Citation Nr: 21006095 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 15-05 092 DATE: February 3, 2021 ORDER Entitlement to an initial disability rating in excess of 20 percent for degenerative disc disease of the lumbar spine disorder is denied. Entitlement to an initial disability rating in excess of 10 percent for left lower extremity radiculopathy is denied. Entitlement to a total disability rating based upon individual unemployability (TDIU) due to all service-connected disabilities from April 24, 2017 to September 25, 2018 is granted. FINDINGS OF FACT 1. The Veteran’s lumbar spine disorder does not manifest as forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. 2. Left lower extremity radiculopathy does not manifest as moderate incomplete paralysis of the sciatic nerve. 3. The weight of evidence of record show that the Veteran was unable to secure or follow substantially gainful employment as a result of service-connected disabilities by her report in a July 2019 claim from April 24, 2017 and prior to September 25, 2018. CONCLUSIONS OF LAW 1. The criteria for disability rating in excess of 20 for the Veteran’s lumbar spine disorder have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5243-5242 (2019). 2. The criteria for a disability rating in excess of 10 percent for the Veteran’s left lower extremity radiculopathy have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.14, 4.124a, Diagnostic Code 8520 (2019). 3. The criteria for entitlement to a TDIU from April 24, 2017 to September 25, 2018 have been met. 38 U.S.C. §§ 1155, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 4.18, 4.19 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1994 to August 2002. These matters come before the Board of Veteran’s Appeals (Board) on appeal from April 2013 and January 2015 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). The January 2015 rating decision denied claims for increased ratings. The RO characterized a February 2015 VA Form 9 as a notice of disagreement, a March 2016 statement of the case (SOC) was issued (but entitled “supplemental statement of the case” (SSOC)), and a May 2016 substantive appeal was filed (by way of a VA Form 646), and then the RO certified these matters to the Board. As such the increased disability rating claims are properly on appeal before the Board. In February 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that proceeding has been associated with the Veteran’s claims file. Subsequent to the February 2018 Board hearing, the Veteran indicated that she desired another Board hearing. The Board sent the Veteran a letter in December 4, 2020, to ascertain whether she still desired another hearing. To date, the Veteran has not responded to the Board’s letter. As more than 30 days have passed since the issuance of the clarifying letter, the Veteran’s request for a hearing is considered withdrawn. See 38 C.F.R. § 20.704(d). The Board has reviewed the evidence of record comprehensively. Although the Board has an obligation to provide reasons and bases to support a decision, there is no requirement to discuss, in detail, all the evidence submitted by or on behalf of a Veteran or an appellant. See Gonzales v. West, 218 F. 3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and the most relevant evidence about what this evidence shows, or fails to show, about the issues on appeal. The Veteran must not assume that the Board has overlooked pieces of evidence that are not discussed explicitly. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran or appellant). Competent Evidence Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). If the evidence is competent, the Board must then determine if the evidence is credible. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511 (1995). Increased Disability Ratings The Veteran contends that the disability ratings assigned to the two disabilities, as noted above, do not contemplate the severity of her respective symptoms. A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule). The percentage ratings contained in the Rating Schedule represent, as far as can practicably be determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and to consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. See Schafrath v. Derwinski, 1 Vet. App. 589, 592-93 (1991). Where there is a question as to which of two ratings to apply, VA will assign the higher rating if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. Otherwise, VA will assign the lower rating. Id. The Board will consider whether separate ratings may be assigned for separate periods of time based on the facts found, a practice known as “staged ratings.” See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Lumbar spine disorder Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. Deluca v. Brown, 8 Vet. App. 202 (1995). Functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective enervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45. VA must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss under 38 C.F.R. § 4.40, which requires VA to regard as “seriously disabled” any part of the musculoskeletal system that becomes painful on use. See DeLuca, supra. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Painful motion is an important factor of joint disability, which is entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain and numbness in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. See Saunders v. Wilkie, 886 F. 3d 1356 (Fed. Cir. 2018). Musculoskeletal VA examinations, to be adequate, must address particular issues when are where that are practicable and medically possible to include active and passive motion; weight bearing and non-weight bearing; range of motion of an opposing joint; and findings as to loss of motion during flare-ups. See Correia v. McDonald, 28 Vet. App. (2016); Sharp v. Shulkin, 29 Vet. App. 26 (2017). The RO rated the Veteran’s lumbar spine disorder under 38 C.F.R. § 4.71a, Diagnostic Code 5243-5242. Hyphenated Diagnostic Codes are used when a rating under one Diagnostic Code requires use of an additional Diagnostic Code to identify the basis for the rating. 38 C.F.R. § 4.27. Here, the hyphenated Diagnostic Code indicates that the Veteran’s lumbar spine disorder is rated, by analogy, under the criteria of the General Rating Formula (Diagnostic Code 5242) as well as the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes (Diagnostic Code 5243). The General Rating Formula pertinent to the thoracolumbar spine assigns a 20 percent disability rating when forward flexion of the thoracolumbar spine is greater than 30 degrees but less than 60 degrees; the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or if there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, such as scoliosis, reversed lordosis, or abnormal kyphosis. 38 C.F.R. § 4.71a. A 40 percent disability rating is assigned when there is forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. Lastly, a 100 percent disability rating is assigned when there is unfavorable ankylosis of the entire spine. Id. 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. See 38 C.F.R. § 4.71a, General Formula, Note (2); see also Plate V. 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. 38 C.F.R. § 4.71a, General Formula, Note (5). IVDS is rated either under the General Rating Formula or alternatively under the Formula for Rating IVDS on Incapacitating Episodes, whichever method results in a higher disability rating. The Formula for Rating IVDS Based on Incapacitating Episodes provides a 20 percent disability rating is warranted for incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. And, a 40 percent disability rating is assigned for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. An incapacitating episode is defined as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id. at Note (1). Evidence and Analysis In a November 2004 notation, a VA clinician indicated that the Veteran had decreased lumbar spine range of motion secondary to pain and stiffness. However, there was no point tenderness and intact sensory and motor function. In a September 2005 lay statement, the Veteran reported that her lumbar spine disorder had worsened, noting difficulties walking and standing. The Veteran also wrote that her pain radiates to her neck and into her left leg. Bending, standing, and walking (for long distances) had become difficult. And, the Veteran indicated that she had to sleep with a pillow between her legs to alleviate pain. A VA thoracolumbar conditions was scheduled for October 2004; however, the Veteran failed to appear and failed to explain this failure. In correspondence received in September 2007, the Veteran wrote that she was satisfied with the decision involving her claim. The Veteran only referenced the increased disability rating that she had received for migraine; however, the Veteran did not reference her lumbar spine disorder increased disability rating claim. In a March 2008 VA treatment record, a VA physician noted that the Veteran did not have neurological deficits related to her lumbar spine disorder. At this time the Veteran was also afforded magnetic resonance imaging (MRI). This MRI revealed a mild paracentral disc protrusion at the L5/S1 level. Upon review of contemporaneous x-ray imaging of the thoracolumbar spine, a VA clinician rendered an impression of early degenerative disc disease, without evidence of either fracture or subluxation. In April 2008, the Veteran was afforded a VA spine examination. A clinician reviewed the claims file; considered the Veteran’s accounts; and conducted an evaluation. At this time, the Veteran reported that her spinal pain aches, burns and radiates up her spine, noting that pain is especially intense when she turns her neck. The Veteran also endorsed flare-ups and difficulties with locomotion, bending, and stooping. Upon evaluation, forward flexion was to 66 degrees (after repetitive use to 78 degrees); extension was to 16 degrees (after repetitive use to 14 degrees); left lateral flexion was to 12 degrees (after repetitive use to 12 degrees); left lateral rotation was to 18 degrees (after repetitive use to 16 degrees); right lateral flexion was to 14 degrees (after repetitive use to 10 degrees); and right lateral rotation was to 18 degrees (after repetitive use to 16 degrees). The Veteran reported pain upon forward flexion from 40 degrees to 66 degrees. However, the clinician opined that there was no objective evidence of pain upon range-of-motion testing. The was no loss of lumbar curvature upon forward flexion. Neurological testing showed normal motor and sensory systems. The clinician provided a current diagnosis of degenerative disc disease (DDD) of the lumbar spine at L4-5 and L5-S1. In a December 2011 lay statement, the Veteran reported that she experienced back pain daily, which limited activities. Also, the Veteran wrote that her pain radiated to her hips, buttocks, legs, and (sometimes) to her feet. Also, the Veteran indicated that she was pursuing physical therapy (PT). In January 2012, the Veteran was afforded a VA thoracolumbar spine conditions examination. A clinician reviewed the claims file; considered the Veteran’s accounts; and conducted an evaluation. The clinician provided a diagnosis of DDD of the lumbar spine. The Veteran did not report flare-ups. Forward flexion was to 80 degrees; extension was to 20 degrees; right lateral flexion was to 25 degrees; left lateral flexion was to 25 degrees; right lateral rotation was to 35 degrees; and left lateral flexion was to 25 degrees. The Veteran was able to perform repetitive-use testing of at least three repetitions. Upon such, forward flexion was to 80 degrees; extension was to 20 degrees; right lateral flexion was to 25 degrees; left lateral flexion was to 25 degrees; right lateral rotation was to 25 degrees; and left lateral rotation was to 25 degrees. As to functional loss, the clinician reported that the Veteran showed less movement than normal. There was no evidence of muscle tenderness, guarding, or spasm. Muscle-strength testing was normal at all indices. There was no evidence of muscle atrophy. Reflex testing was normal at all indices. Sensory testing was normal at all indices. Radiculopathy testing disclosed mild intermittent pain and mild paresthesias and/or dysesthesias at the left lower extremity. There was no objective evidence of nerve root involvement or ankylosis. While IVDS was present, it did not result in any incapacitating episodes over the past 12 months. X-ray imaging revealed the presence of arthritis; however, there was no radiographic evidence of vertebral fracture. Upon an April 2013 general VA pension examination, a clinician included references to MRIs and x-ray imaging of the Veteran’s thoracolumbar spine. Also, in April 2013, the Veteran was afforded a VA thoracolumbar spine conditions examination. A clinician reviewed the claims file; considered the Veteran’s lay accounts; and conducted an evaluation. This clinician provided diagnoses of osteoarthritis; DDD; and sciatica. The Veteran endorsed flare-ups which she characterized as sharp pain that lasts for two hours, 4-5 times a week. Forward flexion was to 60 degrees; extension was to 25 degrees; right lateral flexion was to 30 degrees or more; left lateral flexion was to 30 degrees or more; right lateral rotation was to 30 degrees or more; and left lateral rotation was to 30 degrees. There was no objective evidence of pain in ranges of motion. Repetitive-use testing of at least three repetitions was possible. Ranges of motion after repetitive-use testing mirrored those of initial ranges of motion. The clinician indicated that functional loss consisted of less movement than normal and pain on movement. There was no evidence of localized tenderness, guarding, or muscle spasm. Muscle-strength testing was normal at all indices. There was no evidence of muscle atrophy. Reflex testing was normal at all indices. Sensory testing was normal at all indices. There was no evidence of ankylosis. Radiculopathy was present, manifesting as moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness if the left lower extremity. The clinician opined that the sciatic nerve root was involved. While IVDS was present, it did not result in any incapacitating episodes over the past 12 months. Functional impact consisted of an inability to stand for a prolonged period or to perform physical work. However, the clinician reported that the Veteran had mild functional limitations and was able to perform sedentary work. In September 2014, VA received copies of the Veteran’s Social Security Administration (SSA) medical records. Medical records consisted of VA treatment records, examination reports and progress notes. In the associated SSA questionnaires and vocational evaluation reports, the Veteran repeated her reports to VA. The Veteran also provided the names and addresses of private clinicians who treated her for her many other claimed disabilities. This file also included a private mental health report. In December 2014, the Veteran was afforded a VA thoracolumbar spine conditions examination. A clinician reviewed the claims file; considered the Veteran’s accounts; and conducted an evaluation. The clinician continued earlier diagnoses. Again, the Veteran endorsed flare-ups which largely manifest in the ways that she had endorsed several months earlier. Forward flexion was to 35 degrees; extension was to 10 degrees; right lateral flexion was to 15 degrees; left lateral flexion was to 15 degrees; right lateral rotation was to 15 degrees; and left lateral rotation was to 15 degrees. The Veteran endorsed pain at all ranges of motion. Now, there was tenderness at multiple spinal locations; however, there was no definite scoliosis and normal lordosis. This tenderness did not result in abnormal gait or abnormal spinal contour. Repetitive-use testing of at least three repetitions was possible. The clinician did not indicate whether repetitive use or flare-ups manifested as limitations characterized as pain, weakness, fatigability or incoordination. Muscle-strength testing was normal at all indices. There was no evidence of muscle atrophy. Reflex testing was normal, with the exceptions of hypoactive at the bilateral ankles. Sensory testing was normal at all indices. There was no evidence of ankylosis. Here, the clinician reported that the Veteran did not have radicular pain or any other signs of symptoms of radiculopathy. The Veteran reported that her disability impacted her ability to work. In pertinent part, the Veteran reported that her disability caused excessive absenteeism; limited sitting time; impacted her ability to cook; impacted her ability to perform all activities of daily living without assistance; inhibited carrying; inhibited bending; and hindered prolonged standing. VA treatment records from the same year through 2016 show that the clinicians followed the course of the Veteran’s DDD (noted periodically as “lumbago with mild degenerative spine disease”). Clinicians monitored the dosing of the Veteran’s prescribed medications. These records also disclose that the Veteran received imaging services and periodic consultations. These records also show numerous telephonic contacts and encounters. And, the Veteran also availed herself of VA physical therapy (PT). In December 2016, the Veteran was afforded a VA thoracolumbar spine conditions examination. A clinician reviewed the claims file; considered the Veteran’s lay accounts; and conducted an evaluation. The clinician provided a diagnosis of degenerative arthritis of the spine. The Veteran endorsed flare-ups, manifesting as limited ability to sit in one position for more than 15 minutes; stand; walk more than 100 feet; stand for more than 10 minutes; and lift more than 10 pounds. Forward flexion was to 60 degrees; extension was to 10 degrees; right lateral flexion was to 30 degrees; left lateral flexion was to 20 degrees; right lateral rotation was to 30 degrees; and left lateral rotation was to 20 degrees. There was no pain upon weight bearing and no objective evidence of tenderness. Repetitive-use testing of at least three repetitions was possible (and the Veteran was examined after repetitive use over time); further, pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. The clinician indicated that the examination took place during a flare-up. However, the clinician noted that pain, weakness, fatigability or incoordination did not significantly limit functional ability during flare-ups. There was no objective evidence of guarding or muscle spasm. Muscle-strength testing was normal at all indices. There was no evidence of muscle atrophy. Reflex testing was normal at all indices. Sensory testing was normal at all indices, with the exception of a decreased result at the foot/toes (L5). There was no evidence of ankylosis. Radiculopathy testing disclosed mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness at the left lower extremity. There was no objective evidence of ankylosis. There was an indication of left sciatic nerve root involvement. However, the clinician indicated that left lower extremity radiculopathy was best characterized as mild. The clinician found no objective evidence of IVDS. Here, the clinician referenced a July 2016 MRI of the lumbar spine which only disclosed multilevel degenerative joint disease, minimal disc displacement annulus fibrosis tears, and nerve root abutment. There was no pain with either active or passive ranges of motion. And, there was no objective evidence of pain with weight-bearing as well as non-weight-bearing. The Veteran indicated that her functional ability to work was affected by an inability to sit in one position for more than 15 minutes; an inability to walk for more than 100 feet; and inability to stand for more than 15 minutes; and an inability to lift objects weighing more than 10 pounds. 2017 Veterans Affairs Medical Center (VAMC) records from Biloxi, Mississippi show that the Veteran received consultations and pain management advisement in 2017. Clinicians opined that the Veteran endorsed back pain on multiple occasions. In a September 2017 letter, a VA physician at the Biloxi VAMC wrote that the Veteran had pending orthopedic surgery and was unable to work. At the February 2018 Board hearing, the Veteran testified that her back locks up which, in turn, renders her bedridden. The Veteran also testified that she took narcotics regularly for back pain; received chiropractic care; and commenced epidural treatments. And, the Veteran indicated that limitations in ranges of motion affected her daily activities, including bodily hygiene. More specifically, the Veteran testified that her children helped her bathe and she used a “potty chair.” See February 28, 2018 Hearing Transcript, p. 16. The Veteran’s 2018 and 2019 VA active problems list includes the on-going problem of chronic low back pain. VA treatment records disclose continuations of earlier protocols. The Veteran also conveyed that she her insomnia was related to mechanical back pain. In September 2019, the Veteran was afforded a VA thoracolumbar spine conditions examination. A clinician reviewed the claims file; considered the Veteran’s lay accounts; and conducted an evaluation. The clinician provided diagnosis of DDD and bilateral lower extremity radiculopathy. Forward flexion was to 70 degrees; extension was to 20 degrees; right lateral flexion was to 20 degrees; left lateral flexion was to 25 degrees; right lateral rotation was to 25 degrees; and left lateral rotation was to 20 degrees. Range of motion results were the same upon passive range of motion. The clinician noted pain upon examination that causes functional loss. There was tenderness of moderate severity at lumbar vertebrae L4-5. There was evidence of pain with weight-bearing. The was no evidence of pain upon non-weight-bearing. Repetitive-use testing of at least three repetitions was possible, without additional losses in ranges of motion. Thus, there was no objective evidence of functional loss upon repeated use over time. Thus, ranges of motion mirrored those noted above. As to flare-ups, which the Veteran reported, the clinician first noted that examination was not taking place during a flare-up. The Veteran reported that functional loss during flare-ups manifest as pain and weakness. The clinician approximated such losses as forward flexion to 40 degrees; extension to 15 degrees; right lateral flexion to 15 degrees; left lateral flexion to 20 degrees; right lateral rotation to 20 degrees; and left lateral rotation to 15 degrees. There was no evidence of guarding or muscle spasm. Additional contributory factors consisted of weakened movement due to muscle or peripheral nerves; disturbance of locomotion; interference with sitting; and interference with standing. There was no objective evidence of ankylosis. The Veteran reported that she was unable to stand or sit for extended periods without aggravation of her lower back pain. The Veteran also reported that she could not ambulate for more than 50 feet. And, lastly, the clinician noted weakness directly related to pain and generalized deconditioning. Muscle-strength testing was normal at all indices. There was no evidence of muscle atrophy. Reflex testing was normal at the bilateral knees and hypoactive at the bilateral ankles. Sensory testing was normal at all indices. Radiculopathy manifested only as mild left lower extremity mild intermittent pain and mild paresthesias and/or dysesthesias. There was no objective evidence of IVDS. As to functional impact on ability to work, the Veteran reported that she could not work due to her inability to sit for long periods without experiencing flare-ups. Also, she indicated that she could not work due to her limited ambulation and the other manifestations of flare-ups noted above. In response to a Board remand directive, the clinician opined that the Veteran has significant back pain that impedes her ability to ambulate long distances and she requires frequent breaks. Additionally, the Veteran cannot sit for long periods of time. The Veteran’s gait is unstable, slow, and antalgic. Lastly, the Veteran experiences frequent flare-ups which require bedrest to assuage the pain. In October 2020, VA received data from SSA which shows a disability onset date of January 1, 2017 and initial entitlement date of June 2017. As noted above, to receive a disability rating in excess of 20 percent, there would need to be a showing of forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. (Or, alternatively for IVDS, incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months.). Upon review of the extensive clinical evidence of record, any of such is not shown. At worst, the Veteran’s forward flexion of her thoracolumbar spine was limited to 35 degrees upon her VA examination in December 2014. And, there was no evidence of ankylosis. Turning to IVDS, when it was objectively noted upon examination, it caused no incapacitating episodes in the previous 12-month periods. Thus, the Veteran’s degree of disability throughout this appeal best approximates a 20 percent disability, wherein the combined range of motion of the thoracolumbar spine is greater than 120 degrees not greater than 235 degrees, which falls within that contemplated by a 10 percent disability rating and sustained functional loss due to flare-ups of pain of her thoracolumbar spine which warrants 10 percent, as noted above. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see also, De Luca, Saunders, both supra. The Veteran sincerely believes that her lumbar spine disability is more severe that that contemplated by a “combined” 20 percent disability rating. While the Veteran is competent to report discernable symptoms (such as pain), the Veteran lacks the medical knowledge and orthopedic expertise to render a competent opinion as to the clinical severity of a thoracolumbar spine disability. See Jandreau supra. Whereas, the Board assigns significant probative weight to the multiple VA examinations of record. In each instance, a clinical professional reviewed the claims file; considered the Veteran’s lay accounts; and conducted an evaluation. Moreover, each examination report includes extensive clinical findings which assess the medical vectors of a thoracolumbar spine disability. For the reasons articulated above, the Board finds that the Veteran’s lumbar spine disorder does not warrant a disability rating in excess of 20 percent. Left lower extremity radiculopathy The Board refers to the evidence discussed above pertaining to left lower extremity radiculopathy. The Veteran contends that a 10 percent disability rating does not contemplate the severity of left lower extremity radiculopathy. The RO has evaluated this disability under 38 C.F.R. § 4.124a, Diagnostic Code 8520. Diagnostic Codes 8520-8730 address ratings for paralysis of the peripheral nerves affecting the lower extremities, neuritis, and neuralgia. 38 C.F.R. § 4.124a, Diagnostic Codes 8520-8730. Under Diagnostic Code 8520, ratings of 10, 20, and 40 percent are warranted, respectively, for mild, moderate, and moderately severe incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a, Diagnostic Code 8520. A disability rating of 60 percent is warranted for severe incomplete paralysis with marked muscle atrophy. Id. An 80 percent disability rating is warranted with complete paralysis of the sciatic nerve. Id. The term “incomplete paralysis,” with respect to peripheral nerve injuries, indicates a degree of loss or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the lesion or to partial regeneration. Where the involvement is wholly sensory, the rating should be for mild, or at the most, moderate symptomatology. See 38 C.F.R. § 4.124a. The words “slight,” “mild,” “moderate” and “severe” as used in the various diagnostic codes are not defined in the VA 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 In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. Special consideration should be given to any psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, and injury to the skull. 38 C.F.R. § 4.120. Evidence and Analysis Upon the January 2012 VA examination, the VA clinician reported that radiculopathy testing disclosed mild intermittent pain and mild paresthesias and/or dysesthesias at the left lower extremity. Upon the April 2013 VA examination, the VA clinician indicated that radiculopathy was present, manifesting as moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness if the left lower extremity. The clinician opined that the sciatic nerve root was involved. Upon the December 2014 VA examination, the VA clinician reported that the Veteran did not have any radicular pain or any other signs of symptoms of radiculopathy. This same month the Veteran was afforded a VA peripheral nerve conditions examination. A clinician reviewed the claims file; considered the Veteran’s lay accounts; and conducted an evaluation. This clinician did not provide a current diagnosis. Moreover, the clinician did not report any symptoms associated with the Veteran left lower extremity. The clinician did note that the Veteran walked with a left-leg limp with fair heel/toe/tandem walk. The Veteran subjectively endorsed that the etiology of her abnormal gait was back pain. The left sciatic nerve was normal; the left obturator nerve was normal. Based upon these clinical findings, the clinician opined that the Veteran’s peripheral nerve condition did not impact her ability to work. Here, the clinician did note that the Veteran had lumbago with degenerative spine disease; however, there was no objective evidence of either motor or sensory deficits related to the lumbar spine. A review of VA treatment records reveals that the Veteran complained of left lower extremity discomfort and pain. Clinicians monitored the course of the Veteran’s treatment; monitored the efficacy of medications; and provided educational programming on pain control methods. As noted above, these records also disclose telephonic encounters and PT services. Clinicians provided multiple notations concerning the status of the Veteran left lower extremity. Upon the December 2016 VA examination, the clinician opined that radiculopathy testing disclosed mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness at the left lower extremity. There was an indication of left sciatic nerve root involvement. Hence, the clinician indicated that left lower extremity radiculopathy was best characterized as mild. This same month the Veteran was afforded another VA peripheral nerve conditions examination. A clinician reviewed the claims file; considered the Veteran’s lay accounts; and conducted an evaluation. The clinician indicated that the Veteran did have symptoms attributable to a peripheral nerve condition. As to symptoms, the Veteran’s left lower extremity evinced mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness. The Veteran’s gait was normal. The clinician did indicate that the left sciatic showed severity of incomplete paralysis, characterized as mild. Based upon these clinical findings, the clinician opined that the Veteran’s peripheral nerve condition did not impact her ability to work. At the February 2018 Board hearing, the Veteran testified that her left leg was swollen. Further, she stated that she was told that she had sciatic nerve damage. This nerve damage made her left leg numb and elicited pain as if her left leg were on fire. Upon the September 2019 VA examination, the clinician reported that radiculopathy manifested only as mild left lower extremity mild intermittent pain and mild paresthesias and/or dysesthesias. As noted above, to receive a higher disability rating there would need to be a showing of moderate incomplete paralysis of the left sciatic. Upon contemplation of the totality of evidence of record, such is not disclosed. At worst, the clinical evidence shows that Veteran’s left lower extremity radiculopathy manifests as mild incomplete paralysis of the left sciatic nerve. While the clinical evidence of record does show that there were findings in April 2013 as to as moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness if the left lower extremity, these findings are outliers within the body of the Veteran’s many VA examinations. Here, the Board takes especial note of the December 2014 VA peripheral nerve conditions examination, in which the clinician indicated that the Veteran’s left sciatic nerve was normal. The Board considered the Veteran’s testimony and reporting of leg numbness and pain like it was on fire and that she was prescribed strong pain medication for her back and radiating pain and for headaches. The Board considered her reports of requiring a walker and that she has been told she needs a hip replacement. The Board also considered the Veteran’s report in her July 2019 claim for a TDIU that she was employed up to April 2017. In assigning a mild vice moderate or more severe rating, the Board considered the inconsistent records of observed limp at times but normal gait at other times and that mobility is limited by multiple disabilities including the back and hip. The Board has considered the Veteran’s accounts of severe “fire-like” left lower extremity nerve pain and numbness. Indeed, the Veteran is competent to report discernable pain. See Jandreau, supra. However, this was not consistently reported to examiners who evaluated her reports and functional loss and in their judgment predominantly considered the radiculopathy itself as mild. Whereas, the Board assigns significant probative weight to the multiple VA examination reports of record. In each instance, a clinical professional reviewed the claims file; considered the Veteran’s lay accounts; and conducted an evaluation. Moreover, each examination report includes extensive clinical findings which assess the medical vectors of left lower extremity radiculopathy. For the reasons articulated above, the Board finds that the Veteran’s disability does not warrant a disability rating in excess of 10 percent. TDIU In order to establish entitlement to a TDIU due to service-connected disabilities, there must be impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. See 38 U.S.C. §§ 1155; 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). Consideration may be given to the veteran’s level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). “Substantially gainful employment” is that employment “which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides.” Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991). “Marginal employment shall not be considered substantially gainful employment.” 38 C.F.R. §§ 4.16(a), “Substantially gainful employment” is that employment “which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides.” Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991). “Marginal employment shall not be considered substantially gainful employment.” 38 C.F.R. § § 4.16(a) The regulatory scheme for a TDIU provides both objective and subjective criteria. Hatlestad, supra; VAOPGCPREC 75-91 (Dec. 27, 1991) 57 Fed. Reg. 2317 (1992). The objective criteria, set forth at 38 C.F.R. § § 3.340(a)(2), provide for a total rating when there is a single disability or a combination of disabilities that results in a 100 percent schedular evaluation. Subjective criteria, set forth at 38 C.F.R. §§ 4.16(a), provide for a TDIU when, due to service-connected disability, a veteran is unable to secure or follow a substantially gainful occupation, and has a single disability rated 60 percent or more, or at least one disability rated 40 percent or more with additional disability sufficient to bring the combined evaluation to 70 percent. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In exceptional circumstances, where the veteran does not meet the aforementioned percentage requirements, a total rating may nonetheless be assigned upon a showing that the individual is unable to obtain or retain substantially gainful employment. 38 C.F.R. § 4.16(b). Evidence and Analysis As of this decision, the Veteran is service-connected for the following disabilities: 1) schizoaffective disorder at 50 percent from October 27, 2003, at 70 percent from October 11, 2011, at 100 percent from September 25, 2018; 2) migraine headaches at 30 percent from August 26, 2002, at 50 percent from April 23, 2012; 3) lumbar spine disorder at 20 percent from August 25, 2002; 4) left lower extremity radiculopathy at 10 percent from October 11, 2011; 5) tinnitus at 10 percent from September 25, 2018; 6) right lower extremity radiculopathy at 10 percent from September 9, 2019; 7) hypertension at a noncompensable rating from August 26, 2002. Therefore, the Veteran met the schedular requirements for entitlement to a TDIU from October 27, 2003. She has been rated as 100 percent disabled and granted special monthly compensation under 38 U.S.C. § 1114 (s) since September 25, 2018. Therefore, the issue is whether the Veteran was unemployable prior to that date. A review of the evidence of record discloses that the Veteran graduated high school and two years of college credit. Additionally, the Veteran took specialized training courses in the handling of hazardous materials; lifesaving; and leadership development. The Veteran’s professional experience consists of work as a cashier in a food franchise; work as a teacher in multiple settings; a driver; a secretary; a clothing store owner; and as an assisted living elder-care technician. Additionally, the Veteran had extensive experience working in the field of motor transportation, to include mechanic duties, during her over 8 years of active duty service. The Veteran contends that she was discharged from her last position due to excessive absenteeism, which the Veteran attributes to limitations imposed upon her by her service-connected disabilities. As noted above, the Veteran was determined disabled for SSA purposes (which is not analogous a VA determination) as of January 1, 2017. In her July 2004 VA Form 28-1900, the Veteran sought vocational rehabilitation services contending that she needed help finding a position which did not require excessive standing. The Veteran indicated that he wanted to drive trucks. Upon a December 2004 VA mental health disorders examination, a VA psychiatrist noted that the Veteran reported that she could not work because of anxiety attacks. The psychiatrist provided a diagnosis of generalized anxiety disorder. The psychiatrist wrote that the Veteran was competent to handle her finances. As noted above, in a September 2005, the Veteran reported that her lumbar spine disorder had worsened, noting difficulties walking and standing. The Veteran also wrote that her pain radiates to her neck and into her leg. Bending, standing, and walking (for long distances) has become difficult. And, the Veteran indicated that she had to sleep with a pillow between her legs to alleviate pain. Upon a November 2006 VA migraine examination, a clinician noted that the Veteran indicated that she stayed in bed three times a week because of headaches. In March 2007, VA received a lay statement from the Veteran. In pertinent part, she conveyed she had needles and “shock” applied to her leg, which caused acute “denervation.” The Veteran referred to a private treatment record from December 2002 (which precedes the chronological window under consideration). Upon a VA rehabilitation and employment assessment of this same month, a VA rehabilitation consultant noted that the Veteran had difficulties with prolonged standing and walking; stooping; squatting; lifting; bending; twisting; kneeling; crouching; and crawling. However, the Veteran endorsed that she was able to perform all daily life activities. The Veteran drove and also had reliable transportation. This consultant opined that testing and evaluation showed that the Veteran had abilities for probable vocational success in the fields of skilled technology; skilled science work; consumer economics; outdoor pursuits; professional business; skilled business; clerical work; communications; skilled work in the arts; professional service; and skilled service. Upon an April 2008 VA mental health disorders examination, a psychiatrist opined that Veteran reported that she quit her last job because of anxiety attacks, sleepiness, hallucinations, fear, bad luck, and worries about safety. The psychiatrist noted significant employment impairment because of a host of psychiatric symptoms and back pain. In a December 2011 lay statement, the Veteran reported that she experienced back pain daily, which limits activities. In January 2012, the Veteran’s pastor submitted a letter. In pertinent part, he wrote that he was concerned about the Veteran’s mental and physical health, which had been going in a “downward spiral” for 5 years. This pastor also indicated that the Veteran reported that her pain was overwhelming. This same month, the Veteran submitted a lay statement in which she reported that she suffers from panic attacks, anxiety, and depression. The Veteran also wrote that she slept little and mostly remained in her house. Upon the April 2013 thoracolumbar spine examination, the clinician indicated that the Veteran’s functional loss consisted of less movement than normal and pain on movement. In a VA mental health disorders examination of the same month, a psychologist indicated that the Veteran mental health disabilities were productive of occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. In December 2014, the VA clinician, who conducted the thoracolumbar spine conditions examination, indicated that the Veteran endorsed that her lumbar spine disorder impacted her ability to work. In pertinent part, the Veteran subjectively reported that her disability caused excessive absenteeism; limited sitting time; impacted her ability to cook; impacted her ability to perform all activities of daily living without assistance; inhibited carrying; inhibited bending; and hindered prolonged standing In a VA headaches examination report of the same month, a clinician reported that the Veteran endorsed very prostrating and prolonged attacks of migraines or nonmigraine pain productive of severe economic inadaptability. However, this clinician opined that migraines or nonmigraine pain had no effect on the Veteran’s ability to work. In January 2015, the Veteran submitted a lay stated in which she reported that she had started school but her vehicle “broke down.” The Veteran indicated that she had severe financial difficulties, but she wanted to save money to purchase a new vehicle. In a May 2016 statement, the Veteran’s representative wrote that the Veteran has tried to work since 2012, but the Veteran’s service-connected disabilities, to include lumbar spine disorder and service-connected left lower extremity radiculopathy made fulfilling the tasks of a job impossible. The representative did not indicate the type of work for which fulfilling tasks would be impossible. In December 2016, a VA clinician opined that the Veteran’s hypertension had no effect on her employment. The clinician who conducted the December 2016 VA thoracolumbar spine conditions examination wrote that the Veteran indicated that her functional ability to work was affected by an inability to sit in one position for more than 15 minutes; an inability to walk for more than 100 feet; and inability to stand for more than 15 minutes; and an inability to lift objects weighing more than 10 pounds. Upon a VA mental health disorders examination in January 2017, a psychologist indicated that the Veteran’s cyclothymic disorder was productive of occupational and social impairment with reduced reliability and productivity. The psychologist indicated that the Veteran reported that she quit her job as an assisted living elder-care technician in 2015 because of lumbar spine pain. In a February 2017 addendum, the psychologist noted that the Veteran’s cyclothymic disorder was more serious than originally thought. In this addendum, the psychologist provided no guidance as to any degree of additional impact on the Veteran’s ability to work. In a July 2019 claim for a TDIU, the Veteran reported working until April 2017. In a September 2017 letter, a VA physician noted that the Veteran was unable to work “at this time” due to current medical conditions. In a September 2017 letter, a VA physician at the Biloxi VAMC wrote that the Veteran had pending orthopedic surgery and was unable to work. At the February 2018 Board hearing, the Veteran testified that her lumbar spine disorder inhibited her hygienic needs. Also, her absenteeism and “sitting” led to termination at her last two jobs. The Veteran underscored that her lumbar spine disorder symptoms were responsible for excessive absenteeism and therefor caused her employment terminations. In a March 2018 letter, a VA physician wrote that the Veteran’s mental health disorder was posttraumatic stress disorder (PTSD). This physician, without any clinical findings concluded that PTSD had rendered the Veteran unemployable. A review of the Veteran’s VA treatment records discloses that the Veteran requested the physician write this letter in her behalf. Upon a VA mental health disorders examination in February 2019, a psychologist provided a current diagnosis of schizoaffective disorder. This mental health disability was productive of occupational and social impairment with reduced reliability and productivity. The VA clinician who conducted the September 2019 thoracolumbar spine conditions examination wrote that the Veteran conveyed that she was unable to stand or sit for extended periods without aggravation of her lower back pain. The Veteran also conveyed that she could not ambulate for more than 50 feet. And, lastly, the clinician noted weakness directly related to pain and generalized deconditioning. Upon a September 2019 VA headaches examination, a clinician indicated that the Veteran is unable to perform work-related duties during migraine attacks, as her vision becomes blurry and “bright lights” appear. In response to a Board remand directive, this clinician wrote that the Veteran would have troubles in work environments due to nearly daily migraines. Also, it would be difficult for the Veteran to work with computer monitors due to eye strain. Upon an October 2019 VA mental disorders examination, a psychologist indicated that the Veteran’s schizoaffective disorder was productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. As noted above, the Veteran was rated at 100 percent for schizoaffective disorder from September 25, 2018. The Board will return to this issue after the earlier periods are evaluated. infra. As the evidence discloses, prior to the October 2019, no clinician opined that the Veteran was rendered totally unemployable from any service-connected disability. The Board does note that the Veteran has endorsed that her service-connected lumbar spine disorder hinders standing, sitting, and ambulating. Indeed, this situation presents obstacles. The Veteran’s work history shows that the Veteran has skills in the fields of cashiering, teaching, driving, secretarial duties, business ownership, and assisted living. Also, the Veteran’s educational attainment includes two years of college and specialized training courses in the handling of hazardous materials; lifesaving; and leadership development. And, the VA rehabilitation consultant found that the that testing and evaluation showed that the Veteran had abilities for probable vocational success in the fields of skilled technology; skilled science work; consumer economics; outdoor pursuits; professional business; skilled business; clerical work; communications; skilled work in the arts; professional service; and skilled service. The Veteran’s education, work history in various fields, and vocational testing demonstrate that the Veteran has sufficient skills to obtain and maintain substantial employment considering her specific education and specific work experience in multiple professions. See Withers v. Wilkie, 30 Vet. App. 139 (2018). As to accounts of employment, the Board finds that the Veteran has offered varying accounts as to why she is not employed. At certain points, the Veteran reported that she quit and at other points (to include sworn testimony at the Board hearing), the Veteran conveyed that absenteeism (attributable to service-connected disabilities) and “sitting” led to termination at her last two jobs. The Board finds that the Veteran’s accounts have been internally inconsistent as well as inconsistent with other evidence of record. See Caluza, supra. As such, the Board assigns diminished probative weight to the Veteran’s lay representations. However, the Board places weight on her reports of working up to April 2017 as a teacher. No response for employment date from the last employer has been obtained. The Board recognizes that the Veteran experiences difficulties standing, walking, lifting and sitting for extended periods of time. Likewise, the Board recognizes that the Veteran is hindered greatly when unexpected migraines arise. And the Board realizes that the Veteran’s mental health disability impacts aspects of employment. Nevertheless, the Veteran has engaged in employment up to April 2017 using education skills and vocational/rehabilitation benefits prior to that date suggesting that she had the capacity for work. The Board will resolve any doubt in the Veteran’s favor and find that she was unemployable because of the combination of limitations from all service connected disabilities starting April 26, 2017, the date reported by the Veteran of her last job in which she was unable to perform the required duties. The Board places weight on the Veteran’s own statement of when she could no longer work. However, prior to this date these limitations do not rise to the level of rendering the Veteran totally impaired physically, occupationally, or socially. Also, the Veteran’s myriad work experiences, to include ownership of a clothing store, suggest that the Veteran has entrepreneurial acumen, teaching expertise, clerical prowess, and experience in elder care. The Board finds, as did the VA rehabilitation counselor, that these professional skills would allow the Veteran to obtain substantial gainful employment in positions that do not require extensive sitting, walking, standing, or lifting. Moreover, the record discloses that the Veteran’s drives, which strongly suggests that she has not had difficulty getting back and forth from a job (other than when her car broke down). As to the Veteran’s migraines, these too can be accommodated in the contemporary workplace, where many employers offer accommodations pursuant to the mandates of the ADA. It is not farfetched to see a work environment where the Veteran could have an accommodation of “isolated time,” in which to recover from the onset of migraine. And, an accommodation for periodic breaks would allow the Veteran to alternate between a stationary position and a dynamic position (wherein the Veteran could take short invigorating breaks). Accordingly, the preponderance of evidence is against granting entitlement to a TDIU prior to April 24, 2017. As such, the benefit of doubt doctrine is not for application in this case. See 38 U.S.C. § § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Other Considerations The receipt of a 100 percent schedular rating for a service-connected disability does not necessarily render moot any pending claim for a TDIU. See Bradley v. Peake, 22 Vet. App. 280, 291-92 (2008). Although no additional disability compensation may be paid when a total schedular disability rating is already in effect, Bradley recognizes that a separate award of a TDIU predicated on a single disability may form the basis for an award of special monthly compensation under 38 U.S.C. § 1114(s). See id. Thus, the Court reasoned, it might benefit the Veteran to retain the TDIU rating, even where a 100 percent schedular rating has also been granted. 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). As of October 27, 2011, the Veteran did have a single disability rated at 70 percent (schizoaffective disorder). And, as of September 25, 2018, this disability was rated at 100 percent. Here, the Board observes that the Veteran is currently in receipt of SMC as of September 25, 2018—coincidental with the grant of 100 percent for schizoaffective disorder, under the provisions of 38 U.S.C. § 1114(s). Thus, the award noted in Buie has already been granted. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. J. Komins, 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.