Citation Nr: 21006020 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 08-18 872 DATE: February 3, 2021 ORDER Entitlement to an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the cervical spine associated with undiagnosed illness is granted. Entitlement to an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the right shoulder associated with undiagnosed illness is granted. Entitlement to an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the left hip associated with undiagnosed illness is granted. Entitlement to an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the right hip associated with undiagnosed illness is granted. Entitlement to an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the left knee associated with undiagnosed illness is granted. Entitlement to an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the right knee associated with undiagnosed illness is granted. Entitlement to an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the left ankle associated with undiagnosed illness is granted. Entitlement to an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the right ankle associated with undiagnosed illness is granted. Entitlement to a total disability evaluation based on individual unemployability (TDIU) effective July 26, 2001, but no earlier, is granted. Entitlement to Dependents Educational Assistance (DEA) effective July 26, 2001, but no earlier, is granted. REMANDED Entitlement to a disability evaluation in excess of 10 percent for painful motion of the cervical spine associated with undiagnosed illness is remanded. Entitlement to a disability evaluation in excess of 20 percent for painful motion of the right shoulder associated with undiagnosed illness is remanded. Entitlement to a disability evaluation in excess of 10 percent for painful motion of the left hip associated with undiagnosed illness is remanded. Entitlement to a disability evaluation in excess of 10 percent for painful motion of the right hip associated with undiagnosed illness is remanded. Entitlement to a disability evaluation in excess of 10 percent for painful motion of the left knee associated with undiagnosed illness is remanded. Entitlement to a disability evaluation in excess of 10 percent for painful motion of the right knee associated with undiagnosed illness is remanded. Entitlement to a disability evaluation in excess of 10 percent for painful motion of the left ankle associated with undiagnosed illness is remanded. Entitlement to a disability evaluation in excess of 10 percent for painful motion of the right ankle associated with undiagnosed illness is remanded. FINDINGS OF FACT 1. The Veteran initially submitted claims of entitlement to service connection for “joint pain” throughout his body as well as “spot numbness” between his right shoulder blade and spine on July 26, 2001. 2. The Veteran exhibited painful motion of his cervical spine, right shoulder, left hip, right hip, left knee, right knee, left ankle, and right ankle throughout the period on appeal. 3. No claim, formal or informal, of entitlement to service connection for “joint pain” or “spot numbness” was received by VA prior to July 26, 2001. 4. Since July 26, 2001, the Veteran's service-connected disabilities, in combination, prevented him from maintaining substantially gainful employment consistent with his work and educational background. 5. The effective date of the Veteran’s award of DEA benefits is directly predicated on the effective date of the Veteran’s award of TDIU. CONCLUSIONS OF LAW 1. The criteria for an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the cervical spine associated with undiagnosed illness have been met. 38 U.S.C. § 5110 (West 2014); 38 C.F.R. § 3.400 (2019). 2. The criteria for an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the right shoulder associated with undiagnosed illness have been met. 38 U.S.C. § 5110 (West 2014); 38 C.F.R. § 3.400 (2019). 3. The criteria for an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the left hip associated with undiagnosed illness have been met. 38 U.S.C. § 5110 (West 2014); 38 C.F.R. § 3.400 (2019). 4. The criteria for an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the right hip associated with undiagnosed illness have been met. 38 U.S.C. § 5110 (West 2014); 38 C.F.R. § 3.400 (2019). 5. The criteria for an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the left knee associated with undiagnosed illness have been met. 38 U.S.C. § 5110 (West 2014); 38 C.F.R. § 3.400 (2019). 6. The criteria for an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the right knee associated with undiagnosed illness have been met. 38 U.S.C. § 5110 (West 2014); 38 C.F.R. § 3.400 (2019). 7. The criteria for an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the left ankle associated with undiagnosed illness have been met. 38 U.S.C. § 5110 (West 2014); 38 C.F.R. § 3.400 (2019). 8. The criteria for an effective date of July 26, 2001, but no earlier, for the award of additional separate service connection for painful motion of the right ankle associated with undiagnosed illness have been met. 38 U.S.C. § 5110 (West 2014); 38 C.F.R. § 3.400 (2019). 9. The criteria for entitlement to a TDIU on a schedular basis have been met since July 26, 2001, but no earlier. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.1, 4.3, 4.16, 4.17, 4.19, 4.25, 4.26 (2019). 10. The criteria for entitlement to DEA have been met since July 26, 2001, but no earlier. 38 U.S.C. § 5110 (2018); 38 C.F.R. §§ 3.310, 3.155, 3.400 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1988 to September 1992. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2002 Rating Decision of a Department of Veterans Affairs (VA) Regional Office (RO), which granted entitlement to service connection for joint and muscle pain and numbness, right shoulder, cervical spine; gastrointestinal disorder; headaches; fatigue; Raynaud’s type symptoms (body temperature changes); anxiety disorder manifested by mood swings, lack of concentration, and memory loss, due to undiagnosed illness, with an initial rating of 20 percent, effective July 26, 2001. The Veteran appealed the Rating Decision’s assigned initial rating, and in February 2007, the Board remanded the claim for additional development. Following completion of the development requested in the February 2007 remand, in a September 2007 Rating Decision, the VA Appeals Management Center (AMC) granted separate evaluations of 10 percent for joint and muscle pain involving the right shoulder and cervical spine; 10 percent for gastrointestinal disorder with complaints of body temperature changes (Raynaud’s type symptoms) manifested by undiagnosed illness; 10 percent for headaches manifested by undiagnosed illness; and 10 percent for undifferentiated somatoform disorder and anxiety disorder with mood swings, lack of concentration, memory loss and fatigue manifested by undiagnosed illness, all effective July 26, 2001. The Board also notes that in the September 2007 Rating Decision, the AMC assigned the rating of 10 percent for joint and muscle pain involving the right shoulder and cervical spine, manifested by undiagnosed illness, under Diagnostic Code 8850-5025, effective July 26, 2001. In a May 2008 Rating Decision, the RO increased the rating from 10 percent to 20 percent, effective July 26, 2001. In August 2012, the Board again remanded the claim for additional development. Subsequently, in a January 2013 Rating Decision, the AMC increased the rating for the joint and muscle pain characterized as involving the right shoulder, cervical spine, knees, ankles and hips, manifested by undiagnosed illness, to 40 percent, effective September 5, 2012. See AB v. Brown, 6 Vet. App. 35, 38 (1993) (where a claimant has filed a notice of disagreement as to an RO decision assigning a particular rating, a subsequent RO decision assigning a higher rating, but less than the maximum available benefit, does not abrogate the pending appeal). In April 2013, the Board issued a decision that in pertinent part, (1) denied an initial rating in excess of 20 percent for joint and muscle pain involving the right shoulder, cervical spine, knees, ankles, and hips, prior to April 23, 2007; (2) granted a staged initial rating of 40 percent, but no higher, for joint and muscle pain involving the right shoulder, cervical spine, knees, ankles, and hips, from April 23, 2007; and (3) denied an initial rating in excess of 40 percent for joint and muscle pain involving the right shoulder, cervical spine, knees, ankles, and hips, from September 5, 2012. The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (Court) to the extent that it denied entitlement to an initial rating for joint and muscle pain involving the right shoulder, cervical spine, knees, ankles, and hips in excess of 20 percent prior to April 23, 2007 and in excess of 40 percent from April 23, 2007. In a September 2014 Memorandum Decision, the Court vacated these aspects of the Board’s decision and remanded them to the Board for further proceedings consistent with the Court’s decision. In the September 2014 Memorandum Decision, the Court also found that the issue of entitlement to a TDIU was reasonably indicated by the evidence and that, although the Board had jurisdiction to consider the claim, it failed to provide analysis of the evidence as to possible TDIU entitlement pursuant to 38 C.F.R. § 4.16. See Rice v. Shinseki, 22 Vet. App. 447 (2009) (holding that a request for TDIU is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability or disabilities; if the claimant or the record reasonably raises the question of whether the Veteran is unemployable due to the disability for which an increased rating is sought, then part and parcel to that claim for an increased rating is whether a total rating based on individual unemployability as a result of that disability is warranted). The Court therefore vacated that portion of the Board’s decision failing to adjudicate the issue of entitlement to a TDIU and remanded the matter for further proceedings consistent with its decision. In compliance with the Court’s decision, the Board finds that the issue of entitlement to a TDIU is properly on appeal before the Board, as listed on the title page of this decision. In April 2015 and October 2016, the Board remanded the Veteran’s increased rating claim and TDIU claim for additional development. In a March 2018 Rating Decision, the RO granted separate awards of service connection for painful motion of the right shoulder (with a 20 percent disability evaluation), painful motion of the cervical spine (with a 10 percent disability evaluation), painful motion of the left ankle (with a 10 percent disability evaluation), painful motion of the left hip (with a 10 percent disability evaluation), painful motion of the left knee (with a 10 percent disability evaluation), painful motion of the right ankle (with a 10 percent disability evaluation), painful motion of the right hip (with a 10 percent disability evaluation), and painful motion of the right knee (with a 10 percent disability evaluation). These separate grants of entitlement to service connection were all made effective April 23, 2007, the date of VA medical evidence which purportedly revealed an increase in the disabilities. However, in a July 2018 Notice of Disagreement, the Veteran expressed dissatisfaction with the March 2018 Rating Decision and indicated that he wanted earlier effective dates and increased disability evaluations for all of the now separately-evaluated disabilities (i.e., right shoulder, cervical spine, left ankle, left hip, left knee, right ankle, right hip, right knee); specifically, the Veteran requested the highest possible ratings from the earliest possible dates, to include entitlement to a TDIU. In an October 2018 decision, the Board granted entitlement to a TDIU. Pursuant to the Board decision, in a January 2019 Rating Decision, the RO granted entitlement to a TDIU and eligibility to Dependents’ Educational Assistance effective September 5, 2012, the date of a VA examination documenting that the Veteran had to reduce the number of hours he worked due to his service-connected disabilities. However, in an October 2019 Notice of Disagreement, the Veteran expressed dissatisfaction with the January 2019 Rating Decision; specifically, he argued for an effective date prior to September 5, 2012, for the grant of entitlement to a TDIU, to include the grant of entitlement to a TDIU on an extraschedular basis prior to April 23, 2007. The issue of entitlement to a TDIU prior to September 5, 2012, as well as the issues of entitlement to increased disability evaluations and earlier effective dates for disabilities of the right shoulder, cervical spine, left ankle, left hip, left knee, right ankle, right hip, and right knee, now return to the Board for adjudication. In May 2012, the Veteran testified at a Board videoconference hearing before a Veterans Law Judge (VLJ). A transcript of that hearing has been associated with the claims file. In correspondence dated in October 2020, the Veteran was notified that the VLJ who conducted his May 2012 hearing was no longer employed at the Board and given the opportunity to request another Board hearing. As the Veteran did not respond within the requisite time period, the Board will proceed with the appeal using the May 2012 Travel Board hearing transcript of record. On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). This law creates a new framework for Veterans dissatisfied with VA’s decision on their claim to seek review. Here, the appellant has not opted-in to VA’s test program, the Rapid Appeals Modernization Program (RAMP), with respect to the claims addressed herein. Although the AMA was implemented effective February 19, 2019, the Rating Decision on appeal was issued prior to that date. Accordingly, the Board will review this appeal under the existing Legacy Appeals System. Pursuant to the Veterans Claims Assistance Act of 2000 (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2014); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a); see also Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Neither the Veteran nor his attorney have raised any issues with the duty to notify or duty to assist with respect to the issues decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Effective Dates The Veteran seeks entitlement to effective dates prior to April 23, 2007, for the separate grants of service connection for painful motion of the right shoulder, cervical spine, left ankle, left hip, left knee, right ankle, right hip, and right knee disabilities (all associated with undiagnosed illness). Generally, the effective date of an award of disability compensation based on an original claim shall be 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. However, if the claim is received within one year after separation from service, the effective date of an award of disability compensation shall be the day following separation from active service. 38 U.S.C. § 5110 (b)(1); 38 C.F.R. § 3.400 (b)(2)(i). Under 38 U.S.C. § 5110 (a), the effective date of an increase in a veteran’s disability compensation shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. The provisions of 38 U.S.C. § 5110 (b)(2) provides an exception to this general rule: “The effective date of an award of increased compensation shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date.” Thus, “the plain language of [section] 5110(b)(2) . . . only permits an earlier effective date for increased disability compensation if that disability increased during the one-year period before the filing of the claim.” Thus, three possible dates may be assigned depending on the facts of an increased rating earlier effective date case: (1) If an increase in disability occurs after the claim is filed, the date that the increase is shown to have occurred (date entitlement arose) (38 C.F.R. § 3.400 (o)(1)); (2) If an increase in disability precedes the claim by a year or less, the date that the increase is shown to have occurred (factually ascertainable) (38 C.F.R. § 3.400 (o)(2)); or (3) If an increase in disability precedes the claim by more than a year, the date that the claim is received (date of claim) (38 C.F.R. § 3.400 (o)(2)). See Gaston v. Shinseki, 605 F.3d 979, 982-84 (Fed. Cir. 2010); Harper v. Brown, 10 Vet. App. 125, 126 (1997). “Claim” is defined broadly to include 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); Brannon v. West, 12 Vet. App. 32, 34-5 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). VA amended its regulations on March 24, 2015 to require that all claims governed by VA’s adjudication regulations be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The amendments, however, are only effective for claims and appeals filed on or after March 24, 2015. As this appeal was filed prior to that date, the amendments are not applicable in this instance and the regulations in effect prior to March 24, 2015 will be applied. Here, by way of history, the Veteran initially filed claims of entitlement to service connection for “joint pain” throughout his body as well as “spot numbness” between his right shoulder blade and spine received by VA on July 26, 2001. In a September 2002 Rating Decision, the RO granted entitlement to service connection for “joint/muscle pain numbness, right shoulder, cervical spine, gastrointestinal disorder, headaches, fatigue, Raynaud's type symptoms (body temperature changes), anxiety disorder manifested by mood swings, lack of concentration, memory loss due to undiagnosed illness.” A 20 percent disability rating was assigned effective July 26, 2001, (the date of the claim), pursuant to Diagnostic Codes 8850-5025 (undiagnosed illness rated by analogy to fibromyalgia). Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. The Veteran filed a timely Notice of Disagreement in August 2003, at which time he expressed disagreement with the RO combining all of his symptoms into a single disability rating. In a September 2007 Rating Decision, the AMC granted entitlement to a separate evaluation for “joint and muscle pain involving the right shoulder and cervical spine manifested by undiagnosed illness” and assigned a 10 percent disability rating effective July 26, 2001, (the date of the Veteran’s initial claim), pursuant to Diagnostic Codes 8850-5025 (undiagnosed illness rated by analogy to fibromyalgia). This Rating Decision also granted entitlement to a separate evaluation for “gastrointestinal disorder with complaints of body temperature changes (Raynaud's type symptoms) manifested by undiagnosed illness” and assigned a 10 percent disability rating effective July 26, 2001, pursuant to Diagnostic Codes 8873-7304 (undiagnosed illness rated by analogy to gastric ulcer). The Rating Decision also granted entitlement to a separate evaluation for “headaches manifested by undiagnosed illness” and assigned a 10 percent disability rating effective July 26, 2001, pursuant to Diagnostic Codes 8881-8100 (undiagnosed illness rated by analogy to migraine). Finally, the Rating Decision granted entitlement to a separate evaluation for “undifferentiated somatoform disorder and anxiety disorder with mood swings, lack of concentration, memory loss and fatigue manifested by undiagnosed illness” and assigned a 10 percent disability rating effective July 26, 2001, pursuant to Diagnostic Codes 9400-9423 (generalized anxiety disorder rated by analogy to unspecific somatic symptom and related disorder). These four separate disability evaluations rated as 10 percent disabling each effectively replaced the single disability evaluation rated as 20 percent provided for in the prior September 2002 Rating Decision. In a subsequent May 2008 Rating Decision, the RO recharacterized the Veteran’s “joint and muscle pain involving the right shoulder and cervical spine manifested by undiagnosed illness” as “joint and muscle pain involving the right shoulder and cervical spine, knees, ankles and hips manifested by undiagnosed illness” and increased the disability rating to 20 percent effective July 26, 2001, (the date of the Veteran’s initial claim). This recharacterization implicitly acknowledged that the Veteran also experienced pain in his knees, ankles, and hips, since July 2001. In a January 2013 Rating Decision, the RO increased the Veteran’s disability rating for joint and muscle pain involving the right shoulder and cervical spine, knees, ankles and hips manifested by undiagnosed illness to 40 percent effective September 5, 2012, based on the results of a VA examination conducted on that date; however, in a subsequent July 2013 Rating Decision, the RO changed the effective date for the 40 percent rating to April 23, 2007, the date of a VA primary care note which purportedly demonstrated that the Veteran’s disabilities had gotten worse. Finally, in a March 2018 Rating Decision, the RO granted separate evaluations for (1) painful motion of the right shoulder, evaluated as 20 percent disabling under Diagnostic Code 5201 (limitation of arm motion); (2) painful motion of the cervical spine, evaluated as 10 percent disabling under Diagnostic Code 5237 (lumbosacral or cervical strain); (3) painful motion of the left hip, evaluated as 10 percent disabling under Diagnostic Code 5252 (limitation of thigh flexion); (4) painful motion of the right hip, evaluated as 10 percent disabling under Diagnostic Code 5252 (limitation of thigh flexion); (5) painful motion of the left knee, evaluated as 10 percent disabling under Diagnostic Code 5260 (limitation of leg flexion); (6) painful motion of the right knee, evaluated as 10 percent disabling under Diagnostic Code 5260 (limitation of leg flexion); (7) painful motion of the left ankle, evaluated as 10 percent disabling under Diagnostic Code 5271 (limited motion of ankle); and (8) painful motion of the left ankle, evaluated as 10 percent disabling under Diagnostic Code 5271 (limited motion of ankle). Crucially, all of these separate evaluations were granted effective April 23, 2007, the date of a VA primary care note which purportedly demonstrated that the Veteran’s disabilities had gotten worse. These eight separate disability evaluations effectively replaced the single disability evaluation for “joint and muscle pain involving the right shoulder and cervical spine, knees, ankles and hips, manifested by undiagnosed illness” rated as 40 percent under Diagnostic Codes 8850-5025, which was decreased to 20 percent and then terminated effective April 23, 2007. As the Veteran has argued for earlier effective dates with respect to all of these disabilities, the Board must now consider whether these separate grants of service connection awarded in the March 2018 Rating Decision could have been assigned effective dates prior to April 23, 2007. The claims here may arguably be construed as either claims for earlier effective dates for service connection for the various disabilities on appeal, or as claims for earlier effective dates for higher ratings as these disabilities may be viewed as part and parcel of the underlying increased rating claim for overall joint pain. The Board notes that the Court has held in Clemmons v. Shinseki, 23 Vet. App. 1 (2009) that when a claimant makes a claim, he/she is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. Here, the Veteran has continuously prosecuted a claim for joint pain since he initially filed his service-connection claim on July 26, 2001. The Board finds that the Veteran’s July 26, 2001, claim was sufficiently specific and evidenced the Veteran’s intent to file a claim for all joint pain, however characterized. This interpretation is supported by the Veteran’s August 2003 Notice of Disagreement, in which he clarified that his intent was to file a claim for all joint pain, to include pain in his cervical spine, right shoulder, hips, knee, and ankles. The question, thus, then becomes a determination of the date entitlement arose for separate additional service connection for painful motion of the cervical spine, right shoulder, hips, knees, and ankles. The Board recognizes that joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint, even if arthritis is not present. See 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 3-5 (2011). A veteran experiencing an actually painful joint is entitled to at least the minimum compensable rating for the joint under the appropriate diagnostic code to the joint involved. In other words, section 4.59 does not require “objective” evidence of painful motion. If credible, lay testimony may consist of a veteran’s own statements to the extent that the statements describe symptoms capable of lay observation. Petitti v. McDonald, 27 Vet. App. 415, 424-30 (2015). Relevant to the instant case, 10 percent is the minimum compensable rating under Diagnostic Code 5237 (lumbosacral or cervical strain), Diagnostic Code 5252 (limitation of thigh flexion), Diagnostic Code 5260 (limitation of leg flexion), Diagnostic Code 5271 (limited motion of ankle); while 20 percent is the minimum compensable rating under Diagnostic Code 5201 (limitation of arm motion). As such, the Veteran would be entitled to these minimum compensable ratings so long as there is credible evidence of pain in each respective joint, even if arthritis is not present. The law provides that an effective date generally can be no earlier than the “facts found.” DeLisio v. Shinseki, 25 Vet. App. 45 (2011), quoting 38 U.S.C. § 5110 (a) (“[T]he effective date of an award shall be fixed in accordance with the facts found.”). These “facts found” include the date the disability first manifested and the date entitlement to benefits was authorized by law and regulation. See 38 C.F.R. § 3.400 (the effective date “will be the date of receipt of the claim or the date entitlement arose, whichever is the later”); see also Ellington v. Peake, 541 F.3d 1364, 1369 (Fed. Cir. 2008)(finding the effective date provisions of 38 C.F.R. § 3.400 “consistent with 38 U.S.C. § 5110 “); Livesay v. Principi, 15 Vet. App. 165, 171 (2001) (en banc) (rejecting argument that 38 C.F.R. § 3.400 (q) (stating that the effective date for reopened claim is the “date of receipt of the new claim or [the] date entitlement arose, whichever is later”) is inconsistent with 38 U.S.C. § 5110 (a)). Id. The Court has specifically held that if a claimant filed a claim for benefits for a disability before he actually had the disability, the effective date for benefits can be no earlier than the date the disability first manifested. See McGrath v. Gober, 14 Vet. App. 28, 35 (2000) (remanding case for Board to determine when the disability manifested itself under all of the “facts found” and to assign an effective date for benefits accordingly); see also Ellington, 541 F.3d at 1369 (finding it “illogical” to award benefits on a certain date “when the evidence indicates that those conditions did not develop until some later date”). Significantly, the RO established April 23, 2007, as the current effective date for the separate grants of service connection for the aforementioned disabilities on the basis of it being the date that a VA primary care note purportedly demonstrated that these disabilities had worsened. However, review of this April 23, 2007, primary care note does not reveal any specific range of motion findings or other evidence demonstrating a worsening of the Veteran’s various disabilities on that particular date. Rather, the April 2007 primary care note explained that the Veteran had developed pains in multiple joints (shoulders, back, hips, knees, ankles, wrists, and fingers) since his service in the Gulf War, and that both the multiple joint pain and fibromyalgia pain have not subsided over many years despite regular antiinflammatory medication treatment, indicating that the diseases were not curable. Additionally, the April 23, 2007, VA primary care note indicated that ranges of motion were painful in all joints of the Veteran’s body, to include his shoulders, wrists, lower back, hips, knees, and ankles. Rather than indicate that the Veteran’s various disabilities had worsened in severity on that date, the April 2007 primary care note instead suggested that the Veteran’s various joints had been actually painful for many years prior to 2007. Indeed, a review of the record prior to April 23, 2007, corroborates that the Veteran’s cervical spine, right shoulder, hips, knees, and ankles exhibited painful motion throughout the entire period on appeal. On his initial July 26, 2001, claim form, the Veteran explicitly indicated that he sought entitlement to service connection for joint pain. Specifically, at that time, he described his joint pain as “constant” and reported that it increased with activity, temperature, or position. Crucially, he did not limit his claim of joint pain to a particular area of the body, although he additionally reported constant numbness between his right shoulder blade and spine, and explained that this numbness would sometimes transition into piercing pain. In an August 2001 correspondence, the Veteran’s spouse indicated that they had attempted many different remedies to alleviate his different joint aches and pains, although nothing seemed to help. In an October 2001 VA examination report, the Veteran reported pain, weakness, and stiffness in his right shoulder, as well as flare ups that occurred daily and lasted eight-to-ten hours. Range of motion testing revealed “slight pain on motion only” in the right shoulder. The Veteran also reported pain, stiffness, and fatigability in the lower cervical spine, as well as flare ups that occurred daily and lasted one-to-two hours. Range of motion testing revealed “some painful motion” in the cervical spine. With respect to fatigue, the Veteran reported generalized muscle aches and weakness, although the October 2001 VA examiner found that his symptomatology did not meet the requirements for chronic fatigue syndrome. The Veteran was diagnosed as having “right shoulder - normal range of motion, painful motion, undiagnosed illness” as well as “cervical spine - normal range of motion, painful motion, undiagnosed illness.” The October 2001 VA examiner also noted that the Veteran had to quit his prior occupation building log cabins and post-and-beam homes as a result of muscle and joint pain. An April 2002 VA treatment note indicated that the Veteran developed joint pains after his return from the Gulf War which persisted into the present. In his August 2003 Notice of Disagreement, the Veteran clarified that his pain was constant and located in all joints, to include shoulders, elbows, wrists, fingers, upper and lower back, hips, knees, and ankles. He further indicated that in his initial statement regarding joint pain, “all joints were inferred but not noted.” In a September 2004 Decision Review Officer (DRO) hearing, the Veteran testified that his joint pain was his most disabling condition because it was constant and never subsided. Read in conjunction with the April 23, 2007, VA primary care note, these records suggest that the Veteran’s cervical spine, right shoulder, left hip, right hip, left knee, right knee, left ankle, and right ankle were actually painful throughout the entire rating period on appeal. As July 26, 2001, is the later of the date of claim and date entitlement arose, the evidence of record supports entitlement to an earlier effective date of July 26, 2001, for the separate awards of service connection for painful motion of the cervical spine, right shoulder, left hip, right hip, left knee, right knee, left ankle, and right ankle. 38 U.S.C. § 5107 (b); 38 C.F.R.§ 3.400 (b)(2)(i). The preponderance of the evidence is against an effective date earlier than July 26, 2001, as no claim, formal or informal, for service connection for joint pain was received by VA prior to that date. Entitlement to an earlier effective date of July 26, 2001, for the award of separate grants of service connection for painful motion of the cervical spine, right shoulder, left hip, right hip, left knee, right knee, left ankle, and right ankle is granted. TDIU The Veteran also seeks entitlement to a TDIU prior to September 5, 2012. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. 38 U.S.C. § 1155 (West 2014). Total disability is considered to exist when there is any impairment which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340(a)(1). Total disability may or may not be permanent. Id. Total ratings are authorized for any disability or combination of disabilities for which the Rating Schedule prescribes a 100 percent evaluation. 38 C.F.R. § 3.340(a)(2). A TDIU may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). If there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. Id. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g., orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. Id. Here, the Veteran’s painful motion of various joints manifested by undiagnosed illness will be considered as one disability for these purposes. Entitlement to a total rating must be based solely on the impact of the Veteran's service-connected disabilities on his ability to keep and maintain substantially gainful employment. See 38 C.F.R. §§ 3.340, 3.341, 4.16. 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). For VA purposes, the term "unemployability" is synonymous with an inability to secure and follow a substantially gainful occupation. VAOPGPREC 75-91; 57 Fed. Reg. 2317 (1992). Consideration may be given to the Veteran's level of education, special training, and previous work experience in arriving at a conclusion. However, individual unemployability must be determined without regard to any nonservice-connected disabilities or the Veteran's advancing age. 38 C.F.R. §§ 3.341(a), 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose, 4 Vet. App. at 363. The phrase “unable to secure and follow a substantially gainful occupation” has two components: (A) an economic component (an occupation earning more than marginal income); and (B) a noneconomic component (including (1) the veteran’s history, education, skill, and training; (2) whether the veteran has the physical ability; and (3) whether the veteran has the mental ability). Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). If a Veteran fails to meet the threshold minimum percentage standards enunciated in 38 C.F.R. § 4.16(a), rating boards should refer to the Director of Compensation and Pension Service for extraschedular consideration all cases where the Veteran is unable to secure or follow a substantially gainful occupation by reason of service-connected disability. 38 C.F.R. § 4.16(b); see also Fanning v. Brown, 4 Vet. App. 225 (1993). Thus, the Board must evaluate whether there are circumstances in the Veteran's case, apart from any nonservice-connected conditions and advancing age, which would justify a TDIU rating. 38 C.F.R. §§ 3.341(a), 4.16(a), 4.19; see also Van Hoose, supra; Hodges v. Brown, 5 Vet. App. 375 (1993); Blackburn v. Brown, 4 Vet. App. 395 (1993). The Veteran's service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue must be addressed. 38 C.F.R. § 4.16(b). When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. The Veteran served in the U.S. Marine Corps from 1988 to 1992, during which time he worked as a Food Service Specialist. As a civilian, the Veteran worked in various contracting carpenter positions as well as a sales clerk at a hardware store. From 1994 through 1998, he was employed at contracting company until he reportedly quit due to muscle/joint pain and an inability to work in a “structured environment.” The Veteran and his spouse subsequently opened a home-based computer software sales business. In 2001, he returned to working as a carpentry construction contractor in the capacity as a subcontractor for a friend, and also began buying and reselling homes with his brother. In approximately 2008, the Veteran stopped working with his friend and worked solely with his brother and spouse as a self-employed contractor. His level of education is two years of high school. The Veteran contends that he is prevented from performing substantially gainful employment due to the combination of his service-connected disabilities. He asserts that the pain he experiences in his muscles and joints renders it difficult to focus and tolerate interactions with others. He also indicated experiencing difficulty concentrating and memory lapses, and that his anxiety disorder made it difficult to be around crowds and other people in an office environment. Here, as a result of the above decision to grant entitlement to an effective date of July 26, 2001, (the date of initial claim), for the awards of additional separate service connection for painful motion of the cervical spine, right shoulder, left hip, right, hip, left knee, right knee, left ankle, and right ankle associated with undiagnosed illness (disabilities resulting from common etiology which are considered as one disability for purposes of 4.16(a)), the Board emphasizes that the schedular percentage criteria for TDIU have been met throughout the entire rating period on appeal. See 38 C.F.R. §§ 4.16(a), 4.25, 4.26. Consequently, the only remaining question is whether the Veteran is unable to secure or follow a substantially gainful occupation since July 26, 2001, as a result of his service-connected disabilities, considered in combination. 38 C.F.R. § 4.16(a). In analyzing the evidence, the Board must determine, as a question of fact, both the weight and credibility of the evidence. Equal weight is not accorded to each piece of evidence contained in a record; every item does not have the same probative value. The Board must account for the evidence which it finds to be persuasive or unpersuasive, analyze the credibility and probative value of all material evidence submitted by and on behalf of a claimant, and provide the reasons for its rejection of any such evidence. See Struck v. Brown, 9 Vet. App. 145, 152 (1996); Caluza v. Brown, 7 Vet. App. 498, 506 (1995); Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994); Abernathy v. Principi, 3 Vet. App. 461, 465 (1992); Simon v. Derwinski, 2 Vet. App. 621, 622 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164, 169 (1991). Here, the evidence of record supports the award of a TDIU rating throughout the entire rating period on appeal (i.e., since July 26, 2001) in this case. In an August 2001 lay statement, the Veteran’s spouse indicated that the Veteran had worked in construction building post-and-beam homes, but that he had not been employed for the past two years because he was unable to do many of the tasks required of him. An October 2001 VA examination report indicated that the Veteran worked at home as a “computer software worker,” but that he had to quit his prior occupation building log cabins and post-and-beam homes as a result of muscle and joint pain. Credible lay statements were also submitted in March 2017 which attested to the current severity of the combination of the Veteran’s service-connected disabilities and their impact on his ability to function in a work setting. These statements, from a friend with whom he worked with as a subcontractor, indicated that the Veteran was only able to work 2 to 3 hours per day before having to leave due to service-connected symptomatology. Moreover, as to the medical evidence in support of the TDIU claim, a September 2012 Gulf War General Medical Examination indicated that service-connected painful motion impacted his ability to work. Specifically, the Veteran had continued to work regularly as a self-employed construction contractor. He did most of the actual, physical work himself, although he also employed subcontractors. He noted that because his fibromyalgia symptoms of chronic pain worsened after activity along with the fatigue, he generally had to work at a slower pace on projects and generally had to limit his workday to approximately five to six hours per day instead of the usual eight or more hours per day. He no longer did very heavy jobs involving lifting, and he also tried to avoid working in smaller cramped spaces, as working in such areas aggravated his pain due to body posturing. As a result, his productivity had significantly decreased. At that time, he reported losing approximately two weeks total from work in the past twelve months due to his joint pain. An April 2018 VA Heart Conditions examination report indicated that the Veteran’s service-connected sinus arrhythmia / supraventricular auricular beats impacted his ability to work in that activities that stressed the cardiopulmonary system (such as walking, lifting, and running) resulted in heart symptoms. The examiner indicated that sinus arrhythmia disorder would limit a physical occupation involving lifting, running, or activities that stressed the cardiopulmonary system, but would not interfere with sedentary work. The Veteran was also provided with a VA Mental Disorders examination in April 2018, at which time the examiner opined that his service-connected psychiatric symptomatology resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. At that time, the Veteran reported that he had been working in the construction business for the past 15 to 20 years, and that things at work were “decent” because he was his own boss. However, he stated that his job performance in his own company was “horrible” because he generally could only work approximately four hours per day due to his pain and gastrointestinal problems. He also explained that years ago he worked in the computer business but had trouble with customer service due to his irritability, and that construction was a better fit for him because he could mostly work alone and did not have to interact with customers as frequently as he did in the computer business. Additionally, the Veteran's attorney submitted an "Employability Evaluation" dated in January 2015 that he obtained from a Certified Rehabilitation Counselor with a Master of Science degree. The private counselor indicated that, given the continuity of the medical records and interviews with the Veteran and his spouse, it was her vocational opinion that the Veteran would not have been able to secure and follow competitive employment from 1998 onward due to his service-connected disabilities. Specifically, the private counselor explained that: He clearly was having a multitude of service-connected medical problems that affected his ability to work a full day. He often called in sick, left work early and had no tolerance to deal with work stress given the level of his pain and mood disorder. Over this period he has been receiving extensive on the job support and accommodations from family members and friends who clearly provided a protected and sheltered environment. His wife informed me from 1998 to date she has filled in for her husband with painting, running errands and customer billing. If working in any other setting he would not have been allowed to pick and choose his duties, leave work regularly, call in sick on a weekly basis or speak in an inappropriate and disrespectful manner. He clearly would have been terminated if these behaviors persisted. It is my opinion that even though [the Veteran] had earnings above the poverty level after 1998 through present, his work was and is sheltered employment because he is working for his brother and from home and thus many accommodations were made. The Board finds that all of the above evidence is entitled to significant probative value in support of the Veteran's claim. In short, there is clear, credible, and probative medical and lay evidence in support of the claim of entitlement to a TDIU throughout the entire rating period on appeal. The Board acknowledges that the Veteran appears able to perform certain aspects of daily living. However, the law recognizes that a person may be too disabled to engage in employment, although he or she is fairly comfortable at home or upon limited activity, such as the Veteran in this case. See 38 C.F.R. § 4.10. A veteran also does not have to prove that he or she is 100 percent unemployable in order to establish an inability to maintain a substantially gainful occupation, as required for a TDIU award. See 38 C.F.R. § 3.340(a); Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). In adjudicating TDIU claims, marginal employment shall not be considered to be substantially gainful employment. 38 C.F.R. § 4.16(a). Thus, a TDIU may be awarded in such instances. Marginal employment generally shall be deemed to exist when a veteran’s earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Id. The ability to work sporadically or obtain marginal employment is not substantially gainful employment. Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). Where reasonably raised by the facts of a particular case, the Board must address the issue of whether the Veteran’s ability to work might be limited to marginal employment and, when appropriate, explain why the evidence does not demonstrate that the Veteran is incapable of more than marginal employment. See Ortiz-Valles v. McDonald, 28 Vet. App. 65, 71 (2016). However, marginal employment may also be held to exist on a facts found basis when earned annual income exceeds the poverty threshold. 38 C.F.R. § 4.16(a). Such situations may include, but are not limited to, employment in a protected environment such as a family business or sheltered workshop. Id. For pension cases, examples of marginal employment are a self-employed farmer, a small business owner, a contractor, or a person employed at less than half the usual remuneration (payment received for usual employment). See 38 C.F.R. § 4.17(a). Here, the Veteran most recently worked as a construction contractor in a family business, and the record reflects that family members regularly covered for him, as he was unable to work a full day due to his service-connected symptomatology, both physical and psychiatric. Additionally, after the Veteran left his job in construction in 1998 due to joint pain, he worked for a period at home with his spouse in an attempt to generate income, which the January 2015 rehabilitation counselor characterized as sheltered employment. The Veteran has attained only a two-year high school education, and has not demonstrated any specific training or job skills other than carpentry/construction. Even without consideration of the effects of his age and nonservice-connected disorders, the evidence of record shows the Veteran's service-connected disabilities, standing alone, considered in combination, prevented him from securing gainful employment consistent with his work and educational background throughout the rating period on appeal, from July 26, 2001. 38 C.F.R. § 4.16(a), 4.19; see also Blackburn v. Brown, 4 Vet. App. 395, 398 (1993); Van Hoose v. Brown, 4 Vet. App. 361 (1993). In conclusion, the Board finds that the evidence supports the grant of entitlement to a TDIU effective July 26, 2001. 38 C.F.R. § 4.3. The medical and lay evidence of record establishes that the combination of the Veteran's service-connected disabilities prevented him from securing or following substantially gainful employment consistent with his work and educational background since July 26, 2001. 38 C.F.R. § 4.16. Entitlement to a TDIU prior to receipt of the Veteran’s July 26, 2001, service connection claims is denied because the evidence does not show (and it is not claimed) that the Veteran had a claim pending prior to this date. 38 U.S.C. § 5110; 38 C.F.R. § 3.400 (generally, except as otherwise provided, the effective date of an award of compensation based on an original claim or a claim reopened after final disallowance will be the date of receipt of the claim or the date entitlement arose, whichever is later). DEA DEA is a program of education or special restorative training that may be authorized for an eligible person if the applicable criteria are met. 38 U.S.C. §§ 3500, 3501 (2014); 38 C.F.R. §§ 21.3020, 21.3021 (2019). Basic eligibility for certification of DEA exists if the veteran was discharged from service under conditions other than dishonorable, or died in service, and either (1) has a permanent total service-connected disability, or (2) a permanent total service-connected disability was in existence at the date of the veteran’s death, or (3) died as a result of a service-connected disability, or, if a service member (4) is on active duty as a member of the Armed Forces and, for a period of more than 90 days, has been listed by VA concerned as missing in action, captured in line of duty by a hostile force, or forcibly detained or interned in the line of duty by a foreign government or power. 38 C.F.R. § 3.807 (2019). The Board finds that an effective date of July 26, 2001, but not earlier, for basic eligibility for Chapter 35 DEA benefits, is warranted. The only method of eligibility for Chapter 35 benefits which is relevant to the Veteran is through having service-connected disability which has been rated 100 percent or to have been granted a TDIU. Since the effective date for DEA benefits was directly predicated on finding that the Veteran had a permanent and total disability due to service-connected disabilities, and because of the Board’s current finding that the Veteran was entitled to a TDIU as of July 26, 2001, the Board finds that July 26, 2001, is the earliest date on which the Veteran could establish eligibility for Chapter 35 benefits. Accordingly, entitlement to an earlier effective date for DEA benefits is also granted. REASONS FOR REMAND The Veteran also seeks entitlement to increased disability evaluations for his service-connected disabilities of the right shoulder, cervical spine, left ankle, left hip, left knee, right ankle, right hip, and right knee. Unfortunately, the Board finds that additional development must be undertaken before these claims can be adjudicated on the merits. With respect to the Veteran’s claims of entitlement to increased disability evaluations for his service-connected disabilities of the right shoulder, cervical spine, left ankle, left hip, left knee, right ankle, right hip, and right knee, the Board notes that these disabilities share a common etiology. However, the Veteran has not been provided with VA examinations relevant to these disabilities since February 2016, approximately five years ago. A review of the evidence added to the claims file since that time suggests that these disabilities may have increased in severity since the date of the February 2016 VA examinations. For instance, VA treatment records dated as recently as January 2020 show that the Veteran receives regular treatment for pain, and it appears that his oxycodone dosage to treat pain related to fibromyalgia was increased in or around August 2019. While the Board is not required to direct a new examination simply due to the passage of time, a new examination is appropriate when there is evidence that the disability in question has undergone an increase in severity since the time of the last examination. See Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); see also Bolton v. Brown, 8 Vet. App. 185, 191 (1995); Caffrey v. Brown, 6 Vet. App. 377, 381 (1995). As such, the Board finds that the matters must be remanded so that the Veteran can be provided with contemporaneous VA examinations to assess the current severity of his right shoulder, cervical spine, left ankle, left hip, left knee, right ankle, right hip, and right knee disabilities. Lastly, in light of Correia v. McDonald, 28 Vet. App. 158 (2016) and Sharp v. Shulkin, 29 Vet. App. 26 (2017), and as the rating period on appeal dates back to July 2001, the VA examiner is asked to provide retrospective opinions regarding the severity of the Veteran’s service-connected cervical spine, right shoulder, left hip, right hip, left knee, right knee, left ankle, and right ankle disabilities. In Correia, the Court held that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing, and, if possible, with range of motion measurements of the opposite undamaged joint. Correia, 28 Vet. App. at 168. Additionally, in Sharp, the Court held that, pursuant to VA regulations and the VA Clinician’s Guide, when conducting evaluations for musculoskeletal disabilities, VA examiners are obligated to inquire whether there are periods of flare-ups and, if the answer is yes, to state their severity, frequency, and duration, name the precipitating and alleviating factors, and estimate, per the veteran, to what extent, if any, flare-ups and repetitive use over time affect functional impact. Sharp, 29 Vet. App. at 26. Further, VA examiners are expected to offer opinions on functional loss that would occur during flare-ups and repetitive use over time based on estimates derived from relevant sources, including the Veteran’s lay statements. Id. at 34. In other words, stating that the examination was not conducted during a flare-up or following repetitive use over time as the sole rationale for not addressing the functional impacts of such is not sufficient. The matters are REMANDED for the following action: Schedule the Veteran for VA examinations by a qualified examiner to determine the current nature, extent, and severity of the service-connected right shoulder, cervical spine, left ankle, left hip, left knee, right ankle, right hip, and right knee disabilities. The entire record, including a copy of this Remand, must be reviewed by the examiner in conjunction with the examination. Range of motion studies must include active and passive motion on weight-bearing and nonweight-bearing. The examiner must note any further functional limitations due to pain, weakness, fatigue, incoordination, or any other such factors. If the VA examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he/she must clearly explain the basis for this decision. The examiner must also ask the Veteran to identify the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment resulting from flare-ups and on repeated use. The examiner should describe the nature and severity of all symptoms of the Veteran’s right shoulder, cervical spine, left ankle, left hip, left knee, right ankle, right hip, and right knee disabilities, taking into consideration the Veteran’s statements regarding the extent of his symptoms. The examiner should specifically note if the Veteran’s symptoms are constant, or nearly so, and refractory to therapy. All findings should be described in detail and should be accompanied by a complete rationale. Lastly, in light of Correia and Sharp, with respect to each disability on appeal, the VA examiner is asked to provide a retrospective opinion addressing prior range of motion of the joint, painful motion (and at what point it started), additional loss of motion after repetitions, and functional loss due to pain (considering active and passive motion as well as weight-bearing and nonweight-bearing considerations-throughout the period on appeal) dating back to July 2001. If the examiner is unable to provide a retrospective opinion, then the examiner must provide a thorough explanation as to why such opinion cannot be provided. Any additional impairment on use or in connection with flare-ups should be described in terms of the degree of additional range of motion loss. The examiner should specifically describe the severity, frequency, and duration of flare-ups; name the precipitating and alleviating factors; and estimate (as best as can be ascertained from the Veteran's self-reports as well as from clinical records and other evidence) to what extent, if any, such flare-ups affect functional impairment. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, then the examiner must clearly explain why that is so. Tiffany Dawson Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Anthony M. Flamini 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.