Citation Nr: 21076727 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 16-30 499 DATE: December 27, 2021 ORDER Service connection for a chronic skin disorder, including chloracne, is denied. Service connection for median nerve paralysis of the right upper extremity is denied. Service connection for median nerve paralysis of the left upper extremity is denied. Service connection for sciatic nerve neuralgia of the left lower extremity is denied. Service connection for sciatic nerve neuralgia of the right lower extremity is denied. A compensable rating for bilateral hearing loss is denied. A compensable rating for loss of sense of smell is denied. A compensable rating for loss of sense of taste is denied. A compensable rating for deviation of the nasal septum is denied. Restoration of a 10 percent rating for gastroesophageal reflux disease (GERD) is granted, subject to the regulations governing the payment of monetary awards. A rating in excess of 10 percent for residuals of an injury of the left thumb from December 1, 2012 to March 15, 2014, and from January 22, 2021, is denied. A rating of 10 percent for residuals of an injury of the left thumb from March 15, 2014, to January 22, 2021, is granted, subject to the regulations governing the payment of monetary awards. A total rating by reason of individual unemployability due to service-connected disabilities (TDIU) prior to August 15, 2019, is granted, subject to the regulations governing the payment of monetary awards. An effective date earlier than June 25, 2013, for the award of a 20 percent rating for degenerative disc disease of the cervical spine is denied. FINDINGS OF FACT 1. The Veteran's skin disorders, including squamous cell carcinoma, basal cell carcinoma, and actinic keratosis was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 2. The preponderance of the evidence of record is against finding that the Veteran has had chloracne at any time during or approximate to the pendency of the claim. 3. The Veteran's nerve paralysis of the right upper extremity (other than neuropathy secondary to cervical degenerative disc disease) was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 4. The Veteran's nerve paralysis of the left upper extremity (other than neuropathy secondary to cervical degenerative disc disease) was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 5. The Veteran's sciatic nerve neuralgia of the left lower extremity was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 6. The Veteran's sciatic nerve neuralgia of the right lower extremity was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 7. The preponderance of the evidence of record is against finding that the Veteran has had acute or subacute peripheral neuropathy at any time during or approximate to the pendency of the claim. 8. Veteran's bilateral hearing has been manifested by hearing acuity of no worse than Level I in the right ear and no worse than Level I in the left ear. 9. Throughout the appeal, the Veteran has manifested partial loss of the sense of smell. 10. Throughout the appeal, the Veteran has manifested partial loss of the sense of taste. 11. Throughout the appeal, the Veteran's deviated septum has not resulted in either 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. 12. In February 2011, service connection for GERD was awarded with a 10 percent rating based on manifestations of intermittent exacerbations that were controlled by medication; examination in March 2014 showed GERD to be manifested by infrequent episodes of epigastric distress that are controlled by mediation. 13. Throughout the appeal, the residuals of an injury of the left thumb have been primarily manifested by pain, limitation of motion of the left thumb with a gap of less than one inch between the thumb pad and the fingers, incoordination, and ligament laxity. 14. The Veteran's claim for TDIU was received on June 25, 2013; the Veteran's service-connected disabilities have rendered him unemployable since that date. 15. Service connection for degenerative disc disease of the cervical spine, rated noncompensable, was established by rating decision in May 2013. 16. The Veteran submitted an informal claim for an increased rating for his cervical spine disorder no earlier than June 25, 2013. CONCLUSIONS OF LAW 1. The criteria for service connection for a chronic skin disorder, including skin cancer or chloracne, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for median nerve paralysis of the right upper extremity have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for median nerve paralysis of the left upper extremity have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for sciatic nerve neuralgia of the left lower extremity have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for sciatic neuralgia of the right lower extremity have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for a compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100. 7. The criteria for a compensable rating for loss of sense of smell have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.31, 4.87a, Diagnostic Code 6275. 8. The criteria for a compensable rating for loss of sense of taste have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.31, 4.87a, Diagnostic Code 6276. 9. The criteria for a compensable rating for deviation of the nasal septum have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.31, 4.97, Diagnostic Code 6502. 10. The criteria for restoration of a 10 percent rating, but no more, for GERD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.114, Diagnostic Code 7346. 11. The criteria for a 10 percent rating, but no more, for residuals of an injury of the left thumb have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.71a, Diagnostic Code 5228. 12. The criteria for a TDIU rating as of June 25, 2013, have been met. 38 U.S.C. § 5110(a)(b); 38 C.F.R. § 3.400(o). 13. The criteria for an effective date for a 20 percent rating prior to June 25, 2013 for degenerative disc disease of the cervical spine have not been met. 38 U.S.C. § 5110(a)(b); 38 C.F.R. § 3.400(o). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1967 to September 1990. In August 2019, a Travel Board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran's claims file. The issues currently on appeal, in addition to the issue of service connection for chronic obstructive pulmonary disease (COPD), were remanded for further development of the evidence in May 2020. While pending dispatch, service connection was granted for peripheral neuropathy of the upper extremities as secondary to the Veteran's service-connected cervical spine disorder was granted. The Board notes that the Veteran has claimed upper extremity nerve paralysis as a result of exposure to herbicides while on active duty. Thus, the issues related to direct service connection remain on appeal. Following development ordered by the Board, service connection was established for COPD. Therefore, this issue is no longer on appeal. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition, as identified in 38 C.F.R. § 3.309(a), noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). Service connection may also 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). Where a veteran who served for ninety days or more during a period of war (or during peacetime service after December 31, 1946) develops certain chronic diseases, such as cancer or diseases of the nervous system, to a degree of 10 percent or more within one year from separation from service, such diseases may be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In order to prevail on the issue of service connection, there must be medical evidence of current disability; medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1990). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1990); 38 C.F.R. § 3.303(a). The Board has reviewed all of the evidence in the Veteran's claims file, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence where appropriate and the analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The statutory provision specifically covering Agent Orange is 38 U.S.C. § 1116. Under 38 U.S.C. § 1116(f), a claimant, who, during active service, served in the Republic of Vietnam (RVN) during the Vietnam era, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that he was not exposed to any such agent during that service. Disease associated with exposure to certain herbicide agents, listed in 38 C.F.R. § 3.309, will be considered to have been incurred in service under the circumstances outlined in that section even though there is no evidence of such disease during the period of service. If a veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied: AL amyloidosis; Chloracne or other acneform disease consistent with chloracne; type 2 diabetes; Hodgkin's disease; ischemic heart disease; all chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia); multiple myeloma; non-Hodgkin's lymphoma; Parkinson's disease; early-onset peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancers of the lung, bronchus, larynx, or trachea), and soft-tissue sarcoma. 38 C.F.R. § 3.309(e). Aside from these presumptive provisions, service connection might be established by satisfactory proof of direct service connection. See Combee v. Brown, 34 F.3rd 1039 (Fed. Cir. 1994). Service connection for a skin disorder, including chloracne The Veteran contends he currently has a chronic skin disorder, the skin disorder chloracne, that results from his exposure to herbicide agents while serving in the RVN while on active duty. After his testimony at the Board hearing, the Board expanded the issue to include all the Veteran's skin disorders. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of skin cancer as evidenced by VA examination dated in September 2014. Cancer is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. Review of the record fails to show that the disability was manifested during service or shown as chronic in service. Similarly, the record does not show that the disorder manifested to a compensable degree within the one-year presumptive period, and was not noted in service with attributable continuity of symptomatology. VA treatment records dated in December 2006 show that the Veteran denied skin rashes at that time. The Veteran claimed service connection for skin cancer as related to exposure to Agent Orange in 2012. The record does not include a pre-application demonstration of skin cancer. Thus, skin cancer was first diagnosed in the record on VA examination in September 2014, which is many years after the Veteran's separation from service and years outside of the applicable presumptive period. Regarding chloracne, the September 2014 VA examination finds no evidence of this disorder either in service or thereafter. During the August 2019 Travel Board hearing, the Veteran testified to having visited a corpsman in service and being given powder, seeing a dermatologist after service who has prescribed creams, and had rashes on his skin since service. He was afforded a VA examination in January 2021 at which time the diagnoses were chloracne, reportedly diagnosed in 2008 and squamous cell carcinoma, reportedly diagnosed in 2006. The Veteran reported that he had a stem cell transplant in 2008 after which he had a rash that "comes and goes." He believed this rash was related to Agent Orange to which he was exposed while serving in the RVN. He also had actinic keratosis of the back and chest, for which he was treated from 2006 to 2012, and squamous cell carcinoma of the nose and lip that was removed in 2006. The actinic keratosis was last active in 2012 and the carcinoma remained in remission, but he was followed by the dermatology clinic. Following examination, the examiner opined that it was less likely than not that the Veteran's skin disorders were related to service. There was no current chronic diagnosis made for chloracne, basal cell carcinoma, actinic keratosis or squamous cell carcinoma. The examiner noted that the Veteran's basal and squamous cell carcinomas as well as actinic keratosis had been treated and were currently resolved. The only skin condition that lingered was noted to be a papular rash to the anterior and posterior trunk are and the face area. The Veteran reported that these areas were non-pruritic. He described the areas as a hard and rough persistent rash. On the face, it was noticeable with erythema to the cheek area. On the back and chest areas it was a palpable rough rash. The examiner described chloracne as a rare eruption of blackheads, cysts and nodules. Examination showed no blackheads or cysts to be visible. Rather, there were only areas of rough batches of rash spread throughout the skin areas. The examiner concluded the Veteran did not have a skin condition to include chloracne that was at least as likely as not incurred in or caused by an injury, event, or disease during service. The examiner stated that since the current rash did not present on examination as chloracne as evidenced by current research, a nexus had not been established. The Board finds that the Veteran's diagnosis of chloracne is made by history only, without an actual demonstration of the disease. As such, the presumptive provisions regarding herbicide exposure are not for application. While the Veteran is competent to report having experienced symptoms of chloracne since service and consistently since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of chloracne as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Regarding the Veteran's other skin disorders, service connection may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran's skin disorders and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. The record does not contain evidence of manifestations of skin cancer or actinic keratosis during service or within the one-year presumptive period. There is no competent evidence (including any medical opinions) relating the Veteran's skin cancer with service, including as a result of exposure to herbicide agents while in Vietnam. In fact, the only opinion in the record regarding a skin disorder is the 2021 examiner's opinion that indicates that the Veteran's basal and squamous cell carcinomas as well as actinic keratosis had resolved with treatment. Any current skin disorder was not considered to be chloracne and no relationship was drawn between a current skin disability and the Veteran's period of active duty. As noted, while the Veteran believes his current skin disorder is related to an in-service injury, event, or disease, including exposure to Agent Orange, he is not competent to provide a nexus opinion in this case. Jandreau 492 F.3d at 1372. Consequently, the Board gives more probative weight to the competent medical evidence. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran's claim for service connection for a chronic skin disorder, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Service connection for median nerve paralysis of the right and left upper and lower extremities The Veteran has also claimed service connection for neuropathy of the right and left upper and lower extremities as a result of exposure to Agent Orange. The Board notes that service connection has been granted for peripheral neuropathy of the upper extremities secondary to degenerative disc disease of the cervical spine, but the matter has not been adjudicated on a direct basis as a result of herbicide agents exposure. Therefore, this discussion is necessary to address all of the Veteran's contentions. As noted, chronic disease of the nervous system are enumerated conditions under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. Review of the Veteran's service treatment records (STRs) shows that while on active duty he had some complaints related to numbness of his extremities. In November 1979, he had complaints of numbness of the hand following an injury of his elbow. In December 1984, he complained of numbness from his mid back to his feet when he bent his head down. Physical examination was normal. On follow-up evaluation in January 1985, the Veteran stated that he had shooting pain from the neck down the back and the back of the legs. Evaluation was essentially within normal limits. The impression was non-radicular neck pain. On reenlistment physical in April 1985, annual physical in May 1988, and on retirement physical in August 1990 ; neurologic examinations were normal. Post service VA treatment records dated in April 2006 show neurologic evaluation to be normal. In December 2006, it was found that he had no numbness, tingling or other neurologic symptoms. The Veteran has not been afforded a specific neurologic examination, but VA examinations of the thoracolumbar spine and cervical spine in December 2012 show no sensory deficits of any of the Veteran's extremities and no evidence of radiculopathy. Identical findings were noted on VA examination of the low back in March 2014. On VA examination of the cervical spine in September 2019, sensory examination of the upper extremities was normal. There was no evidence of radiculopathy. On VA examination of the cervical spine in March 2020, sensory examination of the upper extremities was normal, but moderate radiculopathy of the upper extremities was noted. The Board finds that while the Veteran had some episodes of numbness of his extremities while he was on active duty, a chronic neurologic disability was not demonstrated in service. This finding is supported by the normal neurologic findings on routine physical examinations in 1985, 1988, and on retirement examination in 1990. Moreover, VA treatment records in 2006 and VA examinations in 2012 and 2014 show no evidence of peripheral neuropathy. As such, the record fails to show a chronic neurologic disability was manifested during service or shown as chronic in service. Similarly, the record does not show that any chronic disorder was manifested to a compensable degree within the one-year presumptive period, and was not noted in service with attributable continuity of symptomatology. The Board acknowledges that early-onset peripheral neuropathy is a disease for which service connection may be presumed as being the result of herbicide agents exposure. As outlined above, however, there is no evidence that the Veteran manifested early-onset peripheral neuropathy. There is also no competent evidence that the Veteran's currently diagnosed neuropathy of the upper or lower extremities is related to his in-service exposure to herbicide agents. As such, there is no basis for a finding that the Veteran has chronic peripheral neuropathy resulting from herbicide agents exposure. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran's claim for service connection for neuropathy of the upper or lower extremities, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. The United States Court of Appeals for Veterans Claims (Court) has held that "staged" ratings are appropriate for an increased rating claim where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). A compensable rating for bilateral hearing loss The Veteran contends that his bilateral hearing loss is more disabling than currently evaluated. During the hearing before the undersigned, the Veteran testified that his hearing had worsened over the past five years and that his right ear hearing loss was worse than his left. He also stated that he had hearing aids, but that they were not functioning properly. Service connection for bilateral hearing loss was granted by rating decision dated in February 2011. The current noncompensable evaluation was assigned at that time. The Veteran's application for TDIU, which was accepted as an increased rating claim for all service-connected disabilities, was received in June 2013. Evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, Diagnostic Code 6100. To evaluate the degree of disability from bilateral service-connected hearing loss, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII. An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b). An audiometric examination was conducted by VA in March 2014. At that time, the Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 20 60 65 70 54 84% LEFT 15 30 55 60 40 94% A VA audiology note dated in February 2020 shows that the Veteran reported continuing hearing loss, worse on the right. Pure tone testing showed normal hearing through 1 kHz in the right ear and normal hearing to 1.5 kHz in the left ear. There was sloping hearing loss at higher hertz. Speech recognition testing was 80 percent correct in the right ear and 92 percent correct in the left ear. Both these figures were considered "good." An audiometric examination was conducted by VA in January 2021. At that time, the Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 15 65 65 70 54 96% LEFT 15 45 70 65 49 98% Applying the results to Table VI, the findings yield a numeric designation of Level I in the right ear and Level I in the left ear. Entering the resulting bilateral numeric designation of Level I for the right ear and Level I for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a noncompensable disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 has not been shown. The Board expressly acknowledges its consideration of the lay evidence of record when adjudicating this claim, including the Veteran's testimony regarding a worsening of his hearing loss over the years, and difficulty hearing others. He is competent to report difficulty with his hearing; however, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). The rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing. The functional impact that the Veteran describes, is contemplated by the rating criteria. Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Veteran's main complaint is reduced hearing acuity and clarity, which is what is contemplated in the rating assigned. See Rossy v. Shulkin, 29 Vet. App. 142, 145 (2017). Accordingly, the preponderance of the most probative evidence is against the claim of entitlement to a compensable rating for hearing loss. In reaching the conclusion above, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A compensable rating for loss of sense of smell and taste The Veteran contends that his loss of the sense of smell and taste are more disabling than currently evaluated. During the hearing before the undersigned, the Veteran testified that his problem with taste was mostly that he could not differentiate between tastes; he had also lost most of his sense of smell. An examination was conducted by VA in December 2012. At that time, the diagnosis was hyposmia, which is further described as a reduced ability to detect odors. The Veteran currently had a partial loss of sense of smell and a partial loss of sense of taste. Qualitative smell testing was performed. This suggested a severe microsomia. Testing of taste revealed 2/4 results with the Veteran missing bitter and sour. The examiner indicated that, while the Veteran was currently retired, his inability to smell natural gas affected his work in heating and air conditioning maintenance. An examination was conducted by VA in March 2014. At that time the diagnoses were hyposmia, partial loss of the sense of smell, and hypogeusia, partial loss of the sense of taste. These were described by the examiner as being partial in severity. Functional impairment was described as the disorders would prohibit employment that would require the ability to detect odors, such as a natural gas leak, but would otherwise have no effect on his ability to perform employment. For complete loss of the sense of smell, a 10 percent rating is warranted. 38 C.F.R. § 4.87a, Diagnostic Code 7295. For complete loss of the sense of taste, a 10 percent rating is warranted. 38 C.F.R. § 4.87a, Diagnostic Code 7296. In every instance where the minimum schedular evaluation requires residuals and the schedule does not provide a no percent evaluation, a no percent evaluation will be assigned when the required residuals are not shown. 38 C.F.R. § 4.31. Review of the record shows that the Veteran has demonstrated partial loss of the sense of smell and taste throughout this appeal. Absent complete loss of either of these senses, a compensable rating is not warranted. Id. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran's claim for increased rating for loss of the senses of smell and taste, and the claims must be denied. Because the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A compensable rating for deviation of the nasal septum Service connection for residuals of a nasal fracture was granted by rating decision dated in February 2011. A noncompensable rating was assigned at that time as a deviated nasal septum under the provisions of Diagnostic Code 6502. The noncompensable rating for the Veteran's deviated septum has been assigned under DC 6502 for deviation of the nasal septum. DC 6502 provides that a maximum 10 percent rating will be assigned for a deviated septum when there is either 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. 38 C.F.R. § 4.97, DC 6502. The rating schedule authorizes the assignment of a 0 percent (noncompensable) rating in every instance in which the rating schedule does not provide for such a rating and the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. The Veteran was afforded a VA examination in December 2012. At that time, the diagnoses included deviated nasal septum. The VA examiner stated that there was neither at least 50 percent obstruction of the nasal passage on both sides due to traumatic septal deviation or complete obstruction on one side due to traumatic septal deviation. A VA examination was conducted in March 2014. Once again, the VA examiner stated that there was neither at least 50 percent obstruction of the nasal passage on both sides due to traumatic septal deviation or complete obstruction on one side due to traumatic septal deviation. At the hearing before the undersigned, when asked whether the Veteran had any obstruction in his nasal passage, the Veteran responded that he only had the deviated septum on the right side. Throughout the appeal, the record shows that the Veteran has neither at least 50 percent obstruction of the nasal passage on both sides due to traumatic septal deviation or complete obstruction on one side due to traumatic septal deviation. As the criteria for a compensable rating were not shown, a compensable rating is not warranted. Restoration of a 10 percent rating for GERD The Veteran contends that his service-connected GERD remains as disabling as it was when he was first awarded the 10 percent rating. Review of the record shows that service connection was established by rating decision dated in February 2011. At that time, a 10 percent rating was awarded on the basis of VA outpatient treatment records dated in October 2010. In his testimony before the undersigned at the Board hearing, the Veteran stated that the disability from his GERD had not improved, but had been consistently bothersome to him. VA outpatient treatment records dated in October 2010 show that the Veteran had a history of GERD with intermittent exacerbations requiring the mediation Gaviscon as needed. He slept on two pillows due to his GERD. An examination was conducted by VA in March 2014. At that time, he complained of infrequent episodes of epigastric distress. The Veteran had no complaints of esophageal stricture, spasm of the esophagus, or acquired diverticulum of the esophagus. There were no other pertinent physical findings, complications, conditions, signs or symptoms. Imaging studies were not performed, but laboratory testing showed no significant bloodwork test findings. The examiner stated that the Veteran's esophageal condition did not impact his ability to work. The examiner noted that the Veteran remarked that he had no problems with his esophageal condition "as long as I take my medications." The Veteran's GERD is rated by analogy to 38 C.F.R. § 4.114, Diagnostic Code (DC) 7346, for hiatal hernia. Pursuant to DC 7346, a 10 percent disability rating is warranted for two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent evaluation is warranted for persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. The maximum 60 percent evaluation is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. Examinations less full or complete than those on which payments were authorized or continued will not be used as a basis for reduction. Ratings on account of diseases subject to temporary or episodic improvement which have been in effect for 5 years or more will not be reduced on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. 38 C.F.R. § 3.344. To reduce the veteran's disability rating the regulations require that the VA examination performed prior to the rating reduction be full and complete, and that the extent of the medical examinations made prior to this VA examination, with their findings and conclusions, be discussed by the Board. Following this, the VA examination on which the reduction was based must be shown to be as full and complete as the prior examinations. Then, the Board must make a specific finding that the Veteran's condition has actually improved, or that there has been "material improvement" that was "reasonably certain...(to) be maintained under the ordinary conditions of life." See Brown v. Brown, 5 Vet. App. 413 (1993). Review of the record shows that the Veteran was awarded a 10 percent rating based on findings of intermittent exacerbations of his GERD that were controlled by medication. The Board finds that similar findings were demonstrated on examination in March 2014. The Veteran gave credible testimony that his disability was unchanged from the time of the initial award of a 10 percent rating. He is competent to report his readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). For this reason, the Board finds that the rating reduction made following the March 2014 VA examination was not proper and the 10 percent evaluation should have been continued. To this extent, the appeal is granted. A higher 30 percent rating under DC 7346 is not warranted unless there is persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. This has not been demonstrated in the record and the Veteran did not testify that his GERD had reached the extent whereby a 30 percent rating would be indicated. Thus, the Veteran's GERD did not more nearly approximate persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A higher 30 percent rating under DC 7346 is not warranted. Rating for limitation of motion of the left thumb Service connection for status post fracture of the left thumb was granted by rating decision dated in February 2011. An initial noncompensable rating was awarded at that time under the provisions of Diagnostic Code 5228 from July 16, 2010, the date of the Veteran's claim. While the Veteran disagreed with the rating, he did not submit a timely appeal after he was furnished a Statement of the Case. The rating was increased to 10 percent disabling, effective December 1, 2012, by rating decision dated in May 2013 and then reduced to noncompensable, effective March 15, 2014, by rating decision dated in April 2014. The rating was again increased to 10 percent by rating decision dated in August 2021, effective January 22, 2021. The Veteran continues to express dissatisfaction with the rating, and it is less than the maximum under the applicable criteria. Therefore, the claim remains on appeal. See AB v. Brown, 6 Vet. App. 35 (1993). The Veteran's service-connected left thumb fracture residuals is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5228. Under Diagnostic Code 5228, a noncompensable disability rating is warranted for limitation of motion of the major thumb with a gap of less than 1 inch between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. A 10 percent disability rating is warranted under Diagnostic Code 5228 for limitation of motion of the major thumb with a gap of one to two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. A maximum 20 percent rating under Diagnostic Code 5228 is warranted for limitation of motion of the major thumb with a gap of more than two inches between the thumb pad and the ringers, with the thumb attempting to oppose the fingers. In determining disability ratings, Diagnostic Code 5228 makes no differentiation between the major and minor hands. In addition, if there is X-ray evidence of degenerative arthritis in the Veteran's left thumb, the Board will also consider a rating under Diagnostic Code 5003. Under that code, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a, Diagnostic Code 5003. When, however, the limitation of motion is noncompensable under the appropriate diagnostic codes, a rating of 10 percent may be applied to each such major joint or group of minor joints affected by limitation of motion. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, X-ray evidence of arthritis involving two or more major joints, or two or more minor joint groups, will warrant a rating of 10 percent; in the absence of limitation of motion, X-ray evidence of arthritis involving two or more major joint groups with occasional incapacitating exacerbations will warrant a 20 percent rating. The above ratings will not be combined with ratings based on limitation of motion. Under 38 C.F.R. § 4.45(f), for the purpose of rating disability from arthritis, the only major joints are the shoulder, elbow, wrist, hip, knee and ankle. Additionally, groups of multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities; the interphalangeal, metatarsal and tarsal joints of the lower extremities; the cervical vertebrae; the dorsal vertebrae; and the lumbar vertebrae, are considered groups of minor joints, ratable on parity with major joints. 38 C.F.R. § 4.45(f). Compensable evaluations are also warranted with objective evidence of ankylosis of the thumb. See 38 C.F.R. § 4.71a, Diagnostic Code 5224. An examination was conducted by VA in December 2012. At that time, the diagnosis was gamekeeper thumb. It was initially noted that this was the right thumb, but the evaluation report deals with the left thumb. It was noted that the Veteran was right hand dominant. The Veteran described flare-ups of the function of his hand that was worse with grasping activities or gripping. There was limitation of motion of the left thumb. There was a gap between the thumb pad and the fingers that was less than one inch. There was pain at the gap of less than one inch. The Veteran was able to perform repetitive use testing without additional limitation of motion and continued gap between the thumb pad and the fingers of less than one inch. There was tenderness to palpation of the left thumb. Grip strength on the left was only 4/5. There was no ankylosis of the thumb. X-ray studies showed degenerative or traumatic arthritis of the left thumb. The examiner stated that the Veteran would have difficulty with heavy labor or activities that required grip strength. An examination was conducted by VA on March 15, 2014. At that time, the diagnosis was gamekeeper's thumb of the left hand. The Veteran reported having no flare-ups that impacted the function of the hand. He did have limitation of motion or evidence of painful motion of the thumb. There was no gap between the thumb pad and the fingers. The Veteran was able to perform repetitive use testing without additional limitation of motion or functional loss and without a gap between the thumb pad and the fingers. There was pain on palpation of the joint or soft tissue. Strength was 5/5 in the left hand. There was no ankylosis. The examiner found laxity to the radial deviation of the left thumb indicating that the thumb metacarpophalangeal (MCP) joint had ulnar collateral ligament laxity. He did not use an assistive device. Imaging studies showed arthritis of the left hand. An examination was conducted by VA in January 2021 to evaluate the residuals of a fracture of the left thumb. The diagnosis was degenerative arthritis of the left thumb. It was noted that the Veteran had fractured the ulnar base of the proximal phalanx and had degenerative joint disease of the distal interphalangeal joint. Another diagnosis was gamekeeper's thumb. The Veteran reported that he had experienced a hard time with some hand movements such as gripping, pulling, and grasping objects. He reported intermittent pain when picking up objects and sometimes when trying to make a fist. He stated that he could not completely bend his thumb. He had intermittent pain with grabbing and picking up objects. He reported intermittent pain when picking up objects and sometimes while trying to make a fist. He was right hand dominant. The inability to grab objects, which occurred two to three times per week and lasted up to five to six hours. Range of motion of the left thumb showed range of motion of the MCP joint from 0 to 90 degrees, with normal being 100 degrees. Motion of the proximal interphalangeal (PIP) joint was from 0 to 65 degrees, with normal being to 90 degrees. There was no gap between the thumb and the fingers. There was pain on movement with the Veteran unable to perform some range of motion exercises with the left thumb. Abnormal range of motion did not contribute to a functional loss. Pain was noted, but this did not result in functional loss. Pain was noted on finger flexion, finger extension and opposition with the thumb. There was no evidence of pain with use of the hand. There was no evidence of localized tenderness or pain on palpation. The Veteran was able to perform repetitive use testing without additional functional loss of range of motion. The Veteran was not examined immediately after repetitive use over time. There was pain and incoordination that affected functional loss. Range of motion was further decreased to 75 degrees at the MCP joint and 55 degrees at the PIP joint. There was no gap between the pad of the thumb and the fingers. The examination was not being conducted during a flare-up with range of motion estimated to be 85 degrees at the MCP joint and 55 degrees at the PIP joint. There was no ankylosis. Muscle strength testing was 4/5 in the left hand. There was no muscle atrophy. The examiner indicated that the Veteran's hand disorder would affect his employment status as the Veteran would not be able to grab and hold objects appropriately. He also reported decreased strength to the left hand due to the left thumb injury. There was objective evidence of pain on passive range of motion testing and when the joint is used for non-weight bearing. Based on the foregoing, the Board finds a 10 percent rating is warranted throughout the appeal period, including from March 15, 2014, to January 22, 2021 (when the Veteran is currently assigned a 0 percent rating). In this regard, it is noted that during the March 2014 VA examination, while the Veteran was shown to be able to close the gap between the thumb pad and fingers, pain and MCP joint ulnar collateral ligament laxity was demonstrated. The January 2021 VA examination similarly showed findings that warranted the assignment of a 10 percent rating from that date. As noted above, a 10 percent rating is warranted under Diagnostic Code 5228 for a gap of at least 1 to 2 inches (2.5 to 5.1 cm) between the thumb pad and the fingers with the thumb attempting to oppose the fingers; and a maximum 20 percent rating under Diagnostic Code 5228 is warranted for limitation of motion of the major thumb with a gap of more than two inches (5.1 cm) between the thumb pad and the ringers, with the thumb attempting to oppose the fingers. In this case, the gap between the Veteran's right thumb pad and fingers at his initial VA examination, which took place in December 2012, was found to be just under one inch between the thumb pad and fingers of the left hand. This was found to be sufficient to warrant a 10 percent rating under Diagnostic Code 5228. The Board finds that this level of impairment was maintained on examination in March 2014 so that the 10 percent rating continued to be warranted. To this extent, the appeal is allowed. The record indicates that a higher disability rating is not warranted under Diagnostic Code 5228. In order to assign the next-higher, 20 percent rating under this diagnostic code, the medical evidence must show a gap of more than 2 inches between the Veteran's left thumb pad and fingers when attempting to oppose his fingers. This has not been shown during any of the VA examinations, or in the Veteran's treatment records; thus, he does not meet the criteria for a higher rating under Diagnostic Code 5228. Similarly, a disability rating in excess of 10 percent is not warranted any other applicable diagnostic code. The Veteran does not have ankylosis of the left thumb, as noted in the VA examinations that have been performed. As such, a rating in excess of 10 percent for favorable ankylosis, or 20 percent for unfavorable ankylosis, under Diagnostic Code 5224, are not warranted. The Board finds that a compensable rating under Diagnostic Code 5003 is also not appropriate in this case. While there is evidence of arthritis, the Board highlights that that the Veteran has been granted a compensable rating based on a limitation of motion of his left thumb. Moreover, the thumb constitutes only one minor joint group. See 38 C.F.R. § 4.45. Diagnostic Code 5003 requires X-ray evidence of arthritis in two minor joint groups in order for a 10 percent rating to be assigned. Therefore, even with demonstrated arthritis, a compensable disability rating cannot be assigned under Diagnostic Code 5003. The Board finds that the currently assigned 10 percent disability rating for the thumb already contemplates any functional impairment related to pain, weakness, fatigability, on limitation of motion and does not warrant a higher rating. See DeLuca v. Brown, 8 Vet. App. 202, 206-08 (1995); 38 C.F.R. § 4.45. For these reasons, the Board finds that a rating in excess of 10 percent for the Veteran's left thumb disability is not warranted. TDIU prior to August 15, 2019 The record shows that TDIU was granted by rating decision dated in November 2019, effective on August 15, 2019. The effective date was set as the date of the receipt of the Veteran's claim for TDIU. The Veteran has contended that an earlier effective date should be for this award. Total disability ratings for compensation may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided 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. When these percentage standards are not met, consideration may be given to entitlement on an extraschedular basis, taking into account such factors as the extent of the service-connected disability, and employment and educational background. It must be shown that the service-connected disability produces unemployability without regard to advancing age. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16, 4.19. The effective date for an increased rating will be the earliest date as of which it is factually ascertainable that an increase in disability had occurred, provided a claim is received within one year from such date; otherwise, the effective date for an increased rating will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a)(b); 38 C.F.R. § 3.400(o). The Board notes that the Veteran's initial claim was received by VA on June 25, 2013. TDIU was initially denied by rating decision dated in April 2014, which was appealed by the Veteran. At the time of this denial service connection was in effect for posttraumatic stress disorder (PTSD), rated 50 percent disabling; cervical disc disease, rated 20 percent disabling; myelodysplasia, status post allogenic stem cell transplant, rated 10 percent disabling; tinnitus, rated 10 percent disabling; GERD, now rated 10 percent disabling; status post fracture of the left thumb; now rated 10 percent disabling; and noncompensable disabilities of bilateral hearing loss, loss of the sense of smell, loss of the sense of taste, and status post nasal fracture. The Veteran's combined evaluation was 70 percent disabling. Additional ratings made during the pendency of this appeal included an increase of the Veteran's PTSD rating to 70 percent, effective July 16, 2010; and the establishment of service connection for COPD, rated 10 percent from May 22, 2014. The rating for the Veteran's myelodysplasia was decreased to noncompensable, effective March 2, 2020. The Veteran's appeal of denial of TDIU also included an appeal of the 50 percent rating that had been assigned for his PTSD. Therefore, the matter of TDIU would have been on appeal in any event. See Rice v. Shinseki, 22 Vet. App. 447 (2009). In a formal application for TDIU, received by VA on August 19, 2019, the Veteran stated that he had one year of college education and training in HVAC. He stated that he had been self-employed in HVAC and had last worked in 2006. On examination by VA in April 2014, the examiner quantified the Veteran's social and industrial impairment as having deficiencies in most areas such as work, school, family relations, judgment, thinking and/or mood. Symptoms included intrusive thoughts, avoidance behavior, guilt feelings, diminished interest in significant activities, irritable behavior, hypervigilance, exaggerated startle response, sleep disturbance, anxiety, and difficulty adapting to stressful circumstances. Regarding the Veteran's ability to maintain employment, the examiner opined that the Veteran would have moderate impairment due to irritability, mild impairment due to lack of concentration, and no impairment due to lack of motivation. The rationale for this dealt with the Veteran's age and adequate income from his military retirement and VA disability compensation. On examination of the cervical spine in December 2012, the Veteran reported having flare-ups that were worse with increased neck flexion. Initial ranges of motion were normal in all planes of movement. He did not have functional loss or muscle spasm. On VA examination in March 2014, the diagnosis was degenerative arthritis of the spine. Pain and limitation of motion was noted in all planes of movement. Functional loss was shown to be less movement than normal and pain on movement. There was localized tenderness, but no muscle spasm or muscle atrophy. Imaging studies showed arthritis of the spine. During the hearing before the undersigned, the Veteran stated that he became unable to work as a result of an inability to deal with his mental health issues, neck disability and ringing in his ears. In a September 2019 opinion, a VA examiner stated that the Veteran would not be able to perform more than sedentary work as a result of his service-connected disabilities. The November 2019 rating decision that awarded TDIU did so on the basis that the Veteran's myelodysplasia caused fatigue, his neck condition made it difficult to turn his head or flex his neck without pain, and that his PTSD would cause intrusive thoughts that interfered with his ability to stay focused and disrupted his sleep. Based on this, it was reasonable to conclude that he would be unable to perform substantially gainful employment. The VA rating decision that established entitlement to TDIU did so on the basis of the combined effects of the Veteran's PTSD and cervical spine disorder. The effective date that was assigned was supposedly based on the date of the receipt of the Veteran's application for TDIU, but as noted, the claim actually dates to the application for increased ratings that was received on June 25, 2013. (It is incidentally noted that the date of August 15, 2019, was actually incorrect as the Veteran's claim was received several days later.). Based upon the date of the receipt of the Veteran's claim for TDIU, eligibility should be effective on June 25, 2013. To this extent, the appeal is allowed. An effective date for a 20 percent rating prior to June 25, 2013 for degenerative disc disease of the cervical spine Service connection for degenerative disc disease of the cervical spine was established by rating decision dated in May 2013. A noncompensable evaluation was assigned at that time under the provisions of diagnostic Codes 5003 and 5242. As noted, the Veteran's claim for increase based on unemployability was received on June 25, 2013; this was accepted as an informal increased rating claim for all service-connected disabilities. Following examination, the rating for the Veteran's cervical spine was increased to 20 percent, by rating decision dated in April 2014, effective June 25, 2013. The Veteran appealed the effective date of the award. The effective date for an increased rating will be the earliest date as of which it is factually ascertainable that an increase in disability had occurred, provided a claim is received within one year from such date; otherwise, the effective date for an increased rating will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a)(b); 38 C.F.R. § 3.400(o). Effective on and after March 24, 2015, VA updated the regulations concerning the filing of claims. 79 Fed. Reg. 57,660 (Sept. 24, 2014) (codified in 38 C.F.R. Parts 3, 19, and 20 (2015)). In part, the Department replaced the informal/formal claims process with a standardized and more formal process. See 79 Fed. Reg. at 57,663-64; see also 38 C.F.R. § 3.155 (2015). As a result of the rulemaking, a complete claim on an application form is required for all types of claims. 38 C.F.R. § 3.155(d). As these new regulations only became effective as of March 24, 2015, the do not apply to the current appeal. Prior to March 24, 2015, any communication or action indicating an intent to apply for one or more benefits under the laws administered by VA, from a claimant, his or her duly authorized representative, a Member of Congress, or some person acting as next of friend of a claimant who is not sui juris may be considered an informal claim. Such informal claim must identify the benefit sought. 38 C.F.R. § 3.155 (a). Once a formal claim for pension or compensation has been allowed or a formal claim for compensation disallowed for the reason that the service-connected disability is not compensable in degree or a claim for pension denied for the reason the disability was not permanently and totally disabling, receipt of one of the following may be accepted as an informal claim for increased benefits or an informal claim to reopen: The date of outpatient or hospital examination or date of admission to a VA hospital or uniformed services hospital. The date of receipt of evidence from a private physician when evidence furnished by or on behalf of the claimant is within the competence of the physician. 38 C.F.R. § 3.157(b). (Continued on the next page) Review of the record shows that the Veteran did not appeal the initial noncompensable rating assigned for his service-connected cervical spine disorder. Moreover, he did not submit a formal or informal claim for the benefit. The Board has reviewed the results of the December 2012 and the March 2014 VA examinations on which the initial noncompensable and 20 percent ratings were based. Specifically, in December 2012, the Veteran showed no limitation of motion or pain on motion of the cervical spine, while in March 2014, limitation of motion sufficient to justify the 20 percent rating that was awarded was manifested. The increase was set as of the date of the Veteran's claim for an increased rating based on TDIU. The record does not contain any document that may be considered to be a formal or informal claim for increase for the cervical spine disability. While he did seek VA treatment for various disabilities, there is no indication in these treatment records that the Veteran's cervical spine disability increased in severity from that observed in December 2012. There is also no indication that the cervical spine disability increased in severity in the one year prior to the date of the TDIU claim. Moreover, the mere receipt of medical records cannot be construed as an informal claim for the benefit. Brannon v. West, 12 Vet. App. 32, 35 (1998). Under these circumstances, as the Board cannot identify a claim, either formal or informal, for increase for cervical spine disability, there is no basis for an effective date earlier than the informal claim received on June 25, 2013, and the claim must be denied. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Joseph P. Gervasio 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.