Citation Nr: 21011179 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 14-35 211A DATE: March 1, 2021 ORDER An initial rating in excess of 30 percent prior to December 12, 2019, and in excess of 50 percent thereafter, for the Veteran’s service-connected acquired psychiatric disorder, is denied. An initial rating of 100 percent is granted for the period prior to March 1, 2011, for residual hypothyroidism, status post Grave’s disease. A rating in excess of 30 percent for residual hypothyroidism, status post Grave’s disease, is denied. An effective date earlier than August 22, 2011 for the grant of service connection for an acquired psychiatric disorder is denied. An effective date earlier than June 21, 2010 for the grant of service connection for residual hypothyroidism, status post Grave’s disease, is denied. REMANDED Entitlement to a rating in excess of 20 percent for lumbosacral strain with scoliosis (lumbar spine disability) is remanded. Entitlement to service connection for radiculopathy, left lower extremity, is remanded. Entitlement to service connection for radiculopathy, right lower extremity, is remanded. FINDINGS OF FACT 1. For the period prior to December 12, 2019, the Veteran’s acquired psychiatric disorder was manifested by symptoms of the type and extent, frequency, and/or severity (as appropriate) that are indicative of no more than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 2. For the period from December 12, 2019, onward, the Veteran’s acquired psychiatric disorder has been manifested by symptoms of the type and extent, frequency, and/or severity (as appropriate) that are indicative of occupational and social impairment with reduced reliability and productivity due to such symptoms as: a flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and, difficulty in establishing and maintaining effective work and social relationships. 3. For the period prior to March 1, 2011, the Veteran’s residual hypothyroidism, status post Grave’s disease, has been manifested by hypothyroidism with myxedema (cold intolerance, muscular weakness, cardiovascular involvement (including, but not limited to hypotension, bradycardia, and pericardial effusion) and mental disturbance (including, but not limited to dementia, slowing of thought, and depression). 4. For the period from March 1, 2 011, onward, the Veteran’s residual hypothyroidism, status post Grave’s disease, has not been manifested by hypothyroidism with myxedema. 5. The Veteran’s initial claim for service connection for an acquired psychiatric disorder was received on August 22, 2011; the Veteran was granted service connection for an acquired psychiatric disorder effective August 22, 2011. 6. The Veteran’s initial claim for service connection for residual hypothyroidism, status post Grave’s disease, was received on June 21, 2010; the Veteran was granted service connection for residual hypothyroidism, status post Grave’s disease, effective June 21, 2010. CONCLUSIONS OF LAW 1. Prior to December 12, 2019, the criteria for a rating in excess of 30 percent for an acquired psychiatric disorder, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9435. 2. On and after December 12, 2019, the criteria for a rating in excess of 50 percent for an acquired psychiatric disorder, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9435. 3. Prior to March 1, 2011, the criteria for a rating of 100 percent for residual hypothyroidism, status post Grave’s disease, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.119, Diagnostic Code 7903. 4. On and after March 1, 2011, the criteria for a rating in excess of 30 percent for residual hypothyroidism, status post Grave’s disease, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.119, Diagnostic Code 7903. 5. The criteria for an effective date earlier than August 22, 2011, for the grant of service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 5103, 5103A, 5110 (2012); 38 C.F.R. § 3.400 (2018). 6. The criteria for an earlier effective date for the grant of service connection for residual hypothyroidism, status post Grave’s disease, have not been met. 38 U.S.C. §§ 5103, 5103A, 5110 (2012); 38 C.F.R. § 3.400 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1990 to July 1992. This appeal began with a March 2012 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO) that: (1) denied service connection for post-traumatic stress disorder (PTSD); (2) denied service connection for status post Grave’s disease; and, (3) continued a 10 percent disability rating assigned for the Veteran’s service-connected lumbosacral strain with scoliosis. When this matter initially came before the Board of Veterans Appeals (Board) in April 2018, the Board: (1) granted service connection for an acquired psychiatric disorder diagnosed as other specified trauma and stressor related disorder; (2) granted service connection for status post Grave’s disease with residual hypothyroidism; and, (3) remanded the issue of an increased rating for the lumbosacral strain with scoliosis, noting the last VA examination of record for this issue was conducted in 2011. In August 2018, the RO issued a rating decision implementing the Board’s April 2018 decision. The RO assigned an initial rating of 30 percent, effective August 22, 2011, for the Veteran’s service-connected acquired psychiatric disorder; and assigned an initial rating of 30 percent for status post Grave’s disease with residual hypothyroidism. In September 2019, the Veteran filed a Notice of Disagreement (NOD), seeking: (1) a higher disability rating for his acquired psychiatric disorder (seeks 50 percent); (2) a higher disability rating for his status post Grave’s disease with residual hypothyroidism (seeks 100 percent); (3) an earlier effective date for the grant of service connection for his acquired psychiatric disorder (seeks effective date of June 21, 2010); and, (4) an earlier effective date for the grant of service connection for his status post Grave’s disease with residual hypothyroidism (no specific date mentioned for this claim). In October 2019, the Board granted an increased rating of 20 percent for the Veteran’s service-connected lumbosacral strain. In February 2020, the RO issued a rating decision that granted an increased rating of 50 percent, effective December 12, 2019, for the Veteran’s service-connected acquired psychiatric disorder. As the disability rating assigned did not represent a total grant of benefits sought on appeal, the claim for an increase remained before the Board. AB v Brown, 6 Vet. App. 35, 39 (1993). The RO also issued a February 2020 Statement of the Case (SOC) that: (1) denied a rating in excess of 30 percent prior to December 12, 2019, and in excess of 50 percent thereafter, for the Veteran’s service-connected acquired psychiatric disorder; (2) denied an initial rating in excess of 30 percent for residual hypothyroidism, status post Grave’s disease; (3) denied an earlier effective date for the grant of service connection for the acquired psychiatric disorder; and, (4) denied an earlier effective date for the grant of service connection for residual hypothyroidism, status post Grave’s disease. The Veteran appealed to the United States Court of Appeals for Veteran’s Claims (Court). In August 2020, the Veteran’s representative and the VA General Counsel filed a joint motion for partial remand (JMPR) as the parties had agreed that when the Board issued its October 2019 decision, the Board failed to address the expressly raised argument by the Veteran’s counsel that separate ratings are warranted for radiculopathy of the bilateral lower extremities. On remand, the Board must “reexamine the evidence of record, seek any other evidence the Board feels is necessary, and issue a timely, well-supported decision in this case.” However, the parties specifically noted that the Board had granted entitlement to an increased rating of 20 percent for the Veteran’s service-connected spine disability and that this is a favorable finding that the Court may not disturb. The Court granted the JMPR in August 2020. The case has now been returned to the Board for appellate review. Consistent with the August 2020 JMPR, the Board has added the issues of entitlement to service connection for radiculopathy, left lower extremity, and radiculopathy, right lower extremity. Also consistent with the August 2020 JMPR, the Board will leave undisturbed the 20 percent rating assigned for the Veteran’s service-connected spine disability, and only assess whether the Veteran is entitled to a rating in excess of 20 percent. The issues of an increased rating for the acquired psychological disorder and residual hypothyroidism, status post Grave’s disease, are addressed in the decision below, along with the request for earlier effective dates of their respective grants of service connection. The issues concerning service connection for radiculopathy of the left and right lower extremities, as well as the increased rating claim for the service-connected lumbosacral strain with scoliosis, are addressed in the REMAND section below. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4 (2018). The 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 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 (2012); 38 C.F.R. § 4.1 (2018). 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 (2018). Consideration of the whole recorded history is necessary so that a rating may accurately compensate the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31 (1999). 1. Entitlement to a rating in excess of 30 percent prior to December 12, 2019, and in excess of 50 percent thereafter, for an acquired psychiatric disorder. Under the General Rating Formula for Mental Disorders, a 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care and conversation normal), due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, and recent events). A 50 percent evaluation will be assigned with evidence of occupational and social impairment with reduced reliability and productivity due to such symptoms as: a flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as: suicidal ideations; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of the veteran’s personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform the activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. The Veteran underwent a VA psychiatric examination in September 2011. The examiner noted the Veteran did not have a current diagnosis of PTSD, but he did have a diagnosis of “mood disorder due to general medical condition (Grave’s disease and thyroidectomy).” No other mental disorder was diagnosed. The examiner noted the Veteran’s symptoms included chronic sleep impairment, flattened effect, and disturbances of motivation and mood. The examiner noted at that time, the Veteran reported he has been with his wife for the last 16 years; that they have been married for six years; and that they have a five-year-old child. The Veteran reported he has a good relationship with his wife, but he gets angry at times, yelling and screaming, which scares the child. He reports that he liked the Army but was discharged medically for back problems. He reported he worked a few years for security firms and has worked for last 13 years at a cable company. He reported he has been counseled on the job for a poor attitude (grump, negative, and angry). Patient reports he has problems with his wrist which has had him on light duty at work and that this is both stressful and depressing. The examiner opined the Veteran has occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran underwent a private examination for mental disorders in April 2014. The examiner diagnosed the Veteran with post-traumatic stress disorder (PTSD) and unspecified depression. The examiner noted the Veteran stated he was deployed to Iraq during the Gulf War and was a member of a long-range reconnaissance team. He reported his team was responsible for retrieving enemy bodies and body parts; and putting them into mass graves - a job he described as "surreal." He also stated he was almost killed on 3 occasions. When asked how his military experiences affect him today, he said he continues to have nightmares and his wife tells him he talks, thrashes and becomes violent in his sleep. He often checks the locks on doors and windows, and he looks outside for any possible intruders or dangers. He never really feels completely safe. In public places, he is vigilant and aware of people in his environment. In restaurants, he sits close to the exit and must be able to see everyone present. In the grocery, he gets irritated with people who are going to slow or get in the way. He watches people and is vigilant to any sign he might be carrying a firearm. He notes people’s posture and the way they sit. He is easily irritated and avoids most unfamiliar public places. The examiner noted the Veteran reported he was not motivated or driven to do anything; he had poor memory and concentration; and, he denied auditory or hallucinations. In terms of family life, he was married with a 7-year-old son. At work, he reported difficulty and irritability but is usually able to conceal his emotions from coworkers and supervisors. The Veteran underwent another VA psychiatric examination in December 2019. The examiner noted the Veteran had 2 current diagnoses: (1) Other Specified Mental Disorder Due to Another Medical Condition; and (2) Other Specified Trauma and Stressor-Related Disorder. The examiner stated there is significant overlap and interdependence of symptoms such that differentiating what symptoms are related to each diagnosis cannot be done in whole without resorting to mere speculation. The examiner noted the Veteran’s symptoms include depressed mood; anxiety; suspiciousness; chronic sleep impairment; flattened affect; disturbances of motivation and mood; and impaired impulse control, such as unprovoked irritability with periods of violence. The examiner noted the Veteran’s speech was normal in volume, rate and prosody. Some increased psychomotor activity was observed. Eye contact was poor-to-fair. He was cooperative with the evaluation. Mood appeared depressed and anxious. Affect was generally restricted. There was no evidence of hallucinations or delusional thoughts. There is no gross indication of thought disorder. No obsessions or compulsions were observed. Insight is fair. Judgement appears adequate. Memory and concentration appeared mildly impaired, secondary to mood and anxiety. He denied current suicidal or homicidal ideation, plans, or intent. The examiner opined that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. VA treatment records from the Albuquerque VAMC are associated with the Veteran’s claims file. In summary, these records reflect diagnosis and treatment for PTSD and depression over the years, to include medication and therapy. In a February 2015 letter, a readjustment counseling therapist at the Vet Center stated he met the Veteran in October 2014; that the Veteran completed the intake process in November 2014 where he was diagnosed with PTSD; and, that the Veteran has been seen for individual treatment. The therapist also stated that due to the severity of the Veteran’s PTSD symptoms, he requires continued care for the foreseeable future. Lay evidence has also been associated with the Veteran’s claim file. In March 2015, statements were received from the Veteran, the Veteran’s wife, the Veteran’s mother-in-law who is a licensed massage therapist, and a fellow soldier. The Veteran stated he was not an angry person before he went into military – he was very easy going, had a lot of friends, and an active social life. However, he said i the years following service, he found his anger and depression getting worse, most of the times over some very small things in his life or with his family. The Veteran’s wife stated that on a daily basis, the Veteran suffers from knee pain, back pain, headaches, odd rashes that seem to come out of nowhere, depression, anger that escalates to uncontrollable rage, extreme sleeping issues from insomnia to exhaustion, diarrhea, shaking extremities, and now he is having memory problems. Based on the above, the Board finds that the currently assigned 30 percent disability rating prior to December 12, 2019, and 50 percent rating thereafter are appropriate. Prior to December 12, 2019, the Veteran’s symptoms are not shown to more nearly approximate occupational and social impairment with reduced reliability and productivity. Indeed, the Veteran reported continuing to maintain a good relationship with his wife and son, although he did note that he got angry at times, and long-term employment. Although he reported chronic sleep impairment, flattened effect, and disturbances of motivation and mood, there is no evidence showing impaired judgment or thinking or difficulty establishing and maintaining relationships during this time. Compellingly, the Board notes that the VA examiner during this period found the Veteran’s symptomatology to be mild and, at most, to cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. This level of symptomatology corresponds to no more than the 30 percent rating currently assigned prior to December 12, 2019. From December 12, 2019, the Board finds that a rating of 70 percent is not appropriate. This is so because the record does not reflect a time when the Veteran exhibited symptoms of the type, extent, frequency, or severity indicative of those identified as warranting a 70 percent rating, such as suicidal ideations; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of the veteran’s personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Here, the Veteran has consistently maintained a relationship with his wife and son. Therefore, the Board finds that he does not have deficiencies in family relations. There is no evidence that the Veteran experienced near-continuous panic or depression or that he has demonstrated impairment of judgment or thinking. No suicidal or homicidal ideation has been reported. To the contrary, the December 2019 VA examiner specifically found those symptoms not to be present, finding instead that the Veteran’s symptomatology caused no more than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. In sum, the Board finds that the level of severity of the Veteran’s psychiatric symptoms do not support the assignment of a 70 percent rating on and after December 12, 2019. The Board further finds that a rating of 100 percent is not appropriate in this case at any point during the appeal period. This is so because the record does not reflect a time when the Veteran exhibited symptoms of the type, extent, frequency, or severity indicative of those identified as warranting a 100 percent rating, such as gross impairment in thought process or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. Thus, a 100 percent rating is not warranted for the Veteran’s acquired psychiatric disorder at any point during the appeal period. The Board is aware that the presence or absence of specific symptoms, which correspond to a particular rating, is not dispositive. 38 C.F.R. § 4.130; Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). However, as noted above, the evidence does not show that the Veteran’s symptomatology is more severe than considered by the 30 percent disability rating assigned prior to December 12, 2019, and the 50 percent disability rating assigned thereafter. The Board has also considered the lay statements from the Veteran and the Veteran’s family members. Lay persons are competent to provide opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, in this case, such an opinion falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). To the extent that the Veteran and his spouse, sister, and father-in-law contend that his acquired psychiatric disability is more severe than evaluated, while they are competent to describe his symptoms, they are not competent to report that his acquired psychiatric disability is of sufficient severity to warrant a certain percent evaluation under VA’s criteria for rating an acquired psychiatric disability, as such an opinion requires medical expertise which they do not possess. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau, 492 F.3d 1372. As such, the Board concludes that the preponderance of the evidence is against the claims for a disability rating in excess of 30 percent for an acquired psychiatric disorder prior to December 12, 2019, and in excess of 50 percent thereafter. 38 U.S.C. § 5107(b). The benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 49. 2. Entitlement to a rating in excess of 30 percent for residual hypothyroidism, status post Grave’s disease. The Veteran is currently service-connected for hypothyroidism and seeks an increased rating. His hypothyroidism is currently rated as 30 percent disabling under Diagnostic Code 7903. Under Diagnostic Code 7903, a maximum 100 percent rating is assigned for hypothyroidism with myxedema (cold intolerance, muscular weakness, cardiovascular involvement (including, but not limited to hypotension, bradycardia, and pericardial effusion) and mental disturbance (including, but not limited to dementia, slowing of thought, and depression)). Note 1 following the 100 percent rating states: This rating is to continue for 6 months beyond the date an examining physician has determined crisis stabilization. Thereafter, the residual effects of hypothyroidism shall be rated under the appropriate diagnostic code(s) within the appropriate body system(s) (e.g., eye, digestive, and mental disorders). A 30 percent rating is assigned for hypothyroidism without myxedema. Note 2 following the 30 percent rating states: This rating is to continue for 6 months after initial diagnosis. Thereafter, rate residuals of disease or medical treatment under the most appropriate diagnostic code(s) under the appropriate body system (e.g., eye, digestive, mental disorders). Note 3 following the 30 percent rating states: If eye involvement, such as exophthalmos, corneal ulcer, blurred vision, or diplopia, is also present due to thyroid disease, also separately evaluate under the appropriate diagnostic code(s) in §4.79, Schedule of Ratings—Eye (such as diplopia (DC 6090) or impairment of central visual acuity (DCs 6061-6066)). Private treatment records from the Mayo clinic are associated with the Veteran’s claim file. A June 2010 record reflects the Veteran was seen for Grave’s disease. The examiner noted the Veteran’s primary symptoms were heat intolerance, irritability, some loose stools, and fairly marked tremors. He did not report any heart palpitations or weight loss. He did note some dyspnea on exertion. It was noted thyroid blood tests revealed his TSH was 0.02, his total T4 was 19.1, and normal range is 4.5 to 12.0. A thyroid scan showed a homogeneous bilateral uptake, although the right upper lobe did appear to be somewhat hypofunctioning. Treatment options were discussed, and the Veteran confirmed he wanted to pursue radioactive iodine therapy. Private treatment records from a private physician are associated with the Veteran’s claim file. A June 2010 record reflects the Veteran’s primary symptoms include heat intolerance, irritability, some loose stools, and fairly marked tremors. He has not really reported any heart palpitations or weight loss. He has noted some dyspnea on exertion. A July 2010 record reflects the Veteran reported he is feeling about the same, although he thinks his heat intolerance and tremors have improved. A September 2010 record reflects the Veteran has Grave’s disease and underwent ablation July 11th. He feels much improved, not quite back to normal but his tremors have resolved, he has gained some weight, and overall feels better. The Veteran underwent a general VA examination in January 2011. The examiner noted a diagnosis of Grave’s disease and that records from June 2010 describes symptoms of heat intolerance, irritability, loose stools, marked tremors with no palpitations, weight changes at that time. His TSH was 0.2 with increased total T4, and a thyroid scan was completed revealing homogeneous bilateral uptake with somewhat hypofunctioning right upper lobe. He was started on atenolol 25 mg q.d. (has since stopped per Veteran.) His thyroid was noted to be twice the size of a normal thyroid and he was diagnosed with hyperthyroidism and radio-active iodine treatment was recommended with symptoms and findings consistent with Grave’s disease. Veteran states he had one treatment with radioactive iodine in August 2010. He denies any neck symptoms. He states he is short of breath with moderate exertion, but denies any cough, wheezing, hemoptysis, night sweats, history of hypertension, angina, dizziness, syncope, fever, or weight loss. He does have fatigue, but attributes this to trouble sleeping and states he gets 5 hours if he is lucky and he has had problems with insomnia for the past 20 years or so. The examiner noted the following diagnosis: history of Grave’s disease, status post radiation with residual hypothyroidism. The Veteran underwent a private examination in November 2017. The examiner stated he was asked to render an opinion regarding service connection for Grave’s Disease. The examiner opined that the Veteran’s diagnosis of Grave’s disease with subsequent hypothyroidism, as well as his other symptoms, to include tremor, headaches, exhaustion, cognitive dysfunction, rashes, arthralgias and myalgias, and diarrhea were a textbook description of “Gulf War Syndrome.” The Veteran underwent another VA examination in January 2020. The examiner noted a diagnosis of status post Grave’s disease with residual hypothyroidism; that the Veteran has radioactive iodine treatment (ablation) in 2011; and, that he has ongoing treatment with Synthroid. The examiner noted the Veteran reported that since his last exam, nothing is new; his doctor still cannot find a steady dose of his meds, and the dose keeps changing. He states he notes his pulse rate and other symptoms vary with medication dose changes - nothing consistent. Upon physical exam, his eyes were normal; his neck was normal; and, his pulse was regular. The examiner stated the Veteran does not currently have any findings, signs or symptoms attributable to his thyroid condition. Post service VA treatment records from the Albuquerque VAMC are associated with the Veteran’s claims file. A June 2019 primary care note reflects the Veteran underwent a review of systems. As for his endocrine system, the examiner noted there was no polydipsia, heat or cold intolerance, or weight changes. Based on the above, the Board finds that a staged rating is appropriate for the Veteran’s service-connected residual hypothyroidism, status post Grave’s disease. While the evidence is clear that the Veteran does not have any current symptoms, it is also clear that when the Veteran was first diagnosed in 2010, the Veteran exhibited many of the symptoms that fall in the 100 percent rating criteria, namely cold intolerance, muscular weakness, fatigue, dyspnea on exertion, exhaustion and mental disturbance including depression. Further the evidence shows these symptoms did not abate until after the Veteran underwent ablation on July 11, 2010. As noted in the treatment records referenced above, a September 2010 record reflects the Veteran stated he felt much improved, not quite back to normal, but his tremors have resolved, he has gained some weight, and overall, he feels better. As such, in light of the evidence noted above, and consistent with Note 1that follows the rating criteria for a 100 percent rating (that this rating is to continue for 6 months beyond the date an examining physician has determined crisis stabilization), the Board finds that a 100 percent rating is warranted for the period on appeal prior to March 1, 2011 - a date that is 6 months after the September 2010 record that reflects crisis stabilization. For the period from March 1, 2011 onward, the Board concludes that the preponderance of the evidence is against the claim for a disability rating in excess of 30 percent as the Veteran is not shown to have exhibited symptoms consistent with a 100 percent rating for hypothyroidism with myxedema (cold intolerance, muscular weakness, cardiovascular involvement (including, but not limited to hypotension, bradycardia, and pericardial effusion) and mental disturbance (including, but not limited to dementia, slowing of thought, and depression)). The January 2020 VA examiner specifically stated the Veteran does not currently have any findings, signs or symptoms attributable to his thyroid condition. This position is supported by the VA treatment records, as a June 2019 record reflects, upon review of the Veteran’s endocrine system, there is no polydipsia, heat or cold intolerance, or weight changes. As such, the Board concludes that the preponderance of the evidence is for granting a 100 percent disability rating for residual hypothyroidism, status post Grave’s disease for the period prior to March 1, 2011; and against the claim for a disability rating in excess of 30 percent for the period thereafter. 38 U.S.C. § 5107(b). For the latter, the benefit-of-the-doubt rule does not apply, and the claim must be denied (in part). 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 49. Effective Date(s) Generally, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. In deciding this case based on its application of the law to the pertinent facts, the Board notes that the “date of receipt” of claim means the date on which the claim was received by VA, except as to specific provisions for claims received in the State Department, the Social Security Administration, or the Department of Defense. 38 C.F.R. § 3.1(r). 3. Entitlement to an earlier effective date for the grant of service connection for an acquired psychiatric disorder. The Veteran seeks an effective date earlier than August 22, 2011, for the grant of service connection for an acquired psychiatric disorder. More specifically, the Veteran contends in his September 2019 NOD that he is entitled to an effective date of June 21, 2010 – the date he filed his service connection claim for “Gulf War Syndrome/Grave’s disease” – because in support of this claim, he had submitted numerous statements which showed he endorsed anger and described noticeable behavioral changes since service. Upon review of the record, the Board finds that there is no basis to grant an effective date prior to August 22, 2011, for the award of service connection for an acquired psychiatric disorder. The law is clear that the effective date for an original claim for service connection is the date of receipt of the claim or the date entitlement arose, whichever is later. Here, the Veteran filed an initial claim for service connection for post-traumatic stress disorder (PTSD) that was received by VA on August 22, 2011. As such, the date of receipt of claim is August 22, 2011. Thus, even assuming that entitlement to service connection for an acquired psychiatric disorder arose prior to that date, the earliest possible effective date of a grant of service connection for an acquired psychiatric disorder would be the date the initial service connection claim was received—August 22, 2011. Contrary to the Veteran’s contentions, the record does not establish that he made an “informal” claim for an acquired psychiatric disorder on June 21, 2010. In the various filings the VA received from the Veteran on the date of June 21, 2010, the Veteran made clear that he was requesting service-connection for Gulf War Syndrome/Grave’s disease, and that he was also seeking an increased rating for his service-connected lumbar strain. He did not make a claim of any type of acquired psychological disorder at that time. The Board acknowledges the lay statements and buddy statements that note the Veteran had anger and irritability problems, but the Board finds that the evidence does not establish an etiological relationship, or nexus, between the Veteran’s acquired psychological disorder and his service until the April 30, 2014 examination report by a private licensed clinical psychologist that gave a diagnosis of PTSD and opined that the Veteran developed PTSD in response to his time in the military. As discussed above, the law provides that the effective date of a claim will be the date of receipt of the claim or the date entitlement arose, whichever is the later. In this case, the Veteran filed his claim on August 22, 2011, and the date entitlement arose was April 30, 2014 – the date of the private exam that provided a nexus between the Veteran’s acquired psychiatric disorder and his service. As such, there is no evidence or argument to support an effective date for the grant of service connection prior to August 22, 2011.This is the earliest effective date possible based upon the facts in this case and the law and regulations. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). An effective date earlier than August 22, 2011 for service connection for an acquired psychiatric disorder is not warranted. 4. Entitlement to an earlier effective date for the grant of service connection for residual hypothyroidism, status post Grave’s disease. The Veteran seeks an effective date earlier than June 21, 2010, for the grant of service connection for residual hypothyroidism, status post Grave’s disease. No specific earlier date was listed in the Veteran’s September 2019 NOD for this claim. Upon review of the record, the Board finds that there is no basis to grant an effective date prior to June 21, 2010, for the award of service connection for an acquired psychiatric disorder. The law is clear that the effective date for an original claim for service connection is the date of receipt of the claim or the date entitlement arose, whichever is later. Here, the Veteran filed an initial claim for service connection for Grave’s disease that was received by VA on June 21, 2010. As such, the date of receipt of claim is June 21, 2010. Thus, even assuming that entitlement to service connection for residuals of Grave’s disease arose prior to that date, the earliest possible effective date of a grant of service connection for residuals of Grave’s disease would be the date the initial service connection claim was received—June 21, 2010. As for the date entitlement arose, the Board notes that the evidence does not establish an etiological relationship between the Veteran’s residuals of Grave’s disease and his service until the November 16, 2017 examination report by a private physician who opined that the Veteran’s diagnosis of Grave’s disease with subsequent hypothyroidism, as well as his other symptoms, to include tremor, headaches, exhaustion, cognitive dysfunction, rashes, arthralgias and myalgias, and diarrhea were a textbook description of “Gulf War Syndrome.” As discussed above, the law provides that the effective date of a claim will be the date of receipt of the claim or the date entitlement arose, whichever is the later. In this case, the Veteran filed his claim on June 21, 2010, and the date entitlement arose was November 16, 2017 – the date of the private exam that provided a nexus between the Veteran’s residual hypothyroidism status post Grave’s disease and his service. As such, there is no evidence or argument to support an effective date for the grant of service connection prior to June 21, 2010. This is the earliest effective date possible based upon the facts in this case and the law and regulations. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). An effective date earlier than June 21, 2010 for service connection for residual hypothyroidism status post Grave’s disease is not warranted. REASONS FOR REMAND 1. Entitlement to a rating in excess of 20 percent for lumbosacral strain with scoliosis is remanded. 2. Entitlement to service connection for radiculopathy, left lower extremity is remanded. 3. Entitlement to service connection for radiculopathy, right lower extremity is remanded. The Board finds that additional action is required prior to appellate review of the Veteran’s claims for service connection for radiculopathy of the left and right lower extremity, as well as the Veteran’s claim for entitlement to a rating in excess of 20 percent for lumbosacral strain with scoliosis. As noted above, in August 2020, the Veteran’s representative and the VA General Counsel filed a JMPR as the parties had agreed that when the Board issued its October 2019 decision, the Board failed to address the expressly raised argument by the Veteran’s counsel that separate ratings are warranted for radiculopathy of the bilateral lower extremities. On remand, the parties agreed that the Board must “reexamine the evidence of record, seek any other evidence the Board feels is necessary, and issue a timely, well-supported decision in this case.” Consistent with the JMPR, a VA examination for the Veteran’s claimed radiculopathy of his left lower extremity and right lower extremity must be obtained. The examiner must address whether any diagnosed radiculopathy in either his left lower extremity, right lower extremity, or both, are secondary to his service-connected lumbar spine disorder, or otherwise due to his military service. To the extent that any diagnosed radiculopathy of the lower extremities may also impact the rating for the Veteran’s service-connected lumbar spine disorder, the Board finds these issues are intertwined and as such, a new VA examination should also be obtained for the Veteran’s service-connected lumbosacral strain with scoliosis. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination with an appropriate medical professional to determine the current nature and etiology of his claimed radiculopathy of the left and right lower extremity. The entire claims file must be made available to, and reviewed by, the examiner. The examiner must opine as to whether it is at least as likely as not (50 percent or greater probability) that: • the Veteran’s radiculopathy of the left and/or right lower extremity, had its onset in service, within one year of separation from service, or is otherwise directly related to his service; • the Veteran’s radiculopathy of the left and/or right lower extremity was caused by his service-connected lumbosacral strain with scoliosis (lumbar spine disability); and • the Veteran’s radiculopathy of the left and/or right lower extremity was aggravated by his service-connected lumbosacral strain with scoliosis (lumbar spine disability). The examiner is advised that the Veteran is competent to report history and symptoms, and that his reports must be considered in formulating the requested opinion. If the examiner rejects the Veteran’s reports, the examiner should provide a rationale for doing so. 2. Schedule the Veteran for an examination with an appropriate medical professional to determine the current severity of his service-connected lumbosacral strain with scoliosis (lumbar spine disability). The entire claims file must be made available to, and reviewed by, the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner must test the range of motion in active motion, passive motion, weight-bearing, and non-weight-bearing, for the joint in question. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner must describe any functional limitation due to pain, weakened movement, excess fatigability, pain with use, or incoordination. Additional limitation of motion during flare-ups and following repetitive use due to limited motion, excess motion, fatigability, weakened motion, incoordination, or painful motion should be noted. If the Veteran describes flare-ups of pain, the examiner must offer an opinion as to whether there would be additional limits on functional ability during flare-ups. All losses of function due to problems such as pain should be equated to additional degrees of limitation of flexion and extension beyond that shown clinically. The examiner must also discuss any functional impact caused by the Veteran’s lumbar spine disability. N. RIPPEL Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Jiggetts 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.