathology suggesting total occupational or social impairment. 5. Prior to July 19, 2016, the Veteran’s RLE radiculopathy was manifested by mild radiculopathy without atrophy. 6. From July 19, 2016, the Veteran’s RLE radiculopathy was manifested by symptoms consistent with moderate radiculopathy of the sciatic nerve. 7. From October 11, 2016, the Veteran’s RLE radiculopathy was productive of symptoms consistent with moderately severe impairment of the sciatic nerve. 8. The Veteran’s service-connected HTN is not productive of diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or more requiring continuous medication for control. 9. The most thorough opinion regarding the functional impact of his service-connected disabilities on his occupational functioning, by far, is a private vocational expert opinion reflecting a thorough review of the Veteran’s file and concluding his service-connected low back disability, right lower extremity radiculopathy, and PTSD render him unable to work. Specifically, she found “it is at least as likely as not that the combination of [those disabilities]…have rendered him unable to secure and follow substantially gainful employment since at least 2008, the year he last earned above the poverty threshold.” Social Security records confirm that the Veteran has not earned money since 2010 and earned less than $6,000 in 2008 and 2009. The expert added that unrelenting back pain and PTSD would leave the Veteran unable to cope with the demands of a regular work week because he would have to “leave early or be absent from work in excess of two times per month.” She also noted his unrelenting back pain and psychiatric struggles would significantly impair his ability to focus and concentrate, preventing him from maintaining adequate pace and response time regardless of the physical demand level of the occupation. Finally, the expert indicated he would likely be unable to meet even the physical requirements for sedentary work given his service-connected disabilities, citing specifically to the technical definition and noting his back disability would prevent him from sitting, standing, or walking for extended periods of time. Considering all this in light of the Veteran’s education level (only up to high school) and work experience (as a truck driver), the Board finds the evidence is at least in relative equipoise as to whether the Veteran’s service-connected disabilities render him unable to obtain or secure substantially gainful employment prior to September 12, 2016. 10. The December 8, 2009 effective date for service connection of an acquired psychiatric disability on appeal is based on the date VA first received his claim seeking service connection for PTSD and there is no indication that he ever filed or expressed the intention to file a prior claim for such benefit. Moreover, as his psychiatric disability is rated separately as anxiety disorder (prior to December 4, 2012) and PTSD (from that date), the rule against pyramiding prohibits the Board from otherwise assigning an earlier effective date solely for his PTSD award. 11. The November 8, 2010 effective date for service connection of HTN on appeal is based on the date VA first received the Veteran’s claim seeking service connection for HTN and there is no indication that he filed or expressed the intent to file a prior claim for such benefit. 12. Although service connection for RLE radiculopathy was raised during the pendency of a rating appeal for low back disability dating back to a December 2008 claim, RLE radiculopathy itself was not first manifested until July 12, 2012 (the currently assigned effective date). 13. As the Board is granting TDIU prior to September 12, 2016, the evidence also reasonably shows the Veteran was permanently and totally disabled prior to that date for purposes of establishing Chapter 35 eligibility. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 40 percent for lumbosacral spine DJD are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5237 (2018). 2. The criteria for an initial increased disability rating in excess of 30 percent for service-connected psychiatric disability prior to December 12, 2012, have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 3.102, 3.321, 4.25, 4.130 (2018). 3. The criteria for an initial increased rating in excess of 50 percent for service-connected psychiatric disability from December 12, 2012, to November 2, 2105, have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 4.25, 4.130 (2018). 4. The criteria for an initial increased rating in excess of 70 percent for service-connected psychiatric disability from November 2, 2015 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 4.25, 4.130 (2018). 5. The criteria for a rating in excess of 10 percent for radiculopathy of the RLE prior to July 19, 2016 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 4.25, 4.130, DC 8520 (2018). 6. The criteria for a 20 percent rating (but not higher) for RLE radiculopathy from July 19, 2016 are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 4.25, 4.130, DC 8520 (2018). 7. The criteria for a 40 percent rating (but not higher) for RLE radiculopathy from October 11, 2016 are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 4.25, 4.130, DC 8520 (2018). 8. The criteria for an initial compensable disability rating for service-connected HTN are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.21, 4.104, DC 7101 (2018). 9. The criteria for TDIU have been met prior to September 12, 2016 (on a schedular and extraschedular basis). 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.1, 4.3, 4.16 (2018); see, e.g., Anderson v. Shinseki, 22 Vet. App. 423 (2009), Thun v. Peake, 22 Vet. App. 111 (2008) (implicitly overruling the holding in Bowling v. Principi, 15 Vet. App. 1 (2001) prohibiting the Board from granting an extraschedular TDIU in the first instance); see also Wages v. McDonald, 27 Vet. App. 233, 239 ) (Kasold, J., concurring) citing Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (determining, in direct disagreement with Bowling, that the Board may award extraschedular TDIU in the first instance). 10. The criteria for entitlement to an effective date prior to December 08, 2009 for a grant of service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.114, 3.155, 3.400 (2018). 11. The criteria for entitlement to an effective date prior to November 8, 2010 for a grant of service connection for HTN have not been met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.114, 3.155, 3.400 (2018). 12. The criteria for entitlement to an effective date prior to July 12, 2012 for a grant of service connection for radiculopathy of the RLE have not been met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.114, 3.155, 3.400 (2018). 13. The criteria for an effective date prior to September 12, 2016 for eligibility to DEA under U.S.C. Chapter 35 have been met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.102, 3.155, 3.400 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1969 to January 1971. These matters are before the Board of Veterans’ Appeals (Board) on appeal from multiple rating decisions. Although the Veteran filed an October 2016 notice of disagreement (NOD) purporting to appeal, among other things, the effective date assigned with an August 2016 award for service-connected lumbar spine disability, the rating decision in question actually reduced the rating for that disability effective July 19, 2016 and, therefore, there was no award or associated effective date assignment for the Veteran to appeal. Consequently, that matter is not before the Board at this time. A June 2018 rating decision during the pendency of this appeal granted earlier effective dates for awards of service connection for RLE radiculopathy (of July 12, 2012), hypertension (of November 8, 2010), and anxiety disorder (of November 9, 2010). Those appeals have been amended to reflect those changes. Although the Veteran also appealed the effective date assigned (September 12, 2016) for a February 2017 award of a TDIU, the Board finds that, as TDIU was raised during the pendency of multiple increased rating claims, it was part and parcel of those claims under Rice v. Shinseki, 22 Vet. App. 447, 455 (2009) and the award in question constituted a partial grant, leaving the residual matter of entitlement to a TDIU prior to that date still substantively on appeal in the first instance. Therefore, that issue has also been amended accordingly. For the reasons outlined above, the Board is granting the appeal seeking TDIU prior to September 12, 2016 and an earlier effective date for Chapter 35 eligibility, obviating any need for further detailed discussion thereof at this time. Increased Ratings – In General Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155 (2012); 38 C.F.R. Part 4 (2018). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2018). It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21 (2018). When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20 (2018). In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the veteran’s condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). However, where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings may be appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See e.g. Hart v. Mansfield, 21 Vet. App. 505 (2007). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2018) (providing, in pertinent part, that reasonable doubt will be resolved in favor of the claimant). When the evidence supports the claim or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). If the preponderance of the evidence weighs against the claim, it must be denied. See id.; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 1. Entitlement to a rating in excess of 40 percent for service-connected DJD of the lumbar spine. Under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), with or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings will apply: A 40 percent rating is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. There are several notes following the General Rating Formula criteria, which provide: (1) Associated objective neurological abnormalities are to be rated separately under an appropriate diagnostic code. (5) Unfavorable ankylosis is a condition in which the entire cervical spine, or the entire spine, is fixed in flexion or extension. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71a. The Veteran’s lumbosacral spine disability has been rated 40 percent disabling under DC 5237 (for lumbosacral or cervical strain). While it can be alternatively rated based on incapacitating episodes of intervertebral disc syndrome (IVDS), as explained further below, the Board finds no evidence of such pathology and, therefore, need not discuss those criteria in detail. Service connection was established for the Veteran’s low back disorder in May 2011. A 40 percent rating was assigned pursuant to DC 5237. Treatment records at the time that service connection was established included VA records which showed chronic low back pain with the use of a corset in 2010. Upon VA examination in April 2011, the Veteran reported low back pain which was getting worse. There was pain, stiffness, weakness, and fatigability, as well as radicular symptoms into the RLE. He could walk normally without any assistive devices. He sometime used a cane. Range of motion (ROM) testing of the lumbar spine showed forward flexion from 0 to 30 degrees without pain. Extension was from 0 to 8 degrees without pain. Right lateral flexion was from 0 to 8 degrees and left lateral flexion was from 0 to 6 degrees. Right and left lateral flexion were from 0 to 20 degrees. After three repetitive movements, lumbar spine ROM testing showed forward flexion from 0 to 20 degrees without pain. Extension was from 0 to 5 degrees without pain. Right lateral flexion was from 0 to 5 degrees without pain. Left lateral flexion was from 0 to 6 degrees without pain. Right and left lateral rotation was from 0 to 20 degrees, bilaterally. When experiencing flare-ups, pain increased. On this exam, there was objective evidence of painful motion, weakness, and tenderness. X-rays showed DJD of the lumbar spine. The above findings resulted in the assignment of a 40 percent rating as noted upon rating decision of May 2011. VA records reflect continued treatment for the low back from 2012 through 2015. Upon VA examination of the spine in July 2016, which included review of the claims file and an in-person evaluation, diffuse degenerative disc disease (DDD) was diagnosed. The Veteran reported flare-ups of low back disability with constant lower back pain that increased with prolonged sitting, standing, walking, bending, lifting, or pulling motions. ROM testing of the lumbar spine showed forward flexion from 0 to 60 degrees. Extension was from 0 to 20 degrees. Right and left lateral flexion were from 0 to 25 degrees, bilaterally. Right and left lateral flexion were from 0 to 25 degrees, bilaterally. There was evidence of localized tenderness or pain on palpation of the joints. After repetitive use testing after three repetitions, ROM was from 0 to 50 degrees of forward flexion. Extension was from 0 to 15 degrees. Bilateral lateral flexion and rotation were from 0 to 20 degrees. There was pain, weakness, and fatigability. There was no IVDS. Upon additional VA spine examination in October 2016, DJD of the lumbar spine was diagnosed. ROM testing was from 0 to 30 degrees of forward flexion. Extension was from 0 to 30 degrees. Bilateral lateral flexion and rotation were from 0 to 15 degrees. The Veteran was unable to sit or stand for more than 25 minutes. He had trouble bending. There was no IVDS. There was no additional loss after three repetitions. After a review of the evidence of record, the Board finds that the preponderance of the evidence is against a finding the Veteran’s lumbosacral spine disability warrants a rating in excess of 40 percent. At no time in the record is there medical evidence of lumbosacral ankylosis which is required for an increased rating. Moreover, while the Veteran has reported flare-ups and the Board has considered their impact and the impact of other functional loss on the severity of his low back disability, under the circumstances, a higher rating based on functional would require the functional equivalent of unfavorable ankylosis of the entire thoracolumbar spine (i.e., it would have to resemble near immobility of the entire thoracolumbar spine). As there is no evidence or allegation suggesting such dire pathology, even in the Veteran’s own reports of flare-ups in low back disability, the Board cannot grant a higher rating on that basis. Moreover, to the extent that any examinations of record fail to comply with Correia v. McDonald, 28 Vet. App. 158 (2016) (holding 38 C.F.R. § 4.59 (2018) requires VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with ROM measurements of the opposite undamaged joint), the Board finds that such error would essentially be harmless here because Correia seeks to ensure accurate and holistic range of motion measurements and, here, the Veteran is already assigned the maximum rating based on limitation of motion of the lumbar spine with no evidence of the requisite ankylosis for a still higher rating. Consequently, there is no basis for awarding an increased rating for the Veteran’s lumbosacral spine disability, the preponderance of the evidence is against the instant claim, the benefit of the doubt rule does not apply, and the appeal thereof must be denied. See 38 U.S.C. § 5107 b) (2012); 38 C.F.R. §§ 3.102, 4.3 (2018). The Board will consider whether a separate rating is warranted for any neurological manifestations of the Veteran’s lumbosacral spine disability later in this decision along with the rating for right lower extremity radiculopathy. 2. Entitlement to an initial rating in excess of 30 percent for service-connected acquired psychiatric disorder prior to December 4, 2012; in excess of 50 percent from December 4, 2012, to November 2, 2015, and in excess of 70 percent from that date forward. The Veteran’s service-connected anxiety/PTSD disability has been rated under DC 9411. 38 C.F.R. § 4.130 (2018). Under the pertinent criteria, a 30 percent disability evaluation is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent disability evaluation is assigned under the general rating formula for mental disorders where the evidence shows occupational and social impairment due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment in short-term and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is assigned for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. Id. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, length of remissions, and the Veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a) (2018). The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. Id. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126(b) (2018). In order to be assigned a particular rating, a Veteran need not demonstrate the presence of all, most, or even some, of the symptoms listed as examples in the rating criteria. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The key element for a rating under the General Formula for Mental Disorders is the degree of social and occupational impairment caused by those symptoms. Private and VA treatment records reflect various mental health diagnoses from 2009 through early 2011, to include PTSD, anxiety, and depression. When examined by VA in April 2011, the Veteran had been married for 19 years. He had good relationships with his children and his grandchildren. He had recently joined a PTSD group. He was active and exercised. On examination, he was anxious, and his affect was broad. His mood was congruent. He was alert and oriented in three spheres. His thought content was coherent and relevant without delusion. Suicidal and homicidal ideations were denied. His memory was normal. The final diagnosis was anxiety disorder. When examined by VA in December 2012, PTSD was diagnosed. The examiner found that occupational and social impairment with occasional decrease in work, efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation best summarized the Veteran’s level of occupational and social impairment. At the time, the Veteran described himself as sometimes “evil” in interactions with his wife. He said he was short tempered, and he was afraid she would leave him due to his irritability and avoidance. He did not feel emotionally close to his family. He attended church and hunted with friends. He attended a weekly PTSD group until 2012, when he stopped because it was causing an increase in PTSD symptoms. His symptoms included sleep disturbance, irritability, hypervigilance and exaggerated startle response. He was noted to be depressed and have anxiety. He had mild memory loss. Upon VA mental health examination in October 2015, PTSD continued as the diagnosis. The examiner found that occupational and social impairment with deficiencies in most areas, such as work school, family relations, judgment, thinking and/or mood best summarized the Veteran’s level of occupational and social impairment. Current symptoms included sleep disturbance, anxiety, suspiciousness, panic attacks that occurred weekly or less often, and disturbances in mood and motivation. Another VA examination was conducted in June 2016. The examiner found that occupational and social impairment with deficiencies in most areas, such as work school, family relations, judgment, thinking and/or mood best summarized the Veteran’s level of occupational and social impairment. Symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, and disturbances in motivation and mood. His speech was spontaneous, and his thought process was logical. He had no suicidal or homicidal ideation. He experienced chronic feelings of guilt and shame regarding the war. He attended group psychotherapy group on a weekly basis. The Board finds that an evaluation in excess of 30 percent is not warranted prior to December 4, 2012 because the evidence does not show symptoms or impairment consistent with a higher 50 percent rating during that period. Rather, the totality of the medical evidence at the time showed he had stable relationships with family, was active, was properly oriented, and had no thought disturbances or abnormal ideation. By all accounts, he was functioning relatively well despite having anxiety and a history of variously diagnosed psychiatric problems. Moreover, a rating in excess of 50 percent is not warranted from December 4, 2012 to November 2, 2015 because there is no suggestion of more severe pathology associated with a higher 70 percent rating. While the evidence certainly suggests he was worse than in the prior period on appeal—he began having more problems with irritability, depression, being “evil” to his wife, and feeling emotionally distant from his family—it does not appear that he suffered from deficiencies in most areas of functioning (e.g., work, school, family relations, judgment, thinking, mood). Rather, his problems seemed to reside primarily in two—family relations and mood. Finally, a rating in excess of 70 percent is not warranted from November 2, 2015 forward. While the Veteran continues to be seen for his psychiatric symptoms and is apparently attending group therapy again, there is simply no evidence or allegation that the Veteran has exhibited or experienced symptoms of a frequency, duration, or severity consistent with the sort of grossly and persistently disabling pathology contemplated by the criteria for a 100 percent rating. Put more simply, there is no indication that he has the kind of total occupational and social impairment required for a higher 100 percent rating. Consequently, the Board finds no basis for awarding a higher rating during any stage on appeal for the Veteran’s service-connected psychiatric disability (which is broadly defined to include both anxiety and PTSD). Therefore, the preponderance of the evidence is against this claim as well, and the appeal thereof must be denied. 3. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the RLE. DC 8520 for paralysis of the sciatic nerve affords an 80 percent rating for complete paralysis (i.e., the foot dangles and drops, no active movement possible of muscle below the knee, flexion of knee weakened or (or very rarely) lost). A 60 percent rating is provided for severe incomplete paralysis of the sciatic nerve with marked muscular atrophy, a 40 percent rating is provided for moderate incomplete paralysis, a 20 percent rating is provided for moderate incomplete paralysis, and a 10 percent rating is provided for mild incomplete paralysis of the sciatic nerve. Words such as “moderate” and “mild” are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6 (2018). Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104 (2012); 38 C.F.R. §§ 4.2, 4.6 (2018). The evidence of record includes a VA examination report of the back in April 2011. Although the Veteran had RLE complaints at that time, nerve conduction studies were normal. VA records reflect, however, that upon evaluation on July 12, 2012, lumbar radiculopathy was diagnosed following pin prick testing. Upon VA examination of the spine in July 2016, there was no muscle atrophy of the RLE and strength, reflexes, and sensation were normal. There was mild pain to the RLE with moderate paresthesias and numbness. The examiner felt there was moderate involvement of the right sciatic nerve. Additional VA examination in October 2016 showed decreased sensation on the right with constant and severe RLE pain and moderate paresthesias and numbness. No other signs or symptoms of radiculopathy were present, and the examiner felt there continued to be moderate overall involvement of the right sciatic nerve. Prior to the July 19, 2016 VA examination, the evidence reflects largely normal neurological testing. However, the July 2016 examiner noted mild and moderate radicular symptoms in the RLE and explicitly felt there was moderate involvement of the right sciatic nerve. The October 11, 2016 examiner also confirmed the location of radicular involvement and notes worsening symptoms that were described as moderate (for paresthesias and numbness) and severe (for RLE pain). Thus, the Board finds the evidence is at least in relative equipoise as to whether the Veteran’s RLE radiculopathy was productive of moderate, incomplete paralysis warranting a higher 20 percent rating from July 19, 2016 and moderately severe impairment warranting a higher 40 percent rating from October 11, 2016. Unfortunately, even higher ratings are not warranted under DC 8520 during any period on appeal. Notably, the July 2016 and October 2016 examinations are the first pieces of clinical evidence suggesting the moderate and moderately severe levels of radicular involvement referenced above, which means 20 and 40 percent ratings are not warranted under the evidence prior to July 19, 2016 and October 11, 2016, respectively. Furthermore, no evidence or allegation since the October 2016 examination suggests any worsening or exacerbation at all, much less one that resembles the kind of severe impairment contemplated by a higher 60 percent rating or complete paralysis required for a maximum 80 percent rating. Finally, the Board notes that there is also no basis for awarding separate or additional ratings based on criteria other than 8520 because there is no evidence or allegation that the Veteran’s service-connected lumbar radiculopathy involves other nerves or nerve groups. Therefore, the Board also finds the preponderance of the evidence is against awarding still higher ratings in excess of 10 percent prior to July 19, 2016, 20 percent between that date and October 11, 2016, or 40 percent from that date. To that extent, the benefit of the doubt rule does not apply and the instant appeal must be denied. 4. Entitlement to an initial compensable rating for HTN. 38 C.F.R. § 4.104, DC 7101 provides that hypertensive vascular disease is defined either as hypertension or as isolated systolic hypertension. HTN is defined as diastolic blood pressure predominately 90 mm or greater, and isolated systolic hypertension is defined as systolic blood pressure predominately 160 mm or greater, with a diastolic blood pressure of less than 90 mm. This code requires that HTN due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, be evaluated as part of the condition causing hypertension rather than by a separate evaluation (as hypertension). Under DC 7101, HTN or isolated systolic hypertension must be confirmed by blood pressure readings taken two or more times on at least three different days and is rated according to a range of diastolic pressure levels. The minimum compensable rating of 10 percent disabling is available where diastolic pressure is predominantly 100 or more, or where systolic pressure is predominately 160 or more, or where an individual with a history of diastolic pressure predominantly 100 or more requires continuous medication for control of HTN. See 38 C.F.R. § 4.104, DC 7101 (2018). It is noted that when examined by VA in June 2016, the Veteran stated that he had been diagnosed with this condition shortly after service discharge. Review of the record corroborates his recitation of a long history of diagnosis of HTN. Treatment included daily medication for control. Blood pressure readings were recorded as 146/76, 131/74, and 142/65. Upon additional VA examination in October 2016, the Veteran continued with his medication for control of HTN. The examiner noted that the Veteran did not have a history of a diastolic blood pressure reading predominantly 100 or more. Blood readings of 156/83, 134/78, and 156/90, were noted. Upon review of the medical evidence of record, the Board finds that a compensable disability rating for HTN is not warranted. The medical evidence does not demonstrate that the Veteran’s diastolic pressure has been prominently 100 or more nor systolic pressure predominantly 160 or more. Moreover, while the Board acknowledges that the Veteran has been prescribed medication (Lisinopril) for his high blood pressure, the evidence does not establish a history of diastolic pressure predominantly 100 or more as determined by the above summarized VA examination reports. Given the clearly defined nature of the rating criteria in question, the Board finds there is simply no evidence that the Veteran’s hypertension meets the criteria for a minimum compensable rating (i.e., either predominantly 100 or greater diastolic pressure or a history of such pressure that requires continuous medication for control). Therefore, the preponderance of evidence is against a compensable rating for service-connected HTN, the benefit of the doubt doctrine does not apply, and the appeal in this matter must be denied. Gilbert, supra. Effective Dates – In General The provisions of 38 U.S.C. § 5110(a) (2012) state that, unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. The effective date of an award of disability compensation to a Veteran shall be the day following the date of discharge or release if application therefor is received within one year from such date of discharge or release. 38 U.S.C. § 5110(b)(1) (2012). The provisions of 38 C.F.R. § 3.400 (2018) stipulate that, except as otherwise provided, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. In the case of direct service connection, the effective date of an award is the day following separation from active service or date entitlement arose if a claim is received within 1 year after separation from service; otherwise, the date of receipt of claim, or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2) (2018). A specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by VA. 38 C.F.R. § 3.151(a) (2018). The term “claim” or “application” means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief of entitlement, to a benefit. 38 C.F.R. § 3.1(p) (2018). “Date of Receipt” generally means the date on which a claim, information or evidence was received by VA. 38 C.F.R. § 3.1(r) (2018). The regulations also provide that a veteran may receive benefits by filing an informal claim, which is defined by ‘[a]ny communication or action, indicating an intent to apply for one or more benefits under the laws administered by the Department of Veterans Affairs, from a claimant…may be considered an informal claim.” 38 C.F.R. § 3.155 (2018). Such an informal claim must identify the benefit sought; and, upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. Id. 5. Entitlement to an effective date earlier than December 8, 2009 for the grant of service connection for an acquired psychiatric disorder. A brief procedural overview here is crucial in explaining the scope of this claim. On December 9, 2009, the Veteran filed a claim seeking service connection for PTSD. A May 2011 rating decision granted service connection for anxiety disorder (effective November 8, 2010) but denied it for PTSD based on a finding that the Veteran met the diagnostic criteria for the former but not the latter. The Veteran initiated a timely appeal thereof by October 2011 correspondence. During the pendency of that appeal, a February 2016 rating decision granted service connection for PTSD, effectively combining the two service-connected psychiatric disorders into one service-connected disability rated under two codes—first as anxiety disorder (rated 30 percent from November 8, 2010 to December 3, 2012) and then as PTSD (rated 50 percent from December 4, 2012 and 70 percent from November 2, 2015). Moreover, the “new” award of service connection was described expressly as PTSD “previously rated as anxiety disorder.” In essence, it created one continuous rating for a broad service-connected psychiatric disability that stretched back to November 8, 2010 to capture the February 2016 decisions finding that the Veteran’s “previously rated anxiety disorder has developed to meet the criteria for PTSD.” Subsequently, a June 2018 rating decision granted an earlier December 8, 2009 effective date for the broadly service-connected psychiatric disability (including both anxiety disorder and PTSD) based on the date VA first received the original claim for PTSD). This appears on his rating codesheet as an earlier effective date for the initial 30 percent rating for anxiety disorder but, given the evolutionary nature of his psychiatric disability (described above), applies to the entire, broader service-connected psychiatric disability. Critically, as the medical evidence suggests that service-connected PTSD and anxiety disorder represent different stages of the same overarching disability entity, the change in rating and DC comports with 38 C.F.R. § 4.125(b) and, more importantly, awarding an effective date prior to December 4, 2012 for PTSD would result illegal pyramiding (i.e., double compensation for the same disability, pathology, and impairment) during that period in question. Thus, the only remaining question before the Board is whether an effective date is warranted for the broad service-connected psychiatric disability prior to December 8, 2009. Unfortunately, as that is the date VA first received the claim underlying this appeal, a threshold question here is whether an earlier date of claim may be applied. Unfortunately, there is no evidence in the record that the Veteran filed any type of claim or expressed intent to file a claim for a psychiatric disorder before December 8, 2009. Therefore, December 8, 2009 is the earliest possible effective date for this award under the law. 6. Entitlement to an effective date earlier than November 8, 2010, for the grant of service connection for HTN. As above, the effective date on appeal here is based on the date VA first received correspondence indicating an intent to file a claim of service connection for hypertension. Absent any evidence that the Veteran ever expressed an intent to file a claim prior to that date, that date is the earliest possible effective date under the law. 38 C.F.R. § 3.400 (2018).   7. Entitlement to an effective date earlier than July 12, 2012, for the grant of service connection for RLE radiculopathy. The effective date on appeal here is based on the date RLE radiculopathy was first diagnosed following pin prick testing. As the award of service connection in question came during the pendency of and was part and parcel of a broader, overarching claim seeking a higher rating for lumbar spine disability, this claim inherits its original date of claim of December 8, 2009. Thus, the critical question now is whether entitlement to RLE radiculopathy is warranted prior to July 12, 2012. In the context of a claim of service connection, the date of entitlement hinges on when the service-connected disability first manifested itself. See McGrath v. Gober, 14 Vet. App. 28, 35 (2000). As summarized earlier, while the Veteran complained of RLE symptoms in April 2011, nerve conduction studies were negative for RLE radiculopathy at the time and the condition was not confirmed until pin prick testing was performed on July 12, 2012 VA evaluation. Therefore, that is the date entitlement arose and the current effective date is the earliest possible under the law. MORGAN YUAN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Hal Smith The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.