Citation Nr: 21063649 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 16-40 652A DATE: October 15, 2021 ORDER Entitlement to service connection for a right wrist disability is denied. Entitlement to service connection for a lumbar spine disability is denied. Entitlement to service connection for a disability manifested by sleep impairment as secondary to a lumbar spine disability is denied. Entitlement to service connection for a left sciatic nerve disability as secondary to a lumbar spine disability is denied. Entitlement to an initial compensable rating for bilateral hearing loss is denied. Entitlement to an initial compensable rating for linear scars of the right knuckle, left side of back, and left toe is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded FINDINGS OF FACT 1. The evidence is against finding that the Veteran's right wrist disability began during active service, or is otherwise related to an in-service event, injury, or disease. 2. The evidence is against finding that the Veteran's lumbar spine disability began during active service, or is otherwise related to an in-service event, injury, or disease 3. The evidence is against a finding that the Veteran's sleep impairment and left sciatic nerve disability are secondary to a service-connected disability, and are not otherwise related to an in-service event, injury, or disease. 4. For the entire rating period on appeal, the Veteran's bilateral hearing loss has been manifested by no more than a Level I impairment in his right ear and a Level I impairment in his left ear. 5. For the entire rating period on appeal, the Veteran's linear scars of the right knuckle, left side of back, and left toe were not deep and nonlinear, painful, unstable, associated with underlying soft tissue damage, of an area of at least 6 square inches, or resulting in some disabling effect. CONCLUSIONS OF LAW 1. The criteria for service connection for a right wrist disability have not been satisfied. 38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for a lumbar spine disability have not been satisfied. 38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for service connection for sleep impairment have not been satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310. 4. The criteria for service connection for a left sciatic nerve disability have not been satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.310. 5. The criteria for a compensable disability rating for service-connected bilateral hearing loss have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.85, Diagnostic Code 6100. 6. The criteria for a compensable disability rating for a service-connected linear scars of the right knuckle, left side of back, and left toe have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.118, Diagnostic Codes 7801 to 7805. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 1993 to September 1997, to include service in Southwest Asia and Somalia. His awards and decorations include the Combat Action Ribbon, among many others. This matter comes before the Board of Veterans' Appeals (Board) from a January 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The issue were previously before the Board in January 2021, where they were remanded for additional development. They have since returned for further appellate review. The Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge in January 2020. A transcript of that hearing is of record. The Board notes that the Veteran has requested that this case be advanced on the docket due to "financial distress." See February 17, 2021 Correspondence. Notably, advancement of the docket may be granted if the appellant is seriously ill or is under severe financial hardship, or if other sufficient cause is shown. 38 C.F.R. § 20.902(c). Here, however, the Veteran has not submitted any additional evidence in support of his motion to advance his claim on the docket, nor the does the record document the Veteran's financial hardship. In the absence of sufficient cause, the Veteran's motion to advance on the docket is denied. Service Connection Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has established certain rules and presumptions for chronic diseases, such as arthritis. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). 1. Service connection for a right wrist disability The Veteran has a current right wrist disability. For example, at his March 2021 VA examination he was diagnosed with a chronic right wrist strain. Thus, the remaining question is whether the current right wrist disability is related to service. For the reasons that follow, the Board finds that service connection is not warranted. Service treatment records (STRs) show no complaints, diagnosis, or treatment related to a right wrist disability. While his STRs do note a laceration to the right knuckle area (for which a scar is already service-connected), he did not report any wrist pain at the time, despite the Veteran's testimony during his hearing before the undersigned that his wrist pain began at that time. As the Veteran reported other ailments during service, and wrist problems are the type that a reasonable person would report while in the military with access to healthcare, if the Veteran was experiencing problems with his right wrist during service the Board would expect that he would have reported these problems to medical professionals. Moreover, during his August 1997 separation examination, evaluation of the upper extremities was normal, and the Veteran specifically denied having had swollen or painful joints in a corresponding report of medical history. If right wrist pain was present during service, the Board would expect the Veteran would have responded "yes" when asked if he had swollen or painful joints at separation because a reasonable person would have interpreted the question to include symptoms of wrist pain. A right wrist disability is not shown by medical evidence until approximately October 2007, many years after the Veteran's separation from service, where the Veteran submitted a workman's compensation claim after an October 16, 2007 patrol bike accident while working as a police officer. As a chronic right wrist disability is not shown to have been present during service or in the first year after separation of service, and continuity of symptomatology leading to a diagnosis of such is not shown, in-service incurrence of the Veteran's right wrist disability cannot be presumed. See 38 C.F.R. §§ 3.307, 3.309(a). To the extent the Veteran asserts a continuity of symptomatology beginning during service, the Board finds these statements to lack credibility as they are in direct conflict with the Veteran's report of medical history at separation from service where he denied symptoms indicative of any wrist disability. The Board finds the report of medical history at separation from service to be more reliable than more recent assertions as it was done contemporaneous to service and for the purpose of identifying disability at that time. Pursuant to the Board's remand, the Veteran presented for a VA examination in March 2021, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The examiner opined that it was less likely than not that the Veteran's right wrist disability is related ot his military service, explaining that the record is absent any wrist injury until his October 2007 occupational accident. The Board finds the above opinion highly probative as it was made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran. The opinion is also supported by other evidence of record, include the lack of any complaints regarding right wrist pain until his 2007 post-service accident. There is also no medical opinion or competent and credible evidence in significant conflict with the VA medical opinion. For the above reasons, the preponderance of the evidence is against the claim and service connection for a right wrist disability is denied. 2. Service connection for a lumbar spine disability 3. Service connection for a disability manifested by sleep impairment and a left sciatic nerve disability as secondary to a lumbar spine disability The Veteran has a current lumbar spine disability. For example, at a March 2021 VA examination he was diagnosed with degenerative arthritis of the lumbar spine. Thus, the remaining question is whether the current lumbar spine disability is related to service. For the reasons that follow, the Board finds that service connection is not warranted. Similar to the Veteran's right wrist claim above, the Veteran's STRs show no complaints, diagnosis, or treatment related to a lumbar spine disability. While the Veteran has asserted that a November 1994 incident where he suffered a head laceration (for which service connection is in effect) also resulted in his lumbar spine disability as he fell backwards and landed on his tailbone, records pertaining to this head injury do not reflect any issues with the Veteran's back despite his assertions that he reported back pain at the time. As the Veteran reported other ailments during service, and as low back problems are the type that a reasonable person would report while in the military with access to healthcare, if the Veteran was experiencing problems with his lumbar spine the Board would expect that he would have reported these problems to medical professionals. Moreover, during his separation examination, evaluation of the spine was normal, and he specifically denied recurrent back pain in his corresponding report of medical history. If a lumbar spine issue was present during service, the Board would expect the Veteran would have responded "yes" when asked if he had recurrent back pain at separation because a reasonable person would have interpreted the question to include symptoms of lumbar spine pain. A lumbar spine disability is not shown by medical evidence until approximately September 2006, many years after the Veteran's separation from service. Regarding onset of symptoms related to a lumbar spine disability, post-service the Veteran reported to a private physician in June 2010 that injured his back at that time while washing his car. Of particular note, the Veteran further stated in July 2010 that he has had back problems on and off since injuring his back in motorcycle school as a police officer. These statements are in conflict with the Veteran's statements during his more recent hearing before the undersigned where he reported that his back injury while washing his car only re-aggravated his purported in-service back injury, and call into question the veracity of his statements regarding the onset of his lower back pain. As a chronic lumbar spine disability is not shown to have been present during service or in the first year after separation of service, and continuity of symptomatology leading to a diagnosis of such is not shown, in-service incurrence cannot be presumed. See 38 C.F.R. §§ 3.307, 3.309(a). To the extent the Veteran asserts a continuity of symptomatology beginning during service, the Board finds these statements to lack credibility as they are in direct conflict with the Veteran's report of medical history at separation from service where he denied recurrent back pain, as well as earlier private treatment records where he reported back problems on and off since injuring his back in police motorcycle school. The Board finds the report of medical history at separation from service, a s well as his earlier treatment records, to be more reliable than more recent assertions as it was done contemporaneous to service and for the purpose of identifying disability at that time. The Veteran presented for a VA examination in March 2021, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The examiner opined that it was less likely than not that the Veteran's lumbar spine disability is related to his military service, explaining that review of records indicates Veteran did not have any complaints of back pain while in service. Rather, records indicates he had an on-the-job injury as a police officer after service, The Board finds the above opinion highly probative as it was made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran. The opinion is also supported by other evidence of record, include the lack of any complaints regarding right wrist pain until his 2007 post-service accident. The Board acknowledges the March 2020 opinion provided by private practitioner, Dr. J.A., that the Veteran had a "traumatic incident" in service that resulted in his current low back disability. This opinion, however, contains no further rationale. Additionally, and despite Dr. J.A. also noting that this opinion is based on review of the entire record, as the Board has previously noted the Veteran's STRs are actually absent any injury to the low back, and the record is absent any complaints of low back pain until many years after service. Thus, the Board afford' s Dr. J.A.'s opinion little, if any, probative weight compared to that of the VA examiner. For the above reasons, the preponderance of the evidence is against the claim and service connection for a lumbar spine disability is denied. As to the Veteran's additional claims that he suffers from sleep impairment related to his low back pain, as well as left lower extremity neurological impairments, as noted above, the record is against a finding that the Veteran's lumbar spine disability is related to his military service. Thus, service connection for sleep impairment and lower extremity radiculopathy on a secondary basis must also be denied as a matter of law, as only a disability that was caused or aggravated by a service-connected disease or injury can be service connected. See 38 C.F.R. § 3.310; Sabonis v. Brown, 6 Vet. App. 426 (1994) (noting that when the law is dispositive of the claim, then the claim must, as a matter of law, be denied because of the absence of legal merit or lack of entitlement under the law). The Veteran has not asserted, nor does the record suggest, that either disability is related to service on a direct basis. As to all of the service connection claims denied above, the Board has considered the Veteran's statements, to include his assertions that his disabilities are related to service. As the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., back pain, lower extremity pain, and sleep difficulties; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the opinions rendered by trained medical professionals based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claims, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Ratings Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. The evidentiary record does not reasonably raise the prospect that the Veteran's disability is not and cannot be adequately rated under the Rating Schedule. 4. A compensable rating for bilateral hearing loss Ratings of defective hearing are based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination testing together with the average hearing threshold level as measured by pure tone audiometry tests in the frequencies 1000, 2000, 3000 and 4000 Hertz. 38 C.F.R. § 4.85. Under 38 C.F.R. § 4.85, Table VI, Numeric Designation of Hearing Impairment Based on Puretone Threshold Average and Speech Discrimination, is used to determine a Roman numeral designation (I through XI) for hearing impairment based on a combination of the percent of speech discrimination and the pure tone threshold average. The Roman numeral designation is located at the point where the percentage of speech discrimination and pure tone average intersect. 38 C.F.R. § 4.85(b). The pure tone threshold average is the sum of the pure tone thresholds at 1000, 2000, 3000, and 4000 Hertz, divided by 4. Table VII, Percentage Evaluation for Hearing Impairment, is used to determine the rating by combining the Roman numeral designations for hearing impairment of each ear. The horizontal rows represent the ear having the better hearing and the vertical columns the ear having the poor hearing. The disability rating is located at the point where the rows and column intersect. 38 C.F.R. § 4.85(e). When the pure tone threshold at each of the four specified frequencies of 1000, 2000, 3000 and 4000 Hertz is 55 decibels or more, the Roman numeral designation for hearing impairment will be determined from either Table VI or Table VIA, whichever results in the higher numeral. When the pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the Roman numeral designation for hearing impairment will be determined from either Table VI or Table VIA, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86. Table VIA can also be used when the examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc. 38 C.F.R. § 4.85(c). By way of background, the Veteran was awarded service connection for right ear hearing loss in the January 2015 rating decision on appeal and was assigned a noncompensable (zero percent) disability rating. Hearing loss in his left ear, however, was denied, based in part on an absence of hearing loss in that ear for VA purposes. See 38 C.F.R. § 3.385. The Veteran filed a timely appeal of both the initial rating assigned for his right ear, and the service connection denial for the left. In January 2021, the Board granted service connection for left ear hearing loss, and both ears are now service-connected effective January 23, 2014.As such, the issue is now recharacterized as entitlement to a compensable rating for bilateral hearing loss. Turning to the evidence during the appeal, the Veteran was afforded a VA audiological examination for his initial claim in January 2015. The Veteran reported difficulty hearing conversations. The results of the examination, as measured by a puretone audiometry test, were as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 20 25 20 45 28 LEFT 15 20 15 25 19 In addition, speech recognition was 96 percent in both ears, as measured by the Maryland CNC test. Applying these values to Table VI, both ears are each assigned a Level I Roman numeral designation. Pursuant to Table VII, this corresponds with a noncompensable rating. An additional examination was afforded to the Veteran in March 2021. He continued to report difficulty hearing conversation. The results of the physical examination, as measured by a puretone audiometry test, were as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 30 35 45 65 44 LEFT 25 30 35 60 38 Speech recognition was 100 percent in both ears, as measured by the Maryland CNC test. Applying these values to Table VI, his right and left ears are each assigned a Level I Roman numeral designation. Pursuant to Table VII, this continues to correspond with a noncompensable rating. Based upon the mechanical application of the above audiological results to the rating criteria, at no point during the period on appeal does the Veteran's hearing loss warrant a compensable rating. The Veteran's medical treatment records are not in significant conflict with these findings. See, e.g., March 2020 Medical Treatment Record Non-Government Facility. The Board has considered the Veteran's complaints regarding the functional impact of his hearing loss on his daily life, but the assignment of disability ratings for hearing impairment is derived from a mechanical formula based on levels of pure tone threshold average and speech discrimination. The audiological findings discussed above are more probative than the Veteran's lay contentions as to the extent of his hearing loss. Thus, as the evidence is against a finding that the Veteran's bilateral hearing loss more nearly approximates the criteria for higher ratings, entitlement to an increased rating for bilateral hearing loss is not warranted. 38 C.F.R. §§ 4.3, 4.7, 4.85. 5. A compensable rating for linear scars of the right knuckle, left side of back, and left toe The Veteran was awarded service connection for linear scars of the right knuckle, left side of back, and left toe (originally claimed as surgical residuals) in the January 2015 rating decision on appeal, where a noncompensable rating was assigned. He asserts that the severity of his scars warrant higher initial ratings. For the below reasons, the Board finds that a higher rating is not warranted. Diagnostic Codes 7800 to 7805 pertain to scars. 38 C.F.R. § 4.118. The Schedule of ratings for the skin were amended effective August 13, 2018. See 83 Fed. Reg. 32,592 (July 13, 2018). Here, the Veteran's initial service connection claim was filed on January 23, 2014, which is also the effective date for his rating. Thus, prior to August 13, 2018, the Board will consider the old version of the diagnostic codes only (old code); however, for the period beginning August 13, 2018 the Board will consider both the old and amended version (amended code) of the diagnostic codes and rate based on whichever is most favorable to the Veteran. Diagnostic Code 7800 deals with scars and disfigurement of the head, face, or neck and, while not revised by the recent regulatory amendments, is inapplicable to the present appeal. Diagnostic Code 7801 provides for a 10 percent disability evaluation for a scar that is not of the head, face, or neck, that is deep and nonlinear (old code) or associated with underlying soft tissue damage (amended code), and that has an area of at least 6 square inches (39 sq. cm.). Higher ratings are available if larger areas are affected. Under the old code, a "deep scar" is defined as one associated with underlying soft tissue damage. The old and amended codes also differ regarding instructions for totalling the area affected when there is more than one qualifying scar. Diagnostic Code 7802 provides for a 10 percent disability evaluation for a scar not of the head, face, or neck, that is superficial and nonlinear (old code) or not associated with underlying soft tissue damage (amended code) and which covers an area of at least 144 square inches (929 sq. cm.) or more. No higher ratings are available under either version of this code. Under the old code, a "superficial scar" is defined as one not associated with underlying soft tissue damage. The old and amended codes also differ regarding instructions for totalling the area affected when there is more than one qualifying scar. Diagnostic Code 7804 provides for a 10 percent disability evaluation for one or two scars that are unstable or painful. A 20 percent disability evaluation is assigned where there are three or four scars that are unstable or painful. A 30 percent disability evaluation is assigned where there are five or more scars that are unstable or painful. An unstable scar is one where there is frequent loss of skin covering over the scar. If one or more scars are both unstable and painful 10 percent is added to the evaluation. Under the new and amended codes, pursuant to Diagnostic Code 7805, a scar may be rated on any disabling effect(s) not considered as part of Diagnostic Codes 7800 to 7804. At his initial VA examination in January 2015, where the nature and etiology of the Veteran's scars were described. Specifically, in April 1994, the Veteran had surgery at Camp Pendleton on the left fourth toe to shave a protruding bone. Physical examination revealed a "hardly visible thin linear flat non tender scar" 1.5 centimeters long that the Veteran said he applies medicated cream to that area to avoid dryness. He also noted that he prefers to wear wide shoes to avoid rubbing on the fourth toe. As to the right knuckle, the Veteran sustained a laceration in June 1996 which resulted in a scar that the examiner described as a "hardly visible," u-shaped fine line scar 2 centimeters long that was not painful and non-tender. Finally, as to the left upper back scar, the Veteran described that they had to walk five miles back and forth daily for 30 days, and that the metal clip of his canteen was rubbing on the sacroiliac area and caused a sore. The examiner noted two residual linear scars, 2.5 centimeters and 3 centimeters long, that were non-tender and not painful. None of the scars by themselves were noted to result in any limitation of function. The Board notes that a second VA examination was afforded that year in October 2015. However, this examination was only for the purposes of evaluating the severity of a scar on the Veteran's scalp, which is separately service-connected and not on appeal. At the Veteran's hearing before the undersigned, he was asked if any scar was painful and noted that he could not distinguish between the pain in his toe and its scar, and that his back scar was "itchy" and "aggravating." He also specifically stated that his right finger scar was not painful. Upon VA examination again in March 2021, physical examination of the Veteran's scars was not in conflict with the 2015 examination. No scar of the toe, finger, or back was noted to be painful or unstable, deep and nonlinear, associated with underlying soft tissue damage, of an area of at least 6 square inches, or resulting in any limitation of function. The Veteran's treatment records are not in significant conflict with the above findings upon examination. Based on the foregoing, the Board finds that a compensable rating for any of the Veteran's scars on appeal is not warranted. The Board has considered all relevant Diagnostic Codes pertaining to scars. None of the Veteran's scars on appeal are deep and non-linear, associated with underlying soft tissue damage, unstable or painful, or at least 6 square inches. Therefore, Diagnostic Codes 7801, 7802, and 7804 are inapplicable. The evidence of record also shows there are no other disabling effect(s) related to these scars by themselves not considered in a rating provided under Diagnostic Codes 7801 to 7004. Therefore, Diagnostic Code 7805 is also inapplicable. 38 C.F.R. § 4.118. Thus, as the preponderance of the evidence is against the Veteran's claim for a compensable rating for his right knuckle, left side of back, and left toe scars, the claim for an increased rating must be denied. 38 C.F.R. §§ 4.3, 4.7. The Board is sympathetic to the Veteran's lay statements that his scars are worse than currently evaluated, and those statements have been considered. The Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). He is not, however, competent to identify a specific level of disability according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran's scars have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and the clinical records) directly address the criteria under which the disabilities are evaluated. The medical and lay evidence has been assessed by the Board in determining the overall disability rating. REASONS FOR REMAND In correspondence received by VA on February 17, 2021, the Veteran suggested that he was unemployable due to service-connected disabilities. A claim for a total disability rating based on individual unemployability, whether expressly or reasonably raised by the record, is not a separate claim for benefits but is instead part of the adjudication of a claim for increased compensation. Rice v. Shinseki, 22 Vet. App. 447 (2009). Thus, when entitlement to a TDIU is raised during the appeal of a disability rating, it is part of the claim for benefits for the underlying disability. Id. at 453-54. However, this issue is not yet ripe for review and must be remanded for additional development. See VAOPGCPREC 6-96. The Veteran has not submitted a formal application for a TDIU and has not been provided with notice appropriate for such a claim. Such must be remedied on remand. The matter is therefore REMANDED for the following action: Request that the Veteran complete a VA Form 21-8940 (Veteran's Application for Increased Compensation Based on Unemployability) and issue the Veteran notice consistent with his claim of entitlement to a TDIU. Then, undertake any additional development, as warranted. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Scarduzio, 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.