Citation Nr: 21026906 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 08-09 834A DATE: May 4, 2021 ORDER A 20 percent rating, but no more, for cervical spine segmental dysfunction with spondylosis is granted, subject to the payment of monetary benefits. A rating in excess of 10 percent for traumatic brain injury (TBI) with post/trauma headaches and intermittent dizziness with vertigo prior to September 23, 2008, is denied. A rating in excess of 10 percent for TBI since September 23, 2008, is denied. An initial rating in excess of 70 percent for adjustment disorder with mixed emotional features of anxiety and depression associated with TBI is denied. A rating in excess of 30 percent for post/trauma headaches associated with TBI is denied. A rating in excess of 30 percent for intermittent dizziness with vertigo associated with TBI is denied. A rating in excess of 20 percent for lumbosacral strain is denied. An effective date prior to September 23, 2008, for a total disability rating due to individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The Veteran had active duty from November 1971 to May 1977; he has been rated at 100 percent disabled based on unemployability plus special monthly compensation since September 2008. 2. A cervical spine disability has been manifested by subjective complaints of pain; objective findings include forward flexion to be, at worst, 40 degrees, the combined range of motion of the cervical spine to be, at worst, 100 degrees, and no muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis, ankylosis, or intervertebral disc syndrome (IVDS). 3. Prior to September 23, 2008, TBI was manifested by subjective complaints of dizziness; objective findings included no evidence of multi-infarct dementia associated with brain trauma. 4. Since September 23, 2008, the cognitive impairment from a TBI warrants level "1" impairment on the table of facets of cognitive impairment for impairment in memory, attention, concentration, executive functions, and orientation. 5. An adjustment disorder has been manifested by subjective complaints of depression, anxiety, and suicidal ideation when stressed; objective findings include depressed mood, and normal speech, thought processes, and memory. 6. Headaches have been manifested by subjective complaints of severe headaches; objective findings include, at worst, migraines that do not include very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 7. Intermittent dizziness with vertigo is assigned the maximum rating authorized under Diagnostic Code (DC) 6204. 8. A lumbar spine disability has been manifested by subjective complaints of pain; objective findings include forward flexion to be, at worst, 40 degrees, and no ankylosis or IVDS. 9. The Veteran filed a claim for a TDIU on August 28, 2015. The evidence does not show that his service-connected disabilities caused unemployability until September 2008; no document filed before August 28, 2015, could be construed as a claim for a TDIU. CONCLUSIONS OF LAW 1. The criteria for a 20 rating, but no more, for cervical spine segmental dysfunction with spondylosis have been met. 38 U.S.C. §§ 1110, 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, DC 5237 (2020). 2. The criteria for a rating in excess of 10 percent for TBI with post/trauma headaches and intermittent dizziness with vertigo prior to September 23, 2008, have not been met. 38 U.S.C. §§ 1110, 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, DCs 8045-9304 (2020). 3. The criteria for a rating in excess of 10 percent for TBI since September 23, 2008, have not been met. 38 U.S.C. §§ 1110, 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, DC 8045 (2020). 4. The criteria for a rating in excess of 70 percent for adjustment disorder with mixed emotional features of anxiety and depression associated with TBI have not been met. 38 U.S.C. §§ 1110, 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, DC 9440 (2020). 5. The criteria for a rating in excess of 30 percent for post/trauma headaches associated with TBI have not been met. 38 U.S.C. §§ 1110, 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, DC 8100 (2020). 6. There is no legal basis for a rating in excess of 30 percent for intermittent dizziness with vertigo associated with TBI. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321, 4.87, DC 6204 (2018). 7. The criteria for a rating in excess of 20 percent for lumbosacral strain have not been met. 38 U.S.C. §§ 1110, 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, DC 5237 (2020). 8. The criteria for an effective date prior to September 23, 2008, for TDIU have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. §§ 3.155, 3.400 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran testified before the Board in June 2009, May 2010, August 2012, September 2014, and most recently in November 2020. The issues have also been the subject of several remands and Veterans Claims Court decisions. At this juncture, he has been 100 percent disabled since September 2008. Increased Rating Claims Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. §§ 4.1. Separate diagnostic codes identify the various disabilities. As to the Veteran's orthopedic appeals (cervical spine and lumbar spine), the disabilities are rated under DC 5237 for strain. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, this diagnostic code was not changed. Similarly, the regulations addressing arthritis have not been changed. Although the regulations for IVDS have been amended, the medical evidence does not reflect a diagnosis of IVDS for either the cervical or lumbar spine so those regulations will not be addressed. Cervical Spine Disability The Veteran is in receipt of a 10 percent rating under DC 5237 for a cervical spine disability. The Board will consider all appropriate diagnostic codes. Under the relevant diagnostic codes, a 20 percent rating is warranted when the objective medical evidence shows: forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; the combined range of motion of the cervical spine not greater than 170 degrees; muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; or IVDS with incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 30 percent rating is warranted when the objective medical evidence shows: forward flexion of the cervical spine 15 degrees or less; or favorable ankylosis of the entire cervical spine. As to forward flexion, the medical evidence does not show it to be between 15 and 30 degrees or at 15 degrees or less. Specifically, in a June 2009 clinical record, the Veteran complained of neck stiffness and soreness. Upon examination, forward flexion of the cervical spine was to 45 degrees. Further, in a July 2009 clinical record, he complained of cervical spine pain. Upon examination, forward flexion of the cervical spine was to 50 degrees. In addition, in a January 2011 VA examination, forward flexion was limited to 40 degrees. In a March 2013 clinical record, the Veteran complained of neck pain that caused headaches; however, upon examination, forward flexion was normal. Based on the above, a higher rating is not warranted based on forward flexion. As to the combined range of motion of the cervical spine, the medical evidence shows it to be less than 170 degrees. Specifically, in a June 2009 clinical record, forward flexion was 45 degrees, extension was 45 degrees, and left and right flexion was 20 degrees, respectively. This equaled a combined range of motion of 130 degrees. Further, in a July 2009 clinical record, forward flexion was 50 degrees, extension was 10 degrees, left flexion was 22 degrees, and right flexion was 20 degrees. This equaled a combined range of motion of 102 degrees. In addition, in a January 2011 VA examination, forward flexion was 40 degrees, extension was 30 degrees, and left and right flexion was 15 degrees, respectively. This equaled a combined range of motion of 100 degrees. As such, this evidence supports a 20 percent rating. However, a 30 percent rating is not warranted as forward flexion is not limited to 15 degrees or less (as it has been recorded as 45 degrees, 50 degrees, 40 degrees, and normal) and ankylosis is not shown. Specifically, in a January 2011 VA examination, there was no evidence of ankylosis. Further, as range of motion of the neck was reported, by definition it is not fixated in a favorable position). In sum, the medical evidence supports a 20 percent rating, but no more, for a cervical spine disability based on the combined range of motion of the cervical spine to be, at worst, 100 degrees. The medical evidence does not support a rating in excess of 20 percent, as ankylosis is not shown and forward flexion of the cervical spine is not limited to 15 degrees or less. Therefore, the medical evidence supports a 20 percent rating, but no more, for a cervical spine disability. TBI Prior to September 23, 2008 Prior to September 23, 2008, the Veteran was rated at 10 percent under DCs 8045-9304 for TBI with headaches, dizziness, and vertigo. The issues of dizziness and vertigo and headaches were separately rated effective September 23, 2008, and will be considered below. The criteria for evaluating residuals of TBI were revised during the pendency of this appeal. The Board will designate the regulations in effect prior to the respective changes as the pre-amended regulations and the subsequent regulations as the amended regulations. The timing of this change requires the Board to first consider the claim under the appropriate pre-amended regulations for any period prior to the effective date of the amended diagnostic codes. Thereafter, the Board must analyze the evidence dated after the effective date of the new regulations and consider whether a rating higher than the previous rating is warranted. See VAOPGCPREC 7-2003; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Prior to October 2008, under DC 8045 (brain disease due to trauma), purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, were rated 10 percent and no more under DC 9304. This 10 percent rating was not combined with any other rating for a disability due to brain trauma. Ratings in excess of 10 percent for brain disease due to trauma under DC 9304 were not assignable in the absence of a diagnosis of multi-infarct dementia associated with brain trauma. 38 C.F.R. § 4.124 (a). Under the amended regulations, TBI residuals are evaluated under DC 8045 based on three main areas of dysfunction: cognitive, emotional/behavioral, and physical. Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. VA is to evaluate cognitive impairment under the table titled Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified ("TBI Table"). The TBI Table contains 10 important facets of a TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th highest level of impairment labeled "total." If no facet is evaluated as "total," the overall percentage rating is assigned based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. The terms mild, moderate, and severe TBI, which may appear in medical records, refer to a classification of a TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under DC 8045. A 10 percent rating is warranted when the highest level of evaluation for any facet is "1." A 40 percent rating warranted when the highest level of evaluation for any facet is "2." A 70 percent rating is assigned if "3" is the highest level of evaluation for any facet. However, the medical evidence does not show a diagnosis of multi-infarct dementia. Specifically, in a March 2005 clinical record, he reported some misalignment due to a prior head injury. However, dementia was not diagnosed. Further, in November 2005, he denied headaches and dizziness. In addition, a December 2006 MRI showed no evidence of focal occlusive or aneurysmal disease in the skull. Therefore, as dementia was not shown, the medical evidence does not support a rating in excess of 10 percent for TBI prior to September 23, 2008. TBI since September 23, 2008 Since September 23, 2008, the Veteran has been rated at 10 percent under DC 8045 for TBI. TBI residuals are evaluated under DC 8045 based on three main areas of dysfunction: cognitive, emotional/behavioral, and physical. Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. VA is to evaluate cognitive impairment under the table titled Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified ("TBI Table"). The TBI Table contains 10 important facets of a TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th highest level of impairment labeled "total." If no facet is evaluated as "total," the overall percentage rating is assigned based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. The terms mild, moderate, and severe TBI, which may appear in medical records, refer to a classification of a TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under DC 8045. A 10 percent rating is warranted when the highest level of evaluation for any facet is "1." A 40 percent rating warranted when the highest level of evaluation for any facet is "2." A 70 percent rating is assigned if "3" is the highest level of evaluation for any facet. Turning to the medical evidence, in a September 2013 VA examination, there were no complaints of impairment of memory, attention, concentration, or executive functions. Judgment, motor activity, consciousness, communication, and spatial orientation were normal. Social interaction was rated as occasionally inappropriate, as the Veteran reported getting angry easily. However, this neurobehavioral effect was not noted to interfere with workplace interaction or social interaction. Further, in an April 2015 VA examination, the Veteran reported mild memory loss and poor concentration. However, judgment, orientation, consciousness, and communication were normal. Social interaction was rated as occasionally inappropriate, as the Veteran reported getting angry easily. However, this neurobehavioral effect was not noted to interfere with workplace interaction or social interaction. In addition, he stated that the subjective symptoms of headaches, light sensitivity, noise sensitivity, and anxiety mildly interfered with work, activities of daily living, and social interaction. In a June 2016 VA examination, the Veteran reported mild memory loss and poor concentration. Social interaction was rated as occasionally inappropriate, as he stated that he would get angry easily. However, this neurobehavioral effect was not noted to interfere with workplace interaction or social interaction. Further, he explained that the subjective symptoms of headaches, light sensitivity, noise sensitivity, and anxiety mildly interfered with work, activities of daily living, and social interaction. In addition, in an April 2019 VA examination, the Veteran reported short term memory loss such as not remembering names and being unable to finish sentences. However, judgment, social interaction, orientation, motor activity, communication, and consciousness were normal. Further, spatial orientation was rated as mildly impaired, as the Veteran stated he would get lost without GPS. However, he reported no neurobehavioral effects and no subjective symptoms. Based on the above, the medical evidence does not support a rating in excess of 10 percent for TBI since September 23, 2008. A 10 percent rating is based on the Veteran's spatial orientation and memory being mildly impaired, social interaction being occasionally inappropriate, and three or more subjective symptoms that mildly interfered with work and social interaction. A higher rating based on cognitive impairment would require an evaluation of at least a "2" on a facet of the TBI Table. While the Veteran reported memory loss, there was no objective evidence of impaired memory. Further, social interaction was not rated as frequently inappropriate and spatial orientation was not determined to be moderately impaired, such that he had difficulty using GPS. In addition, while he reported subjective symptoms of TBI, they were not determined to moderately interfere with work. Clinical records do not contradict these findings. Therefore, a "2" on the TBI table is not warranted. For these reasons, the medical evidence does not support a rating in excess of 10 percent for TBI prior to September 23, 2008. Adjustment Disorder The Veteran is in receipt of a 70 percent rating under DC 9440 for a psychiatric disability. A 70 percent rating is warranted when the objective medical evidence shows occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted when the objective medical evidence shows total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Turning to the medical evidence, in a May 2013 clinical record, the Veteran was oriented. While he denied suicidal and homicidal ideation, he reported having suicidal thoughts in the past when stressed. He also explained that he spent his days working around the house and liked to go out for breakfast with a friend. Further, in an October 2013 clinical record, the Veteran reported a history of sad mood, isolation, anhedonia, poor energy, poor motivation, and suicidal thoughts. Upon examination, he exhibited normal eye contact, normal thoughts, and there was no evidence of suicidal or homicidal ideation. In addition, in an April 2014 clinical record, the Veteran stated that when he had suicidal ideation, he tried to focus away from it. He also explained that he and his wife liked to travel. Upon examination, speech was fluent, thought processes were normal, and no memory problems were noted; however, he reported difficulty falling asleep and stated that he exhibited worries. In an April 2015 VA examination, the examiner wrote that the Veteran was oriented, thought processes were logical, and self-care and hygiene were good. However, mood was rated as mildly depressed and the Veteran reported a history of suicidal ideation when stressed. Further, in an August 2015 clinical record, he reported doing well with anxiety and depression. Upon examination, eye contact and mood were good, speech and motor activity were normal, and thoughts were clear; however, attention, concentration, and memory were fair. In a November 2016 clinical record, the Veteran's mood and concentration were normal and he denied suicidal and homicidal ideation. While his thought processes were scattered, thought content was normal. Further, in an April 2017 clinical record, the clinician wrote that the Veteran's mood was stable and positive, thinking was logical, and speech was fluent. At this time, the Veteran also denied suicidal and homicidal ideation. In an April 2019 VA examination, the Veteran reported being close with his family and having close friends at church. He also stated that when the weather was nice, he did projects around the house. Upon examination, he presented as mildly anxious and depressed; however, speech was linear, and no psychosis was observed. Based on the above, the medical evidence does not support a rating in excess of 70 percent for adjustment disorder. In this regard, the medical evidence showed that the Veteran reported a history of depression, anxiety, and suicidal ideation; however, he stated that he only exhibited suicidal ideation when stressed and tried to focus away from it. Further, the Veteran reported having good social relationships with family and friends and enjoying doing work around the house. In addition, mood, speech, thought processes, and memory were rated as normal. He was not noted to be disoriented, engage in grossly inappropriate behavior and delusions, be a danger to himself or others, or unable to perform activities of daily living or any symptoms like or similar to those for a higher rating. Therefore, the medical evidence does not support a rating in excess of 70 percent for adjustment disorder. Headaches The Veteran is in receipt of a 30 percent rating under DC 8100 for headaches. Under DC 8100, a 50 percent rating is warranted when the objective medical evidence shows migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Turning to the medical evidence, migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability have not been shown. Specifically, in September 2013, April 2015, and June 2016 VA examinations, the Veteran complained of severe headaches. While he was noted to experience migraines with characteristic prostrating and prolonged attacks, they were not productive of severe economic inadaptability. Further, in an April 2019 VA examination, he complained of throbbing head pain. However, upon examination, he was not noted to experience characteristic prostrating attacks of migraine headache pain. Based on the above, the medical evidence does not support a rating in excess of 30 percent for headaches. In this regard, the medical evidence showed, at worst, migraines with characteristic prostrating attacks that were not productive of severe economic inadaptability. Clinical records do not contradict these findings. Therefore, the medical evidence does not support a rating in excess of 30 percent for headaches. Dizziness The Veteran is in receipt of a 30 percent rating under DC 6204 for dizziness which is the maximum schedular rating. The Board has considered whether there is any other schedular basis for granting a higher rating in excess of 30 percent for the Veteran's chronic vertigo but finds no legal basis for a higher rating under any alternative diagnostic code. At this junction, the Board notes that as the evidence does not show cerebellar gait (DC 6205), loss of an auricle (DC 6207), or any neoplasm of the ear (DC 6208), a separate or alternative evaluation under these codes is not warranted. In sum, the medical evidence does not support a higher rating for dizziness/vertigo. He is currently in receipt of the maximum rating under DC 6204 and his disability does not meet the criteria for a higher rating under another diagnostic code. Lumbar Spine Disability The Veteran is in receipt of a 20 percent rating under DC 5237 for a lumbar spine disability. The Board will consider all appropriate diagnostic codes. Under the relevant diagnostic codes, a 40 percent rating is warranted when the objective medical evidence shows: forward flexion of the thoracolumbar spine 30 degrees or less; favorable ankylosis of the entire thoracolumbar spine; or IVDS with incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months Turning to the medical evidence, in a September 2013 VA examination, forward flexion was to 60 degrees with painful motion at 40 degrees. Further, in an April 2015 VA examination, the Veteran complained of back pain. Upon examination, forward flexion was to 80 degrees. In addition, in a June 2016 VA examination, forward flexion was to 70 degrees. Therefore, the medical evidence does not support a higher rating on this basis. Next, there is no evidence of ankylosis or IVDS. Specifically, in September 2013, April 2015, and June 2016 VA examinations, ankylosis and IVDS were not noted. This evidence does not support a higher rating. In sum, the medical evidence does not support a rating in excess of 20 percent for a lumbar spine disability. In this regard, the medical evidence showed forward flexion of the thoracolumbar spine to be, at worst, 40 degrees and there was no evidence of ankylosis or IVDS. Clinical records do not contradict these findings. Therefore, the medical evidence does not support a rating in excess of 20 percent for a lumbar spine disability. As to all the increased rating claims, the Board has also considered the Veteran's lay statements and testimony that his disabilities are worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of these disorders according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran's disabilities has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings directly address the criteria under which these disabilities are evaluated. Moreover, as the examiners have the requisite medical expertise to render medical opinions regarding the degree of impairment caused by these disabilities and had sufficient facts and data on which to base the conclusion, the Board affords the medical opinions great probative value. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable, and the appeals are denied except for the cervical spine disability which has been granted to 20 percent but no more. Effective Date for TDIU Except as otherwise provided, the effective date of an evaluation and award for pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after a final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. A specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid to any individual under the laws administered by VA. 38 U.S.C. § 5101 (a). A "claim" is defined as a formal or informal communication, in writing, requesting a determination of entitlement, or evidencing a belief in entitlement to a benefit. 38 C.F.R. §§ 3.1 (p), 3.151. The essentials for any claim, whether formal or informal, are: 1) an intent to apply for benefits; 2) and identification of the benefits sought; and 3) a communication in writing. Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009). The date of a receipt of a claim is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1 (r). In an August 2017 rating decision, the Regional Office granted a TDIU effective September 23, 2008, the date in which the Veteran met the schedular requirements for TDIU. He contends that an earlier effective date is warranted. The Veteran's combined rating for TDIU has been at 90 percent since September 23, 2008. As such, he has been eligible for a TDIU since that date. Moreover, he filed a claim for TDIU in August 2015. There is no document in the file previous to this date that could be construed as a claim for a TDIU or an intent to file such that an earlier effective date could be preserved. Therefore, the proper effective date is September 23, 2008, the date in which entitlement to TDIU arose. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28. Vet. App. 366, 369-370 (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Ragofsky, Attorney Advisor 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.