Citation Nr: 21022737 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 19-06 714 DATE: April 19, 2021 ORDER Prior to November 20, 2018, entitlement to a compensable rating for a right anterior tibia scar is denied. From November 20, 2018, entitlement to a rating in excess of 10 percent for a right anterior tibia scar is denied. Prior to August 14, 2015, entitlement to an increased initial rating of 50 percent for posttraumatic stress disorder (PTSD) is granted. Entitlement to an initial rating in excess of 50 percent for PTSD is denied. Entitlement to an initial rating in excess of 30 percent for diverticulitis with gastroesophageal reflux disease (GERD) is denied. Entitlement to an effective date earlier than June 20, 2015 for the grant of service connection for left lower extremity radiculopathy is denied. REMANDED Entitlement to an increased rating for osteoarthritis of the cervical spine, rated as 10 percent disabling prior to July 30, 2020 and 20 percent disabling thereafter, is remanded. Entitlement to a rating in excess of 20 percent for osteoarthritis with osteophytes of the lumbar spine is remanded. Entitlement to an initial rating in excess of 20 percent for left lower extremity radiculopathy is remanded. Entitlement to an increased rating for headaches, muscle contraction post head trauma, rated as 30 percent disabling from June 20, 2015 to August 24, 2015 and noncompensable thereafter, is remanded. Entitlement to a total disability rating based upon individual unemployability (TDIU) prior to June 20, 2015 is remanded. Entitlement to eligibility for Dependency and Educational Assistance (DEA) benefits prior to June 20, 2015 is remanded. FINDINGS OF FACT 1. Prior to November 20, 2018, the Veteran’s right anterior tibia scar was essentially asymptomatic, with no functional limitation. 2. From November 20, 2018, the Veteran’s right anterior tibia scar has been shown to be painful; there is no evidence of instability or other associated functional impairment. 3. During the entire appeal period, the Veteran’s PTSD has caused occupational and social impairment with reduced reliability and productivity due to such symptoms as disturbances of motivation and mood and difficulty in establishing and maintaining effective relationships; more severe occupational and social impairment has not been established. 4. During the entire appeal period, the Veteran’s diverticulitis with GERD has been manifested by alternating diarrhea and constipation with bowel disturbance; there is no evidence he experienced adhesions, weight loss, malnutrition, or other symptom combinations productive of severe impairment of health. 5. In a June 2013 rating decision, the Regional Office (RO) denied entitlement to an increased rating for the Veteran’s lumbar spine disability. The Veteran did not appeal that decision. 6. On June 20, 2015, VA received the Veteran’s claim for an increased rating for his lumbar spine disability; no communication or medical evidence received prior to that date established entitlement to service connection for left lower extremity radiculopathy. CONCLUSIONS OF LAW 1. Prior to November 20, 2018, the criteria for a compensable rating for a right anterior tibia scar were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code (DC) 7804. 2. From November 20, 2018, the criteria for a rating in excess of 10 percent for a right anterior tibia scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, DC 7804. 3. Prior to August 14, 2015, the criteria for an increased initial 50 percent rating for PTSD were met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, DC 9411. 4. The criteria for an initial rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, DC 9411. 5. The criteria for an initial rating in excess of 30 percent for diverticulitis with GERD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, DC 7323-7319. 6. The criteria for an effective date earlier than June 20, 2015 for the grant of service connection for left lower extremity radiculopathy were not met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 1964 to September 1968 and from April 1976 to July 1990. These matters arose to the Board of Veterans’ Appeals (Board) from October 2015, November 2015, and December 2018 rating decisions issued by a Department of Veterans Affairs (VA) RO. In April 2020, the Board determined the Veteran had submitted a timely notice of disagreement with respect to several issues that had not been readjudicated. Consequently, the Board directed the RO to issue a Statement of the Case (SOC) readjudicating those issues, pursuant to Manlincon v. West, 12 Vet. App. 238 (1999). In June 2020, the RO issued a SOC denying entitlement to an earlier effective date for the award of service connection for diverticulitis and GERD. The Veteran did not perfect his appeal as to that issue. Then, in September 2020, the RO issued another SOC readjudicated the remaining seven issues identified by the Board. The Veteran perfected his appeal as to those issues by filing a VA Form 9 in November 2020. Also in April 2020, the Board remanded the issues of entitlement to service connection for bilateral hearing loss, entitlement to increased initial ratings for PTSD and diverticulitis with GERD, and entitlement to a total disability rating based upon individual unemployability (TDIU) for additional evidentiary development. Service connection for bilateral hearing loss was subsequently granted by the RO; that issue is no longer on appeal. In addition, TDIU was ultimately awarded, effective June 20, 2015. The remaining issues on appeal, to include entitlement to an earlier effective date for the award of TDIU, are addressed herein. In August 2020, the Board remanded the issues of entitlement to an increased rating for headaches and entitlement to an earlier effective date for the establishment of basic eligibility for Dependents’ Educational Assistance (DEA) benefits. These issues are addressed herein. Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 (2020). There is no evidence of any VA error in notifying or assisting the Veteran that reasonably affects the fairness of this adjudication. See 38 C.F.R. § 3.159. Neither the Veteran nor his lawyer have raised any other issues with the duty to notify or duty to assist; the Veteran’s lawyer has submitted numerous statements containing boilerplate legal arguments but has made no specific allegations of errors on VA’s part other than general requests for increased disability compensation. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Increased Rating Claims Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. The veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). As with all claims for VA disability compensation, the Board must assess the credibility and weigh all the evidence, including lay and medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert denied, 523 U.S. 1046 (1998). 1. Entitlement to an increased rating for a right anterior tibia scar The Veteran’s right anterior tibia scar is currently rated as noncompensable prior to November 20, 2018 and 10 percent disabling thereafter. His symptoms are rated under DC 7804; however, the Board will briefly address all DCs pertinent to scars. See 38 C.F.R. § 4.118. Under DC 7804, a 10 percent rating is warranted for one or two scars that are unstable or painful. A 20 percent rating is warranted for three or four scars that are unstable or painful. A 30 percent rating is warranted for five or more scars that are unstable or painful. Id. at DC 7804. Note (1) to DC 7804 provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, the rater should add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3) provides that scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under DC 7804, when applicable. Id. DC 7805 provides that VA should evaluate any disabling effect(s) not considered in a rating provided under DCs 7800-7804 under an “appropriate” DC. Id. at DC 7805. DC 7800 addresses scars of the head, face, or neck; as the Veteran’s scar is on his right leg, DC 7800 is not applicable. Id. at DC 7800. DC 7801 addresses scars not of the head, face, or neck that are deep and nonlinear; under DC 7801, a 20 percent rating is warranted for scarring with an area or areas of at least 12 square inches (77 square cm) but less than 72 square inches (465 square cm). Id. at DC 7801. However, because the Veteran’s scar is not large enough to warrant an increased rating under DC 7801, that DC is likewise inapplicable. Scars on areas other than the head, face, or neck that are superficial and that do not cause limited motion are rated pursuant to DC 7802. Under DC 7802, a 10 percent rating is warranted for scar(s) with an area or areas of 144 square inches (929 sq. cm.) or greater. Id. at DC 7802. Here, again, there is no evidence of record to suggest that the Veteran’s right anterior tibia scar is large enough to warrant a compensable rating under these criteria. On review, the Board finds increased ratings are not warranted in this case. The record reflects the Veteran underwent VA Compensation and Pension (C&P) examinations for scars in August 2015, November 2018, and September 2020. The August 2015 C&P report noted the Veteran had a single, linear, healed scar on the medial aspect of his right leg; the scar was 5 cm x 0.3 cm. The examiner noted the scar was not painful or unstable. No functional impact was noted. The November 2018 C&P report noted the Veteran’s complaints of intermittent pain in his right tibia scar; he denied any treatment or limitations in his activities due to the scar, however. The examiner noted the presence of a single scar on the Veteran’s right leg that was painful, itchy, and tender. There was no loss of covering or other signs of instability. No functional impairment was noted. On the basis of this report, demonstrating the Veteran’s right anterior tibia scar had become painful, the RO awarded the Veteran a compensable evaluation, effective on the date of the examination. The September 2020 C&P report indicates the Veteran reported occasional pain and itching regarding his right anterior tibia scar. The examiner noted the Veteran had painful scars on his abdomen (which are separately service-connected) but found no evidence of instability. The examiner in fact noted the Veteran’s right anterior tibia scar was not painful to palpation. No functional limitation was noted. The Board has reviewed the Veteran’s VA treatment records, which do not indicate treatment for any scar-related symptoms. In addition, the Board notes the Veteran has not identified any specific symptoms pertaining to his right anterior tibia scar that were not described by the C&P reports discussed above. On the contrary, the Veteran has made no specific allegations with respect to this claim. The Board finds the preponderance of the evidence is against entitlement to a compensable rating prior to November 20, 2018, or to a rating in excess of 10 percent thereafter. Prior to the November 2018 C&P examination, there is no evidence to indicate the Veteran’s right anterior tibia scar was painful, unstable, or indeed symptomatic in any way. The August 2015 C&P examination report reflects the Veteran denied any symptoms associated with his right leg scar, and there is no subsequent clinical or lay evidence (prior to the November 2018 C&P examination) indicating the onset of pertinent symptoms. From November 20, 2018, there is no probative evidence of record demonstrating the Veteran has three or more scars, or similar symptoms, that are painful or unstable, as is required for a higher rating under DC 7804. See 38 C.F.R. § 4.118. As noted above, the C&P examination reports reflect the Veteran has a single scar that is tender but not unstable. There is no probative evidence calling these findings into question. There is likewise no evidence to suggest the Veteran’s scar (or any other residual symptoms) cover an area of at least 77 square cm—the criteria for an increased 20 percent evaluation under DC 7801. See id. at DC 7801. The Board has considered the Veteran’s lay statements of record; however, the record does not indicate he has made any specific assertions with respect to his right anterior tibia knee scar, other than what was noted on the C&P examination reports. The initial noncompensable rating is consistent with his report of asymptomatic scarring, and the 10 percent rating, effective November 20, 2018, is likewise consistent with a single, painful, stable scar. Thus, the Board finds the Veteran’s lay statements are consistent with the objective findings noted above and align with the criteria for an initial noncompensable rating and an increased 10 percent rating as of November 20, 2018. There is no evidence to suggest any symptoms that have resulted in functional impairment beyond that which is contemplated by the Veteran’s current staged rating. In sum, the evidence deemed most probative by the Board establishes that the Veteran’s right tibia scar was essentially asymptomatic prior to November 20, 2018, and thereafter has been manifested by a single, painful scar. There are no additional symptoms which warrant compensable evaluations under any other DC. Neither the Veteran nor his lawyer have raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the record). The claim for an increased rating is denied. 2. Entitlement to an increased initial rating for PTSD The Veteran contends he is entitled to an initial rating in excess of 30 percent for his PTSD, and to a rating in excess of 50 percent from August 14, 2015. The Veteran’s symptoms are rated under 38 C.F.R. § 4.130, DC 9411. All psychiatric disabilities are evaluated under a general rating formula for mental disorders. Under the general rating formula, a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: 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; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation 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 ideation; 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 personal appearance and hygiene; difficulty in adapting to stressful situations (including work or a worklike setting); and inability to establish and maintain effective relationships. Id. Finally, a total schedular rating of 100 percent is warranted when the disorder results in 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 activities of daily living (including maintenance of mental and personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The symptoms listed in the rating schedule are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Nevertheless, all ratings in the general rating formula are associated with objectively observable symptomatology, and in Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013), the Federal Circuit stated that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” The Federal Circuit further noted that “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” Id. Thus, “[a]lthough the veteran’s symptomatology is the primary consideration, the regulation also requires an ultimate factual conclusion as to the veteran’s level of impairment in ‘most areas.’” Id. at 118. As such, the Board will consider both the Veteran’s specific symptomatology as well as the occupational and social impairment associated with the DC to determine whether an increased evaluation is warranted. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126; see Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). The rating agency shall assign an evaluation based upon all the evidence of record that bears on occupational and social impairment, rather than solely upon the examiner’s assessment of the level of disability at the moment of the examination. Id. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. Id. The “such symptoms as” language means “for example,” and does not represent an exhaustive list of symptoms that must be found before granting the rating of that category. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The list of examples provides guidance as to the severity of symptoms contemplated for each rating. Id. However, this fact does not make the provided list of symptoms irrelevant. See Vasquez-Claudio v. Shinseki, 713 F.3d 112, 116–17 (Fed. Cir. 2013). The Veteran must still demonstrate either the particular symptoms associated with the rating sought, or other symptoms of similar severity, frequency, and duration. Id. at 117. VA must engage in a holistic analysis that assesses the severity, frequency, and duration of the signs and symptoms of the psychiatric disability; quantifies the level of occupational and social impairment caused by those symptoms; and assigns an evaluation that most nearly approximates the level of occupational and social impairment. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). The Board notes that the Diagnostic and Statistical Manual, Fourth Edition, allowed for the assignment of Global Assessment of Functioning (GAF) scores, which are a scale reflecting the psychological, social, and occupational functioning on a hypothetical continuum of mental health illness. However, VA regulations were amended to adopt the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), which eliminated the use of GAF scores for evaluating mental illness. 80 Fed. Reg. 14,308 (Mar. 19, 2015). As GAF scores are no longer held to be an effective method of evaluating the severity of psychiatric disabilities, the Board will not rely on any GAF scores in adjudicating the present claim. Golden v. Shulkin, 29 Vet. App. 221, 224–26 (2018). In October 2012, the Veteran presented for an initial psychotherapy evaluation at his VA hospital. He was alert, cooperative, and fully oriented. He denied any past or current suicidal or homicidal ideation, plan, or intent. The Veteran reported sleep difficulties, recurring nightmares, and hypervigilance; he reported keeping a Japanese sword under his bed. He also reported being “physically assaultive” towards his wife in his sleep while dreaming about combat situations. He denied any history of mental health treatment. On mental status examination, the Veteran was appropriately dressed, his mood was euthymic, and his affect was even. It was noted the Veteran “mentioned experiencing transient suicidal thoughts but cited that he would not act on these thoughts as they are not consistent with his religious beliefs.” The Veteran received a VA C&P examination for his PTSD in February 2013. The report diagnosed the Veteran with adjustment disorder with depressive mood and determined the Veteran’s mental disability caused 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 reported he spent most of his days caring for his wife; he stated he had been mostly reclusive since he stopped working as a pastor about a year prior. The Veteran stated he began receiving treatment for mental health problems in October 2012. He had been working as a pastor until February 2012, when he quit; he explained he quit because he was frustrating with arguing among members of his church. The Veteran denied any legal problems or substance abuse. The examiner identified symptoms of depressed mood, anxiety, suspiciousness, and chronic sleep impairment. (No mental status examination was performed.) The examiner noted the Veteran did not appear to pose a threat to himself or others, and that his symptoms had a negligible impact on his functioning; however, over the past year he had been experiencing “significant” depressive symptoms and had been “increasingly reclusive.” In July 2014, a VA treatment note shows the Veteran experienced “paranoid delusions.” Over the next several months of follow-up treatment, he consistently denied suicidal or homicidal ideation. He continued to report sleep disturbances and concentration and memory difficulties. In September 2014, he reported issues with anger and cognitive difficulties, including progressive difficulties with memory; however, he denied hallucinations, delusions, or suicidal/homicidal ideation. In June 2015, the Veteran submitted a mental health symptom checklist wherein he reported symptoms of anger, anxiety, chronic sleep problems, denial, depression, difficulty making decisions, flashbacks, inability to make and keep friends, inappropriate behavior, intrusive thoughts, isolation, lack of self-esteem, memory loss, no friends, periods of violence, problems with communication, problems getting along with people, sense of helplessness, suspiciousness, and takes medications for mental conditions. The Veteran received a C&P examination in August 2015. The report reflects he met the criteria for a PTSD diagnosis due to negative alterations in mood and cognitions relating to recalling and focusing on the Veteran’s combat service in Vietnam. (He received the Purple Heart Medal and Combat Action Ribbon for his service, among other medals and decorations.) The examiner concluded the Veteran’s psychiatric symptoms caused 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. The Veteran stated that he lived with his wife and was close with several family members. He remained unemployed. He reported taking medication for his PTSD. His symptoms included depressed mood, anxiety, chronic sleep impairment, mild memory loss, and disturbances of motivation and mood. Additional symptoms included avoidance and intrusive thoughts. The examiner noted the Veteran’s mood was normal and his affect was appropriate. The Veteran continued to be followed for his PTSD symptomatology. His VA medical records show he experienced ongoing sleep disturbances and intrusive memories, among other symptoms. In August 2020, the Veteran underwent another C&P examination. The examiner determined the Veteran had occupational and social impairment with reduced reliability and productivity. His symptoms included depressed mood, anxiety, suspiciousness, panic attacks occurring weekly or less often, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances, including work or a work-like setting. After a thorough review of the evidence, the Board finds that, when resolving reasonable doubt in the Veteran’s favor, his symptoms warrant an increased initial rating of 50 percent prior to August 14, 2015. As discussed above, the evidence of record demonstrates the Veteran suffers from occupational and social impairment with reduced reliability and productivity throughout the appeal period with symptoms including disturbances of motivation and mood and difficulty in establishing and maintaining effective relationships. The Veteran’s lay statements and pertinent medical records demonstrate that, prior to August 14, 2015, he consistently experienced memory impairment, anger outbursts, social isolation, depressive symptoms, and reclusive tendencies—symptoms reasonably contemplated by the 50 percent rating criteria. The Board acknowledges the Veteran’s February 2013 C&P report seems to indicate less severe overall impairment. Notwithstanding, the report also reflects the examiner’s comment that the Veteran had recently quit his job, was “increasingly” isolated and reclusive, and was experiencing “significant” depressive symptoms. These can be said to constitute “disturbances of motivation and mood” and “difficulty in establishing and maintaining effective relationships,” both of which are included in the 50 percent criteria. See 38 C.F.R. § 4.130. When considered in conjunction with the Veteran’s outpatient treatment records and his lay descriptions of his symptoms, the Board finds the Veteran’s symptoms more nearly approximated a level of impairment consistent with a 50 percent rating. The Board further finds, however, that the Veteran’s disability picture has not more nearly approximated occupational and social impairment with deficiencies in most areas at any point during the appeal period. The record contains no evidence of illogical, obscure, or irrelevant thought content or speech; near-continuous panic or depression (as opposed to intermittent periods of panic or depression); obsessional or violent behavior; or an inability to establish and maintain effective relationships. The Board notes the Veteran has reported some difficulty in adapting to stressful circumstances; however, he has shown an ability to serve as a full-time caregiver for his wife who has suffered from significant mental health issues, thus indicating his ability to at least somewhat effectively manage stress. The Board has also considered various other symptoms reported by the Veteran, including sleep impairment, episodes of “fighting” in his sleep, depression, irritability, and anxiety—none of these symptoms are of similar severity, duration, or frequency as to warrant a 70 percent rating under the relevant criteria. The Board acknowledges the Veteran reported a history of transient suicidal ideation (as reported in his October 2012 initial psychiatric evaluation), which is one of the factors included in the 70 percent rating criteria. However, the C&P examination reports, VA outpatient records, and lay statements of record since that evaluation reflect the Veteran has not reported suicidal ideation since that time—indeed, he has repeatedly denied experiencing suicidal ideation. Moreover, the C&P reports of record include a broader discussion of the severity, frequency, and duration of the Veteran’s symptoms, with accompanying conclusions regarding the Veteran’s overall impairment. Thus, despite his history of suicidal ideation he has been shown to suffer from occupational and social impairment with no more than reduced reliability and productivity. The Veteran’s PTSD has not been shown to result in total occupational and social impairment, as the Veteran has been able to maintain close relationships (i.e., his marriage, albeit not without some strain). He therefore cannot be considered “totally” impaired socially or occupationally. (Dealing with interpersonal conflict at his church, which the Veteran stated was the reason for his quitting being a pastor, is not the same as being totally unable to function in a work environment.) Furthermore, the C&P examinations did not demonstrate that the Veteran suffered from gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, or a persistent danger of hurting self or others. He has also not been shown to have intermittent inability to perform activities of daily living, disorientation to time or place, or memory loss for names of close relatives, own occupation, or own name. No other symptoms of similar severity, frequency, and duration to those listed under the 100 percent criteria have been demonstrated. In sum, since the Veteran’s claim for service connection was granted, the evidence of record demonstrates that the overall impairment caused by his PTSD more nearly approximates occupational and social impairment with reduced reliability and productivity due to such symptoms as disturbances of motivation and mood and difficulty in establishing and maintaining effective relationships. More severe occupational and social impairment has not been established. Neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. at 369-70. The claim for an increased initial rating of 50 percent, but no higher, will be granted. 3. Entitlement to an increased initial rating for diverticulitis with GERD The Veteran contends his service-connected diverticulitis and GERD symptoms are more severe than what his current disability rating reflects. The Veteran is currently in receipt of an initial 30 percent rating under DC 7327- 7319. 38 C.F.R. § 4.114. Under DC 7319, a 30 percent rating is warranted for severe disability, with diarrhea or alternating diarrhea and constipation, with more or less constant abdominal distress. This appeal dates back to the Veteran’s claim for service connection. After careful review, the Board finds, for the reasons discussed below, that the Veteran’s symptomatology has more nearly approximated the criteria for a 30 percent rating—the maximum available schedular rating under DC 7319—for the entire appeal period. On review, the evidence of record reflects the Veteran’s symptoms can be fairly characterized as severe with alternating diarrhea and constipation, with more or less constant abdominal distress, since receipt of his claim. The Veteran’s VA outpatient notes show he has been followed throughout the appeal period for gastrointestinal distress and heartburn. In October 2015, the Veteran was afforded a VA C&P intestinal examination; the report revealed diverticulitis with alternating diarrhea and constipation, indigestion, and belching. The examiner further noted the Veteran had occasional episodes of bowel disturbance with abdominal distress. However, there was no indication of weight loss, malnutrition, or any other pertinent diagnoses or symptoms. The Veteran also received a C&P examination for stomach and duodenal conditions. The report confirmed symptoms of heartburn and indigestion as well as recurring episodes, at least monthly, of abdominal pain that was pronounced, continuous, and only partially relieved by standard ulcer therapy. Again, there was no evidence of anemia, weight loss, nausea, vomiting, hematemesis, or melena. There was no indication of incapacitating episodes or other conditions, to include peritoneal adhesions. In November 2018, the Veteran received esophageal and intestinal C&P examinations. The esophageal examination report noted the Veteran’s reports of recurrent heartburn precipitated by eating certain foods. The Veteran denied taking medication for his symptoms. The only symptom identified by the examiner was pyrosis. The intestinal conditions examination report confirmed a diagnosis of diverticulitis. The Veteran reported intermittent pain on his right side upon eating steak; the examiner noted this pain would subside after a few minutes without treatment. Continuous medication was not required. The examiner indicated the Veteran did not experience episodes of bowel disturbance with abdominal distress or exacerbations or attacks of his intestinal condition. There was no evidence of weight loss, malnutrition, or other health effects. In September 2020, the Veteran underwent a diverticulitis C&P examination. The report reflects a diagnosis of GERD with no current symptoms. A September 2020 C&P examination of intestinal conditions revealed active diverticulitis; however, no signs or symptoms were noted. There was no indication of episodes of bowel disturbance with abdominal distress or exacerbations. No weight loss or malnutrition was indicated. The examiner clarified that the Veteran’s diverticulitis was asymptomatic on the day of the examination. In addition to the C&P reports, the Board has also reviewed pertinent treatment notes of record, which collectively show the Veteran has been followed for diverticulitis and GERD with periodic symptoms of abdominal distress, to include reports of diarrhea and constipation. Based on the evidence of record, the Board concludes the Veteran’s symptoms have more nearly approximated the criteria for a 30 percent rating under DC 7319 throughout the appeal period. The Board finds that a rating in excess of 30 percent is not warranted by the evidence of record. As noted above, the Veteran’s currently assigned 30 percent rating under DC 7319 is the maximum available schedular rating under that DC. Notwithstanding, DC 7327 (governing diverticulitis), instructs VA to rate pertinent symptoms as for irritable colon syndrome (DC 7319), peritoneal adhesions (DC 7301), or ulcerative colitis (DC 7323), depending on the predominant disability picture. Moreover, GERD-like symptoms are rated under DC 7346 (applicable to hiatal hernia symptoms). As such, the Board has considered the application of other DCs pertaining to the gastric system. See Mittleider v. West, 11 Vet. App. 181, 182 (1998) (when the effects of a service-connected disability have not been clinically disassociated from those of a non-service-connected disorder, all relevant signs and symptoms must be attributed to the service-connected disability); see also 38 C.F.R. § 4.114 (noting that ratings under the DCs applicable to disabilities of the digestive system will not be combined with each other; instead, a single evaluation will be assigned under the DC which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation). However, a higher rating under any of the other potentially applicable DCs is not warranted in this case. With respect to DC 7301, a separate or compensable rating is not warranted because there is no evidence of adhesions. Likewise, there is no evidence to suggest the Veteran has been diagnosed with ulcerative colitis or has ever suffered symptoms of a degree or severity as to warrant a rating in excess of 30 percent under DC 7323; the Veteran has not experienced attacks of colitis with accompanying malnutrition, with health only fair during remissions. In addition, an increased rating under DC 7346 is not warranted; although the Veteran has reported nausea and vomiting on occasion, there is no evidence of material weight loss and hematemesis or melena with moderate anemia, or other symptom combinations productive of severe impairment of health. The probative evidence reflects the Veteran’s GERD has been productive of pyrosis (heartburn), and at times has been asymptomatic. (The Board notes that the Veteran has separately been awarded service connection for hemorrhoids and for an appendectomy scar.) The Veteran has offered no specific arguments or descriptions of symptoms pertaining to the severity of his diverticulitis or GERD. The Board acknowledges that the Veteran, in advancing this appeal, believes his disability is more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms. See Layno v. Brown, 6 Vet. App. 465 (1994). In this case, however, the competent medical evidence offering detailed, specific, and specialized determinations pertinent to the rating criteria are the most probative evidence with regard to evaluating the Veteran’s symptoms. Moreover, the medical evidence as described above is largely consistent with the Veteran’s descriptions of his symptoms (as noted in the C&P reports), and the Board has taken both lay and medical evidence into account when assigning the current uniform 30 percent rating. In sum, the evidence deemed most probative by the Board establishes the Veteran’s diverticulitis with GERD more nearly approximates the criteria for a 30 percent rating throughout the entire appeal period. As shown above, the Board has considered the Veteran’s symptoms under other pertinent criteria, but finds there are no other DCs which either provide for an evaluation higher than the currently-assigned rating of 30 percent, or are appropriate for rating the Veteran’s symptoms. Neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. at 369-70. Accordingly, given the Veteran’s symptomatology, the most appropriate DC for rating purposes is DC 7319. The preponderance of the evidence is against a rating in excess of 30 percent. Earlier Effective Date Claim Unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increased compensation shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefore. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA’s adjudication regulations be filed on a standard form. Prior to March 24, 2015, VA recognized formal and informal claims. The amendments also, inter alia, eliminated the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen. See 79 Fed. Reg. 57,660 (Sept. 25, 2014), codified as amended at 38 C.F.R. §§ 3.151, 3.155 (2016). The amended regulations, however, apply only to claims filed on or after March 24, 2015. For effective date purposes, “claim” was defined as a formal or informal written communication identifying and requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit. 38 C.F.R. § 3.1(p) (2014). Any communication or action indicating an intent to apply for one or more benefits under the laws administered by VA, from a claimant, his or her duly authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris, could be considered an informal claim. See 38 C.F.R. § 3.155 (2014). Such an informal claim must identify the benefit sought. Id. VA is required to identify and act on informal claims for benefits. 38 U.S.C. § 5110(b)(3); 38 C.F.R. §§ 3.1(p), 3.155(a); see also Servello v. Derwinski, 3 Vet. App. 196, 198-200 (1992). Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). 4. Entitlement to an effective date earlier than June 20, 2015 for the award of service connection for left lower extremity radiculopathy The Veteran seeks an earlier effective date for his award of service connection for left lower extremity radiculopathy. Historically, the Veteran was granted service connection for a lumbar spine disability in a rating decision issued in 1990. At that time, there was no probative evidence of lower extremity radiculopathy. In September 2012, the Veteran filed a claim for an increased rating for his lumbar spine disability. That claim was denied in a June 2013 rating decision. The Veteran did not appeal that decision within one year of receiving notice of the decision. Thus, thus decision is final. See 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.156, 20.1103. The Veteran next filed a claim for increased compensation on June 20, 2015. Notably, the month prior, in May 2015, he was afforded a VA C&P examination during which the examiner noted there were no signs or symptoms of radiculopathy in the Veteran’s lower extremities. In September 2015, a VA C&P back examination did reveal evidence of left lower extremity radiculopathy. Accordingly, VA granted service connection, effective on the date of the Veteran’s claim. The Board has carefully reviewed the record to determine whether any communications by or on behalf of the Veteran were submitted prior to his current effective date that could be construed as a claim for service connection for left lower extremity nerve impairment. See 38 C.F.R. § 3.1(p) (2014); Servello, 3 Vet. App. at 198-200. In so doing, the Board is mindful that a claim is deemed to encompass all symptoms reasonably presented in the record, regardless of how those symptoms are diagnosed or labeled. See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009). However, while VA must interpret a claimant’s submissions broadly, VA is not required to conjure up issues not raised by claimant. That is to say, VA is not required to anticipate any potential claim for a particular benefit where no intention to raise it was expressed. Brannon v. West, 12 Vet. App. 32, 35 (1998) (medical records cannot constitute an initial claim for service connection but rather there must be some intent by the claimant to apply for the benefit); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). In this case, the Board finds there are no communications of record during the relevant time period that could serve as the basis for an earlier effective date under 38 U.S.C. § 5110(a). As noted above, the Veteran had previously submitted claims pertaining to his lumbar spine disability; however, there is no evidence to suggest lower extremity nerve impairment was ever noted during the course of these claim. The first evidence of radiculopathy appeared in the September 2015 C&P report—at which point the RO promptly granted service connection. The Board finds it particularly probative that the May 2015 C&P examination report found no conclusive evidence of radiculopathy; this establishes that the it was not ascertainable prior to receipt of the Veteran’s June 2015 claim that he suffered from left lower extremity radiculopathy. The Board recognizes clinical records were previously recognized, in some instances, as informal claims under 38 C.F.R. § 3.157(b) (2014); however, this applied only if the evidence pertained to examination or treatment of a disability for which service connection had been previously established, or when a claim specifying the benefit sought was received within one year from the date of such examination, treatment, or hospital admission. Here, while the Veteran’s lawyer has made general assertions of entitlement to an earlier effective date, there is no medical documentation indicating the criteria for an earlier effective date for an award of service connection for left lower extremity radiculopathy were met. In sum, having reviewed all communications in the claims file, the Board finds there is no probative evidence the Veteran submitted any formal or informal communications with respect to his left lower extremity radiculopathy prior to his June 20, 2015 claim. See 38 C.F.R. § 3.1(p) (2014). Neither the Veteran nor his lawyer have identified any specific claims or evidence prior to his current effective date that would justify an earlier effective date. Accordingly, there is no legal basis for awarding an effective date earlier than June 20, 2015. The law is dispositive in this matter; for the reasons discussed above, the Veteran’s claim must be denied. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). REASONS FOR REMAND 5. Entitlement to an increased rating for osteoarthritis of the cervical spine is remanded. 6. Entitlement to an increased rating for osteoarthritis with osteophytes of the lumbar spine is remanded. The Veteran was last given VA C&P examinations for his cervical and lumbar spine disabilities in September 2020. Unfortunately, the Board finds these examinations are inadequate for rating purposes. First, although the Veteran reported flare-ups of neck and back pain, and the examiner solicited information regarding the severity, frequency, and duration of such flare-ups, the Board is confused by the examiner’s findings in terms of range of motion lost during flare-ups. Specifically, the examiner noted the Veteran had exactly the same range of motion during flare-ups as he did on initial testing. This is particularly confusing given the examiner’s comment that pain during flare-ups would result in additional functional impairment. The Board is not convinced these examination reports comply with Sharp v. Shulkin, 29 Vet. App. 26 (2017), which directs examiners to attempt to capture lost range of motion during flare-ups by employing a comprehensive analysis of the severity, frequency, and duration of flare-ups, to include the Veteran’s descriptions. In addition, the C&P reports do not meet the requirements of Correia v. McDonald, 28 Vet. App. 158, 169-70 (2016). That case establishes that examiners have an obligation to record the results of range of motion testing for pain on both active and passive motion and in weight-bearing and non-weight-bearing situations, ideally with a specific indication at which degree of motion pain begins. The September 2020 C&P reports simply note there was objective evidence of pain on passive range of motion testing (with no evidence of pain on weight-bearing); no range of motion estimates were provided in this context. Accordingly, the Board finds an updated examination is required to satisfy VA’s duty to assist. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (when VA undertakes to provide a claimant with an examination or medical opinion, it must ensure the examination or opinion is adequate). 7. Entitlement to an increased initial rating for left lower extremity radiculopathy is remanded. Because the claim concerning the proper rating for the Veteran’s lumbar spine disability could impact the rating for his left lower extremity radiculopathy, the two claims are inextricably intertwined and must, therefore, both be remanded. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). 8. Entitlement to an increased initial rating for headaches is remanded. The Veteran’s headaches are currently rated as 30 percent disabling from June 20, 2015 to August 24, 2015, and noncompensable thereafter, under DC 8100. 38 C.F.R. § 4.124A. Under DC 8100, a 30 percent rating is warranted for headaches with characteristic prostrating attacks occurring on an average once a month over the last several months, while a noncompensable rating is assigned for headaches with less frequent attacks. In this regard, the Board finds the record is unclear regarding the nature and severity of the Veteran’s headache symptoms. Notably, despite the fact the RO reduced the Veterans’ rating to noncompensable, effective August 24, 2015, a November 2018 VA C&P examination indicated the Veteran’s headaches resulted in “severe functional impairment.” (A subsequent C&P examination in September 2020 reflects less severe symptoms.) The Boards notes that, as a basic matter, severe functional impairment is not consistent with a noncompensable rating. See 38 C.F.R. § 4.1 (noting that the rating schedule is designed to “represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions”). However, the Board lacks the medical expertise and information necessary to rate the severity of the Veteran’s headaches. Consequently, an updated examination and opinion is necessary. 9. Entitlement to an effective date earlier than June 20, 2015 for the award of TDIU is remanded. 10. Entitlement to an effective date earlier than June 20, 2015 for the award of DEA benefits is remanded. The RO granted TDIU and eligibility for DEA benefits, effective June 20, 2015, in a September 2020 rating decision. In that decision, the RO determined June 20, 2015 was “the date eligibility criteria [were] met” for these benefits. See 38 C.F.R. § 4.16(a) (to qualify for TDIU, the evidence must show that a veteran is unable to secure and follow a substantially gainful occupation as a result of service-connected disability, and there is one disability ratable at 60 percent or more, or, if more than one disability, at least one disability ratable at 40 percent or more and a combined disability rating of 70 percent). The Board notes the appeal period in this case started with the Veteran’s 2012 claim for service connection for PTSD. As discussed above, the Board granted an increased initial rating of 50 percent for PTSD, which means the schedular criteria of 38 C.F.R. § 4.16(a) are met prior to June 20, 2015. However, the RO has not adjudicated whether entitlement to TDIU prior to June 20, 2015 is warranted. As such, the issue must be remanded for initial consideration by the RO. The issue of entitlement to an earlier effective date for the award of eligibility for DEA benefits is inextricably intertwined with the issue of entitlement to a TDIU; that issue must likewise be remanded. See Tyrues v. Shinseki, 23 Vet. App. at 177. The matters are REMANDED for the following action: 1. Obtain any outstanding VA medical records pertaining to the Veteran, to include records from October 2020 to the present. 2. Schedule the Veteran for an examination to determine the nature and severity of his cervical spine disability, to include associated radiculopathy. (a) Identify and describe all symptoms and manifestations attributable to the service-connected cervical spine disability, to include any neurological impairment. All necessary diagnostic testing and evaluation should be performed, including range of motion testing in both passive and weight-bearing situations. (b) Determine whether the cervical spine exhibits pain or painful motion, weakened movement, premature or excess fatigability, or incoordination; and, if feasible, these determinations should be expressed in terms of the degree of additional functional loss, including in terms of what effect, if any, this has on the range of motion of the cervical spine, including during times when these symptoms are most problematic (“flare-ups”) or during prolonged, repetitive, use of the cervical spine. (c) Inquire whether there are periods of flare-ups and, if the answer is yes, to state their severity, frequency, and duration; name the precipitating and alleviating factors; and estimate, ‘per [the] veteran,’ to what extent, if any, they affect functional impairment. (d) If the Veteran does not wish to appear at an examination, the Veteran is asked to submit to the VA a statement answering these questions concerning his flare-ups: as to their “severity, frequency, and duration; name the precipitating and alleviating factors; and estimate, to what extent, if any, they affect functional impairment. 3. Schedule the Veteran for an examination to determine the nature and severity of his lumbar spine disability, to include associated radiculopathy. (a) Identify and describe all symptoms and manifestations attributable to the service-connected lumbar spine disability, to include any neurological impairment. All necessary diagnostic testing and evaluation should be performed, including range of motion testing in both passive and weight-bearing situations. (b) Determine whether the lumbar spine exhibits pain or painful motion, weakened movement, premature or excess fatigability, or incoordination; and, if feasible, these determinations should be expressed in terms of the degree of additional functional loss, including in terms of what effect, if any, this has on the range of motion of the lumbar spine, including during times when these symptoms are most problematic (“flare-ups”) or during prolonged, repetitive, use of the lumbar spine. (c) Inquire whether there are periods of flare-ups and, if the answer is yes, to state their severity, frequency, and duration; name the precipitating and alleviating factors; and estimate, ‘per [the] veteran,’ to what extent, if any, they affect functional impairment. (d) If the Veteran does not wish to appear at an examination, the Veteran is asked to submit to the VA a statement answering these questions concerning his flare-ups: as to their “severity, frequency, and duration; name the precipitating and alleviating factors; and estimate, to what extent, if any, they affect functional impairment. 4. Schedule the Veteran for an examination to determine the current severity of his headaches. The examiner should provide a full description of the disability from June 2015 to the present, to include reporting all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. If the examiner determines the Veteran’s headaches are not productive of “characteristic prostrating attacks,” the examiner should provide a detailed rationale explaining this finding. The examiner should specifically discuss the November 2018 VA C&P examination finding of “severe functional impairment.” 5. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of entitlement to earlier effective dates for the awards of TDIU and DEA benefits. If the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ryan, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.