Citation Nr: 21073163 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 17-22 599 DATE: December 7, 2021 ORDER Entitlement to restoration of a 20 percent disability rating for service-connected degenerative disc disease of the lumbar spine (a low back disability) effective May 1, 2015 is denied. Entitlement to a disability rating in excess of 20 percent prior to May 1, 2015, in excess of 10 percent from May 1, 2015 to April 22, 2021, and in excess of 40 percent thereafter, for a service-connected degenerative low back disability is denied. Entitlement to restoration of a 20 percent disability rating for service-connected left lower extremity radiculopathy effective May 1, 2015 is denied. Entitlement to a disability rating in excess of 20 percent prior to May 1, 2015, in excess of 10 percent from May 1, 2015 to April 22, 2021, and in excess of 20 percent thereafter, for service-connected degenerative left lower extremity radiculopathy is denied. Entitlement to a disability rating in excess of 10 percent prior to April 23, 2021, and in excess of 20 percent thereafter, for service-connected degenerative right lower extremity radiculopathy is denied. REMANDED Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is remanded. Entitlement to a certificate of eligibility for financial assistance in acquiring specially-adapted housing or a special home adaptation grant is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to September 6, 2019 is remanded. FINDINGS OF FACT 1. Evidence available at the time of the rating reduction reflected improvement in the Veteran's low back disability; the evidence of record showed that the Veteran's disability had been manifested by sustained improvement. 2. Prior to May 1, 2015, the Veteran's low back disability did not more nearly approximate forward flexion of the thoracolumbar spine 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. 3. From May 1, 2015 to April 22, 2021, the Veteran's low back disability did not more nearly approximate forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, the combined range of motion of the thoracolumbar spine not greater than 120 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 4. From April 23, 2021, the Veteran's low back disability did not more nearly approximate unfavorable ankylosis of the entire thoracolumbar spine. 5. Evidence available at the time of the rating reduction reflected improvement in the Veteran's left lower extremity radiculopathy; the evidence of record showed that the Veteran's disability had been manifested by sustained improvement. 6. Prior to May 1, 2015, the Veteran's left lower extremity radiculopathy did not more nearly approximate moderately severe incomplete paralysis of the sciatic nerve. 7. From May 1, 2015 to April 22, 2021, the Veteran's left lower extremity radiculopathy did not more nearly approximate moderate incomplete paralysis of the sciatic nerve. 8. From April 23, 2021, the Veteran's left lower extremity radiculopathy did not more nearly approximate moderately severe incomplete paralysis of the sciatic nerve. 9. Prior to April 23, 2021, the Veteran's right lower extremity radiculopathy did not more nearly approximate moderate incomplete paralysis of the sciatic nerve. 10. From April 23, 2021, the Veteran's right lower extremity radiculopathy did not more nearly approximate moderately severe incomplete paralysis of the sciatic nerve. CONCLUSIONS OF LAW 1. The criteria for restoration of a 20 percent disability rating for a service-connected low back disability effective May 1, 2015 have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.344, 4.71a, Diagnostic Code 5242. 2. The criteria for a disability rating in excess of 20 percent prior to May 1, 2015, in excess of 10 percent from May 1, 2015 to April 22, 2021, and in excess of 40 percent thereafter, for a service-connected degenerative low back disability have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5242. 3. The criteria for restoration of a 20 percent disability rating for a service-connected left lower extremity radiculopathy effective May 1, 2015 have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.344, 4.124a, Diagnostic Code 8520. 4. The criteria for a disability rating in excess of 20 percent prior to May 1, 2015, in excess of 10 percent from May 1, 2015 to April 22, 2021, and in excess of 20 percent thereafter, for service-connected degenerative left lower extremity radiculopathy have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 5. The criteria for a disability rating in excess of 10 percent prior to April 23, 2021, and in excess of 20 percent thereafter, for service-connected degenerative right lower extremity radiculopathy have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1989 to March 1993, and from June 2004 to April 2005. This matter comes before the Board of Veterans' Appeals (Board) from January 2015 and October 2016 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The issues were previously before the Board in July 2019 and March 2021, at which time the Board remanded them for additional development. They now return for further appellate review. The Board notes that, during a VA back examination in April 2021, the Veteran asserted that his disabilities prevented him from performing a number of daily activities without assistance. He also reported the occasional use of a wheelchair and crutches. Thus, the Board finds that a claim for SMC based on the need for aid and attendance is raised by the record. Although no formal claim for SMC has been submitted, one is not needed for this type of ancillary benefit that is part of an underlying claim of benefits. Accordingly, the Board has jurisdiction over this issue, and it is further addressed in the Reasons for Remand section of this decision below. Increased Ratings Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. The evidentiary record does not reasonably raise the prospect that the Veteran's disabilities are not and cannot be adequately rated under the Rating Schedule. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and therefore not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria."). 1. A rating in excess of 20 percent prior to May 1, 2015, in excess of 10 percent from May 1, 2015 to April 22, 2021, and in excess of 40 percent thereafter, for a low back disability, to include whether the reduction from 20 percent to 10 percent effective May 1, 2015 was proper. 2. A rating in excess of 20 percent prior to May 1, 2015, in excess of 10 percent thereafter, from May 1, 2015 to April 22, 2021, and in excess of 20 percent thereafter for left lower extremity radiculopathy, to include whether the reduction from 20 percent to 10 percent effective May 1, 2015 was proper. 3. A rating in excess of 10 percent prior to April 23, 2021, and in excess of 20 percent thereafter, for right lower extremity radiculopathy. Regulations specify that disabilities of the spine should be evaluated under the General Rating Formula for Diseases and Injuries of the Spine (Spinal Formula). 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. When intervertebral disc syndrome (IVDS) is present, it is to be evaluated under the Spinal Formula unless it is more favorable to rate under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula). Ratings under the Spinal Formula are made 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. As relevant to the thoracolumbar spine, the Spinal Formula provides for a 20 percent disability rating when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, when the combined range of motion of the thoracolumbar spine is not greater than 120 degrees, or when muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent disability rating is assigned for forward flexion of the thoracolumbar spine to 30 degrees or less, or with favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine and a 100 percent rating is assigned with unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Spinal Formula. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is to 90 degrees and the normal combined range of motion is 240 degrees. Id., Note (2). Associated objective neurologic abnormalities should be rated separately under an appropriate diagnostic code. Id., Note (1). Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). Ankylosis is also defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 93 (30th ed. 2003). Alternatively, the IVDS Formula provides for rating based on the total duration of incapacitating episodes. 38 C.F.R. § 4.71a, IVDS Formula. Incapacitating episodes are defined as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id., Note (1). A 20 percent disability rating is assigned with incapacitating episodes having a total duration of at least 2 weeks. Higher ratings are available with incapacitating episodes of greater duration during a 12-month period. By way of history, the Veteran's low back disability was initially awarded a 10 percent disability rating under Diagnostic Code 5242, effective May 1, 2005. Service connection for left lower extremity radiculopathy associated with the Veteran's low back disability has also been in effect since May 1, 2005, under Diagnostic Code 8520 for incomplete paralysis of the sciatic nerve. See 38 C.F.R. § 4.124a. In March and September 2012 rating decisions, the RO granted increased 20 percent ratings for his left lower extremity radiculopathy and low back disability, effective November 15, 2011, and April 27, 2012, respectively. In December 2013, the Veteran filed several claims for increased ratings, including for his low back and left lower extremity radiculopathy, as well as a service connection claim for right lower extremity radiculopathy. As a result of the Veteran's new claims, VA back and peripheral nerve examinations were afforded on October 1, 2014. On October 8, 2014, while the RO granted the Veteran service connection for right lower extremity radiculopathy effective the date of his December 30, 2013 claim, they proposed to reduce the 20 percent ratings for the left lower extremity and low back claims to 10 percent based on the findings of the aforementioned VA examinations. These reductions to 10 percent were effectuated in a subsequent rating decision in January 2015 and effective on May 1, 2015. Thereafter, the Veteran filed the present appeal, which now includes both the issues of entitlement to increased disability ratings and the propriety of the rating reductions. The Board also notes that, during the appeal and subsequent to the Board's most recent remand, the Veteran's low back disability was increased to 40 percent effective April 23, 2021. As higher ratings remain available from that date, entitlement to a rating in excess of 40 percent for the low back disability is also on appeal. Additionally, the Veteran's bilateral lower extremity radiculopathy disabilities were both increased to 20 percent, also effective April 23, 2021. For the same reasons stated above, those disabilities also remain on appeal. Under 38 C.F.R. § 3.105(e), when a reduction in evaluation of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. The beneficiary will be notified at his or her latest address of record of the contemplated action and furnished detailed reasons therefor and will be given 60 days for the presentation of additional evidence to show that compensation payments should be continued at their present level. Unless otherwise provided in paragraph (i) of this section, if additional evidence is not received within that period, final rating action will be taken, and the award will be reduced or discontinued effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires. Here, the RO did provide the notice and response time ordinarily required by 38 C.F.R. § 3.105(e), in the October 8, 2014 rating decision. Therefore, the next question for the Board to address is whether the reduction was warranted. As for whether the reduction was proper on a factual basis, substantively, a rating cannot be reduced unless improvement is shown to have occurred. 38 U.S.C. § 1155. 38 C.F.R. § 3.344 provides additional requirements for ratings that, as here, have been in effect for five or more years. In short, these protections are aimed at ensuring that any improvement in the condition at issue is reasonably certain to be maintained under the ordinary conditions of life. Furthermore, the United States Court of Appeals for Veterans Claims has held that, in any case, a rating reduction must be based on improvement in a disability that reflects an improvement in the Veteran's ability to function under the ordinary conditions of life and work. Brown v. Brown, 5 Vet. App. 413, 421 (1993). A rating reduction case focuses on the propriety of the reduction and is not the same as an increased rating issue. See Peyton v. Derwinski, 1 Vet. App. 282, 286 (1991). Care must be taken to ensure that a change in an examiner's evaluation reflects an actual change in a veteran's condition, and not merely a difference in the thoroughness of the examination or in descriptive terms, when viewed in relation to the prior disability history. See 38 C.F.R. §§ 4.1, 4.2, 4.13; see also Brown 5 Vet. App. at 420-22. VA is not limited, however, to medical indicators of improvement. Rather, VA may rely on non-medical indicators of improvement. See Faust v. West, 13 Vet. App. 342, 349-50 (2000). After a review of the evidence, the Board determines that the original 20 percent ratings at the time of the Veteran's increased rating claims for his low back disability and left lower extremity radiculopathy no longer represented the Veteran's symptomatology, that the preponderance of the evidence reflected improvement in the Veteran's condition, and that therefore the reduction of each rating to 10 percent was appropriate. In addition, the Veteran is not entitled to a rating in excess of 20 percent for the first period on appeal (prior to May 1, 2015). As such, and for the following reasons, the current ratings assigned are proper. As noted above, the RO assigned 20 percent disability evaluations for the Veteran's service-connected low back disability in September 2012. The Veteran's left lower extremity radiculopathy was increased to 20 percent the previous March 2012. The RO's evaluations at the time were based on the findings of VA examinations in March 2012 and again in August 2012 that noted symptoms that included chronic low back pain and moderate radiculopathy in the left lower extremity. Range of motion in the lumbar spine during these examinations indicated flexion to, at worst, 60 degrees, and a combined range of motion of, at worst, 140 degrees. See 38 C.F.R. § 4.71a, Spinal Formula. The Board acknowledges that the August 2012 examination indicated a diagnosis of IVDS with incapacitating episodes of at least 6 weeks in duration during the previous 12 months. However, the previous examination in March 2012 did not find that the Veteran had any incapacitating episodes associated with IVDS. Again, incapacitating episodes are defined as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, IVDS Formula. Here, while the Veteran may have described the need for bed rest during the August 2012 examination, he did not actually describe a specific duration. There is also no indication in the record that any bed rest was physician-prescribed. As such, the Veteran's 20 percent rating based on the Spinal Formula, rather than a higher 60 percent rating under the IVDS Formula, was proper at the time. Regardless, the Board points out that the Veteran did not appeal the September 2012 rating decision that awarded an increased 20 percent rating for the low back disability and, as such, that decision became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. As noted previously, the Veteran was afforded new VA examinations in October 2014 for the purposes of his claims for increased ratings. Flexion in the Veteran's lumbar spine was noted to be 90 degrees or greater and his combined range of motion was 300 degrees. The examiner specifically noted that pain, weakness, fatigability, and incoordination did not further limit functional ability during flare ups or when the back is used repeatedly. Of note, the Veteran specifically denied flare-ups of low back pain, and while IVDS was again noted, there were no incapacitating episodes. Further, muscle strength and reflex testing was normal, with sensation decreased only in the feet/toes. The examiner opined that the Veteran's radiculopathy, now bilateral, was only mild. Based on the foregoing, the RO determined in its January 2015 rating decision that the overall evidentiary record showed that the severity of the Veteran's low back and left lower extremity radiculopathy MD more nearly approximated the criteria for lower, 10 percent ratings. The Board agrees. As noted above, under the Spinal Formula, a 20 percent rating is warranted when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, when the combined range of motion of the thoracolumbar spine is not greater than 120 degrees, or when muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 38 C.F.R. § 4.71a. Alternatively, a 20 percent rating is warranted under the IVDS Formula when there is IVDS and incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. Id. Additionally, a 20 percent rating is warranted for radiculopathy affecting the sciatic nerve when its severity is noted to be moderate. 38 C.F.R. § 4.124a, Diagnostic Code 8520. Moreover, the Board finds that relevant medical treatment records are not in significant conflict with the above findings upon VA examination that show sustained improvement of his low back disability and left lower extremity radiculopathy at the time. For example, VA treatment records note only decreased range of motion due to low back pain and lower extremity numbness. A December 2013 VA treatment record for the purposes of assessing the management of his overall chronic pain (the Veteran has additional musculoskeletal disabilities) notes the Veteran as having ongoing back pain since 2004, "but not necessarily to the point where it was severe enough to require opioids and has been managed at times without opioids." As the evidence shows sustained improvement in the Veteran's low back disability and left lower extremity radiculopathy between the assignment of the Veteran's 20 percent ratings and the October 2014 VA examination, it follows that disability ratings in excess of 20 percent for the period on appeal prior to the rating reductions to 10 percent is also not warranted. As previously noted, the Veteran filed his increased rating claims in April 2014. Under 38 C.F.R. § 3.400(o)(2), the effective date in a claim for an increased rating will be one year prior to the date of receipt of the increased rating claim provided that the evidence reflects a worsening of the disability during that one-year time period. See Gaston v. Shinseki, 605 F.3d 979 (Fed. Cir. 2010). At no time from the year prior to the filing of the Veteran's increased rating claims in April 2014 do the Veteran's medical records reflect symptoms that more closely warrant a higher, 40 percent evaluation under Diagnostic Code 5242 of the Spinal Formula, i.e., forward flexion of the thoracolumbar spine 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine or the functional equivalent thereof. See 38 C.F.R. § 4.71a; see also Chavis v. McDonough, 34 Vet. App. 1, 20 (2021) (holding that the criteria for a rating based on ankylosis may be met by evidence demonstrating the functional equivalent of ankylosis). Further, at no time from the year prior to the filing of the Veteran's increased rating claim in April 2014 do the Veteran's medical records reflect symptoms that more closely warrant a higher, 40 percent evaluation during that period under Diagnostic Code 8520 for moderately severe incomplete paralysis of the sciatic nerve. See 38 C.F.R. § 4.124a. Additionally, as the October 2014 VA examination found the Veteran's radiculopathy to be mild in severity, bilaterally, with normal reflexes and strength, a rating in excess of the 10 percent that was assigned for the Veteran's right lower extremity radiculopathy during this period on appeal was also not warranted. Id. As to the 40 and 20 percent ratings recently assigned for the Veteran's low back and bilateral lower extremity radiculopathy effective from April 23, 2021, respectively, these ratings were assigned based upon the findings upon VA examination on that date. Of note, and as to the 10 percent ratings assigned from May 1, 2015 to April 22, 2021 for his low back and radiculopathy, there are no medical records during this period in significant conflict with the October 2014 examination, with the Veteran continuing to report chronic low back pain and radicular symptoms. The Veteran submitted a private disability benefits questionnaire dated in September 2017. As noted by the Board in its July 2019 remand, this examination is incomplete for evaluation purposes since the examiner did not have a goniometer. Further, with regards to the bilateral lower extremities, the examination report shows that the Veteran had symptoms of reduced muscle strength and muscle atrophy attributed to bilateral total knee replacements and left ankle reconstruction. Consequently, this examination also cannot be used to evaluate the Veteran's bilateral lower extremity radiculopathy. During the April 2021 VA back examination, the Veteran reported being unable to now stand, sit, or walk long distances without pain, as well as numbness and muscle spasms in the low back radiating down the legs. Range of motion testing revealed flexion to 30 degrees. While the examination was performed during flare-up and is considered representative of range of motion during flare-up, the examiner further estimated that the Veteran's flexion would be further reduced to 20 degrees after repeated use over time. Treatment records do not show greater limitation of motion than the examination findings. Given the above, a higher rating is not warranted based on limitation of motion. 38 C.F.R. § 4.71a, Spinal Formula. The record does not indicate unfavorable ankylosis at any point to warrant at least the next higher 50 percent rating. The Board notes that "unfavorable ankylosis" is defined as "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 dislocation; or neurologic symptoms due to nerve root stretching." See id., Note (5). None of these have been shown by the record. Further, the examiner did not find a current diagnosis of IVDS. As such a higher rating is not warranted under the IVDS Formula. 38 C.F.R. § 4.71a Regarding relevant neurological findings, the Board notes again that the Veteran was assigned 20 percent ratings bilaterally for his lower extremity radiculopathy effective the date of the above back examination, which also included a separate peripheral nerve examination. The Veteran reported mild numbness in his lower extremities, as well as moderate pain and paresthesias/dysesthesias. While the Board acknowledges that the examiner found the severity of the Veteran's radiculopathy to be moderately severe, the Board notes that reflex testing in each lower extremity was normal. Sensation was also only noted to be decreased, rather than absent, in the lower leg/ankle downward. While muscle strength testing showed active movement against gravity in knee extension, strength was only slightly reduced in the remainder of the lower extremities. Pursuant to 38 C.F.R. § 4.124a, when the nerve involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The evidence discussed above reflects that, throughout most of the relevant rating period on appeal, the Veteran's right and left lower extremity symptomatology manifested as the sensory symptoms of pain, paresthesias, and numbness, which would not warrant a finding that the symptoms were at least moderately severe. As such, the Board finds that the Veteran's service-connected radiculopathy of the right and left lower extremities has not manifested as moderately severe or greater symptomatology in either lower extremity from April 2021, and increased ratings are not warranted. 38 C.F.R. §§ 4.3, 4.7, 4.124a, Diagnostic Code 8520. While acknowledging, as a final matter, that the Veteran presented to the April 2021 VA examination in a wheel chair, the Board notes that the Veteran has additional, nonservice-connected disabilities, including knee disabilities, and medical treatment records dated just prior to the examination indicate that the Veteran was involved in a motorcycle accident in February 2021 which fractured the tibia in his right lower extremity. While the Board acknowledges the limitations caused by the Veteran's low back disability and associated radicular symptoms, it does not appear that the Veteran's mobility limitations during the April 2021 examination were due solely to his service-connected back and radiculopathy disabilities by themselves. The Board will, however, will not disturb any of the increased ratings assigned effective the date of the examination. The Board is sympathetic to the Veteran's lay statements that his disabilities are worse than currently evaluated, and those statements have been considered. The Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). He is not, however, competent to identify a specific level of disability according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran's disabilities have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and the clinical records) directly address the criteria under which the disabilities are evaluated. The medical and lay evidence has been assessed by the Board in determining the overall ratings. In sum, as the evidence is against a finding that the severity of the Veteran's disability warrants higher ratings, the claims for increased disability ratings for his low back and bilateral radiculopathy disabilities must be denied. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. REASONS FOR REMAND While the Board regrets further delay, the Veteran's remaining claims must be remanded for additional development. 1. SMC based on the need for aid and attendance. 2. Housebound status/home adaption grant. As noted previously, a claim for SMC based on the need for aid and attendance has been raised by the record. On remand, the Veteran should be afforded an examination to determine if SMC based on the need for aid and attendance due to his service-connected disabilities is warranted. As any examination afforded to the Veteran to determine his need for aid and attendance could impact his claim for a certificate of eligibility for financial assistance in acquiring specially adapted housing or a special home adaptation grant, these claims are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Thus, the Veteran's specially adapted housing/home adaptation grant must be deferred. 3. TDIU prior to September 6, 2019. By way of background, the RO granted the Veteran a TDIU effective September 6, 2019, after the Board's first remand in 2019, in a January 2021 rating decision. In the same rating decision, the RO also granted service connection claims for an acquired psychiatric disorder and migraine headaches. Recently, in July 2021, the Veteran timely appealed the January 2021 rating decision, including the ratings assigned for his migraine headaches and acquired psychiatric disorder. As the Veteran's TDIU is currently effective as of the September 6, 2019 effective date assigned for the Veteran's 70 percent rating for an acquired psychiatric disorder, adjudication of the Veteran's effective date for his TDIU would be premature. Additionally, and similarly to the adapted housing/home adaptation grant claim, any VA examination to determine the Veteran's need for aid and attendance may also impact the Veteran's entitlement to an earlier effective date for his TDIU. As such the TDIU claim must also be deferred. The matters are therefore REMANDED for the following actions: 1. Schedule the Veteran for a VA examination to assess whether he requires aid and attendance due to service-connected disabilities. The examiner should assess whether any assistance deemed necessary is due to such service-connected disabilities as opposed to other nonservice-connected conditions. (Continued on the next page) 2. Then, the record should again be reviewed. If any benefit sought on appeal remains denied, to include the claims for specially adapted housing/home adaptation grant and an earlier effective date for a TDIU, the Veteran and his representative should be furnished with a supplemental statement of the case and be given the opportunity to respond. L. BARSTOW Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Scarduzio, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.