Citation Nr: 21010237 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 16-51 817 DATE: February 24, 2021 ORDER Service connection for degenerative arthritis of the lumbar spine with intervertebral disc syndrome (hereinafter referred to as lumbar spine disability) is denied. Service connection for degenerative arthritis of the cervical spine, status post C4-5 diskectomy and decompression (hereinafter referred to as cervical spine disability) is denied. Service connection for right upper extremity radiculopathy, to include secondary to the cervical spine disability, is denied. Service connection for left upper extremity radiculopathy, secondary to the cervical spine disability, is denied. An initial compensable rating for the service-connected hypertension is denied. As the reduction from a 100 percent rating to a 30 percent rating for the service-connected valvular heart disease with severe aortic insufficiency and left ventricular hypertrophy (previously rated as diastolic heart murmur with moderate AI, and hereinafter referred to as VHD) was improper, restoration of the 100 percent rating, effective August 1, 2014, is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) is rendered moot and therefore dismissed. FINDINGS OF FACT 1. The preponderance of the evidence is against the finding that the Veteran’s lumbar spine disability had its onset in service, manifested to a compensable degree within one year of discharge, or is otherwise causally related to service. 2. The preponderance of the evidence is against the finding that the Veteran’s cervical spine disability had its onset in service, manifested to a compensable degree within one year of discharge, or is otherwise causally related to service. 3. The preponderance of the evidence supports a finding that the Veteran’s right upper extremity radiculopathy is secondary to a nonservice-connected cervical spine disability. 4. The preponderance of the evidence supports a finding that the Veteran’s left upper extremity radiculopathy is related to a non-service connected disability his secondary to a nonservice-connected cervical spine disability. 5. The Veteran’s service-connected hypertension is treated with continuous medication for control, but he does not have a history of diastolic pressure predominately 100 or more. 6. The procedural requirements for notification of the proposed reduction from 100 percent to 30 percent for the service-connected VHD were not satisfied. 7. As the 100 percent schedular disability rating is restored for the service-connected VHD, and the Veteran is in receipt of the 100 percent disability rating for the entire period on appeal, and a special monthly compensation (SMC) at the housebound rate, there remain no questions of law or fact to be decided regarding entitlement to a TDIU. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a lumbar spine disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.  2. The criteria for entitlement to service connection for a cervical spine disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for entitlement to service connection for right upper extremity radiculopathy, to include secondary to cervical spine disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for entitlement to service connection for left upper extremity radiculopathy, to include secondary to cervical spine disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for an initial compensable rating for the service-connected hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.104, Diagnostic Code (DC) 7101. 6. The reduction in disability rating for the service-connected VHD from 100 percent to 30 percent, effective August 1, 2014 is void ab initio and the 100 percent evaluation is restored effective August 1, 2014. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.105, 3.344. 7. The restoration of the 100 percent schedular disability rating for the service-connected VHD for the entire period on appeal establishes restoration of SMC(s) at the housebound rate for that period, and therefore renders the TDIU claim moot. 38 U.S.C. §§ 1114, 7104, 7105(d)(5); 38 C.F.R. §§ 3.105, 3.341, 3.350, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from December 1982 to November 1991. This matter is before the Board of Veterans’ Appeals (the Board) on appeal from the May 2014 and August 2015 Department of Veterans Affairs (VA) Regional Office (RO) rating decisions. The May 2014 rating decision reduced the Veteran’s disability evaluation for the service-connected valvular heart disease with severe aortic insufficiency and left ventricular hypertrophy (previously diastolic heart murmur with moderate AI and hereinafter referred to as VHD) from 100 percent to 30 percent commencing August 1, 2014. The Veteran’s Notice of Disagreement (NOD) was received in May 2014. The Statement of the Case was issued in September 2016 and the Veteran’s VA Form 9, substantive appeal to the Board was received in October 2016. The August 2015 rating decision, inter alia, granted service connection for hypertension with an initial noncompensable rating from March 16, 2015, denied a TDIU, denied service connection for degenerative arthritis of the lumbar spine with intervertebral disc syndrome (claimed as thoracic kyphosis, hereinafter referred to as lumbar spine disability), denied service connection for degenerative arthritis of the cervical spine, status post C4-5 diskectomy and decompression (hereinafter referred to as cervical spine disability), denied service connection for right upper extremity radiculopathy, and denied service connection for left upper extremity radiculopathy. The Veteran’s NOD was received in August 2018. The Statement of the Case was issued in September 2016 and the Veteran’s VA Form 9, substantive appeal to the Board was received in October 2016. In May 2019, the Veteran appeared before the undersigned Veterans Law Judge (VLJ) for a videoconference hearing. The transcript is of record. In December 2019, the Board remanded the claims for further development and adjudication. Service Connection Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C. §§ 1131, 1137; 38 C.F.R. § 3.303.  Generally, to establish service connection, there must be lay or medical evidence of (1) a current disability, (2) incurrence or aggravation of a disease or injury in service, and (3) a nexus between the in-service injury or disease and the current disability. Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).  Service connection for certain chronic diseases, including arthritis, may also be established on a presumptive basis by showing that such a disease was manifested to a degree of 10 percent or more within one year from the date of separation from service.  38 U.S.C. § 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a).  In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service.  38 C.F.R. § 3.307(a).  To establish service connection under this provision, there must be: evidence of a chronic disease shown as such in service (or within an applicable presumptive period under C.F.R. § 3.307), and subsequent manifestations of the same chronic disease; or, if the fact of chronicity in service is not adequately supported, by evidence of continuity of symptomatology after service.  The provisions of 38 C.F.R. § 3.303(b) relating to continuity of symptomatology, however, can be applied only in cases involving those conditions explicitly enumerated under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).  Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).  Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has clarified that lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).  The credibility and weight of all the evidence, including the medical evidence, should be assessed to determine its probative value, and the evidence found to be persuasive or unpersuasive should be accounted for, and reasons should be provided for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value.  It is the Board’s responsibility to determine whether a preponderance of the evidence supports the claim or whether the evidence is in relative equipoise, with the veteran prevailing in either event, or whether there is a preponderance of evidence against the claim, in which case the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Then, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102.  1. Entitlement to service connection for a lumbar spine disability. The Veteran seeks service connection for a lumbar spine disability and alleges that his disability stemmed from a sports injury and a car accident, both of which occurred in service. The Veteran’s service treatment records (STRs) contain a January 1982 entrance examination with no noted problems. An August 1983 treatment note within the Veteran’s STRs indicates that he complained of low back pain after playing basketball. The pain had its onset two days before and the Veteran did not take any medications for it. There were no back spasms, but the Veteran’s back was tender. He was diagnosed with lower back sprain. His treatment included physical therapy, ice and heat. There were no limitations on the Veteran’s duty. His physical therapy note indicates that he had lower back pain with spasms. A September 1983 treatment note within the Veteran’s STRs indicates that he complained of back pain which had its onset four days ago. The back pain resulted from moving wall lockers in his company. He was noted to have limited range of motion due to pain. His back worsened when bending forward. He was diagnosed with strained muscles in his back. His treatment included Tylenol and heat packs. He was limited to no physical training for four days. There was no follow up treatment. A November 1987 treatment note within the Veteran’s STRs indicates that he complained of headache, back ache, and neck ache, due to a traffic accident. The Veteran was noted to be conscious and alert. He complained that his entire body aches. He was noted to have cervical tenderness and good low back range of motion. Cervical spine x-rays were negative. A follow up November 1987 treatment note indicates that the Veteran had cervical spine issues due to a motor vehicle injury. He was recommended pain medication and no physical training for five days. A December 1987 periodic physical examination did not reveal any problems. A December 1987 follow up note within the Veteran’s STRs indicates that he was seen for follow up due to the injuries sustained in a motor vehicle accident. The Veteran was noted to have soreness mostly in the neck and back. The note indicates that the Veteran was doing better that his range of motion was better. He was diagnosed with a muscular skeletal strain and ordered a cervical collar, medications, and physical therapy. A December 1987 physical therapy note within the Veteran’s STRs indicates that he had a cervical strain due to motor vehicle accident. The Veteran also had mid back pain with spasms. An August 1988 treatment note within the Veteran’s STRs indicates that he was playing football and fell back. The Veteran was noted to have prior lower back pain from a car accident which resolved. He was noted to have low back pain with spasms. He was prescribed pain medication and ordered follow up. A September 1988 treatment note within the Veteran’s STRs indicates that the Veteran re-injured his back by falling on it during a football game. Onset was one week ago. The Veteran complained of lower back pain increasing with lifting and bending. It was noted that the Veteran’s original injury occurred four months ago and lower back pain previously resolved. The Veteran was assessed as having lower back pain. An additional September 1988 treatment note indicates that the Veteran’s low back pain has not resolved. A May 1989 note within the Veteran’s STRs indicates that the Veteran underwent x-rays of the left hand due to an automobile accident. The treatment note indicates that the Veteran had a car accident the prior day and that he injured his left hand. It was noted that there was very little evidence of trauma to the hand, but that manipulation seems to cause severe pain and limited range of motion. The Veteran was diagnosed with a left wrist sprain. A July 1990 treatment note within the Veteran’s STRs indicates that he complained of low back pain for two days. The Veteran’s pain began after he tried to lift an object. The pain was noted to be increasing with movement and travelling from the right side to the ribcage. He was noted to have muscular strain, chondritis, and radicular pain. He was recommended physical therapy and light duty. A December 1990 physical examination for discharge did not reveal any problems. An August 2005 VA treatment note indicates that the Veteran complained of chronic neck and back pain. An April 2010 VA treatment indicates that the Veteran had a diagnosis of degenerative disc disease (DDD) of the lumbar spine as well as cervical spine changes. He was recommended to undergo an MRI of the neck and take pain medication for his lumbar spine symptoms. In June 2015, the Veteran underwent a VA examination for his claim. He was diagnosed with degenerative arthritis of the spine and intervertebral disc syndrome (IVDS). He reported having low back pain for several years which occurs most days for several hours. He also reported flare ups of sharp back pain. The VA examiner concluded that the Veteran did not have radicular pain, or any other signs or symptoms associated with radiculopathy. The VA examiner noted that there were imaging studies confirming evidence of arthritis. Following the examination and a review of the Veteran’s file, the VA examiner noted that it is less likely than not that the Veteran’s current back disability had its onset in service or was otherwise causally related to service. The VA examiner noted that based on the examination and a review of the Veteran’s records, including records of strains during service, it is highly likely that the strains resolved without intervention. The VA examiner concluded that it is highly unlikely that the Veteran’s in-service strains resulted in any long-term sequelae. The VA examiner also indicated that this is congruent with the medical literature regarding back pain. Pursuant to the December 2019 Board remand, the June 2015 VA medical opinion lacks adequate rationale for the conclusions reached. A December 2016 VA physical therapy note indicates that the Veteran was referred for physical therapy due to low back pain which radiated into the left hip and leg. The chronicity of the back pain was noted to be 7 to 8 years. The Veteran was diagnosed with DDD which was most severe at L5-1. It was also noted that his symptoms were consistent with spinal stenosis and piriformis syndrome on the left side. He was recommended to undergo therex and manual therapy as well as potentially dry needling. An October 2017 VA lumbar spine imaging report indicates that the Veteran underwent x-rays of the lumbar spine. The impressions portion of the report indicates that the Veteran had lower lumber spine osteoarthritis and disc disease with no posterior osteophytes. An April 2019 private emergency room discharge note from Fort Washington Medical Center indicates that the Veteran was treated for chronic back pain that radiates to his leg. A September 2019 VA imaging study indicates that the Veteran had degenerative changes of the lower lumbar spine. In January 2020, the Veteran underwent a VA examination for his claim. The 2015 diagnoses of degenerative arthritis of the spine and IVDS were confirmed. The VA examiner also diagnosed the Veteran with bilateral lower extremity radiculopathy. The Veteran reported injuring his back playing sports and being treated in service. He reported his back symptoms remaining the same. The Veteran was diagnosed with mild lower extremity radiculopathy with sciatic nerve involvement. There was no ankylosis of the spine and no neurologic abnormalities. The Veteran was diagnosed with IVDS of the thoracolumbar spine with no incapacitating episodes. The Veteran was not noted to use any assistive devices for his lumbar spine disability. There were no scars or any other pertinent findings. The VA examiner noted that imaging studies have been performed with documented arthritis. The imaging studies did not reveal a thoracic vertebral fracture with loss of 50 percent or more height or any other significant findings. Under functional impact, the VA examiner noted that the Veteran is a locator technician and has missed 2 to 4 weeks of work time in the last 12 months due to degenerative arthritis and IVDS with bilateral lower extremity radiculopathy. The Veteran was noted to have difficulties with prolonged standing and walking. After reviewing the Veteran’s records, the VA examiner concluded that it is less likely than not that the Veteran’s lumbar spine disability was incurred in or caused by the Veteran’s service. The VA examiner indicated that the Veteran was diagnosed with his lumbar spine disability in June 2015 pursuant to x-rays, and that they were unable to confirm a previous injury in the Veteran’s STRs. In October 2020, an addendum medical opinion was obtained. The VA examiner reviewed the Veteran’s entire file including the September 1983, December 1987, May 1989, June 1989, and December 1990 STR notations, as well as the Veteran’s VA treatment records and previous VA examination reports. After the review, the VA examiner indicated that the Veteran was involved in a motor vehicle accident in March 1989 which resulted in back pain. The VA examiner went on to state that x-rays were negative for any bony injury or degenerative changes. The VA examiner noted an earlier 1983 episode of back pain and indicated that this clearly resolved as there was no follow up treatment and no complaints until the Veteran’s 1989 motor vehicle accident. The VA examiner noted that the Veteran’s separation examination was negative for back conditions and there was no evidence of a back condition until more than 15 years after service. The VA examiner explained that degenerative lumbar spine disease is considered to be a natural aging process due to normal wear and tear. The VA examiner indicated that the Veteran’s in-service back pain was acute and self-limited and resolved by separation. The VA examiner concluded that the medical evidence does not support the Veteran’s claim of a chronic condition arising in service and stated that it is less likely than not that the Veteran’s DDD with resultant IVDS is due to or incurred in motor vehicle accident during service. Based on a review of the entire record, the preponderance of the evidence supports the finding that the Veteran’s current lumbar spine disability did not have its onset in service, and it is not otherwise causally related to service, to include claimed in-service injuries. Likewise, arthritis was not manifested to a compensable degree within the first post-service year. As such, service connection is not warranted. The Veteran’s lumbar spine disability did not have its onset in service and did not manifest as arthritis within one year of discharge. The Veteran’s STRs, private treatment records, VA treatment records, the June 2015 VA examination report, and the October 2020 addendum medical opinion indicate that the Veteran’s current lumbar spine disability did not have its onset until August 2005. Specifically, the Veteran’s VA treatment records indicate that he was treated for chronic back pain in August 2005. His April 2010 VA treatment note also indicates that the Veteran was diagnosed with DDD of the lumbar spine. Moreover, the December 2016 VA physical therapy note indicates that onset of the Veteran’s back pain was 7 to 8 years ago. It is noted that the Veteran may have had previous intermittent back pain, but his VA treatment records indicate that he was not treated for it until August 2005 and not diagnosed with DDD of the lumbar spine until April 2010. With respect to the June 2015 VA examination report, while the medical opinion lacks full rationale, the totality of the evidence in this case supports the conclusions that were reached within. Of note, the Veteran’s STRs contain several notations of complaints and treatments for low back pain and strains as a result of a sports injury in August 1983, moving lockers in September 1983, a motor vehicle accident (MVA) in November 1987 and December 1987, sports injury in August 1988, another sports injury in September 1988, and lifting an object in July 1990. However, the preponderance of the medical evidence indicates that these injuries required only conservative treatment, did not amount to bony or degenerative injuries as confirmed by x-rays, and resolved prior to discharge. Indeed, the Veteran had normal x-rays following his November 1987 MVA, and his periodic examinations as well as his December 1990 discharge examinations did not reveal any lumbar problems or back pain. An August 1988 note indicates that the lower back pain following his MVA has resolved. Moreover, the October 2020 VA addendum opinion corroborates the Veteran’s STRs and indicates that the Veteran’s current back disability did not have its onset in service and did not manifest to a compensable degree as arthritis within one year of discharge. While the October 2020 VA addendum opinion does not specifically list each instance in the Veteran’s STRs noting back pain, it is clear from the VA examiners evidence review and discussion that the entirety of the Veteran’s STRs were considered. Additionally, the October 2020 VA examiner lists the 1989 MVA as related to his lumbar disability instead of the November 1987 MVA. As previously noted, the 1989 MVA involved an injury to the Veteran’s left arm only. However, this appears to be a harmless typographical error. It is clear that the October 2020 VA examiner correctly summarized the diagnosis and treatment that the Veteran underwent following his in-service November 1987 MVA as the VA examiner notes the injury resulting in neck and back pain with negative x-rays and absence of any bony injury or degenerative changes. Overall, the October 2020 VA addendum opinion was based on a thorough review of the Veteran’s records, providing full rationale for the conclusions reached. The October 2020 VA addendum opinion is also corroborated by the Veteran’s STRs and post-discharge records. As such, the October 2020 VA addendum opinion is afforded probative value. With respect to nexus, the October 2020 VA addendum opinion indicates that the Veteran’s current lumbar spine disability is less likely than not related to service, to include the claimed in-service back strains. The VA examiner also noted that the Veteran’s lumbar spine disability did not have its onset until more than 15 years after service, that the in-service injuries did not involve bony or degenerative injuries, and that degenerative lumbar spine disease is considered to be a natural aging process due to normal wear and tear. The Veteran’s records likewise corroborate these findings. With respect to the Veteran’s sincere belief that his current lumbar spine disability relates to service, the Veteran is not competent to provide a medical nexus opinion as to a relationship between his current disability and service; or, any other disease or injury in service. This requires medical expertise and falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011).  In this regard, any actual diagnosis of a back disability, and causation between service and disability, requires objective testing and medical expertise to diagnose.  See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  To the extent that the Veteran believes that his current lumbar spine disability was caused by service and his in-service injuries, as a lay person, he is not shown to possess any specialized training in the medical field. The Veteran is not deemed competent to know the cause of lumbar spine disability, as this is an internal physiological process that requires medical expertise. Even considering the Veteran’s credible reports of back pain since service, the preponderance of the most probative and competent evidence of record is against finding that the back pain associated with the current back disability is the same cause of the back pain that the Veteran experienced more contemporaneous in time to service. Accordingly, the Veteran’s opinion as to the nexus in this case is not competent evidence. Id.  In sum, the preponderance of the evidence is against a finding that the Veteran’s lumbar spine disability had its onset in service, or is otherwise causally related to service; and, arthritis is not shown to have manifested to a compensable degree within one year of discharge.  Accordingly, the benefit-of-the-doubt rule enunciated in 38 U.S.C. § 5107(b) is not for application, and service connection is not warranted.  2. Entitlement to service connection for cervical spine disability. The Veteran seeks service connection for a cervical spine disability. He asserts that his cervical spine disability is a result of his in-service MVAs and in-service sports injury. The pertinent STRs with respect to this claim were discussed in the previous section of this decision. An April 2005 VA MRI of the cervical spine indicates no evidence of recurrent epidural abcess. The report indicates postoperative changes of discectomy and fusion with instrumentation at C4-5, bulging discs with central and exit foraminal stenosis. The report also notes probable cervical radicular pain to the right upper extremity and history of previous cervical surgery with the Veteran having similar symptoms for the past several months. The Veteran was recommended to continue using medication for his neck pain and muscle spasms. An October 2005 VA treatment note indicates that the Veteran was treated for chronic neck paint and was recommended ibuprofen. The note indicates that the Veteran’s neck pain is a result of a previous neck surgery, and that the Veteran also has decreased sensation in hands as a residual. The note also indicates that the Veteran reported having neck surgery in February 2005 for an infection. A November 2005 VA treatment note indicates that the Veteran reported a February 2005 neck surgery potentially for diskitis. The note indicates that the Veteran was status post neck disc removal. A May 2006 VA treatment note indicates that the Veteran presented to VA urgent care with right upper back pain radiating to his right arm. It was noted that the Veteran had previous history of neck surgery and similar symptoms for several months. The Veteran reported being treated for this at a different VA facility and being told there is a disc slipping with recommendation that he complete physical therapy. The VA treatment note goes on to state that a review of remote data indicates a history of C4-5 diskectomy and C4 partial corpectomy in February 2005 but that there are no neurosurgery notes, indicating that the procedure was potentially completed by a private provider contracted by the VA. Previous MRI of the cervical spine was reviewed and the Veteran was recommended to continue treating his pain with medication. In June 2015, the Veteran underwent a VA examination for his claim. He was diagnosed with degenerative arthritis of the spine and IVDS. Imaging studies confirming arthritis were noted. After a review of the Veteran’s records, the VA examiner concluded that it is less likely than not that the Veteran’s cervical spine disability is related to service. The VA examiner indicated that the injuries noted in the Veteran’s STRs are highly likely to resolve without intervention and very unlikely to result in any long-term sequelae. Pursuant to the December 2019 Board remand, the June 2015 VA medical opinion lacks probative value because it is not supported by a rationale that explains the basis for the conclusion reached. An April 2016 VA treatment note indicates that the Veteran underwent his second neck surgery that month. The Veteran underwent physical therapy following the surgery. An October 2016 VA physical therapy note indicates that the Veteran was diagnosed with cervical disc degeneration and that his cervicalgia has an overall slow progress. It was noted that at some point the fusions in the Veteran’s neck are going to limit his motion, and that he is recommended to keep up with his home exercise program or it will get worse. It was also noted that the Veteran met full potential through conservative measures. An October 2017 VA imaging report indicates that the Veteran is status post C3-4 and C4-5 anterior cervical discectomy and fusion. The C3-4 hardware was noted to be new, but the C4-5 hardware was unchanged. There was no acute fracture, subluxation or evidence of hardware loosening noted. There was no prevertebral soft tissue swelling. The loss of cervical lordosis was unchanged. It was also noted that the C5-6 through C7-T1 degenerative changes were stable. The Veteran was diagnosed with cervicalgia. A May 2018 VA treatment note indicates that the Veteran has a history of cervical disc problems with 2 neurosurgical procedures and continues to have left sided neck and upper back pain. There was no recent trauma or strained muscles noted. The Veteran reported that steroid injections did not help much. It was noted that the Veteran is recommended to follow up with neurosurgery for treatment. He was noted to have cervical radiculopathy. A February 2019 cervical spine imaging report indicates that the Veteran was status post anterior fusion from C3 through C5. There was straightening of the normal cervical lordosis. There was moderate disc space narrowing at the C5-6 and C6-7 with severe disc space narrowing at C7-T1. On the right, there is severe C3-4, severe C4-5, moderate to severe C5-6, moderate to severe C6-7, and moderate to severe C7-T1 neural foraminal narrowing. On the left, there is mild to moderate C2-3, moderate C3-4, mild to moderate C4-5, moderate C5-6, moderate C6-7, and moderate to severe C7-T1 neural foraminal narrowing. In January 2020, the Veteran underwent a VA examination for his claim. June 2014 diagnoses of degenerative arthritis of the spine and spinal stenosis were confirmed. He was noted to have bilateral upper extremity radiculopathy as diagnosed in February 2016 and status post cervical fusion in October 2017. The Veteran reported the onset of his disability to be 1987 and being involved in a motor vehicle accident, having neck issues, and being treated by military doctors. He also reported going through physical therapy and his symptoms remaining the same. He reported flare ups of worsening neck pain which last for hours. The Veteran was noted to have radiculopathy with mild, intermittent upper extremity pain and mild numbness. The radiculopathy was described as mild on both sides. There was no ankylosis. The Veteran was diagnosed with IVDS of the cervical spine with no incapacitating episodes. The Veteran was not noted to use any assistive devices for his cervical spine disability. It was noted that there were imaging studies confirming arthritis of the cervical spine and that the Veteran did not have a cervical spine fracture with loss of 50 percent or more of height. A June 2014 MRI was cited illustrating transitional changes above fusion with stenosis at C3-4, fusion at C4-5, less generative changes at C5-6, and stenosis at C6-7, and stable instrumentation at C4-5. With respect to functional impact, the VA examiner noted that the Veteran was a locator technician and lost 2 to 4 weeks of work in the last 12 months. It was noted that the Veteran has difficulty with bending his neck. After reviewing the Veteran’s file, the VA examiner concluded that the Veteran’s cervical spine disability was less likely than not incurred in or caused by service. The VA examiner indicated that they were unable to confirm in-service automobile accidents or sports injuries within the Veteran’s STRs. In October 2020, the VA produced an addendum medical opinion. After reviewing the Veteran’s entire file, the VA examiner indicated that records from November and December 1987 reflect evaluation and treatment for a neck strain with negative x-rays. The VA examiner also indicated May and June 1989 treatments for an automobile accident and noted that these were related to the Veteran’s lumbar spine. The VA examiner further indicated that there is no evidence of a neck condition until 2003 with subsequent fusion in 2004 and a second procedure approximately 10 years later. The VA examiner then noted that there is no evidence of further treatment for a neck injury following the 1987 and 1989 events and that it appears that the cervical strain was acute, self-limited, and resolved with treatment, and that the Veteran served for 3 years afterwards without any further complaints. The VA examiner stated that it is unlikely that the Veteran would be able to serve 3 years and then had an additional 12 year gap until he was treated with ongoing neck pain dating back from 1987 and that imaging did not reveal any bony injury or DDD. It was further explained that DDD is considered a natural aging process due to normal wear and tear and desiccation of the discs. In the Veteran’s case, it was explained that DDD was the indication for his initial and subsequent surgery. The VA examiner also noted that DJD is also a natural aging process and there was no indication it occurred in service. Thus, the VA examiner concluded that it is less likely than not that the Veteran’s neck disability, including status post two cervical fusions, abcess and residuals, are due to or incurred in service, including the Veteran’s cervical strain or any pain that arose from the 1989 motor vehicle accident. The VA examiner noted that their conclusions are evidenced by the Veteran’s negative separation examination and the gap in treatment from 1991 to 2003. Based on a review of the entire record, the preponderance of the evidence supports the finding that the Veteran’s current cervical spine disability did not have its onset in service, and it is not otherwise causally related to service, to include the claimed in-service injuries. Likewise, arthritis was not manifested to a compensable degree within the first post-service year. As such, service connection is not warranted. The Veteran’s cervical spine disability did not have its onset in service and did not manifest as arthritis within one year of discharge. The Veteran’s STRs, private treatment records, VA treatment records, and the October 2020 VA addendum medical opinion indicate that the Veteran’s current cervical spine disability did not have its onset until approximately 2003. Specifically, the October 2020 VA medical opinion and the Veteran’s VA treatment records indicate that the Veteran’s cervical spine disability had its onset in 2003 with the Veteran undergoing first neck surgery in either 2004 or February 2005. The date of the first surgery is unclear as the Veteran provides different reports with respect to date and purpose of the surgery. Of note, the Veteran’s STRs contain two notations of complaints and treatments for neck pain and strains as a result of an MVA in November 1987 and December 1987. However, the preponderance of the medical evidence indicates that this injury was treated conservatively, that the cervical spine x-rays were clear, that the injury did not amount to bony or degenerative injury, and that it resolved prior to discharge. Indeed, the Veteran had normal x-rays following his November 1987 MVA, and only had one follow up note with respect to neck pain. Additionally, his December 1990 discharge examinations did not reveal any cervical problems or neck pain. Moreover, the October 2020 VA addendum opinion corroborates the Veteran’s STRs and indicates that the Veteran’s current neck disability did not have its onset in service and did not manifest to a compensable degree as arthritis within one year of discharge. While the October 2020 VA examiner incorrectly notes the May 1989 MVA as relating to lumbar spine, it is clear from the record and the Veteran’s reports that it was the November 1987 MVA that resulted in neck and back pain. All records associated with the May 1989 MVA indicate that the Veteran only complained of a left wrist injury and was diagnosed with a left wrist sprain. Thus, it is clear that the October 2020 VA examiner correctly summarized the diagnosis and treatment that the Veteran underwent following his in-service November 1987 MVA as the VA examiner notes that the injury resulted in neck and back pain but the cervical spine x-rays were negative for any bony injury or degenerative changes. Overall, the October 2020 VA addendum opinion was based on a thorough review of the Veteran’s records, providing full rationale for the conclusions reached. The October 2020 VA addendum opinion is also corroborated by the Veteran’s STRs and post-discharge records. As such, the October 2020 VA addendum opinion is afforded probative value. With respect to nexus, the October 2020 VA addendum opinion indicates that the Veteran’s current cervical spine disability is less likely than not related to service, to include the claimed-inservice MVA. The VA examiner also noted that the Veteran’s lumbar spine disability did not have its onset until 12 years after service with a 12-year gap in treatment. Also, the VA examiner indicated that in-service MVA did not involve bony or degenerative injuries and resolved, and that degenerative lumbar spine disease is considered to be a natural aging process due to normal wear and tear. The Veteran’s records likewise corroborate these findings. With respect to the Veteran’s sincere belief that his current cervical spine disability relates to service, the Veteran is not competent to provide a medical nexus opinion as to a relationship between his current disability and service; or, any other disease or injury in service. This requires medical expertise and falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011).  In this regard, any actual diagnosis of a back disability, and causation between service and disability, requires objective testing and medical expertise to diagnose.  See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  To the extent that the Veteran believes that his current cervical spine disability was caused by the in-service MVA, as a lay person, he is not shown to possess any specialized training in the medical field. The Veteran is not deemed competent to know the cause of cervical spine disability, as this is an internal physiological process that requires medical expertise. Even considering the Veteran’s credible reports of neck pain since service, the preponderance of the most probative and competent evidence of record is against finding that the neck pain associated with the current cervical spine disability is the same cause of the neck pain that the Veteran experienced more contemporaneous in time to service. Accordingly, the Veteran’s opinion as to the nexus in this case is not competent evidence. Id.  In sum, the preponderance of the evidence is against a finding that the Veteran’s cervical spine disability had its onset in service, or is otherwise causally related to service; and, arthritis is not shown to have manifested to a compensable degree within one year of discharge.  Accordingly, the benefit-of-the-doubt rule enunciated in 38 U.S.C. § 5107(b) is not for application, and service connection is not warranted.  3. Entitlement to service connection for right upper extremity radiculopathy. 4. Entitlement to service connection for left upper extremity radiculopathy. The Veteran seeks service connection for bilateral upper extremity radiculopathy and asserts that his disabilities are related to the in-service neck injury sustained in an MVA. The pertinent STRs with respect to these claims were discussed in the first section of this decision which pertained to the Veteran’s lumbar spine disability. A June 2006 VA treatment note indicates that the Veteran had radicular pain in his right shoulder into the elbow. The pain was noted to be nothing new. Under assessment, it was noted that the Veteran had cervical radicular pain to the right upper extremity which was not actual shoulder pain. It was noted that the Veteran had a history of previous cervical surgery and has been having similar symptoms for the past several months. The Veteran’s VA treatment records indicate that he continued to receive treatment for cervical radiculopathy. A July 2014 VA EMG indicates that the Veteran had an abnormal study. There was electrodiagnostic evidence of a chronic left cervical radiculopathy which appeared to be predominately C5 distribution evidenced by polyphasia and decreased recruitment in deltoid, biceps, and rhomboid. There was no electrodiagnostic evidence of right cervical radiculopathy. The report stated that there were several limitations to the EMG when assessing radiculopathy. In June 2015, the Veteran underwent a VA examination for peripheral nerves. He was diagnosed with radicular syndrome of the upper limbs. The Veteran reported injuring his neck playing football in 1989 and being treated in sick call for cervical traction. He reported having surgery in 2005 due to cervical stenosis – rupture disc and cervical stenosis with myelopathy. He was also noted to have bilateral C8 dermatomal distribution dysesthesia. The VA examiner noted the February 2014 MRI confirming cervical spine stenosis. The Veteran’s bilateral median and ulnar nerves were noted to be affected with mild incomplete paralysis. After reviewing the records and the examination results, the VA examiner concluded that the Veteran’s bilateral upper extremity radiculopathy is at least as likely as not due to his cervical spine disability. Based on the review of the entire record, the preponderance of the evidence supports a finding that the Veteran’s current bilateral upper extremity radiculopathy did not have its onset in service, did not manifest to a compensable degree within one year of discharge, and is not otherwise causally related to service, to include the claimed in-service injury. Essentially, the evidence in this case indicates that the Veteran’s bilateral upper extremity radiculopathy is related to his cervical spine disability, for which service connection has been denied. As such, service connection is not warranted. The Veteran’s upper extremity radiculopathy did not have its onset in service and did not manifest to a compensable degree within a year of discharge. While there is a singular notation of radicular pain within the Veteran’s STRs, that radicular pain was attributed to a lumbar spine injury which resolved before discharge. Additionally, a singular instance of radicular pain noted in the Veteran’s STRs does not establish onset of chronic radiculopathy, particularly given that there was no follow up treated and the Veteran’s discharge examination did not contain any upper extremity or cervical problems. The Veteran’s VA treatment records indicate that the Veteran’s bilateral upper extremity radiculopathy had its onset following the Veteran’s first neck surgery, which was approximately in 2004 or 2005. A July 2014 VA EMG confirmed evidence of left cervical radiculopathy and indicated that there me limitations with diagnosing radiculopathy by EMG. Thus, the probative medical evidence of record indicates that the Veteran’s bilateral upper extremity radiculopathy did not have its onset in service and did not manifest to a compensable degree within one year of discharge. With respect to nexus, the probative medical evidence of record, including the Veteran’s VA treatment records and the June 2015 peripheral nerves VA examination report indicate that the Veteran’s bilateral upper extremity radiculopathy is attributable to his cervical spine disability. The July 2014 VA EMG report notes cervical radiculopathy. The June 2015 peripheral nerves VA examination report indicates that the Veteran’s upper extremity radiculopathy is a result of his cervical spine disability. These records were compiled by medical providers during diagnosis and treatment, and further outweigh the Veteran’s assertions. In sum, the preponderance of the medical evidence is against a finding that the Veteran’s bilateral upper extremity radiculopathy had its onset in service, manifested to a compensable degree within one year of discharge, or was otherwise causally related to service, to include the claimed in-service injury. Moreover, the Veteran’s bilateral upper extremity radiculopathy has been attributed to his cervical spine disability, for which service connection has been denied. Accordingly, the benefit-of-the-doubt rule enunciated in 38 U.S.C. § 5107(b) is not for application, and service connection is not warranted.  Increased Rating Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. Separate diagnostic codes identify the various disabilities. It is necessary to rate the disability from the point of view of the Veteran working or seeking work, 38 C.F.R. § 4.2, and to resolve any reasonable doubt regarding the extent of the disability in the Veteran’s favor. 38 C.F.R. § 4.3. If there is a question as to which disability rating to apply to the Veteran’s disability, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When the Veteran appeals the initial assignment of a disability rating, the severity of the disability is considered during the entire period from the initial assignment of the disability rating to the present time. Fenderson v. West, 12 Vet. App. 119 (1999). Staged ratings must be considered, which are appropriate when the evidence establishes that the claimed disability manifested symptoms that would warrant different ratings for distinct time periods during the appeal. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). See also Fenderson v. West, 12 Vet. App. 119, 126 (1999) (applying this concept to initial ratings). 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). However, pyramiding, that is the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a Veteran’s service-connected disability. 38 C.F.R. § 4.14. 5. Entitlement to an initial compensable rating for the service-connected hypertension. The Veteran contends that his service-connected hypertension is more severe than what is represented by the initial noncompensable disability evaluation currently assigned. At the May 2019 Board hearing, he testified that he now has to take medication to control his hypertension and experiences symptoms such as shortness of breath and fatigue. The Veteran’s hypertension is currently rated as noncompensable under 38 C.F.R. § 4.104, DC 7101. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. Under DC 7101, hypertensive vascular disease with diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control, is rated 10 percent disabling. 38 C.F.R. § 4.104, DC 7101. Hypertensive vascular disease with diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more, is rated 20 percent disabling. Id. Hypertensive vascular disease with diastolic pressure predominantly 120 or more is rated 40 percent disabling. Id. Hypertensive vascular disease with diastolic pressure predominantly 130 or more is rated 60 percent disabling. Id. Note (1) to DC 7101 provides that hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. 38 C.F.R. § 4.104. The Veteran’s VA treatment records contain blood pressure readings consisting of 128/86 in April 2016; 137/87 in June 2016; 111/71, 122/75, and 108/69 in November 2016; 127/84 in December 2016; 112/80, 124/73, and 123/83 in January 2017; 128/84 in March 2017; 154/89 and 137/89 in October 2017; 132/85 in November 2017; 123/81 in January 2018; 107/77 in March 2018; 110/78 and 122/74 in May 2018; 147/81 in October 2018; 106/71 and 106/63 in January 2019; 117/82 and 114/65 in February 2019; 111/77 and 105/66 in March 2019; 126/66 in May 2019; 106/78 and 110/72 in September 2019; 114/76 and 131/74 (noting that it remains reasonable without medication) in October 2019; 117/82 and 111/78 in December 2019; and 114/78 in January 2020. In November 2018, the Veteran underwent a VA examination for his claim. The 2018 diagnosis of hypertension was confirmed. The VA examiner indicated that the Veteran did not have a history of diastolic blood pressure elevation to predominately 100 or more. The examination blood pressure readings consisted of 120/68, 120/70, and 118/70, with an average reading of 119/69. There were no other pertinent findings, and the VA examiner concluded that the Veteran’s hypertension did not impact his ability to work. An April 2019 private triage note indicates that the Veteran’s blood pressure was recorded at 101/77. In January 2020, the Veteran underwent another VA examination for his claim. The VA examiner noted a March 2015 diagnosis of hypertension. The Veteran reported having occasions of elevated blood pressure from 2015 and starting blood pressure medication in 2018. The VA examiner noted that the Veteran’s treatment plan includes taking continuous medication for hypertension and that he does not have a history of diastolic blood pressure elevation to predominately 100 or more. The examination blood pressure readings consisted of 110/74, 118/80, and 116/76. There were no other pertinent physical findings, and the VA examiner concluded that the Veteran’s hypertension did not impact his ability to work. Based on the review of the entire record, the preponderance of the evidence supports a finding that the Veteran’s recorded diastolic pressure was consistently less than 100 and his recorded systolic pressure was consistently less than 160. Thus, an assignment of an initial compensable rating is not warranted. Throughout the period on appeal, the Veteran’s VA treatment records and the VA examination reports indicate that he Veteran’s the Veteran’s recorded diastolic pressure was consistently less than 100 and his recorded systolic pressure was consistently less than 160. He treated his hypertension with daily medication. The competent medical evidence of record does not indicate any diastolic pressure readings over 100 or any systolic pressure readings over 160. As noted above, the record is absent for blood pressure readings over 160 (systolic) or over 100 (diastolic), and his blood pressure readings appear to be consistently below 160 (systolic) or 100 (diastolic). Additionally, the evidence does not support a finding of a history of diastolic pressure of predominantly 100 or higher. Thus, after a review of the pertinent evidence, the criteria for the assignment of a compensable rating for the service-connected hypertension have not been met or approximated. As the preponderance of the evidence is against a schedular compensable rating for hypertension, there is no reasonable doubt to be resolved, and the appeal as to a compensable disability rating for hypertension must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102. 6. Propriety of the rating reduction from 100 percent to 30 percent for the service-connected VHD, to include whether an increased rating is warranted. The Veteran contests the rating reduction from 100 percent to 30 percent for the service-connected VHD effective August 1, 2014 as determined in the May 2014 rating decision. The Veteran’s VHD is rated under 38 C.F.R. §4.104, Diagnostic Code (DC) 7000. By way of history, a June 2008 rating decision restored a previous reduction for the service-connected VHD from 30 percent to 100 percent from November 1, 2007. Thus, at the time of the reduction, the Veteran’s 100 percent disability rating was in effect since October 12, 2005. In a December 2012 rating decision, the RO proposed to reduce the disability evaluation for the service-connected VHD from 100 percent to 10 percent. The rating decision indicated that a VA examination showed that the Veteran did not require any medication for his disability and that his METs were greater than 7. The rating decision went on to state that because his METs were greater than 7, it is proposed that the Veteran’s disability evaluation is decreased to 10 percent. The rating decision did not provide an effective date for reduction but noted that if enacted, the proposal would reduce the Veteran’s overall disability evaluation from 100 percent to 30 percent. The Veteran was notified of the rating decision in December 2012, and the notification letter indicated that he had 60 days to submit additional evidence and 30 days to request a personal hearing. In January 2013, the Veteran submitted correspondence indicating that he would like a hearing concerning the issue of reduction. The request was received within 30 days from the date of the notice of the December 2012 rating decision. In February 2013, the RO sent the Veteran a correspondence indicating that his predetermination hearing was scheduled for March 20, 2013. The following day, the RO sent another correspondence indicating that the predetermination hearing was scheduled for March 13, 2013, not March 20, 2013. There is no indication in the Veteran’s file that the predetermination hearing took place. In a March 2014 rating decision, the RO reduced the disability evaluation for the service-connected VHD from 100 percent to 10 percent from June 1, 2014. The rating decision noted that the Veteran was notified of the initial proposal to reduce in December 2012 and that the effective date of the reduction is June 1, 2014, which is the first day of the month following the 60 days’ notice from the final determination. The rating decision did not mention the Veteran’s previous request for a predetermination hearing or whether this hearing took place. Then, in May 2014, the RO issued the rating decision on appeal reducing the disability evaluation for the service-connected VHD from 100 percent to 30 percent from August 1, 2014. The rating decision noted that the Veteran was first notified of the proposed reduction in a December 2012 rating decision for which he received notice the same month. The rating decision also noted that the Veteran’s due process expired March 2013. The rating decision found that the current severity of the Veteran’s disability did not support a 30 percent evaluation, but because the disability has been evaluated at 30 percent or more since November 1991, the disability cannot be reduced except upon a showing that such rating was based on fraud. To that extent, the May 2014 rating decision noted that it served as a correction to the December 2012 rating decision which erroneously proposed a reduction to 10 percent. This reduced the Veteran’s overall disability rating from 100 percent to 50 percent. It was noted that the effective date was August 1, 2014, which is the first day of the month following the 60 days’ notice from this final determination. In May 2014, the Veteran was also notified of the May 2014 rating decision. The notification letter indicates that the disability evaluation for the service-connected VHD is reduced from 100 percent to 20 percent from August 1, 2014. The notification did not mention the Veteran’s right to submit evidence within 60 days’ or request a predetermination hearing within 30 days. Finally, in an August 2020 rating decision, the disability evaluation for the service-connected VHD was increased from 30 percent to 60 percent from January 31, 2020. A veteran’s disability rating may not be reduced unless an improvement in the disability is shown to have occurred. 38 U.S.C. § 1155. When a reduction is effectuated without following the applicable regulations, to include procedural and substantive provisions, the reduction is void ab initio. See Greyzck v. West, 12 Vet. App. 288, 292 (1999). Where a reduction in an evaluation of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, the procedural requirements of 38 C.F.R. § 3.105(e) must be met. Pursuant to 38 C.F.R. § 3.105(e), the AOJ must issue a rating action proposing the reduction and setting forth all material facts and reasons for the reduction. The Veteran must then be given 60 days to submit additional evidence and to request a predetermination hearing. Then, a rating action will be taken to effectuate the reduction. 38 C.F.R. § 3.105(e). The effective date of the reduction will be the last day of the month in which a 60-day period from the date of notice to the Veteran of the final action expires. 38 C.F.R. § 3.105 (e), (i)(2)(i). Where a rating reduction does not comply with the provisions of applicable VA regulations, the reduction is void ab initio. See Greyzck v. West, 12 Vet. App. 288 (1999). In this case, because the reduction caused the Veteran’s overall disability rating to be reduced, the procedural requirements of 38 C.F.R. § 3.105 apply. At the outset, a review of the above history reveals that the procedural requirements of 38 C.F.R. § 3.105(e) were not met. As such, the reduction is void ab initio. Specifically, the AOJ failed to issue a rating decision proposing the reduction and setting forth all material facts and reasons for the reduction. The December 2012 rating decision cannot serve as the initial proposal to reduce the rating, as the decision erroneously notified the Veteran that the disability evaluation for the service-connected VHD will be reduced from 100 to 10 percent, failing to set forth the material facts of the reduction. Subsequently, the May 2014 rating decision was the first time that the AOJ proposed to reduce the disability evaluation for the service-connected VHD from 100 percent to 30 percent effective August 1, 2014. Moreover, the Veteran requested a pre-determination hearing within 30 days following the December 2012 proposal to reduce; and, while the record reflects that the hearing was scheduled, and then rescheduled to an earlier date, there is nothing in the claims file to suggest that the hearing was held or that the Veteran failed to report to the hearing. As the procedural requirements of 38 C.F.R. § 3.105(e) were not met, the 100 percent disability rating for the service-connected VHD is restored effective August 1, 2014. As noted above, a rating decision proposing a reduction must set forth all material facts and reasons for the reduction. In this case, the December 2012 rating decision did not set forth all material facts when it failed to provide the Veteran with the correct disability rating for the proposed evaluation or a date for the proposed reduction. Indeed, the first time that the Veteran was notified that his disability rating would be reduced from 100 percent to 30 percent was the May 2014 rating decision on appeal. Moreover, the May 2014 rating explicitly stated that it was correcting the December 2012 rating decision. As the December 2012 proposal to reduce the disability rating necessitated a correction, it cannot serve as an adequate proposal to reduce the Veteran’s disability rating. In essence, the December 2012 is void because it did not set forth all material facts and reasons for the reduction as required by 38 C.F.R. § 3.105(e). Effectively, the AOJ failed to issue an adequate initial proposal to reduce the disability rating from 100 percent to 30 percent, and instead issued a rating decision finalizing the reduction. This deprived the Veteran of his due process rights. Assuming arguendo, that the procedural requirements for the proposed reduction were met, the reduction in this case is still void ab initio because neither the December 2012 nor the May 2014 rating decisions adequately considered or applied the provisions of 38 C.F.R. § 3.344. At the time of the reduction, the Veteran’s 100 percent disability evaluation has been in effect for more than five years. As such, the provisions of 38 C.F.R. § 3.344 (a) and (b) apply, which govern the reduction of ratings in effect for five years or more. See Brown, 5 Vet. App. at 420-22 (finding that the duration of a rating, in rating reduction claims, is measured from the effective date of the prior rating to the effective date of the reduced rating). In this regard, the Veteran’s initial disability evaluation of 100 percent for the service-connected VHD has been in effect since October 12, 2005, which is more than five years prior to the August 1, 2014 severance. In cases where a rating has been in effect for five years or more, the rating agency must make reasonably certain that the improvement will be maintained under the conditions of ordinary life even if material improvement in the physical or mental condition is clearly reflected. Kitchens v. Brown, 7 Vet. App. 320, 324 (1995). A rating that has been in effect for five years or more may not be reduced on the basis of only one examination in cases where the disability is the result of a disease subject to periodic or episodic improvement. 38 C.F.R. § 3.344 (a). The five-year period is calculated from the effective date of the rating to the effective date of the reduction. Brown v. Brown, 5 Vet. App. 413, 419 (1993). Furthermore, under 38 C.F.R. § 3.344, the RO must find the following: (1) based on a review of the entire record, the examination forming the basis for the reduction is full and complete, and at least as full and complete as the examination upon which the rating was originally based; (2) the record clearly reflects a finding of material improvement; and (3) it is reasonably certain that the material improvement found will be maintained under the ordinary conditions of life. See Kitchens v. Brown, 7 Vet. App. 320 (1995); Brown v. Brown, 5 Vet. App. 413 (1993). If doubt remains, after according due consideration to all the evidence, the rating agency will continue the rating in effect. 38 C.F.R. § 3.344 (b). The rating decision and statement of the case (SOC) pertaining to the rating reductions must reflect full consideration of the procedural due process provisions of 38 C.F.R. § 3.344 (a)-(b). Here, the reductions are improper because the provisions of 38 C.F.R. § 3.344 were not met. In this regard, the May 2014 rating decision which effectuated the reduction did not find that the record demonstrated sustained improvement and the RO did not address whether any improvement in the disabilities actually reflected an improvement in the Veteran’s ability to function under the ordinary conditions of life and work. See 38 C.F.R. §§ 4.1, 4.2, 4.13; see also Brown, 5 Vet. App. at 420-22; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The May 2014 rating decision mentions that there was sustained improvement in the Veteran’s disability but fails to mention whether this improvement actually reflected an improvement in the Veteran’s ability to function under the ordinary conditions of life and work. The October 2020 Statement of the Case indicates the Veteran is capable of light sedentary work but does not discuss the improvement in the ordinary conditions of the Veteran’s life. The analysis was not done as required by 38 C.F.R. § 3.344. As such, even if the procedural provisions under 38 C.F.R. § 3.105(e) were met, the failure to properly consider and apply the provisions of 38 C.F.R. § 3.344, renders the rating decision void ab initio. Such an omission is erroneous and not in accordance with the law. See Hayes v. Brown, 9 Vet. App. 67, 73 (1996). In summary, as the AOJ did not satisfy the procedural requirements set forth in See 38 C.F.R. § 3.105(e), the reduction in this case is void ab initio, and the 100 percent disability rating for the service-connected VHD is restored, effective August 1, 2014. See 38 C.F.R. § 3.105 (e)(i). The restoration of the 100 percent rating for the service-connected VHD from August 1, 2014 represents a maximum grant of benefits in this case, and the claim for an increased rating for the service-connected VHD is no longer before the Board. 7. Entitlement to a TDIU. The Board has jurisdiction where there is a question of law or fact necessary to a decision by the Secretary of VA under a law that affects the provision of benefits administered by VA. 38 U.S.C. § 7105(d)(5). The United States Court of Appeals for Veterans Claims (Court) has recognized that a 100 percent rating under the Schedule for Rating Disabilities means that a Veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990). Thus, if VA has found a Veteran to be totally disabled as a result of a particular service-connected disability or combination of disabilities pursuant to the rating schedule, there is no need, and no authority, to otherwise rate that Veteran totally disabled on any other basis. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding a request for TDIU moot where 100 percent schedular rating was awarded for the same period). However, a grant of a 100 percent disability does not always render the issue of TDIU moot. VA’s duty to maximize a claimant’s benefits includes consideration of whether his disabilities establish entitlement to special monthly compensation (SMC) pursuant to 38 U.S.C. § 1114 (s). See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011). That statute provides for additional compensation if the Veteran is in receipt of a 100 percent rating and has additional disability ratable at 60 percent or higher. The Court held in Buie and Bradley that a 100 percent schedular rating does not render TDIU moot if the TDIU is predicated on one service-connected disability, and as such, would assist the Veteran in obtaining SMC pursuant to 38 U.S.C. § 1114(s). In this case, the Veteran was already in receipt of SMC pursuant to 38 U.S.C. § 1114(s) from May 29, 2014 to August 1, 2014 on the account of VHD rated at 100 percent and his additional service-connected disabilities independently ratable at 60 percent or more from May 29, 2014. The restoration of the 100 percent disability rating for VHD likewise restores this previous entitlement. Accordingly, the Veteran is already in receipt of the maximum rating for the period on appeal. In other words, an award of a TDIU would not assist the Veteran in obtaining SMC pursuant to 38 U.S.C. § 1114(s) as he is already in receipt. Because the Veteran’s benefits would not be maximized by an award of a TDIU for the period on appeal, the issue is rendered moot. L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kuksova, Kseniya 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.