Citation Nr: 21001714 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 18-45 525 DATE: January 11, 2021 ORDER Entitlement to service connection for a schizoaffective disorder is granted. Entitlement to service connection for hypertension is denied. Entitlement to service connection for a right knee disability is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for headaches is granted. Entitlement to a rating in excess of 10 percent prior November 20, 2019, and in excess of 20 percent as of November 20, 2019, for degenerative arthritis of the spine is denied. Entitlement to an rating in excess of 20 percent for left lower extremity radiculopathy is denied. Entitlement to an earlier effective date than February 28, 2017, for service connection for left lower extremity radiculopathy is denied. Entitlement to an earlier effective date than February 28, 2017, for service connection for degenerative arthritis of the spine is denied. REMANDED Entitlement to service connection for erectile dysfunction is remanded. FINDINGS OF FACT 1. Resolving all reasonable doubt in the Veteran’s favor, the Board finds that the Veteran has a schizoaffective disorder that is etiologically related to service or service-connected disabilities. 2. The preponderance of the evidence does not establish that the any knee disability was initially manifested in service; manifested with knee arthritis to a compensable degree within one year of service separation; or is causally or etiologically related to service. 3. The preponderance of the evidence is against finding that hypertension is related to service or caused or aggravate by a service-connected disability, or manifested within one year following separation from service. 4. Resolving all reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s tension headaches are etiologically related to service-connected disabilities. 5. The Veteran's left lower extremity radiculopathy is manifested by no more than moderate incomplete paralysis of the sciatic nerve. 6. Prior to November 20, 2019, the evidence did not show 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 7. AS of November 20, 2019, the evidence does not show that a lumbar spine disability manifested with forward flexion of the thoracolumbar spine to 30 degrees or less; or ankylosis. 8. VA first received a claim of entitlement to service connection for back on February 28, 2017. In April 2017, VA established entitlement to service connection for degenerative arthritis of the spine with lumbar spine degenerative disc disease, claimed as back pain, and assigned a 10 percent rating, effective February 28, 2017; and entitlement to service connection for left lower extremity radiculopathy and assigned a 20 percent rating, effective February 28, 2017, the date the claim was first received by VA. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for schizoaffective disorder have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 3.306. 2. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.310. 3. The criteria for entitlement to service connection for a right knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. The criteria for entitlement to service connection for a left knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 5. The criteria for entitlement to service connection for headaches have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 3.306. 6. The criteria for entitlement to an increased rating for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8520. 7. The criteria for entitlement to a rating in excess of 10 percent prior November 20, 2019, for degenerative arthritis of the spine, and in excess of 20 percent as of November 20, 2019, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.71a, Diagnostic Code 5235- 5243. 8. The criteria for entitlement to an effective date earlier than February 28, 2017, for service connection of left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.1, 3.102, 3.155, 3.400. 9. The criteria for entitlement to an effective date earlier than February 28, 2017, for service connection of degenerative arthritis of the spine have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.1, 3.102, 3.155, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1979 to February 1982. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from October 2015 and April 2017 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Board remanded these claims to the Agency of Original Jurisdiction for additional action. Service Connection Service connection may be established for disability caused by disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § § 3.30. In order to establish service connection for a claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence, generally medical, of a causal relationship between the claimed in service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be established for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in-service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. Secondary service connection may be established for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). Lay testimony is competent when it regards the readily observable features or symptoms of injury or illness and may provide sufficient support for a claim of service connection. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran is competent to provide testimony concerning factual matters of which he has firsthand knowledge, such as experiencing a physical symptom such as pain. Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). Therefore, the Board must assess the competence and credibility of lay statements. Barr v. Nicholson, 21 Vet. App. 303 (2007). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while weight and credibility are factual determinations going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67 (1997). A Veteran need only demonstrate that there is an approximate balance of positive and negative evidence to prevail. To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). While the Board must provide reasons and bases supporting a decision, there is no need to discuss, in detail, the evidence submitted by or on behalf of the Veteran. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence of record. The Veteran should not assume that the Board has overlooked pieces of evidence that are not explicitly discussed. Timberlake v. Gober, 14 Vet. App. 122 (2000). 1. Entitlement to service connection for a psychiatric disability The Veteran contends that service connection for a psychiatric disability is warranted. Having reviewed all of the evidence of record, and resolving reasonable doubt in favor of the Veteran, the Board finds that service connection for a psychiatric disability is warranted. The service medical records do not contain complaints, treatment, or diagnoses for any psychiatric condition.  During a January 2019 private examination, after review of the service, VA and civilian medical records, in a thorough, detailed report, the examiner, a psychologist, provided a professional medical opinion, that it was as likely as not that the Veteran had schizoaffective disorder which began in service, continued uninterrupted to the present, and was aggravated by left lower extremity radiculopathy and degenerative arthritis of the spine with lumbar spine degenerative disc disease. The examiner also included several research articles from journals to support the opinion. In support of the claim, the Veteran has also provided VA with several written statements describing his psychiatric condition and the impact it has had on his life. The Board is not free to substitute its own judgment for that of a medical expert. Colvin v. Derwinski, 1 Vet. App. 171 (1991). However, the Board is required to assess the credibility and weight to be given to evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). The Board has considered the January 2019 private examination and finds it to be credible, competent, and probative as it is supported by detailed rationale and provided by a trained medical professional who specifically identified and discussed the Veteran’s contention and theory concerning service and the claimed disability. The probative value of medical evidence is based on the physician’s knowledge and skill in analyzing the data, and the medical conclusion she reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. Guerrieri v. Brown, 4 Vet. App. 467 (1993). The Board acknowledges that there may be contradictory evidence of record, such as VA medical examination from January 2020 that did not find a psychiatric disability to be related to service. That examination found that the Veteran had been recently diagnosed with depression, which was 36 years following separation from service, and therefore, the depression was less likely than not related to service. The Board finds that rationale to be sparse, and to not have considered the Veteran’s lay testimony regarding symptoms during and since service. However, the Board cannot ignore the medical evidence finding that the Veteran’s psychiatric disability was incurred in service and was aggravated by a service-connected disability.  Accordingly, after a careful review of the evidence of record, the Board finds that the evidence is, at least, in equipoise in regard to a finding that the current psychiatric disability is due to active service or secondary to a service-connected disability. The Board will resolve reasonable doubt in favor of the Veteran and finds that schizoaffective disorder was incurred in service. Therefore, the Board concludes that service connection for schizoaffective disorder is warranted as the evidence shows that it is at least as likely as not that schizoaffective disorder was incurred in service and aggravated by a service-connected disability. Accordingly, as the evidence is in equipoise for the claim of entitlement to service connection for schizoaffective disorder, the claim must be granted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for headaches The Veteran contends that service connection for headaches is warranted. Specifically, the Veteran asserts that a headache disability began during service and continues to the present. In the alternative, the Veteran contends that a headache disability has been aggravated by a service-connected psychiatric disability and back disability. Having reviewed all of the evidence of record, and resolving reasonable doubt in favor of the Veteran, the Board finds that service connection for headaches is warranted. The service medical records do not contain complaints, treatment, or diagnoses for any headache condition.  During a June 2020 private examination, the examiner, a Doctor of Osteopathic Medicine, diagnosed tension headaches. After examining the Veteran and review of the claims file, in a detailed report, the examiner opined that it was as likely as not that chronic headache pain was caused by service-connected degenerative arthritis of the spine with lumbar spine degenerative disc disease and left lower extremity radiculopathy and symptoms of diagnosed mental health conditions. In support of the claim, the examiner cited to and provided a research study showing a link between a psychiatric disabilities, chronic pain, and headaches. In support of the claim, the Veteran has also provided VA with several written statements describing his headache condition and the impact it has had on his life. The Board is not free to substitute its own judgment for that of a medical expert. Colvin v. Derwinski, 1 Vet. App. 171 (1991). However, the Board is required to assess the credibility and weight to be given to evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). The Board has considered the June 2020 private examination and finds it to be credible, competent, and probative as it is supported by detailed rationale and provided by a trained medical professional who specifically identified and discussed the Veteran’s contention and theory concerning service and the claimed disability. The probative value of medical evidence is based on the physician’s knowledge and skill in analyzing the data, and the medical conclusion she reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. Guerrieri v. Brown, 4 Vet. App. 467 (1993). The Board acknowledges that there may be contradictory evidence of record.  However, the Board cannot ignore the medical evidence finding that the Veteran’s headache disability was incurred in service and was aggravated by a service-connected disability.  Accordingly, after a careful review of the evidence of record, the Board finds that the evidence is, at least, in equipoise in regard to a finding that the current headache disability is secondary to a service-connected disability. The Board will resolve reasonable doubt in favor of the Veteran and finds that a headache disability is secondary to the Veteran’s service- connected disabilities. Therefore, the Board concludes that service connection for headaches is warranted as the evidence shows that it is at least as likely as not that a current headache disability is secondary to service-connected disabilities. Accordingly, as the evidence is in equipoise for the claim of entitlement to service connection for headaches, the claim must be granted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for hypertension. The Veteran contends that currently diagnosed hypertension is a result of service. The service medical records do not contain complaints, treatment, or diagnoses of hypertension. The evidence does not show any medical evidence to establish that hypertension developed to a compensable degree within one year following separation from service to qualify for the presumption of service connection. An October 2015 medical record shows a diagnosis of hypertension made many years after separation from service. There is no competent evidence of record that relates hypertension to service. There is no evidence of record suggesting that hypertension manifested to a compensable degree within one year following separation from service. The Veteran has not submitted any competent evidence relating hypertension to service or any service-connected disabilities and his own statements are not competent evidence because, as a lay person, he does not possess the training to provide that type of etiology opinion. The Veteran has also not alleged a specific event or injury that would support a relationship between the current diagnosis and his service. The duty to assist includes providing a medical examination or obtaining a medical opinion when such is necessary to make a decision on the claim. An examination is required when (1) there is evidence of a current disability, (2) evidence establishing an in-service event, injury, or disease, or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. McLendon v. Nicholson, 20 Vet. App. 79 (2006). After reviewing the record, the Board finds that a VA examination is not needed in this case. There is no evidence of record of any in-service event, injury or disease which relates to the claimed disability. Additionally, there is no evidence of a continuity of symptoms dating from the Veteran's service, which relates to the claimed disability. Therefore, an examination is not necessary in order to make a decision in this case. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for hypertension. Therefore, the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 4. Entitlement to service connection for a right knee disability. 5. Entitlement to service connection for a left knee disability. The Veteran seeks entitlement to service connection for a bilateral knee disability. The Veteran has not offered any lay statement as to why he believes any knee disability is the result of service. He only asserts that service connection is warranted for a bilateral knee disability. The service medical records do not contain complaints, treatment, or diagnoses of any knee disability while on active duty service. The competent medical evidence of record shows that the Veteran was diagnosed with osteoarthritis of the knees in October 2015, approximately 33 years after service. The Board finds that service connection for a bilateral knee disability is not warranted as the record does not show any clinical findings or diagnoses of arthritis within one year of separation from active duty. The Veteran’s service medical records do not show a diagnosis of arthritis while in service or within one year of separation from service. The first competent evidence of any knee condition comes more than 33 years after separation from active duty service. Accordingly, service connection for a bilateral knee disability on presumptive basis is not warranted. The Board also finds that the weight of the evidence is against a finding that any knee disability is etiologically related to the Veteran’s active duty service on a direct basis. The Veteran has not asserted, and the service medical records do not show, evidence of in-service disease or injury involving the knees. The Veteran’s service medical records do not show any complaints or treatment for knee problems. The January 1982 separation examination found the Veteran’s lower extremities to be normal. Thus, there is no in-service evidence of knee problems, nor has the Veteran specifically alleged any event involving either knee during service. Moreover, the evidence of record does not include lay evidence of continuity of symptomatology since service, or evidence that a competent medical professional has linked the Veteran’s alleged any current knee condition to his period of service. The post-service VA treatment records do not show evidence of any knee problems until decades after separation from service. The Veteran has not identified any outstanding records of pertinent treatment regarding the claimed disability. The Veteran has not submitted any competent evidence relating any alleged knee condition to service and his own statements, if any, are not competent evidence because as a lay person he does not possess the training to provide that type of opinion. The Board is cognizant that the Veteran has not been provided a VA examination concerning the knee claim, and that opinions have not been obtained. The Board finds that development is not necessary as there is no competent evidence indicating that any knee disability may be related to service. McLendon v. Nicholson, 20 Vet. App. 79 (2006). An examination is required when (1) there is evidence of a current disability, (2) evidence establishing an in-service event, injury, or disease, or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. McLendon v. Nicholson, 20 Vet. App. 79 (2006). After reviewing the record, the Board finds that a VA examination is not needed. There is no evidence of record of any in-service event, injury or disease which relates to the claimed disabilities. Additionally, there is no evidence of a continuity of symptoms dating from the Veteran’s service, which relates to the claimed disabilities. Therefore, an examination is not necessary in order to decide this case. To the extent that the Veteran has asserted that any knee disability is related to service, a conclusory generalized lay statement alleging nexus between a current disability and service does not meet the standard to warrant a VA examination. Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). As the preponderance of the evidence does not show that the Veteran’s claimed current knee disability was incurred in-service, may be presumed to have been incurred in service, or show a medical nexus between the presently diagnosed condition and the Veteran’s service, service connection for a bilateral knee disability cannot be granted on a direct basis. The Board acknowledges the Veteran’s contention that a current knee disability is the result of his active duty service. Although lay persons are competent to provide opinions on some medical issues, the specific musculoskeletal conditions in this case outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In this instance, the Veteran as a lay person has not been shown to be capable of making medical conclusions, especially as to complex medical questions, such as a link between his current musculoskeletal conditions and his active duty service. Thus, any lay statements from the Veteran regarding any such link are not competent. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for a bilateral knee disability. The Board is appreciative of the Veteran’s faithful and honorable service to our country. However, as the preponderance of the evidence is against the claim of entitlement to service connection for a bilateral knee disability, the claim must be and is denied. 38 U.S.C. § 5107b; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4. The Schedule is primarily a guide in the rating 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 diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period for which the appeal has been pending. Powell v. West, 13 Vet. App. 31 (1999). Consideration must be given as to whether staged ratings should be assigned to compensate entitlement to a higher rating at any point during the pendency of the claim. When the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings is necessary. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). While the Board must provide reasons and bases supporting a decision, there is no need to discuss, in detail, all the evidence submitted by or on behalf of the Veteran. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence of record. The Veteran should not assume that the Board has overlooked pieces of evidence that are not explicitly discussed. Timberlake v. Gober, 14 Vet. App. 122 (2000). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the Veteran. Equal weight is not given to each piece of evidence contained in the record. Every item of evidence does not have the same probative value. When the evidence is assembled, the Board is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 6. Entitlement to a rating in excess of 10 percent prior November 20, 2019, for degenerative arthritis of the spine, and in excess of 20 percent as of November 20, 2019, Disabilities of the spine that are rated under the General Rating Formula for Diseases and Injuries of the Spine include vertebral fracture or dislocation (Diagnostic Code 5235), sacroiliac injury and weakness (Diagnostic Code 5236), lumbosacral or cervical strain (Diagnostic Code 5237), spinal stenosis (Diagnostic Code 5238), unfavorable or segmental instability (Diagnostic Code 5239), ankylosing spondylitis (Diagnostic Code 5240), spinal fusion (Diagnostic Code 5241), and degenerative arthritis of the spine (Diagnostic Code 5242). Degenerative arthritis of the spine can also be rated using Diagnostic Code 5003. 38 C.F.R. § 4.71a. The General Rating Formula for Diseases and Injuries of the Spine provides a 20 percent rating for forward flexion of the 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. 38 C.F.R. § 4.71a. A 30 percent rating is assigned for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. 38 C.F.R. § 4.71a. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine of 30 degrees or less; or, unfavorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a. Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate Diagnostic Code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). For VA compensation purposes, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 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 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. 38 C.F.R. § 4.71a , Plate V, General Rating Formula for Diseases and Injuries of the Spine, Note (2). The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a , General Rating Formula for Diseases and Injuries of the Spine, Note (4). 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. Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. 38 C.F.R. § 4.71a , General Rating Formula for Diseases and Injuries of the Spine, Note (3). 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 (0 degrees) always represents favorable ankylosis. The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). Disability of the thoracolumbar and cervical spine segments are to be rated separately, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (6). Diagnostic Code 5243 provides that intervertebral disc syndrome (IVDS) is to be rated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. The Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes provides that a 10 percent rating is warranted for IVDS with incapacitating episodes 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 for IVDS with incapacitating episodes 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 for IVDS with incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A 60 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a , Diagnostic Code 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. An incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a , Diagnostic Code 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (1). If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, each segment is to be rated on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (2). The Veteran’s degenerative arthritis of the spine has been rated under Diagnostic Codes 5242 as 10 percent prior to November 20, 2019, and 20 percent as of November 20, 2019. As an initial matter, the Board notes that the Veteran underwent VA back examination in March 2017. The Board finds the March 2017 back examination to be incomplete as the examiner did not provide an opinion as to functional loss of range of motion during flare-ups and after repeated use over time because the Veteran was not examiner during a flare-up or after repeated use. The Board notes that an opinion is speculative when it is based on the absence of procurable information or an examiner’s shortcomings or general aversion to offering an opinion on issues not directly observed. Direct observation of functional impairment during a flare-up is not a prerequisite to offering an opinion. Case law and VA guidelines anticipate that examiners will offer flare up opinions based on estimates derived from information procured from relevant sources, including the lay statements of Veterans.  Sharp v. Shulkin, 29 Vet. App. 26 (2017).  Accordingly, the Board finds the March 2017 VA back examination report to be incomplete for rating purposes and it will not be considered in adjudication of this claim. A May 2015 radiograph of the lumbar spine revealed mild levoscoliosis, moderate to marked disc space narrowing from L3-L4 through L5-S1, mild to moderate multilevel facet arthropathy, and no osseous lesion. During VA examination in November 2019, the Veteran denied experiencing flare-ups of pain but acknowledged having pain all the time. The Veteran stated that he went to the emergency room four times this year for the back but denied back surgeries, hospitalizations, and steroid injections. The Veteran was able to walk with a cane and wore a back brace to help with stability. On physical examination, at worst, the Veteran had forward flexion of the thoracolumbar spine to 65 degrees. Extension was to 10 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 20 degrees. The Veteran did have guarding of the thoracolumbar spine resulting in abnormal gait or abnormal spinal contour. The Veteran did not have lumbar ankylosis, spasms, atrophy, tenderness, or weakness. The Veteran was noted as having incapacitating episodes of spine disease but was not prescribed bed rest by a physician in the past 12 months. Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. The record currently contains no other examinations that are valid for rating purposes. The Board notes that there has been no medical evidence of ankylosis of the thoracolumbar spine during the course of the appeal. Thus, a higher rating cannot be assigned on that basis. Prior to November 20, 2019, the Board finds that the evidence did not show limitation of lumbar spine flexion to be greater than 30 degrees but not greater than 60 degrees. The evidence also did not show 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. Therefore, a rating higher than 10 percent was not warranted prior to November 20, 2019. The Board has considered any additional limitation of function due to pain and other factors, but the evidence does not show any additional limitation of function that would support the assignment of a rating greater than 10 percent. The Board finds that as of November 20, 2019, but not earlier, the Veteran's back disability has warranted a 20 percent rating, but not higher. The November 2019 VA examination found that after testing the Veteran had guarding of the thoracolumbar spine resulting in abnormal gait or abnormal spinal contour. Pursuant to Diagnostic Code 5242, that level of impairment is consistent with a 20 percent rating. As of November 20, 2019, a higher rating is not warranted because the evidence of record does not show the Veteran has ever had ankylosis or forward flexion of the thoracolumbar spine limited to 30 degrees or less. The Board has considered any additional functional loss due to pain or other factors, but finds that the objective evidence does not show additional functional loss that would warrant elevation to any higher ratings. The Board has also considered whether a higher rating could be assigned under the intervertebral disc syndrome formula based on incapacitating episodes. However, to date, the Veteran has not been shown to have incapacitating episodes of intervertebral disc syndrome requiring bed rest prescribed by a physician and treatment by a physician of any duration. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of a rating greater than 10 percent for a lumbar spine disability prior to November 20, 2019. Thus, the claim for an increased rating prior to November 20, 2019, is denied. Additionally, the Board finds that the preponderance of the evidence is against the assignment of a rating greater than 20 percent for a lumbar spine disability as of November 20, 2019. Therefore, the Board finds that the preponderance of the evidence is against the assignment of any higher ratings and the appeal must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 7. Entitlement to an increased rating for left lower extremity radiculopathy An April 2017 rating decision established service connection for left lower extremity radiculopathy and assigned a 20 percent rating, effective February 28, 2017, pursuant to Diagnostic Code 8520. With spine disabilities, any associated objective neurologic abnormalities should be rated separately under an appropriate Diagnostic Code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). Diagnostic Code 8520, 8620, and 8720 are used to rate paralysis, neuritis, and neuralgia of the sciatic nerve. Those Diagnostic Codes provide that mild incomplete paralysis, neuritis, or neuralgia of the sciatic nerve is rated 10 percent. Moderate incomplete paralysis, neuritis, or neuralgia is rated 20 percent. Moderately severe incomplete paralysis, neuritis, or neuralgia is rated 40 percent. Severe incomplete paralysis, neuritis, or neuralgia, with marked muscular atrophy, is rated 60 percent. Complete paralysis, neuritis, or neuralgia of the sciatic nerve, where the foot dangles and drops, with no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost, is rated 80 percent. 38 C.F.R. § 4.124a, Diagnostic Code 8520, 8620, 8720. The term incomplete paralysis with peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement. When there is bilateral involvement, the VA adjudicator is to combine the ratings for the peripheral nerves, with application of the bilateral factor. 38 C.F.R. § 4.124a. Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. 38 C.F.R. § 4.124. The Board finds that the Veteran is not entitled to higher rating for radiculopathy of the left lower extremity. As an initial matter, the Board again notes that a March 2017 VA back examination report has been found to be incomplete for rating purposes and will not be considered in adjudication of this claim. At a November 2019 VA examination, the Veteran's left lower extremity radiculopathy was described as mild constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and mild numbness with involvement of the sciatic nerve. Overall, the Veteran was found to have moderate radiculopathy of the left lower extremity. That finding provides evidence that the Veteran's disability is not manifested by moderately severe incomplete neuralgia of the sciatic nerve. Furthermore, there was evidence of normal sensation to light touch of the lower extremities. Reflexes and muscle strength were normal and there was no muscle atrophy. The Board finds that during the period on appeal, the Veteran's left lower extremity radiculopathy disability has manifested as no more than a moderate level of severity of sciatic nerve involvement. The Veteran's lay statements throughout the claim period show only complaints about constant moderate pain and periods of numbness and tingling of the left lower extremity, starting from the lower back. The Board finds that even considering the Veteran's lay statements and complaints, the November 2019 VA examiner of record provided a medically competent conclusion that the Veteran's condition is only considered moderate, which the Board finds to be highly probative of the severity of the radiculopathy. The evidence shows that the neurologic disability is only sensory and thus should be rated mild, or at most, moderate in degree, and does not include loss of reflexes or muscle atrophy that would allow neuritis to be considered moderately severe in the sciatic nerve, although some sensory disturbance and constant moderate pain are shown. Consequently, as the examiner did not conclude that sciatic nerve disability amounted to a moderately severe condition, and the evidence does not show diminished strength or reflexes, or any muscle atrophy, the Board finds that a rating higher than 20 percent is not warranted. Accordingly, the Board finds that the preponderance of the evidence is against the claim for an increased rating and the claim must be denied. The Board has considered whether referral for consideration of the assignment of an extraschedular rating is warranted. In exceptional cases an extraschedular rating may be provided. The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular ratings for that service-connected disability are inadequate. Therefore, initially, there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the Rating Schedule for that disability. 38 C.F.R. § 3.321; Thun v. Peake, 22 Vet. App. 111 (2008). If the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the Rating Schedule, the assigned schedular rating is adequate, and no referral is required. However, if the schedular rating does not contemplate the claimant's level of disability and symptomatology, and is found inadequate, the Board must determine whether the claimant's exceptional disability picture exhibits other related factors provided by the regulation as governing norms such as marked interference with employment and frequent periods of hospitalization. When the Rating Schedule is inadequate to rate a claimant's disability picture and that picture has related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for a determination of whether, to accord justice, the claimant's disability picture requires the assignment of an extraschedular rating. 38 C.F.R. § 3.321(b)(1). The Board finds that the symptomatology and impairment caused by the Veteran's left lower extremity radiculopathy are specifically contemplated by the schedular rating criteria, and no referral for extraschedular consideration is required. The schedular rating criteria specifically provide for ratings based on the neurological symptoms exhibited by the Veteran. The Veteran's radiculopathy disability is manifested by sensory symptoms, specifically considered by the rating schedule. Therefore, in the absence of exceptional factors, the Board finds that the criteria for referral for consideration of the assignment of an extraschedular rating are not met. 38 C.F.R. § 3.321(b)(1); Thun v. Peake, 22 Vet. App. 111; Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218 (1995). Effective Date 8. Entitlement to an earlier effective date for service connection for left lower extremity radiculopathy 9. Entitlement to an earlier effective date for service connection for degenerative arthritis of the spine Generally, the effective date for service connection is the date of receipt of the claim or date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. The effective date of a rating and award of compensation on an original claim for compensation will be the day following separation from active duty service or date entitlement arose if the claim is received within one year after separation from service. Otherwise, the effective date will be the date of receipt of the claim or date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a)-(b)(1); 38 C.F.R. § 3.400 (b)(2). A claim is a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p). Any communication or action, indicating an intent to apply for one or more benefits under the laws administered by VA, from a claimant, a duly authorized representative, or a person acting as next friend who is not sui juris may be considered an informal claim. 38 C.F.R. § 3.155. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the Veteran, it will be considered filed as of the date of receipt of the informal claim. If a formal claim is received after one year of its receipt, then the effective date will be the date of VA’s receipt of the formal application form. Jernigan v. Shinseki, 25 Vet. App. 220 (2012); 38 U.S.C. § 5103 (b); 38 C.F.R. § 3.155. The effective date of a claim will be the date of the informal claim if VA did not send a claimant a formal application form after receiving an informal claim, as required by 38 C.F.R. § 3.155, because the one-year time limit to return the formal claim did not begin. Quarles v. Derwinski, 3 Vet. App. 129 (1992). The Veteran contends he is entitled to an earlier effective date than February 28, 2017, for service connection for degenerative arthritis of the spine and service connection for left lower extremity radiculopathy associated with degenerative arthritis of the spine. The Veteran filed an original claim for service-connection for back pain on February 28, 2017. As a result of that claim filing, in April 2017, VA established entitlement to service connection for degenerative arthritis of the spine with lumbar spine degenerative disc disease, claimed as back pain, and assigned a 10 percent rating, effective February 28, 2017; and entitlement to service connection for left lower extremity radiculopathy and assigned a 20 percent rating, effective February 28, 2017, after consideration of a March 2017 positive opinion from a VA medical examiner. VA assigned February 28, 2017 as the effective date for both claims as that is the date the claim was first received by VA. The Board finds that the record does not show any communication that could be interpreted as a claim for benefits for a back disability or any associated residuals prior to the receipt of the February 28, 2017, claim. Therefore, an earlier effective date prior to February 28, 2017, is not warranted as that is the date the claim was first filed. The Board notes that while the Veteran has claimed entitlement to an earlier effective date for service connection for degenerative arthritis of the spine and service connection for left lower extremity radiculopathy associated with degenerative arthritis of the spine, the Veteran and the representative have provided no evidence showing that an earlier effective date is warranted and have provide no explanation for that contention. They simply state that an earlier effective date is warranted and have provided no basis for that contention and have not suggested a more appropriate effective date, or that any earlier claim was filed for benefits for a back disability or any neurologic residuals of a back disability. The record does not show any evidence or statement prior to February 28, 2017, relating to any claim for a back disability. Therefore, the Board finds that the effective date for service connection for degenerative arthritis of the spine and service connection for left lower extremity radiculopathy associated with degenerative arthritis of the spine can be no earlier than the date of the claim was first filed. 38 C.F.R. § 3.158 (a); Sabonis v. West, 6 Vet. App. 426 (1994); 38 U.S.C. § 5107. The Board is sympathetic to the Veteran’s situation. However, the legal authority governing effective dates is clear and specific. The Board is not authorized to rule in equity, but is bound by the applicable statutes and regulations. Any claim in equity should be pursued with the Secretary of VA. 38 U.S.C. § 503. The Board is appreciative of the Veteran’s faithful and honorable service to our country. However, as there is no legal basis for assignment of any earlier effective date, and because the preponderance of the evidence is against the claim for any earlier effective date, the Board finds that the claim must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for erectile dysfunction is remanded. Although the Board regrets the delay, additional development is needed prior to further disposition of the claim of entitlement to service connection for erectile dysfunction. VA’s statutory duty to assist the Veteran includes the duty to conduct a thorough examination so that the evaluation of the claimed disability will be a fully informed one. Green v. Derwinski, 1 Vet. App. 121 (1991); Snuffer v. Gober, 10 Vet. App. 400 (1997). Assistance by VA includes providing a medical examination or obtaining a medical opinion when an examination or opinion is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The Veteran’s service medical record contains evidence of genitourinary issues while in-service. In August 1981, the Veteran was treated for urethral discharge. The Board also notes that the Veteran has presented evidence of a current diagnosis of erectile dysfunction. However, the Veteran has not been provided a VA examination concerning the claim of entitlement to service connection for erectile dysfunction. Because the Veteran may have a disability that is related to service, the Board finds that the Veteran should be provided VA examinations to determine the nature and etiology of claimed erectile dysfunction. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran’s claim. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). On remand, an examination must be scheduled and an opinion as to the etiology of the claimed erectile dysfunction disability should be requested. McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The Veteran is notified that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claim. The consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. § 3.655. The matters are REMANDED for the following action: 1. Contact the Veteran and request that he provide information as to treatment for erectile dysfunction, including the names and addresses of all health care providers whose records have not already been provided to VA. On receipt of the requested information and the appropriate releases, contact all identified health care providers and request copies of all available records pertaining to treatment of the Veteran, not already of record. If identified records are not obtained, then notify the Veteran. 38 C.F.R. § 3.159(e). 2. Schedule the Veteran for an examination to determine the nature and etiology of any erectile dysfunction. The examiner must review the claims file, including this Remand, and should note that review in the report. The examiner should opine whether the it is at least as likely as not (50 percent or greater probability) that erectile dysfunction is related to active service or any event, disease, or injury during service, including whether it (1) began during active service, (2) manifested within one year after separation from service, (3) was noted during service with continuity of the same symptomatology since service, (4) was caused by any service-connected disability or treatment for any service-connected disability, or (5) has been aggravated (increased in severity beyond the natural progress of the disorder) by any service-connected disability, or treatment for any service-connected disability. The examiner should address the Veteran’s lay statements, if any, regarding the claimed disability and its etiology. The examiner must consider and discuss the lay statements and should reconcile the opinion with any previous opinions of record. The examiner should discuss the significance of the service medical records showing urethral discharge in August 1981. A clearly stated rationale for each opinion offered must be provided and cannot be based on the lack of an in-service record of the claimed disability. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mondesir, Eric 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.