Citation Nr: 21007340 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 09-03 874 DATE: February 9, 2021 ORDER Entitlement to an initial evaluation in excess of 30 percent for bilateral pes planus with callouses prior to June 22, 2015, and in excess of 50 percent thereafter, is denied. Entitlement to an initial evaluation in excess of 20 percent for radiculopathy of the right lower extremity affecting the sciatic nerve is denied. Entitlement to an initial evaluation in excess of 10 percent for radiculopathy of the right lower extremity affecting the femoral nerve is denied. Entitlement to an initial evaluation in excess of 10 percent for right knee strain with instability is denied. Entitlement to an initial evaluation in excess of 10 percent for right knee strain and bursitis with painful motion is denied. Entitlement to an initial compensable evaluation for hemorrhoids prior to June 22, 2015, and in excess of 10 percent thereafter, is denied. Entitlement to a total disability rating based on unemployability due to service-connected disabilities (TDIU) is denied. Entitlement to an effective date prior to April 21, 2018, for the assignment of a 10 percent evaluation for a laceration scar on the upper lip based on characteristic of disfigurement is denied. FINDINGS OF FACT 1. Prior to June 22, 2015, the Veteran’s bilateral pes planus was not pronounced, with extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achilles on manipulation, not improved by orthopedic shoes or appliances. 2. Since June 22, 2015, the Veteran’s bilateral pes planus has been assigned the maximum schedular rating available for pes planus. 3. The Veteran has had no more than moderate incomplete paralysis of the right sciatic nerve. 4. The Veteran has had no more than mild incomplete paralysis of the right femoral nerve. 5. The Veteran’s painful motion of the right knee has not been productive of actual or functional flexion limited to 30 degrees; actual or functional flexion limited to 5 degrees; dislocated semilunar cartilage; removal of semilunar cartilage; ankylosis; impairment of the tibia and fibula; or genu recurvatum. 6. The Veteran has no more than slight lateral instability of the right knee. 7. Prior to June 22, 2015, the Veteran has not been shown to have had hemorrhoids that are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. 8. Since June 22, 2015, the Veteran has not been shown to have hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. 9. The Veteran meets the schedular criteria for TDIU. 10. The Veteran’s service-connected disabilities do not render her unable to secure or follow a substantially gainful occupation. 11. In an October 2012 rating decision, the Regional Office (RO) granted service connection for a laceration scar of the upper lip and assigned a noncompensable evaluation, effective from July 1, 2006. The Veteran did not file a notice of disagreement (NOD) or submit new and material evidence within one year of the issuance of that decision. 12. In a September 2016 rating decision, the RO denied entitlement to a compensable evaluation for a laceration scar of the upper lip. The Veteran did not file a notice of disagreement (NOD) or submit new and material evidence within one year of the issuance of that decision. 13. The Veteran later submitted a statement indicating an intent to file for an increased rating for the laceration scar on April 21, 2018. VA received her claim for an increased rating on July 9. 2018. In a September 2018 rating decision, the RO increased the evaluation to 10 percent, effective April 21, 2018, which was the date of the Veteran’s intent to file the claim for an increased rating. 14. It was not factually ascertainable that an increase in the severity of the Veteran’s laceration scar of the upper lip had occurred one year prior to April 21, 2018. CONCLUSIONS OF LAW 1. Prior to June 22, 2015, the criteria for an evaluation in excess of 30 percent for bilateral pes planus have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40-4.45, 4.71a, Diagnostic Code 5276. 2. On or after June 22, 2015, the criteria for an evaluation in excess of 50 percent for bilateral pes planus have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40-4.45, 4.71a, Diagnostic Code 5276. 3. The criteria for an evaluation in excess of 20 percent for radiculopathy of the right lower extremity with sciatic nerve impairment have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.21, 4.120, 4.123, 4.124a, Diagnostic Code 8520. 4. The criteria for an evaluation in excess of 10 percent for radiculopathy of the right lower extremity with femoral nerve impairment have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.21, 4.120, 4.123, 4.124a, Diagnostic Code 8526. 5. The criteria for an evaluation in excess of 10 percent for right knee strain with painful motion have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40-4.45, 4.71a, Diagnostic Code 5019-5260. 6. The criteria for an evaluation in excess of 10 percent for right knee strain with instability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40-4.45, 4.71a, Diagnostic Code 5257. 7. Prior to June 22, 2015, the criteria for an initial compensable evaluation for hemorrhoids have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.118, Diagnostic Code 7336. 8. On or after June 22, 2015, the criteria for an evaluation in excess of 10 percent for hemorrhoids have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.10, 4.118, Diagnostic Code 7336. 9. The criteria for TDIU have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. 10. The criteria for an effective date prior to April 21, 2018, for the assignment of a 10 percent evaluation for a laceration scar of the upper lip based on character of disfigurement have not been met. 38 U.S.C. § 1155, 5110; 38 C.F.R. §§ 3.400, 20.204, 20.101, 20.302, 20.1103. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1986 to June 2006. This case comes before the Board of Veterans’ Appeals (Board) on appeal from December 2007 and September 2018 rating decisions. In July 2014, the Veteran testified at a hearing before a Veterans Law Judge who is no longer employed at the Board. A transcript of that hearing is associated with the record. In June 2017, the Board notified the Veteran of the fact that the Veterans Law Judge that conducted the hearing was no longer employed by the Board and that she had the opportunity to testify at another hearing. 38 U.S.C. § 7107(c); 38 C.F.R. § 20.707. She opted for an additional hearing and testified at a December 2017 hearing before the undersigned Veterans Law Judge. A transcript of that hearing is associated with the record. In October 2014, the Board remanded the case to the Agency of Original Jurisdiction (AOJ) for further development. In a November 2016 rating decision, the AOJ increased the evaluations for the Veteran’s bilateral pes planus, right knee strain, hemorrhoids, and radiculopathy of the right lower extremity. Because the increased evaluations do not constitute full grants of the benefits sought, the increased rating issues remain in appellate status. See AB v. Brown, 6 Vet. App. 35, 38 (1993). In June 2018, the Board remanded the case again for further development. That development was completed, and the case has since been returned to the Board for appellate review. In a September 2018 rating decision, the AOJ, in pertinent part, granted service connection for posttraumatic stress disorder (PTSD) and assigned a 30 percent evaluation, effective from April 21, 2018. The AOJ also increased the rating for a laceration scar on the upper lip based on character of disfigurement from noncompensable to 10 percent disabling, effective from April 21, 2018. The Veteran submitted a notice of disagreement (NOD) in which she disagreed with the effective dates assigned for the grant of service connection for PTSD and for the increased rating for the laceration scar on the upper lip. The AOJ issued a statement of the case (SOC) pertaining to these issues in February 2019. However, the Veteran limited her August 2019 substantive appeal to the issue for an earlier effective date for the increased rating for the laceration scar on the upper lip only. Therefore, the issue of entitlement to an effective date earlier than April 21, 2018, for the grant of service connection for PTSD is not currently before the Board. Law and Analysis The Veteran and her representative have not raised any issues with the duty to notify or duty to assist with regard 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). Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where a veteran appeals the denial of a claim for an increased disability rating for a disability for which service connection was in effect before he filed the claim for increase, the present level of the veteran’s disability is the primary concern, and past medical reports should not be given precedence over current medical findings. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994). However, where the question for consideration is a higher initial rating since the grant of service connection, evaluation of the medical evidence since the grant of service connection to consider the appropriateness of “staged rating” (assignment of different ratings for distinct periods of time, based on the facts found) is required. Fenderson v. West, 12 Vet. App. 119, 126 (1999); see also Hart v. Mansfield, 21 Vet. App. 505 (2007). 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 of 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). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other 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. § 4.40. Pain on movement, swelling, deformity or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59. Moreover, although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011) Bilateral Pes Planus The Veteran is currently assigned an initial 30 percent evaluation for her bilateral pes planus prior to June 22, 2015, and a 50 percent evaluation thereafter, pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5276. Under Diagnostic Code 5276, a 30 percent evaluation is warranted for bilateral disability when there is severe disability, characterized by objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities. A maximum 50 percent rating requires bilateral pes planus that is pronounced, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achilles on manipulation, not improved by orthopedic shoes or appliances. When a condition is specifically listed in the rating schedule (pes planus in this case), it may not be rated by analogy. Copeland v. McDonald, 27 Vet. App. 333 (2015). Diagnostic Code 5284 does not apply to the eight foot conditions specifically listed in the rating schedule under Diagnostic Codes 5276-5283. Id. at 337. In this case, Diagnostic Code 5284, which covers other foot injuries, along with the other Diagnostic Codes applicable to the foot, do not need to be considered because the Veteran’s service-connected foot disability, pes planus, is specifically listed by the schedule. See Suttmann v. Brown, 5 Vet. App. 127, 134 (1993) (providing that “[a]n analogous rating... may be assigned only where the service-connected condition is “unlisted.”). Thus, the only Diagnostic Code relevant to this appeal is Diagnostic Code 5276. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to increased evaluations for bilateral pes planus for either period on appeal. Prior to June 22, 2015, the evidence does not show that the Veteran’s bilateral pes planus is pronounced, with extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achilles on manipulation, not improved by orthopedic shoes or appliances. In fact, during a July 2007 VA examination, the examiner noted that the Veteran had bilateral pes planus. He indicated that she had right foot pain four times per week that lasted for eight hours and traveled up her right leg, but she denied having any pain, weakness, stiffness, swelling, or fatigue at rest. The examiner also noted that there was no deformity, such as inward rotation of the superior portion of the os calcis, medial tilting of the upper border of the talus, marked pronation, or the whole foot everted in either foot. In addition, the examiner reported that there was no tenderness to palpation of the right or left foot plantar surfaces. The right and left Achilles tendon revealed good alignment. The VA examiner found that the Veteran did not have extreme tenderness of the plantar surface of either foot, and there was no objective evidence of a marked deformity or marked pronation of either foot. Therefore, the Veteran’s bilateral pes planus does not warrant a higher rating prior to June 22, 2015. Since June 22, 2015, the Veteran’s bilateral pes planus is assigned a 50 percent evaluation, which is the maximum schedular rating available for pes planus. As such, an increased rating cannot be granted under that diagnostic code. The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. However, an increased evaluation for the Veteran’s bilateral pes planus is not warranted on the basis of functional loss due to pain in this case, as the Veteran’s symptoms are supported by pathology consistent with the assigned ratings, and no higher. In this regard, the Board observes that the Veteran has complained of pain throughout the period on appeal. However, the effect of the pain in the Veteran’s feet is already contemplated in the assigned evaluations. The Veteran’s complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant an increased evaluation beyond those already assigned. Indeed, a June 2015 VA examiner specifically noted that the Veteran experienced pain with standing, but that she had no other functional loss due to pain, during flare-ups, or with repeated use over time. Likewise, an August 2018 VA examiner opined that the Veteran should limit tasks requiring standing or walking due to her bilateral pes planus. She noted that pain was present with weight-bearing that interfered with standing or walking for prolonged periods; however, there was no other functional loss during flare-ups or when the feet were used repeatedly over a period of time. Accordingly, the Board concludes that increased evaluations are not warranted for the Veteran’s service-connected bilateral pes planus for either period on appeal. Radiculopathy of the Right Lower Extremity The Veteran is currently assigned a 20 percent evaluation for radiculopathy of the right lower extremity affecting the sciatic nerve, pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8520, and a 10 percent evaluation for radiculopathy of the right lower extremity affecting the femoral nerve, pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8526. Under Diagnostic Code 8520, moderate incomplete paralysis is assigned a 20 percent rating, and moderately severe incomplete paralysis is warranted for a 40 percent rating. Severe incomplete paralysis of the sciatic nerve with marked muscular atrophy warrants a 60 percent rating. With complete paralysis of the sciatic nerve, which warrants an 80 percent rating, the foot dangles and drops, there is no active movement possible of muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a. Under Diagnostic Code 8526, mild incomplete paralysis of the femoral nerve, as well as neuritis and neuralgia of that nerve, warrants a 10 percent rating. Moderate incomplete paralysis is assigned a 20 percent rating. Severe incomplete paralysis of the femoral nerve warrants a 30 percent rating. Complete paralysis of the femoral nerve with paralysis of quadriceps extensor muscles warrants a 40 percent rating. 38 C.F.R. § 4.124a. Under 38 C.F.R. § 4.124a, disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, the rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is only sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. In rating peripheral nerve disability, neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate incomplete paralysis, or with sciatic nerve involvement, for moderately severe incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, can receive a maximum rating of moderate incomplete paralysis, except for tic douloureux or trifacial neuralgia, which may be rated up to complete paralysis. 38 C.F.R. § 4.124. 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. 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 considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to higher evaluations for her right lower extremity radiculopathy of the sciatic and femoral nerves. The weight of the evidence of record does not demonstrate manifestations consistent with moderately severe incomplete paralysis, severe incomplete paralysis, or complete paralysis of the sciatic nerve during the appeal period. Nor does the weight of the evidence of record demonstrate manifestations consistent with moderate or severe incomplete paralysis or complete paralysis of the femoral nerve. Rather, the evidence of record demonstrates that there was no atrophy, no abnormal muscle tone or bulk, no complete paralysis, no organic changes, no foot drop, and no paralysis of the quadriceps extensor muscles of the right lower extremity. During a September 2012 VA examination, the examiner noted that the Veteran had moderate paresthesias and/or dysesthesias and numbness of the right lower extremity. Her deep tendon reflexes were normal, and sensation to light touch were normal or decreased but not absent. There were no other signs or symptoms of radiculopathy. The examiner noted moderate radiculopathy of the right sciatic nerve, but he did not indicate any involvement of the right femoral nerve. During an October 2015 VA examination, the examiner noted that the Veteran had mild constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness of the right lower extremity. However, he indicated that the Veteran had severe right lower extremity radiculopathy involving the femoral and sciatic nerves. In an August 2016 VA examination report, the examiner noted mild constant pain, intermittent pain, paresthesias and/or dysesthesias, and numbness of the right lower extremity. Muscle strength testing was 5/5 with no muscle atrophy, and the deep tendon reflexes were 2+. There were no other signs or symptoms of radiculopathy, and the examiner reported only mild involvement of the right sciatic nerve. VA subsequently sought a VA medical opinion noting that the October 2015 VA examiner noted decreased sensation of upper anterior thigh, thigh/knee, lower leg/ankle, and foot/toes and identified the sciatic nerve and femoral nerve as the affected nerve roots associated with his radiculopathy. The examiner had described the severity as severe. In an October 2016 VA opinion, the August 2016 VA examiner reported that he or she did not find any objective evidence of femoral nerve involvement during the August 2016 VA examination. The examiner stated, “Regarding the difference between [the] 2015 evaluation and current evaluation of [the right] femoral nerve, [i]t is most likely that [the Veteran’s] condition has improved with continuous treatment.” The examiner also noted that the findings were mostly based on subjective complaints so evaluations by two different examiners at two different times will be different. During a January 2017 VA examination, the examiner noted moderate constant pain, severe intermittent pain, severe paresthesias and/or dysesthesias, and severe numbness of the right lower extremity. The deep tendon reflexes were 2+, and sensation to light touch was normal or decreased but not absent. Muscle strength testing was also 5/5 without any muscle atrophy. There were no other signs or symptoms of radiculopathy, yet the examiner reported severe involvement of the right sciatic nerve. The examiner did not indicate any involvement of the right femoral nerve. During an April 2019 VA examination, the Veteran reported having severe constant pain, intermittent pain, and paresthesias and/or dysesthesias of the right lower extremity, but she denied having any numbness of the right lower extremity. Muscle strength testing was normal without any atrophy. Her deep tendon reflexes and a sensory examination were also normal. There were no trophic changes, and the Veteran’s gait was normal. The examiner noted that the Veteran had moderate incomplete paralysis of the right sciatic nerve. The examiner did not indicate that the Veteran had involvement of the right femoral nerve. Although some of the examiners described the Veteran’s radiculopathy as severe, the Board notes that the impairment has been wholly sensory. Indeed, as noted above, the Veteran has normal muscle strength and reflexes, and there have been no trophic changes. VA examiners also indicated that there were no signs or symptoms other than the pain and numbness noted. When the involvement is only sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Moreover, the October 2016 VA examiner reported that there was no objective evidence of femoral nerve involvement during the August 2016 VA examination, and other VA examiners did not indicate involvement of the right femoral nerve. Based on the foregoing, the evidence shows that the Veteran has no more than moderate incomplete paralysis of the right sciatic nerve and no more than mild incomplete paralysis of the right femoral nerve. Therefore, the Board finds that the preponderance of the evidence is against a finding that higher evaluations are warranted for radiculopathy of the right lower extremity affecting the sciatic and femoral nerves. Right Knee The Veteran is currently assigned a 10 percent evaluation for a right knee strain and bursitis with painful motion, pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5019-5260. She is also assigned a separate 10 percent evaluation for right knee strain with instability, pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5257. 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. Diagnostic Code 5019 provides that bursitis will be rated on limitation of motion of affected parts, as degenerative arthritis. Under Diagnostic Code 5260, a noncompensable evaluation is contemplated for flexion limited to 60 degrees. A 10 percent disability evaluation is assigned when flexion is limited to 45 degrees, and a 20 percent disability evaluation is warranted when flexion is limited to 30 degrees. A 30 percent disability evaluation is assigned when flexion is limited to 15 degrees, which is the maximum evaluation available under Diagnostic Code 5260. Under Diagnostic Code 5261, a noncompensable evaluation is assigned for extension limited to 5 degrees. A 10 percent evaluation is warranted for extension limited to 10 degrees. A 20 percent evaluation is contemplated for extension limited to 15 degrees. A 30 percent evaluation is assigned for extension limited to 20 degrees. A 40 percent evaluation is warranted for extension limited to 30 degrees. A 50 percent evaluation is assigned for extension limited to 45 degrees. Diagnostic Code 5019 pertains to bursitis. Under Diagnostic Code 5019, bursitis is rated on limitation of the motion of affected parts, as degenerative arthritis. Under Diagnostic Code 5258, dislocated semilunar cartilage, with frequent episodes of locking, pain, and effusion into the joint, warrants a 20 percent disability rating. 38 C.F.R. § 4.71a, Diagnostic Code 5258. Semilunar cartilage is the meniscus lateralis articulationis genus (lateral meniscus) and the meniscus medialis articulationis genus (medial meniscus). See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 273, 1013 (28th ed. 1994). A 20 percent rating is the maximum schedular evaluation available under Diagnostic Code 5258. Under Diagnostic Code 5259, a 10 percent disability evaluation is assigned for the symptomatic removal of semilunar cartilage. Under Diagnostic Code 5262, pertaining to impairment of the tibia and fibula, a 10 percent disability rating is assigned for malunion with slight knee or ankle disability, and a 20 percent disability rating is warranted for malunion with moderate knee or ankle disability. A 40 percent disability rating is appropriate where there is nonunion of the tibia and fibula with loose motion requiring a brace. 38 C.F.R. § 4.71a, Diagnostic Code 5262. Under Diagnostic Code 5263, a 10 percent disability rating is assigned for acquired, traumatic genu recurvatum with weakness and insecurity in weight-bearing objectively demonstrated. 38 C.F.R. § 4.71a, Diagnostic Code 5263. Diagnostic Code 5010 states that traumatic arthritis is to be rated as degenerative arthritis under Diagnostic Code 5003, which in turn, states that the severity of degenerative arthritis, established by X-ray findings, is to be rated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint or joints affected. When there is arthritis with at least some limitation of motion, but to a degree which would be noncompensable under a limitation-of-motion code, a 10 percent rating will be assigned for each affected major joint or group of minor joints. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent evaluation is warranted if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and a 20 percent evaluation is authorized if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Code 5003. VA Office of General Counsel has provided guidance concerning increased rating claims for knee disorders. Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition was not “duplicative of or overlapping with the symptomatology” of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). VA General Counsel has stated that compensating a claimant for separate functional impairment under Diagnostic Code 5257 and 5003 does not constitute pyramiding. See VAOPGCPREC 23-97 (July 1, 1997). VA General Counsel held in VAOPGCPREC 23-97 that a veteran who has arthritis and instability of the knee may be rated separately under Diagnostic Codes 5003 and 5257, provided that a separate rating must be based upon additional disability. When a knee disorder is already rated under Diagnostic Code 5257, the veteran must also have limitation of motion under Diagnostic Code 5260 or 5261 in order to obtain a separate rating for arthritis. If the veteran does not at least meet the criteria for a zero percent rating under either of those codes, there is no additional disability for which a rating may be assigned. In VAOPGCPREC 9-98, General Counsel also held that if a veteran has a disability rating under Diagnostic Code 5257 for instability of the knee, and there is also x-ray evidence of arthritis, a separate rating for arthritis could also be based on painful motion under 38 C.F.R. § 4.59. In addition, General Counsel considered a hypothetical situation in which a knee disability was evaluated under Diagnostic Code 5259 that was productive of pain, tenderness, friction, osteoarthritis established by x-rays, and a slight loss of motion. For the purposes of the hypothetical, it was assumed that Diagnostic Code 5259 did not involve limitation of motion. Given the findings of osteoarthritis, the General Counsel stated that the availability of a separate evaluation under Diagnostic Code 5003 in light of sections 4.40, 4.45, 4.59 must be considered. See Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991). Absent x-ray findings of arthritis, limitation of motion should be considered under Diagnostic Codes 5260 and 5261. The claimant’s painful motion may add to the actual limitation of motion so as to warrant a rating under Diagnostic Codes 5260 or 5261. The General Counsel further noted in VAOPGCPREC 9-98 that the removal of the semilunar cartilage may involve restriction of movement caused by tears and displacements of the menisci, but that the procedure may result in complications such as reflex sympathetic dystrophy, which can produce loss of motion. Therefore, limitation of motion is a relevant consideration under Diagnostic Code 5259, and the provisions of 4.40, 4.45, and 4.59 must be considered. In addition, the VA General Counsel has held that separate ratings may be assigned under Diagnostic Code 5260 and Diagnostic Code 5261 for disability of the same joint. VAOPGCPREC 9-2004 (September 17, 2004). The regulations provide that the normal range of motion of the knee is zero degrees on extension to 140 degrees on flexion. 38 C.F.R. § 4.71, Plate II. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to increased evaluations for her service-connected right knee strain with painful motion and instability. Initially, the Board finds that the Veteran is not entitled to an increased evaluation under Diagnostic Code 5260 for limitation of flexion for the right knee. In fact, the record does not show that the Veteran’s right knee flexion was limited to 30 degrees or less to warrant a higher evaluation. In fact, during a July 2007 VA examination, the Veteran demonstrated right knee flexion to 140 degrees, and a June 2015 VA examination revealed right knee flexion to 95 degrees. An August 2018 VA examination also documented right knee flexion to 90 degrees. As such, an increased evaluation is not warranted under Diagnostic Code 5260. The Board also finds that the Veteran is not entitled to higher or separate ratings under Diagnostic Code 5261 for limitation of extension for her right knee throughout the appeal period. The record does not show that extension was limited to 10 degrees or more to warrant a separate 10 percent evaluation or higher. In fact, during the July 2007, June 2015, and August 2018 VA examinations, the Veteran demonstrated right knee extension to 0 degrees. As such, an increased or separate evaluation under Diagnostic Code 5261 is not warranted for the right knee. In addition, the Board finds that the Veteran is not entitled to a higher evaluation for lateral instability or recurrent subluxation under Diagnostic Code 5257 for the right knee throughout the appeal. The Board notes that the Veteran reported that she had instability and giving way of her right knee during the July 2007 VA examination. The July 2007 VA examiner found that her anterior and posterior cruciate ligaments and the medial and lateral collateral ligaments were abnormal with only slight instability on testing. In addition, the June 2015 and August 2018 VA examiners noted that there was no history of lateral instability in the right knee. The June 2015 and August 2018 VA examiners further noted that there was no joint instability with joint stability testing of the right knee. Anterior, posterior, medial, and lateral instability testing were all normal in the right knee. In addition, the July 2007, June 2015, and August 2018 VA examiners reported that that there was no subluxation in the right knee. Thus, the evidence does not show that the Veteran has more than slight impairment, and the preponderance of the evidence weighs against entitlement to a higher evaluation under Diagnostic Code 5257 for the right knee. In an effort to afford the Veteran the highest possible rating, the Board has also considered whether any other rating criteria are applicable. The assignment of a particular diagnostic code is “completely dependent on the facts of a particular case.” Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the current diagnosis, and demonstrated symptomatology. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Thus, the Board has considered the propriety of assigning a higher, or separate, rating under another diagnostic code. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). Nevertheless, the Board finds that higher or separate evaluations are not warranted under Diagnostic Code 5258 for dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint, or under Diagnostic Code 5259 for the symptomatic removal of semilunar cartilage. The Board notes that semilunar cartilage is the meniscus lateralis articulationis genus (lateral meniscus) and the meniscus medialis articulationis genus (medial meniscus). See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 273, 1013 (28th ed. 1994). The July 2007 VA examiner noted that medial and lateral meniscus testing of the right knee was within normal limits. The June 2015 VA examiner also indicated that the Veteran did not have nor had she ever had a meniscus condition in her right knee. The August 2018 VA examiner did note that the Veteran had a right meniscal tear, but the examiner did not indicate whether she had frequent episodes of locking, pain, and effusion into the joint. Thereafter, in a May 2019 VA medical opinion, the VA examiner stated that there was no evidence of dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint; or the symptomatic removal of semilunar cartilage. The May 2019 VA examiner noted that the Veteran reported frequent episodes of pain in the right knee; otherwise, there was no evidence of locking or effusion on examination and she had no history of right knee surgery. Thus, the evidence does not show a higher or separate evaluation is warranted under Diagnostic Codes 5258 and 5259. The Board has also considered whether a higher or separate evaluation is warranted under any other diagnostic code. However, as the evidence of record does not demonstrate that the Veteran has ankylosis, impairment of the tibia and fibula, or genu recurvatum, she is not entitled to higher evaluations under Diagnostic Codes 5256 (ankylosis), 5262 (impairment of the tibia and fibula), and 5263 (genu recurvatum). There is simply no evidence of such manifestations. Indeed, based on the aforementioned range of motion findings, the record shows that the Veteran’s right knee is not fixated or immobile. Ankylosis is defined as “immobility and consolidation of a joint due to disease, injury, surgical procedure.” Lewis v. Derwinski, 3 Vet. App. 259 (1992) (internal medical dictionary citation omitted). Moreover, the June 2015, August 2018, and May 2019 VA examiners specifically reported that the Veteran did not have ankylosis of the right knee. The June 2015 and August 2018 VA examiners also indicated that the Veteran did not have genu recurvatum, and the August 2018 VA examiner reported that there was no evidence of tibial and fibular impairment of the right leg. Therefore, separate or higher evaluations are not warranted under Diagnostic Codes 5256, 5262, and 5263. In addition, the Board notes that the Veteran has been assigned a 10 percent rating, which contemplates painful motion. There is no x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. In fact, a May 2019 VA x-ray of the right knee was negative, and no degenerative joint disease was shown. Thus, increased or separate evaluation is not warranted under Diagnostic Code 5010. The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. However, an increased evaluation for the Veteran’s right knee disability is not warranted on the basis of functional loss due to pain or weakness in this case, as the Veteran’s symptoms are supported by pathology consistent with the assigned evaluation, and no higher. In this regard, the Board observes that the Veteran complained of pain throughout the appeal period. However, the effect of the pain in the Veteran’s right knee is already contemplated in the assigned evaluations. The Veteran’s complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant increased evaluations beyond those already assigned. During the July 2007 VA examination, the Veteran indicated that she had weakness caused by prolonged standing, early morning stiffness of the right knee joint, swelling after running or excessive walking, redness after prolonged walking, giving way with running, and fatigue during and following running or walking. She complained of pain elicited by physical activity. However, the July 2007 VA examiner reported that joint function was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. The examiner indicated that the functional impact of the Veteran’s knee was impairment for her active lifestyle. The June 2015 VA examiner noted that pain was noted on flexion during range of motion testing and that the pain caused functional loss. However, the examiner reported that the Veteran would not limit range of motion and that she would still maintain flexion to 95 degrees and extension to 0 degrees. The examiner also noted that there was no additional limitation in range of motion following repetitive use testing. The June 2015 VA examiner opined that the Veteran’s right knee disabilities caused difficulty sitting for prolonged periods, standing, and ascending and descending stairs. The August 2018 VA examiner noted that the Veteran’s abnormal range of motion with pain on flexion and extension contributed to a functional loss in that the Veteran had reduced ability to bend, kneel, stoop, and crawl. However, the VA examiner reported that there was no additional limitation in range of motion following repetitive use testing. The VA examiner noted that the Veteran experienced increased pain with repetitive movement, which led to functional loss that was not feasible to be described in terms of range of motion because it was variable. The August 2018 VA examiner indicated that the Veteran’s right knee disabilities impacted her functional impairment because she was unable to perform prolonged standing, sitting, or walking, and she should limit stairs. The June 2015 and August 2018 VA examiners further noted that the Veteran had normal right leg muscle strength. The VA examiners also reported that the Veteran had no muscle atrophy. Thus, even taking into account the Veteran’s reports, the evidence does not show that she more nearly approximates the criteria for higher evaluations. Indeed, she has still maintained flexion greater than required by the rating criteria for an increased evaluation. Accordingly, the Board concludes that increased or separate evaluations are not warranted for the Veteran’s service-connected right knee strain with painful motion and instability. Hemorrhoids The Veteran is currently assigned a noncompensable evaluation for hemorrhoids prior to June 22, 2015, and a 10 percent evaluation thereafter, pursuant to 38 C.F.R. § 4.114, Diagnostic Code 7336. Under Diagnostic Code 7336, external or internal hemorrhoids are assigned a noncompensable evaluation they are mild or moderate. A 10 percent evaluation is warranted when hemorrhoids are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A maximum 20 percent evaluation is contemplated for hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. The terms “occasional,” “frequent,” “fairly frequent,” “mild,” “moderate,” “extensive” and “large” are not defined in the regulations. 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. Although the use of such terms by VA examiners and others is evidence to be considered by the Board, it is not dispositive of the issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to an initial compensable evaluation for hemorrhoids prior to June 22, 2015, or in excess of 10 percent thereafter. Prior to June 22, 2015, the evidence does not show hemorrhoids that are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. The Veteran was afforded a VA examination in September 2012 during which the examiner noted a history of hemorrhoids since 2001. The Veteran complained of recurrent hemorrhoids and indicated that she treated her hemorrhoids with Proctofoam. The Veteran declined a physical examination. The examiner found that she had mild or moderate internal or external hemorrhoids that were inflamed and somewhat bloody, which is consistent with the currently noncompensable evaluation assigned prior to June 22, 2015. There is no evidence that the Veteran had large or thrombotic hemorrhoids that were irreducible with excessive redundant tissue and evidence frequent recurrences for this period. Thus, a compensable evaluation is not warranted prior to June 22, 2015. Since June 22, 2015, the evidence does not show hemorrhoids with persistent bleeding with secondary anemia or with fissures. During a June 2015 VA examination, the Veteran reported that her hemorrhoids began in 1987 and stated that she treated her hemorrhoids with Proctofoam. An examination revealed small or moderate external hemorrhoids that were irreducible with excessive redundant tissue. The examiner did not find anal fissures. Laboratory testing also included a complete blood count (CBC) that showed 13.7 grams per deciliter of hemoglobin, 41.9 percent of hematocrit, and a white blood cell count of 6.1 with 214 platelets. The examiner found that the Veteran had mild or moderate external hemorrhoids. During an August 2018 VA examination, the Veteran complained of intermittent periods of pain and bleeding with constipation. She indicated that she treated her hemorrhoids with Proctofoam and sitz baths. The examiner noted that the Veteran was not examined and that there were no colonoscopy reports to view. The examiner found that the Veteran had mild or moderate internal or external hemorrhoids. There is no evidence that the Veteran had hemorrhoids with persistent bleeding with secondary anemia or with fissures since June 22, 2015. Thus, an evaluation in excess of 10 percent is not warranted during this time period. Based on the foregoing, the Board finds that a compensable evaluation prior to June 22, 2015, or in excess of 10 percent thereafter, is not warranted for the Veteran’s hemorrhoids. Accordingly, the claim is denied. The Veteran and her representative have not raised any other issues with regard to increased evaluations decided herein, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). TDIU All veterans who are shown to be unable to secure and follow a substantially gainful occupation by reason of service-connected disability shall be rated totally disabled. For VA purposes, total disability exists when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. §§ 3.340, 4.16(b). A total disability rating for compensation may be assigned, where the schedular rating is less than total, when a veteran is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Nevertheless, even when the percentage requirements are not met, entitlement to TDIU on an extraschedular basis may be granted in exceptional cases when the veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. 38 C.F.R. § 4.16(b). Entitlement to a total rating must be based solely on the impact of service-connected disabilities on the ability to keep and maintain substantially gainful employment. See 38 C.F.R. §§ 3.340, 3.341, 4.16. 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 inability to secure and follow a substantially gainful occupation. VAOPGPREC 75-91, 57 Fed. Reg. 2317 (Jan. 21, 1992). Consideration may be given to the veteran’s education, special training, and previous work experience, but not to his or her age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also 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 a veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose, 4 Vet. App. at 363. In this case, the Veteran is currently service-connected for bilateral pes planus (50 percent disabling), obstructive sleep apnea (50 percent disabling), lumbar degenerative disc disease with middle paraspinal strain and intervertebral disc syndrome (40 percent disabling), PTSD (30 percent disabling), painful scar from a laceration of the upper lip (20 percent disabling), right lower extremity radiculopathy affecting the sciatic nerve (20 percent disabling), right knee strain with instability (10 percent disabling), right foot hammertoe (10 percent disabling), hermorrhoids (10 percent disabling), right lower extremity radiculopathy affecting the femoral nerve (10 percent disabling), maxillary sinusitis (10 percent disabling), right knee strain and bursitis with painful motion (10 percent disabling), and a scar from a laceration of the upper lip based on characteristics of disfigurement (10 percent disabling). Her combined evaluation has been 70 percent since July 1, 2006, 80 percent since June 24, 2011, 90 percent since June 22, 2015, and 100 percent since April 21, 2018. The Veteran does meet the schedular criteria for TDIU. Nevertheless, in considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the evidence does not show that the Veteran’s service-connected disabilities render her unable to secure or follow a substantially gainful occupation. During the July 2014 hearing, the Veteran reported that she was employed. However, during the December 2017 hearing, she later reported that she resigned from her job in July 2017 due to her service-connected disabilities, including her back, radiculopathy, and pes planus. The record shows that the AOJ attempted to obtain information from the Veteran for her claim, including her employment history, but she did not provide the requested information. See August 2018 remand letter (request for completed TDIU application (VA Form 21-8940)). The Court has held that “[t]he duty to assist is not always a one-way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.” See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Moreover, the evidence of record shows that the Veteran has been working full-time as a mental health counselor since the December 2017 hearing. See, e.g., August 2018 VA PTSD examination report (Veteran currently works as a resident counselor working towards licensure and is seeing patients under supervision), April 2019 VA peripheral nerves examination report (Veteran works full-time as a mental health counselor). The Veteran undoubtedly has experienced industrial impairment as a result of her service-connected disabilities, as evidenced by her combined evaluations. However, the evidence does not establish that her service-connected disabilities preclude gainful employment. The Board notes that “[t]he percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations.” 38 C.F.R. § 4.1; see also Van Hoose, 4 Vet. App. at 363 (noting that the disability rating itself is recognition that industrial capabilities are impaired; the record must reflect some factor which takes the case outside the norm) and 38 C.F.R. § 4.15. Based on the foregoing, the Board finds that the requirements for TDIU have not been met. Therefore, the Board finds that the weight of the evidence is against the Veteran’s claim. As such, the benefit-of-the-doubt rule does not apply, and the claim is denied. Gilbert, 1 Vet. App. 49, 53. In reaching this determination, the Board also notes that the Veteran has been assigned a combined 100 percent evaluation since April 21, 2018. In Bradley v. Peake, 22 Vet. App. 280, 294 (2008), the Court determined that a separate TDIU rating predicated on one disability (although perhaps not ratable at the schedular 100 percent level) when considered together with another disability, separately rated at 60 percent or more, could warrant special monthly compensation under 38 U.S.C. § 1114(s). Thus, it might be of benefit the Veteran to retain the TDIU rating, even where a 100 percent schedular rating has also been granted, as a separate award of TDIU predicated on a single disability may form the basis for an award of special monthly compensation (SMC). See also Guerra v. Shinseki, 642 F.3d 1046 (Fed. Cir. 2011); Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2010). The Veteran has not asserted that she is unable to work due to a single disability. Rather, she has reported due to multiple service-connected disabilities resulted in her resignation. Accordingly, the Board finds that the Veteran is also not entitled to TDIU on or after April 21, 2018, on this basis. Effective Date Unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a). The effective date for an award of service connection is the day following separation from active service or the date entitlement arose, if the claim is received within one year after separation from service; otherwise, the effective date is the later of the date of receipt of the claim or the date entitlement to service connection arose. 38 C.F.R. § 3.400(b)(2). The effective date of an award of increased compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred if the claim is received within one year from such date. Otherwise, the effective date will be the date of receipt of the claim. 38 U.S.C. § 5110(b); 38 C.F.R. § 3.400(o)(2); see also Gaston v. Shinseki, 605 F.3d 979, 983 (Fed. Cir. 2010) (“It is clear from the plain language of [section] 5110(b)(2) that it 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.”); Hazan v. Gober, 10 Vet. App. 511, 519 (1997) (“increase” for this purpose is one to the next disability level); VAOPGCPREC 12-98 (Sept. 23, 1998). Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA’s adjudication regulations be filed on a standard form. The amendments implement the concept of an intent to file a claim for benefits, which operates similarly to the informal claim process, but requires that the submission establishing a claimant’s effective date of benefits must be received in one of three specified formats. The amendments also eliminate the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen under 38 C.F.R. § 3.157. See 79 Fed. Reg. 57,660 (Sept. 25, 2014) (now codified at 38 C.F.R. §§ 3.1 (p), 3.151, 3.155). The amendments apply only to claims filed on or after March 24, 2015. Because the Veteran’s claims were received by VA prior to that date, the former regulations apply, as provided below. A specific claim in the form prescribed by VA must be filed in order for benefits to be paid or furnished to any individual under the laws administered by VA. 38 U.S.C. § 5101(a) (previously 38 U.S.C. § 3001(a)); 38 C.F.R. § 3.151(a). The term “claim” or “application” means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). Any communication or action indicating an intent to apply for one or more benefits under the laws administered by VA from a claimant may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. 38 C.F.R. § 3.155(a). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). In considering the evidence of record under the laws and regulations, the Board concludes that the Veteran is not entitled to an effective date earlier than April 21, 2018, for the assignment of a 10 percent evaluation for her service-connected laceration scar on the upper lip based on a character of disfigurement. In an October 2012 rating decision, the AOJ granted service connection for a laceration scar on the upper lip and assigned a noncompensable evaluation, effective from July 1, 2006. The Veteran did not file a notice of disagreement (NOD) or submit new and material evidence within one year of the issuance of that decision. Therefore, the October 2012 rating decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 20.204, 20.302, 20.1103. In a September 2016 rating decision, the AOJ later denied a compensable evaluation for the laceration scar on the upper lip based on a character of disfigurement. The Veteran did not file a NOD or submit new and material evidence within one year of the issuance of that decision. Therefore, the September 2016 rating decision is also final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 20.204, 20.302, 20.1103. The Veteran later submitted a statement indicating an intent to file for an increased rating for the laceration scar on April 21, 2018. VA received her claim for an increased rating on July 9. 2018. In a September 2018 rating decision, the AOJ increased the evaluation to 10 percent, effective April 21, 2018, which was the date of the Veteran’s intent to file the claim for an increased rating. Based on the foregoing, the Board concludes that the September 2016 rating decision became final and that the Veteran first filed an intent to claim an increased evaluation on April 21, 2018. There is also no evidence showing that it was factually ascertainable that an increase had occurred within one year prior to the receipt of the April 21, 2018, claim, as there is no evidence pertaining to the severity of the disability during that time period. See Gaston v. Shinseki, 605 F.3d 979, 983 (Fed. Cir. 2010). Accordingly, the Board finds that an effective date prior to April 21, 2018, is not warranted for the assignment of a 10 percent evaluation for a laceration scar of the upper lip based on character of disfigurement. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Osegueda, 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.