Citation Nr: 21026389 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 10-27 933 DATE: May 3, 2021 ORDER Entitlement to an initial disability rating in excess of 20 percent for service-connected chronic lumbosacral strain with spasm is denied. Entitlement to a separate disability rating of 10 percent for left lower extremity radiculopathy of the sciatic nerve, associated with chronic lumbosacral strain, from August 3, 2017, is granted, subject to the regulations governing payment of monetary awards. Entitlement to an initial disability rating of 20 percent, but no higher, for right lower extremity radiculopathy of the sciatic nerve, associated with chronic lumbosacral strain, from August 3, 2017, is granted, subject to the regulations governing payment of monetary awards. Entitlement to an initial disability rating in excess of 20 percent for service-connected degenerative disc disease, cervical spine, is denied. Entitlement to an initial disability rating in excess of 20 percent for right upper extremity radiculopathy, associated with cervical spine disability, is denied. Entitlement to an initial disability rating in excess of 10 percent for service-connected residual scar, laceration right outer eye, is denied. Entitlement to an initial disability rating in excess of 10 percent for service-connected residual scars, right outer eye/parietal scalp (claimed as scars eye/head), is denied. Entitlement to an initial disability rating of 30 percent, but no higher, for irritable bowel syndrome, is granted, effective April 1, 2008, subject to the regulations governing payment of monetary awards. Entitlement to a disability rating in excess of 30 percent, for service-connected irritable bowel syndrome (IBS), throughout the appeal period, is denied Entitlement to an initial disability rating of 30 percent, but no higher, for sarcoidosis, is granted from April 1, 2008, subject to the regulations governing payment of monetary awards. Entitlement to a disability rating in excess of 30 percent for service-connected sarcoidosis, for the entire appeal period, is denied From April 1, 2008 to October 22, 2008, entitlement to a total disability rating based on individual unemployability (TDIU) is denied. From October 23, 2008 to December 14, 2015, entitlement to TDIU is dismissed. From December 15, 2015 to January 25, 2016, entitlement to TDIU is granted. From December 15, 2015 to January 25, 2016, entitlement to special monthly compensation (SMC) at the housebound rate under the provisions of 38 U.S.C. § 1114 (s) is granted. FINDINGS OF FACT 1. At worst, the Veteran's forward flexion of the back was noted to be limited to 60 degrees with pain, and there was no evidence of any form of ankylosis. 2. The Veteran's mild left lower extremity sciatic nerve radiculopathy associated with the lumbar spine disability was first documented in August 3, 2017, and there is no evidence of any earlier manifestations. 3. The August 2017 VA examination shows the Veteran's right lower extremity sciatic nerve radiculopathy associated with the lumbar spine disability was moderate in degree, and there is no evidence of such manifestation prior to August 3, 2017. 4. At worst, the Veteran's forward flexion of the cervical spine was limited to 20 degrees, and he was consistently found not to have any form of ankylosis, nor has he been prescribed bedrest by a physician due to incapacitating episodes. 5. The February 2017 VA examination showed mild radiculopathy in the right upper extremity, involving the upper, middle, and lower radicular groups, and there is no evidence of such manifestations prior to February 24, 2017. 6. The evidence shows, at worst, one characteristic of disfigurement, i.e. scar at least 0.6cm wide at widest part (2cm width in this case), in the right outer eye area (laceration scar); keloid formation, inflammation and hypopigmented skin does not exceed 39 square centimeters. 7. The Veteran has no more than two scars, located in the right outer eye/parietal scalp area, that are both stable, with no indication of frequent loss of covering skin over the scars. 8. For the entire appeal period, the Veteran's IBS was manifested by more or less constant abdominal pain and discomfort/abdominal distension persisting mostly throughout the day, accompanied by five to six loose bowel movements per day. 9. For the entire appeal period, the Veteran's service-connected sarcoidosis resulted in pulmonary manifestations, accompanied by persistent symptoms requiring chronic low dose or intermittent corticosteroids. 10. From April 1, 2008 to October 22, 2008, the Veteran's service-connected disabilities did not render him unable to secure or follow any substantially gainful occupation. 11. As a result of the grants herein, the Veteran will be assigned a 100 percent combined schedular rating for his service-connected disabilities from October 23, 2008 to December 14, 2015; during this time, there was no single service-connected disability that rendered him unable to secure or follow any substantially gainful occupation. 12. From December 15, 2015 to January 25, 2016, the Veteran's service-connected PTSD alone rendered him unable to secure or follow any substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial disability rating in excess of 20 percent for service-connected chronic lumbosacral strain with spasm have not been met. 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5237. 2. The criteria for entitlement to a separate disability rating of 10 percent for left lower extremity radiculopathy of the sciatic nerve, associated with chronic lumbosacral strain, from August 3, 2017, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.124a, Diagnostic Code 8520. 3. The criteria for entitlement to an initial 20 percent rating, but no higher, for right lower extremity radiculopathy of the sciatic nerve, associated with chronic lumbosacral strain, from August 3, 2017, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.124a, Diagnostic Code 8520. 4. The criteria for entitlement to an initial disability rating in excess of 20 percent for service-connected cervical spine degenerative disc disease have not been met. 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5242. 5. The criteria for entitlement to an initial disability rating in excess of 20 percent for right upper extremity radiculopathy, associated with cervical spine disability, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.124a, Diagnostic Code 8513. 6. The criteria for entitlement to an initial disability rating in excess of 10 percent for service-connected residual scar, laceration right outer eye, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7800. 7. The criteria for entitlement to an initial disability rating in excess of 10 percent for service-connected residual scars, right outer eye/parietal scalp (claimed as scars eye/head), have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7804. 8. The criteria for entitlement to an initial 30 percent disability rating, but no higher, for service-connected irritable bowel syndrome, were met from April 1, 2008. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.114, Diagnostic Code 7319. 9. The criteria for entitlement to a disability rating in excess of 30 percent for service-connected irritable bowel syndrome (IBS), throughout the appeal period, is denied. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.114, Diagnostic Code 7319. 10. The criteria for entitlement to an initial 30 percent disability rating, but no higher, for service-connected sarcoidosis, were met from April 1, 2008. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.21, 4.97, Diagnostic Codes 6846, 6600. 11. The criteria for entitlement to a disability rating in excess of 30 percent for service-connected sarcoidosis, for the entire appeal period, is denied. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.21, 4.97, Diagnostic Codes 6846, 6600. 12. From April 1, 2008 to October 22, 2008, the criteria for entitlement to a TDIU were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. 13. From October 23, 2008 to December 14, 2015, entitlement to a TDIU is moot and is dismissed. 38 U.S.C. §§ 7105 (2012); 38 C.F.R. §§ 4.16. 14. From December 15, 2015 to January 25, 2016, entitlement to a TDIU was warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. 15. From December 15, 2015 to January 25, 2016, the criteria for entitlement to SMC under the provisions of 38 U.S.C. § 1114 (s) have been met. 38 U.S.C. §§ 1114 (s), 5103(a), 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.350. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1984 to March 2008. The Veteran testified at a Board hearing before a Veterans Law Judge (VLJ) who has since retired from the Board, and a transcript has been associated with the claims file. An August 2016 Board letter informed him that he had the opportunity to have another hearing before a VLJ who would decide his claim. The Veteran indicated in a September 2016 submission that he did not desire a new hearing. Although additional evidence has been associated with the claims file since the issuance of the most recent Supplemental Statement of the Case, remand is not needed. These were treatment records provided by the Veteran, along with a written waiver of initial consideration by the Agency of Original Jurisdiction (AOJ). Having reviewed the record, the Board finds that there has been substantial compliance with its December 2016 Board remand directives. Stegall v. West, Vet. App. 268, 270-71 (1998). During the pendency of the appeal period, the Veteran was granted TDIU and SMC effective January 26, 2016, pursuant to a May 2019 rating decision, which noted that "this rating represents a full and final determination of this issue on appeal. As such, this issue is considered resolved in full." However, the Board finds the period prior to January 26, 2016 is still on appeal. Specifically, although the earlier Board remands indicated that the Veteran's TDIU claim arises from a February 2009 rating decision, it was actually reasonably raised as part of his appeal as to the initial ratings assigned for his service-connected disabilities (from April 1, 2008). See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). Thus, the Board finds the issue of TDIU prior to January 26, 2016 (from April 1, 2008 to January 25, 2016) remains before the Board and will further address this matter in detail below. While a claim for an entitlement to service connection for visual impairment was also remanded pursuant to the most recent Board remand, this claim is no longer in appellate status, as the Veteran was granted service connection for dry eye syndrome, bilateral, with history of iritis associated with sarcoidosis, with a non-compensable rating, under DC 6018-6066 (which takes into consideration visual acuity), from April 1, 2008, pursuant to a June 2017 rating decision. Because this decision represents a full grant of the benefit sought on appeal, this issue is no longer before the Board. See Grantham v Brown, 114 F. 3d 1156 (Fed Cir 1997). In May 2020, the Veteran submitted a Notice of Disagreement in response to "all issue[s]" from a June 2019 letter. There was no June 2019 rating decision, but a May 2019 decision did address various claims. However, the notification letter clearly told him the forms he could submit if he disagreed with any of the issues in that decision, and the Notice of Disagreement form he submitted is outdated and is not valid for appealing VA decisions made after February 2019, when the Veterans Appeals Improvement and Modernization Act of 2017 (Appeals Modernization Act or AMA), Pub. Law 115-55, became effective. Therefore, no further action can be taken on his Notice of Disagreement. The Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant, when rendering a decision on appeal. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board has thoroughly reviewed all the evidence in the Veteran's VA files. In every decision, the Board must provide a statement of the reasons or bases for its determination, adequate to enable the Veteran to understand the precise basis for the Board's decision, as well as to facilitate review by the United States Court of Appeals for Veterans Claims (Court). 38 U.S.C. § 7104 (d)(1) (2012); see Allday v. Brown, 7 Vet. App. 517, 527 (1995). Although the entire record must be reviewed by the Board, the Court has repeatedly found that the Board is not required to discuss, in detail, every piece of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001) (rejecting the notion that the Veterans Claims Assistance Act mandates that the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran. See Timberlake v. Gober, 14 Vet. App. 122 (2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra. Increased Rating Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects the ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify various disabilities and the criteria for specific ratings. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. 38 C.F.R. § 4.40. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. Also, in Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, at Note 1. Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Separate ratings may be assigned for separate periods of time based on the facts found; this practice is known as staged ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). If two disability ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.1. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran. 38 C.F.R. § 4.3. 1. Entitlement to an initial disability rating in excess of 20 percent for service-connected chronic lumbosacral strain with spasm 2. Entitlement to an initial disability rating in excess of 10 percent for service-connected right sciatic nerve associated with chronic lumbosacral strain with spasm 3. Entitlement to a separate disability rating for left sciatic nerve associated with chronic lumbosacral strain with spasm The Veteran contends that he cannot stand or sit for a prolonged period and has difficulty moving and lifting items. He also reports constant muscle spasms and pain and further notes that many of his prescribed medications have only nominal, if any, impact on his condition. The Veteran is currently in receipt of a 20 percent disability rating for his lumbosacral strain condition, effective April 1, 2008, and a separate 10 percent rating for the right sciatic nerve condition, effective August 3, 2017. As discussed in more detail below, a higher rating for the lumbosacral strain is not warranted; however, a 20 percent rating is granted for the right sciatic nerve condition, as well as a separate 10 percent rating for the left sciatic nerve condition. Pertinent regulations for consideration were provided to the Veteran in the May 2019 Supplemental Statement of the Case (SSOC) and will not be repeated here in full. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. However, the criteria for DC 5237 pertaining to lumbar strain were not revised. The Veteran first underwent a VA examination in July 2008. The Veteran complained of lumbar pain, which he described as moderate constant pain, but otherwise denied any pain radiating to his lower extremities. The Veteran presented a normal gait and denied the use of assistive devices. His forward flexion of lumbar spine was to 90 degrees, lateral flexion right and left to 30 degrees, respectively, rotation right and left to 30 degrees, and extension to 30 degrees. With repetitive use, there was no additional ROM limitation by pain, fatigue, weakness or lack of endurance. The Veteran denied any flare-ups, and there was no spasm, no weakness and normal tenderness. Both sensory and motor functions were normal, and he denied any incapacitating episodes during a 12-month period. The examiner indicated that there would be no functional impairment that would preclude the Veteran from seeking employment. In January 2009, the Veteran was diagnosed with chronic lumbosacral strain with spasm. His forward flexion of the spine was to 60 degrees with pain, and there was no additional limitation of ROM following repetitive use. Deep tendon reflexes and neurological exam results were normal, with intact sensory and antalgic gait, and an x-ray of his lumbar spine was normal. There was also no evidence of ankylosis. During a January 2010 VA examination, the Veteran's lower back forward flexion of the lower back was noted to be limited to 80 degrees, with no additional ROM limitation after repetitive testing. Motor function, deep tendon reflexes, sensory, and gait were normal on exam, and the x-rays of the lumbar spine were negative. There was also no evidence of ankylosis. The examiner indicated that the associated functional impairment would be that trouble walking on a daily basis and limited ability to bend/lift. During an October 2010 VA examination, the Veteran's ROM of flexion was limited to 65 degrees, with objective evidence of pain. While there was objective evidence of pain following repetitive motion, there was no additional ROM limitation after repetitions. The Veteran reported constant daily pain that is progressively worsening, and inability to sit/stand for long periods of time, and there was evidence of constant mild to moderate back ache, but there was no evidence of incapacitating episodes of spine disease. His reflex exam/light touch/sensory/pinprick exam were all normal, with no evidence of any affected nerve associated with his cervical spine disability. During the February and August 2017 VA examinations, the Veteran reported pain in his back, with prolonged standing/sitting seemingly aggravating his pain, as well as daily flare-ups. He identified prolonged walking/sitting/standing/running/heavy lifting as functional loss/impairment associated with his back condition. During both examinations, he manifested the following: his initial ROM of forward flexion was limited to 90 degrees, with evidence of pain with weight bearing and pain noted on exam but not resulting in functional loss. The Veteran was able to perform repetitive use testing with at least three repetitions, without any additional loss of function or ROM. Despite the fact that the Veteran was not examined during a flare-up or immediately after repetitive use over time, the examiner indicated that pain/weakness/fatigability/incoordination significantly limit functional ability with repeated use over a period of time, but when asked to describe in terms or ROM, opined that he is unable to do so as the Veteran could not be examined under such circumstances. His muscle strength/reflex exam/sensory exam results were all normal, with no evidence of muscle atrophy. There was no evidence of ankylosis, other neurologic abnormalities, IVDS, or assistive devices. During the August 2017 VA examination, the Veteran was first found to have moderate right lower sciatic nerve radiculopathy (moderate paresthesias and/or dysesthesias and numbness, no constant/intermittent pain) and mild left lower sciatic nerve radiculopathy (mild paresthesias and/or dysesthesias and numbness, no constant/intermittent pain). As for any functional impairment, heavy lifting or prolonged walking were found to be limited in the occupational setting. After reviewing all pertinent records, the Board finds that the Veteran is not warranted a rating in excess of 20 percent throughout the appeal period for the lumbar spine condition. At no time during the appeal period was the Veteran's forward flexion of the thoracolumbar spine limited to 30 degrees or less, or presented any form of ankylosis, as required for an increased rating. At worst, the Veteran's forward flexion was noted to be limited to 60 degrees with pain, and there was no evidence of any form of ankylosis. Additionally, his muscle strength/reflex exam/sensory exam were all consistently normal, with no evidence of muscle atrophy. Thus, the claim is denied. The Board also considered the possibility of awarding a higher rating with consideration of 38 C.F.R. §§ 4.40 and 4.45 and declines to do so. The Board acknowledges the Veteran's lay reports of symptoms and that he has constant pain and has difficulty walking/sitting/standing for a prolonged period, as well as the inability to run/do heavy lifting. To the extent that the Veteran has experienced functional loss due to pain and pain on movement, these symptoms have been fully contemplated by the Veteran's assigned schedular rating (ie. less movement than normal, weakened movement, and pain/movement). The DeLuca concepts of functional loss, painful motion, etc. are still used to apply the rating criteria found in the diagnostic codes. Thompson v. McDonald, 815 F.3d 781 (Fed. Cir. 2016) and Mitchell v. Shinseki, 25 Vet. App. 32, 36 (2011). The Thompson court explained: "Section 4.40 also makes clear that functional loss may be due to pain and that pain may render a part seriously disabled. When evaluating a disability, § 4.40 provides a broad canvas. However, whatever the background, an applicant for disability benefits is rated based on the criteria set forth in § 4.71a." Thompson, 815 F.3d at 786. Therefore, pain alone without it resulting in any functional loss is not enough to warrant an increased rating. Here, the Veteran was consistently able to perform after repetitive use testing, with no additional limitation of range of motion. As such, the current rating adequately compensates him for his pain with some limited motion, and a higher rating is not warranted under DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). As for rating the condition based on the criteria for IVDS, there is no indication a physician has prescribed bedrest, which is how VA defines incapacitating episodes. Additionally, the Board has considered whether there are neurological abnormalities that would warrant a separate rating for any time period on appeal. In a May 2019 rating decision, RO granted a separate 10 percent rating under DC 8620 for the right sciatic nerve associated with chronic lumbosacral strain with spasm, effective August 3, 2017. Although the RO did not take any actions that would lead him to believe the radiculopathy rating was part of his appeal to the Board, such as include it as an issue in the Supplemental Statement of the Case, the Veteran did subsequently file a Notice of Disagreement (NOD) in May 2020, claiming that he disagrees with the May 2019 rating decision. Thus, the Board finds the issue relating to a right lower sciatic nerve radiculopathy is part and parcel of the appeal presently before the Board. Moreover, as will be discussed immediately below, the Board finds the Veteran warrants a separate 10 percent rating for his left lower sciatic nerve radiculopathy associated with the lumbar spine disability. Under DC 8520, a 10 percent evaluation is assigned for mild incomplete paralysis of the sciatic nerve. DCs 8620 and 8720 utilize the same rating criteria as DC 8520, though with particularized instructions found in 38 C.F.R. §§ 4.123 and 4.124. See 38 C.F.R. § 4.123 (indicating neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated with a maximum equal to severe, incomplete paralysis); 38 C.F.R. § 4.124 (indicating neuralgia characterized by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated with a maximum equal to moderate incomplete paralysis). A Note at the beginning of 38 C.F.R. § 4.124a indicates that disability from neurological disorders is rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function, and that with partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The words mild, moderate, moderately severe, and severe as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are "equitable and just." See 38 C.F.R. § 4.6. In addition, in rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. A Note at the beginning of 38 C.F.R. § 4.124a indicates that disability from neurological disorders is rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function, and that with partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The words mild, moderate, moderately severe, and severe as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration and that, when the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a ; see also 38 C.F.R. § 4.123 (indicating neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated with a maximum equal to severe, incomplete paralysis); 38 C.F.R. § 4.124 (indicating neuralgia characterized by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated with a maximum equal to moderate incomplete paralysis). With regards to the right lower sciatic nerve radiculopathy that the Veteran is in receipt of a 10 percent, under DC 8520, the Board finds that the Veteran warrants a higher rating of 20 percent, but no higher, under DC 8520. Notably, there is evidence of moderate paresthesias and/or dysesthesias and numbness that is moderate in its overall severity, with no evidence of constant/intermittent pain present in the August 2017 VA examination. However, to the extent that there is no indication of any worse impairment of motor, sensory, or partial loss of one or more extremities with neurological lesions, and considering that his muscle strength/reflex exam/sensory exam results were consistently noted as normal, with no evidence of muscle atrophy or assistive devices, the Board finds that the Veteran warrants a rating of only 20 percent, but no higher, under DC 8520, for his right lower sciatic nerve radiculopathy. Additionally, this rating was not warranted for any earlier time period on appeal because there was no evidence of right lower sciatic nerve radiculopathy prior to the August 2017 VA examination. Notably, prior to that VA examination, the medical evidence consistently showed he had normal lower extremity strength, normal/intact sensation in the lower extremities, and normal deep tendon reflexes and neurological exams. See July 2008, January 2009, January 2010, October 2010, February 2017 VA examinations. Regarding the left lower sciatic nerve radiculopathy associated with the service-connected lumbar spine disability, the Board finds that the Veteran warrants a separate 10 percent rating, under DC 8520, effective August 3, 2017. During the August 2017 VA examination, the Veteran first manifested mild paresthesias and/or dysesthesias and numbness in the left sciatic nerve that is mild in its overall severity, with no evidence of constant/intermittent pain. Otherwise, his muscle strength/reflex exam/sensory exam results were consistently noted as normal, with no evidence of muscle atrophy or assistive devices. Therefore, the Veteran's manifestation of intact and normal reflex/muscle strength/sensory exam, objective classification of the extent of nerve impairment as "mild," coupled with the lack of persuasive evidence of any objective symptoms, warrant no more than a 10 percent rating for mild left sciatic nerve radiculopathy, effective August 3, 2017. In doing so, the Board also points out that this is the earliest effective date available for the grant of a separate 10 percent rating under DC 8520, as the prior medical evidence did not suggest he had any left lower extremity radiculopathy. See July 2008, January 2009, January 2010, October 2001, February 2017 VA examinations, all showing normal lower extremity strength and sensation in the lower extremity. The Board considered the Veteran's lay assertion that he has functional limitations of inability to stand or sit for a prolonged period, has difficulty moving and lifting and has constant muscle spasms and pain. The Board finds these statements to be credible and competent to the extent that the relay the professing witness's own experiences and personal observations. Layno v. Brown, 6 Vet. App. 465 (1994). However, since the degree of the Veteran's impairment depends on the clinically significant symptoms and objectively measurable criteria under the rating schedule, the Board affords greater evidentiary weight to the contemporaneous medical records and objective examinations by medical professionals over the subjective lay statements offered by the Veteran. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. The Veteran's representative raised the issue of whether referral for extraschedular consideration is warranted. See September 2019 Appellate Brief. An extraschedular disability rating is warranted when the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). See Thun v. Peake, 22 Vet. App. 111, 115-16 (2008), aff'd sub nom. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009); Anderson v. Shinseki, 22 Vet. App. 423, 427 (2009). Both elements must be satisfied to warrant extraschedular referral. Yancy v. McDonald, 27 Vet. App. 484, 494-95 (2016). Recently, the United States Court of Appeals for Veterans Claims (CAVC) issued an en banc decision in Long v. Wilkie, No. 16-1537 (Vet. App. December 30, 2020), which provided, in part, six non-exhaustive or mandatory guiding principles to facilitate proper analysis of Thun's first step. First, the sole focus of Thun's first step is on the ability of the rating schedule to evaluate the veteran's symptomatology; extraschedular consideration is not applicable to claims that may be properly evaluated with conventional schedular rating tools. See Morgan v. Wilkie, 31 Vet. App. 162, 168 (2019). Second, Thun's first step deals exclusively with whether the veteran's symptoms (interchangeably referred to by the CAVC as "functional impairments") are exceptional, whereas Thun's second step considers the functional effects of those symptoms. See Yancy v. McDonald, 27 Vet. App. 484, 494 (2016). Third, where a symptom or impairment is not compensable under the rating schedule, such as is the case for psychiatric conditions without a valid DSM-5 diagnosis, see Martinez-Bodon v. Wilkie, 32 Vet. App. 393, 404 (2020), it also does not warrant extraschedular consideration as this would amount to a backdoor means to obtaining compensation for a condition the rating schedule intends to exclude. Fourth, extraschedular consideration is not warranted for symptoms or effects that lack a nexus to service or to a service-connected disability. Fifth, the Board is only required to discuss the theories of entitlement raised by the Veteran or reasonably raised by the record. Sixth, in reviewing the Board's analysis of referral for extraschedular consideration, the CAVC will be mindful of the rule against prejudicial error. Thus, a failure of the Board to discuss whether extraschedular consideration is warranted for a particular symptom does not require an automatic remand. After considering the contentions and the evidence in this case, the Board finds that referral for extraschedular consideration is not warranted for the service-connected chronic lumbosacral strain with spasm or bilateral lower extremity radiculopathy for any part of the rating period on appeal. The Board is cognizant of the evidence showing certain functional impairments as due to his alleged symptoms, potentially suggestive of marked interference with employment (i.e. any heavy lifting or prolonged walking may limit functional ability in the occupational setting). However, the Board points out that the rating schedule for the musculoskeletal system as a whole is capable of assessing the Veteran's alleged symptomatology (i.e. limitation of motion, incapacitating episodes, functional loss and painful motion), and the rating schedule for neurological conditions encompasses the severity of any symptoms shown with resulting impairmentand that for this reason, the Board finds referral for extraschedular consideration is not warranted. Thus, even acknowledging the evidence suggesting functional effects of that impairment (i.e. Thun's second step), to the extent that Thun's first step has not been met, the Board finds that extraschedular consideration is not warranted for the Veteran's service-connected lumbar spine or radiculopathy disabilities. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. The claim is denied. 4. Entitlement to a disability rating in excess of 20 percent for service-connected degenerative disc disease, cervical spine 5. Entitlement to a disability rating in excess of 20 percent, for right upper radiculopathyinvolving upper, middle, and lower radicular groupsassociated with cervical spine disability The Veteran contends that he cannot stand or sit for a prolonged period and has difficulty moving and lifting items. He also reports constant muscle spasms and pain and further notes that many of his prescribed medications have very poor response. The Veteran is currently in receipt of a 20 percent disability rating for his cervical spine degenerative disc disease, effective April 1, 2008, under DC 5242. Pertinent regulations for consideration were provided to the Veteran in the May 2010 Statement of the Case (SOC) and will not be repeated here in full. As briefly addressed above, during the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. The Board is allowed to consider these changes, although the RO has not yet done so. 38 CFR 20.904(d)(2) (remand to the AOJ is not necessary for consideration of law not already considered by the AOJ, including regulations). Prior to the regulatory change, DC 5242 provided criteria for degenerative arthritis of the spine, referencing DC 5003. As of February 7, 2021, the amended version of DC 5242 provides criteria for degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome, and references DC 5003 and 5010. Under the amended criteria, DC 5003 now provides criteria for degenerative arthritis, other than post-traumatic (but the rating criteria itself, including that applicable to spine disorders, remain the same as the pre-amendment version) and DC 5010 now provides criteria for post-traumatic arthritis, and directs ratings be based on "limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with § 4.25." The Veteran first underwent a VA examination in January 2009, during which time the examiner indicated x-rays showed degenerative disc disease of cervical spine. The Veteran complained of constant moderate pain, but this was not noted to affect his ability to walk or cause prescribed bedrest due to incapacitating episodes. His ROM of forward flexion was from 20 degrees to 40 degrees, with pain, and there was no additional limitation of ROM following repetitive use. His straight leg raise test was negative, with "normal" neurologic/deep tendon reflexes/sensory exams. Activities of daily living (sleeping, chores, dressing, bathing, and toileting) were noted as affected due to his cervical spine condition. During the January and October 2010 VA examinations, his forward flexion of the cervical spine was limited to either 20 or 25 degrees, and while there was objective evidence of pain following repetitive motion, there was no additional limitation of motion after three repetitions during both examinations. The Veteran reported constant daily pain that is mild to moderate in its severity, but his reflex exam/light touch/sensory/pinprick exam were all normal, with no evidence of any affected nerve associated with his cervical spine disability. In regards to any functional impairment, he was noted to have trouble walking and have difficulty bending/lifting. During both the February and August 2017 VA examinations, the Veteran was diagnosed with degenerative arthritis of the spineand the Veteran manifested the following identical factual findings throughout these examinations. He reported flare-ups occurring about twice a week as well as worsening pain with lifting/strenuous activities, and functional impairments consisting of the inability to lift overhead/prolonged sitting/standing/heavy lifting/exercising. The Veteran's initial ROM of forward flexion of the cervical spine was to 45 degrees, and he was able to perform repetitive use testing with no additional loss of function or ROM. With regards to whether pain/weakness/fatigability/incoordination significantly limit functional ability after repetitive use testing or during flare-ups, the examiner noted that such cannot be said without mere speculation as the Veteran was not examined immediately after repetitive use over time or during a flare-up, but noted the Veteran's reportthat he gets more pain which results in some loss of ROM after repeated use and during flare-ups. He reported constant neck pain, and lifting and strenuous activities make the pain worse, with flare-ups of the neck pain twice a week. He reported functional loss of inability to exercise, do heavy lifting, lift overhead, and do prolonged sitting/standing. His muscle strength/reflex exam/sensory exam were all normal, with no evidence of muscle atrophy. There was no evidence of ankylosis, IVDS, or assistive devices. Throughout the February 2017 and August 2017 VA examinations, the Veteran was also found to have radiculopathy in the right upper extremity involving the upper (C5/C6), middle (C7), and lower radicular (C8/T1) groups. Specifically, during the February 2017 VA examination, the Veteran was found to have mild intermittent pain, paresthesias and/or dysesthesias, and numbness, that is mild in its overall severity. Moreover, during the August 2017 VA examination, the examiner indicated that he has mild intermittent pain and paresthesias and/or dysesthesias on the right upper extremity that is mild in its overall severity. There were no other neurologic abnormalities noted to be related to the cervical spine disability. As for any functional impairment, the examiner indicated that any heavy lifting or prolonged walking may limit functional ability in the occupational setting. After reviewing all pertinent records, the Board finds that the Veteran does not warrant a rating in excess of 20 percent under either version of DC 5242 (neither version is particularly favorable in this case). At no time during the appeal period did the Veteran manifest any form of ankylosis or forward flexion of the cervical spine limited to 15 degrees or less. At worst, the Veteran's forward flexion of the cervical spine was limited to 20 degrees, and he was able to perform repetitive use testing with no additional loss of function or ROM. Additionally, he was consistently not found to have any form of ankylosis, and his muscle strength/reflex exam/sensory exam were all normal, with no muscle atrophy. As for rating the condition based on IVDS, while he has described incapacitating episodes, he has not been prescribed bedrest by a physician. Thus, this claim is denied. The Board also considered whether the Veteran would be entitled to a higher rating on the basis of 38 C.F.R. §§ 4.40 and 4.45. DeLuca and its progeny. While the Veteran reported limited ability and/or inability to exercise, do heavy lifting, lift overhead, do prolonged sitting/standing, these symptoms have been fully contemplated by the Veteran's assigned schedular rating (ie. pain/movement, less movement than normal). He was able to perform repetitive use testing with at least three repetitions, with no additional loss of function or ROM afterwards. As such, the current rating adequately compensates him for his pain with some limited motion, and a higher rating is not warranted under this basis. Additionally, the Board has considered whether there are neurological abnormalities that would warrant a separate rating for any time period on appeal. In a June 2017 rating decision, the RO granted a separate 20 percent rating for the right upper radiculopathy as secondary to the service-connected disability of cervical spine degenerative disc disease, under DC 8513, effective February 24, 2017. Although the RO did not include this issue in the SSOC nor did the Veteran choose to contest that rating, the RO stated in the June 2017 rating decision that this is "inextricably intertwined" with the decision. Therefore, the Board finds the question of a higher rating for right upper radiculopathy is part and parcel of the appeal before the Board. As addressed above, the medical evidence first establishes that the Veteran first had radiculopathy of the right upper extremityinvolving the upper (C5/C6), middle (C7), and lower radicular (C8/T1) groupsassociated with the cervical spine disability in February 2017. In this case, the evidence of record demonstrates that the Veteran is right-handed; hence, the right side is the major side. Under 38 C.F.R. § 4.124a, DC 8513, a 20 percent rating is warranted for mild incomplete paralysis of all radicular groups. Here, there is no indication of a moderate or more severe level of disability or other associated neurologic disability. Specifically, during the February 2017 VA examination, the Veteran was found to have only mild intermittent pain, paresthesias and/or dysesthesias, and numbness, that is mild in its overall severity; and during the August 2017 VA examination, the examiner indicated that he has mild intermittent pain and paresthesias and/or dysesthesias in the right upper extremity that is mild in its overall severity. His reflex exam/sensory/muscle strength exam were also consistently found to be all normal, with no evidence of muscle atrophy. Additionally, complete paralysis of the right upper extremity has not been demonstrated by the evidence. Accordingly, the Board finds that the Veteran is not warranted a rating in excess of 20 percent under DC 8513. Additionally, the rating was not warranted for any earlier time period on appeal because there was no evidence of right upper extremity neurological issues prior to the February 2017 VA examination. Notably, prior to the February 2017 VA examination, he consistently demonstrated normal upper extremity strength, normal/intact sensation, and normal reflexes and neurological exams. See January 2009, January 2010, October 2010, February 2017 VA examinations. There is also no evidence of neurological impairment of the left upper extremity due to the cervical spine condition that would warrant a separate rating. Moreover, the Board acknowledges his right upper extremity radiculopathy associated with the cervical spine disability involves the upper, middle, and lower radicular groups, a separate rating is not available under the DCs addressing other nerves in the right (major) upper extremity. As noted in the June 2017 rating decision, only one evaluation is allowed for the incomplete paralysis of the right upper extremity, despite the fact that his upper, lower and middle radicular groups are affected. The current 20 percent rating under DC 8513 is the highest available under the potentially applicable diagnostic codes. Furthermore, that rating contemplates incomplete mild paralysis of the radicular groups affecting all shoulder, elbow, hand, and wrist movements, and the Board finds that the assignment of separate ratings under different Diagnostic Codes would constitute pyramiding, and therefore, finds such unwarranted. See 38 C.F.R. § 4.14, 4.124a (DCs 8510, 8511, and 8512). Last but not least, with regards to whether the Veteran's condition warrants an extraschedular consideration referral, the Board finds it is not warranted. First, the Veteran has not provided any specific contentions in this regard, and even assuming his symptoms result in functional impairment that would markedly interfere with employment, the rating schedule for the musculoskeletal system as a whole is capable of assessing the Veteran's alleged symptomatology (inability to exercise, do heavy lifting, lift overhead, do prolonged sitting/standing)i.e. limitation of motion, functional loss and painful motion, incapacitating episodes and the rating schedule for neurological conditions does the same. Since Thun's first step has not been met, the Board finds that extraschedular consideration is not warranted for the Veteran's service-connected cervical spine or radiculopathy disabilities. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. The claim is denied. 6. Entitlement to a disability rating in excess of 10 percent for service-connected for residual scar, laceration right outer eye 7. Entitlement to a disability rating in excess of 10 percent for service-connected residual scars, right outer eye/parietal scalp (claimed as scars eye/head) The Veteran seeks higher ratings for his residual scars of lacerations to the right outer eye and right outer eye/parietal scalp. The Veteran advances the same arguments for these conditionsthat his right eye is not in line with his left eye after having the fracture fixed, and claims this disfigurement is very disabling. The Veteran is currently in receipt of a 10 percent rating for residual scar of laceration right outer eye, under DC 7800, effective April 1, 2008, and a 10 percent rating for residual scar of right outer eye/parietal scalp under DC 7804, effective October 23, 2008. VA amended the criteria for rating skin disabilities effective from August 13, 2018. See 83 Fed. Reg. 32592 (July 13, 2018); 83 Fed. Reg. 38663 (Aug. 7, 2018). However, DCs 7800 and 7804 were not changed by the August 2018 amendments. Additionally, the regulations pertaining to rating skin disabilities were previously revised during the pendency of the Veteran's claim seeking service connection for his skin disability, with the regulatory changes becoming effective October 23, 2008. In fact, he was initially granted 10 percent rating for each of the scars under the criteria for DCs 7800 and 7804 for the period effective prior to October 23, 2008 (criteria for DCs that were effective August 30, 2002)and both the pre-2008 and 2008 versions of pertinent regulations were provided in a May 2010 SOC. With regards to DC 7800, while the rating criteria for the pre-2008 (i.e. 2002) version and the post-amended 2008 version are identical, the later version is more favorable for the Veteran to the extent it provides two additional notes (note (4) and (5))and of particular significance is note (4) of the 2008 version, which provides consideration for separate evaluations for disabling effects other than disfigurement associated with individual scars, such as pain, instability, and residuals of associated muscle or nerve injury, under the appropriate DCs and apply 4.25 to combine the evaluation with the evaluation assigned under DC 7800. With regards to DC 7804, the Board again finds the more recent 2008 version more favorable, as the earlier version (effective 2002) provides criteria for only a 10 percent rating, while the later one provides criteria for up to a 30 percent rating. Thus, the Board will proceed its analysis under the criteria for DC 7800 and 7804 under the 2008 version. The Veteran first underwent a VA examination in July 2008, during which time he was noted to have two asymptomatic residual scars. He was found to have a residual asymptomatic scar in the right orbit area (superficial; nontender; nonpainful; no ulceration or breakdown at the scar; no elevation or depression; no loss of underlying tissue; not adherent to the underlying tissue; smooth texture; no discoloration) that measures 1cm x 0.1 cm that is very faint and barely visible, follows the crease line between the upper and lower eyelid and does not affect the eye. There was evidence of inflammation/keloid formation causing an insignificant amount of disfigurement. His second scar in the right temporal region was noted as follows: 4cm x width of 0.1cm to 0.2cm; superficial, nontender, nonpainful; not adherent to the underlying tissue; no inflammation/edema/keloid formation at the scar site; no elevation or depression; no loss of underlying tissue; no ulceration or breakdown; scar causing an insignificant amount of disfigurement in the right temporal region. In a January 2009 VA examination, the Veteran's right outer eye laceration scar was described as the following: 0.1 x 2cm; horizontal; affects his activities of daily living, but not his occupation (interfering with his activities of daily living such as sleep and chores); tender to touch; not adherent to underlying tissue; smooth texture; stable scar without elevation or depression; superficial without inflammation, edema, or keloid formation; hypopigmented without gross distortion of the face; without induration, inflexibility, or limitation of motion caused by the scar. His right parietal scalp laceration scar was noted as the following: 2 x 7cm; tender to touch; smooth texture; stable without elevation or depression; superficial without inflammation, edema or keloid formation; hypopigmented without distortion of the face, induration, inflexibility or limitation of motion caused by the scar. The examiner explained that this second scar occurred after his right orbit fracture, which caused fluttering of the eyelids, numbness and pain, interfering with his activities of daily living such as sleep and chores. During a January 2010 VA examination, the Veteran was noted to have two scars: the first one was noted to be located at the right eyea small "X" mark, with each leg of the X measuring 0.2 cm, that is non-tender, non-adherent, not unstable, not ulcerated, not elevated or depressed, not painful, with no evidence of inflammation or keloid formation, gross distortion of the face, induration/inflexibility, or limitation of motion or function caused by the scar. The second scar was noted to be located in the parietal area on the right (3cm x 0.3cm, non-tender, non-adherent, not unstable, not ulcerated; neither elevated nor depressed; no ulcerations or breakdowns; not painful; no inflammation or keloid formation present; no gross distortion of the face; no induration or inflexibility; no limitation of motion or limitation of function caused by the scar; superficial and normal color). The total body surface of the areas was noted to be less than 1% of the exposed skin and less than 1% of the total body surface. There was no indication of disfiguring associated with the scars. During an October 2010 VA examination, the Veteran was diagnosed with "right temporal scarwell healed." He was noted to have a scar in the right temporal area, with no skin breakdown over the scar. He complained of numbness and pruritis on the right temporal area. On physical examination, his skin was found to be painful and deep, 0.1 cm (width) by 3.5 cm (length), with visible/palpable underlying soft tissue loss with an area 6 square inches (39 square cm) or less. However, there was no evidence of inflammation/edema/keloid formation/abnormal texture/elevated or depressed contour/hypo or hyperpigmentation/any other disabling effects. There was also no indication of indurated or inflexible skin or that not adherent to underlying tissue. The Veteran underwent a VA examination in February 2017, during which time he was diagnosed with scar over the right side of the face. He was not found to have any scars on the truck/extremities (regions other than the head, face, or neck). The Veteran reported complete numbness on the right side of the face where he had a plate and 8 screws placed and much pain over where the plate was placed as well. He also reported headaches and a throbbing sensation after strenuous activity. None of his scars were noted to be painful, unstable with frequent loss of covering of skin over the scar, or due to burns. The examiner explained that he has pain associated with the plate and screws that were placed as a result of his surgery post in-service injury, but added that the scar itself is not painful. His scar on the right side of the head was noted to be 5cm x 0.1cm, and approximate total area of head, face, and neck with hypo/hyperpigmented areas as 0.5cm square. There was no indication of gross distortion or asymmetry of facial features or visible or palpable tissue loss. During the August 2017 VA examination, he was found to have two scars on the right side of the face that are each 5cm x 0.1cm in its length and width. The Veteran reported numbness and pain over the right side where the plate was placed, but he was not found to have painful/unstable scar, or scars due to burns. There was no indication of elevation, depression, adherence to underlying tissues, or missing underlying soft tissues. There was no indication of gross distortion or asymmetry of facial features or visible or palpable tissue loss. His treatment records only show that he has no lesions, areas of discoloration, or rashes. Based on a review of the claims file and lay contentions, the Board finds that higher ratings are not warranted for either scar throughout the appeal period. First, with regards to the residual scar of the right eye/parietal scalp rated under DC 7804, the Board finds that the Veteran does not warrant a rating in excess of 10 percent under any of the versions of DC 7804 throughout the appeal period. Neither the medical nor the lay evidence shows that the Veteran had more than two scars throughout the appeal period (evidence consistently showed only up to two scars, in the right parietal scalp and right orbit/eye), and both of them were consistently found to be stable, with no indication of any frequent loss of covering skin over the scar/underlying tissue. Thus, the claim for higher rating is denied. As for the residual scar, laceration right outer eye, rated under DC 7800, the evidence shows, at worst, one characteristic of disfigurement, i.e. scar at least 0.6cm wide at widest part (2cm width in this case). There was no evidence of other disfigurement characteristics, and the scar did not cause visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features. Even taking into consideration his statements that his right eye is not in line with his left eye, he was consistently found not to have any gross distortion or asymmetry of one feature or paired set of features. Furthermore, while the examination shows keloid formation/inflammation and hypopigmented skin, it must be an area exceeding six square inches or 39 square centimeterswhich is not the case here. See 38 C.F.R. § 4.118, Diagnostic Code 7800, Note (1). In addition, while the Board acknowledges the Veteran's contention of numbness/pain in the right side of the face, he already has a separate 10 percent rating for residuals of the fracture. Accordingly, based on a review of the evidence, the Board finds that higher ratings are not warranted for either scar disability, and the claims are denied. The Board also considered whether extraschedular consideration is warranted, but finds such inapplicable. Although the Board acknowledges the Veteran's contentions regarding his right eye not being in line with his left eye after having the fracture fixed, to the extent the rating schedule for scars would compensate for the Veteran's symptomatology (if it were present)ie. gross distortion or asymmetry of features or paired sets of features, or surface contour of scar (see DC 7800)and more importantly, as there is neither objective nor subjective indication of these symptoms resulting in marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards, the Board finds that extraschedular consideration is not warranted. As the evidence preponderates against the increased rating claim, to include extraschedular referral, the benefit-of-the-doubt doctrine is not for application. The claim is denied. 8. Entitlement to an initial disability rating greater than 10 percent prior to February 24, 2017, and greater than 30 percent thereafter, for service-connected irritable bowel syndrome (IBS) The Veteran seeks a higher disability rating for his irritable bowel syndrome (IBS). He contends that he has to go to the restroom six to eight times a day, cannot eat out or go anywhere without a plan for a restroom, and noted that his condition is not chronic diarrhea. He also added that he has major abdominal pain and distress. The Veteran is currently in receipt of a 10 percent rating prior to February 24, 2017, and a 30 percent rating thereafter, under DC 7319, for his service-connected IBS. Pertinent regulations for consideration were provided to the Veteran in the May 2010 Statement of the Case (SOC) and will not be repeated here in full. The Veteran first underwent a VA examination in July 2008, during which time he was diagnosed with IBS, mildly active at the time of the exam. He reported generalized abdominal pain and discomfort (not a sharp pain, but a crampy ache-type pain, which bothers him throughout the day). He reported 5-6 bowel movements a day, sensation of bloated abdominal distension, bowel movements averaging about five times a day, affecting his activities of daily living and work. Physical examination of abdominal condition showed general discomfort on palpation. He denied nausea, vomiting, fever, or chills. He also reported having been prescribed with Metamucil and a high fiber diet. During a January 2010 VA examination, the Veteran reported an urge to use the restroom immediately after eating, which has been worsening. He was also noted to have had slight bleeding from time to time, with generalized abdominal pain and discomfort (not a sharp pain, but a crampy ache-type pain, which bothers him throughout the day). He reported 5-6 bowel movements a day, sensation of bloated abdominal distension, bowel movements averaging about five times a day, affecting his activities of daily living and work. Physical examination of abdominal condition showed general discomfort on palpation, with no evidence of specific masses, enlargement of organs, rebound tenderness, or ascites. His peristalsis and rectal exam results were noted as normal, except for some tenderness of rectal area. During a February 2017 VA examination, he was diagnosed with IBS, and the Veteran reported having to use a restroom 6-8 times a day (constant diarrhea), taking Bentyl (which does not seem to help). His condition was noted to require continuous medication (Bentyl). His IBS manifested recurring episodes of symptoms that are not severe (occurring about 4 or more times a year, with average duration of episodes lasting 10 days or more), continuous abdominal pain, periodic nausea (occurring 4 or more times per year, with each episode lasting less than a day), periodic vomiting (occurring 4 or more times per year, with each episode lasting less than a day), and periodic melena (occurring 4 or more times per year, with each episode lasting less than a day). He was not found to have any other conditions, and was found to have constant abdominal pain that is aggravated after eating. During the August 2017 VA examination, the Veteran made the same reports he made during the February 2017 VA examination. The Veteran was found to manifest symptoms of diarrhea (6-8 times daily), occasional nausea and vomiting, frequent episodes of bowel disturbance with abdominal distress, and 7 or more episodes of exacerbations and/or attacks of the intestinal condition. Prior to February 24, 2017 In light of the frequency and the severity of his loose bowel movements and constant abdominal distress, the Board finds that the Veteran warranted a rating of 30 percent under DC 7319 prior to February 24, 2017. In this case, the Veteran manifested more or less constant abdominal pain and discomfort/abdominal distension persisting mostly throughout the day, accompanied by five to six loose bowel movements per day. Moreover, due to his loose bowel movements/having to visit restroom extremely frequently throughout the day (five to six times on average) and constant/near-constant abdominal pain and discomfort, his condition was noted to affect his activities of daily living and work. See July 2008 and January 2010 VA examinations. In light of above, and resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran warranted a 30 percent ratingwhich is the highest schedular rating available under DC 7319for his IBS condition, prior to February 24, 2017. Throughout the appeal period As the Veteran is in receipt of the highest schedular rating under DC 7319 for IBS throughout the appeal period, there is no basis to award a higher rating. Accordingly, the Board has considered whether a higher rating is warranted under any other potentially applicable DC. See 38 C.F.R. § 4.118, Schedule of Ratings-Digestive System. However, the Board finds such not warranted, as the evidence of record does not establish that the Veteran has any abdominal/digestive system conditions other than IBS. The Board finds that the criteria of DC 7319 are the most appropriate for evaluating the Veteran's IBS, as it specifically contemplates the symptoms experienced by the Veteran due to his abdominal conditioni.e. loose bowel movements, more or less abdominal distress, and diarrhea. Butts v. Brown, 5 Vet. App. 532, 538 (1993) (finding that the assignment of a particular diagnostic code is "completely dependent on the facts of a particular case"). Furthermore, ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, which, here, is DC 7319 for the reasons given above. The Board also considered whether the Veteran warrants extraschedular consideration for his IBS condition as the representative has raised this issue (although without providing any specifics as to why he warrants it for his IBS condition). In this case, while there is evidence of frequent bowel movements throughout the day, accompanied by pain, affecting his activities of workpotentially suggestive of marked interference with employmentto the extent that the Veteran's symptoms (severe frequent loose bowel movements with abdominal distress) are already adequately contemplated and described by the schedule for the digestive system, the Board finds that such consideration is not warranted. In sum, as the evidence preponderates against the claim, to include extraschedular referral, the benefit-of-the-doubt doctrine is not for application. The claim is denied. 9. Entitlement to an initial compensable rating prior to February 24, 2017, and in excess of 30 percent thereafter, for service-connected sarcoidosis The Veteran claims that he has multiple symptoms, to include issues with his eyes/lungs, difficulty breathing, joint pain, swollen glands, skin eruptions, fatigue and muscle aches, as well as lymph nodes in his lungs two to three times per year, nasal mucosa, clubbing of the fingertips, enlargement of the salivary glands and issues with his thyroid. He also claims he has black spots on his lungs and skin rashes over his body. He claims that he has taken Prednisone for many years from 2007 to the present. He is currently in receipt of an initial non-compensable rating prior to February 24, 2017, and a 30 percent rating, thereafter, under DC 6846, for his service-connected sarcoidosis. Ratings under DCs 6600 through 6817 and 6822 through 6847 will not be combined with each other. See 38 C.F.R. § 4.96 (a). Where there is lung or pleural involvement, ratings under diagnostic codes 6819 and 6820 will not be combined with each other or with diagnostic codes 6600 through 6817 or 6822 through 6847. A single rating will be assigned under the diagnostic code which reflects the predominant disability with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. Under Diagnostic Code 6846, sarcoidosis with pulmonary involvement with persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids is rated 30 percent disabling. Sarcoidosis with pulmonary involvement requiring systemic high dose (therapeutic) corticosteroids for control is rated 60 percent disabling. Sarcoidosis with cor pulmonale, or; cardiac involvement with congestive heart failure, or; progressive pulmonary disease with fever, night sweats, and weight loss despite treatment, is rated 100 percent disabling. 38 C.F.R. § 4.97, Diagnostic Code 6846. Alternatively, sarcoidosis may be rated pursuant to Diagnostic Code 6600 under the rating criteria for chronic bronchitis. 38 C.F.R. § 4.97, Diagnostic Code 6846 ("or rate active disease or residuals as chronic bronchitis (Diagnostic Code 6600) and extra-pulmonary involvement under specific body system involved"). Diagnostic Code 6600 provides ratings for chronic bronchitis based on the results of pulmonary function tests (PFTs). FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56- to 70-percent predicted or; DLCO (SB) of 56- to 65-percent predicted, is rated 30 percent disabling. FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40- to 55-percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit), is rated 60 percent disabling. FEV-1 less than 40 percent of predicted value, or; FEV-1/FVC less than 40 percent predicted, or; DLCO (SB) less than 40 percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy is rated 100 percent disabling. 38 C.F.R. § 4.97, Diagnostic Code 6600. In July 2008, the Veteran was diagnosed with mild pulmonary sarcoidosis of the pulmonary type, and was noted to have persistent dyspnea on exertion. He complained of a non-productive cough, shortness of breath, and exertional dyspnea with running more than half a mile or walking for more than 34 of a mile. He was noted to have been on a 10-day Prednisone therapy for his shortness of breath and non-productive cough (although dose unknown), but had never been hospitalized or had incapacitating episodes requiring hospitalization. Physical examination of the chest showed clear lungs, unremarkable cardiac exam, and pulmonary function test results were consistent with sarcoidosis. The Veteran also reported that he is not on oxygen therapy for his respiratory condition. During a January 2010 VA examination, his primary symptom was found to be persistent dyspnea on exertion (labored breathing), and he was also noted to have a dry cough. Physical examination showed clear lungs, with no evidence of cor pulmonale or right ventricular hypertrophy or pulmonary hypertension. His pulmonary function studies revealed a FVC of 36 percent, FEV-I of 90 percent, FEV-1/FVC of 76 percent, and DLCO of 83 percent of predicted (it does not say whether it was pre- or post-bronchodilator results). His chest x-ray was negative, and there was no significant weight change (+/- 2 to 3 pounds) or evidence of a condition suggestive of causing restrictive disease. The examiner further indicated that he could walk about 30 yards without having to sit down and rest because of shortness of breath. During an October 2010 VA examination, the Veteran was diagnosed with sarcoidosis with pulmonary manifestations. He complained of frequent pruritic rashes on upper body/arms/legs, difficulty breathing at night, persistent dyspnea with moderate to heavy exertion. He was noted to have been on Prednisone for a long time. There was no pulmonary history of hemoptysis, respiratory failure, cor pulmonale, pulmonary hypertension, sleep apnea symptoms, night sweats, chronic pulmonary mycosis, spontaneous pneumothorax, asthma, bronchiectasis, pulmonary embolism or pleurisy with empyema. However, he was noted to have near-constant non-productive cough, purulent/mucopurulent productive cough, wheezing, dyspnea (at rest). Physical examination showed no evidence of abnormal breath sounds, congestive heart failure, or pulmonary hypertension, or signs of significant weight loss or malnutrition. In February 2017, the Veteran was diagnosed with sarcoidosis, and he reported primary symptoms being shortness of breath, generalized fatigue, and muscle aches. He reported being on Prednisone daily and receiving ongoing treatments. His condition was noted to require chronic low dose (maintenance) corticosteroids, but does not require the use of inhaled medications, oral bronchodilator, antibiotics or outpatient oxygen therapy. His condition consisted of symptoms of persistent shortness of breath, pulmonary involvement (sarcoidosis), and night sweats, with no other pertinent physical findings or symptoms. Pursuant to the August 2017 VA examination, the Veteran was noted to have the same symptoms as in February 2017. His condition was found to require chronic low dose (maintenance) corticosteroids. The examiner indicated that the Veteran does not have ophthalmologic, renal, cardiac, neurologic or other organ system involvement due to sarcoidosis. He reported that he is currently on Prednisone daily, and described his main symptoms as shortness of breath, generalized fatigue, and muscle aches. The examiner referenced a PFT test from March 2017, which showed the following results, with FVC percent predicted noted as most accurately reflecting the Veteran's level of disability : pre-bronchodilator (FVC 69.9 percent predicted, FEV-1 60.5 percent predicted, FEV-1/FVC 69 percent, DLCO 66.5 percent predicted) and post-bronchodilator (FVC 75.8 percent predicted, FEV-1 77.9 percent predicted, FEV-1/FVC 89.2 percent). The Veteran was not found to have multiple respiratory conditions nor functional impact associated with his condition. His treatment records document several pulmonary function test results conducted throughout the appeal period: FEV-1 of 91 percent predicted, FVC of 77 percent predicted, and FEV-1 of 91 percent predicted (see October 2014 VA treatment records); FVC of 90 percent, FEV-1 of 81 percent, FEV-1 of 90 percent (see August 2009 VA treatment records); FVC 88 percent predicted FEV-1 82.5 percent predicted, with normal diffusion and lung capacity (see January 2010 VA treatment records). His treatment records even prior to February 24, 2017 show that he was prescribed Prednisone for his sarcoidosis condition (see October 2007 VA treatment records, he was on a short course of prednisone for his sarcoidosis; see August 2009 VA treatment records, Prednisone 20mg tab for 20 days from April 16, 2007; see July 2012 VA treatment records, Prednisone 20mg tab for 10 days, 2 tabs/day; see April 2014 VA treatment records, Prednisone 10mg tab for 28 days; see October 2014 and August 2014 VA treatment records, Prednisone 10mg for 30 days; see May 2015 VA treatment records, Prednisone 10mg for 28 days). Prior to February 24, 2017 As addressed above, the Veteran is in receipt of a non-compensable rating under DC 6846 prior to February 24, 2017. The Board concludes that the Veteran's service-connected sarcoidosis more closely approximates persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids, corresponding to a 30 percent disability rating under Diagnostic Code 6846 prior to February 24, 2017. He was consistently found to manifest sarcoidosis with pulmonary manifestations, accompanied by persistent symptoms requiring chronic low dose or intermittent corticosteroids. Even though the July 2008 and January 2010 VA examinations indicated that the Veteran was either on the 10 day Prednisone therapy or not on any treatment for his sarcoidosis condition, there are treatment records showing more extensive intermittent Prednisone prescriptions throughout those time periods, and the October 2010 VA examination provides that he has been on Prednisone for a long period (see August 2009 VA treatment records, Prednisone 20mg tab for 20 days from April 16, 2007; see July 2012 VA treatment records, Prednisone 20mg tab for 10 days, 2 tabs/day; see April 2014 VA treatment records, Prednisone 10mg tab for 28 days; see October 2014 and August 2014 VA treatment records, Prednisone 10mg for 30 days; see May 2015 VA treatment records, Prednisone 10mg for 28 days). Thus, the Board finds that the Veteran warrants a 30 percent rating under DC 6846. Although the Board also considered whether the Veteran warrants a higher rating under DC 6846, the Board finds such not applicable. Specifically, at no time during the appeal period has the Veteran manifested sarcoidosis requiring high dose corticosteroids for control (prescription of Prednisone primarily limited to 10mg tab for a duration of about a month, and the highest being 20mg tab (two tabs) for 10 days). Moreover, there is no suggestion that his sarcoidosis manifested by cor pulmonale, cardiac involvement with congestive heart failure, or progressive pulmonary disease with fever, night sweats, and weight loss despite treatment. While there is evidence of pulmonary disease (sarcoidosis) and night sweats, there is no objective nor subjective evidence of weight loss despite treatment and fever. The Board considered whether the Veteran would be warranted a higher rating under another DC (i.e. DC 6600), but he would only be warranted a 10 percent rating under DC 6600. Notably, his pulmonary function test shows FEV-1/FVC of 76 percent, suggestive of a 10 percent rating. See January 2010 VA examination and January 2010 VA treatment records. Thus, evaluating the Veteran's sarcoidosis based on his respiratory function under DC 6846 would result in a higher rating of 30 percent. Thus, the Board finds that the Veteran warrants an initial rating of 30 percent, but no higher, for his sarcoidosis condition. Effective February 24, 2017 The Board concludes that the Veteran's service-connected sarcoidosis most closely approximates persistent symptoms requiring chronic low dose (maintenance) or intermittent corticosteroids effective February 24, 2017, and a higher rating than 30 percent is not warranted. The Board finds that the Veteran's service-connected sarcoidosis has not manifested in impairment meeting the criteria for a disability rating in excess of 30 percent. Specifically, at no time during the period on appeal has the Veteran been shown to have pulmonary involvement requiring systemic high dose corticosteroids for control. His condition was consistently found to require chronic low dose (maintenance) corticosteroids instead. Moreover, there is no suggestion that his sarcoidosis manifested by cor pulmonale, cardiac involvement with congestive heart failure, or progressive pulmonary disease with fever, night sweats, and weight loss despite treatment. While there is evidence of pulmonary disease (sarcoidosis) and night sweats, there is no objective nor subjective evidence of weight loss despite treatment and fever. His symptoms were noted as primarily consisting of persistent shortness of breath, pulmonary involvement (sarcoidosis), and night sweats. Thus, the claim for a higher rating is denied. A rating greater than 30 percent is also not warranted under DC 6600, as the pulmonary function tests do not show FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted; or maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit); there is FEV-1 less than 40 percent of predicted value, or; the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC) less than 40 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale, or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy. Id. His FEV-1 was at worst 60.5 percent predicted and FEV-1/FVC 69 percent, warranting a 30 percent rating, which is what the Veteran is already in receipt of. Thus, the claim is denied. The Board has also considered whether this condition should be referred for extraschedular consideration, but finds it not applicable. Although the Board acknowledges that some of the reported symptoms are not specifically contemplated by the rating schedule for the disease of the lungs and pleura, there is no evidence the Veteran's general fatigue/joint pain, swollen glands, skin eruptions, clubbing of the fingertips, enlargement of the salivary glands and issues with thyroids are etiologically related to or part of his sarcoidosis disability. His symptoms associated with sarcoidosis were consistently noted as shortness of breath, cough, dyspnea and/or wheezing/night sweats, despite his reports of other symptoms. Moreover, neither the Veteran nor his representative alleges that these symptoms manifest to such severity/frequency that result in marked interference with employment and there is no persuasive indication of such in the record. When asked during a VA examination, he also reported that he had never been hospitalized or had incapacitating episodes requiring hospitalization. As the evidence preponderates against the increased rating claim, to include extraschedular referral, the benefit-of-the-doubt doctrine is not for application. The claim is denied. 10. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) As briefly noted in the introduction, while the Veteran was granted TDIU and SMC from January 26, 2016, the Board will proceed its analysis as to whether the Veteran was entitled to TDIU prior to January 26, 2016, as TDIU was part and parcel of the initial increased rating claims (from April 1, 2008) currently on appeal. With the grants herein, the Veteran will have a combined rating of 90 percent from April 1, 2008 to October 22, 2008, and a combined rating of 100 percent from October 23, 2008. The Veteran claims that the vocational rehabilitation counselor stated it would almost be impossible to find him work due to disability. The Veteran further claims that going to school using his GI Bill should not be a reason for denying TDIU. It appears that the Veteran was last employed around April 2008, prior to which he worked in management for almost 10 years for the Air Force (see July 2008 VA examination, stating that he has been unemployed for the last three months; see DD-214 form, military occupational specialty listed as services craftsman). He indicated that he became too disabled to work as of April 1, 2008, but stated that he did not leave his last job due to his disability; he further indicated that he does not receive/expect to receive workers compensation benefits, but stated that he receives/expects to receive retirement benefits (from the military). See January 2016 and June 2009 VA 21-8940 forms. As for educational history, he stated he had up to three years of college. See January 2016 VA 21-8940 form. He also stated that he is not presently employed. However, since retiring from the military, he has attended school and/or undergoing training for heating/AC/auto technician from September 1, 2010 to August 27, 2014. It does not appear that he was attending school and/or undergoing training or employed anytime other than from September 1, 2010 to August 27, 2014. April 1, 2008 to October 22, 2008 Initially, the Board notes that the Veteran has multiple service-connected disabilities, with at least one disability rated 40 percent or more, with a combined rating of 90 percent with the grants herein. He meets the schedular TDIU criteria under 38 C.F.R. § 4.16(a). Therefore, a TDIU is warranted if the evidence shows that he has been unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities, considering his specific educational and employment background, but without regard to age, non-service connected disabilities, or previous unemployability status. See 38 C.F.R. §§ 4.16(a), 4.19. The Board finds that the Veteran was not warranted TDIU throughout this roughly six-month period as the preponderance of the evidence shows that his service-connected disabilities did not render him unable to secure or follow a substantially gainful occupation. While some of the July/August 2008 VA examinations show that some of the Veteran's service-connected disabilities (i.e. PTSD, allergic rhinitis) resulted in nasal congestion causing fatigue, reduced ability to concentrate/read/study, hyperarousal, avoidance, and restricted mood, there is no indication that these symptoms were of such severity that they prevented him from securing or following any substantially gainful occupation. In fact, the VA examiner for PTSD indicated that he had been able to work effectively in his position in the military and that his PTSD just prevented him from achieving higher ranks/using all his functional abilities, and the VA examiner for allergic rhinitis only indicated congestion causing fatigue as a related symptom. Moreover, even after acknowledging symptoms of his other service-connected disabilities, the VA examiners indicated that these had no impact on his occupation. The Veteran's service-connected disabilities, especially in their combined effect, would certainly have an impact on his ability to work. The fact he has a combined rating of 90 percent is recognition of the significant effect of these conditions on his functional abilities. However, there is no persuasive evidence that his service-connected disabilities prevented him from securing or following any substantially gainful occupation throughout this period. Thus, this claim is denied. October 23, 2008 to December 14, 2015 Initially, the Board notes that with the grants herein, the Veteran will have a combined total disability rating throughout this time period, beginning October 23, 2008. Therefore, the issue of entitlement to a TDIU is potentially moot. See, e.g., Bradley v. Peake, 22 Vet. App. 280, 294 (2008); see also Buie v. Shinseki, 24 Vet. App. 242, 248 (2010). The Board recognizes that it is not categorically true that assignment of a total schedular rating always renders a TDIU request moot, particularly as it relates to possible entitlement to special monthly compensation. See Bradley, 22 Vet. App. at 293. In Bradley, the Court held that a TDIU rating predicated on one disability (although perhaps not ratable at the schedular 100 percent level) when considered together with another disability separately rated at 60 percent or more could warrant special monthly compensation. Here, however, the Board does not find the Veteran could have been awarded TDIU based on any single disability. Despite the significant effect of his service-connected conditions as reflected by the total combined disability rating there is no persuasive evidence he was not capable of gainful employment consistent with his background as a result of any single condition. At least from September 1, 2010 to August 27, 2014, it appears that the Veteran was attending school full-time (i.e. Central Tech) and/or undergoing training (heating/AC/auto technician). See January 2016 VA 21-8940 form, see also January 2010 VA examination. While the Board acknowledges the Veteran's contention that his attending school should not be a basis for a denial for TDIU entitlement, the Board underlines the fact that not only was he enrolled in school full-time, but also that he denied missing any time from school despite some problems with concentration, trouble reading due to concentration, and some trouble retaining materialsand his memory was noted to be only slightly impaired and that his memory was fairly intact for recent and remote events (see March 2011 VA examination, which shows that he was a full-time student at Central Tech in Sumter working on an HVAC for 2 years and he denied missing any time from school in the past year even though he reported some problems with concentration and reading). During the March 2011 VA examination, the Veteran also only reported not having enjoyed his classes in USC for the reasons of his classes being large in size and programs not being hands-on, and he added feeling less irritated and agitated at the Central Tech due to its offering smaller and more hands-on classes. The Board acknowledges that "the skills needed to attend school are different from the skills needed to compete successfully in the workplace," Washington v. Derwinski, 1 Vet. App. 459, 465 (1991). Therefore, while his educational history is not dispositive evidence concerning his ability to obtain/maintain employment, it is relevant evidence that the Veteran had the ability to complete a number of the types of tasks required of sedentary work (e.g., submitting written work, reading and understanding instructions, completing discrete tasks, meeting deadlines, and interacting with others). In making this determination, the Board acknowledges and follows the Court's admonition in Washington that school attendance does not, per se, support a conclusion that a veteran is employable. The Board notes that there are several important differences between the facts in Washington and this case and in the Board's analysis in that case and this one. First, the Court in Washington noted that "there is no evidence in the record...that the veteran is successfully pursuing his studies." In this case, the record indicates the Veteran did successfully complete his studies. Second, the veteran in Washington was taking "real estate brokers/agents courses" with the aim of "self-employment as a real estate investor." There is not a clear link between courses providing basic knowledge to be a real estate broker/agent and the actual mental and physical tasks required of a self-employed real estate investor. Here, however, the Veteran successfully completed coursework that involved some of the same technical skills that would be required in employment in his chosen field (e.g., (heating/AC/auto technician). In other words, the Board recognizes that attending school does not necessarily involve the same skills as the competitive workplace. Some courses are more general or theoretical and, depending on the course of study, successful completion of a course of study may not indicate the presence of a skill sufficient to perform an occupational task in an occupational setting. But, successfully completing training as a heating/AC/auto technician, including hands-on classes per the Veteran, does indicate the presence of some of the same skills that would be required in an occupational field for which his training would suit him. Considering his years in a management position in the military, he had skills and experience that would be required in a variety of employment situations, and the medical evidence did not show he was unable to perform the mental and physical tasks of employment. Therefore, there is no evidence any single service-connected disability would have resulted in unemployability, and for the aforementioned reasons, the award of a 100 percent combined schedular evaluation within the circumstances of this case rendered the TDIU claim moot throughout this period. It is thus dismissed. December 15, 2015 to January 25, 2016 It appears that the Veteran completed his school/training in August 2014. On December 15, 2015, the rating for his PTSD was increased to 70 percent. The Board reiterates that the Veteran is receipt of a combined total disability rating throughout this period, but has considered whether TDIU is moot per Bradley. The Board acknowledges his MOS was service craftsman (3M071), involving somewhat broad range of managerial and/or potentially sedentary work that involve duties of managing, supervising, and administering and operating facilities, training, scheduling and overseeing installation, among others), as well as additional specialized educational/training experience in HVAC program and heating/AC/auto technician work. However, with the increase to 70 percent for his service-connected PTSD, the medical evidence showed he was experiencing suicidal ideation, difficulty in adapting to stressful circumstances, including work or a worklike setting, impaired judgment, and disturbances of motivation and mood, among various other symptoms. Thus, considering the severity and symptoms of his service-connected PTSD, the Board finds the Veteran's service-connected PTSD alone could be the basis for a grant of entitlement to TDIU. The RO chose January 26, 2016 as the effective date, as that was the date the TDIU claim was received. However, an effective date up to one year earlier could be assigned if warranted by the evidence. Here, the Veteran's increase for PTSD was effective December 15, 2015, and the evidence of record reasonably showed his PTSD prevent gainful employment at that time. Thus, the Board concludes TDIU should have been granted from December 15, 2015 to January 25, 2016. Additionally, for SMC purposes, the Veteran's TDIU based on his service-connected PTSD disability alone satisfies the requirement of a "service-connected disability rated as total." See Buie, 24 Vet. App. at 251; see also Bradley, 22 Vet. App. at 293. Specifically, SMC is payable at a specified rate under 38 U.S.C. § 1114 (s) when a Veteran has a single service-connected disability rated as 100 percent and (1) has additional service-connected disability or disabilities independently ratable at 60 percent or more, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems; or, (2) is permanently housebound by reason of service-connected disability or disabilities. 38 C.F.R. § 3.350 (i). See also Gazelle v. Shulkin, 868 F.3d. 1006, 1012 (Fed. Cir. 2017) (holding that "§ 1114(s)(1) unambiguously requires the veteran's additional disabilities be rated at least at sixty percent based upon the combined ratings table and not the addition of individual disability ratings as argued"). While the separate disabilities rated as 60 percent disabling must involve separate and distinct anatomical segments or body systems, the fact that the total disability and the independent 60 percent disabilities result from a common etiological agent will not preclude entitlement. In this case, because the Veteran's TDIU is based on a single service-connected disability (TDIU), which is therefore considered a total rating. The Veteran also has additional service-connected disabilities, other than PTSD, combined at a rating of at least 60 percent disabling. As the criteria for SMC under 38 U.S.C. § 1114 (s) have been met, SMC is also granted throughout this period. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Lee 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.