Citation Nr: 21004349 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 15-18 216 DATE: January 26, 2021 ORDER Entitlement to an increased rating for lumbar spine intervertebral disc syndrome, with thoracic spine compression fracture and spondylosis and intervertebral disc syndrome, currently rated 20 percent disabling prior to March 16, 2018, and 40 percent thereafter, is denied. Entitlement to an initial disability rating in excess of 10 percent for degenerative joint disease, left hip (adduction) is denied. Entitlement to an initial disability rating in excess of 10 percent for degenerative joint disease, right hip (adduction) is denied. Entitlement to an initial compensable disability rating for degenerative joint disease, left hip (flexion) is denied. Entitlement to an initial compensable disability rating for degenerative joint disease, right hip (flexion) is denied. Entitlement to an initial compensable disability rating for degenerative joint disease, left hip (extension) is denied. Entitlement to an initial compensable disability rating for degenerative joint disease, right hip (extension) is denied. Entitlement to an initial compensable disability rating for erectile dysfunction is denied. Entitlement to an initial disability rating in excess of 10 percent for left lower extremity radiculopathy, sciatic nerve, prior to March 16, 2018, and in excess of 20 percent thereafter is denied. Entitlement to an initial disability rating in excess of 20 percent for right lower extremity radiculopathy, sciatic nerve, is denied. Entitlement to an initial disability rating in excess of 20 percent for left lower extremity radiculopathy, femoral nerve is denied. Entitlement to an initial disability rating in excess of 20 percent for right lower extremity radiculopathy, femoral nerve is denied. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, left hip (extension) is denied. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, right hip (extension) is denied. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for erectile dysfunction is denied. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, left hip (adduction) is denied. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, right hip (adduction) is denied. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, left hip (flexion) is denied. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, right hip (flexion) is denied. Entitlement to an effective date earlier than January 16, 2018, for the grant of special monthly compensation, based on the loss of use of a creative organ is denied. Entitlement to an effective date earlier than November 8, 2017, for the grant of service connection for radiculopathy, left sciatic nerve is denied. Entitlement to an effective date earlier than November 8, 2017, for the grant of service connection for radiculopathy, right sciatic nerve is denied. Entitlement to an effective date earlier than March 16, 2018, for the grant of service connection for radiculopathy, left femoral nerve is denied. Entitlement to an effective date earlier than March 16, 2018, for the grant of service connection for radiculopathy, right femoral nerve is denied. REMANDED Entitlement to service connection for left lower extremity joint pains is remanded. Entitlement to service connection for right lower extremity joint pains is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for chronic fatigue is remanded. Entitlement to service connection for migraine headaches is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU), prior to January 16, 2018 is remanded. FINDINGS OF FACT 1. Prior to March 16, 2018, the Veteran’s back disability was manifested by forward flexion limited to 45 degrees and functional impairment due to pain. 2. From March 16, 2018, the Veteran’s back disability was manifested by forward flexion limited to no less than 10 degrees, without ankylosis of any segment of the spine or physician-prescribed bed rest. 3. The Veteran’s left hip degenerative joint disease is manifested with painful motion and extension to 10 degrees; but without ankylosis, flail joint, or impairment of the femur. 4. The Veteran’s left hip degenerative joint disease is manifested with painful motion and flexion to 65 degrees, but without ankylosis, flail joint, or impairment of the femur. 5. The Veteran’s left hip degenerative joint disease is manifested with painful motion and limitation of adduction with an inability to cross his legs. There was no showing of limitation of abduction of motion lost beyond 10 degrees, or evidence of ankylosis, flail joint, or impairment of the femur. 6. The Veteran’s right hip degenerative joint disease is manifested with painful motion and extension to 10 degrees; but without ankylosis, flail joint, or impairment of the femur. 7. The Veteran’s right hip degenerative joint disease is manifested with painful motion and flexion to 65 degrees, but without ankylosis, flail joint, or impairment of the femur. 8. The Veteran’s right hip degenerative joint disease is manifested with painful motion and limitation of adduction with an inability to cross his legs. There was no showing of limitation of abduction of motion lost beyond 10 degrees, or evidence of ankylosis, flail joint, or impairment of the femur. 9. The Veteran’s erectile dysfunction is manifested in loss of erectile power. It does not result in penile deformity. 10. Prior to March 16, 2018, radiculopathy of the sciatic nerve of the left lower extremity was no more than of mild severity. 11. Since March 16, 2018, radiculopathy of the sciatic nerve of the left lower extremity was no more than of moderate severity. 12. For the entire appeals period, radiculopathy of the sciatic nerve of the right lower extremity was no more than of moderate severity. 13. For the entire appeal period, radiculopathy of the femoral nerve of the left lower extremity was no more than of moderate severity. 14. For the entire appeal period, radiculopathy of the femoral nerve of the right lower extremity was no more than of moderate severity. 15. The Veteran’s claim for service connection for degenerative joint disease, left hip was received on January 16, 2018. 16. The Veteran’s claim for service connection for degenerative joint disease, right hip was received on January 16, 2018. 17. The Veteran’s claim for service connection for erectile dysfunction was received on January 16, 2018. 18. The Veteran filed a claim for increased rating for his service connected back disability on November 8, 2017, and this was interpreted to include a claim for radiculopathy of the left and right sciatic nerve. 19. Entitlement to service connection for peripheral neuropathy of the left and right femoral nerves arose March 16, 2018, the date of the VA examination that identified involvement of the femoral nerves. CONCLUSIONS OF LAW 1. The criteria for an increased rating for intervertebral disc syndrome, lumbar and thoracic spine, currently rated 20 percent disabling prior to March 16, 2018, and 40 percent disabling thereafter, have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. § 4.71a, DC 5242-5237. 2. The criteria for entitlement to an initial disability rating in excess of 10 percent for degenerative joint disease, left hip (adduction) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5253. 3. The criteria for entitlement to an initial disability rating in excess of 10 percent for degenerative joint disease, right hip (adduction) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5253. 4. The criteria for entitlement to an initial compensable disability rating for degenerative joint disease, left hip (flexion) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5252. 5. The criteria for entitlement to an initial compensable disability rating for degenerative joint disease, right hip (flexion) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5252. 6. The criteria for entitlement to an initial compensable disability rating for degenerative joint disease, left hip (extension) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5251. 7. The criteria for entitlement to an initial compensable disability rating for degenerative joint disease, right hip (extension) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5251. 8. The criteria for Entitlement to an initial compensable disability rating for erectile dysfunction have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.16, 4.115b, Diagnostic Code 7599-7522. 9. The criteria for entitlement to an initial disability rating in excess of 10 percent for left lower extremity radiculopathy, sciatic nerve, prior to March 16, 2018, and in excess of 20 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.124a, DC 8520. 10. The criteria for entitlement to an initial disability rating in excess of 20 percent for right lower extremity radiculopathy, sciatic nerve, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.124a, DC 8520. 11. The criteria for entitlement to an initial disability rating in excess of 20 percent for left lower extremity radiculopathy, femoral nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.124a, DC 8526. 12. The criteria for entitlement to an initial disability rating in excess of 20 percent for right lower extremity radiculopathy, femoral nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.124a, DC 8526. 13. The criteria for entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, left hip (extension) have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 14. The criteria for entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, right hip (extension) have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 15. The criteria for entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for erectile dysfunction have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 16. The criteria for entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, left hip (adduction) have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 17. The criteria for entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, right hip (adduction) have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 18. The criteria for entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, left hip (flexion) have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 19. The criteria for entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, right hip (flexion) have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 20. The criteria for entitlement to an effective date earlier than January 16, 2018, for the grant of special monthly compensation, based on the loss of use of a creative organ have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 21. The criteria for entitlement to an effective date earlier than November 8, 2017, for the grant of service connection for radiculopathy, left sciatic nerve have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. The criteria for entitlement to an effective date earlier than November 8, 2017, for the grant of service connection for radiculopathy, right sciatic nerve have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 22. The criteria for entitlement to an effective date earlier than March 16, 2018, for the grant of service connection for radiculopathy, left femoral nerve have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 23. The criteria for entitlement to an effective date earlier than March 16, 2018, for the grant of service connection for radiculopathy, right femoral nerve have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1987 to September 1990. These matters come before the Board of Veterans’ Appeals (Board) on appeal from January 2018, April 2018, and May 2018 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In November 2018, the Board remanded the appeal. Increased Ratings Disability ratings are determined by applying a schedule of reductions in earning capacity from specific injuries or a combination of injuries that is based upon the average impairment of earning capacities. 38 U.S.C. § 1155. Each disability must be viewed in relation to its entire history, with emphasis upon the limitations proportionate to the severity of the disabling condition. 38 C.F.R. § 4.1. Where there is a question as to which of the two disability evaluations is applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence of record, any reasonable doubt remaining will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. When the appeal arises from an initial assigned rating, consideration must be given to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a ; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. When rating the Veteran’s service-connected disability, the entire medical history must be reviewed. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board must also fully consider the lay assertions of record. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). 1. Entitlement to initial ratings for lumbar spine intervertebral disc syndrome, with thoracic spine compression fracture and spondylosis and intervertebral disc syndrome, currently rated 20 percent disabling prior to March 16, 2018, and 40 percent disabling from that date The Veteran filed his current claim for increased rating for lower back disability in November 2017. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted 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 warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. On VA examination in December 2017, the Veteran reported flare-ups of back pain described as sharp pain, tightness and spasm. He reported he was unable to sit or stand for a long period of time. Initial ranges of motion were noted as: flexion to 50 degrees; extension to 10 degrees; right lateral flexion to 25 degrees; left lateral flexion to 30 degrees; right lateral rotation to 20 degrees; and left lateral rotation to 20 degrees. There was objective evidence of pain on passive range of motion testing of the back; there was no evidence of pain with weight bearing. Pain was noted with flexion, extension, and right and left lateral extension. There was no tenderness or pain on palpation of the joint or associated soft tissue of the thoracolumbar spine. After repetitive use testing, ranges of motion were: flexion to 45 degrees; extension to 10 degrees; right lateral flexion to 25 degrees; left lateral flexion to 20 degrees; right lateral rotation to 20 degrees; and left lateral rotation to 20 degrees. The examiner stated that pain, weakness, fatigability or incoordination did not significantly limit functional ability with flare ups. There was no guarding or muscle spasm of the thoracolumbar spine. There was no muscle atrophy. The examiner noted numbness and tingling of both feet. There was positive straight leg raising test on both sides. There was no ankylosis of the spine. The examiner noted intervertebral disc syndrome. There were no episodes of acute signs or symptoms that required bedrest prescribed by a physician in the past 12 months. On VA examination conducted March 16, 2018, initial ranges of motion were noted as: flexion to 10 degrees; extension to 5 degrees; right lateral flexion to 10 degrees; left lateral flexion to 15 degrees; right lateral rotation to 20 degrees; and left lateral rotation to 20 degrees. There was objective evidence of pain on passive range of motion testing of the back; there was evidence of pain with weight bearing. The examiner stated that “the initial range of motion was low and it was done in severe pain. The Veteran was unable to do observed repetitive range of motion test because of severe pain. Therefore I cannot give estimate of range of motion during flare up without resorting to mere speculation.” There was muscle spasm resulting in abnormal gait or abnormal spinal contour. There was no guarding. The examiner noted that “contributing factors of disability are described as difficulty and pain doing the initial range of motion. He could not stand for long even during the range of motion test. He has pain difficulty doing prolong walking and he cannot do weight bearing for long.” There was no muscle atrophy. The Veteran was unable to perform straight leg raising test. The examiner noted bilateral radiculopathy involving the femoral and sciatic nerves bilaterally. There was no ankylosis of the spine. There were no other neurologic abnormalities. The examiner noted intervertebral disc syndrome. There were no episodes of acute signs or symptoms that required bedrest prescribed by a physician in the past 12 months. On VA examination in January 2020, the Veteran reported that his inability to stand or sit for longer than 20 minutes at a time. “Ability to lift and carry is impaired and bending and squatting is impaired.” Initial ranges of motion were noted as: flexion to 15 degrees; extension to 12 degrees; right lateral flexion to 20 degrees; left lateral flexion to 20 degrees; right lateral rotation to 10 degrees; and left lateral rotation to 10 degrees. The examiner noted that the Veteran’s ability to lift and carry would be impaired because of diminished range of motion. There was no pain on weight bearing and no additional loss of range of motion after repetitive testing. The examiner estimated the ranges of motion after repeated use and/or flare-ups as the same as the initial ranges of motion. There was no guarding or muscle spasm. Muscle strength testing was normal and there was no muscle atrophy. Straight leg raising test was negative bilaterally. There was radiculopathy involving the sciatic nerve bilaterally. There was no ankylosis. There were no other neurologic abnormalities. The examiner stated that the Veteran did not have intervertebral disc syndrome. The examiner stated: “In my opinion, there is a strong tendency to magnify symptoms. For example, when testing ROM of the lumbar spine, Veteran was very limited but watching him remove his pants for the examination he was able to flex the back much more than when I was taking my goniometer readings.” The December 2017 examination report noted flexion, after repetitive use testing, to 45 degrees. While this was noted as painful, it is consistent with a finding of forward flexion of greater than 30 degrees but not greater than 60 degrees as contemplated by the 20 percent rating assigned. The preponderance of the evidence is against the assignment of a rating in excess of 20 percent prior to March 16, 2018. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. For the period from March 16, 2018, the RO has assigned a 40 percent rating. This is the highest rating possible for limitation of motion. A higher rating would require evidence of ankylosis of the spine which has not been shown. Regarding neurological impairment, the Veteran has already been granted service connection for right and left lower extremity radiculopathy and the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with his spine disability. Alternatively, a higher rating may be possible DC 5243, for intervertebral disc syndrome (IVDS). Diagnostic Code 5243 provides that IVDS is to be rated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating IVDS 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 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 2 weeks during the past 12 months. Higher ratings, up to 60 percent, are warranted where episodes last for greater durations. 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes. Note 1 to Diagnostic Code 5243 provides that, for purposes of ratings under Diagnostic Code 5243, 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. Id. at Note 1. The Board finds that the preponderance of the evidence is against higher ratings based on incapacitating episodes at any time during the appeal. While the Veteran has a diagnosis of IVDS, the evidence of record is against a finding that he was ever prescribed bed rest by a physician for a two-week duration or more, such that he meets the criteria for a rating higher than 10 percent. In denying such a rating, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. In sum, the preponderance of the evidence is against a rating in excess of 20 percent prior to March 16, 2018, and against a rating in excess of 40 percent from March 16, 2018. 2. Entitlement to an initial disability rating in excess of 10 percent for degenerative joint disease, left hip (adduction) 3. Entitlement to an initial disability rating in excess of 10 percent for degenerative joint disease, right hip (adduction) 4. Entitlement to an initial compensable disability rating for degenerative joint disease, left hip (flexion) 5. Entitlement to an initial compensable disability rating for degenerative joint disease, right hip (flexion) 6. Entitlement to an initial compensable disability rating for degenerative joint disease, left hip (extension) 7. Entitlement to an initial compensable disability rating for degenerative joint disease, right hip (extension) Service connection was granted for the Veteran’s left and right hip degenerative joint disease condition in an April 2018 rating decision. The RO assigned six separate ratings: left hip degenerative joint disease (adduction) (DC 5253), which was rated at an initial 10 percent evaluation; right hip degenerative joint disease (adduction) (DC 5253), which was rated at an initial 10 percent evaluation; left hip degenerative joint disease, (extension) (DC 5251) and limitation of flexion (DC 5252) - both rated as noncompensable; and right hip degenerative joint disease, (extension) (DC 5251) and limitation of flexion (DC 5252) - both rated as noncompensable. These ratings are under 38 C.F.R. § 4.71a, and made effective as of January 16, 2018, the date his intent to file a claim correspondence was received by VA. Separate ratings for the hip and thigh are available pursuant to DCs 5250 - 5255. Specifically, DC 5251 evaluates limitation of extension of the thigh; DC 5252 evaluates limitation of flexion of the thigh; and DC 5253 evaluates limitations of abduction, adduction, and rotation of the thigh. Normal hip flexion is to 125 degrees; normal hip abduction is to 45 degrees. 38 C.F.R. § 4.71, Plate II. On VA examination in March 2018, the Veteran reported flare-ups of bilateral hip pain. He reported constant excruciating pain that impaired sitting, walking, lying down, and doing chores around the house. The pain was relieved with medications and lying in certain positions. Initial ranges of right hip motion were: flexion to 70 degrees; extension to 15 degrees; abduction to 20 degrees; adduction to 10 degrees; external rotation to 30 degrees; and internal rotation to 35 degrees. Adduction was limited such that the Veteran could not cross his legs. Pain was noted on examination and caused functional loss. There was tenderness to the trochanter area from palpation of the lateral aspect of the thigh and the pelvic area at the inguinal area. There was no evidence of pain with weight bearing. There was no additional loss of function or range of motion with repetitive use. The examiner estimated ranges of motion after repeated use over time as: flexion to 70 degrees; extension to 15 degrees; abduction to 20 degrees; adduction to 10 degrees; external rotation to 30 degrees; and internal rotation to 35 degrees. The examiner estimated ranges of motion during flare-ups as: flexion to 65 degrees; extension to 10 degrees; abduction to 15 degrees; adduction to 10 degrees; external rotation to 25 degrees; and internal rotation to 30 degrees. The examiner described weakness. The Veteran could not do prolonged standing with weight bearing. Muscle strength was 4/5 for flexion, extension, and adduction. There was no muscle atrophy. There was no ankylosis of the hip. There was early osteoarthritis of the hip by X-ray. Initial ranges of left hip motion were: flexion to 70 degrees; extension to 15 degrees; abduction to 30 degrees; adduction to 20 degrees; external rotation to 25 degrees; and internal rotation to 20 degrees. Adduction was not limited such that the Veteran could not cross his legs. Pain was noted on examination and caused functional loss. There was tenderness to the trochanter area from palpation of the lateral aspect of the thigh and the pelvic area at the inguinal area. There was evidence of pain with weight bearing. There was no additional loss of function or range of motion with repetitive use. The examiner estimated ranges of motion after repeated use over time as: flexion to 70 degrees; extension to 15 degrees; abduction to 30 degrees; adduction to 20 degrees; external rotation to 25 degrees; and internal rotation to 20 degrees. Adduction would be limited such that the Veteran could not cross his legs. The examiner estimated ranges of motion during flare-ups as: flexion to 65 degrees; extension to 10 degrees; abduction to 25 degrees; adduction to 15 degrees; external rotation to 20 degrees; and internal rotation to 15 degrees. Adduction would be limited such that the Veteran could not cross his legs. The examiner described weakness. The Veteran could not do prolonged standing with weight bearing. Muscle strength was 4/5 for flexion, extension, and adduction. There was no muscle atrophy. There was no ankylosis of the hip. There was early osteoarthritis of the hip by X-ray. A. DC 5251 (limitation of extension of the thigh) and DC 5252 (limitation of flexion of the thigh). As noted earlier, a compensable rating is warranted under DC 5251, if the Veteran’s left or right hip extension was limited to 5 degrees. Under DC 5252, a compensable 10 percent rating is warranted if flexion is limited to 45 degrees; a higher 20 percent rating is warranted if flexion is limited to 30 degrees. See 38 C.F.R. § 4.71a. Based on the evidence, however, an initial compensable rating is not warranted under DC 5251 or DC 5252 for either hip. The record does not show that thigh extension is limited to 5 degrees for either hip. It also does not show that thigh flexion was limited to 45 degrees for either hip. The VA examination report recorded his left hip extension and flexion were, at worst, to 10 degrees and 65 degrees, respectively. Right hip extension and flexion were, at worst, to 10 degrees and 65 degrees, respectively. These were the estimated ranges during flare-ups. There was no additional function loss in range of motion after repetitive-use testing. There were no other range of motion findings which showed further limitations of extension or flexion of his left or right hip. Moreover, although the Veteran experienced pain on extension and flexion, there was no indication that his reported pain and functional limitation caused by his left or right hip disability further limited his extension or flexion to a level approximating the criteria for a 10 percent rating under either DC 5251 or DC 5252. 38 C.F.R. §§ 4.40, 4.45. Accordingly, the Board finds that the left and right hip degenerative joint disease, with limitation of extension and limitation of flexion do not warrant compensable ratings at any time during the appeal. B. DC 5253 (impairment of the thigh). Under DC 5253, a 10 percent rating is warranted for limitation of rotation of the affected leg (with an inability to “toe-out” more than 15 degrees) or limitation of adduction causing an inability to cross legs, and a 20 percent evaluation for limitation of abduction resulting in motion lost beyond 10 degrees. Initial 10 percent ratings were assigned to the Veteran’s left and right hip disabilities, as the March 2018 examination report reflected that he could not cross his legs due to limitation of adduction. However, a higher 20 percent rating under DC 5253 is not warranted for either hip, as it has not been shown that abduction in the thigh had motion lost beyond 10 degrees. The available range of motion studies show abduction was to 25 degrees for the left hip and 15 degrees for the right hip. Therefore, a higher 20 percent rating under DC 5253 is not warranted for either hip. Further, although the Veteran experiences pain on abduction and adduction, there is no indication that his reported pain and functional limitation caused by his left ir right hip disability further limits his abduction to a level approximating the maximum 20 percent rating. 38 C.F.R. §§ 4.40, 4.45; see also Mitchell, 25 Vet. App. at 38. Importantly, separate ratings for painful abduction, adduction, and/or rotation may not be assigned, as these are all evaluated under the same diagnostic code, DC 5253, and it is settled law that a single disability is not entitled to more than one disability rating within the same diagnostic code unless the regulation expressly provides otherwise. See Cullen v. Shinseki, 24 Vet. App. 74, 84 (2010). Therefore, the Board finds that the Veteran’s left and right hip degenerative joint disease with limitation of rotation warrants no more than the 10 percent evaluation currently assigned under DC 5253. The Board has considered other diagnostic codes, but found that they are not applicable here. The medical evidence of record reveals that he does not have ankylosis (DC 5250), flail joint of the hips (DC 5254), or impairment of the femur (DC 5255). Accordingly, a higher rating for either hip under these codes is not appropriate at any time during the appeal. Accordingly, the preponderance of the evidence is against the assignment of higher initial ratings for left or right hip degenerative joint disease. As the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107; 38 C.F.R. § 4.3. There are no additional expressly raised or reasonably raised issues raised on the record. 8. Entitlement to an initial compensable disability rating for erectile dysfunction The Veteran seeks a compensable initial rating for erectile dysfunction. For the reasons that follow, the Board finds that a compensable rating is not warranted. The Veteran’s erectile dysfunction is rated analogous to 38 C.F.R. § 4.115b, DC 7522. Under DC 7522, a 20 percent rating is warranted for deformity of the penis with loss of erectile power. These criteria are considered conjunctive. A “deformity” under DC 7522 means “a distortion of the penis, either internal or external,” based on the ordinary meaning of the term as gleaned from Dorland’s Illustrated Medical Dictionary. See Williams v. Wilkie, 30 Vet. App. 134 (2018). The Veteran underwent a VA examination in March 2018. Erectile dysfunction was noted. The Veteran denied voiding dysfunction or renal dysfunction. The Veteran declined physical examination of the penis, testes, epididymis, and prostate. The examiner did not identify any internal deformity involving the penis. The examiner also opined the disability had no occupational impact. Medical records in the file do not otherwise reflect a distortion of the penis, either internal or external. Based on consideration of all evidence of record, the Board finds that a higher 20 percent rating is not warranted. Although there is loss of erectile power, there is no evidence of penis deformity. Accordingly, the evidence does not more nearly approximate the criteria corresponding to an initial compensable rating under DC 7522. In sum, the evidence does not show the Veteran’s erectile dysfunction more nearly approximates the criteria corresponding to a compensable rating. Accordingly, an increased initial rating is not warranted. There are no additional expressly or reasonably raised issues on the record related to this issue. 9. Entitlement to an initial disability rating in excess of 10 percent for left lower extremity radiculopathy, sciatic nerve, prior to March 16, 2018, and in excess of 20 percent thereafter 10. Entitlement to an initial disability rating in excess of 20 percent for right lower extremity radiculopathy, sciatic nerve Service connection for radiculopathy of the sciatic nerve of right and left lower extremity was granted in a January 2018 rating decision. The RO assigned initial 10 percent ratings, effective November 8, 2017, under 38 C.F.R. § 4.124a, DC 8520 for the left and right. A May 2018 rating decision awarded a higher 20 percent rating for the right sciatic nerve, effective November 8, 2017. It also awarded a higher 20 percent rating for the left sciatic nerve, effective March 16, 2018. The Veteran seeks higher ratings. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8620 and 8720.). Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. A VA examination in December 2017 noted normal lower extremity reflexes bilaterally. There was decreased sensation over the L3/4 and L5 distribution on the right. Sensory examination was normal for the left lower extremity. Straight leg raising test was positive bilaterally. Muscle strength testing was 4/5 on the right and 5/5 on the left for all lower extremity muscles tested. The examiner noted mild paresthesias and mild numbness of the bilateral lower extremities. The examiner also noted numbness and tingling of both feet. The examiner noted radiculopathy involving the left and right sciatic nerves. The radiculopathy was noted as mild bilaterally. On VA examination in March 2018, the examiner noted moderate constant pain, moderate paresthesias, and moderate numbness, bilaterally. There was decreased sensation over the L3/4, L4/L5/S1 and L5 distributions bilaterally. The examiner noted radiculopathy involving the left and right sciatic nerves. The radiculopathy was noted as moderate bilaterally. On VA examination in January 2020, the Veteran reported stabbing pain in the left side of the buttock that goes down the back of the left leg to the toes. The examiner noted normal lower extremity reflexes bilaterally. Lower extremity sensory examination was normal bilaterally, and straight leg raising test was negative bilaterally. The examiner noted mild intermittent pain, mild paresthesias, and mild numbness, bilaterally. The radiculopathy was noted as mild bilaterally. Left Based on the above, the Board finds that the level of impairment demonstrated in the Veteran’s radiculopathy of the sciatic nerve of the left lower extremity is most analogous to mild incomplete paralysis prior to March 16, 2018, and moderate incomplete paralysis, thereafter. Thus, higher ratings are not warranted. Prior to March 16, 2018, objective findings revealed normal sensory examination on the left, and no more than mild impairment overall. In this regard, motor strength tests were normal at 5/5; paresthesias, dysesthesias and numbness were described as mild. Further, the December 2017 examiner noted that sensory touch tests were normal and opined that the overall level of impairment from the left sciatic nerve paralysis was no worse than mild. The March 16, 2018 examiner found moderate constant pain, with moderate numbness and paresthesias. The current 20 percent rating is reflective of this moderate degree of impairment. The probative evidence of record is against a higher rating at any time on appeal. The evidence does not support a finding of moderately severe or severe impairment during the period on appeal. The 2017, 2018, and 2020 examinations do not result in any objective finding of levels of moderately severe or severe impairment on examination. The 2017 VA examiner described the symptoms of numbness, paresthesias and/or dysesthesias as only mild in severity. The 2018 VA examiner described them as moderate. The 2020 examiner described them as mild. Therefore, the objective findings overall reflect mild to moderate impairment overall. The Board notes that the cumulative evidence does not reflect the presence of symptoms that would demonstrate more severe impairment, such as trophic changes, muscle atrophy, absent reflexes or foot drop. Accordingly, a higher 40 percent rating is not warranted at any time on appeal. In conclusion, the preponderance of the evidence is against finding for an initial rating in excess of 10 percent for radiculopathy of the sciatic nerve of the left lower extremity, prior to March 16, 2018, and in excess of 20 percent thereafter. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7; see Hart, 21 Vet. App. at 505. There are no additional expressly or reasonably raised issues presented on the record. Right Based on the above, the Board finds that the level of impairment demonstrated in the Veteran’s radiculopathy of the sciatic nerve of the right lower extremity is most analogous to moderate incomplete paralysis throughout the appeals period. Thus, a higher rating is not warranted. The December 2017 examiner noted normal decreased sensation over the L3/4 and L5 distribution on the right, with no more than mild impairment overall. Muscle strength testing was nearly normal at 4/5 on the right. The examiner noted mild paresthesias and mild numbness. The radiculopathy was noted as mild on the right. The March 2018 examiner found moderate constant pain, with moderate numbness and paresthesias. The current 20 percent rating is reflective of this moderate degree of impairment. The probative evidence of record is against a higher rating at any time on appeal. The evidence does not support a finding of moderately severe or severe impairment during the period on appeal. The 2017, 2018, and 2020 examinations do not result in any objective finding of levels of moderately severe or severe impairment on examination. The 2017 VA examiner described the symptoms of numbness, paresthesias and/or dysesthesias as only mild in severity. The 2018 VA examiner described them as moderate. The 2020 examiner described them as mild. Therefore, the objective findings overall reflect mild to moderate impairment overall. The Board notes that the cumulative evidence does not reflect the presence of symptoms that would demonstrate more severe impairment, such as trophic changes, muscle atrophy, absent reflexes or foot drop. Accordingly, a higher 40 percent rating is not warranted at any time on appeal. In conclusion, the preponderance of the evidence is against finding for an initial rating in excess of 20 percent for radiculopathy of the sciatic nerve of the right lower extremity. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7; see Hart, 21 Vet. App. at 505. There are no additional expressly or reasonably raised issues presented on the record. 11. Entitlement to an initial disability rating in excess of 20 percent for left lower extremity radiculopathy, femoral nerve 12. Entitlement to an initial disability rating in excess of 20 percent for right lower extremity radiculopathy, femoral nerve Awards for separate ratings for radiculopathy, femoral nerves of the left and right lower extremities were established in a May 2018 rating decision. Initial 20 percent ratings were assigned, effective March 16, 2018, pursuant to 38 C.F.R. § 4.124a, DC 8526, for incomplete paralysis of the anterior crural (femoral) nerve. Under DC 8526, mild incomplete paralysis is rated 10 percent disabling; moderate incomplete paralysis is rated 20 percent disabling; severe incomplete paralysis is rated 30 percent disabling. The term “incomplete paralysis,” with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. 38 C.F.R. § 4.124a. The terms “mild,” “moderate,” “moderately severe,” and “severe” are not defined in the rating schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. VA examination in March 2018 noted radiculopathy involving the L2/L3/L4 (femoral) nerve roots bilaterally. There was no muscle atrophy. Muscle strength was 4/5 or 5/5 in all lower extremity muscles bilaterally. The examiner noted the radiculopathy was moderate bilaterally. On VA examination in January 2020, the Veteran reported stabbing pain in the left side of the buttock that goes down the back of the left leg to the toes. The examiner noted normal lower extremity reflexes bilaterally. Lower extremity sensory examination was normal bilaterally, and straight leg raising test was negative bilaterally. The examiner noted involvement of the sciatic nerve bilaterally, but not the femoral nerve on either side. The radiculopathy was noted as mild bilaterally. The evidence of record does not indicate impairment beyond moderate incomplete paralysis for the left or right femoral nerve. There is no indication of paralysis, weakness, atrophy, loss of tone, disturbed circulation or significant muscle weakness. The March 2018 VA examiner found the radiculopathy to be moderate in severity. The January 2020 VA examiner did not provide a diagnosis for radiculopathy of the femoral nerve, thereby suggesting no significant symptoms. There is no medical opinion to the contrary. In short, the preponderance of the evidence is against the claim and the benefit-of-the-doubt rule does not apply. Accordingly, the claims for initial ratings in excess of 20 percent for radiculopathy, femoral nerve of the left and right lower extremities, is denied. At no point has the evidence approximated the criteria corresponding to a higher rating for either side. See Hart, supra. There are no additional expressly or reasonably raised issues presented on the record. Effective Dates Generally, except as otherwise provided, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. The effective date of an original award of direct service connection is the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service; otherwise, date of receipt of claim, or date entitlement arose, whichever is later. 38 U.S.C. § 5110 (b); 38 C.F.R. § 3.400 (b)(2)(i). Secondary service connection is granted for a “disability which is proximately due to or the result of a service-connected disease or injury.” 38 C.F.R. § 3.310 (a). The effective date of awards of claims granted on a secondary basis can be no earlier than the date of the claim for compensation on a secondary basis. See Ellington v. Nicholson, 22 Vet. App. 141, 145 (2007) (finding that the effective date for a grant of service connection for diabetes and hypertension as secondary to leukemia was the date of the claim for secondary service connection, not the date of the claim of service connection for leukemia), aff’d sub nom. Ellington v. Peake, 541 F.3d 1364 (Fed. Cir. 2008); Ross v. Peake, 21 Vet. App. 528, 532-33 (2008) (holding that the effective date for a grant of secondary service connection for depression with anxiety was the date of the secondary service connection claim, not the date of the claim for service connection for the primary heart condition). As it relates to the Veteran’s claims, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has repeatedly rejected the argument that a disability service connected as secondary to an underlying service-connected disability be entitled to the effective date of the underlying disability. See Manzanares v. Shulkin, 863 F.3d 1374 (Fed. Cir. 2017); Ellington v. Peake, 541 F.3d at 1364. See also Ross v. Peake, 21 Vet. App. 528 (2008). The Federal Circuit has also found that there is nothing in the history of 38 C.F.R. § 3.310 (a) to suggest that a claim for secondary service connection should be treated as part of a claim for primary service connection. Manzanares v. Shulkin, 863 F.3d at 1374. Additionally, the Federal Circuit has determined that nothing in 38 C.F.R. § 3.155 (d)(2) regarding “ancillary benefits” supports the Veteran’s position taken here. Id. The governing regulations dictate that the effective date will be the date of receipt of the claim or the date entitlement arose, whichever is the later, and the Board is bound by that authority. 38 U.S.C. § 5110a; 38 C.F.R. § 3.400. 13. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, left hip (extension) 14. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, right hip (extension) 15. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, left hip (adduction) 16. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, right hip (adduction) 17. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, left hip (flexion) 18. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for degenerative joint disease, right hip (flexion) The Veteran has disagreed with the effective dates of the awards of service connection for degenerative joint disease of the hip. The effective dates assigned in the April 2018 rating decision on appeal for the service connection awards for degenerative joint disease of the hip are January 16, 2018, the date his claim for service connection for bilateral hip disabilities was received. The Veteran has not made any argument as to why he thinks earlier effective dates are warranted. A March 2018 VA examination report included an opinion linking the Veteran’s hip condition to his service connected back disability. The effective date for the grant of service connection will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400. A careful review of the record shows that there is no evidence of a claim, formal or informal, or expressed written intent to file a claim for service connection for hip disability prior to January 16, 2018. Neither the Veteran nor his attorney have asserted otherwise. The legal authority governing effective dates is clear and specific, and the Board is bound by such authority. Here, based on the evidence of record and the applicable VA regulations, the earliest date allowable for the awards of service connection for degenerative joint disease of the left and right hips is the current effective date of January 16, 2018, the date on which the Veteran’s claim for service connection was initially received. See 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. As the preponderance of the evidence is against the claims, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 19. Entitlement to an effective date earlier than January 16, 2018, for the grant of service connection for erectile dysfunction 20. Entitlement to an effective date earlier than January 16, 2018, for the grant of special monthly compensation, based on the loss of use of a creative organ The Veteran has disagreed with the effective dates of the awards of service connection for erectile dysfunction and SMC based on loss of use of creative organ. The effective dates assigned in the April 2018 rating decision on appeal for the awards for service connection for erectile dysfunction and SMC based on loss of use of creative organ are January 16, 2018, the date his claim for service connection for erectile dysfunction was received. The Veteran has not made any argument as to why he thinks earlier effective dates are warranted. A March 2018 VA examination report included an opinion linking the Veteran’s erectile dysfunction to his service connected back disability. The effective date for the grant of service connection will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400. A careful review of the record shows that there is no evidence of a claim, formal or informal, or expressed written intent to file a claim for service connection for erectile dysfunction prior to January 16, 2018. Neither the Veteran nor his attorney have asserted otherwise. The legal authority governing effective dates is clear and specific, and the Board is bound by such authority. Here, based on the evidence of record and the applicable VA regulations, the earliest date allowable for the awards of service connection for erectile dysfunction, and the award of SMC for loss of use of creative organ, is the current effective date of January 16, 2018, the date on which the Veteran’s claim for service connection was initially received. See 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. As the preponderance of the evidence is against the claims, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 21. Entitlement to an effective date earlier than November 8, 2017, for the grant of service connection for radiculopathy, left sciatic nerve 22. Entitlement to an effective date earlier than November 8, 2017, for the grant of service connection for radiculopathy, right sciatic nerve The Veteran filed a claim for increased rating for his service connected back disability on November 8, 2017. Subsequently, a December 2017 VA examination identified radiculopathy of the left and right sciatic nerves associated with the service connected back condition. The January 2018 rating decision on appeal granted service connection for radiculopathy of the left and right lower extremity sciatic nerves, and assigned an effective date of November 8, 2017 for the awards. The effective date for the grant of service connection will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400. The RO interpreted the claim for increased rating for back disability received November 8, 2017 to include a claim for service connection for the associated radiculopathy of the left and right sciatic nerve. Entitlement arose from the date of the December 2017 examination that identified radiculopathy of the left and right sciatic nerve. The legal authority governing effective dates is clear and specific, and the Board is bound by such authority. Here, based on the evidence of record and the applicable VA regulations, the earliest date allowable for the awards of separate ratings for radiculopathy of the left and right sciatic nerves is the current effective date of November 8, 2017, the date on which the Veteran’s claim for increased rating for his back disability was received. See 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. As the preponderance of the evidence is against the claims, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 23. Entitlement to an effective date earlier than March 16, 2018, for the grant of service connection for radiculopathy, left femoral nerve 24. Entitlement to an effective date earlier than March 16, 2018, for the grant of service connection for radiculopathy, right femoral nerve The earliest date allowable for the award of service connection for left and right femoral nerve radiculopathy is the current effective date of March 16, 2018, the date entitlement arose. This is so because involvement of the femoral nerves was not shown on the previous, December 2017 VA examination which identified radiculopathy involving the sciatic nerve bilaterally. See 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). REASONS FOR REMAND 1. Entitlement to service connection for left lower extremity joint pains is remanded. 2. Entitlement to service connection for right lower extremity joint pains is remanded. 3. Entitlement to service connection for sleep apnea is remanded. 4. Entitlement to service connection for chronic fatigue is remanded. 5. Entitlement to service connection for migraine headaches is remanded. The Board’s November 2018 remand noted the Veteran’s assertion that he was exposed to radiation in service, as a result of being in contact with depleted uranium. The Board observed that the Veteran had submitted some information indicating a potential causal relationship between radiation exposure and his joint/muscle pain, erectile dysfunction, migraine headaches, and other claimed disabilities; as such, the provisions of 38 C.F.R. § 3.311 are applicable to this appeal, and further development to comply with the provisions of that section was in order. The Board’s remand indicated that the RO was to initiate development to obtain all relevant records concerning the Veteran’s exposure to radiation and that all “such records were to be forwarded to the Undersecretary for Health, who will be responsible for preparation of a dose estimate, to the extent feasible, based on available methodologies. The Board noted that such development had not been accomplished in this case. The action paragraphs of the remand specifically instructed the RO to: 1) give the Veteran notice of the information and evidence that he should submit to substantiate his claim of hazardous materials exposure during active duty: 2) then undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s claims, to specifically include any additional military records that may further document his exposure to ionizing radiation; and 3) if indicated, undertake development to obtain a dose estimate from the Undersecretary for Health in accordance with 38 C.F.R. § 3.311. The RO sent the Veteran a letter in December 2018 requesting that he identify the disabilities associated with radiation exposure, and that he complete a Radiation Risk Activity Information sheet. The Veteran did not respond to the letter, and the RO did not undertake the further action on the radiation development directed in the Board’s remand. As the Board’s November 2018 remand instructions were not substantially complied with, a remand is required in the case for the service connection claims. Stegall v. West, 11 Vet. App. 268, 271 (1998). 6. Entitlement to TDIU prior to January 16, 2018 is remanded A January 2019 rating decision granted TDIU effective January 16, 2018, but the Board observes that the claim for a TDIU is part-and-parcel of the Veteran’s November 2017 increased rating claim for his service-connected lumbar spine disability. Thus, the Board must consider whether TDIU was warranted earlier than January 16, 2018. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009); Harper v. Wilkie, 30 Vet. App. 356 (2018). The appeal period under review includes the one-year look back period (i.e. back to November 2016). Although the Veteran specifically averred that his service-connected lumbar spine disability and related pain precluded employment in his May 2018 TDIU application (VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability), the records from the Social Security Administration (SSA) reveal that he sought SSA disability benefits, in part, due to his sleep apnea. A service connection claim for sleep apnea is on appeal and remanded for further development. The matter of whether TDIU is warranted prior to January 16, 2018 is inextricably intertwined with the pending service connection claim for sleep apnea. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s service connection claims, to specifically include any additional military records that may further document the Veteran’s exposure to ionizing radiation. 2. Thereafter, undertake development to obtain a dose estimate from the Undersecretary for Health in accordance with 38 C.F.R. § 3.311. 3. Readjudicate the issues on appeal, to include the matter of entitlement to a TDIU prior to January 16, 2018. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Mazzucchelli, 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.