Citation Nr: A21017205 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 210422-155064 DATE: October 25, 2021 ORDER A rating in excess of 40 percent for intervertebral disc syndrome of the lumbar spine (hereinafter, "lumbar spine disability") is denied. A rating in excess of 10 percent for right lower extremity radiculopathy is denied. A rating in excess of 30 percent for widespread dermatitis pilaris and scattered folliculitis with onychomycosis of both feet (hereinafter, "skin disability") is denied. A rating in excess of 20 percent for cervical spondylosis (hereinafter, "cervical spine disability") is denied. An initial rating in excess of 20 percent for right upper extremity radiculopathy is denied. A rating in excess of 10 percent for chondromalacia of the right patella (hereinafter, "right knee disability") is denied. Restoration of a 30 percent rating for left upper extremity radiculopathy is granted, effective July 27, 2020. An effective date earlier than April 17, 2020 for the award of a 40 percent rating for lumbar spine disability is denied. An effective date earlier than April 17, 2020 for the award of a 20 percent rating for cervical spine disability is denied. An effective date earlier than April 17, 2020 for the award of a 20 percent rating for right upper extremity radiculopathy is denied. An effective date earlier than April 17, 2020 for the award of a 10 percent rating for right knee disability is denied. An earlier effective date for the award of a 30 percent rating for skin disability is denied. An earlier effective date for the award of a 10 percent rating for right lower extremity radiculopathy is denied. An earlier effective date of January 27, 2017 is granted for the award of a total disability rating based on individual unemployability due to service-connected disability (TDIU), subject to the law and regulations governing the award of monetary benefits. An earlier effective date of January 27, 2017 is granted for the establishment of basic eligibility for education benefits under Chapter 35, Title 38, United States Code (Dependents' Education Assistance (DEA)). FINDINGS OF FACT 1. During the period on appeal, the Veteran's service-connected lumbar spine disability was not manifested by ankylosis or the functional equivalent thereof, incapacitating episodes as defined by VA regulation, or associated neurologic impairment other than the already separately evaluated right lower extremity radiculopathy. 2. During the period on appeal, the Veteran's service-connected right lower extremity radiculopathy was not manifested by moderate incomplete paralysis. 3. During the period on appeal, the Veteran's service-connected skin disability was not manifested by characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; nor was it manifested by a requirement of constant or near-constant systemic therapy over the past 12-month period. 4. During the period on appeal, the Veteran's service-connected cervical spine disability was not manifested by forward flexion limited to 15 degrees or less, ankylosis or the functional equivalent thereof, incapacitating episodes as defined by VA regulation, or associated neurologic impairment other than the already separately evaluated upper extremity radiculopathy. 5. During the period on appeal, the Veteran's service-connected right upper extremity radiculopathy was not manifested by moderate incomplete paralysis. 6. During the period on appeal, the Veteran's service-connected right knee disability exhibited painful motion, but was not manifested by flexion limited to 30 degrees or less, or extension limited to 15 degrees or more. 7. The evidence does not establish that there was actual improvement of the Veteran's service-connected left upper extremity radiculopathy under the normal circumstances of life and work at the time of the reduction at issue. 8. The Veteran did not have an unadjudicated claim pertaining to his lumbar spine disability prior to April 17, 2020. 9. The Veteran did not have an unadjudicated claim pertaining to his cervical spine disability prior to April 17, 2020. 10. The Veteran did not have an unadjudicated claim pertaining to the radiculopathy of his right upper extremity prior to April 17, 2020. 11. The Veteran did not have an unadjudicated claim pertaining to his right knee disability prior to April 17, 2020. 12. The Veteran has been in receipt of a 30 percent rating for his service-connected skin disability since July 1, 1993, which is the day after his separation from service. 13. A November 2017 rating decision established service connection for right lower extremity radiculopathy, evaluated as 10 percent disabling from January 27, 2017; the Veteran was informed of that decision, including his right to appeal, and did not appeal. 14. The Veteran had a TDIU claim pending from January 27, 2017 that was not adjudicated until July 2020. 15. From January 27, 2017 to April 16, 2020 the Veteran was service connected for a lumbar spine disability, evaluated as 20 percent disabling; right lower extremity radiculopathy, evaluated as 10 percent disabling; a skin disability, evaluated as 30 percent disabling; hemorrhoids, evaluated as 10 percent disabling; cervical spine disability, evaluated as 10 percent disabling; left upper extremity radiculopathy, evaluated as 30 percent disabling; and a right knee disability, retinal scarring, and residual scars from cyst removal, all evaluated as 0 (zero) percent (noncompensably) disabling. His overall combined rating was 70 percent. 16. It is at least as likely as not that the Veteran was unable to obtain and/or maintain substantially gainful employment due to his service-connected disabilities for the period from January 27, 2017 to April 16, 2020. 17. The basic eligibility criteria for education benefits under Chapter 35 (DEA) are met from January 27, 2017. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 40 percent for service-connected lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 2. The criteria for a rating in excess of 10 percent for service-connected right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8520. 3. The criteria for a rating in excess of 30 percent for service-connected skin disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.118, Diagnostic Code 7806. 4. The criteria for a rating in excess of 20 percent for service-connected cervical spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71, Diagnostic Code 5237-5243. 5. The criteria for an initial rating in excess of 20 percent for service-connected right upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8512. 6. The criteria for a rating in excess of 10 percent for service-connected right knee disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 7. The reduction in the evaluation of left upper extremity radiculopathy, from 30 to 20 percent, was improper. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.105, 3.344, 4.1, 4.2, 4.3, 4.7, 4.10, 4.13. 8. The criteria for an effective date earlier than April 17, 2020 for the assignment of a 40 percent rating for service-connected lumbar spine disability have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 9. The criteria for an earlier effective date for the assignment of a 30 percent rating for service-connected skin disability have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 10. The criteria for an effective date earlier than April 17, 2020 for the assignment of a 20 percent rating for service-connected cervical spine disability have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 11. The criteria for an effective date earlier than April 17, 2020 for assignment of a 20 percent rating for service-connected radiculopathy of the right upper extremity have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 12. The criteria for an effective date earlier than April 17, 2020 for assignment of a 10 percent rating for service-connected right knee disability have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 13. The criteria for an earlier effective date for the assignment of a 10 percent rating for service-connected radiculopathy of the right lower extremity have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 14. Resolving reasonable doubt in the Veteran's favor, the criteria for an earlier effective date of January 27, 2017 for the award of a TDIU have been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.340, 3.400, 4.16. 15. The criteria for an earlier effective date of January 27, 2017 for the establishment of basic eligibility for education benefits under Chapter 35 (DEA) have been met. 38 U.S.C. §§ 3500, 3501, 3510, 5107, 5110; 38 C.F.R. §§ 3.400, 3.807. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from June 1968 to June 1993. The original rating decision underlying this appeal was issued in July 2020 by a Department of Veterans Affairs (VA) Regional Office (RO). Following a denial on Higher-Level Review in March 2021, the Veteran timely appealed to the Board of Veterans' Appeals (Board), requesting direct review of the evidence considered by the agency of original jurisdiction. See April 2021 VA Form 10182; 38 C.F.R. §§ 20.202, 20.202(b)(1). Increased Rating Disability evaluations are determined by the application of a schedule of ratings, which is in turn based on the average impairment of earning capacity caused by a given disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the evaluations to be assigned to the various disabilities. The law mandates resolving any reasonable doubt regarding the degree of disability in favor of the claimant. 38 C.F.R. § 4.3. If there is a question as to which of two evaluations shall be 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. If different disability ratings are warranted for different periods of time over the life of a claim, "staged" ratings may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). The Board notes that the current evaluations for the Veteran's service-connected lumbar spine disability, right upper extremity radiculopathy, and right knee disability were all made effective from April 17, 2020; and he contended that an earlier effective date was warranted for those ratings. Issues of entitlement to earlier effective dates for the assignment of a 30 percent rating for service-connected skin disability, and a 10 percent rating for right lower extremity radiculopathy, are also before the Board. For the reasons detailed below, the Board finds that no earlier effective dates are warranted for these disabilities. As such, in evaluating these disabilities, the Board's focus is on the severity of those disabilities from April 17, 2020. The Board also notes that revisions were made to some of the rating criteria used to evaluate disabilities of the musculoskeletal system and muscle injuries, effective February 7, 2021. See 85 Fed. Reg. 76453 (November 30, 2020). However, those revisions did not take effect until after the record on appeal closed in July 2020. As such, they are not applicable. 1. Entitlement to a rating in excess of 40 percent for lumbar spine disability The Veteran's lumbar spine disability has been evaluated pursuant to the General Rating Formula for Diseases and Injuries of the Spine, which provides that with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees, but not greater than 85 degrees; or, if the combined range of motion of the thoracolumbar spine is greater than 120 degrees, but not greater than 235 degrees; or, if there is muscle spasm, guarding, or localized tenderness not resulting in an abnormal gait or abnormal spinal contour; or, if there has been a vertebral body fracture with loss of 50 percent or more of the height. An evaluation of 20 percent is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; or if the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or if there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. An evaluation of 40 percent is warranted for forward flexion of the thoracolumbar spine limited to 30 degrees or less; or for favorable ankylosis of the entire thoracolumbar spine. An evaluation of 50 percent requires unfavorable ankylosis of the entire thoracolumbar spine. An evaluation of 100 percent requires unfavorable ankylosis of the entire spine. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right lateral rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees, and the normal ranges of motion for each component of spinal motion are the maximum that can be used for calculation of the combined range of motion. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (2). For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). The Veteran's lumbar spine disability has been manifested by pain and resulting functional impairment, to include limitation of motion. He also reported at a July 2020 VA examination that the pain hindered a restful night's sleep, as well as caused difficulty with extended standing and walking. When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated by the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The United States Court of Appeals for Veterans Claims (Court) has clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). The Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis, and must be considered when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011). The evaluation criteria are meant to encompass and take into account the presence of pain, stiffness, or aching, which are generally present when there is a disability of the spine. Therefore, an evaluation based on pain alone would not be appropriate, unless there is specific nerve root pain, for example, that could be evaluated under the neurologic sections of the rating schedule. Here, the evidence does not reflect that the Veteran's service-connected lumbar spine disability was manifested by ankylosis during the period on appeal. In fact, the July 2020 VA examination explicitly found that he did not have ankylosis, nor does the record show he was otherwise diagnosed with ankylosis. The record also does not reflect functional impairment that is the equivalent of favorable and/or unfavorable ankylosis under the General Rating Formula for Diseases and Injuries of the Spine, to include during flare-ups. See Chavis v. McDonough, No. 18-2928 (U.S. Vet. App. April 16, 2021). As a general matter, the Board notes that ankylosis is the immobility and consolidation of a joint due to disease, injury, or surgical procedure. See Dinsay v. Brown, 9 Vet. App. 79, 81 (1996); Lewis v. Derwinski, 3 Vet. App. 259 (1992) (citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)). Here, the July 2020 VA examination showed that the lumbar spine had forward flexion to 30 degrees; and extension, right and left lateral flexion and rotation all to 10 degrees. Although these results reflect limitation of motion, they do not show immobility and/or consolidation of the joint. Further, there was no change in these results following repetitive use testing. Moreover, the examiner stated that these results were medically consistent with the Veteran's statements describing functional loss with repeated use over time, and during flare-ups. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Veteran has not identified any inaccuracy regarding the July 2020 VA examination findings, to include in his April 2021 Form 10182. In light of the foregoing, the Board finds the Veteran's service-connected lumbar spine disability was not manifested by the functional equivalent of ankylosis during the period that is the focus of this appeal. The Board has also considered the applicability of the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. See 38 C.F.R. § 4.71a, Diagnostic Code 5243. As noted above, intervertebral disc syndrome is recognized as part of the Veteran's service-connected disability. However, for purposes of the Formula, an incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. See 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note (1). Here, a thorough review of the record does not reflect that the disability of the Veteran's lumbar spine has been manifested by incapacitating episodes as defined by VA regulation. In fact, the July 2020 VA examination report explicitly stated that the Veteran did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. As an additional matter, the Board observes that Note (1) of the General Rating Formula for Diseases and Injuries of the Spine provides that any associated objective neurologic impairments should be rated separately under the appropriate Diagnostic Code. See 38 C.F.R. § 4.71a. Here, the record, including the VA examination reports in this case, do not reflect that he has associated neurologic impairment other than the already separately evaluated radiculopathies of the lower extremities. No additional, separate ratings are warranted. In light of the foregoing, the Board must find that the preponderance of the evidence is against the assignment of a rating in excess of 40 percent for the Veteran' service-connected lumbar spine disability, to include on the basis of "staged" rating(s). The appeal of this issue is denied. 2. Entitlement to a rating in excess of 10 percent for right lower extremity radiculopathy The Veteran's right lower extremity radiculopathy is evaluated pursuant to the criteria found at 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under that diagnostic code, complete paralysis of the sciatic nerve, which is rated as 80 percent disabling, contemplates the foot dangling and dropping, no active movement possible of the muscles below the knee, and flexion of the knee weakened or (very rarely) lost. Incomplete paralysis of the sciatic nerve warrants a 60 percent evaluation if it is severe with marked muscular atrophy; a 40 percent evaluation if it is moderately severe; a 20 percent evaluation if it is moderate; and a 10 percent evaluation if it is mild. Neuritis and neuralgia of the nerve are evaluated on a similar scale under Diagnostic Codes 8620 and 8720. 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 terms "mild," "moderate," and "severe" are not defined in the 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. The use of terminology such as "moderate" or "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. The Board notes, for reference and illustrative purposes, that the definition for "mild" includes not very severe. WEBSTER'S II NEW COLLEGE DICTIONARY at 694 (1995). In addition, a synonym for "mild" is "slight" and definitions for "slight" include small in size, degree, or amount. Id. at 1038. The definitions for "moderate" include of average or medium quantity, quality, or extent. Id. at 704. Finally, definitions of "severe" include extremely intense. Id. at 1012. It is noted that the term "moderately severe" indicates impairment greater than moderate but not to the extent as to be considered severe. The Board also acknowledges that VA's Adjudication Manual, M21-1, III.iv.4.N.4.c (November 16, 2017) discusses the terminology in 38 C.F.R. § 4 .124a, Diagnostic Codes 8510-8730. The Manual indicates with regard to "mild" as follows: As this is the lowest level of evaluation for each nerve this is the default assigned based on the symptoms, however slight, as long as they were sufficient to support a diagnosis of the peripheral nerve impairment for service connection purposes. In general, look for a disability limited to sensory deficits that are lower graded, less persistent, or affecting a small area. A very minimal reflex or motor abnormality potentially could also be consistent with mild incomplete paralysis. The Manual indicates with regard to "moderate": Symptoms will likely be described by the claimants and medically graded as significantly disabling. In such cases a larger area in the nerve distribution may be affected by sensory symptoms. Other sign/symptom combinations that may fall into the moderate category include combinations of significant sensory changes and reflex or motor changes of a lower degree, or motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate. The Manual indicates with regard to "moderately severe": The moderately severe evaluation level is only applicable for involvement of the sciatic nerve. This is the maximum rating for sciatic nerve neuritis not characterized by the organic changes specified in 38 C.F.R. § 4.123. Motor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a high level of limitation or disability is expected. Atrophy may be present. However, for marked muscular atrophy see the criteria for a severe evaluation under 38 C.F.R. § 4.124a, Diagnostic Code 8520. The Manual indicates with regard to "severe": In general, expect motor and/or reflex impairment (for example, atrophy, weakness, or diminished or hyperactive reflexes) at a grade reflecting a very high level of limitation or disability. Trophic changes may be seen in severe longstanding neuropathy cases. For the sciatic nerve (38 C.F.R. § 4.124a, Diagnostic Code 8520) marked muscular atrophy is expected. Even though severe incomplete paralysis cases should show findings substantially less than representative findings for complete impairment of the nerve, the disability picture for severe incomplete paralysis may contain signs/symptoms resembling some of those expected in cases of complete paralysis of the nerve. Neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain should be rated as high as severe incomplete paralysis of the nerve (38 C.F.R. § 4.123). Prior to November 2017 revisions, VA's Adjudication Procedures Manual M21-1, Part III, Subpart iv, Chapter 4, § G(4) defined "mild" incomplete paralysis as demonstrating subjective symptoms or diminished sensation; "moderate" incomplete paralysis as featuring the absence of sensation confirmed by objective findings; and "severe" incomplete paralysis as featuring more than sensory findings (such as atrophy, weakness, and diminished reflexes). In June 2016, VA amended the M21-1 adjudication manual "to further clarify the intent of VA's policy," and the relevant portion of the M21-1 adjudication manual included the following: Important: This provision does not mean that if there is any impairment that is non-sensory (or involves a non-sensory component) such as a reflex abnormality, weakness or muscle atrophy, the disability must be evaluated as greater than moderate. Significant and widespread sensory impairment may potentially indicate the same or even more disability than a case involving a minimally reduced or increased reflex or minimally reduced strength. The Adjudication Manual is not binding on the Board. DAV v. Sec'y of Veterans Affairs, 859 F.3d 1072, 1077 (Fed. Cir. 2017) ("The M21-1 Manual is binding on neither the agency nor tribunals"). Nevertheless, it does provide useful guidance in defining these terms, particularly if the Veteran demonstrates impairment consistent with higher rating(s) than that currently in effect. Stated another way, the Board will look to see if there are findings that would warrant a higher rating under the M21-1 provisions, but will not deny a higher rating for the sole reason that those provisions are not satisfied. During the period on appeal, the Veteran's service-connected right lower extremity radiculopathy was not manifested by moderate incomplete paralysis. In pertinent part, at the July 2020 VA examination the Veteran was found to have mild incomplete paralysis of the right lower extremity. Although the Board is not bound by this finding, it is probative evidence for consideration. As detailed below, the Board is persuaded that the Veteran's radiculopathy is, in fact, shown to be no more than mild in degree (i.e., it is not very severe, and is no more than small in size, degree, or amount). Initially, the Board notes that the Veteran denied constant pain of the right lower extremity at the July 2020 VA examination. He also reported no more than mild intermittent pain, paresthesias and/or dysesthesias, and numbness of the right lower extremity. Sensory examination was decreased but not absent for the right upper anterior thigh, thigh/knee, lower leg/ankle, and foot/toes. Moreover, muscle strength testing was 5/5 (normal strength) throughout the right lower extremity. Similarly, reflexes were 2+ (normal) for the right knee and ankle. In short, the July 2020 VA examination revealed little or no functional impairment of the right lower extremity, which is consistent with a finding of mild incomplete paralysis. The Veteran has not identified any inaccuracy with respect to these examination findings. Nothing in the other evidence of record demonstrates moderate incomplete paralysis of the right lower extremity during the period that is the focus of this appeal, to include on the basis of "staged" ratings. In light of the foregoing, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 10 percent for the service-connected right lower extremity radiculopathy. The appeal of this issue is denied. 3. Entitlement to a rating in excess of 30 percent for a skin disability The Veteran's service-connected skin disability is currently evaluated pursuant to the General Rating Formula for the Skin. 38 C.F.R. § 4.118, Diagnostic Code 7806. Under that Formula, a 10 percent rating is warranted for characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body; or at least 5 percent, but less than 20 percent, of exposed areas affected; or when intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs have been required for a total duration of less than 6 weeks over the past 12-month period. A 30 percent rating is warranted for characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or when systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs have been required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is warranted for characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or when constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs have been required over the past 12-month period. Here, a July 2020 VA skin diseases examination found that the Veteran's service-connected skin disability covered 20 to 40 percent of his total body area and did not affect exposed areas. Moreover, the report of that examination stated that he had received no medical treatment for the service-connected disability, to include any type of systemic therapy. The Veteran has not identified any inaccuracy with respect to these examination findings. Further, nothing in the other evidence of record for this period demonstrates that the service-connected disability was manifested by characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or by a need for constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs have over the past 12 months. For these reasons, the Board finds the preponderance of the evidence is against a rating in excess of 30 percent for the Veteran's service-connected skin disability, to include as a "staged" rating. The appeal as to this issue is denied. 4. Entitlement to a rating in excess of 20 percent for cervical spine disability The General Rating Formula for Diseases and Injuries of the Spine provides that with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, a 10 percent rating is warranted for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, if the combined range of motion of the cervical spine is greater than 170 degrees, but not greater than 335 degrees; or, if there is muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, if there is vertebral body fracture with loss of 50 percent or more of the height. An evaluation of 20 percent is warranted for forward flexion of the cervical spine greater than 15 degrees, but not greater than 30 degrees; or, if the combined range of motion of the cervical spine is not greater than 170 degrees. Forward flexion of the cervical spine to 15 degrees or less, or favorable ankylosis of the entire cervical spine, warrants a 30 percent evaluation. An evaluation of 40 percent is warranted for unfavorable ankylosis of the entire cervical spine. 38 C.F.R. § 4.71a. Here, even with consideration of the Veteran's complaints of pain, the record does not reflect that his cervical spine disorder has been manifested by forward flexion limited to 15 degrees or less during the period that is the focus of this appeal. In pertinent part, pain and tenderness was noted at a July 2020 VA examination of the Veteran's neck. He also reported difficulty with side to side movement. In addition, pain was noted in weight bearing and non-weight bearing. See Correia v. McDonald, 28 Vet. App. 158 (2016). Nevertheless, he had forward flexion of the cervical spine to 30 degrees. Passive motion was the same as active motion. Id. There was no change following repetitive motion testing. Further, the examiner stated the examiner stated that these results were medically consistent with the Veteran's statements describing functional loss with repeated use over time, and during flare-ups. See Sharp, supra. The Board also notes that the July 2020 VA examination explicitly found there was no ankylosis of the cervical spine. Moreover, the aforementioned range of motion findings reflect the Veteran would not have the functional equivalent of ankylosis during flare-ups. See Chavis, supra. The Board further notes that while the July 2020 VA examiner found the Veteran to have intervertebral disc syndrome of the cervical spine, it was also found he did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. Nothing in the other evidence of record demonstrates incapacitating episodes as defined by VA regulation. Thus, the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes is not for application in this case. Finally, the Board finds the Veteran does not have any associated neurologic impairment of the cervical spine other than the already separately evaluated radiculopathy of the upper extremities. In pertinent part, the July 2020 VA examination explicitly found there was no such additional impairment. The Veteran has not identified any inaccuracy regarding the findings of the July 2020 VA examination of his cervical spine, to include as part of the pertinent April 2021 Form 10182. For all of these reasons, the Board finds that a rating in excess of 20 percent is not warranted for the Veteran's service-connected cervical spine disability, to include as a "staged" rating. The appeal of this issue is denied. 5. Entitlement to an initial rating in excess of 20 percent for right upper extremity radiculopathy The Veteran's service-connected radiculopathies of the upper extremities have been evaluated pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8512 based on impairment of the lower radicular group. For the dominate extremity (in this case, the Veteran's right extremity), that diagnostic code provides for a 20 percent rating for mild incomplete paralysis, a 40 percent rating for moderate incomplete paralysis, a 50 percent rating for severe incomplete paralysis, and a 70 percent rating for complete paralysis of the lower radicular group manifested by a list of impairments to the hand. Similarly, for the non-dominate (left) upper extremity, a 20 percent rating is warranted for mild incomplete paralysis, a 30 percent is warranted for moderate incomplete paralysis, a 40 percent rating is warranted for severe incomplete paralysis, and a 60 percent rating is available for complete paralysis. Here, the record does not reflect that the Veteran's right upper extremity radiculopathy was manifested by moderate incomplete paralysis during the period on appeal. In pertinent part, the July 2020 VA examination found the Veteran to have mild incomplete paralysis. He denied constant pain of the right upper extremity and reported no more than mild intermittent pain, paresthesias and/or dysesthesias, and numbness of the right upper extremity. Sensory examination was decreased but not absent for the shoulder area and inner/outer forearm. Moreover, muscle strength testing was 5/5 (normal strength) throughout the right upper extremity. In short, the July 2020 VA examination report revealed little or no functional impairment of the right upper extremity, which is consistent with a finding of mild incomplete paralysis; i.e., paralysis that was not very severe, and no more than small in size, degree, or amount. The Veteran has not identified any inaccuracy with respect to the aforementioned findings on the pertinent July 2020 VA examination. Nothing in the other evidence of record demonstrates moderate incomplete paralysis of the right upper extremity during the period that is the focus of this appeal. In light of the foregoing, the Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for service-connected right upper extremity radiculopathy. The appeal as to this issue is denied. 6. Entitlement to a rating in excess of 10 percent for right knee disability The Veteran seeks a higher rating for his right knee disability. In pertinent part, the record reflects that he has painful motion of the knee. For limitation of motion, there are two potentially applicable diagnostic codes. First, Diagnostic Code 5260, which provides evaluations based on limitation of flexion. Limitation of flexion to 60 degrees merits a noncompensable, or 0 percent, evaluation. A 10 percent evaluation is assigned for limitation to 45 degrees. Limitation to 30 degrees of flexion warrants a 20 percent evaluation, and a 30 percent evaluation is assigned for limitation of flexion to 15 degrees. Limitation of extension is rated under Diagnostic Code 5261. A noncompensable evaluation is assigned for limitation of extension to 5 degrees. A 10 percent evaluation is for assignment when extension is limited to 10 degrees. Fifteen degrees of limitation merits a 20 percent evaluation, and 20 degrees of limitation merits a 30 percent evaluation. Limitation to 30 degrees is evaluated as 40 percent disabling, and limitation to 45 degrees warrants a 50 percent evaluation. VA General Counsel held in VAOPGCPREC 9-2004 that separate ratings under Diagnostic Codes 5260 and 5261 may be assigned for disability of the same joint. Normal range of motion of the knee is from zero degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II. Here, even when taking into account the Veteran's complaints of pain, his right knee was not manifested by flexion limited to 30 degrees or less, or extension limited to 15 degrees or more, during the period on appeal. In pertinent part, the July 2020 VA examination of the knees noted that the Veteran reported difficulty standing for long periods of time. There was evidence of pain in weight bearing and non-weight bearing. Nevertheless, he had right knee flexion to 70 degrees, and normal extension to 0 degrees. Passive motion was the same as active motion. There was no change following repetitive use testing. In addition, the examiner stated that these results were medically consistent with the Veteran's statements describing functional loss with repeated use over time, and during flare-ups. In short, the July 2020 VA examination findings do not reflect that the Veteran had limitation of motion to the extent necessary for a rating in excess of 10 percent, or assignment of separate compensable ratings under Diagnostic Code 5260 and 5261. No such limitation is demonstrated in the other evidence of record for the period that is the focus of this appeal. VA recognizes that separate ratings may be assigned for knee disability under some Diagnostic Codes where the symptomatology supporting the evaluations does not overlap; limitation of motion (5260/5261) and instability (5257) are distinct from each other, for example. 38 C.F.R. § 4.41; see generally VAOPGCPREC 23-97 and VAOPGCREC 9-98. However, as discussed below, no such separate and distinct symptomatology is demonstrated in this case. In pertinent part, the Board notes that the required manifestations for evaluation under Diagnostic Codes 5256 (knee, ankylosis), 5258 (cartilage, dislocated, semilunar), 5259 (symptomatic removal of semilunar cartilage), 5262 (tibia and fibula, impairment of), and 5263 (genu recurvatum) are not applicable, as the presence of ankylosis of the right knee, dislocation or removal of the semilunar cartilage, impairment of the tibia or fibula, or genu recurvatum has not been demonstrated. Prior to February 7, 2021, Diagnostic Code 5257 provided that slight impairment of either knee, including recurrent subluxation or lateral instability, warranted a 10 percent evaluation. A 20 percent evaluation required moderate impairment, while a 30 percent evaluation required severe impairment. As noted, significant changes were made to the criteria for evaluating orthopedic disabilities under 38 C.F.R. § 4.71a, effective February 7, 2021. See 85 Fed. Reg. 76460 (Feb 7, 2021). VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of the change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. Here, as noted previously, the revisions at issue did not take effect until after the record on appeal closed in July 2020. As such, they are not applicable. Moreover, even assuming the revisions could be applied, they would not result in the assignment of a higher or separate rating. Effective February 7, 2021, Diagnostic Code 5257 provides ratings for both recurrent subluxation or instability of the knee and for patellar instability. As it pertains to recurrent subluxation or instability of the knee, new Diagnostic Code 5257 provides a 10 percent rating for a sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for either (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device, or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device or bracing for ambulation. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device and bracing for ambulation. As it pertains to patellar instability of the knee, new Diagnostic Code 5257 provides a 10 percent rating for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A 30 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Note (1) provides that for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note (2) provides that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). In this case, the July 2020 VA examination report explicitly noted that the Veteran did not have a history of recurrent subluxation or instability of the right knee. Further, joint stability tests were all normal. In addition, there was no evidence he required the use of a brace. No such impairment is demonstrated in the other evidence of record for the period that is the focus of this appeal. In addition, the Veteran has not identified any inaccuracy regarding the July 2020 VA examination findings as they related to his right knee, to include in his April 2021 Form 10182. In light of the foregoing, the Board finds the preponderance of the evidence is against the Veteran's claim for a rating in excess of 10 percent for his service-connected right knee disability. The appeal of this issue is denied. 7. Propriety of the reduction of the evaluation for radiculopathy of the left upper extremity, from 30 percent to 20 percent The provisions of 38 C.F.R. § 3.105(e) allow for the reduction in evaluation of a service-connected disability when warranted by the evidence, but only after following certain procedural guidelines. The RO must issue a rating action proposing the reduction and setting forth all material facts and reasons for the reduction. The veteran must then be given 60 days to submit additional evidence and to request a predetermination hearing. Then a rating action will be taken to effectuate the reduction. 38 C.F.R. § 3.105(e). The effective date of the reduction will be the last day of the month in which a 60-day period from the date of notice to the veteran of the final action expires. 38 C.F.R. § 3.105(e), (i)(2)(i). In this case, the Veteran did not receive notice of the proposed reduction in the assigned rating for his service-connected left upper extremity radiculopathy. However, as noted in the July 2020 rating decision that effectuated the reduction, the reduction did not cause a change in the Veteran's combined disability rating. Therefore, the regulation governing the procedural steps generally required in rating reduction cases did not apply. See Stelzel v. Mansfield, 508 F.3d 1345, 1349 (Fed. Cir. 2007) (holding that VA was not obligated to provide a veteran with 60 days' notice if the decision did not reduce the overall compensation paid to the veteran); see also VAOPGCPREC 71-91 (Nov. 7, 1991) (where the evaluation of a specific disability is reduced, but the amount of compensation is not reduced because of a simultaneous increase in the evaluation of one or more other disabilities, section 3.105(e) does not apply). Notwithstanding the fact the procedural steps of 38 C.F.R. § 3.105(e) do not apply in this case, a rating reduction is not proper unless the veteran's disability shows actual improvement in his or her ability to function under the ordinary conditions of life and work. See Faust v. West, 13 Vet. App. 342, 349 (2000). Regulations "impose a clear requirement that VA rating reductions . . . be based upon a review of the entire history of the Veteran's disability." Brown v. Brown, 5 Vet. App. 413, 420 (1993); 38 C.F.R. §§ 4.1, 4.2, 4.13. A rating reduction is proper if the evidence reflects an actual change in the disability. The examination reports reflecting such change must be based upon thorough examinations. Brown, 5 Vet. App. at 421. The evidence must reflect an actual change in the Veteran's condition and not merely a difference in the thoroughness of the examination or in the use of descriptive terms. 38 C.F.R. § 4.13. It must also be determined that any such improvement also reflects an improvement in the veteran's ability to function under ordinary conditions of life and work. 38 C.F.R. §§ 4.2, 4.10; Brown, supra. Significantly, in a rating reduction case, VA has the burden of establishing that the disability at issue has improved. A rating reduction case focuses on the propriety of the reduction and is not the same as an increased rating case. See Peyton v. Derwinski, 1 Vet. App. 282, 286 (1991). In considering the propriety of a reduction, the Board must focus on the evidence available to the adjudicator at the time the reduction was effectuated, although post-reduction evidence may be considered in the context of evaluating whether the condition demonstrated actual improvement. Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-282 (1992). In this case, no explicit determination was made regarding whether there was actual improvement of the Veteran's service-connected left upper extremity radiculopathy under the normal circumstances of life and work at the time of the reduction. There was also no such determination at the time of the July 2020 VA examination. Following review of the record, the Board is not persuaded that the evidence establishes that there was actual improvement in the Veteran's service-connected left upper extremity radiculopathy under the normal circumstances of life and work at the time of the reduction at issue. As such, the reduction was improper. The prior 30 percent rating is restored effective July 27, 2020. Effective Date In general, the effective date for an award of service connection is the date of receipt of the claim, or the date entitlement arose, whichever is later. The effective date of an award based on a claim reopened after final adjudication shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of the application to reopen. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. Similarly, the effective date for an increased rating will be the date of receipt of the claim, or the date entitlement arose, whichever is later. Id. For an increase in disability compensation, the effective date will be the earliest date as of which it is factually ascertainable that an increase in disability occurred if a claim is received within 1 year from such date; otherwise, it is the date of receipt of the claim. 38 C.F.R. § 3.400(o)(2). The Board notes that VA amended its regulations on March 24, 2015 to require that claims be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The amendments, however, are only effective for claims and appeals filed on or after March 24, 2015. Prior to March 24, 2015, VA recognized formal and informal claims. A formal claim was one that had been filed on a form prescribed by the Secretary. 38 C.F.R. § 3.151. Any communication or action from a claimant indicating an intent to apply for one or more benefits under the laws administered by VA could be considered an informal claim. Upon receipt of an informal claim, if a formal claim had not been filed, an application form was to be forwarded to the claimant for execution. If received within 1 year from the date it was sent to the claimant, the formal claim was considered to have been filed as of the date of receipt of the informal claim. When a claim had been filed which met the requirements of 38 C.F.R. § 3.151, an informal request for increase or reopening was accepted as a claim. 38 C.F.R. § 3.155. 8. Entitlement to an effective date earlier than April 17, 2020 for the assignment of a 40 percent rating for lumbar spine disability 9. Entitlement to an effective date earlier than April 17, 2020 for the assignment of a 20 percent rating for cervical spine disability 10. Entitlement to an effective date earlier than April 17, 2020 for assignment of a 20 percent for right upper extremity radiculopathy 11. Entitlement to an effective date earlier than April 17, 2020 for assignment of a 10 percent rating for right knee disability. In this case, the Board finds that the record does not reflect that the Veteran had any unadjudicated claims regarding his lumbar spine, cervical spine disability, right upper extremity radiculopathy, and/or right knee disability prior to April 17, 2020. In pertinent part, the record reflects that many of these disabilities had been adjudicated in prior decisions. For example, a February 1993 rating decision established service connection for the lumbar spine disability, effective July 1, 1993, and evaluated it as 10 percent disabling. A September 1994 rating decision denied a rating in excess of 10 percent for the service-connected lumbar spine disability. That decision also granted service connection for acne lesions, evaluated as noncompensable from July 1, 1993. Thereafter, a November 1994 rating decision assigned a 10 percent rating for the acne lesions from October 24, 1994. Rating decisions dated in April 1995, August 1995, and January 1996 continued the 10 percent evaluations for both the Veteran's lumbar spine disability and acne lesions. The record reflects that the Veteran perfected an appeal as to ratings in excess of 10 percent for the lumbar spine disability and acne lesions. Following a June 1997 Board remand of those issues, a December 1997 rating decision assigned a 20 percent rating for the lumbar spine disability, effective October 1, 1997; and denied a rating in excess of 10 percent for the acneform lesions. That decision also granted service connection for the right knee disability, effective July 1, 1993, and evaluated that disability as noncompensably disabling. A subsequent decision review officer (DRO) rating action in April 1998 reflects that the 20 percent rating for the lumbar spine disability was made effective July 1, 1993. Thereafter, a November 1999 conference report reflects that the Veteran contended that he was entitled to a 30 percent rating for his acneform lesions and was agreeable to withdrawing his appeal on that issue should such a rating be granted. The Veteran reiterated this position in a statement dated that same month. He also reported in that statement that the 20 percent rating for his lumbar spine from July 1, 1993 satisfied his appeal of that issue. A DRO rating decision issued later in November 1999 assigned a 30 percent rating for the Veteran's acneform lesions from July 1, 1993. The Veteran's November 1999 statement withdrew his appeal as to the lumbar spine claim, and that his appeal on the skin disability claim was limited to a 30 percent rating effective from July 1, 1993. Consequently, the claims for which appeals had been filed were resolved. A subsequent November 2017 rating decision granted service connection for right lower extremity radiculopathy associated with the lumbar spine disability. An initial 10 percent rating was assigned, effective January 27, 2017. That decision also denied ratings in excess of 20 percent for the lumbar spine disability, and a rating in excess of 30 percent for the skin disability. That decision further recognized the skin disability as being widespread dermatitis pilaris and scattered folliculitis with onychomycosis of both feet. The Veteran was informed of that decision, including his right to appeal, and did not appeal. Finally, a January 2018 rating decision granted service connection for the cervical spine disability and associated radiculopathy of the left upper extremity from January 27, 2017. The Veteran did initiate an appeal of the decision regarding the cervical spine disability. However, he did not perfect his appeal as to that claim after a Statement of the Case (SOC) was promulgated in February 2020. The record does not otherwise reflect that a unadjudicated claim was filed regarding the lumbar spine, cervical spine disability, right upper extremity radiculopathy, and/or right knee disability prior to April 17, 2020. Specifically, no such claim was received on one of the requisite forms for the period from March 24, 2015; nor did he file an informal or informal claim during the period prior to that date. The Veteran has not contended and/or identified there was an unadjudicated claim regarding any of these issues prior to April 17, 2020. Moreover, he has not contended and/or identified evidence demonstrating a higher rating was warranted for these disabilities, to include during the one-year period prior to the April 17, 2020 claim. In light of the foregoing, the Board finds no basis for the assignment of an effective date earlier than April 17, 2020 for the assignment of a 40 percent rating for the lumbar spine disability, 20 percent for the cervical spine disability, 20 percent for the right upper extremity radiculopathy, and 10 percent for the right knee disability. These claims must be denied. 12. Entitlement to an earlier effective date for the assignment of a 30 percent rating for skin disability The March 2021 Higher-Level Review rating decision found that entitlement to an earlier effective date for an increased rating for service-connected skin disability prior to April 17, 2020 could not be established. However, as noted above, the 30 percent rating has been in effect since July 1, 1993. The Board notes this is the day after the Veteran's separation from service, which is the earlier effective date allowed under the law. In light of the foregoing, the claim for an earlier effective date for the assignment of a 30 percent rating for service-connected skin disability must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). 13. Entitlement to an earlier effective date for the assignment of a 10 percent rating for right lower extremity radiculopathy The March 2021 Higher-Level Review rating decision found that an effective date for the increased evaluation to 10 percent for service-connected right lower extremity radiculopathy could not be established prior to April 17, 2020. However, as noted above, the 10 percent rating for this disability was assigned effective January 27, 2017. The Veteran was informed of the November 2017 decision that effectuated that rating, including his right to appeal, and did not appeal. As such, that decision, including the effective date assigned for the right lower extremity radiculopathy, is final. See 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 20.1100, 20.1103. The Board acknowledges that there are two statutory exceptions to the rule of finality. First, pursuant to 38 U.S.C. § 5108, the Secretary must reopen a claim "[i]f new and material evidence [regarding the claim] is presented or secured." Second, a decision "is subject to revision on the ground of clear and unmistakable error [CUE]." 38 U.S.C. § 5109A. However, in Rudd v. Nicholson, 20 Vet. App. 296 (2006), the Court emphasized that because the proper effective date for an award based on a claim to reopen can be no earlier than the date on which that claim was received, only a request for revision based on clear and unmistakable error (CUE) could result in the assignment of an earlier effective date for the appellant's awards. See also Leonard v. Nicholson, 405 F.3d 1333, 1337 (Fed. Cir. 2005) ("[A]bsent a showing of [clear and unmistakable error, the appellant] cannot receive disability payments for a time frame earlier than the application date of his claim to reopen, even with new evidence supporting an earlier disability date."). In regard to potential CUE in the November 2017 rating decision's assignment of the January 27, 2017 effective date for right lower extremity radiculopathy, the Court has held that for a valid claim of CUE, the claimant must assert more than a disagreement as to how the facts were weighed or evaluated; he or she must, with some degree of specificity, identify the alleged error and provide persuasive reasons why the result would have been different but for the alleged error. The mere assertion of CUE is not sufficient to reasonably raise the issue. See Russell v. Principi, 3 Vet. App. 310 (1992) (en banc); Fugo v. Brown, 6 Vet. App. 40 (1993), en banc review denied, Fugo v. Brown, 6 Vet. App. 162 (1994). Here, the record does not reflect the Veteran has even alleged CUE in the November 2017 rating decision. Therefore, no further discussion of the matter is warranted at this time. For all these reasons, the issue of an earlier effective date for assignment of a 10 percent rating for service-connected right lower extremity radiculopathy is denied. 14. Entitlement to an effective date earlier than April 17, 2020 for the award of a TDIU A TDIU claim is a claim for increased compensation. As such, the effective date rules for increased compensation apply to TDIU claims. See Hurd v. West, 13 Vet. App. 449 (2000). The Court noted in Hazan v. Gober, 10 Vet. App. 511 (1992) that 38 U.S.C. § 5110(b)(2) requires a review of all the evidence of record (not just the evidence not previously considered) in order to ascertain the earliest possible effective date. Determining whether an effective date assigned for an increased rating is correct or proper under the law requires (1) a determination of the date of the receipt of the claim as well as (2) a review of all the evidence of record to determine when an increase in disability was "ascertainable." Hazan, 10 Vet. App. at 521. In this case, the RO found the date of claim to be April 17, 2020 when the Veteran's VA Form 21-8940 was received by VA. However, in Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court held that a claim of entitlement to TDIU is part of an increased rating claim when such claim is expressly raised by the Veteran or reasonably raised by the record. The Court further held that when evidence of unemployability is submitted at the same time that the Veteran is appealing the initial rating assigned for a disability, TDIU will be considered part and parcel of the claim for increased compensation for the underlying disability. Id. In this case, the record reflects the Veteran submitted an intent to file that was received by VA on January 27, 2017. Additionally, his Notice of Disagreement (NOD) to a January 2018 rating decision reflects he was seeking a TDIU as part of his disagreement with the ratings assigned in that decision. He also submitted evidence in support of a TDIU in February and March 2020. Consequently, the Board concludes that TDIU must be considered part and parcel of the January 27, 2017 claim. Moreover, the TDIU claim was not adjudicated until the July 2020 rating decision. Therefore, and in accord with Rice, supra, the Board finds that January 27, 2017 is the date of claim in this case. It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16(b). A total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. A total disability may or may not be permanent. Total ratings will not be assigned, generally, for temporary exacerbations or acute infectious diseases except where specifically prescribed by the schedule. 38 C.F.R. § 3.340(a). A total disability rating for compensation purposes may be assigned where the schedular rating is less than total, where it is found that the disabled person is unable to secure or follow substantially gainful occupation as a result of a service-connected disability ratable at 60 percent or more or as a result of two or more disabilities, providing at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 4.16(a). From January 27, 2017 to April 16, 2020 the Veteran was service connected for a lumbar spine disability, evaluated as 20 percent disabling; right lower extremity radiculopathy, evaluated as 10 percent disabling; a skin disability, evaluated as 30 percent disabling; hemorrhoids, evaluated as 10 percent disabling; cervical spine disability, evaluated as 10 percent disabling; left upper extremity radiculopathy, evaluated as 30 percent disabling; and a right knee disability, retinal scarring, and residual scars from cyst removal, all evaluated as 0 (zero) percent (noncompensably) disabling. His overall combined rating was 70 percent. Therefore, he satisfied the schedular criteria for consideration of TDIU. Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, "entitlement to a TDIU is based on an individual's particular circumstances." Rice, 22 Vet. App. at 452. Therefore, in adjudicating a TDIU claim, VA must take into account the individual Veteran's education, training, and work history. Hatlestad v. Derwinski, 1 Vet. App. 164 (1991) (level of education is a factor in deciding employability); see Friscia v. Brown, 7 Vet. App. 294 (1994) (considering Veteran's experience as a pilot, his training in business administration and computer programming, and his history of obtaining and losing 19 jobs in the previous 18 years); Beaty v. Brown, 6 Vet. App. 532 (1994) (considering Veteran's 8th grade education and sole occupation as a farmer); Moore v. Derwinski, 1 Vet. App. 356 (1991) (considering Veteran's master's degree in education and his part-time work as a tutor). Neither a claimant's age nor the impairment caused by nonservice-connected disabilities is for consideration in determining whether a TDIU is warranted. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361 (1993). In Ray v. Wilkie, 31 Vet. App. 58 (2019), the Court provided a list of potentially relevant factors to be considered in determining whether a veteran can secure and follow a substantially gainful occupation under 38 C.F.R. § 4.16. Pertinent to the present appeal, the Court found that consideration of a veteran's physical ability is necessary, with possible relevant factors including limitations as to lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as audio and visual limitations. Here, the record reflects the Veteran had impairment of prolonged standing and walking due to the service-connected disabilities of the lumbar and cervical spines. His service-connected right knee disability and right lower extremity radiculopathy contributed to such problems. In addition, there is evidence that he would have trouble grasping, typing, and reaching due to his service-connected left upper extremity radiculopathy. The Board further notes the Veteran provided a private vocational assessment report dated in March 2020 which concluded he had been precluded from obtaining and maintaining substantially gainful employment since at least January 2017. Nothing in the record causes the Board to doubt the qualifications of this private clinician to provide a competent medical opinion. In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. See Id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See Id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion . . . must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). In this case, the March 2020 private clinician was familiar with the nature and history of the Veteran's service-connected disabilities from a telephonic assessment and review of his medical records. Further, the clinician's opinion was not expressed in speculative or equivocal language, and was supported by stated rationale, to include reference to the impairment attributable to the Veteran's service-connected disabilities, as well as examples of what is expected in areas of substantially gainful employment. No competent medical opinion is of record that explicitly refutes the March 2020 vocational opinion regarding the Veteran's employability. Therefore, the Board finds the opinion to be adequate, persuasive, and entitled to significant probative weight. In light of the foregoing, and resolving reasonable doubt in favor of the Veteran, the Board finds that it is at least as likely as not he was unable to obtain and/or maintain substantially gainful employment due to his service-connected disabilities for the period from January 27, 2017 to April 16, 2020. Accordingly, a TDIU is warranted for that period. The Veteran has not contended that he filed a claim for TDIU prior to January 27, 2017. Nor is such demonstrated by the other evidence of record. Therefore, an effective date earlier than January 27, 2017 is not warranted. 15. Entitlement to an effective date earlier than April 17, 2020 for the establishment of basic eligibility for education benefits under Chapter 35 (DEA) Basic eligibility for Chapter 35 benefits for the child or surviving spouse of a veteran may be established if: (1) the veteran was discharged from service under conditions other than dishonorable, or died in service; and (2) the veteran has a permanent total service-connected disability; or (3) a permanent total service-connected disability was in existence at the date of the veteran's death; or (4) the veteran died as a result of a service-connected disability. 38 U.S.C. §§ 3500, 3501, 3510; 38 C.F.R. § 3.807. In this case, the Veteran is still living. Therefore, the only legal basis for establishing basic eligibility for Chapter 35 benefits is his having a permanent and total service-connected disability, to include on the basis of TDIU. For the reasons detailed above, the Board has found the Veteran is entitled to an earlier effective date of January 27, 2017 for the assignment of a TDIU. As such, basic eligibility for Chapter 35 education benefits is also established from that date. As the basic eligibility criteria are not met prior to January 27, 2017, an effective date earlier than that is not warranted. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board John Kitlas, 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.