Citation Nr: 21000216 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 19-35 810A DATE: January 4, 2021 ORDER New and material evidence having been received, the claim to reopen service connection for kidney stones is reopened. Entitlement to service connection for kidney stones is denied. Entitlement to an effective date earlier than November 19, 2014 for the grant of service connection for IBS is dismissed as a matter of law. Entitlement to an effective date earlier than December 5, 2017 for the grant of a separate rating for left knee instability is denied. Entitlement to an initial rating greater than 10 percent for right knee instability is denied. Entitlement to an initial rating greater than 10 percent for left knee instability is denied. Entitlement to a rating greater than 10 percent for right knee strain is denied. Entitlement to a rating greater than 10 percent for left knee strain is denied. Entitlement to a rating greater than 10 percent for a back disability is denied. Entitlement to a rating greater than 10 percent for radiculopathy of the right lower extremity is denied. Entitlement to a rating greater than 10 percent for radiculopathy of the left lower extremity is denied. Entitlement to a rating greater than 10 percent for residuals of a right wrist injury is denied. Entitlement to a rating greater than 10 percent for tinnitus is denied. Entitlement to a compensable rating for allergic rhinitis is denied. Entitlement to a compensable rating for costochondritis is denied. Entitlement to a compensable rating for hypertension is denied. Entitlement to a compensable rating for hemorrhoids is denied. Entitlement to a rating greater than 100 percent for unspecified bipolar disorder with posttraumatic stress disorder (PTSD) is denied. Entitlement to a rating greater than 30 percent for irritable bowel syndrome (IBS) is denied. Entitlement to an effective date earlier than December 5, 2017 for Dependents’ Educational Assistance (DEA) under 38 U.S.C. Chapter 35 is denied. Entitlement to a total rating due to service-connected disability based on individual unemployability (TDIU) is dismissed as moot. REMANDED Entitlement to special monthly compensation based on the need for the aid and attendance of another is remanded. Entitlement to a temporary total disability (TTD) rating is remanded. FINDINGS OF FACT 1. In a July 2015 rating decision, the Agency of Original Jurisdiction (AOJ) denied the Veteran’s claim for service connection for kidney stones. The Veteran did not perfect an appeal of this decision and it is final. 2. The evidence received since the July 2015 rating decision relates to an unestablished fact and raises a reasonable possibility of substantiating the claim for service connection kidney stones. 3. The Veteran’s kidney stones manifested after service and are not otherwise shown to be related to service. 4. The claim for an earlier effective date (EED) for the grant of service connection for IBS is not permissible under the law. 5. The Veteran filed an increased rating claim for service-connected left knee strain on December 5, 2017. 6. Left knee instability arose on the December 22, 2017, date of a VA examination on which a finding of left knee instability was initially made. 7. Throughout the appeal period, the Veteran’s right knee instability has not been productive of more than slight impairment. 8. Throughout the appeal period, the Veteran’s left knee instability has not been productive of more than slight impairment. 9. Throughout the appeal period, the Veteran demonstrated full range of motion of the right knee with pain. 10. Throughout the appeal period, the Veteran demonstrated full range of motion of the left knee with pain. 11. At no time during the duration of this appeal has the evidence shown limitation of thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or a combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 12. Throughout the appeal period, the Veteran’s radiculopathy of the right lower extremity has been productive of no more than mild incomplete paralysis of the sciatic nerve. 13. Throughout the appeal period, the Veteran’s radiculopathy of the left lower extremity has been productive of no more than mild incomplete paralysis of the sciatic nerve. 14. Throughout the appeal period, residuals, right wrist injury, has been manifested in limitation of motion, pain on movement and tenderness on palpation; there is no evidence of ankylosis. 15. Throughout the appeal period, the Veteran has been in receipt of the maximum schedular rating for tinnitus. 16. Throughout the appeal period, the Veteran’s allergic rhinitis is not shown to have been productive of greater than 50-percent obstruction of the nasal passages on both sides or complete obstruction on one side. 17. Throughout the appeal period, the Veteran’s costochondritis has been productive of intermittent rib cage pain and occasional associated fatigue-pain on the right side. 18. Throughout the appeal period, the Veteran’s hypertension has not manifested in diastolic pressure over 100 or systolic pressure over 160. 19. Throughout the appeal period, the Veteran’s hemorrhoids were not manifested by fissures, persistent bleeding with secondary anemia, or frequent recurrences of large or thrombotic hemorrhoids that were irreducible with excessive redundant tissue. 20. Throughout the appeal period, the Veteran has been in receipt of a 100 percent schedular rating for service-connected unspecified bipolar disorder with PTSD. 21. Throughout the appeal period, the Veteran has been in receipt of the maximum schedular rating for IBS. 22. Prior to December 5, 2017, the Veteran did not have a permanent and total service-connected disability. 23. The Veteran has been in receipt of a 100 percent disability rating and SMC under 38 U.S.C. § 1114(s) for the entire period on appeal. CONCLUSIONS OF LAW 1. The July 2015 rating decision that denied the Veteran’s claim for service connection for kidney stones is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 2. New and material evidence has been received to warrant reopening the previously denied claim of entitlement to service connection for kidney stones. 38 U.S.C. §§ 5107, 5108; 38 C.F.R. § 3.156. 3. The criteria for service connection for kidney stones are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. 4. The claim of entitlement to an earlier effective date for the grant of service connection for IBS is dismissed as a matter of law. 38 U.S.C. § 5110; 38 C.F.R. § 3.400; Rudd v. Nicholson, 20 Vet. App. 296 (2006). 5. The claim for an effective date earlier than April 28, 2016, for the award of a separate 10 percent rating for left knee instability are not met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. 6. Throughout the appeal period, the criteria for a rating in excess of 10 percent for right knee instability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5257. 7. Throughout the appeal period, the criteria for a rating in excess of 10 percent for left knee instability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DC 5257. 8. Throughout the appeal period, the criteria for a rating in excess of 10 percent for right knee strain based on limitation of motion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.59, 4.71a, DC 5260. 1. Throughout the appeal period, the criteria for a rating in excess of 10 percent for left knee strain based on limitation of motion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.59, 4.71a, DC 5260. 2. Throughout the appeal period, the criteria for entitlement to a rating in excess of 10 for the Veteran’s back disability are not met at any point during the duration of this appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DCs 5235-5243. 3. Throughout the appeal period, the criteria for a rating in excess of 10 percent for right lower extremity sciatic nerve radiculopathy are not met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. § 4.124a, DC 8520. 4. Throughout the appeal period, the criteria for a rating in excess of 10 percent for left lower extremity sciatic nerve radiculopathy are not met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. § 4.124a, DC 8520. 5. Throughout the appeal period, the criteria for a rating in excess of 10 percent, for residuals, right wrist injury, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DCs 5214, 5215. 6. Throughout the appeal period, the criteria for a rating in excess of 10 percent for tinnitus are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.87, DC 6260. 7. Throughout the appeal period, the criteria for a compensable evaluation for allergic rhinitis are not met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. § 4.97, DC 6522. 16. Throughout the appeal period the criteria for a compensable rating for costochondritis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.20, 4.71a, DC 5297. 17. Throughout the appeal period, the criteria for a compensable disability evaluation for hypertension are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.104, DC 7101. 18. Throughout the appeal period, the criteria for a compensable rating for hemorrhoids are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.114, DC 7336. 19. There is no legal basis for the assignment of a disability rating in excess of 100 percent for unspecified bipolar disorder with PTSD during the pendency of this appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.130, DC 9432-9411. 20. Throughout the appeal period, the criteria for entitlement to a rating greater than 30 percent for IBS have not been established. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. § 4.114, DC 7319. 21. The criteria for an effective date earlier than December 5, 2017 for the establishment of basic eligibility to DEA benefits are not met. 38 U.S.C. §§ 3500, 3501, 3510, 5107, 5110; 38 C.F.R. §§ 3.400, 21.3020, 21.3021. 22. Entitlement to a TDIU is dismissed as moot. 38 U.S.C. § 7105. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 2008 to November 2014. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The record shows that the Veteran’s representative initiated an appeal of additional issues arising out of the March 2018 rating decision when he filed a notice of disagreement in October 2018; however, he limited the issues on appeal as noted above when he filed the substantive appeal in December 2019. See 38 C.F.R. §§ 19.20-19.22. A. Claim to Reopen Service Connection for Kidney Stones In general, rating decisions that are not timely appealed are final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.1103. Pursuant to 38 U.S.C. § 5108, a finally disallowed claim may be reopened when new and material evidence is presented or secured to that claim. New evidence is evidence not previously submitted to agency decision makers. Material evidence means existing evidence which, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156. The credibility of the evidence is presumed and the threshold for submission is low. Justus v. Principi, 3 Vet. App. 510, 513 (1992); Shade v. Shinseki, 24 Vet. App. 110, 117-18 (2010). The basis of the AOJ’s initial denial of service connection for kidney stones in July 2015 is that there was no evidence of kidney stones either in service or after service. The evidence that the AOJ considered at that time included a May 2015 VA examination report which did not show the presence of kidney stones. The Veteran did not appeal this decision and new and material evidence was not received within one year of the decision. Therefore, the decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.1103. Evidence received since the July 2015 adverse rating determination includes VA medical records which show that the Veteran was found by CT scan in November 2016 to have a left kidney stone. This evidence is considered new as it was not previously considered and it is material since it goes to an essential element of service connection, i.e., it goes to the issue of establishing a present disability. 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The claim is thus reopened. 38 C.F.R. § 3.156. B. Service Connection for Kidney Stones The Veteran’s service treatment records do not show complaints, treatment or diagnoses related to kidney stones or to kidney problems. Post-service medical evidence includes the Veteran’s report at a May 2015 VA examination that he may have passed a kidney stone in early May 2015, but that he did not seek medical attention at that time, and he had no medical record of a kidney condition. He denied at this examination having or passing a kidney stone in service. Magnetic resonance imaging findings of the Veteran’s spine in February 2016 revealed a possible renal cyst in the right kidney. Post-service medical evidence also includes a VA outpatient record in November 2016 which contains the Veteran’s report that he “woke up in a lot of pain in the left kidney [and] it felt like a kidney stone floating around”. CT scan findings at that time revealed a 5mm left proximal ureteral stone. In addition, the Veteran reported at a June 2017 VA outpatient clinic that he had a stone while deployed that he passed four weeks later, but he did not know the size. The Veteran’s June 2017 report that he had and passed a kidney stone in service is not reflected in his service treatment records. Indeed, the May 2015 VA examiner reported that the Veteran’s service treatment records and all available medical records do not document a history of kidney stones. Moreover, this report is inconsistent with the Veteran’s earlier report at the May 2015 VA examination wherein he denied having or passing kidney stones in service. For this reason, his statements of having and passing a kidney stone in service are not deemed credible. Thus, as kidney stones were not noted during service and there is no credible evidence to show that there were characteristic manifestations sufficient to identify the disease process during service, service connection under 38 C.F.R. § 3.303 (b) is not warranted. Although, as noted, the Veteran was subsequently found by CT scan to have a left kidney stone in November 2016, there is no probative evidence relating this disability to service. The Veteran’s belief that this kidney stone is related to service has been considered; however, he is not shown to have the medical expertise to render an opinion regarding the etiology of this kidney stone. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Inasmuch as an essential element of the claim for service connection for kidney stones has not been established, i.e., (3) evidence of a nexus between a claimed in-service disease or injury and the present disability, the claim must be denied. 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In reaching this conclusion the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against this claim, that doctrine is not applicable in the instant appeal. 38 U.S.C. § 5107 (b). C. EED for the Grant of Service Connection 1. IBS Once a decision assigning an effective date becomes final, that assignment cannot be challenged through a freestanding claim of entitlement to an earlier effective date. Rudd v. Nicholson, 20 Vet. App. 296, 299-300 (2006). The Board is required to dismiss freestanding claims for entitlement to earlier effective dates. Id.; see also DiCarlo v. Nicholson, 20 Vet. App. 52 (2006) (stating there is no such procedure as a freestanding challenge to the finality of a VA decision). Put another way, if there is disagreement as to the effective date assigned in a given rating action, it must be timely appealed (within one year of notice of the rating decision assigning the effective date). In this case, the AOJ granted service connection for IBS in July 2015 at which time the AOJ assigned a 30 percent rating effective November 19, 2014. The Veteran did not appeal that decision and it is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. The earliest indication of the Veteran’s disagreement with the effective date of the grant is a notice of disagreement that he filed in October 2018. As this was not filed within one year of the July 2015 rating decision, it is not a timely appeal of the assigned effective date. Accordingly, the claim is dismissed. Rudd, 20 Vet. App. at 299-300; DiCarlo, 20 Vet. App. 52. 2. Left Knee Instability In July 2015, the AOJ granted service connection for left knee strain and assigned a 0 percent rating. In April 2016, the AOJ increased this rating to 10 percent, effective in November 2015, based on painful motion. See 38 C.F.R. §§ 4.59, 4.71a, DC 5260. In March 2018, the AOJ assigned the Veteran a separate 10 percent rating for left knee instability effective December 5, 2017. The Veteran appeals the effective date of this separate rating. The effective date of an award of disability compensation shall be the day following separation from service or the date entitlement arose if the claim is received within one year of separation. Otherwise, the effective date shall be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(b); 38 C.F.R. § 3.400(b)(2). Upon review of the record, the Board finds that entitlement to an effective date earlier than December 5, 2017 for a separate rating for the Veteran’s left knee instability is not warranted. The date of claim is the December 5, 2017 date that the Veteran filed a claim for compensation benefits. The date that entitlement arose is the date that instability of the left knee was first noted. This was at a VA examination conducted on December 21, 2017. Findings at this examination revealed a positive Lachman’s test (anterior instability) of 1+ instability (0-5 millimeters). There is no earlier documentation of left knee instability. In fact, a VA examination conducted in February 2016 was negative for left knee instability. In light of these facts, there is simply no basis to award the Veteran a separate rating for left knee instability any earlier than the December 5, 2017 date of claim. 38 C.F.R. § 3.400. As the preponderance of the evidence is against the claim for an effective date earlier than December 5, 2017 for the award of a separate rating for left knee instability, the claim is denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).   D. Ratings in Excess of 10 Percent 1. Right and Left Knee Instability By way of background, the Veteran has been in receipt of 10 percent ratings for right and left knee strain since November 2015. He is rated for these disabilities under 38 C.F.R. § 4.71a, DC 5260, for limitation of motion. The AOJ continued 10 percent ratings for these disabilities in the March 2018 rating decision. The Veteran’s appeal for higher ratings based on limitation of motion is discussed below. The present issue originates from the March 2018 grant of separate ratings for right and left knee instability under 38 C.F.R. § 4.71a, DC 5257. Under Diagnostic Code 5257, a knee impairment with recurrent subluxation or lateral instability is rated 10 percent when slight, 20 percent when moderate, and a maximum 30 percent when severe. 38 C.F.R. § 4.71a. Descriptive words, such as “slight,” “moderate” and “severe,” are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The use of descriptive terminology by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision. 38 U.S.C. § 7104 (a); 38 C.F.R. §§ 4.2, 4.6. VA examination findings in December 2017 show for the first time that the Veteran had knee instability. The Veteran demonstrated at this examination positive anterior instability (Lachman test) in the right and left knees of 1+ (0-5 millimeters). Posterior (drawer test), medial, and lateral instability tests were normal in both knees. Higher than 10 percent ratings for right and left knee instability are not warranted based on the minimal to normal findings of instability at the December 2017 VA examination, and on the lack of any contrary medical findings in the evidence. While the Veteran is competent to give evidence about what he observes or experiences including his symptoms, see, e.g., Layno v. Brown, 6 Vet. App. 465 (1994), his belief that he is entitled to higher ratings than that assigned for his right and left knee instability is outweighed by the objective medical findings discussed above and on VA’s Schedule for Rating Musculoskeletal Disorders. As the preponderance of the evidence is against ratings in excess of 10 percent for right and left knee instability throughout the appeal period, the benefit-of-the-doubt doctrine is not for application and the claims are denied. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 49. 2. Right and Left Knee Strain The Veteran’s right and left knee strain are rated under the diagnostic codes for limitation of motion of the knee joint. They are rated as 10 percent disabling under 38 C.F.R. § 4.71, DC 5260, for painful motion. 38 C.F.R. § 4.59. Leg flexion limited to 60, 45, 30, and 15 degrees warrant noncompensable, 10 percent, 20 percent, and 30 percent evaluations, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Leg extension limited to 5 degrees warrants a noncompensable evaluation, and extension limited to 10 degrees warrants a 10 percent evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5261. The normal range of motion for the knee is from 0 degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71, Plate II. It is the intent of the rating schedule to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. A compensable evaluation under Diagnostic Code 5003 and 38 C.F.R. § 4.59 (for painful motion) is in order where arthritis is established by x-ray findings and no compensable limitation of motion of the affected joint is demonstrated. See Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991); see also VAOPCGPREC 9-98 (Aug. 14, 1998). Where a compensable limitation of motion is demonstrated in the joint, the Lichtenfels rule is not applicable. The Veteran’s claim for increased ratings for right and left knee strain was received in December 2017. Also in December 2017, he was afforded a VA examination of his knees and lower legs at which time he was diagnosed as having right and left knee strain. He reported increasing pain when standing for prolonged periods, squatting and walking extended periods. He did not report having flare ups of the knees or lower legs. Findings at the December 2017 examination revealed that right and left knee flexion was normal with flexion to 140 degrees and extension to 0 degrees. There was pain on examination, which was noted to cause functional loss, but with no additional limitation of motion with repeated use over a period of time. When asked to provide an opinion regarding functional loss due to flare ups, the examiner reported “not applicable”. There was evidence of pain with weight bearing, and no objective evidence of localized tenderness or pain on palpation. Muscle strength testing on a scale was normal (5/5), and there was no ankylosis of the knees or knee subluxation. Findings regarding knee instability are discussed above. The examiner reported that the Veteran used a cane as an assistive device. He also reported that the occupational impact of this disability were problems with standing for prolonged periods, squatting and walking extended periods. As noted, in order to be entitled to a higher than 10 percent rating based on limitation of flexion, the Veteran must demonstrate flexion limited to 30 degrees. 38 C.F.R. § 4.71a, DC 5260. The pertinent evidence does not meet these criteria. Rather, range of motion testing at the December 2017 VA examination shows that the Veteran had full range of motion in both knees with flexion to 140 degrees. Moreover, the Veteran’s report of pain did not further limit his functional use. Also, the December 2017 examiner reported that the Veteran did not have ankylosis in either knee. In light of this evidence and the lack of any evidence to the contrary, the Board finds that a preponderance of the evidence is against higher than 10 percent ratings for the Veteran’s right and left knee strain based on limitation of flexion throughout the period on appeal. A separate rating for limitation of extension is not warranted since the Veteran does not have a compensable rating under both Codes 5260 and 5261. See VAOPGCPREC 9-2004; 69 Fed. Reg. 59990 (2004). As noted, findings at the December 2017 examination revealed normal extension to 0 degrees. As the preponderance of the evidence is against these claims, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 49. 3. Back Disability The Veteran is presently evaluated as 10 percent disabled for his service-connected lumbosacral strain with degenerative joint disease L5-S1 under the General Rating Formula for Diseases and Injuries of the Spine. See 38 C.F.R. § 4.71a, DC 5242. The pertinent evidence in this case does not meet the criteria for a higher rating of 20 percent. That is, the evidence does not show limitation of lumbar spine flexion to be greater than 30 degrees but not greater than 60 degrees. The evidence also does not show a combined range of motion of the thoracolumbar spine not greater than 120 degrees. See 38 C.F.R. § 4.71a, DC 5242, Plate V, General Rating Formula for Diseases and Injuries of the Spine, Notes (2), (4). Rather, the Veteran demonstrated full flexion to 90 degrees at the December 2017 VA examination and his combined range of motion of the thoracolumbar spine was 230 degrees. While the Veteran is shown have back pain that significantly limits his functional ability with repeated use, he is not shown to have additional limitation of motion with repeated use. The examiner was unable to say without speculation if the Veteran’s pain significantly limits functional ability during a flare up. Findings were negative for straight leg raising and for muscle spasm or guarding of the thoracolumbar spine, although the examiner also noted that there was “some” guarding. Additional findings revealed that there was no pain on passive range of motion and no pain when the joint was used in non-weight bearing. See Correia v. McDonald, 28 Vet. App. 158 (2016). In short, the evidence in this case does not more closely approximate the criteria for a higher rating of 20 percent under the General Rating Formula for Diseases and Injuries of the Spine at any point during the duration of this appeal. 38 C.F.R. § 4.71a, Code 5237; Hart v. Mansfield, 21 Vet. App. 505, 519 (2007). Regarding neurological findings at the December 2017 VA examination, the Veteran’s muscle strength was normal at 5/5 and neurological findings were unremarkable except for radiculopathy which is separately rated. Accordingly, separate ratings for associated objective neurologic abnormalities are not warranted. 38 C.F.R. § 4.71, Code 5237, Note (1). In terms of a higher rating under the criteria for IVDS, the December 2017 VA examiner reported that the Veteran had IVDS, but he did not have incapacitating episodes of spine disease. Such a finding does not warrant a higher rating under the criteria for IVDS. 38 C.F.R. § 4.71a, Code 5243. Lastly, the Veteran’s belief that his back disability manifested by pain warrants a higher rating is outweighed by the objective medical findings discussed above and on VA’s Schedule for Rating Musculoskeletal Disorders. For the foregoing reasons, the Board finds that the weight of the evidence is against a rating greater than 10 percent for lumbosacral strain with degenerative joint disease L5-S1, at any point during the pendency of this appeal. See Hart, 21 Vet. App. at 519. 12 Vet. App. at 126. As such, the benefit-of-the-doubt doctrine does not apply and the claim for a higher rating is denied. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 49. 4. Radiculopathy of the Right and Left Lower Extremities Under Diagnostic Code 8520 for the sciatic nerve, a 20 percent rating is warranted for moderate incomplete paralysis, a 40 percent rating is warranted for moderately severe incomplete paralysis, and a 60 percent rating is warranted where there is severe incomplete paralysis of the sciatic nerve with marked muscular atrophy. An 80 percent rating will be assigned where there is complete paralysis of the sciatic nerve, where the foot dangles and drops, there is no active movement possible of muscles blow the knee, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a. Symptoms of the Veteran’s radiculopathy at the December 2017 VA examination include left-sided and right-sided intermittent pain that was mild in degree, paresthesias and/or dysesthesias in both lower extremities that was mild in degree, and mild numbness in both lower extremities. There were no other signs or symptoms of radiculopathy noted and no other neurological findings found on examination. The Veteran’s overall radicular assessment for left and right lower extremity radiculopathy was assessed as mild. These findings do not more closely approximate the criteria for a higher rating for moderate incomplete paralysis of the lower extremities. 38 C.F.R. § 4.124a, DC 8520. Regarding the Veteran’s statements to the effect that his right and left lower extremity radiculopathy warrant higher ratings, his opinion is outweighed by the objective medical findings discussed above and on VA’s Schedule for Rating diseases of the peripheral nerves. For the foregoing reasons, the Board finds that the weight of the evidence is against a rating greater than 10 percent for radiculopathy of the right or left lower extremities, sciatic nerve, at any point during the pendency of this appeal. See Hart, 21 Vet. App. at 519. 12 Vet. App. at 126. As such, the benefit-of-the-doubt doctrine does not apply and the claims for higher ratings are denied. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 49. 5. Residuals of a Right Wrist Injury The Veteran has been in receipt of a maximum 10 percent rating for residuals, right wrist injury, under DC 5215 for the duration of this appeal. Pursuant to DC 5215, a maximum 10 percent evaluation is warranted for either the major or minor extremity if dorsiflexion is less than 15 degrees or palmar flexion is limited in line with the forearm. 38 C.F.R. § 4.71a. The Veteran reported at a VA examination in December 2017 that he experiences right wrist pain after writing for extended periods. Findings revealed palmar flexion to 70 degrees, dorsiflexion to 70 degrees, ulnar deviation to 40 degrees and radial deviation to 20 degrees. He was assigned a 10 percent rating based on painful motion. 38 C.F.R. § 4.40. A higher than 10 percent rating is simply not feasible under Code 5215 even considering functional loss due to pain and other factors since the maximum rating assignable under DC 5215 is 10 percent. See Johnston v. Brown, 10 Vet. App. 80, 84-85 (1997). In order for the Veteran to receive a disability rating in excess of 10 percent for his residuals, right wrist injury, he would have to meet the criteria under Diagnostic Code 5214 for ankylosis of the right wrist. A review of the medical and lay evidence of record does not establish ankylosis of the wrist. In this regard, the Veteran was specifically noted by the December 2017 VA wrist examiner to not have ankylosis of the right wrist. The Board has considered the Veteran’s belief that he is entitled to a higher rating for his wrist disability. However, as the current evaluation contemplates pain, limitation of motion, and the absence of ankylosis, there is simply no basis for a higher evaluation. As the preponderance of the evidence is against this claim, the benefit-of-the-doubt doctrine is not for application and the claim is denied. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 49. 6. Tinnitus The Veteran appeals his 10 percent rating for tinnitus and asserts that he is entitled to a higher rating. Under Code 6260, recurrent tinnitus warrants a maximum 10 percent rating whether it is in one ear or both ears. See Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006) (holding that 38 C.F.R. § 4.25 (b) and Code 6260 limits a veteran to a single disability rating for tinnitus, regardless whether the tinnitus is unilateral or bilateral). Thus, as the Veteran has been in receipt of the maximum 10 percent rating for tinnitus throughout the period of the appeal, there is no legal basis upon which to award a higher schedular disability rating. Sabonis v. Brown, 6 Vet. App. 426 (1994). As to consideration of referral for an extraschedular rating, the Veteran has not contended, and the evidence does not reflect, that he has experienced symptoms outside of those listed in the rating criteria. Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017). Therefore, referral for extraschedular consideration is not warranted. E. Compensable Ratings In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 CFR §4.31. 1. Allergic Rhinitis The Veteran’s allergic rhinitis is rated under 38 C.F.R. § 4.97, DC 6522. Under this code, a 10 percent rating is warranted where there are no polyps, but there is greater than 50-percent obstruction of the nasal passages on both sides or complete obstruction on one side. Under 38 C.F.R. § 4.97, DC 6523 for bacterial rhinitis, a 10 percent rating is warranted with permanent hypertrophy of turbinates and with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side. The veteran reported at a VA examination in December 2017 that he has experienced more frequent allergy symptoms which he described as sneezing and drainage. He said that he treats his symptoms with over-the-counter allergy medication such as Benadryl and nasal sprays. On examination there was not greater than 50% obstruction of the nasal passage on both sides due to rhinitis nor was there complete obstruction on the right or left side due to rhinitis. Also, no nasal polyps were found. He was found to have permanent hypertrophy of the nasal turbinates. The December 2017 VA examination findings do not support a compensable rating for the Veteran’s allergic rhinitis due the fact that he was not shown to have greater than 50-percent obstruction of the nasal passages on both sides or complete obstruction on one side. Moreover, medical treatment records that pertain to the appeal period likewise do not support the criteria for a compensable rating. The Veteran’s opinion that he is entitled to a compensable rating for his allergic rhinitis has been considered. However, his opinion is outweighed by the objective medical findings discussed above and on VA’s Schedule for rating disorders of the respiratory system. For the foregoing reasons, the preponderance of the evidence does not support a compensable rating for the Veteran’s allergic rhinitis at any point during the appeal period. Hart, 21 Vet. App. at 519. As the preponderance of the evidence is against this claim, the benefit-of-the-doubt doctrine is not for application and the claim is denied. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 49. 2. Costochondritis The Veteran’s service-connected costochondritis is not specifically listed in the rating schedule; therefore, it is rated analogous to a disability in which not only the function is affected, but anatomical localization and symptoms are closely related. 38 C.F.R. §4.20. Under DC 5297 for ribs, removal of, a 10 percent rating is warranted for the removal or one or resection of two or more ribs without regeneration. For the removal of two ribs, a 20 percent rating is warranted, and for the removal of three or four ribs, a 30 percent rating is warranted. A 40 percent rating requires resection of five or six ribs and a 50 percent rating for more than six ribs. Note (1): The rating for rib resection or removal is not to be applied with ratings for purulent pleurisy, lobectomy, pneumonectomy or injuries of pleural cavity. Note (2): However, rib resection will be considered as rib removal in thoracoplasty performed for collapse therapy or to accomplish obliteration of space and will be combined with the rating for lung collapse, or with the rating for lobectomy, pneumonectomy or the graduated ratings for pulmonary tuberculosis. The Veteran reported at a VA examination in December 2017 that he experiences intermittent rib cage pain wrapped around his chest. He was noted to have injury to muscle group XXI: Muscles of respiration: thoracic muscle group on the right side. He was also noted to have occasional associated fatigue-pain on the right side. The examiner reported that the Veteran had no other pertinent physical findings, complications, conditions, signs or symptoms related to the condition. The examiner also reported that the condition had no impact on the Veteran’s ability to work. As the pertinent findings do not show that the Veteran has had the removal or resection of his ribs or symptoms analogous thereto, the weight of the evidence does not support a compensable rating. As the preponderance of the evidence is against this claim, the benefit-of-the-doubt doctrine is not for application and the claim for a compensable rating is denied. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 49. 3. Hypertension The Veteran’s hypertension was evaluated under Diagnostic Code 7101. 38 C.F.R. § 4.104. Under Diagnostic Code 7101, a 10 percent rating is assigned for diastolic pressure predominately 100 or more, or; systolic pressure predominantly 160 or more, or is the minimum rating for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. Id. The Veteran’s hypertension was evaluated at a VA examination in December 2017. The examiner reported that the Veteran did not have a history of diastolic blood pressure predominantly 100 or more. Blood pressure readings at the examination revealed blood pressure readings of 112 systolic over 78 diastolic, 114 systolic over 81 diastolic, and 111 systolic over 80 diastolic, for an average of 112 systolic over 79 diastolic. The examiner also reported that the Veteran’s blood pressure does not impact his ability to work. Neither findings at this examination nor findings as noted on pertinent medical treatment records support the criteria for a compensable rating. See 38 C.F.R. § 4.104, DC 7101. The Veteran’s opinion that he is entitled to a compensable rating for his hypertension has been considered. However, his opinion is outweighed by the objective medical findings discussed above and on VA’s Schedule for rating disorders of the cardiovascular system. For the foregoing reasons, the preponderance of the evidence does not support a compensable rating for the Veteran’s hypertension at any point during the appeal period. Hart, 21 Vet. App. at 519. As the preponderance of the evidence is against this claim, the benefit-of-the-doubt doctrine is not for application and the claim is denied. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 49.   4. Hemorrhoids The Veteran contends that symptoms of his hemorrhoids warrant a compensable rating. The Veteran’s hemorrhoids are rated under 38 C.F.R. § 4.114, DC 7336, under which mild or moderate external or internal hemorrhoids warrant a noncompensable rating. Large or thrombotic, irreducible hemorrhoids with excessive redundant tissue, evidencing frequent recurrences warrant a 10 percent rating, and hemorrhoids with persistent bleeding and with secondary anemia, or with fissures warrant a rating of 20 percent. The Veteran underwent a VA examination in December 2017 where he reported that he continues to have some itching and discomfort at the site. The examiner noted that the condition did not require continuous medication. Physical examination revealed small external hemorrhoids that were mild to moderate in degree. There were no other pertinent physical findings, complications, conditions, signs or symptoms found that were related to the condition. As noted, in order to warrant a compensable rating, the evidence must show hemorrhoids that are large or thrombotic, irreducible, with excessive redundant tissue, with anal fissure, or with persistent bleeding with secondary anemia during the period on appeal. The VA examiner’s findings in December 2017 of mild to moderate external hemorrhoids along with the Veteran’s report of experiencing some itching and discomfort at the site are consistent with mild to moderate hemorrhoids. The Veteran’s opinion that he is entitled to a compensable rating for hemorrhoids has been considered. However, his opinion is outweighed by the objective medical findings discussed above and on VA’s Schedule for rating disorders of the digestive system. For the foregoing reasons, the Board finds that a preponderance of the evidence is against a compensable rating for the Veteran’s service-connected hemorrhoids. As the preponderance of the evidence is against a compensable rating at any point during the pendency of this appeal, the benefit-of-the-doubt doctrine does not apply, and the claim is denied. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. 49. F. Rating Greater Than 100 Percent for Psychiatric Disability The Veteran is at the maximum 100 percent rating for unspecific bipolar disorder with PTSD for the duration of this appeal, that is, since December 5, 2017. 38 C.F.R. § 4.125, DCs 9432 9411. As such, there is no other more applicable DC for which a disability rating in excess of 100 percent for the disorder may be warranted. In short, as the Veteran has been in receipt of the maximum schedular disability rating available under 38 C.F.R. § 4.130, DCs 9432-9411, for his service-connected unspecified bipolar disorder with PTSD throughout the appeal period, there is no legal basis upon which to award a higher schedular disability rating. Sabonis v. Brown, 6 Vet. App. 426 (1994). G. Rating Greater Than 30 Percent for IBS Under DC 7319 for IBS, a 30 percent rating is the maximum schedular rating assigned for severe diarrhea or alternating diarrhea and constipation, with constant abdominal distress. 38 C.F.R. § 4.114. As the Veteran has already been rated at 30 percent for the duration of this appeal period, a higher rating under DC 7319 is not warranted. The Board has also considered whether a higher rating is available under DC 7346 (GERD). This DC provides for a 60 percent rating for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. The medical evidence does not support a disability rating higher than 30 percent at any time during the period under review. That is, at no time does the medical evidence reflect that the Veteran has experienced material weight loss, anemia, or severe impairment of health due to his IBS. Examination findings in December 2017 reveal that the Veteran did not have material weight loss, nor did he have malnutrition, serious complications or other general health effects attributable to the intestinal condition. While it is apparent that he requires medication (miralax) for treatment on a continuous basis, the symptoms are most consistent with the current 30 percent rating. Regarding consideration of referral for an extraschedular rating, the Veteran has not contended, and the evidence does not reflect, that he has experienced symptoms outside of those listed in the rating criteria. Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017). Therefore, referral for extraschedular consideration is not warranted. For the foregoing reasons, the Board finds that an increased rating in excess of 30 percent for service-connected IBS is denied. As the preponderance of the evidence is against a higher rating at any point during the pendency of this appeal, the benefit-of-the-doubt doctrine does not apply and the claim for a higher rating is denied. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 49. H. EED for DEA Benefits For the purposes of DEA benefits, basic eligibility exists if a veteran was discharged from service under conditions other than dishonorable, and if he has a permanent and total service-connected disability. 38 U.S.C. § 3501; 38 C.F.R. §§ 3.807, 21.3021(p). There are other avenues through which basic eligibility may be granted; however, they involve factors not applicable here, e.g., the death of a veteran or if a veteran is currently on active duty. Id. Permanence of total disability will be taken to exist when such impairment is reasonably certain to continue throughout the life of the disabled person. Diseases and injuries of long-standing that are actually totally incapacitating will be regarded as permanently and totally disabling on the probability that permanent improvement under treatment is remote. The age of the disabled person may be considered in determining permanence. See 38 C.F.R. § 3.340(b). Once permanence is established, a veteran need not undergo further VA examination in order to retain her rating for the permanent disability. See 38 C.F.R. § 3.327(b)(2)(iii). The Board finds that entitlement to a TDIU rating prior to December 5, 2017 is not warranted since the Veteran did not have a permanent and total service-connected disability prior to December 5, 2017. As noted, the effective date of his 100 percent schedular rating for service-connected unspecified bipolar disorder with PTSD is December 5, 2017. Since eligibility for DEA benefits is predicated on a finding of permanent and total disability, the effective date of such eligibility cannot precede the date permanent and total disability was awarded, which was December 5, 2017. Accordingly, entitlement to an effective date earlier than December 5, 2017 for the establishment of basic eligibility for DEA benefits is denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). I. TDIU A TDIU may be assigned “where the schedular rating is less than total” and a veteran is unable to secure or follow substantially gainful employment as a result of his service-connected disabilities. 38 C.F.R. § 4.16. In some cases, but not all, the assignment of a total schedular rating renders a TDIU claim moot. See Bradley v. Peake, 22 Vet. App. 280, 294 (2008). The Veteran may receive a total (100 percent) rating based on a combination of his service-connected disabilities, or for a single service-connected disability. Special monthly compensation (SMC) may be warranted in addition to his regular compensation if the Veteran has a total disability rating for a single disability, and additional service-connected disability or disabilities rated at 60 percent or more. The total rating for the single disability for SMC purposes may be schedular, or may be based on TDIU, so long as TDIU was granted solely because of that single disability. Thus, if the Veteran’s total rating is based on a combination of his service-connected disabilities, (which would mean that his individual service-connected disabilities are each rated at less than 100 percent), then TDIU is not moot if it could be granted on a single disability, in turn making the Veteran eligible for SMC. If, however, he has a single disability already rated at 100 percent, entitlement to TDIU becomes moot, because he has already met that portion of the requirement for SMC. In the instant case, the Veteran has been in receipt of a 100 percent disability rating for his service-connected unspecified bipolar disorder with PTSD since December 5, 2017. In addition, he has been in receipt of SMC under the provisions of 38 U.S.C. § 1114(s) effective December 5, 2017. Thus, given that he is receiving the maximum benefits allowed under the applicable statutes and regulations, the issue of entitlement to a TDIU for the period on appeal, that is, from December 5, 2017, is moot and will be dismissed. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). REASONS FOR REMAND SMC Based on the Aid and Attendance of Another In the March 2018 rating decision on appeal, the AOJ awarded the SMC pursuant to 38 U.S.C. § 1114(s). The Veteran appeals for a higher rate of SMC based on the need for the aid and attendance of another. See 38 U.S.C. § 1114(l). The Veteran submitted a July 2019 affidavit stating that he relies on the aid and attendance of a caregiver and his girlfriend to maintain activities of daily living, primarily due to his service-connected psychiatric disability. His representative asserted in written argument in July 2020 that the Veteran’s physical service-connected disabilities alone warrant SMC based on the aid and attendance of another. The Board notes that the Veteran has not been afforded an Aid and Attendance examination. Accordingly, this matter must be remanded so that the Veteran can be afforded a VA Aid and Attendance examination. 38 U.S.C. § 5103A(d). TTD A temporary total disability (TTD) rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established that a service-connected disability has required hospital treatment in a VA or an approved hospital for a period in excess of 21 days or hospital observation at VA expense for a service-connected disability for a period in excess of 21 days. 38 C.F.R. § 4.29. It is unclear from the record what disability the Veteran is claiming a TTD for. The Veteran’s claim for a TTD and the March 2018 rating decision from which he appeals are vague regarding this issue. Thus, without further specificity regarding this matter, the Board cannot make a fully informed decision. Accordingly, this matter must be remanded so that the Veteran can provide additional detail regarding this claim, along with any supportive evidence and/or information. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The matters are REMANDED for the following action: 1. Ask the Veteran and his representative to provide additional detail regarding the claim for a TTD. This should include what disability the claim pertains to and the period of hospitalization. The Veteran and his representative should also be afforded the opportunity to submit evidence or information to support the claim. 2. Schedule the Veteran for an aid and attendance examination to assess the Veteran’s functional impairment due to his service-connected psychiatric and physical disabilities. The examiner should review the entire claims file and the report of examination should include discussion of the Veteran’s documented history and assertions. All indicated tests and studies should be accomplished and all clinical findings should be reported in detail. It is requested that the guides for conducting aid and attendance examinations be used, and that all clinical findings as to the service-connected disabilities be set forth in detail. The examiner is to consider the following: the inability of Veteran to dress or undress himself, or to keep himself ordinarily clean and presentable; the inability of the Veteran to feed himself through loss of coordination of upper extremities or through extreme weakness; the inability to attend to the wants of nature; and the incapacity, physical or mental, which requires care or assistance on a regular basis to protect the Veteran from hazards or dangers incident to his daily environment. The examination report must include a complete rationale for all opinions expressed 3. Thereafter, and after any further development deemed necessary, the issues on appeal should be readjudicated. If the benefits sought on appeal are not granted, the Veteran and his representative should be provided with a supplemental statement of the case and afforded the appropriate opportunity to respond. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Shawkey, Counsel 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.