Citation Nr: 21001605 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 14-18 517 DATE: January 11, 2021 ORDER The appeal for service connection for a refractive error, is withdrawn. The appeal for service connection for fibromyalgia, is withdrawn. The appeal for service connection for chronic fatigue syndrome, is withdrawn. The appeal for an initial rating greater than 10 percent for tinnitus, is withdrawn. An initial rating of 50 percent for a migraine headache disorder, is granted subject to the laws and regulations governing payment of monetary benefits. A rating greater than 50 percent for a migraine headache disorder, is denied. An initial rating of 40 percent for the low back disability, is granted subject to the laws and regulations governing payment of monetary benefits. A rating greater than 40 percent for the low back disability, is denied. The appeal for a separate, 10 percent rating for right lower extremity radiculopathy from August 27, 2012, is granted subject to the laws and regulations governing payment of monetary benefits An initial 10 percent rating for left lower extremity radiculopathy, prior to June 10, 2014, is granted subject to the laws and regulations governing payment of monetary benefits. The appeal for a rating greater than 40 percent from June 10, 2014, for left lower extremity radiculopathy, is denied. Service connection for posttraumatic stress disorder (PTSD), is granted. Service connection for major depressive disorder is granted. The appeal for service connection for purified protein derivative (PPD), is denied. The appeal for service connection for right ear hearing loss, is denied. The appeal for service connection for a sleep disorder, is denied. REMANDED The appeal for a total disability rating for individual unemployability (TDIU) prior to February 5, 2018, is remanded. The appeal for an initial compensable rating for atopic dermatitis, is remanded. FINDINGS OF FACT 1. In August 2014, prior to the promulgation of a decision in the appeal, VA received notification that a withdrawal of the appeal for service connection for a refractive error was requested. 2. In August 2014, prior to the promulgation of a decision in the appeal, VA received notification that a withdrawal of the appeal for service connection for fibromyalgia was requested. 3. In August 2014, prior to the promulgation of a decision in the appeal, VA received notification that a withdrawal of the appeal for service connection for chronic fatigue syndrome was requested. 4. In August 2014, prior to the promulgation of a decision in the appeal, VA received notification that a withdrawal of the appeal for an initial rating greater than 10 percent for tinnitus was requested. 5. Since the establishment of service connection, the Veteran’s headache disability has been productive of very frequent prostrating attacks and prolonged attacks productive of severe economic inadaptability. 6. Resolving doubt in favor of the Veteran, since the establishment of service connection, the Veteran’s low back disability has been productive of limitation of flexion to 30 degrees or less during flare-ups but has not been manifested by favorable or unfavorable ankylosis of the entire thoracolumbar spine at any time. 7. Resolving doubt in favor of the Veteran, the Veteran’s low back disability has been productive of mild right lower extremity radiculopathy since August 27, 2012. 8. Prior to June 10, 2014, the Veteran’s lumbar spine disability was productive of mild left lower extremity radiculopathy. 9. Since June 10, 2014, the Veteran’s lumbar spine disability has been productive of severe left lower extremity radiculopathy symptoms without evidence of marked atrophy. 10. Resolving doubt in favor of the Veteran, the evidence is at least in equipoise that the Veteran has PTSD related to service. 11. Resolving doubt in favor of the Veteran, the evidence is at least in equipoise that the Veteran has a major depressive disorder related to service. 12. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of tuberculosis exposure. 13. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current right ear hearing loss disability for VA purposes. 14. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a sleep disorder. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal for service connection for a refractive error are met. 38 U.S.C. § 7105 (b)(2), (d)(5) (2012); 38 C.F.R. § 20.204 (2019). 2. The criteria for withdrawal of the appeal for service connection for fibromyalgia are met. 38 U.S.C. § 7105 (b)(2), (d)(5) (2012); 38 C.F.R. § 20.204 (2019). 3. The criteria for withdrawal of the appeal for service connection for chronic fatigue syndrome are met. 38 U.S.C. § 7105 (b)(2), (d)(5) (2012); 38 C.F.R. § 20.204 (2019). 4. The criteria for withdrawal of the appeal for an initial rating greater than 10 percent for tinnitus are met. 38 U.S.C. § 7105 (b)(2), (d)(5) (2012); 38 C.F.R. § 20.204 (2019). 5. The criteria for an initial rating of 50 percent for migraine headaches, are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.3, 4.7, 4.21, 4.124a, Diagnostic Code 8100 (2019). 6. The criteria for an initial rating greater than 50 percent for migraine headaches, are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.3, 4.7, 4.21, 4.124a, Diagnostic Code 8100 (2019). 7. The criteria for an initial rating of 40 percent for the low back disability, is granted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Codes 5242 (2019). 8. The criteria for a rating greater than 40 percent for the low back disability, are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Codes 5242 (2019). 9. Resolving all doubt in favor of the Veteran, the criteria for a 10 percent disability rating from August 27, 2012, for right lower extremity radiculopathy, are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, 4.124, 4.124a, Diagnostic Codes 5242, 8520 (2019). 10. Resolving all doubt in favor of the Veteran, the criteria for an initial 10 percent disability rating prior to June 10, 2014 for left lower extremity radiculopathy, are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, 4.124, 4.124a, Diagnostic Codes 5242, 8520 (2019). 11. The criteria for a rating in excess of 40 percent for left lower extremity radiculopathy for the period from June 10, 2014, are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, 4.124, 4.124a, Diagnostic Codes 5242, 8520 (2019). 12. The criteria for service connection for PTSD are met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304(f) (2019). 13. The criteria for service connection for major depressive disorder are met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2019). 14. The criteria for service connection for PPD are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). 15. The criteria for establishing service connection for right ear hearing loss are not met. 38 U.S.C. §§ 1110, 1031, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2019). 16. The criteria for service connection for a sleep disorder is denied. 38 U.S.C. § 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January 1987 to June 1987, October 1993 to January 1999, January 2009 to March 2010, as well as service in the U.S. Army Reserve. Withdrawn Claims 1. Entitlement to service connection for a refractive error. 2. Entitlement to service connection for fibromyalgia. 3. Entitlement to service connection for chronic fatigue syndrome. 4. Entitlement to an initial rating greater than 10 percent for tinnitus. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105 (2012). An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204 (2019). Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.204. In August 2014, the Veteran submitted a request to withdraw his appeals for service connection for a refractive error, fibromyalgia, and chronic fatigue syndrome, as well as his appeal for an initial rating greater than 10 percent for tinnitus. As the Veteran has withdrawn the appeal as to these issues, there remain no allegations of errors of fact or law for appellate consideration with respect to the claims for service connection for refractive error, fibromyalgia, and chronic fatigue syndrome and the appeal for a higher initial rating for tinnitus. Accordingly, the Board does not have jurisdiction to review the issues and they are dismissed. Initial Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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 for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. A veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). As in the instant case, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as “staged” ratings. Id. at 126. Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Although all the evidence has been reviewed, only the most relevant and salient evidence is discussed below. See Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). 1. Entitlement to an initial rating greater than 30 percent prior to June 10, 2014, and greater than 50 percent thereafter, for a migraine headache disorder. Migraine headaches are rated under Diagnostic Code 8100. 38 C.F.R. § 4.124a. Migraine headaches with less frequent attacks than the criteria for a 10 percent rating are rated as non-compensable. Migraine headaches with characteristic prostrating attacks averaging one in two months over the last several months are rated 10 percent disabling. Migraine headaches with characteristic prostrating attacks occurring on an average once a month over last several months are rated 30 percent disabling. Migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability are rated 50 percent disabling. The term “prostrating attack” is not defined in regulation or case law but can be defined as extreme exhaustion or powerlessness. Fenderson v. West, 12 Vet. App. 119, 126-127 (1999) (quoting Diagnostic Code 8100 verbatim but not specifically addressing the definition of a prostrating attack); DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1531 (32d ed. 2012). Further, “severe economic inadaptability” is also not defined by VA regulation. See Pierce v. Principi, 18 Vet. App. 440, 446 (2004). In addition, the Court has held that nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Id. In this regard, it was explained by the Court that if “economic inadaptability” were read to import unemployability, the appellant, should he or she meet the economic-inadaptability criterion, would then be eligible for a TDIU rather than just a 50 percent rating. Id., citing 38 C.F.R. § 4.16. The Court discussed the notion that consideration must also be given as to whether the disability was capable of producing severe economic inadaptability, regardless of whether the condition was actually causing such inadaptability. See Pierce, 18 Vet. App. at 446. In this regard, VA conceded that the words “productive of” could be read to mean either “producing” or “capable of producing.” Id. at 446-447. The Board may not deny entitlement to a higher rating based on relief provided by medication when those effects are not specifically contemplated by the rating criteria. Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). In this case, service connection for a migraine-like headache disorder was granted in a January 2012 rating decision and rated 30 percent disabling, effective in March 2010. The Veteran appealed the initial rating assigned. During the pendency of the appeal, the AOJ increased the disability rating to 50 percent, effective June 10, 2014. The Veteran was provided with VA examinations in December 2011 (VA Gulf War examination), and VA headache examinations in June 2014 and April 2018. During the December 2011 VA examination, the Veteran reported headaches in the frontal and occipital area and indicated that he experienced the same in service. The Veteran described incapacitating headaches which required him to leave his military tasks on several occasions. He reported that symptoms had gotten progressively worse since they started. He explained that his symptoms had increased since service with pulsate and oppressive pain, nausea and phobia. He reported symptoms in the frontal area treated with over the counter pain relievers. He denied any side effects from treatment. The Veteran also reported frequency of headaches as three times per week, lasting 12-24 hours. He also reported incapacitating episodes approximately three times per month with a duration of 24-48 hours. During the June 2014 VA examination, the Veteran reported experiencing headaches to two to three times per week. He also reported prostrating headaches three to four times per month. He reported that during those events, he had to take medication, lay down in a dark room and rest until the headache was resolved. The Veteran also described symptoms of headache pain, nausea, vomiting, and sensitivity to light. During the April 2018 VA examination, the Veteran reported experiencing migraine episodes one to two times per week, sometimes three times. He also reported pain that accompanied by nausea, vomiting, sensitivity to light and sounds. VA treatment records do not indicate worse findings than those noted during the VA examinations. Based on the foregoing, the Board finds that the Veteran’s headache disability was substantially the same since the establishment of service connection. In this regard, the evidence indicates that in December 2011, the Veteran had prostrating attacks (three times per month) with the substantially the same frequency as he did in June 2014 (three to four times per month). The severity of the prostrating attacks appears to be substantially the same, requiring rest until the headache was gone, lasting 24 to 48 hours in December 2011. The AOJ has already found these symptoms to be sufficiently frequently prostrating and productive of severe economic inadaptability to warrant a 50 percent rating from June 10, 2014. As the Veteran’s symptoms have been substantially the same since the establishment of service connection, the Board resolves any doubt and finds that an initial 50 percent rating is warranted. Because the 50 percent rating is the maximum schedular rating for headaches there is no legal basis upon which to award a higher schedular rating. Thus, the claim for an initial rating greater than 50 percent, must be denied. 2. Entitlement to an initial rating greater than 20 percent for a low back disability prior to June 10, 2014, and greater than 40 percent thereafter. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. The intent of the Rating Schedule is 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. In Burton v. Shinseki, 25 Vet. App. 1, 5 (2011), the Court found that, when 38 C.F.R. § 4.59 is raised by the claimant or reasonably raised by the record, even in non-arthritis contexts, the Board should address its applicability. Diagnostic Code 5003 provides ratings for degenerative arthritis. Diagnostic Code 5003 provides that degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic code(s) for the specific joint(s) involved. 38 C.F.R. § 4.71a, Diagnostic Code 5003. When, however, the limitation of motion of the specific joint(s) involved is noncompensable under the appropriate diagnostic code(s), a 10 percent rating is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent rating is warranted if there is X- ray evidence of involvement of two or more major joints or two or more minor joint groups and a 20 percent rating is authorized if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Code 5003. The provisions of Diagnostic Code 5003 mandate that arthritis be rated based on limitation of motion. However, when the limitation of motion of a joint is non-compensable under the appropriate portion of the Schedule for Rating Disabilities, a 10 percent rating can be assigned for each major joint affected by limitation of motion, to include painful motion, caused by degenerative arthritis established by x-ray. 38 C.F.R. § 4.59; Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991). However, a veteran is not entitled to separate compensable disability awards for both arthritis (under Diagnostic Code 5003) and limitation of motion (under another diagnostic code) in the same joint. Hicks v. Brown, 8 Vet. App. 417 (1995); Lichtenfels, 1 Vet. App at 488. Pursuant to 38 C.F.R. § 4.45 (f), the lumbar vertebrae are considered a group of minor joints that is ratable on a parity with a major joint. Service connection is in effect for degenerative arthritis of the lumbar spine with spondylosis to include intervertebral disc syndrome (IVDS), which is currently evaluated under 38 C.F.R. § 4.71a, Diagnostic Codes 5242-5243. The disability is currently assigned staged ratings as follows: 20 percent prior to June 10, 2014 and 40 percent thereafter. The Veteran’s spine disability is rated under the General Rating Formula for Diseases and Injuries of the Spine. The General Rating Formula for Diseases and Injuries of the Spine holds, in pertinent part, that for DCs 5235 to 5243, a 20 percent rating is warranted for lumbar spine disabilities if forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; or, if the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or if the disability is manifested by muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted when forward flexion of the thoracolumbar spine is 30 degrees or less or there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted when there is unfavorable ankylosis of the entire thoracolumbar spine. A rating of 100 percent is warranted when there is unfavorable ankylosis of the entire spine. The criteria also include the following provisions: Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2): For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. Intervertebral disc syndrome (IVDS) (preoperatively or postoperatively) may be evaluated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating IDS Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined. See 38 C.F.R. § 4.25 (combined ratings table). The Formula for Rating IVDS Based on Incapacitating Episodes provides for a 10 percent rating is warranted when there are incapacitating episodes of IVDS having a total duration of at least one week, but less than two weeks during the past 12 months. A 20 percent rating is warranted when there are incapacitating episodes of IVDS having a total duration of at least two weeks, but less than four weeks during the past 12 months. A 40 percent rating is warranted when there are incapacitating episodes of IVDS having a total duration of at least four weeks, but less than six weeks during the past 12 months. A 60 percent rating when there are incapacitating episodes of IVDS having a total duration of at least six weeks during the past 12 months. An incapacitating episode is defined as a period of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician. An evaluation can be had either on the total duration of incapacitating episodes over the past 12 months or by combining separate evaluations of the chronic orthopedic and neurologic manifestations along with evaluations for all other disabilities under 38 C.F.R. § 4.25, whichever method resulted in the higher evaluation. The Veteran was provided with VA examinations in August 2011, June 2014, and April 2018. During the VA spine examination in August 2011, the Veteran reported current symptoms of severe flare-ups that occurred weekly and lasted three to seven days. He reported precipitating factors of bending at the trunk, walking, and getting out of bed. He also reported more than 15 times where he had to remain resting in bed for three to five days each time, due to low back pain flare-ups. The examiner noted that the Veteran’s incapacitating episodes were due to IVDS. On objective examination in August 2011, the VA examiner noted that the Veteran had thoracolumbar flexion to 59 degrees in active motion. The Veteran was able to complete repetitive testing, but range of motion decreased to 52 degrees of flexion. The examiner also noted spasms and guarding as well as tenderness and back pain with motion. Regarding neurological symptoms, during the August 2011 VA examination, the Veteran denied urinary incontinence or other urinary symptoms. Sensory examination revealed normal right lower extremity peripheral nerves but left lower extremity peripheral nerves had decreased pain or pinprick and decreased light touch. The Veteran also reported left lower extremity numbness. The examiner noted that the location of the abnormality was L5 and S1 dermatomes. As discussed below, service connection is already in effect for the left lower extremity radiculopathy. VA treatment records do not indicate worse findings than those reported during the August 2011 VA examination. During the June 2014 VA examination, the Veteran reported experiencing constant pain with a level between 5 and 9 out of 10. The Veteran reported experiencing flare-ups with functional impairment that he was unable to dress his lower body. On objective examination, the Veteran had flexion to 40 degrees with painful motion beginning at 20 degrees. The Veteran was unable to complete repetitive testing due to severe pain. The examiner noted that the Veteran had localized tenderness or pain to palpation for joints and soft tissue of the thoracolumbar spine. During the June 2014 VA examination, the Veteran also reported severe left leg cramps and numbness. He denied other neurological abnormalities. Muscle strength testing was normal on the right but rated 4 out of 5 on the left. The Veteran also had muscle atrophy on the left side. Reflexes were normal on the right side. Sensory examination was normal on the right. The Veteran denied any radicular pain or symptoms on the right. The examiner determined that the right side was not affected. As discussed below, the Veteran is already in receipt of a separate compensable rating for left lower extremity radiculopathy. The June 2014 VA examiner noted that the Veteran did not have ankylosis of the spine. The June 2014 VA examiner noted that although the Veteran had IVDS, he had not had any bed rest prescribed by a physician in the prior 12 months. Although the Veteran reported experiencing flare-ups, the examiner was unable to express whether pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups or when the joint is used repeatedly over time. During the April 2018 VA examination, the Veteran reported that he experienced flare-ups and that during flare-ups, he stayed in bed. He also reported constant low back pain that radiated toward both lower extremities. Range of motion testing resulted in flexion to 5 degrees. There was objective evidence of pain with weight bearing. There was also objective evidence of localized tenderness or pain on palpation. The Veteran was able to perform repetitive testing without any additional loss of function or range of motion after three repetitions. The examiner noted that the limitation of motion resulted in functional loss with dressing and undressing lower parts of the body. The examiner noted that the Veteran constantly used a brace due to low back pain. The examiner also noted an impact on work in that the Veteran should avoid lifting or carrying objects more than 15 pounds and that there was limitation in standing or sitting position. The April 2018 VA examiner also noted that it would require speculation to know whether the Veteran’s pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over a period of time or during flare-ups. The examiner explained that an opinion concerning additional range of motion loss during flare-ups is not feasible, since in order to provide an additional limitation due to pain, weakness or incoordination (if present) the evaluation must be done in the presence of a flare-up. The April 2018 VA examiner confirmed that the Veteran did not have ankylosis of the spine. The April 2018 VA examiner noted that although the Veteran had IVDS, he had not had any bed rest prescribed by a physician in the prior 12 months. The April 2018 VA examiner noted that there was no objective evidence of right or left radiculopathy. The examiner also noted that it appeared that the Veteran was not doing full effort during the active range of motion evaluation. VA treatment records do not indicate worse findings than those noted in the examination reports. The Board places only a limited probative value on the August 2011 VA spine examination as the examiner did not address or attempt to quantify any additional disability during flare-ups in terms of degrees. The Board places a high probative value on the Veteran’s statements that his flare-ups were so severe that they resulted in incapacitating episodes. The Board finds that given the frequency with which the flare-ups occurred and the fact that they resulted in additional functional loss, the next higher rating is warranted under the DeLuca provisions. For these reasons, a 40 percent initial disability rating is warranted. Thus, the remaining question is whether an initial rating greater than 40 percent is warranted at any time. For the reasons explained below, the Board finds that it is not. The 40 percent disability rating is the highest rating possible for limitation of motion. As such, further consideration of functional loss due to pain under 38 C.F.R. §§ 4.40, 4.45, 4.59 and DeLuca v. Brown, 8 Vet. App. 202 (1995) is not required. See Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Further, there is no evidence of favorable or unfavorable ankylosis of the entire thoracolumbar spine as required to support a rating a 50 percent or 100 percent disability rating, at any time. See e.g. April 2018 VA examination report which noted that there was no ankylosis of the spine. The Board has also considered whether a higher rating is warranted for IVDS but finds that it is not. The Board acknowledges that all of the VA examiners noted that the Veteran had IVDS, but the June 2014 and April 2018 VA examiners determined that there had been no physician-prescribed bed rest during the prior 12 months. Even though the August 2011 VA examiner attributed the Veteran’s approximate 15 days of incapacitating episodes to IVDS, that amount of time, even if it was physician-prescribed bedrest, which hit has not been shown to be, would not be sufficient to warrant the 60 percent disability rating. VA treatment records do not indicate physician prescribed bedrest at any time. Based on the foregoing, the Board finds that an initial rating higher than 40 percent is not warranted for the lumbar spine disability at any time. As to separate ratings for associated neurological impairment, the AOJ granted service connection for the left lower extremity radiculopathy rated as noncompensable prior to June 10, 2014, and 40 percent disabling thereafter. The amount of the assigned rating for the left lower extremity radiculopathy is the subject of a separate issue on appeal and is discussed below. The Veteran also reported right lower extremity symptoms during the August 2012 and April 2018 VA examinations but none were noted on objective evaluation during either examination. The Veteran denied any right lower extremity radiculopathy during the June 2014 VA examination. The August 2012 and April 2018 examiner confirmed that there was no objective evidence of right lumbar radiculopathy at that time but neither examiner indicated that the Veteran’s subjective reports of right lower extremity symptoms were not legitimate. The Board finds it significant that the April 2018 VA examiner noted that the Veteran may not have given his best effort on active range of motion but did not indicate that the Veteran was malingering or otherwise cast doubt on the Veteran’s subjective report of right lower extremity radiculopathy symptoms. As credible, subjective reports of right lower extremity radiculopathy symptoms have been attributed to the lumbar spine disorder, the Board resolves doubt in the Veteran’s favor, the Board finds that a separate, 10 percent rating is warranted for right lower extremity radiculopathy. A rating greater than 10 percent is not warranted for right lower extremity radiculopathy as the reports of the right lower extremity symptoms were subjective and the objective testing did not reveal any abnormality in the right lower extremity at any time. Moreover, as the August 2012 VA examination was the first indication of any right lower extremity symptoms, the Board finds the rating should be effective from August 27, 2012. The Veteran has not reported any other neurological abnormalities at any time, nor has any been shown in VA treatment records or examination reports. In sum, resolving all doubt in favor of the Veteran, the Board finds that an initial 40 percent disability rating is warranted prior to June 10, 2014; however, a rating in excess of 40 percent for the low back disability is not warranted at any time. Further, a separate 10 percent disability rating is warranted for mild right lower extremity radiculopathy, from August 27, 2012. 3. Entitlement to a compensable, initial rating prior to June 10, 2014, and greater than 40 percent thereafter, for left lower extremity radiculopathy. Under Diagnostic Code 8520, a 10 percent disability rating is warranted for mild incomplete paralysis of the sciatic nerve; a 20 percent disability rating is warranted for moderate incomplete paralysis of the sciatic nerve; a 40 percent disability rating is warranted for moderately severe incomplete paralysis of the sciatic nerve; a 60 percent disability rating is warranted for severe incomplete paralysis of the sciatic nerve, with marked muscular atrophy; and an 80 percent disability rating is warranted for complete paralysis of the sciatic nerve. a. Period prior to June 10, 2014. A March 2011 electromyography (EMG) study revealed normal nerves in the left lower extremity. The Veteran was provided with a VA general medical examination in August 2011. The examination report indicates that the Veteran denied having any symptoms in any extremity, including the left lower extremity. However, during the August 2011 VA spine examination, he reported numbness, paresthesias, leg or foot weakness, including numbness down his left leg. Objective testing during the August 2011 VA general examination revealed sensory examination findings regarding vibration, pain/pinprick, position sense, and light touch all normal. The Veteran denied any dysesthesias. The Veteran was also provided with a VA Gulf War examination in December 2011. At that time, he also denied any left lower extremity symptoms. Objective examination resulted in normal findings for the left lower extremity. In August 2012, the Veteran was provided with a VA peripheral nerves examination. At that time, the Veteran reported numbness and tingling to the left lower extremity resulting in difficulty walking. The examiner noted that the Veteran had left lower extremity symptoms attributable to the nerve condition as follows: moderate constant pain that may be excruciating at times, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness. The Veteran also had reduced muscle strength rated as 4 out of 5 on the left side. Sensory examination results were decreased on the left lower extremity. The examiner was asked to identify any lower extremity nerves affected and estimate the amount of incomplete paralysis. Despite the symptoms reported by the Veteran, which the examiner indicated were due to left lower extremity nerve disability, the August 2012 VA examiner ultimately determined that all of the nerves on the left lower extremity were normal. The examiner determined that no evidence of left lower extremity radiculopathy was found but only history and limited sensation suggested left sciatic, left sciatic nerve inflammation on top of a moderate to severe low back pain with degenerative disc disease. The VA treatment records do not indicate worse findings than those noted during the VA examinations. Based on the foregoing, the Board finds that an initial 10 percent rating, but no higher, is warranted for the left lower extremity radiculopathy prior to June 10, 2014. In this regard, the Board finds that the Veteran’s left lower extremity radiculopathy was manifested by pain, numbness, paresthesias and/or dysesthesias as well as reduced strength. However, the evidence demonstrates no more than mild incomplete paralysis as objective testing resulted in normal findings. See March 2011 EMG and August 2012 VA examination report. b. Period from June 10, 2014. The Veteran was provided with VA examinations in June 2014 and April 2018. During the June 2014 VA examination, the Veteran reported left lower extremity symptoms as follows: moderate constant pain that may be excruciating at times, severe intermittent pain, severe paresthesias and/or dysesthesias, and severe numbness. Muscle atrophy was also noted on the left side. The examiner determined that the sciatic nerve was involved, and that the overall severity was moderate. During the April 2018 VA examination, the Veteran reported constant back pain which radiated toward both lower extremities. Objective testing in April 2018 revealed normal muscle strength in the left lower extremity. The examiner noted that the Veteran did not have muscle atrophy. Deep tendon reflexes were normal and sensory testing was normal. The examiner determined that there was no evidence of left lumbar radiculopathy at that time. VA treatment records do not indicate worse findings than those reported during the VA examinations. Based on the foregoing, the Board finds that the Veteran’s left lower extremity radiculopathy was no worse than moderate for the period from June 10, 2014 and a rating greater than 40 percent is not warranted at any time. In reaching these conclusions, the Board has also considered the Veteran’s statements that he is entitled to higher ratings for his left lower extremity radiculopathy. In this case, the Board finds that the Veteran is competent to report his experiences of pain, numbness, tingling and any limitations that he observed through his senses. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); 38 C.F.R. § 3.159 (a)(2). Indeed, the Board considered these statements in its grant of an initial compensable ratings for left lower extremity radiculopathy. The Board acknowledges the Veteran’s belief that his symptoms are of such severity as to warrant higher ratings; however, disability ratings are made by the application of a schedule of ratings which is based on average impairment of earning capacity as determined by the clinical evidence of record. Therefore, the Board finds that the medical findings, which directly address the criteria under which the disability is evaluated, more probative than the Veteran’s assessment of the severity of his disabilities. In sum, resolving all doubt in favor of the Veteran, the Board finds that an initial 10 percent disability rating is warranted for left lower extremity radiculopathy, prior to June 10, 2014; however, a rating in excess of 40 percent for the left lower extremity disability from June 10, 2014 is not warranted. See Hart, supra. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disease or injury. 38 U.S.C. § 1112; 38 C.F.R. § 3.304. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Additionally, for Veterans who served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including hearing loss, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309 (a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303 (b). The use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may only be granted for a current disability; when a claimed condition is not shown, there may be no grant of service connection. See 38 U.S.C. § 1110 (2012); Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability). “In the absence of proof of a present disability there can be no valid claim.” See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The current disability requirement for a service connection claim is satisfied if the claimant has a disability at the time the claim is filed or during the pendency of that claim. See McClain v. Nicholson, 21 Vet. App. 319 (2007). Additionally, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a Veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104 (a) (2012); Baldwin v. West, 13 Vet. App. 1 (1999); see 38 C.F.R. § 3.303 (a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for PTSD. 2. Entitlement to service connection for major depressive disorder. In addition to the foregoing laws and regulations, service connection for PTSD requires medical evidence establishing a diagnosis of the disorder in accordance with 38 C.F.R. § 4.125 (a); a link, established by medical evidence, between current symptomatology and the claimed in-service stressor(s); and credible supporting evidence that the claimed in-service stressor(s) actually occurred. 38 C.F.R. § 3.304 (f). The evidence needed to establish the occurrence of a claimed in-service stressor is typically dependent upon whether the veteran engaged in combat with the enemy, as well as whether the claimed in-service stressor is related to such combat; or, if not, whether there is objective evidence to verify the occurrence of the claimed stressor. See Cohen v. Brown, 10 Vet. App. 128, 147 (1997); see also 38 U.S.C. § 1154 (b) (2012). The regulation also contains specific provisions related to stressors regarding prisoner of war and personal assault and notes that lay evidence may be enough to establish the in-service stressors in those situations. 38 C.F.R. § 3.304 (f). Service connection claims for PTSD based on “fear of hostile military or terrorist activity” are subject to a more relaxed evidentiary standard. 38 C.F.R. § 3.304 (f)(3). Absent clear and convincing evidence to the contrary, a Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor when the evidence establishes: (1) that the claimed stressor is adequate to support a diagnosis of PTSD, as determined by a VA psychiatrist or psychologist, or contract equivalent; (2) that the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service; and (3) that the Veteran’s symptoms relate to the claimed stressor. “Fear of hostile military or terrorist activity” means that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others (e.g., a threat from an actual or potential improvised explosive device, incoming mortar fire, or small arms fire). 38 C.F.R. § 3.304 (f). In this case, VA treatment records consistently indicate current diagnoses of PTSD and major depressive disorder. See e.g. August 2012 VA treatment record. The Veteran was afforded a VA examination in August 2012. At that time, the examiner diagnosed depressive disorder not otherwise specified (NOS). The examiner opined that the Veteran’s disorder was less likely than not related to service. The examiner explained that the Veteran denied any mental health issues during service and that the Veteran did not have any psychiatric treatment until 2012. The examiner noted that the Veteran’s initial mental evaluation was done two years post-service and the reason for the treatment was reported as alcohol related issues. The Veteran reported to the examiner that his depression was due to or the result of his service-connected disorders. The examiner concluded that the Veteran’s mental health condition was not related to, or a result of, or aggravated by, his service-connected disorders or active service. Service treatment records indicate that the Veteran was admitted to a hospital in April 2013, for suicidal ideas. The statement of medical examination and duty status indicated that the “accident” occurred in Iraq, in February 2009, and that the Veteran was on active duty. The record described the nature of the injury as “adjustment disorder with anxiety/depression”. The record also noted that the adjustment disorder with anxiety/depression was incurred in the line of duty. The record also noted the Veteran’s report that he felt anxious and depressed after his arrival from deployment. He reported that events from deployment had him filled with extreme sadness, loss of interest and no motivation. The Veteran was provided with another VA examination in June 2014. The June 2014 VA examiner found that the DSM-V criteria were not met for PTSD. The examiner diagnosed major depressive disorder as well as alcohol abuse that was in remission. The examiner noted that it was not possible to differentiate what symptoms were attributable to each diagnosis. The examiner did not address the adjustment disorder noted in the April 2013 service hospital record. With respect to PTSD, the June 2014 VA examiner found the Veteran’s reported stressor of nightly mortar attacks and dying soldiers as well as being in fear for his life, met the requirements for Criterion A. The examiner did not offer responses with respect to any of the remaining PTSD criteria. The examiner did not offer an opinion as to whether any of the Veteran’s acquired psychiatric diagnoses are related to service. Also in June 2014, a service psychiatrist reviewed the June 2014 VA examination report and VA treatment records and agreed with the diagnoses of major depressive disorder and PTSD. The service psychiatrist noted that both diagnoses were medically disqualifying in accordance with Army regulations. The service psychiatrist reviewed the Veteran’s history of mental health treatment post-deployment and noted that he was admitted to the hospital during a weekend drill, with worsening depressive symptoms and structured suicidal ideations. Based on the foregoing, the Board finds that the evidence is at least in equipoise that the Veteran had major depressive disorder and PTSD related to service. The Board places only limited probative value on the August 2012 VA examination report as the examiner did not have the benefit of the 2013 hospital admission record and June 2014 service psychiatrist’s report. Further, the Board places only a limited probative value on the June 2014 VA opinion as the examiner did not offer any response with respect to PTSD criteria B through H. The August 2012 diagnosis of PTSD was rendered by a VA psychiatrist (Dr. O.M.) who found that the Veteran met the criteria for PTSD and major depressive disorder, under the DSM-IV (which was the pertinent criteria for PTSD at the time the Veteran filed his claim). During the evaluation, the Veteran reported stressors in service, re-experiencing the trauma through flashbacks and nightmares, and avoidance of thoughts, places, and people who remind the Veteran of the traumatic experience. The Board places a high probative value on the August 2012 PTSD diagnosis, particularly as it was confirmed by a service psychiatrist in June 2014 and found to disqualify the Veteran from service. Based on the foregoing, the Board finds the evidence is at least in equipoise that the Veteran has PTSD and major depressive disorder due to service. Service connection for PTSD and major depressive disorder is granted. 3. Entitlement to service connection for purified protein derivative (PPD). Service connection will be presumed for tuberculosis, if manifest to a compensable degree within three years after discharge from service. 38 U.S.C. §§ 1101, 1112, 1133; 38 C.F.R. §§ 3.307, 3.309. Evidence of activity on comparative study of x-ray films showing pulmonary tuberculosis within the 3-year presumptive period provided by § 3.307(a)(3) will be taken as establishing service connection for active pulmonary tuberculosis subsequently diagnosed by approved methods. 38 C.F.R. § 3.371 (a). A diagnosis of pulmonary tuberculosis will be acceptable only when provided in: (1) service department records; (2) VA medical records of examination, observation or treatment; or (3) private physician records on the basis of that physician’s examination, observation or treatment of the Veteran and where the diagnosis is confirmed by acceptable clinical, x-ray or laboratory studies, or by findings of active tuberculosis based upon acceptable hospital observation or treatment. 38 C.F.R. § 3.374. In Tubianosa v. Derwinski, 3 Vet. App. 181, 184 (1992), the Court held that, pursuant to the regulatory provisions of 38 C.F.R. §§ 3.371 and 3.374, VA may not grant service connection for pulmonary tuberculosis unless a claimant submits VA or service physician diagnoses thereof, or submits the diagnoses of a private physician supported by clinical, x-ray, or laboratory studies or evidence of hospital treatment. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease, to satisfy Shedden element (1). The Veteran asserts that he was exposed to tuberculosis during boot camp and that since then, he has experienced fear that he would pass tuberculosis symptoms onto his children and that the tuberculosis symptoms would affect his employment. The Veteran’s March 2010 post-deployment questionnaire noted that the Veteran tested positive on a purified protein derivative (PPD) skin test. However, all testing after March 2010 showed that the Veteran did not have another positive PPD skin test nor tuberculosis. All post-separation medical records also did not contain complaints of or treatment for tuberculosis. Significantly, there was no probative evidence of record of any active pulmonary symptomatology attributed to tuberculosis. Moreover, in the May 2020 informal hearing presentation, the Veteran’s representative acknowledged that the Veteran had never been diagnosed with tuberculosis. Based on the evidence above, the Board finds that the Veteran is not entitled to service connection for any disability manifested by the positive PPD test from March 2010. There is no evidence or assertion that the Veteran has ever been diagnosed with active pulmonary tuberculosis or chronic residuals related thereto. There is only evidence of one positive PPD converter skin test and preventive treatment afterwards while he was still in service. A positive PPD test is not the same as a medical diagnosis of active tuberculosis, nor is it by itself considered a disability that can be service connected. Rather, a PPD test result is considered to be a laboratory finding used in exploring a possible diagnosis of tuberculosis; that is, a purified protein derivative examination is used to test for exposure to Mycobacterium tuberculosis. See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1498, 1962 (30th ed. 2003). Therefore, the positive PPD skin test is more analogous to a laboratory result or symptom, rather than to a disease or injury, and may not be considered a disability for purposes of VA compensation. The Board notes that, under 38 C.F.R. § 4.1, the term “disability” means impairment in earning capacity resulting from diseases and injuries and their residual conditions. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); 61 Fed. Reg. 20,440 (May 7, 1996) (diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol or actual laboratory results are not, in and of themselves, disabilities). It is crucial to note that no underlying disability, tuberculosis or residual related to tuberculosis, has been diagnosed. These residuals include psychiatric residuals that arose from tuberculous exposure. There are no records of diagnosis, treatment, positive x-rays, or laboratory studies that indicate the Veteran had active pulmonary tuberculosis either in service or after service. The Board further finds that active tuberculosis is a disease that is diagnosed based on tests and studies and is beyond the scope of lay observation. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability from the positive PPD test finding or any psychiatric residuals, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim for service connection for tuberculosis exposure. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 5. Entitlement to service connection for right ear hearing loss. VA may only find hearing loss to be a disability when the auditory threshold in any of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; when the auditory thresholds for at least three of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores are less than 94 percent. 38 C.F.R. § 3.385 (2019). Also, the threshold for normal hearing is between 0 and 20 decibels, and higher threshold shows some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The Board acknowledges that the absence of in-service evidence of hearing loss is not fatal to a claim for service connection. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Evidence of a current hearing loss disability (i.e., one meeting the requirements of 38 C.F.R. § 3.385, as noted above) and a medically sound basis for attributing such disability to service may serve as a basis for a grant of service connection for hearing loss. Hensley, 5 Vet. App. at 159; see also Godfrey v. Derwinski, 2 Vet. App. 352 (1992). In this case, the Veteran asserts entitlement to service connection for right ear hearing loss. The agency of original jurisdiction (AOJ) has already found that the Veteran was exposed to noise in service and indeed, his left ear hearing loss is service connected. However, the evidence does not demonstrate that the Veteran has a right ear hearing loss that is severe enough to be considered a disability, as defined by VA regulation, at any time pertinent to the appeal. In this regard, pure tone thresholds were documented as follows at the May 2014 VA examination. 500 Hertz 1000 Hertz 2000 Hertz 3000 Hertz 4000 Hertz Right ear 10 10 10 20 20 Speech audiometry revealed speech recognition ability of 100 percent in the right ear The Veteran also submitted a private audiological examination dated in February 2014. At that time, the Veteran had the following hearing acuity results: 500 Hertz 1000 Hertz 2000 Hertz 3000 Hertz 4000 Hertz Right ear 20 15 15 25 30 The remainder of the evidence does not indicate right ear hearing loss disability as defined by VA regulation. As the right ear pure tone thresholds do not meet the requirements for a hearing loss disability as defined by 38 C.F.R. § 3.385 at any time pertinent to the claim, service connection is not warranted for hearing loss in the right ear on any basis. The Board acknowledges the Veteran’s reports that he has difficulty hearing in the right ear. Although the Veteran is competent to report his observations of difficulty hearing, his statements as to a diagnosis of right ear hearing loss has no probative value as he has not been shown to have the requisite medical expertise and training to diagnose a hearing loss disability. See 38 C.F.R. § 3.159 (a)(2); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Moreover, VA has a strict definition for what it considers a hearing loss disability. 38 C.F.R. § 3.385. The VA requirements for right ear hearing loss disability are simply not met in this case. As such, the Board finds that the preponderance of the evidence is against the claim for service connection for right ear hearing loss for VA purposes. There is no doubt to be resolved, and service connection is not warranted. See 38 C.F.R. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 6. Entitlement to service connection for a sleep disorder. The Veteran asserts that he has a sleep disorder related to service. For the reasons explained below, the Board finds that the claim fails for lack of a current diagnosis. The Board acknowledges that the Veteran reported experiencing sleep problems during service. See March 2010 service treatment record. However, none of the service or VA treatment records diagnosed a sleep disorder. Rather, the June 2014 VA examination report indicates that the Veteran’s difficulty sleeping is a symptom of his major depressive disorder for which the Board has herein granted service connection. There is no indication that there is a separate sleep disorder warranting service connection. The Board acknowledges the Veteran’s belief that he has a sleep disorder. Indeed, the Veteran is competent to report difficulty sleeping as he experiences the same with his own senses. See Layno, supra. However, although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, diagnosis of sleep disorder, falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). In this regard, diagnosis of a sleep disorder requires more than just difficulty sleeping. None of the diagnostic testing in the record indicates a sleep disorder. As no current diagnosis of a sleep disorder is shown, service connection cannot be granted for a sleep disorder at this time. In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine but there is no doubt to be resolved and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to a compensable, initial rating for dermatitis. The Veteran was afforded a VA examination to address the severity of his claimed skin disorder in August 2014. The examiner noted the Veteran’s description of symptoms during a flare-up but did not provide an estimation for the percentage of the body and/or visible area affected during a flare-up. In this regard, the Veteran reported that during a flare-up of the rash, it affects his face and chest and usually lasts for a week at a time. An addendum opinion should be obtained in order to properly evaluate the severity of the dermatitis. 2. Entitlement to a TDIU prior to February 5, 2018. During the pendency of the appeal for higher initial ratings, the Veteran filed a claim for TDIU and indicated that his last date of full-time work was in March 2010. See February 2018 claim. As the Veteran attributed his unemployability to the disorders that were on appeal for higher ratings, the claim for TDIU became part and parcel of the claim for higher initial ratings. Therefore, when the AOJ granted the TDIU effective February 5, 2018, the decision did not fully satisfy the claim. The AOJ should readjudicate the claim and determine whether the Veteran is entitled to a TDIU prior to February 5, 2018. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Following completion of item 1, obtain an addendum opinion from the August 2014 VA examiner. The Board leaves it to the discretion of the clinician as to whether the Veteran needs to be reexamined. Following review of the entire electronic file, the examiner is asked to address the severity of the Veteran’s dermatitis, to include an estimation of the affected body area as well as exposed area, during a flare-up of the rash. Consider that the Veteran reported that during a flare-up, the rash affects his face and chest and lasts for approximately one week. (Continued on the next page)   If possible, the examiner should offer a retrospective opinion regarding the severity of the rash during flare-ups since March 17, 2010, the effective date of service connection. 3. Adjudicate the claim for TDIU prior to February 5, 2018. SCOTT W. DALE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Donna D. Ebaugh, 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.