Citation Nr: 21002920 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 13-29 868 DATE: January 19, 2021 ORDER Entitlement to a disability rating in excess of 10 percent prior to August 28, 2020 and a 20 percent rating thereafter for lumbar spine degenerative joint and disc disease is denied. Entitlement to a compensable rating for bronchitis with pulmonary vascular disease is denied. Entitlement to a rating in excess of 20 percent prior to May 16, 2014 and a 40 percent rating thereafter for right leg deep vein thrombosis (DVT) is denied. REMANDED Entitlement to a total disability rating based upon individual employability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran did not have IVDS with incapacitating episodes that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. 2. Prior to August 28, 2020, forward flexion of the thoracolumbar spine was to 90 degrees at its most limited; the Veteran does not have ankylosis of the spine or functional loss of sufficient severity to warrant additional compensation. 3. From August 28, 2020, limitation of flexion of the lumbar spine was to 50 degrees at its most limited; the Veteran did not have ankylosis of the spine or functional loss of sufficient severity to warrant additional compensation. 4. Throughout the entire appeal period, the Veteran’s bronchitis with pulmonary vascular disease has been asymptomatic. Pulmonary function test (PFT) results revealed FVC of 69 percent predicted; FEV-1 of 81 percent predicted; and FEV-1/FVC of 115 percent predicted. 5. Prior to May 16, 2014, the evidence of record does not show persistent edema, stasis pigmentation, or eczema in the Veteran’s right leg. 6. From May 16, 2014, the Veteran’s right leg had persistent edema and stasis pigmentation but not persistent ulceration or massive board-like edema with constant pain at rest. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 10 percent prior to August 28, 2020 and a 20 percent rating thereafter for lumbar spine degenerative joint and disc disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5242-5243. 2. The criteria for entitlement to a compensable rating for bronchitis with pulmonary vascular disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.97, DC 6817. 3. The criteria for entitlement to a rating in excess of 20 percent prior to May 16, 2014 and a 40 percent rating thereafter for right leg DVT have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.104, DC 7121. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from January 1983 to September 1993, April 1991 to July 1991, November 2001 to November 2003, October 2004 to September 2007, and October 2009 to August 2011. These matters were remanded in June 2016 and March 2020 for additional development. Most recently, in March 2020, the Board remanded the above issues to schedule VA examinations for the Veteran’s increased rating claims. The Veteran underwent these examinations in August 2020. Therefore, the Board is satisfied there was substantial compliance with its remand orders. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). In a June 2020 rating decision, the RO granted a 40 percent rating for the Veteran’s right leg DVT from May 16, 2014. In an October 2020 rating decision, the RO granted a 20 percent rating for the Veteran’s lumbar spine disability from August 28, 2020. Although the June 2020 and October 2020 rating decisions were a partial grant of the benefits sought, the Veteran has not been granted the maximum benefit allowed; thus, the claims are still active. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Increased Rating The Veteran’s entire history is reviewed when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). At the time of an initial rating, consideration of the appropriateness of a staged rating is also required. Fenderson v. West, 12 Vet. App. 119 (1999). Disability evaluations are determined by comparing a Veteran’s symptoms with criteria set forth in VA’s Schedule for Rating Disabilities, which are based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular DC, the higher of the two evaluations is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Pyramiding, that is the evaluation of the same disability, or the same manifestation of a disability, under different DCs, is to be avoided when evaluating a Veteran’s service-connected disability. 38 C.F.R. § 4.14 (2017); see Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). 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; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Staged ratings have been considered for the Veteran’s bronchitis. However, the Board finds that staged ratings are not appropriate for the Veteran’s bronchitis as the evidence demonstrates that the Veteran’s bronchitis has been consistent throughout the appeal period. Staged ratings were also considered for the Veteran’s lumbar spine and right leg DVT. The Board finds staged ratings are appropriate for these conditions as the evidence demonstrates that the Veteran’s lumbar spine and right leg DVT disabilities have varied throughout the appeal period. When evaluating musculoskeletal disabilities, VA must consider whether a higher evaluation is warranted, where the claimant experiences additional functional loss due to pain, weakness, excess fatigability, or incoordination, to include with repeated use or during flare-ups. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the DCs predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996). Painful motion is an important factor of disability, and it is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. See 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011). Nevertheless, pain itself does not rise to the level of functional loss as contemplated by the VA regulations applicable to the musculoskeletal system. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Moreover, functional impairment must be supported by adequate pathology. Id.; Johnson v. Brown, 9 Vet. App. 7, 10 (1996) (both citing to 38 C.F.R. § 4.40). The provisions of 38 C.F.R. §§ 4.40, 4.45 are not for consideration where the veteran is in receipt of the highest rating based on limitation of motion and a higher rating requires ankylosis. Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the question for consideration is the propriety of the initial rating assigned, evaluation of the evidence since the effective date of the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Where VA’s adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or “staged” ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509- 10 (2007); Fenderson, 12 Vet. App. at 126-27. 1. Entitlement to a disability rating in excess of 10 percent prior to August 28, 2020 and a 20 percent rating thereafter for lumbar spine degenerative joint and disc disease is denied. The Veteran seeks a higher rating for her lumbar spine condition. The Veteran is in receipt of a 10 percent rating prior to August 28, 2020 and a 20 percent rating thereafter for lumbar spine degenerative joint and disc disease under DCs 5242-5243. The Veteran’s lumbar spine disability is currently rated under DC 5242-5243. Hyphenated DCs are used when a rating under one DC requires use of an additional DC to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. In the selection of code numbers assigned to disabilities, injuries will generally be represented by the number assigned to the residual condition on the basis of which the rating is determined. The hyphenated DC in this case indicates that the Veteran’s lumbar spine disability is primarily rated under the general rating formula under DC 5242 and that IVDS under DC 5243 is the residual disability. Disability of the spine may be evaluated under either the General Rating Formula or under the formula for rating intervertebral disc syndrome (IVDS) based on incapacitating episodes (DC 5243), whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. Id. Under the General Rating Formula, a 20 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the 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. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A maximum, 100 percent rating is assigned for unfavorable ankylosis of the entire spine. Under DC 5243, the Formula for Rating IVDS Based on Incapacitating Episodes provides for ratings from 10 to 60 percent based on the frequency and duration of incapacitating episodes, defined in Note 1 as 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. A 10 percent rating is assigned for IVDS with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent rating is assigned for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating is assigned for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. The maximum 60 percent schedular rating is warranted for incapacitating episodes having a total duration of at least 6 weeks during the previous 12 months. Turning to the relevant medical evidence, the Veteran’s VA and private treatment records indicate ongoing treatment for low back pain. A June 2011 x-ray revealed disc and facet degeneration of the lumbar spine, causing segmental instability. The Veteran was diagnosed with degenerative disc disease and degenerative joint disease of the lumbar spine. In the June 2011 general medical VA examination, the Veteran reported that she has been treated for her low back pain with ibuprofen and physical therapy. She had physical therapy for four months. The Veteran reported that her back pain is intermittent, occurring about one to three times a year. The Veteran reported that the pain is moderate and can last a few hours to a couple of days. Her back pain is aggravated by exercise and active activities. She performs stretching exercises which are helpful. The Veteran reported that she did not lose time from work in the last year. On examination, before and after repetitive motions, flexion was 0 to 90 degrees, extension was 0 to 30 degrees, right and left side bending were 0 to 35 degrees, rotation on the left and right were 0 to 90 degrees. There was no evidence of fatigue, weakness, lack of endurance, and straight leg testing and Waddell’s testing was negative. In a September 2012 private evaluation for her back pain, the Veteran reported that her back pain was mild. She complained of popping in her back when performing certain activities. An x-ray of the spine revealed L3-S1 degenerative disc disease, low back pain, and L4-5 grade 1+ spondylolisthesis with moderate stenosis. The Veteran reported that she was working with a trainer to relieve her back pain. In the August 2020 VA examination, the examiner noted a diagnosis of degenerative arthritis of the spine. With respect to flare-ups, the Veteran reported flare-ups of a 10 out of 10 that occur on occasion at random, such as when walking or sitting for 2-3 hours. The Veteran reported that the flare-ups last for days. The Veteran also reported that she cannot move at all when she has an episode. She also reported that she cannot lay on her back or “bend at all.” Initial ROM testing revealed forward flexion of 0 to 50 degrees and extension, right and left lateral flexion, and right and left lateral rotation of 0 to 10 degrees. Pain was noted on all movement (forward flexion, extension, lateral flexion, and lateral rotation) and caused functional loss, but abnormal range of motion did not itself contribute to functional loss. There was evidence of pain with weight bearing but no objective evidence of pain with non-weight bearing. Passive ROM of the spine was not performed, as the examiner noted it was not safe or reasonable to perform passive ROM testing on the spine. The Veteran reported sharp pain and constant throbbing of a 7 out of 10 in severity at the L4-S1. Repetitive use testing was performed, and there was no additional loss of function or range of motion after three repetitions. The Veteran was not examined immediately after repetitive use over time or during a flare up, and the examiner noted that the examination was neither medically consistent or inconsistent with the Veteran’s statements describing functional loss with repetitive use over time or during a flare up. The examiner noted that pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time or with respect to flare-ups. The Veteran has guarding and muscle spasm of the lumbar spine that did not result in abnormal gait or abnormal spinal contour. Muscle strength testing was normal. The Veteran did not have muscle atrophy. The reflex and sensory exams were normal. The straight leg raising test was negative. There is no ankylosis of the spine. The Veteran was noted to have IVDS of the lumbar spine. However, the Veteran has not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The examiner noted that the Veteran’s lumbar spine affects her ability to work. Specifically, the Veteran experiences pain when sitting while working, which impacts her ability to concentrate. Based on the evidence above, prior to August 28, 2020, the Veteran’s forward flexion of the spine was 90 degrees and did not meet the criteria for a compensable rating under the DC which requires forward flexion less than 85 degrees. 38 C.F.R. § 4.71a, DC 5242. The evidence also does not show muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Thus, a higher rating than 10 percent is not warranted under the applicable Diagnostic Code. The assigned 10 percent rating for this period is based on painful motion that is not compensable under 38 C.F.R. § 4.59. With respect to functional loss, the Board notes that, prior to August 28, 2020, there is no evidence that the Veteran experienced functional loss due to her lumbar spine disability of a severity to warrant additional compensation. While her treatment records note ongoing treatment of back pain prior to August 28, 2020, she reported that she has not missed work due to her back pain prior to August 28, 2020. In the June 2011 VA examination, she reported that she experienced intermittent episodes of back issues that were spurred by activity, but she was able to treat the episodes with stretching in addition to the ibuprofen and physical therapy she underwent for her back condition. The 2011 VA examiner noted no fatigue, weakness, or lack of endurance. Further, her assigned 10 percent rating for this period compensates her for her painful motion. Therefore, a rating in excess of 10 percent prior to August 28, 2020 is not warranted based on functional loss. The Board notes that, since August 28, 2020, her condition worsened. Her forward flexion was 50 degrees, warranting a 20 percent rating under the Diagnostic Code. 38 C.F.R. § 4.71a, DC 5242. She was noted to have IVDS, however, the evidence does not show that the Veteran has had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. Therefore, a higher rating under DC 5243 is not available. 38 C.F.R. § 4.71a, DC 5243. A higher, 40 percent rating is also not warranted at any point in the appeal period, including after August 28, 2020, under DC 5242 as the evidence does not show forward flexion of the thoracolumbar spine limited to 30 degrees or less or ankylosis of the thoracolumbar spine. 38 C.F.R. § 4.71a, DC 5242. With regard to functional loss for the period prior to August 28, 2020, the Veteran reported that she gets flare-ups on occasion at random after sitting or walking for 2-3 hours, that they last for days, and she cannot move when she experiences an episode. She also stated that her back condition was also aggravated by prolonged sitting, and she is prone to prolonged sitting due to the nature of her job. While the Board acknowledges that the consequences when she has a flare-up are severe, they occur only occasionally and at random by the Veteran’s own statements, and thus, the Board finds that the limitation of motion and function occurring during these random and occasional instances are adequately compensated for under the 20 percent rating. As the Veteran noted, she can walk for 2-3 hours and sit for the same with only occasional flare-ups as a result. Therefore, a rating in excess of 20 percent from August 28, 2020 is not warranted based on functional loss. Given the above, the Board finds that a disability rating in excess of 10 percent prior to August 28, 2020 and a 20 percent rating thereafter for lumbar spine degenerative joint and disc disease is denied. 2. Entitlement to a compensable rating for bronchitis with pulmonary vascular disease is denied. The Veteran contends that she is entitled to a compensable rating for her bronchitis with pulmonary vascular disease. The Veteran is in receipt of a noncompensable rating for bronchitis with pulmonary vascular disease under DC 6817 for pulmonary vascular disease. 38 C.F.R. § 4.97, DC 6817. Under DC 6817, a noncompensable rating is assigned for pulmonary vascular disease that is asymptomatic, following resolution of pulmonary thromboembolism. A 30 percent rating is assigned for symptomatic pulmonary vascular disease, following resolution of acute pulmonary embolism. A 60 percent rating is assigned for chronic pulmonary thromboembolism requiring anticoagulant therapy, or; following inferior vena cava surgery without evidence of pulmonary hypertension or right ventricular dysfunction. A maximum, 100 percent rating is assigned for primary pulmonary hypertension, or; chronic pulmonary thromboembolism with evidence of pulmonary hypertension, right ventricular hypertrophy, or cor pulmonale, or; pulmonary hypertension secondary to other obstructive disease of pulmonary arteries or veins with evidence of right ventricular hypertrophy or cor pulmonale. Additionally, DC 6600 provides the rating criteria for chronic bronchitis. For a 10 percent rating the evidence would need to show FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted. For a 30 percent rating the evidence would need to show FEV-1 of 56 to 70 percent predicted, or; FEV-1/FVC of 56 to 70 percent predicted, or; DLCO (SB) of 56 to 65 percent predicted. For a 60 percent rating the evidence would need to show FEV-1 of 40 to 55 percent predicted, or; FEV-1/FVC of 40 to 55 percent predicted, or; DLCO (SB) of 40 to 55 percent predicted, or; maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation. For a 100 percent rating the evidence would need to show FEV-1 less than 40 percent of predicted, or; FEV-1/FVC less than 40 percent predicted, or; DLCO (SB) less than 40 percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption with cardiorespiratory limitation, or; cor pulmonale or pulmonary hypertension, or; requires outpatient oxygen therapy. 38 C.F.R. § 4.97. Under 38 C.F.R. § 4.96, there are special provisions for the application of evaluation criteria for diagnostic codes 6600, 6603, 6604, 6825-6833, and 6840-6845. In general, Pulmonary Function Tests (PFTs) are required to evaluate respiratory conditions except in certain situations. If a DLCO (SB) test is not of record, evaluation should be based on alternative criteria as long as the examiner states why the DLCO (SB) test would not be useful or valid in a particular case. 38 C.F.R. § 4.96 (d). When evaluating based on PFTs, post-bronchodilator results are to be used unless the post-bronchodilator results were poorer than the pre-bronchodilator results, in which case, the pre-bronchodilator results are used for rating purposes. 38 C.F.R. § 4.96 (d)(5). When there is a disparity between the results of different PFTs, so that the level of evaluation would differ depending on which test result is used, the test result that the examiner states most accurately reflects the level of disability is utilized. 38 C.F.R. § 4.96 (d)(6). Further, ratings under diagnostic codes 6600 through 6817 and 6822 through 6847 may not be combined with each other. In such cases, a single rating will be assigned under the diagnostic code that reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. 38 CFR § 4.96 Turning to the relevant medical evidence, the Board notes that, aside from the Veteran’s VA examinations, the Veteran’s medical records do not show any treatment for her bronchitis with pulmonary vascular disease. In a June 2011 general medical VA examination, the Veteran was noted to have a diagnosis of remote bronchitis. The examiner noted that she experiences an episode of bronchitis which stems from her chronic sinusitis about twice a year. In the May 2012 VA examination, the examiner noted the Veteran’s diagnosis of chronic bronchitis and pulmonary vascular disease. The examiner noted that the Veteran’s respiratory condition does not require the use of oral or parenteral corticosteroid medications, inhaled medications, oral bronchodilators, antibiotics, or outpatient oxygen therapy. The examiner noted that the Veteran’s pulmonary vascular disease is asymptomatic, following resolution of pulmonary thromboembolism. A PFT test was performed, and results of the PFT were as follows: FVC was 69 percent predicted; FEV-1 was 81 percent predicted; and FEV-1/FVC was 115 percent predicted. The examiner noted that the FEV-1/FVC result most accurately reflected the Veteran’s level of disability. Post-bronchodilator testing was not performed as the Veteran’s pre-bronchodilator results were normal. The examiner also noted that DLCO testing was not completed as it was nor indicated in the Veteran’s particular case. Exercise capacity testing was nor performed. A May 2012 x-ray also revealed that the heart was not enlarged; hilar contours and pulmonary vasculature were within normal limits; lungs were clear; and there was no evidence of pleural effusion. In the August 2020 VA respiratory examination, the examiner noted an August 2020 diagnosis of bronchitis with pulmonary vascular disease. The examiner noted that the Veteran does not currently treat her bronchitis with pulmonary vascular disease. The Veteran reported that she last took antibiotics for bronchitis 10 years ago. Specifically, the Veteran’s respiratory condition does not require oral or parenteral corticosteroid medications, inhaled medications, the use of oral bronchodilators, the use of antibiotics, or outpatient oxygen therapy. The examiner noted that the Veteran’s pulmonary vascular disease is asymptomatic, following resolution of pulmonary thromboembolism. The examiner noted that the Veteran’s bronchitis affects her ability to work, as she has to stay home due to cough and fever when she experiences an episode. The evidence above does not show that the Veteran’s pulmonary vascular disease is symptomatic, which is what is required for a compensable, 30 percent rating. Of note, the August 2020 VA examiner noted that the Veteran’s pulmonary vascular disease was asymptomatic. Accordingly, a compensable rating for the Veteran’s bronchitis with pulmonary vascular disease under DC 6817 is not warranted. The Board also considered whether a compensable rating is warranted under DC 6600 for bronchitis. However, according to the evidence of record, the Veteran does not experience symptoms of bronchitis, has not been treated for bronchitis and at the August 2020 VA examination, the Veteran reported that she last took medication for bronchitis approximately 10 years ago. Moreover, the evidence does not show FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted, as is required for a compensable, 10 percent rating under DC 6600 for chronic bronchitis. In the May 2012 PFT, which was the last PFT performed, FVC was 69 percent predicted; FEV-1 was 81 percent predicted; and FEV-1/FVC was 115 percent predicted. Thus, other than occasional coughing and fever not requiring antibiotics or medication, her bronchitis is asymptomatic. Given that the Veteran does not warrant a compensable rating under either DC 6600 or DC 6817, a compensable rating for her pulmonary vascular disease with bronchitis is not warranted. The Board acknowledges the Veteran’s statements that her lung condition is more akin to a blood issue. See January 2020 VA Form 21-4138 Statement in Support of Claim. However, as a lay person she is not competent to make this determination, and the medical evidence of record does not indicate that her pulmonary vascular disease was ever a blood issue. Accordingly, the Board believes the Veteran’s condition is appropriately rated under DC 6817. Given the above, a compensable rating for bronchitis with pulmonary vascular disease is not warranted. 3. Entitlement to a rating in excess of 20 percent prior to May 16, 2014 and a 40 percent rating thereafter for right leg DVT is denied. The Veteran contends that she is entitled to higher ratings for her right leg DVT. The Veteran is in receipt of a 20 percent rating prior to May 16, 2014 and a 40 percent rating thereafter for right leg DVT under DC 7121. Under DC 7121, a 20 percent disability rating is warranted for persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema. A 40 percent disability rating is warranted for persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. A 60 percent disability rating is warranted for persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration. A maximum, 100 percent disability rating is warranted for massive board-like edema with constant pain at rest. Turning to the relevant medical evidence, the Board notes that treatment for the Veteran’s right leg DVT is documented in her VA treatment records. However, the Veteran’s treatment records do not indicate stasis pigmentation or eczema. In a June 2011 general medical VA examination, the VA examiner noted a diagnosis of remote right leg DVT. The VA examiner noted that the Veteran was taking coumadin for her DVT. The examiner noted that both knees were without edema, erythema, or effusion. In the May 2014 VA examination, the VA examiner noted diagnoses of DVT and pulmonary embolus. The examiner noted that the Veteran had intermittent edema on her right side. The Veteran was not noted to have incipient or persistent pigmentation or eczema. The examiner noted that the Veteran’s DVT does not impact her ability to work. In May 2018, the Veteran was admitted to the hospital due to recurrent right DVT and pulmonary embolism. In a December 2018 VA treatment note, the provider noted the Veteran had occasional intermittent lower extremity edema. A June 2019 VA treatment notes indicated the Veteran had localized edema, particularly in her feet and bilateral ankles. In a July 2019 VA treatment note, the Veteran complained of bilateral lower extremity edema. She reported that it becomes more apparent later in the day and goes away after a few days of resting and elevating her feet. In another July 2019 VA treatment note, the VA examiner indicated he did not observe edema on examination. The August 2020 VA examiner noted a diagnosis of right leg DVT. The Veteran was noted to have post-phlebitic syndrome on her right side. She exhibits the following symptoms of post-phlebitic syndrome on her right leg: asymptomatic palpable varicose veins, asymptomatic visible varicose veins, and aching in the right leg after prolonged standing. These symptoms are relieved by elevation of the right leg. The examiner noted that the Veteran also experiences the following symptoms in her right leg: persistent stasis pigmentation and persistent edema. The Veteran reported that she has discoloration on her leg, and her leg swells daily when she sits for too long. The examiner noted that the Veteran’s right leg DVT impacts her ability to work, as the Veteran reported that she sits all day long which increases swelling in her right leg. Prior to May 16, 2014, as the evidence does not show stasis pigmentation or eczema, a higher, 40 percent rating is not warranted under DC 7121 for this period. As for the period after May 16, 2014, a higher, 60 percent rating under DC 7121 is not warranted. While the August 2020 VA examiner noted that the experiences symptoms of persistent pigmentation and persistent edema in her right leg, the evidence does not show that the Veteran has persistent ulceration or massive board-like edema with constant pain at rest as required under Diagnostic Code 7121 for the 60 percent rating. Given the above, a rating in excess of 20 percent prior to May 16, 2014 and a 40 percent rating thereafter for right leg DVT is not warranted. REASONS FOR REMAND 1. Entitlement to a TDIU is remanded. The Board notes that the Veteran has reported that her service-connected disabilities, such as her lumbar spine disability and right leg DVT, prevents her from maintaining gainful employment. Specifically, the Veteran reported that she is unable to perform her work as she is unable to sit for prolonged periods. See August 2020 VA examinations. As such, a request for a TDIU was reasonably raised by the record. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009) (a request for a TDIU, whether expressly raised by a veteran or reasonably raised by the record, is not a separate "claim" for benefits, but rather, can be part and parcel of a claim for an initial rating or increased rating for a disability). Therefore, the issue of entitlement to a TDIU has been added to the present appeal. With respect to the Veteran’s TDIU claim, the Veteran has not submitted a VA Form 21-8940 (Application for Increased Compensation Based on Unemployability), and has not otherwise provided a detailed history of her employment and educational background. As such, the Board finds that a remand is warranted in order to solicit a completed VA Form 21-8940 from the Veteran detailing her work history, along with any other evidence relevant to the issue of entitlement to a TDIU. The matter is REMANDED for the following action: 1. Ask the Veteran to complete and submit a VA Form 21-8940 (Application for Increased Compensation Based on Unemployability). 2. Give the Veteran an opportunity to identify any outstanding pertinent treatment records, VA or private, that have not already been associated with the claims file that are relevant to the issue of entitlement to a TDIU. The AOJ should then attempt to obtain those records if the appellant provides the appropriate authorization. 3. After completing the above action, and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, the claim must be readjudicated. If the claim remains denied, a supplemental statement of the case must be provided to the Veteran and his representative. After the Veteran and her representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. E. Grossman, Associate 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.