Citation Nr: 21061311 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 06-07 544 DATE: October 1, 2021 ORDER Entitlement to a disability rating in excess of 30 percent for sleep apnea prior to October 20, 2009 is denied. Entitlement to a disability rating in excess of 10 percent for sleep apnea from October 20, 2009 is denied. Entitlement to an initial disability rating in excess of 30 percent for impairment of sphincter control prior to March 6, 2010 is denied. Entitlement to a disability rating of 60 percent, but no more, for impairment of sphincter control from March 6, 2010 to November 6, 2019 is denied. Entitlement to a disability rating in excess of 60 percent for impairment of sphincter control from November 6, 2019 is denied. Entitlement to an initial disability rating in excess of 30 percent, but no more, for left foot heel spurs from June 12, 2003, to January 31, 2016, is granted. Entitlement to a disability rating of 30 percent for left foot heel spurs, as of February 1, 2016, is denied. Entitlement to an initial disability rating of 60 percent for chronic fatigue syndrome (CFS) from June 13, 2003 to April 21, 2004, is granted. Entitlement to a total disability rating for CFS from April 22, 2004, to September 10, 2008, is granted. Entitlement to an increased disability rating for CFS from September 11, 2008, is denied. Entitlement to an increased disability rating on an extraschedular basis in excess of 40 percent for fibromyalgia is denied. Entitlement to an increased disability rating on an extraschedular basis in excess of 30 percent for irritable bowel syndrome (IBS) is denied. Entitlement to an effective date prior to June 12, 2003, for service connection for sleep apnea is denied. Entitlement to an effective date of June 12, 2003, for an increased disability rating of 40 percent for fibromyalgia is granted. Entitlement to an effective date of June 12, 2003, for a separate disability rating for impairment of sphincter control, associated with IBS, is granted. REMANDED Entitlement to an initial disability rating in excess of 10 percent for right knee instability is remanded. Entitlement to an initial disability rating in excess of 10 percent for arthritis of the right knee is remanded. Entitlement to an initial disability rating in excess of 10 percent for arthritis of the left knee is remanded. Entitlement to an effective date prior to November 10, 2016, for service connection for right knee instability is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. Entitlement to special monthly compensation for a total disability and a disability rating that is independently 60 percent disabling (SMC TD&60) is remanded. FINDINGS OF FACT 1. Prior to October 20, 2009, the Veteran did not manifest the need for a breathing assistance device and did not manifest chronic respiratory failure with carbon dioxide retention or cor pulmonale at any time during the period on appeal. 2. From October 20, 2009, the Veteran did not manifest chronic respiratory failure with carbon dioxide retention or cor pulmonale at any time during the period on appeal. 3. Prior to March 6, 2010, the Veteran did not manifest extensive leakage and fairly frequent involuntary bowel movements; or complete loss of sphincter control. 4. From to March 6, 2010, to November 6, 2019, the Veteran did not manifest complete loss of sphincter control. 5. From November 6, 2019, the Veteran did not manifest complete loss of sphincter control. 6. From June 12, 2003, to January 31, 2016, the Veteran's left foot spurs manifested severe foot injuries. 7. From February 1, 2016, the Veteran was assigned the maximum disability rating under Diagnostic Code 8284. 8. From June 13, 2003, to April 21, 2004, the Veteran manifested debilitating fatigue and cognitive impairments which are nearly constant and restrict routine daily activities to less than 50 percent of the pre-illness level. 9. From April 22, 2004, to September 10, 2008, the Veteran manifested debilitating fatigue and cognitive impairments which are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care. 10. From September 11, 2008, the Veteran has been assigned a total disability rating for CFS. 11. The Veteran's fibromyalgia disability picture is fully contemplated by the schedular rating criteria. 12. The Veteran's IBS disability picture is fully contemplated by the schedular rating criteria. 13. The Veteran originally filed a claim for service connection for sleep apnea on June 12, 2003, and the Veteran has been granted service connection for sleep apnea effective June 12, 2003. 14. Entitlement to a disability rating of 40 percent for fibromyalgia first arose on June 12, 2003, and the Veteran first filed for service connection for fibromyalgia on June 12, 2003. 15. Entitlement to a disability rating of 30 percent for IBS first arose on June 12, 2003, and the Veteran first filed for service connection for IBS on June 12, 2003. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 30 percent for sleep apnea prior to October 20, 2009 have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.97, Diagnostic Code 6847. 2. The criteria for a disability rating in excess of 50 percent for sleep apnea from to October 20, 2009 have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.97, Diagnostic Code 6847. 3. The criteria for a disability rating disability rating in excess of 30 percent for impairment of sphincter control prior to March 6, 2010 have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.114, Diagnostic Code 7332. 4. The criteria for a disability rating of 60 percent, but no more, for impairment of sphincter control from March 6, 2010 to November 6, 2019 have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.114, Diagnostic Code 7332. 5. The criteria for a disability rating in excess of 60 percent for impairment of sphincter control from November 6, 2019 have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.114, Diagnostic Code 7332. 6. The criteria for an initial disability rating of 30 percent, but no more, for left foot heel spurs from June 12, 2003 to January 31, 2016 have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5284. 7. The criteria for an increased disability rating for left foot heel spurs from February 1, 2016 have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5284. 8. The criteria for a disability rating of 60 percent for CFS from June 13, 2003 to April 21, 2004 have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.88b, Diagnostic Code 6354. 9. The criteria for a total disability rating for CFS from April 22, 2004 to September 10, 2008 have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.88b, Diagnostic Code 6354. 10. The criteria for an increased disability rating from CFS from September 11, 2008 have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.88b, Diagnostic Code 6354. 11. The criteria for an increased disability rating on an extraschedular basis in excess of 40 percent for fibromyalgia have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 3.321(b). 12. The criteria for an increased disability rating on an extraschedular basis in excess of 30 percent for IBS have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 3.321(b). 13. The criteria for an effective date earlier than June 12, 2003 for the assignment of service connection for sleep apnea have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 14. The criteria for an effective date of June 12, 2003 for the assignment of a disability rating of 40 percent for fibromyalgia have been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 15. The criteria for an effective date of June 12, 2003 for the assignment of a separate disability rating for impairment of sphincter control have been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from September 1990 to October 1992. These matters come to the Board of Veterans' Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO) made in July 2004, February 2012, November 2012, and April 2014. This appeal is being adjudicated under the legacy appellate framework. The Veteran initially requested a personal hearing before the Board, but the Veteran withdrew the request. This matter was previously before the Board, and, in February 2019, the Board remanded these matters for further development. Further development in substantial compliance with the Board's remand instructions has been completed. In addition to the issues disposed of by this decision, the Veteran also has pending claims for increased disability ratings for bone spurs of the right heel. These will be adjudicated in a separate Board decision. Increased Rating Disability ratings are determined by applying a schedule of disability ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that disability rating. Otherwise, the lower disability rating is to be assigned. 38 C.F.R. § 4.7. 1. Entitlement to a disability rating in excess of 30 percent for sleep apnea prior to October 20, 2009 is denied. 2. Entitlement to a disability rating in excess of 10 percent for sleep apnea from October 20, 2009 is denied. At issue is whether the Veteran is entitled to an increased disability rating for sleep apnea. The weight of the evidence is denied. The Veteran was first granted service connection for sleep apnea in November 2012. The Veteran appealed the initial disability rating. The Veteran's disability rating was altered throughout the period on appeal, but the Veteran's most recent disability rating was 30 percent from June 12, 2003 to October 19, 2009 and 50 percent thereafter. Disability ratings for sleep apnea are assigned pursuant to Diagnostic Code 6847. A disability rating of 30 percent is assigned for persistent daytime hypersomnolence, and a disability rating of 50 percent is assigned for the requirement to use breathing assistance such as a continuous airway pressure (CPAP) machine. A total disability rating is assigned for chronic respiratory failure with carbon dioxide retention or cor pulmonale; or requires tracheostomy. 38 C.F.R. § 4.97, Diagnostic Code 6847. The Veteran's treatment records indicate that the Veteran manifested sleep problems throughout the period on appeal, but the Veteran's treatment records are silent for the prescription of a breathing assistance device such as a CPAP machine prior to October 2009. The Veteran underwent a VA examination in December 2011. The examiner indicated that the Veteran used a CPAP machine, but the examiner did not diagnose the Veteran with chronic respiratory failure with carbon dioxide retention or cor pulmonale. The Veteran underwent another VA examination in February 2016. The examiner indicated that the Veteran used a CPAP machine, but the examiner did not diagnose the Veteran with chronic respiratory failure with carbon dioxide retention or cor pulmonale. The Veteran underwent another VA examination in November 2019. The examiner indicated that the Veteran used a CPAP machine, but the examiner did not diagnose the Veteran with chronic respiratory failure with carbon dioxide retention or cor pulmonale. The weight of the evidence indicates that the Veteran is not entitled to increased disability ratings for sleep apnea. In order to meet the criteria for an increased disability rating, the Veteran needed to manifest the need for a breathing assistance device, such as a CPAP, prior to October 20, 2009 or manifest chronic respiratory failure with carbon dioxide retention or cor pulmonale at any time during the period on appeal. The Veteran did not manifest the need for a breathing assistance device, such as a CPAP, prior to October 20, 2009 or manifest chronic respiratory failure with carbon dioxide retention or cor pulmonale at any time during the period on appeal. Therefore, the Veteran is not entitled to an increased disability rating. Here, the weight of the probative evidence of record simply fails to demonstrate that the Veteran is entitled to an increased disability rating. Therefore, the evidence in this case is not so evenly balanced so as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such, an increased disability rating for sleep apnea is denied. 3. Entitlement to an initial disability rating in excess of 30 percent for impairment of sphincter control prior to March 6, 2010 is denied. 4. Entitlement to a disability rating of 60 percent, but no more, for impairment of sphincter control from March 6, 2010 to November 6, 2019 is denied. 5. Entitlement to a disability rating in excess of 60 percent for impairment of sphincter control from November 6, 2019 is denied. At issue is whether the Veteran is entitled to increased disability ratings for impairment of sphincter control. The weight of the evidence indicates that the Veteran is entitled to a disability rating of 60 percent but no more effective March 6, 2010, but that the veteran is not otherwise entitled to an increased disability rating. The Veteran was granted service connection for impaired sphincter control in April 2014. The Veteran appealed his initial disability rating. The Veteran's disability rating was altered throughout the period on appeal, but the Veteran's most recent disability rating was 30 percent from September 11, 2008 to November 6, 2019 and 60 percent thereafter. Disability ratings for impaired sphincter control are assigned pursuant to Diagnostic Code 7332. Under Diagnostic Code 7332, a disability rating of 30 percent is assigned for occasional involuntary bowel movements necessitating wearing of pad, and a disability rating of 60 percent is assigned for extensive leakage and fairly frequent involuntary bowel movements; and a total disability rating is assigned for complete loss of sphincter control. 38 C.F.R. § 4.114, Diagnostic Code 7332. The Veteran's treatment records indicate that the Veteran manifested sphincter trouble throughout the period on appeal. The Veteran underwent a VA examination in March 5, 2010. The examiner noted moderate fecal leakage requiring the occasional involuntary bowel movement, but that there was no use of pads. Additionally, the examiner did not indicate that the Veteran manifested complete loss of sphincter control. The Veteran underwent another VA examination in November 2019. The examiner did not indicate that the Veteran manifested a complete loss of sphincter control. The weight of the evidence indicates that the Veteran is not entitled to a disability rating in excess of 30 percent prior to March 6, 2010. In order to meet the criteria for a disability rating in excess of 30 percent, the Veteran needed to manifest extensive leakage and fairly frequent involuntary bowel movements; or complete loss of sphincter control. The record is silent for these symptoms prior to March 6, 2010. Therefore, the Veteran does not meet the criteria for a disability rating in excess of 30 percent. The weight of the evidence indicates that the Veteran is entitled to a disability rating of 60 percent effective March 6, 2010. The Veteran was provided an increased disability rating due to the results of a November 2019 VA examination. It is unclear exactly when the Veteran first began to manifest these increased symptoms. As such, the Veteran is being assigned a disability rating of 60 percent effective March 6, 2010; the day after it is medically ascertainable that the Veteran absolutely did not manifest these symptoms. The weight of the evidence indicates that the Veteran is not entitled to a total disability rating at any time during the period on appeal. In order to meet the criteria for a total disability rating, the Veteran needed to manifest complete loss of sphincter control. The record does not establish this symptom. Therefore, the criteria for this disability have not been met. Here, the weight of the probative evidence of record demonstrates that the Veteran is entitled to a disability rating of 60 percent effective March 6, 2010, but that the Veteran is not otherwise entitled to an increased disability rating. Therefore, the evidence in this case evenly balanced enough so as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such a disability rating of 60 percent effective March 6, 2010 for impaired sphincter control is granted. 6. Entitlement to an initial disability rating of 30 percent, but no more, for left foot heel spurs from June 12, 2003 to January 31, 2016 is granted. 7. Entitlement to a disability rating in excess of 30 percent for left foot heel spurs, as of February 1, 2016, is denied. At issue is whether the Veteran is entitled to increased disability ratings for. The weight of the evidence indicates that the Veteran is entitled to a disability rating of 30 percent throughout the period on appeal. The Veteran was granted service connection for left foot heel spurs in February 2012. The Veteran appealed his initial disability rating. The Veteran's disability rating was altered throughout the period on appeal, but the Veteran's most recent disability rating was 20 percent from June 12, 2003 to January 31, 2016 and 30 percent thereafter. A disability rating of 20 percent for moderately severe foot injuries, and a disability rating of 30 percent is assigned for severe foot injuries. Diagnostic Code 5284. Upon reviewing the medical evidence and examinations of record, the weight of the evidence indicates that the Veteran's bone spurs more closely approximate the criteria of severe rather than moderately severe and a disability rating of 30 percent is granted throughout the period on appeal. 8. Entitlement to an initial disability rating of 60 percent for CFS from June 13, 2003 to April 21, 2004 is granted. 9. Entitlement to a total disability rating for CFS from April 22, 2004 to September 10, 2008 is granted. 10. Entitlement to an increased disability rating for CFS from September 11, 2008 is denied. At issue is whether the Veteran is entitled to increased disability ratings for CFS. The weight of the evidence indicates the Veteran is entitled to a disability rating of 60 percent, but no more, from June 13, 2003 to April 21, 2004 and a total disability ratings. The Veteran was granted service connection for CFS in July 2004. The Veteran appealed his initial disability rating. The Veteran's disability rating was altered throughout the period on appeal, but the Veteran's most recent disability rating was 10 percent from June 13, 2003 to September 10, 2008 and a total disability rating thereafter. Disability ratings for CFS are assigned pursuant to Diagnostic Code 6354. Under Diagnostic Code 6354, a disability rating of 10 percent is assigned for debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms which wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year; or symptoms controlled by continuous medication, and a disability rating of 20 percent is assigned for debilitating fatigue, cognitive impairments, or a combination of other signs and symptoms which are nearly constant and restrict routine daily activities by less than 25 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least two but less than four weeks total duration per year. A disability rating of 40 percent is assigned for debilitating fatigue, cognitive impairments, or a combination of other signs and symptoms which are nearly constant and restrict routine daily activities from 50 to 75 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least four but less than six weeks total duration per year, and a disability rating of 60 percent is assigned for debilitating fatigue, cognitive impairments, or a combination of other signs and symptoms which are nearly constant and restrict routine daily activities to less than 50 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least six weeks total duration per year; and a total disability rating is assigned for debilitating fatigue, cognitive impairments, or a combination of other signs and symptoms which are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care. 38 C.F.R. § 4.88b, Diagnostic Code 6354. The Veteran's medical records indicate that the Veteran manifested CFS symptoms throughout the period on appeal The Veteran underwent a VA examination in August 2003. The Veteran reported: constant daytime somnolence; feeling chronically tired; eight hours of sleep a night; limits his day-time activities below 50 percent of prior levels of activity. The Veteran denied low grade fever or sleep disturbances, and the examiner indicated that there was no evidence of pharyngitis. The Veteran did claim fatigue lasting 24 hours or longer after exercise, frontal headaches, migratory joint pain, and short- and long-term memory loss. The Veteran reported that this limited ability to work by making occupational tasks last longer than they normally should. The Veteran underwent another VA examination on April 21, 2004 which indicated that the Veteran reported low grade fever; nonexudative pharyngitis; muscle ache and weakness all over your body. The examiner indicated that his fatigue lasts more than 24 hours at a time, and that he got headaches in the back of the head and the forehead for five hours at a time at least once per week and cannot be relieved by any medication; as well as migratory joint pain in the elbows, fingers, and knees. The Veteran manifested short- and long-term memory loss, and sleep disturbances. The Veteran underwent another VA examination in August 2009. Based on the results of the August 2009 VA examination, the Veteran was assigned a total disability rating effective September 11, 2008. The Veteran is entitled to a disability rating 60 percent from June 13, 2003 to April 21, 2004. An August 2003 VA examination indicates that the Veteran's CFS limits his day-time activities below 50 percent of prior levels of activity. Therefore, the criteria for a disability rating of 40 percent have been met. The Veteran is not entitled to a disability rating in excess of 60 percent from June 13, 2003 to April 21, 2004. In order to meet the criteria for a disability rating in excess of 40 percent, the Veteran needed to manifest debilitating fatigue, cognitive impairments, or a combination of other signs and symptoms which are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care. The medical evidence of record is silent for documentation of this level of severity due to CFS. Therefore, the criteria for a disability rating in excess of 60 percent have not been met. The Veteran is entitled to a total disability rating effective April 22, 2004. As previously noted, the Veteran underwent another VA examination in August 2009. Based on the results of the August 2009 VA examination, the Veteran was assigned a total disability rating effective September 11, 2008. Nevertheless, this does not address the possibility that the Veteran's disability could have increased in severity between the April 2004 VA examination and the August 2009 VA examination. Therefore, the Veteran is being assigned an effective date of April 22, 2004; the day after the April 2004 VA examination and the earliest possible day that it is medically ascertainable that the Veteran manifested the level of severity required for a total disability rating. Here, the weight of the probative evidence of record demonstrates that the Veteran is entitled to increased disability ratings. Therefore, the evidence in this case is evenly balanced enough so as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such, a disability rating of 60 percent, but no more, from June 13, 2003 to April 21, 2004 and a total disability rating thereafter is granted. Extraschedular Disability Rating In exceptional cases, an extraschedular disability rating may be assigned. 38 C.F.R. § 3.321; Rice v. Shinseki, 22 Vet. App. 447 (2009). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Therefore, initially, there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the disability rating schedule for that disability. See Thun v. Peake, 22 Vet. App. 111 (2008). Under the approach prescribed by VA, if the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the disability rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. In the second step of the inquiry, however, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." 38 C.F.R. § 3.321 (b)(1) (related factors include "marked interference with employment" and "frequent periods of hospitalization"). When the disability rating schedule is inadequate to evaluate a claimant's disability picture, and that picture has related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director, Compensation and Pension Service for completion of the third step-a determination of whether, to accord justice, the claimant's disability picture requires the assignment of an extraschedular disability rating. 11. Entitlement to an increased disability rating on an extraschedular basis in excess of 40 percent for fibromyalgia is denied. At issue is whether the Veteran is entitled to a disability rating of 40 percent on an extraschedular basis. Turning to the first step of the extraschedular analysis, the Board finds that the symptomatology and impairment is specifically contemplated by the schedular disability rating criteria, and no referral for extraschedular consideration is required for this appellate period. Disability ratings for fibromyalgia are assigned under Diagnostic Code 5025. Under Diagnostic Code 5025, disability ratings are assigned for varying degrees of widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms. 38 C.F.R. § 4.71a, Diagnostic Code 5025. The Veteran has not manifested and does not allege any fibromyalgia symptoms that are not considered under Diagnostic Code 5025. Therefore, the Board finds that the Veteran's current disability picture is fully contemplated by the existing schedular disability rating criteria. As such, referral for extraschedular consideration is not warranted. The Board notes that in February 2019 the Board remanded this matter specifically to consider any ocular symptoms associated with the Veteran's fibromyalgia. Any ocular symptoms that the Veteran may or may not be experiencing, however, are being compensated under the separated disability rating that the Veteran was assigned in a separate March 2021 rating decision. 12. Entitlement to an increased disability rating on an extraschedular basis in excess of 30 percent for IBS is denied. At issue is whether the Veteran is entitled to a disability rating of 30 percent for IBS on an extraschedular basis. Turning to the first step of the extraschedular analysis, the Board finds that the symptomatology and impairment is specifically contemplated by the schedular disability rating criteria, and no referral for extraschedular consideration is required for this appellate period. Disability ratings for IBS are assigned under Diagnostic Code 7319. Under Diagnostic Code 7319, disability ratings are assigned for varying degrees of diarrhea, constipation, abdominal distress, and disturbances of bowel function. 38 C.F.R. § 4.114, Diagnostic Code 7319. The Veteran has not manifested and does not allege any IBS symptoms that are not considered under Diagnostic Code 7319. Therefore, the Board finds that the Veteran's current disability picture is fully contemplated by the existing schedular disability rating criteria. As such, referral for extraschedular consideration is not warranted. Effective Date Except as otherwise provided, the effective date of an evaluation and award of compensation of a reopened claim will be the date of receipt of the claim to reopen or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. 13. Entitlement to an effective date prior to June 12, 2003, for service connection for sleep apnea is remanded. At issue is whether the Veteran is entitled to an effective date earlier than June 12, 2003 for the assignment of service connection for sleep apnea. The Veteran first filed for service connection sleep apnea on June 12, 2003, and the Veteran has been granted service connection for sleep apnea effective June 12, 2003. Here, the Veteran was assigned an effective date as of the date his claim was received. The evidence does not show that he filed a claim for this disability prior to June 12, 2003. The Board is bound by the law and is without authority to grant benefits on an equitable basis. See 38 U.S.C. §§ 503, 7104; Harvey v. Brown, 6 Vet. App. 416 (1994). Accordingly, the Veteran's claim is denied. 14. Entitlement to an effective date prior of June 12, 2003, for a disability rating of 40 percent for fibromyalgia is granted. At issue is whether the Veteran is entitled to an effective dater earlier than September 11, 2008 for the assignment of a disability rating of 40 percent for fibromyalgia. The weight of the evidence indicates that the Veteran is not entitled to an earlier effective date. The Veteran first filed for service connection effective June 12, 2003. The Veteran, however, was first given an examination explicitly describing the severity of his fibromyalgia in October 2009. As the Veteran should not be penalized for any delay in providing the Veteran with a VA examination and the October 2009 was the earliest examination to possibly establish his current disability rating, a disability rating of 40 percent effective June 12, 2003 the date the claim for service connection was received is granted. 15. Entitlement to an effective date of June 12, 2003 for a separate disability rating for impairment of sphincter control, associated with IBS, is granted. At issue is whether the Veteran is entitled to an effective date prior to March 17, 2014 for the assignment of a separate disability rating for impairment of sphincter control associated with IBS. The weight of the evidence indicates that the Veteran first filed a claim for service connection which impairment of sphincter control was within the scope of on June 12, 2003, and the Veteran manifested intestinal symptoms throughout the period on appeal. Therefore, an effective date of June 12, 2003 is granted. REASONS FOR REMAND 1. Entitlement to an initial disability rating in excess of 10 percent for right knee instability is remanded. 2. Entitlement to an initial disability rating in excess of 10 percent for arthritis of the right knee instability is remanded. 3. Entitlement to an initial disability rating in excess of 10 percent for arthritis of the right knee instability is remanded. At issue is whether the Veteran is entitled to increased disability rating for instability of the right knee. Unfortunately, this matter must be remanded for further development. Disability ratings for instability of the right knee are assigned pursuant to Diagnostic Code 5257. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The rating criteria under Diagnostic Code 5257 was updated during the period on appeal. 86 Fed. Reg. 8142 (February 4, 2021). When regulations are revised during the pendency of an appeal, the Board is generally required to consider the claim in light of both the former and revised schedular criteria and to apply the regulation more favorable to the Veteran. The new rating criteria, however, may be applied only prospectively from the effective date of the change forward, unless the regulatory change specifically permits retroactive application. VAOPGCPREC 3-2000 (Apr. 10, 2000). The Veteran has been provided VA examinations evaluating the severity of the instability of the right knee, but none of these examinations provide details sufficient to address the issues raised under the new rating criteria. Once VA undertakes the effort to provide the Veteran with a new VA examination, it must provide the Veteran with an adequate one, and an adequate examination is sufficiently detailed in order to ensure that VA's evaluation of the Veteran's claim is fully formed. Barr v. Nicholson, 21 Vet. App. 303 (2007). Therefore, the Veteran's increased rating claim for instability of the left knee must be remanded for a new knee VA examination 4. Entitlement to an effective date prior to November 10, 2016, for service connection for right knee instability is remanded. 5. Entitlement to TDIU is remanded. 6. Entitlement to SMC TD&60 is remanded. The Veteran's claims for an earlier effective date for right knee instability as well as the establishment of TDIU and SMC TD&60 are inextricably intertwined with the Veteran's increased rating claim for right knee instability claim and must be remanded as well. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: Arrange to provide the Veteran with a VA examination in order to determine the current severity of the Veteran's knee disabilities. R.R. WATKINS Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David R. Seaton, 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.