Citation Nr: 21072993 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 19-24 554 DATE: December 7, 2021 ORDER Entitlement to service connection for a right jaw disability is granted. Entitlement to service connection for traumatic brain injury (TBI) / head injury, to include as due to an acquired psychiatric disorder, is denied. Entitlement to a 40 percent rating for right lower extremity (RLE) radiculopathy is granted. Entitlement to a 40 percent rating for left lower extremity (LLE) radiculopathy is granted. Entitlement to an initial rating in excess of 30 percent prior to May 28, 2021 for other specified trauma and stressor-related disorder is denied. Entitlement to an initial rating in excess of 50 percent beginning May 28, 2021 for other specified trauma and stressor-related disorder is denied. Entitlement to an effective date, earlier than March 31, 2015, for the assignment of a 40 percent rating for RLE radiculopathy is denied. Entitlement to an effective date, earlier than March 31, 2015, for the assignment of a 40 percent rating for LLE radiculopathy is denied. REMANDED 1. Entitlement to service connection for erectile dysfunction, to include as due to service-connected back disability, is remanded. 2. Entitlement to a rating in excess of 20 percent, beginning March 1, 2020, for right shoulder degenerative arthritis is remanded. FINDINGS OF FACT 1. The Veteran's right side temporomandibular joint disorder (TMJ) is etiologically related to service. 2. The Veteran does not have a current diagnosis of TBI, and his cognitive impairment is the result of a post-service work-related incident. 3. The evidence is in equipoise as to whether the Veteran's RLE radiculopathy exhibited moderate incomplete paralysis or moderately severe incomplete paralysis. 4. The evidence is in equipoise as to whether the Veteran's LLE radiculopathy exhibited moderate incomplete paralysis or moderately severe incomplete paralysis. 5. For the period prior to May 28, 2021, the Veteran's other specified trauma and stressor-related disorder was characterized by no more than occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 6. Beginning May 28, 2021, the Veteran's other specified trauma and stressor-related disorder was characterized by no more than occupational and social impairment with reduced reliability and productivity. 7. The Veteran's increased rating claim for RLE and LLE radiculopathy was received on March 31, 2015. 8. There is no formal or informal claim for an increased rating for RLE or LLE radiculopathy since the Board's March 2014 final denial and prior to the receipt of the claim on March 31, 2015; nor is there factually ascertainable evidence that an increase in disability occurred within one year prior to March 31, 2015. CONCLUSIONS OF LAW 1. The criteria for service connection for a right jaw disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303 (2020). 2. The criteria for service connection for TBI/head injury with acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303 (2020). 3. The criteria for a 40 percent rating for RLE radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.21, 4.120, 4.123, 4.124, 4.124a, Diagnostic Code 8520 (2020). 4. The criteria for a 40 percent rating for LLE radiculopathy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.21, 4.120, 4.123, 4.124, 4.124a, Diagnostic Code 8520 (2020). 5. Prior to May 28, 2021, the criteria for an initial rating in excess of 30 percent for other specified trauma and stressor-related disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9410 (2020). 6. Beginning May 28, 2021, the criteria for an initial rating in excess of 50 percent for other specified trauma and stressor-related disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9410 (2020). 7. The criteria for an effective date, earlier than March 31, 2015, for the award of an increased rating for RLE radiculopathy have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.1, 3.151, 3.155, 3.400. 8. The criteria for an effective date, earlier than March 31, 2015, for the award of an increased rating for LLE radiculopathy have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.1, 3.151, 3.155, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from November 1967 to April 1969. This matter was previously before the Board in August 2020 in which the Board, in pertinent part, granted the Veteran a 20 percent rating for service-connected right shoulder disability prior to January 9, 2020 and beginning March 1, 2020. A temporary 100 percent rating was assigned from January 9, 2020 to February 29, 2020. The Board also denied an effective date, earlier than March 31, 2015, for the grant of service connection for right shoulder disability. However, the Veteran appealed the Board's decision to the Court of Appeals for Veterans Claims (Court). In his appeal, the Veteran only challenged the Board's decision that denied a rating in excess of 20 percent for right shoulder disability beginning March 1, 2020. As a result of the appeal, the parties entered into a Joint Motion for Partial Remand, and the matter has been returned to the Board to comply with the Court's order. Likewise, claims that were remanded in the Board's August 2020 decision have also been returned to the Board for further appellate review. SERVICE CONNECTION Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a) (2018). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) 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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 38 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Whenever there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107 (b). 1. Entitlement to service connection for a jaw disability. The Veteran contends that service connection is warranted for a jaw disability. After reviewing the evidence of record, the Board finds that service connection is warranted. In his July 2021 VA examination for temporomandibular disorders, the Veteran reported injuring his jaw in service when a land mine blew up and he was hit on the right side. After reviewing the Veteran's service treatment records (STRs), the Board finds his statements are substantiated as records show that the Veteran was treated for injury to his right ear after a mortar attack. It was also noted that it could not be determined if his tympanic membrane was intact. Therefore, as STRs confirm the Veteran's reported injury, an in-service event and/or injury is conceded. With regard to a current diagnosis, the Veteran was diagnosed with bruxism and TMJ bilaterally in his July 2021 VA examination. The examiner concluded that the Veteran's right side TMJ is at least as likely as not due to the in-service mortar attack. In determining the etiology of the Veteran's TMJ, the examiner noted that the Veteran has right side crepitus which can be the result of trauma to the side of the face, and the Veteran had a documented mortar attack in November 1968 that was associated with his right side. The examiner found that, notably, the Veteran's left side TMJ has no pain or obvious sounds. Thus, his right side TMJ is due to service. Based on the above, the Board finds service connection is warranted for a right jaw disability. The evidence shows the Veteran had an in-service injury to his right side, and he has a current diagnosis and a nexus between the two. Therefore, the Veteran has met the required elements for service connection. Accordingly, service connection is granted for a right jaw disability. 2. Entitlement to service connection for TBI/head injury, to include as due to an acquired psychiatric disorder. The Veteran contends service connection is warranted for a TBI and/or head injury. After thoroughly reviewing the evidence of record, the Board finds that service connection is not warranted. In an April 2018 Statement in Support of Claim, the Veteran contends that his TBI was the result of being "knocked out" after a mortar attack in service. He indicated that he was dazed, disoriented, and could hardly walk. He also reported a second incident where he hit a landmine while driving a truck. He stated that his helmet was knocked off and the back of his neck was injured when he "came down on rocks." In an August 2019 VA examination for TBI, the examiner acknowledged that the reported mortar attack occurred; however, the examiner found no diagnosis of TBI. The examiner noted that there was no indication of loss of consciousness, amnesia, or neurological findings in service, and his current examination showed no symptoms or a diagnosis of TBI. The examiner further noted that while the Veteran complained of dizzy and balance issues, the Veteran's dizziness was determined to be allergy based. The Board also observes private treatment records from the Social Security Administration (SSA) that show the Veteran's head injury was due to a post-service work-related injury. Specifically, in a September 1996 treatment record, a private examiner noted that the Veteran presented with a history of dizziness, imbalance, and tinnitus that were related to an accident in October 1995 while working on a construction site. Additionally, in a May 1997 neuropsychological evaluation, it was noted that the Veteran was referred for evaluation as a result of an October 1995 injury while working on bridge construction during a windstorm. The evaluation noted the incident caused the Veteran to be thrown about 20 feet where he suffered crushing injuries when a deck frame broke loose and landed on him. It also caused him to hit his head with an iron rod in the left temporal region. The examiner diagnosed the Veteran with dementia due to head trauma, adjustment disorder with depressed mood, and traumatic head injury by history. Further, in a February 1998 psychological evaluation, the Veteran was diagnosed with amnestic disorder due to head injury, chronic. The examiner noted that since his accident, the Veteran has suffered some cognitive processing difficulties and memory deficits. Based on the above and remaining evidence, the Board finds service connection is not warranted. Here, there is no evidence of a current diagnosis of TBI during the appeal period. In the absence of a current disability, service connection cannot be established. See Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Notwithstanding the above, even if a current disability were present, the Board also finds that any current TBI or residuals thereof, stemmed from his 1995 work injury to his head. As noted by the VA examiner, STRs confirm the Veteran was involved in a mortar attack; however, he was found to have a right ear injury, but no symptoms of a TBI such as loss of consciousness, neurological findings, or other head injury. This finding is confirmed by the Veteran's statements in a post-service VA ear, nose, and throat examination in October 1969 where he reported being exposed to mortar attacks in service and that he had a right ear injury. At that time, the Veteran did not report a head injury but only reported occasional vertigo as a result of the attack due to his ear damage. Likewise, in an October 1969 neuropsychiatric examination, the Veteran reported that he stepped on a booby-trap, but he was not hospitalized and did not have surgery. He indicated he has some headaches behind the right ear, and he had trouble with his hearing, but now he hears well. To the contrary, after his 1995 work injury to his head, the record is replete with documentation of a symptoms related to such an injury, including cognitive issues, psychiatric issues, and amnesia issues. Thus, the Board finds the most probative evidence supports a finding that, to the extent that the Veteran has any current residuals or symptoms of a TBI, these symptoms are related to his post service work injury to his head in 1995. Given these findings, the Board concludes that the preponderance of evidence weighs against the claim and the benefit-of-the-doubt doctrine is inapplicable. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Accordingly, the claim of service connection for TBI is denied. INCREASED RATING Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical, as well as, industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. Where 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. See 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods of time based on facts found, a practice known as "staged" ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Reasonable doubt regarding the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. 1. Entitlement to a rating in excess of 20 percent for RLE radiculopathy. 2. Entitlement to a rating in excess of 20 percent for LLE radiculopathy. The Veteran's right and left lower extremity radiculopathy have been evaluated as 20 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code 8520. Diagnostic Code 8520 provides the rating criteria for paralysis of the sciatic nerve, and therefore, neuritis and neuralgia of that nerve. 38 U.S.C. § 4.124a, Diagnostic Code 8520. Disability ratings of 10 percent, 20 percent, and 40 percent are assigned for incomplete paralysis that is mild, moderate, or moderately severe in degree, respectively. A 60 percent rating is warranted for severe incomplete paralysis with marked muscular atrophy. Complete paralysis of the sciatic nerve, which is rated as 80 percent disabling, contemplates foot dangling and dropping, no active movement possible of muscles below the knee, and flexion of the knee weakened or (very rarely) lost. Words such as "mild," "moderate," and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Additionally, the term "incomplete paralysis," with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a. Turning to the merits of the Veteran's claim, the Board has reviewed the evidence of record and finds that an increased rating is warranted for the Veteran's RLE and LLE radiculopathy. In support of the Board's conclusion, the Board initially notes that in a March 2018 rating decision, the regional office (RO) increased each of the Veteran's ratings for right and left lower extremity radiculopathy to 20 percent disabling. In doing so, the RO relied on the Veteran's July 2015 and December 2017 VA back examinations that indicated the Veteran's bilateral radiculopathy was moderate in severity overall. The Board notes, however, that the examiner in the July 2015 examination specifically noted that the Veteran's lower extremities exhibited symptoms of moderate constant pain, but also severe intermittent pain, paresthesias and/or dysesthesias, and severe numbness. Similarly, in his December 2017 VA back examination, the examiner found moderate constant pain, paresthesias and/or dysesthesias, and moderate numbness, but also severe intermittent pain. Moreover, the Veteran's October 2019 VA back examination showed symptoms of mild numbness, moderate constant pain, and severe symptoms of constant pain and paresthesias and/or dysesthesias associated with his RLE radiculopathy; while his LLE exhibited symptoms of mild constant pain and numbness, and moderate symptoms of intermittent pain and paresthesias and/or dysesthesias. The examiner noted the overall severity was moderate bilaterally. Based on the above findings and remaining evidence, the Board finds the evidence is in equipoise as to whether the Veteran's right and left lower extremities exhibited moderate incomplete paralysis or moderately severe incomplete paralysis. Although the examiners found that his symptoms were moderate overall, his RLE and LLE also exhibited severe symptoms of pain, numbness, paresthesias and/or dysesthesias during the appeal period. As such, the Board resolves all doubt in favor of the Veteran and finds that a 40 percent rating is warranted for RLE radiculopathy and LLE radiculopathy. A rating greater than 40 percent is not warranted as there is no evidence of marked muscular atrophy or complete paralysis of either the right or left lower extremity as required for a higher rating. 38 C.F.R. § 4.124a, Diagnostic Code 8520. 3. Entitlement to a rating in excess of 30 percent prior to May 28, 2021, and in excess of 50 percent thereafter for other specified trauma and stressor-related disorder. The Veteran's other specified trauma and stressor-related disorder has been assigned staged ratings and evaluated under Diagnostic Code 9410 which uses the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, Diagnostic Code 9410. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). 38 C.F.R. § 4.130, Diagnostic Code 9410. A 50 percent rating is assigned when a veteran's psychiatric disorder causes occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-term and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id. The maximum schedular rating of 100 percent is warranted when there is total occupational and social impairment due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation or own name. Id. When determining the appropriate disability evaluation to assign, the Board's primary consideration is a veteran's symptoms, but it must also make findings as to how those symptoms impact a veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Because the use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Mauerhan, 16 Vet. App. at 442; see also Sellers v. Principi, 372 F.3d 1318, 1326-27 (Fed. Cir. 2004). Nevertheless, all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the veteran's impairment must be "due to" those symptoms, a veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. In addition, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the lengths of remissions, and the Veteran's capacity for adjustment during periods of remission. 38 C.F.R. § 4.126 (a). The rating agency shall assign an evaluation based on all evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. Id. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment; but shall not assign an evaluation on the basis of social impairment. 38 C.F.R. § 4.126 (b). Factual Background A review of the evidence shows that the Veteran received a VA PTSD examination in May 2018 where he was diagnosed with other specified trauma and stressor-related disorder. In the examination, the Veteran reported being married one time for fifty years. He reported that he maintains contact with his surviving children and described having a good relationship with them. He denied significant social relationships noting that "they are all dead and gone." Occupationally, the Veteran reported employment history of working for the railroad for three months; then he worked for a company named Valmont from 1969 to 1980. Thereafter, he worked on a ranch for two years, a welding company for five years, a city manager for about seven years, a steel company, a potato plant, and then he started building bridges. The Veteran reported that he was never fired from a position and that he did well at his jobs. He reported that he gardens as a hobby, but he noted that his physical limitations interfere with his activity level. With regard to mental health treatment, he reported having no prior mental health treatment. He endorsed having trouble sleeping and indicated that he was advised to see a mental health provider, but he did not want to. The Veteran's mental status examination showed he was casually dressed. He had fair grooming and hygiene, and his speech, abstract reasoning, memory, and attention were all within normal limits. Thoughts were logical and goal-directed, and the Veteran was oriented x 3. The examiner noted that the Veteran endorsed a periodic depressed mood and intermittent anxiety. He had no suicidal intent or plan, and no history of suicide attempts. The Veteran reported sleep disruption due to a multitude of things and that he has had trouble sleeping since Vietnam. He reported having a history of anger problems that have improved over time, and a history of physical altercations but none in over 20 years. There was no homicidal intent, obsessive-compulsive symptoms (OCD), or hallucinations. The examiner found that the Veteran's symptoms cause occupational and social impairment that are not severe enough either to interfere with occupational and social functioning or to require continuous medication. In his May 2021 mental disorders examination, the Veteran reported being married for 52 years and being close to his son who is in the Navy. He reiterated that he enjoys working in his garden but is limited due to medical conditions. The examiner noted symptoms of anxiety, suspiciousness, chronic sleep impairment, mild memory loss, impairment of short and long term memory, disturbances of motivation and mood, and impaired impulse control. The examiner concluded that the Veteran's symptoms cause occupational and social impairment due to mild or transient symptoms. Analysis Based on the above and remaining evidence, the Board finds that a rating in excess of 30 percent is not warranted for the period prior to May 28, 2021, and a rating in excess of 50 percent is not warranted thereafter. For the period prior to May 28, 2021, the evidence shows that the Veteran was assigned a 30 percent rating based on symptoms of anxiety, chronic sleep impairment, depressed mood, and the May 2018 VA examiner's finding that indicated the Veteran's symptoms cause no more than occupational and social impairment that are not severe enough either to interfere with occupational and social functioning or to require continuous medication. The Board agrees that the evidence does not support a higher rating. In doing so, the Board notes that in the Veteran's May 2018 PTSD examination, the Veteran reported having a stable marriage for fifty years, which he described as "it couldn't be better." He also reported having a good relationship with his children, and although he denied significant social relationships, this was not the result of his psychiatric disorder, but was rather due to death. With regard to occupational impairment, the Veteran reported having numerous work positions, but he did not report occupational impairment due to his psychiatric disorder. This finding is best evidenced by the Veteran's own statement as he reported that he was never fired from a position and he did well at his jobs. He specifically reported that he was released from his railroad job because of his back problems. He reported that he resigned from his next position because the company was making his job miserable. Additionally, he reported that he later worked for a welding company but had to find another job because his boss made some bad investments. Further, he noted that he stopped working as a city manager due to "politics." He explained that he left a steel company because "it was time to leave;" and he left a potato plant because he was bored. The Veteran reported that he then went to work building bridges, but he had a significant injury on the job. Concerning his psychiatric symptoms, the Board notes that the Veteran's primary complaint has been the issue of sleep impairment; however, per the Veteran's own statement, this was multifactorial and was not attributed solely to the Veteran's psychiatric disorder. Similarly, he reported a history of anger problems that have improved over time; and a history of physical altercations, but none in over 20 years. Moreover, the Veteran denied homicidal ideation, OCD symptoms, and hallucinations. Although he endorsed anxiety, it was found to be intermittent; and his depression was noted as periodic. Consistent with this finding are the Veteran's VA treatment records which show consistent denials of anxiety and negative depression screens each year from 2008 to 2020. Although the Veteran had positive PTSD screens in December 2010, June 2015, and November 2020 after reporting symptoms of nightmares, avoidance, being constantly on guard, and feelings of guilt, he also had negative PTSD screens in December 2005 and June 2012. Moreover, despite any PTSD symptoms the Veteran may have endorsed, the Veteran has never been diagnosed with PTSD, and the May 2018 VA PTSD examiner specifically found that the Veteran did not meet the criteria for PTSD. Thus, the Veteran's symptoms of anxiety, depression, nightmares, avoidance, constantly on guard, and feelings of guilt were not of the severity, frequency, or duration to warrant a higher rating. Likewise, the Board notes that for the period beginning May 28, 2021, the Veteran was assigned a higher rating of 50 percent as his May 2021 VA mental disorders examination showed additional symptoms of mild memory loss, impairment of short and long term memory, disturbances of motivation and mood, and impaired impulse control. Nonetheless, the VA examiner concluded that the Veteran's symptoms cause occupational and social impairment due to mild or transient symptoms, which corresponds to a 10 percent rating. See 38 C.F.R. § 4.130, Diagnostic Code 9410. Moreover, there have been no other reported symptoms characterized as disturbances of motivation and mood or impaired impulse control during the appeal period, nor has memory impairment been associated with his psychiatric disorder. Rather, the Veteran was found to have cognitive difficulties and memory deficits due to his past work-related head injury unrelated to service. Thus, these symptoms are also not of the severity, frequency, or duration to warrant a higher rating. For these reasons, the Board finds the preponderance of evidence is against the claim. In the Veteran's case, the evidence shows that even without the benefit of medication or therapy, the Veteran's psychiatric disorder did not cause significant social or occupational impairment as he maintained stable relationships and employment. Moreover, the Veteran's reported symptoms of depression, anxiety, nightmares, avoidance, constantly on guard, feelings of guilt, memory impairment, disturbances of motivation and mood, and impaired impulse control have been attributed to other circumstances, occasionally reported, or not reported at all. Therefore, these symptoms were not of the severity, frequency, or duration to warrant higher ratings. Accordingly, as the preponderance of evidence is against the claim, the benefit-of-the-doubt doctrine is inapplicable. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Accordingly, the claim for higher ratings for other specified trauma and stressor-related disorder is denied. EFFECTIVE DATE 1. Entitlement to an effective date, earlier than March 31, 2015, for the assignment of a 20 percent rating for RLE radiculopathy. 2. Entitlement to an effective date, earlier than March 31, 2015, for the assignment of a 20 percent rating for LLE radiculopathy. In general, the effective date shall be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400 (b)(2)(i). The effective date for an increased rating is to be the earliest date as of which it is factually ascertainable that an increase in disability occurred if a claim is received within one year from such date; otherwise, the effective date for increased rating is the date of receipt of the claim for increase. 38 U.S.C. § 5110 (b)(2); 38 C.F.R. § 3.400 (o)(2); Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010). Determining an appropriate effective date for an increased rating involves an analysis of the evidence to determine (1) when a claim for an increased rating was received and, if possible (2) when the increase in disability actually occurred. 38 C.F.R. §§ 3.155, 3.400(o)(2); see also Hazan v. Gober, 10 Vet. App. 511 (1997). VA amended its adjudication regulations on March 24, 2015 to require that all claims governed by VA's adjudication regulations 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 the amendment, the VA administrative claims process recognized formal and informal claims. A formal claim is one that has been filed in the form prescribed by the Secretary. 38 C.F.R. § 3.151. Any communication or action, indicating an intent to apply for one or more benefits, under the laws administered by VA, from a claimant may be considered an informal claim. In the present case, the Veteran contends an effective date, earlier than March 31, 2015, is warranted for the assignment of 20 percent ratings for RLE and LLE radiculopathy. Historically, the evidence shows that a January 2009 rating decision granted service connection and assigned a 10 percent rating for RLE radiculopathy, effective August 30, 2006. A June 2013 rating decision granted service connection and assigned a 10 percent rating for LLE, effective February 14, 2013. The Veteran appealed for higher ratings, and in a March 2014 decision, the Board granted an earlier effective date to August 30, 2006 for the assigned 10 percent rating for his LLE, but ratings in excess of 10 percent were denied for both service-connected RLE and LLE radiculopathy. The Veteran did not appeal the Board's decision; therefore, the decision became final. On March 31, 2015, the Veteran filed claims, in pertinent part, for increased ratings for his service-connected RLE and LLE radiculopathy. A September 2019 rating decision awarded 20 percent ratings for both claims, effective March 31, 2015. The Board notes, however, that the Veteran has been awarded 40 percent ratings in the decision herein. Therefore, the question before the Board is whether an effective date, earlier than March 31, 2015, is warranted for the award of 40 percent disabling for RLE and LLE radiculopathy. After reviewing the evidence, the Board concludes that an earlier effective date is not warranted. As noted above, the Veteran's current claim for an increased rating for his service-connected RLE and LLE radiculopathy was received on March 31, 2015. For the period between the Board's March 2014 final denial and the receipt of his March 2015 claim, there is no evidence of a formal or informal claim of record, nor has the Veteran asserted such. Further, there is no factually ascertainable evidence from one year prior to the date of the Veteran's March 2015 claim that demonstrates an increase in disability during that period. The earliest evidence available that suggests a worsening in the Veteran's RLE and LLE radiculopathy is the Veteran's July 2015 VA back examination. Otherwise, the remainder VA and private treatment records are silent as to the Veteran's radiculopathy disorders. Based on the foregoing, the Board finds that the evidence preponderates against the claim as there is no evidence of a claim filed since the last denial in the Board's March 2014 decision and prior to his claim filed on March 31, 2015; nor is there factually ascertainable evidence that demonstrates a worsening of the Veteran's radiculopathy one year prior to the filing of the claim. Consequently, the effective date of March 31, 2015, is the earliest allowable date under the law, and an earlier effective date for the assigned 40 percent ratings for RLE and LLE radiculopathy is not warranted. See 38 U.S.C. § 5110 (b)(2); 38 C.F.R. § 3.400 (o)(2). REASONS FOR REMAND 1. Entitlement to service connection for erectile dysfunction, to include as due to service-connected back disability is remanded. In a June 2018 VA examination for erectile dysfunction, the examiner found that the Veteran's erectile dysfunction was less likely than not proximately due to or the result of the Veteran's back disability. In doing so, the examiner noted that the etiology of the Veteran's erectile dysfunction was unknown; however, the examiner found that neurological causes of erectile dysfunction include neurologic and brain injuries such as stroke and spinal cord injuries. The examiner further found that degenerative disc disease is not a cause of erectile dysfunction without significant cord compression. Therefore, since the Veteran does not have a diagnosis of spinal cord or cauda equina compression, it is less likely as not due to his service-connected back disability. The Board notes, however, that a December 2017 MRI of the Veteran's thoracic spine show mild to moderate wedge compression fracture deformity. In addition, a November 2008 VA treatment record shows the Veteran's erectile dysfunction may be due to medication side effects. Given the above, the Board finds remand is warranted to clarify the nature of the Veteran's spinal compression in light of the examiner's opinion and MRI findings, and to consider medication side effects caused by any of the Veteran's service-connected disabilities that may be attributed to the Veteran's erectile dysfunction. 2. Entitlement to a rating in excess of 20 percent, beginning March 1, 2020, for right shoulder degenerative arthritis is remanded. As noted previously, the Veteran's claim for an increased rating in excess of 20 percent beginning March 1, 2020 has been returned to the Board to comply with the Court's order. The Board finds that remand is warranted before the claim can be properly adjudicated. The Board specifically notes that a January 2020 treatment record shows the Veteran was scheduled to begin physical therapy for his shoulder in four weeks; however, these records have not been obtained. As such, remand is warranted to obtain the Veteran's outstanding VA and private treatment records related to his right shoulder since March 1, 2020. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the Veteran's claims folder. 2. Obtain any outstanding private treatment records, to specifically include physical therapy records for the Veteran's right shoulder. The Veteran's assistance should be requested as needed. All obtained records should be associated with the evidentiary record. If the RO cannot obtain records identified by the Veteran, a notation to that effect should be inserted in the file. The Veteran is to be notified of unsuccessful efforts in this regard, in order to allow him the opportunity to obtain and submit those records for VA review. 3. Schedule the Veteran for a VA examination with a qualified clinician to determine the etiology of the Veteran's erectile dysfunction. The examiner must review the claims folder, including a copy of this remand and all lay statements of record. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's erectile dysfunction was proximately caused or aggravated by his service-connected back disability and/or medications associated with any service-connected disabilities. The examiner should provide a complete rationale for any opinions expressed. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. 4. Schedule the Veteran for a VA examination with a qualified clinician to determine the current severity of the Veteran's right shoulder disability. The examiner must review the claims folder, including a copy of this remand and all lay statements of record. With respect to range of motion testing, this must be conducted on active and passive motion and in weight-bearing and non-weightbearing conditions (pursuant to Correia v. McDonald, 28 Vet. App. 158 (2016)). Additionally, the examiner must document all functional loss of the right shoulder. In assessing functional loss, flare-ups must be considered, and the examiner must consider all procurable and ascertainable data and describe the extent of any pain, incoordination, weakened movement, and excess fatigability on use, and, to the extent possible, report functional impairment due to such factors in terms of additional degrees of limitation of motion. degrees of limitation of motion. (pursuant to Sharp v. Shulkin, 29 Vet. App. 26 (2017)). The examiner should provide a complete rationale for any opinions expressed. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. 5. The RO must review the examination reports and all opinions to ensure they are complete, adequate, and comply with the Board's specific remand directives. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Laffitte, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.