Citation Nr: 21076933 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 15-23 049A DATE: December 28, 2021 ORDER Entitlement to an initial rating in excess of 10 percent for arthritis of the back prior to July 5, 2016, is denied. A 20 percent evaluation, but not higher, for arthritis of the back is granted from July 5, 2016, subject to the law and regulations governing the payment of monetary benefits. Entitlement to an initial rating in excess of 10 percent for right hip limitation of extension is denied. A 10 percent initial evaluation, but not higher, for right hip limitation of flexion is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to an initial compensable rating for right hip impairment, post-shrapnel injury, is denied. Entitlement to an initial compensable rating for right little finger limitation of motion is denied. Entitlement to service connection for a skin rash of the right thigh, right hip, and right chest, to include as secondary to exposure to herbicide agents, is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU), beginning April 2, 2011, but not earlier, is granted, subject to the law and regulations governing the payment of monetary benefits. An effective date of April 2, 2012, but not earlier, for special monthly compensation (SMC) based on aid and attendance, is granted. FINDINGS OF FACT 1. Prior to July 5, 2016, the Veteran's arthritis of the back did not manifest to forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, 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 an abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 2. Beginning July 5, 2016, the Veteran was diagnosed with intervertebral disc syndrome (IVDS) that resulted in incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. 3. The Veteran's right hip limitation of extension is currently rated at 10 percent under Diagnostic Code 5251, the maximum rating assignable for limitation of extension to five degrees. 4. The Veteran's right hip limitation of flexion is manifested by pain that results in functional loss for the entire period on appeal. 5. The probative evidence is against finding the Veteran's right hip impairment, post shrapnel injury, produced limitation of rotation of the thigh with the inability to toe-out more than 15 degrees, limitation of adduction resulting in the inability to cross legs, or limitation of thigh abduction with motion lost beyond 10 degrees. 6. A noncompensable rating for musculoskeletal disorders of the little finger is the maximum rating allowable for this disability. 7. The weight of the most competent and probative evidence is against a finding that the Veteran's skin rash of the right thigh, right hip, and right chest had its onset during military service or is otherwise related to such service. 8. The evidence of record demonstrates that the Veteran was unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities prior to April 2, 2012. 9. Resolving all reasonable doubt in his favor, the Veteran was employable as of April 2, 2012, due solely to his posttraumatic stress disorder. CONCLUSIONS OF LAW 1. Prior to July 5, 2016, the criteria for a rating in excess of 10 percent for arthritis of the back have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.21, 4.71a, Diagnostic Code 5242. 2. Beginning July 5, 2016, the criteria for a 20 percent rating, but not higher, for arthritis of the back, have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. § 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.21, 4.71a, Diagnostic Code 5243. 3. The criteria for an initial rating in excess of 10 percent for right hip limitation of extension have not been met. 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5251. 4. The criteria for 10 percent rating, but not higher, for right hip limitation of flexion have not been met. 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5314 5252. 5. The criteria for an initial compensable rating for right hip impairment, post shrapnel injury, have not been met. 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5253. 6. The criteria for an initial compensable rating for right little finger limitation of motion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1-4.14, 4.71a, Diagnostic Code 5230. 7. The criteria for entitlement to service connection for skin rash of the right thigh, right hip, and right chest, to include as secondary to exposure to herbicide agents, have not been met. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.307, 3.309. 8. The criteria for entitlement to a TDIU beginning April 2, 2011, but not earlier, have been satisfied. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. 9. The criteria are met for an effective date of April 2, 2012, for SMC based on aid and attendance. 38 U.S.C. §§ 1114 (s), 5100, 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.326, 3.350, 3.352 (2016). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from January 1967 to February 1970. He was injured in a land mine explosion and awarded a Purple Heart. In May 2018, a Travel Board hearing was held before the undersigned. A transcript of that hearing is of record. This claim was previously before the Board in February 2021, at which time it was remanded for further development. While on remand, the Regional Office (RO) granted a separate noncompensable rating for right hip impairment, post shrapnel injury, in a September 2020 rating decision. The Veteran filed a timely Decision Review Request, VA Form 10182, and requested Direct Review under the Appeals Modernization Act (AMA). However, as the underlying right hip flexion and extension disabilities were under appellate status in the Legacy system, the Board will consider the right hip impairment issue as part and parcel of these issues and adjudicate the claim in the instant decision. INCREASED RATING Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. See 38 U.S.C. § 1155; 38 C.F.R. Part 4. The percentage ratings in VA's Schedule for Rating Disabilities (Rating Schedule) represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. See 38 C.F.R. § 4.1. When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not considered to be contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The United States Court of Appeals for Veterans Claims (Court) clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Instead, in Mitchell, the Court explained that, pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (with swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely 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. Where entitlement to compensation has already been established and increase in disability is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, "staged" ratings are appropriate where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board observes that the words "slight," "moderate," and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6 (2016). It should also be noted that use of descriptive terminology such as "mild" by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 U.S.C. § 7104 (a); 38 C.F.R. §§ 4.2, 4.6. Once the evidence has been assembled, it is the Board's responsibility to evaluate the evidence. 38 U.S.C. § 7104 (a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (2016); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Significantly, regulations pertaining to musculoskeletal disabilities were recently amended and new criteria for rating musculoskeletal disabilities became effective on February 7, 2021. When a law or regulation changes during the course of a claim or an appeal, the version more favorable to the veteran will apply, to the extent permitted by any stated effective date in the amendment in question. VAOPGCPREC 3- 2000; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The recently revised musculoskeletal regulations do not provide for retroactive application; thus, the amendments may be applied as of, but not prior to, February 7, 2021. Hence, for the period beginning February 7, 2021, the version more favorable to the veteran will apply. Entitlement to an initial rating in excess of 10 percent for arthritis of the back prior to October 2, 2020, and in excess of 20 percent thereafter For diagnostic codes 5235 to 5242, the General Rating Formula for Diseases and Injuries of the Spine provides that with or without symptoms such as pain, stiffness, or aching in the area of the spine affected by residuals of injury or disease the following ratings will apply: A 20 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, 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 an abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is warranted when medical evidence shows forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine. Id. A 100 percent rating is warranted if there is unfavorable ankylosis of the entire spine. Id. The criteria recounted above are disjunctive. Johnson v. Brown, 7 Vet. App. 95 (1994) (only one disjunctive "or" requirement must be met in order for an increased rating to be assigned); compare Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive "and" in a statutory provision meant that all of the conditions listed in the provision must be met). Note (1) to the rating formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the Veteran's mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. Ankylosis is "immobility and consolidation of a joint due to a disease, injury, surgical procedure." Lewis v. Derwinski, 3 Vet. App. 259 (1992) (citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th Ed. 1987)). Note (5) under the General Rating Formula for Diseases and Injuries of the Spine provides that unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Moreover, it was recently held in Chavis v. McDonough, No. 18-2928 (U.S. Vet. App., April 16, 2021) that application of §§ 4.40 and 4.45 permits consideration under the General Rating Formula for Diseases and Injuries of the Spine of an evaluation based on ankylosis if a claimant's functional loss is consistent with that contemplated by ankylosis. In other words, if the demonstrated functional loss is the functional equivalent of ankylosis. For purposes of evaluations under diagnostic code 5243, the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes provides for a 20 percent evaluation if incapacitating episodes have a total duration of at least two weeks but less than four weeks; a 40 percent disability rating for intervertebral disc syndrome with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a maximum schedular rating of 60 percent is assigned for intervertebral disc syndrome with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. Note (1): For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021) (changing new diagnostic code applicable to plantar fasciitis from 5285 to 5269). The rating criteria for Diagnostic Codes 5235-5243 and the general rating formula for diseases and injuries of the spine were not revised. However, effective February 7, 2021, the application of Diagnostic Codes 5242 and 5243 were revised as follows: Diagnostic Code 5242, which contemplates degenerative arthritis, now includes degenerative disc disease, and Diagnostic Code 5243, which contemplates intervertebral disc syndrome, is to be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root. VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the Veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. VA thus must consider the claim for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board has considered the Veteran's rating under both the old and new rating criteria from February 7, 2021. Analysis The Veteran's service-connected low back disability was rated as 10 percent disabling prior to October 2, 2020, under Diagnostic Code 5242 and as 20 percent disabling thereafter under Diagnostic Code 5243. The Rating Schedule pertinent to evaluating low back disabilities, recounted above, provides that the Veteran's appealed issue may be granted, partially or in full, if the most probative evidence shows either (1) forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, 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 (20 percent); (2) forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine (40 percent); (3) unfavorable ankylosis of the entire thoracolumbar spine (60 percent evaluation); (4) intervertebral disc syndrome (with disc herniation with compression and/or irritation of the adjacent nerve root on and after February 7, 2021) necessitating doctor-prescribed incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks (20 percent) or 4 to 6 weeks (40 percent) or at least 6 weeks (60 percent) during any 12-month period; or (5) unfavorable ankylosis of the entire spine (100 percent evaluation). The evidence outlining the functional impairment stemming from the frequency, severity, and duration of the Veteran's service-connected low back disability is reflected in his VA and private treatment records, the reports of VA examination completed in March 2013, October 2020, and June 2021, the private Disability Benefits Questionnaire (DBQ) completed on July 5, 2016, and his lay statements. As noted in the Board's prior remands, several of the VA spine examinations provided to the Veteran throughout the appeal period do not adequately describe the functional impairment resulting from the Veteran's low back disability under the governing laws; however, in response to the Board's remands, retrospective medical assessments have been provided which cure these deficiencies, to include quantifying the additional limitation of motion of the thoracolumbar spine on active and passive motion, in weight-bearing and nonweight-bearing positions, after repetitive motion testing, and during a flare-up of symptoms. Applying the pertinent medical evidence to the rating criteria, the most limited flexion of the thoracolumbar spine, to include on active and passive motion, in weight-bearing and nonweight-bearing positions, after repetitive motion testing, and during a flare-up of symptoms, prior to October 2, 2020, was to 80 degrees, but no less, at the March 2013 VA examination. Beginning October 2, 2020, the most limited flexion was to 50 degrees, but no less, at the June 2021 VA examination. The Board observes that flexion of the thoracolumbar spine limited to 80 degrees prior to October 2, 2020, and 50 degrees thereafter, does not meet the criteria for an evaluation in excess of 10 percent and 20 percent, respectively, under the General Rating Formula for Diseases and Injuries of the Spine. However, IVDS was identified at the July 5, 2016, private DBQ and the Veteran had at least 2 weeks but less than 4 weeks of incapacitating episodes over the past 12 months. In light of this finding, the Board finds that a 20 percent rating, but not higher, is warranted, beginning July 5, 2016. This represents a partial allowance of the benefits sought regarding this appealed issue. Concerning entitlement to an even higher initial evaluation, the evidence does not show forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; or, a diagnosis of IVDS prior to July 5, 2016. Furthermore, the evidence does not show forward flexion of the thoracolumbar spine to 30 degrees or less, or IVDS with incapacitating episodes having a total during of at least 4 weeks, beginning July 5, 2016. Finally, the evidence does not show, and the Veteran does not allege, that his service-connected low back disability resulted in ankylosis, actual, functional, favorable, or unfavorable, of any segment of the spine during the appeal period. To this point, while the Board observes that the Veteran experiences limited motion of the thoracolumbar spine, range of motion testing has shown that no segment of the Veteran's spine has been affixed, actually or functionally, at any time during the appeal period. In sum, the Board concludes that the criteria for a 20 percent evaluation, but no higher, for the Veteran's service-connected arthritis of the back is met from July 5, 2016; the preponderance of the evidence is against the assignment of a rating higher than 20 percent thereafter. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to an initial rating in excess of 10 percent for right hip limitation of extension Entitlement to an initial compensable rating for right hip limitation of flexion Entitlement to an initial compensable rating for right hip impairment Limitation of motion of the hip is rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5251, 5252, and 5253. Under Diagnostic Code 5251, a 10 percent rating is warranted for extension of the hip limited to 5 degrees. Under Diagnostic Code 5252, a 10 percent rating is warranted for flexion of the hip limited to 45 degrees; a 20 percent rating is warranted for flexion of the hip limited to 30 degrees; a 30 percent rating is warranted for flexion of the hip limited to 20 degrees; and a 40 percent rating is warranted for flexion of the hip limited to 10 degrees. Under Diagnostic Code 5253, a 10 percent rating is warranted for limited rotation such that the individual cannot toe-out the affected leg more than 15 degrees; a 10 percent rating is also warranted for limited abduction such that the individual cannot cross the legs; and a 20 percent rating is warranted for limited abduction such that motion is lost beyond 10 degrees. Normal range of motion of the hip is from 0 to 125 degrees of flexion and 0 to 45 degrees of abduction. 38 C.F.R. § 4.71, Plate II. The rating criteria for Diagnostic Codes 5251-5253 were not revised on February 7, 2021. Muscle injuries are evaluated pursuant to criteria at 38 C.F.R. §§ 4.55, 4.56, and 4.73. A muscle injury evaluation will not be combined with a peripheral nerve paralysis evaluation of the same body part unless the injuries affect entirely different functions. 38 C.F.R. § 4.55 (a). For rating purposes, the skeletal muscles of the body are divided into 23 muscle groups in 5 anatomical regions, which include 6 muscle groups for the pelvic girdle and thigh (diagnostic codes 5313 through 5318) and 5 muscle groups for the torso and neck (diagnostic codes 5319 through 5323). 38 C.F.R. § 4.55 (b). For muscle group injuries in different anatomical regions which do not act upon ankylosed joints, each muscle group injury shall be separately rated, and the ratings combined under the provisions of 38 C.F.R. § 4.25. 38 C.F.R. § 4.55(f). 38 C.F.R. § 4.56 provides guidance for the evaluation of muscle disabilities as slight, moderate, moderately severe, or severe. As relevant, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement. 38 C.F.R. § 4.56 (c). The type of injury associated with a "moderate" muscle disability is a through and through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. A history with regard to this type of injury should include service department evidence or other evidence of in-service treatment for the wound and consistent complaints of one or more of the cardinal signs and symptoms of muscle disability, particularly lowered threshold of fatigue after average use affecting the particular functions controlled by the injured muscles. Objective findings should include entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue and some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56 (d)(2). The type of injury associated with a "moderately severe" muscle disability is a through and through or deep penetrating wound by a small high-velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intramuscular scarring. A history with regard to this type of injury should include prolonged hospitalization in service for treatment of wound, consistent complaints of cardinal signs and symptoms of muscle disability, and, if present, evidence of inability to keep up with work requirements. Objective findings should include entrance and (if present) exit scars indicating the track of the missile through one or more muscle groups, and indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with the sound side. Tests of strength and endurance compared with sound side should demonstrate positive evidence of impairment. 38 C.F.R. § 4.56 (d)(3). Analysis The Veteran's service-connected right hip limitation of extension is currently evaluated as 10 percent disabling under Diagnostic Code 5251, the service-connected right hip impairment, post shrapnel injury is currently evaluated with a noncompensable rating under Diagnostic Code 5253, and the service-connected right hip limitation of flexion is currently evaluated with a noncompensable rating under Diagnostic Code 5314 5252. The Code of Federal Regulations provides that if a rating is determined on the basis of residual conditions, the number appropriate to the residual condition will be added, preceded by a hyphen. 38 C.F.R. § 4.27. Here, Diagnostic Code 5314 refers to the specific area of the injury while Diagnostic Code 5252 refers to the residual condition, on which the Veteran's disability is currently rated. The evidence outlining the functional impairment stemming from the frequency, severity, and duration of the Veteran's service-connected hip disabilities is reflected in his VA and private treatment records, the reports of VA examination completed in March 2013, January 2020, and June 2021, the private Disability Benefits Questionnaire (DBQ) completed on July 5, 2016, and his lay statements. As noted in the Board's prior remands, several of the VA hip examinations provided to the Veteran throughout the appeal period do not adequately describe the functional impairment resulting from the Veteran's disabilities under the governing laws; however, in response to the Board's remands, retrospective medical assessments have been provided which cure these deficiencies, to include quantifying the additional limitation of motion of the hips on active and passive motion, in weight-bearing and nonweight-bearing positions, after repetitive motion testing, and during flare-ups of symptoms. At the outset, the Board notes that the available medical evidence of record found no ankylosis, malunion or nonunion of femur, flail hip joint, or leg length discrepancy. As such, a rating under Diagnostic Codes 5250, 5254, or 5255 is not warranted. Applying the pertinent medical evidence to the rating criteria, the most limited extension of the right hip, to include on active and passive motion, in weight-bearing and nonweight-bearing positions, after repetitive motion testing, and during flare-ups of symptoms, was to 5 degrees, but no less, at the March 2013 VA examination; the most limited flexion of the right hip was 55 degrees, but no less, at the January 2020 VA examination; and post-test adduction was lost beyond 10 degrees at the July 2016 DBQ. Adduction, however, was not limited so that the Veteran could not cross his legs and post-test rotation was not limited so that the Veteran could not toe-out more than 15 degrees. Furthermore, there is ample evidence of pain in the right hip at the VA examinations that caused functional loss, specifically in flexion. See, January 2020 VA examination, June 2021 VA examination. The Veteran reported that sleeping was difficult because he was unable to get into a comfortable position, as was walking, on even smooth surfaces, for any distance. See, May 2018 Board hearing. Based on the above, the Board finds that an initial increased rating in excess of 10 percent for the Veteran's right hip limitation of extension is not warranted. The Veteran's condition is currently rated at 10 percent. Under Diagnostic Code 5251, a 10 percent rating is the maximum rating assignable for limitation of extension to 5 degrees. As such, a rating in excess of 10 percent is not permitted. As the Veteran could cross his legs and toe-out more than 15 degrees, the evidence is against a finding of a compensable evaluation under Diagnostic Code 5253 for right hip impairment, post-shrapnel injury The Board further notes that compensable limitation of flexion of the right hip has not been approximated. However, since there has been consistent evidence of pain with some limitation of motion, the minimal compensable rating for the joint is warranted, which is 10 percent. See 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201; DeLuca v. Brown, 8 Vet. App. 202 (1995); Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991); Burton v. Shinseki, 25 Vet. App. 1 (2011). Given this evidence and applicable law, and affording the Veteran any benefit of the doubt, the Board finds that his right hip limitation of flexion more closely approximates the 10 percent rating under Diagnostic Code 5252 for the entire appeal period. Given the foregoing, the Board has also considered whether a higher rating for right hip limitation of flexion would be warranted if rated analogous to muscle injury instead. In this case, objection findings at the VA examinations revealed active movement against some resistance during muscle strength testing in flexion, and there was no evidence of scars or muscle atrophy. As such, the Veteran does not meet the criteria for a 30 percent rating for a moderately severe muscle injury. Entitlement to a compensable rating for right little finger limitation of motion Under the criteria of Diagnostic Code 5230, a noncompensable rating is assigned for any limitation of motion of the ring or little finger regardless if the affected hand is dominant or minor. This rating code does not provide for a compensable rating. 38 C.F.R. § 4.71a, Diagnostic Code 5230. Analysis The Veteran's service-connected right little finger limitation of motion is currently evaluated as noncompensable under Diagnostic Code 5230. The evidence outlining the functional impairment stemming from the frequency, severity, and duration of the Veteran's service-connected right little finger disability is reflected in his VA and private treatment records, the reports of VA examination completed in August 2012, October 2018, and June 2021, and his lay statements. As noted in the Board's prior remands, several of the VA hand and finger examinations provided to the Veteran throughout the appeal period do not adequately describe the functional impairment resulting from the Veteran's finger disability under the governing laws; however, in response to the Board's remands, retrospective medical assessments have been provided which cure these deficiencies, to include quantifying the additional limitation of motion of the right little finger on active and passive motion, in weight-bearing and nonweight-bearing positions, after repetitive motion testing, and during a flare-up of symptoms. Applying the pertinent medical evidence to the rating criteria, the Veteran experiences limitation of motion with pain of the right little finger. The rating schedule intends to represent "the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations." 38 C.F.R. § 4.1. Under Diagnostic Code 5230, a 0 percent rating "for 'any limitation of motion' indicates that there is no reduction in earning capacity..., irrespective of impairment of motion." Sowers v. McDonald, 27 Vet. App. 472, 480 (2016). Under this diagnostic code, then, the Veteran cannot recover for any limitation of motion. Unfortunately, the Veteran also cannot be compensated for painful motion under Diagnostic Code 5230. For a painful joint, a veteran can be awarded at least the minimum compensable rating. See 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011) (applying § 4.59 in non-arthritis contexts). But a higher rating for pain is not available under Diagnostic Code 5230 because there is no minimal compensable rating. Sowers, 27 Vet. App. at 480 ("Reading § 4.59 in conjunction with [Diagnostic Code] 5230, [the veteran] is not entitled to a compensable rating under this [code]."). For these reasons, the Veteran is not entitled to a compensable rating under Diagnostic Code 5230. The evidence also does not support additional staged ratings for any time period on appeal, and for no period would the Veteran be entitled to a higher rating under a different Diagnostic Code. Earlier Effective Date Generally, the effective date of an award of a claim is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. If a claim for disability compensation is received within one year after separation from service, the effective date of entitlement is the day following separation or the date entitlement arose. 38 C.F.R. § 3.400 (b)(2). The assignment of effective dates of awards is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. In general, the effective date of an award of increased compensation shall be the earliest as of which it is factually ascertainable that an increase in disability had occurred, if an application is received within one year from such date; otherwise, the effective date will be the date of VA receipt of the claim for increase, or date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a), (b)(2); 38 C.F.R. § 3.400 (o) (2017); Harper v. Brown, 10 Vet. App. 125 (1997). VA law and regulation provide that unless otherwise provided, the effective date of an award of increased evaluation shall be fixed in accordance with the facts found but shall not be earlier than the date of receipt of the application therefor. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400 (o)(1). The Board notes that the effective date of an award of increased compensation may, however, be established at the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if the application for an increased evaluation is received within one year from that date. 38 U.S.C. § 5110 (b)(2); 38 C.F.R. § 3.400 (o)(2). A claim is a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p). Any communication or action indicating an intent to apply for VA benefits from a claimant or representative may be considered an informal claim. Such informal claim must identify the benefit sought. 38 C.F.R. § 3.155 (a). Entitlement to an effective date prior to April 2, 2012, for the grant of TDIU The Veteran argues that he is entitled to an effective date prior to April 2, 2012, for a TDIU. The Veteran argues that the effective date should be April 2, 2008, as that is the last day he worked. See, Jul 2015 Substantive Appeal, VA Form 9. A TDIU claim is treated as a claim for increased compensation, and the effective date rules for increased compensation apply to the TDIU claim. See Hurd v. West, 13 Vet. App. 449 (2000). Total disability ratings are authorized for any disability or combination of disabilities for which the Schedule for Rating Disabilities prescribes a 100 percent disability evaluation, or, with less disability, if certain criteria are met. Id. Where the schedular rating is less than total, a total disability rating for compensation purposes may be assigned when the disabled person is considered to be unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). VA regulations indicate that when a veteran's schedular rating is less than total (for a single or combination of disabilities), a total rating may nonetheless be assigned: 1) if there is only one disability, this disability shall be ratable at 60 percent or more; and 2) if there are two or more disabilities, at least one disability shall be ratable at 40 percent or more, and there must be sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16 (a). Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, constitutes a single disability under § 4.16(a). The same is true for disabilities resulting from common etiology or a single accident. In reaching such a determination, the central inquiry is "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). In the process of determining whether unemployability exists for TDIU, consideration may be given to the veteran's level of education, special training, and previous work experience, but not to his age or to any impairment caused by any non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. In order for a veteran to prevail on a claim for a TDIU, the record must reflect some factor that takes her case outside of the norm. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is a recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether the veteran can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The Veteran filed his claim for a TDIU, VA Form 21-8940, on August 9, 2012, and indicated that he last worked in an office environment. However, his mental health and gunshot wound disabilities prevented him from securing substantially gainful employment. His last date of full-time employment was in April 2008. Prior to April 2, 2012, the Veteran's service-connected disabilities included: (i) residuals of gunshot wounds to the abdomen (30 percent); (ii) right thigh scar (10 percent); (iii) intra-abdominal injury (10 percent); (iv) left lower thorax scars (10 percent); (v) left thigh scars (10 percent); (vi) right index finger arthritis (10 percent); (vii) right index finger scar (0 percent); (viii) right upper arm scars (0 percent); (ix) left arm scars (0 percent); and right leg scars; (x) left leg scars (0 percent). These injuries are all the result of a landmine explosion during service in September 1967. As the disabilities share a common etiology and have a combined rating of 60 percent, the Veteran meets the percentage rating standards to be considered for individual unemployability under 38 C.F.R. § 4.16 (a). The Veteran submitted a statement in July 2012 indicating that he retired as a Supply Cataloger in 2008 due to his service-connected disabilities. The shrapnel in his right groin and knee led to severe back pain that made walking to his desk difficult and, as a result, he was forced to retire earlier than he had anticipated. These disabilities also prevented him from working again following his retirement. The Board will resolve reasonable doubt in the Veteran's favor and award an earlier effective date of April 2, 2011, as the Board finds that it was factually ascertainable that the Veteran was unemployable within one year of the application for TDIU. Based on the evidence presented in this case, the Board finds that the evidence supports a finding that the functional impairment associated with the Veteran's disabilities was of such nature and severity as to preclude substantially gainful employment for one year prior to April 2, 2012. Service Connection Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty, in active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. 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). Generally, to establish service connection for a disability resulting from a disease or injury incurred in service, there must be (1) competent evidence of the current existence of the disability for which service connection is being claimed; (2) competent evidence of incurrence of a disease or injury in active service; and (3) competent evidence of a nexus or connection between the current disability and the disease or injury incurred in service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009); cf. Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). Additionally, a veteran who, during active military, naval, or air service, served in the Republic of Vietnam 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 such veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6)(iii) (2017). A veteran is presumed exposed to Agent Orange if he or she had active military, naval, or air service, in the Republic of Vietnam from January 9, 1962 through May 7, 1975, "unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service." 38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307 (a)(6)(iii). Such service must be either "foot-on-ground" service or service on the inland waterways in the interior of the Republic of Vietnam ("brown water service" versus "blue water service"). See 38 C.F.R. § 3.307(a)(6)(iii) (2017); Haas v. Peake, 525 F.3d 1168 (Fed. Cir. 2008; 66 Fed. Reg. 23,166 (May 8, 2001); VAOPGCPREC 27-97. If a Veteran was exposed to an herbicide agent during active military, naval, or air service, certain enumerated diseases shall be service connected if the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307 (a)(6)(iii) are met, even though there is no record of such disease during service, provided that the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e) (2017). The enumerated diseases acute and subacute peripheral neuropathy. 38 C.F.R. § 3.309(e). VA has determined that there is no positive association between exposure to herbicides and any other condition for which he has not specifically determined a presumption of service connection is warranted. See Diseases Not Associated with Exposure to Certain Herbicide Agents, 75 Fed. Reg. 81,332 (Dec. 27, 2010); see also Determinations Concerning Illnesses Discussed in National Academy of Sciences Report: Veterans and Agent Orange, 77 Fed. Reg. 47,924 (Aug. 10, 2012). Despite the presumptive regulations, a claimant may establish service connection based on exposure to Agent Orange with proof of actual direct causation. Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107 (West 2014); 38 C.F.R. § 3.102 (2016); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Entitlement to service connection for a skin rash of the right thigh, right hip, and right chest, claimed as due to exposure to herbicide agents The Veteran submitted correspondence in July 2012 indicating that he experienced a change in his skin pigmentation on his right thigh, upper chest, and upper arm. The skin was very pale in those areas and noticeably different compared to the rest of his body. The Veteran claimed it was due to being exposed to Agent Orange several times during service in Vietnam. At the March 2018 Board hearing, the Veteran testified that the white spots on his body sometimes become itchy. It was exacerbated in the hot weather with sweating, and they would sometimes become red. The Veteran's spouse testified that she noticed the spots shortly after the Veteran returned from service; they would see a rash and then it would go away after a while. Pursuant to the February 2021 Board remand, the Veteran received a VA examination in June 2021 and the examiner noted a diagnosis of tinea versicolor. Based on the results of the examination, the examiner concluded that the condition was less likely than not caused by service, and there was no documentation of a skin condition during service. Furthermore, there were no findings of an active rash upon examination. An addendum opinion was submitted in August 2021 and the examiner clarified that tinea versicolor was due to a fungus infection and did not result from herbicide or other environmental exposures. Patients who had herbicide or other environmental exposures would develop rashes such as contact dermatitis, urticaria, actinic keratosis, or rosacea. Such rashes would develop over time and there was no evidence that the Veteran had any of those conditions. As such, it was less likely than not that the Veteran's tinea versicolor was related to service. The Board finds the June 2021 VA examination and subsequent August 2021 addendum opinion very competent and probative evidence against the Veteran's claim. The examiner's findings are credible and competent, as they were provided with thorough rationales with regards to the Veteran's skin rash disability and its lack of connection to service, to include herbicide exposure. The examiner provided a thorough opinion explaining why it was less likely than not that it was the result of his military service. Although the Board also found the Veteran and his spouse to be credible in their statements regarding the Veteran's longstanding problems with his skin, and competent to describe generally the conditions that he suffered from, they are not competent to link a specific skin disorder to service or exposure to herbicides. In light of the most competent medical evidence indicating that the Veteran's skin rash disability is not related to service, the Board must unfortunately find that service connection is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. 38 U.S.C. § 5107(b) (West 2014); Ortiz v. Princippi, 274 F. 3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Earlier Effective Date Generally, the effective date of an award of a claim is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. If a claim for disability compensation is received within one year after separation from service, the effective date of entitlement is the day following separation or the date entitlement arose. 38 C.F.R. § 3.400 (b)(2). Entitlement to an effective date prior to October 21, 2019, for the grant of SMC based on aid and attendance An award of special monthly compensation based on housebound status requires that the veteran have a single service-connected disability rated as 100 percent, and (1) has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. This permanently housebound requirement is met when the veteran is substantially confined as a direct result of service-connected disabilities to her or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout her or her lifetime. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350 (i). VA's duty to maximize a claimant's benefits includes consideration of whether his disabilities establish entitlement to special monthly compensation (SMC) under 38 U.S.C. § 1114. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Currently, the Veteran is in receipt of SMC under 38 U.S.C. § 1114(s) from October 21, 2019, based on a rating of 100 percent for his posttraumatic stress disorder (PTSD) and additional service-connected disabilities independently rated at least at 60 percent. However, in a February 2021 rating decision, the RO raised the rating for PTSD to 70 percent back to April 2, 2012. The Board notes that a claim for increased disability compensation may include the "inferred issue" of entitlement to SMC even where the Veteran has not expressly placed entitlement to SMC at issue. Akles v. Derwinski, 1 Vet. App. 118, 121 (1991); see Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2010) (requiring VA to assess all of the claimant's disabilities to determine whether entitlement to SMC under 38 U.S.C. § 1114 (s) is established whenever a Veteran with a total disability rating is subsequently awarded service connection for any additional disability or disabilities even in the absence of an express claim for SMC). A common scenario in which this arises is if the existing record or the Board's actions (e.g., granting an increased rating for a service-connected disability) result in the implication of 38 U.S.C. § 1114 (s) and 38 C.F.R. § 3.350 (i). The Court has interpreted 38 U.S.C. § 1114 (s) to mean that the "total" disability rating does not have to be a 100 percent schedular rating. The total rating requirement may be satisfied where a Veteran has been awarded a TDIU rating for a single disability. See Bradley, 22 Vet. App. at 293. The Bradley decision also held that the direction to treat multiple disabilities as one under 38 C.F.R. § 4.16(a) was specifically limited to TDIU ratings. A TDIU rating based on multiple service-connected disabilities does not satisfy the criteria of one total disability in considering entitlement to SMC under 38 U.S.C. § 1114(s). Id. at 290-91. Reading the evidence in a light most favorable to the Veteran, the Board finds that the Veteran has been unemployable solely due to his PTSD since April 2, 2012, the date that service-connection for the disability was established. More specifically, the August 2012 VA PTSD examiner concluded that it was less likely than not that the Veteran was unemployable due to his PTSD but indicated that the Veteran previously lost several jobs due to the condition. Furthermore, the examiner noted that the Veteran was able to successfully complete 30 years of employment. The Board notes, however, that the Veteran did not receive a diagnosis of PTSD until the August 2012 examination. In other words, the Veteran was able to work for over 30 years with all of his service-connected disabilities, but his PTSD symptoms forced him to leave the workforce. The Veteran indicated that he retired as a supply cataloger because he was mentally and physically unable to work. See July 2012 Statement. His PTSD prevented him from sleeping properly and he had difficulty learning new tasks. The Veteran also stated that the shrapnel injuries made it difficult to walk and get to his desk. Id. However, an August 2012 VA examination found that the Veteran's physical disabilities, including residuals of gunshot wounds to the abdomen, inter-abdominal injury, multiple scars secondary to shrapnel wounds, and right index finger traumatic arthritis, would likely not prevent the Veteran from working in a sedentary environment. Therefore, resolving reasonable doubt in the Veteran's favor, the Board concludes that the Veteran was unemployable solely due to his PTSD. The TDIU based on the Veteran's PTSD satisfies the first requirement for SMC. He also has multiple other service-connected disabilities that have a combined rating of at least 60 percent as of April 2, 2012, which satisfies the second requirement for SMC under 38 U.S.C. § 1114 (s). See 38 C.F.R. § 4.25. As the criteria are met beginning April 2, 2012, an earlier effective date for this benefit is warranted. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Daniels, 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.