Citation Nr: 23004792 Decision Date: 01/25/23 Archive Date: 01/25/23 DOCKET NO. 18-35 826 DATE: January 25, 2023 ORDER Service connection for sleep apnea is denied. An initial rating greater than 20 percent for left lower extremity femoral nerve radiculopathy is denied. An initial rating greater than 20 percent for right lower extremity femoral nerve radiculopathy is denied. A rating greater than 20 percent for left lower extremity sciatic radiculopathy is denied. A rating greater than 20 percent for right lower extremity sciatic radiculopathy is denied. A rating greater than 20 percent for thoracolumbar spine degenerative disc disease (DDD) is denied. A rating greater than 70 percent for posttraumatic stress disorder (PTSD) is denied. An effective date earlier than August 2, 2016, for the award of a 20 percent rating for right lower extremity sciatic radiculopathy is denied. An effective date earlier than July 2, 2017, for the award of a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. Sleep apnea was neither caused nor aggravated by service-connected disabilities or the treatment thereof. 2. Bilateral femoral nerve disabilities manifested by subjective reports of pain and numbness; objective findings did not demonstrate severe and incomplete paralysis. 3. Bilateral sciatic nerve disabilities manifested by subjective reports of pain and numbness; objective findings did not demonstrate moderately severe and incomplete paralysis. 4. The back disability manifested by subjective complaints of chronic pain; objective findings did not demonstrate forward flexion to 30 degrees or less, favorable ankylosis of the entire spine, or intervertebral disc syndrome (IVDS) productive of incapacitating episodes. 5. PTSD is not productive of total occupational and social impairment. 6. April 24, 2015, is the earliest date as of which it is factually ascertainable that an increase in the Veteran's right lower extremity sciatic radiculopathy occurred; the Veteran's claim for an increased rating was received on August 2, 2016, more than one year later. 7. Per the Veteran's statements, he maintained substantially gainful employment until July 2, 2017. CONCLUSIONS OF LAW 1. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 2. The criteria for an initial rating greater than 20 percent for left lower extremity femoral nerve radiculopathy have not been met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 4.124a, DC 8526. 3. The criteria for an initial rating greater than 20 percent for right lower extremity femoral nerve radiculopathy have not been met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 4.124a, DC 8526. 4. The criteria for a rating greater than 20 percent for left lower extremity sciatic radiculopathy have not been met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 4.124a, DC 8720. 5. The criteria for a rating greater than 20 percent for right lower extremity sciatic radiculopathy have not been met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 4.124a, DC 8720. 6. The criteria for a disability rating greater than 20 percent for thoracolumbar spine DDD have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5243. 7. The criteria for a rating greater than 70 percent for PTSD have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.130, DC 9411. 8. The criteria for an effective date prior to August 2, 2016, for the assignment of a 20 percent rating for right lower extremity sciatic radiculopathy have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, DC 8720. 9. The criteria for an effective date prior to July 2, 2017, for the award of a TDIU have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.340, 3.341, 3.400, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from July 1986 to July 1990, including sea service. These matters are before the Board of Veterans' Appeals (Board) on appeal from December 2016, July 2017, and November 2017 rating decisions by Department of Veterans Affairs (VA) Regional Offices (RO). Most recently, these appeals were remanded by the Board in September 2020 for additional development, which has since been completed. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Specifically, a VA addendum opinion was obtained regarding the sleep apnea claim in October 2020, and a Supplemental Statement of the Case (SSOC) was issued in November 2020. Id. The Veteran was formerly represented by a private attorney. That attorney withdrew his representation in December 2020, a fact acknowledged by VA that same month. As the Veteran has not designated a new power of attorney since that time, he is considered unrepresented. Service Connection First, the Veteran is seeking service connection for sleep apnea. On his October 2017 claim, the Veteran did not clarify if he was seeking service connection on direct and/or secondary bases. However, he has not asserted an in-service incurrence at any time, and his service records are silent for relevant diagnoses, symptoms, or treatment. A November 2019 argument from the Veteran's former representative is also limited to a secondary theory of entitlement. Thus, entitlement on a direct basis has not been raised by the Veteran or the record, and the Board's analysis will be limited accordingly. Service connection may be warranted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and, (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). There is no dispute regarding the first and second elements in this case: the Veteran was diagnosed with obstructive sleep apnea during November 2017 and October 2019 VA examinations, and he is currently service-connected for PTSD, a back disability, and multiple radiculopathies. Thus, the appeal may be granted upon the finding of a causal link between the Veteran's non- and service-connected conditions. Historically, a November 2017 VA examination was obtained that does not address this theory of entitlement and thus does not merit further consideration herein. The record also contains an October 2019 private opinion. As noted in the Board's September 2020 remand, this opinion "contains problematic conclusions" and thus lacks probative value. Accordingly, this opinion also does not merit further consideration herein. Rather, a VA addendum opinion was obtained in October 2020. Therein, the examiner offered the following conclusions: First, it is less likely than not that the Veteran's sleep apnea is proximately caused by his PTSD, including antidepressant use. By way of rationale, the examiner noted that there is no literature evidence of a direct or causational link between PTSD, the use of antidepressants, and the development of sleep apnea. This condition is caused by blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep. Risk factors include gender, age, and weight. The Veteran was diagnosed in 2017, at which time he satisfied all of these risk factors. Obesity is a major risk factor through multiple mechanisms, including decreased lung volume, increased soft tissue volume, and potential impairment of the mechanical output of the upper airway muscles. With respect to the 2019 private opinion, the examiner noted that the physician cited to an article which does not suggest a causative relationship between psychiatric disorders and sleep apnea. Second, it is less likely than not that the Veteran's sleep apnea underwent any incremental increase in disability, regardless of its permanence, due to PTSD and related antidepressant use. Here, the examiner noted that medical records do not indicate an increase in sleep apnea due to PTSD and the treatment thereof. These medical records also do not indicate any complications related to sleep apnea, such as chronic respiratory failure with carbon dioxide retention or cor pulmonale. Third, it is less likely than not that the Veteran's sleep apnea was proximately caused by nerve pain medications used to treat the Veteran's back and radiculopathy disabilities. In so finding, the examiner noted that medical literature does not show evidence of a direct or causational link between the use of such medications and the development of sleep apnea. The examiner again identified the primary risk factors of sleep apnea and noted that the Veteran met all three risk factors in this case. Fourth, it is less likely than not that the Veteran's sleep apnea underwent any incremental increase in disability, regardless of its permanence, due to his back and radiculopathy disabilities and the treatment thereof. Again, medical records do not indicate any such incremental increase in the Veteran's sleep apnea due to his nerve pain medications. These records also contain no evidence of complications related to sleep apnea, such as chronic respiratory failure with carbon dioxide retention or cor pulmonale. The October 2020 VA opinion is both adequate and highly probative, as the examiner offered a definitive nexus opinion supported by a detailed rationale which contemplates the nature of sleep apnea, the Veteran's known risk factors, and the lack of supporting evidence in both medical records and academic literature. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008); Prejean v. West, 13 Vet. App. 444, 448-49 (2000). There is no evidence that the VA examiner was not fully aware of the Veteran's medical history or misstated any relevant fact in providing their opinions; rather, the examiner reviewed the Veteran's entire claims file, to include medical records and the positive private opinion. Moreover, there are no competent opinions of record which directly contradict the examiner's findings. Briefly, the Board acknowledges that the Veteran submitted two articles in support of this appeal in November 2019, which the October 2020 examiner did not directly address. However, these articles merely speak to a potential link between the conditions, rather than a specific link in this case. Moreover, the VA examiner undertook an extensive literature review in offering their opinion, which is well-reasoned and based upon both general medical consensus and the Veteran's specific history. Accordingly, the opinion is adequate and does not merit remand at this time. In sum, the persuasive evidence of record weighs against the finding of a nexus between the Veteran's sleep apnea and service-connected disabilities; the benefit-of-the-doubt rule is not applicable, and the appeal seeking secondary service connection for sleep apnea is denied. Increased Ratings Next, the Veteran is seeking higher ratings for several of his service-connected disabilities. Disability ratings are determined by the applications of the VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Femoral and Sciatic Nerve Radiculopathies Currently, the Veteran is pursuing initial ratings greater than 20 percent for his femoral nerve disabilities, and ratings greater than 20 percent for his sciatic nerve disabilities. As these appeals require similar analyses and engage identical appeal periods, they will be addressed simultaneously herein. Here, the Veteran's disabilities have been properly rated under DCs 8526 (femoral) and 8720 (sciatic). Thus, higher ratings are warranted with evidence of the following: Severe and incomplete paralysis (30 percent under DC 8526); and Moderately severe and incomplete paralysis (40 percent under DC 8720). In assessing the impairment caused by peripheral nerve disabilities, the term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The record does not support the award of higher ratings in this case. Given the date of the Veteran's claim, the Board finds that an April 2015 VA examination is sufficiently contemporaneous for consideration herein. At that time, the Veteran reported severe constant pain, intermittent pain, paresthesias/dysesthesias, and numbness of the bilateral lower extremities. Following evaluation, the examiner concluded that the Veteran showed moderate and incomplete paralysis of the bilateral sciatic nerves. The femoral nerves were not assessed at that time. Given his disabilities, the Veteran reported a burning sensation in his legs when using the stairs, in addition to difficulty getting out of bed. Non-sensory symptoms were denied. Additional VA examination was provided in February 2018, during which the Veteran reported moderate intermittent pain of the right lower extremity; mild intermittent pain of the left lower extremity; and mild numbness bilaterally. Following evaluation, the examiner concluded that the Veteran showed moderate and incomplete paralysis of the right sciatic nerve; mild and incomplete paralysis of the left sciatic nerve; and no paralysis of the bilateral femoral nerves (or, normal results). The Veteran testified of numbness and pain bilaterally, which caused him to fall "from time to time" and prohibits driving and outdoor activities. Non-sensory symptoms were not reported. During the appeal period, the Veteran also underwent multiple VA examinations for his back. In October 2016, moderate right lower extremity numbness and severe left lower extremity numbness were recorded; in April 2017, mild right lower extremity numbness and severe left lower extremity numbness were recorded; and in February 2018, the examiner recorded "no evidence of paralysis" of the femoral nerves bilaterally and that the sciatic nerves were "stable." Contemporaneous medical records generally note the Veteran's history of femoral and sciatic nerve disabilities. While reports of paralysis are absent from these records, the Veteran suffered a fall in March 2016 and is consistently considered a fall risk, given his combined disabilities. Upon the above, ratings greater than 20 percent are not warranted for the Veteran's disabilities. At their most severe, the Veteran's disabilities were productive of severe constant pain, dysesthesias/paresthesias, and numbness. Objective testing has not found any degree of paralysis caused by the Veteran's femoral nerve disabilities, and moderate and incomplete paralysis of the sciatic nerves. As a result, the Veteran experienced chronic pain and intermittent numbness of the bilateral lower extremities, absent non-sensory symptoms. Given the Veteran's disability pictures, he was counseled on potential fall risks and suffered one documented fall in 2016; however, his risk profile is typically due to the combined impact of multiple disabilities rather than the Veteran's radiculopathies alone, and despite his risk profile, only one actual fall is noted. Thus, this history is insufficient upon which to award higher ratings, as the requisite degrees of paralysis are not found. In so finding, the Board acknowledges that the Veteran has experienced varying bilateral lower extremity numbness during the period on appeal. However, there is a medical distinction between numbness (loss or impairment of sensation) and paralysis (loss or impairment of motor function). See generally Dorland's Illustrated Medical Dictionary (32d ed. 2012). Here, the Veteran lacks the medical expertise to competently distinguish between these symptoms, which may present similarly to an untrained layperson. Thus, the Board has weighed the Veteran's testimony against the competent medical evidence in this case. In doing so, the Veteran's disability pictures are fully contemplated in the ratings as currently assigned, as more severe paralysis is not found. In sum, the Veteran's disability pictures are commensurate with the criteria for the 20 percent ratings as currently assigned and the appeals are denied. Back Disability The Veteran is also pursuing a rating greater than 20 percent for his back disability. 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. 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); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). 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; Kuzma, 341 F. 3d 1327. Therefore, the Board will consider the Veteran's relevant appeals under both the old and new criteria, and the criteria that is more favorable will be applied. Historically, the Veteran's disability is rated under DC 5243 as IVDS. Under the post-amendment regulations, this DC may only be assigned when there is disc herniation with compression and/or irritation of the adjacent nerve root; otherwise, DC 5242 is to be used. Although such a disability picture is not shown by the record, there is also no negative evidence in this case. Accordingly, the Board will continue to utilize DC 5243 in evaluating this appeal. This determination bears no negative impact on the Veteran, as the pre- and post-amendment criteria under DCs 5242 and 5243 are identical. Further, the criteria under DC 5243 were not altered by the February 2021 amendments. Thus, a 40 percent rating is warranted with evidence of the following: Forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine; or IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. Further, normal combined range of motion (referencing the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation) for the thoracolumbar spine is 240 degrees. 38 C.F.R. § 4.71a, DC 5243 at Note (2). Upon review of the record, a rating greater than 20 percent is denied. The Veteran underwent three VA examinations during the period on appeal. In October 2016, he reported chronic and radiating lower back pain that limited his movement, including bending. The examiner denied ankylosis of the spine or incapacitating episodes of IVDS in the prior 12 months. Initial range of motion testing showed forward flexion to 90 degrees, with no objective evidence of painful motion during flexion. Pain on weight-bearing was reported. Repetitive use did not result in additional loss of motion. The Veteran was not examined immediately after repetitive use over a period of time, such that the examination was neither medically consistent nor inconsistent with the Veteran's statements regarding functional loss under such circumstances. The examiner also could not opine if pain, weakness, fatigability, or incoordination would significantly limit functional ability over a period of time without resorting to mere speculation. Although the Veteran was examined during a flare, additional loss of flexion was not reported; again, the examiner could not opine whether functional ability would be limited by pain, weakness, fatigability, or incoordination without resorting to mere speculation. In April 2017, the Veteran reported difficulty with bending and getting out of bed, in addition to a history of unsteadiness. Following evaluation, the examiner denied ankylosis of the spine or incapacitating episodes of IVDS in the prior 12 months. Initial range of motion testing showed forward flexion to 40 degrees. Pain was observed on movement and contributed to functional loss, including difficulty with prolonged standing or walking. There was also evidence of pain on weight-bearing. Repetitive use did not result in additional loss of motion. The Veteran was not being observed immediately after repetitive use over a period of time or during a flare, and the examination was neither medically consistent nor inconsistent with the Veteran's statements under such circumstances. While the examiner noted that pain, fatigue, weakness, and lack of endurance would contribute to functional loss, they could not describe such loss in terms of range of motion. In February 2018, the Veteran reported chronic pain that impaired his ability to bend, drive, and sleep; however, he denied flare-ups at that time. Following evaluation, the examiner denied ankylosis or IVDS of the spine. Initial range of motion testing showed forward flexion to 45 degrees. Pain was observed on movement and with weight-bearing, and contributed to impaired mobility. Repetitive use did not result in additional loss of motion. Although the Veteran was examined following repeated use over a period of time, additional loss of motion was not reported, and the examiner denied that pain, weakness, fatigability or incoordination would significantly limit the Veteran's functional ability in such circumstances. Given the Veteran's denial of flares, a similar history was not considered by the examiner. Medical records spanning the period on appeal also document the Veteran's reports of chronic and radiating lower back pain. Critically, this body of evidence does not reflect a consistent history of forward flexion limited to 30 degrees or less, favorable ankylosis, or incapacitating episodes of IVDS, nor has the Veteran testified of such. Accordingly, the Veteran has not shown such limitation of flexion, ankylosis, or history of incapacitating episodes as to warrant a grant of this appeal. Even at its most severe, objective testing did not show forward flexion limited to less than 30 degrees at any time, even with the presence of pain, with repeated or prolonged use, during flares, or with accompanying symptoms such as weakness, fatigability, or incoordination. See DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Rather, the Veteran's full disability picture, including forward flexion beyond 30 degrees and chronic lower back pain, is contemplated in the criteria for a 20 percent rating, as currently assigned. In so finding, the Board has considered the Veteran's competent testimony regarding his disability picture. In sum, he asserts that his disability is so severe as to limit outdoor activities, prevent him from driving or bending, and results in a history of falls. While the Board acknowledges that the Veteran's records identify him as a fall risk, only one incidentin 2016is found in the record. More broadly, the Veteran's instability appears to be caused by the combined impact of multiple disabilities, including his back and radiculopathies. Accordingly, the Board has assessed the Veteran's distinct disability pictures against the relevant diagnostic criteria, which do not support the assignment of a higher rating whether on the explicit criteria alone or consideration of the Veteran's combined disability pictures. See also 38 C.F.R. § 4.14 (prohibiting the pyramiding of symptoms). For the preceding reasons, the appeal is hereby denied. PTSD The Veteran is also seeking a rating greater than 70 percent for his PTSD. Considerations in evaluating a mental disorder include the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The evaluation must be based on all the evidence of record that bears on occupational and social impairment rather than solely on an examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a). The Veteran is properly rated under DC 9411 during the period on appeal, such that a 100 percent rating is warranted with evidence of the following: 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 ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closest relatives, own occupation, or own name. In considering the frequency, severity, and duration of the Veteran's symptoms, it is not found that he was rendered totally occupationally and socially impaired due to his psychiatric disability during the period on appeal. He underwent three VA examinations for review. In January 2016, his primary symptoms were identified as follows: anxiety, suspiciousness, chronic sleep impairment, impairment of short- and long-term memory, suicidal ideation, spatial disorientation, and neglect of personal appearance and hygiene. During examination, the Veteran appeared "somewhat tangential" and became tearful when he was asked if he was suicidal, but denied suicidal thoughts. He testified that he was unable to be a passenger in a car, and spoke of two physical altercations under such circumstances. However, he had a positive relationship with his spouse and only "snaps at" his daughter occasionally. As a result, he was assessed as demonstrating occupational and social impairment with occasional decrease in work efficiency and intermittent periods of the inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. Additional VA examination was obtained in August 2016, during which the Veteran endorsed depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, difficulty in adapting to stressful circumstances, and suicidal ideations. Again, the Veteran indicated challenges with his profession, as his memory impairment and mood swings made it difficult for him to drive his truck. During examination, he presented as talkative and agitated, and asked the examiner "what he had to say or do in order to get 100 percent disability." Miller v. Wilkie, 32 Vet. App. 249 (2020). Following evaluation, the examiner determined that the Veteran showed occupational and social impairment with reduced reliability and productivity. The Veteran most recently underwent VA examination in April 2017, at which time his primary symptoms were identified as follows: depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, and suicidal ideations. During examination, the Veteran was cooperative and oriented times 3. He testified as to chronic anxiety and paranoia which made it difficult to be in public or maintain meaningful social relationships. He also spoke of suicidal thoughts, but the examiner did not believe that he posed an imminent risk to himself. Nonetheless, the Veteran continued to treat his symptoms with medication. Following evaluation, the examiner determined that the Veteran showed occupational and social impairment with reduced reliability and productivity. Contemporaneous medical records denote the Veteran's history of PTSD and related symptoms, including chronic mood disturbances and sleep impairment. Suicidal thoughts were typically denied. The Veteran primarily utilized medication to manage his symptoms during this time. Of note, the record contains no additional lay testimony or argument from the Veteran regarding this appeal, including that which speaks to his current disability picture. Upon consideration of the above, it is not found that the Veteran demonstrated total occupational and social impairment due to his psychiatric disability, as required for the assignment of a 100 percent rating. In offering this finding, the Board does not disregard that the Veteran experienced significant functional impairment. During the period on appeal, he showed near-constant depression, anxiety, and sleep impairment with noted periods of suicidal thoughts. As a result, the Veteran was unable to perform certain occupational tasks and struggled to be in public. Although he spoke of a positive relationship with his spouse, he also reported no important social relationships or hobbies. Rather, the Veteran spoke of two physical altercations with others in situations where he lacked control. However, a 100 percent rating requires that a veteran's symptoms result in "total occupational and social impairment," and such a disability picture is not present in this case. Despite his symptoms, the Veteran does not appear to routinely require assistance with the activities of daily living, including basic grooming and hygiene. Although he experienced social restrictions, the Veteran also maintained a positive relationship with his spouse and children. In medical settings, he has consistently shown himself capable of communicating appropriately and effectively with his treatment providers; impaired judgment or thinking has not been shown at any time. Thus, no matter how the Veteran's symptoms are characterized or what their severity may be, the Board cannot say that the Veteran's symptoms have resulted in total social impairment as required for a 100 percent rating. In sum, the evidence does not establish that the Veteran experienced total occupational and social impairment due to his disability, whether due solely to his suicidal ideations or the collective impact of all psychiatric symptoms. Accordingly, his disability picture more nearly approximates the criteria for a 70 percent rating, and the appeal seeking a higher rating is hereby denied. The persuasive weight of the evidence is against the claim, and there is no doubt to be resolved. With respect to the above service connection and increased rating appeals, the Board has considered the Veteran's position that the claimed benefits are warranted. However, he lacks the medical training and expertise to competently identify the etiology of a medical condition or the specific level of disability according to the applicable DC, and his contentions are otherwise unsupported by objective medical evidence. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994). Instead, greater probative value has been offered to the medical evidence in assessing the matters on appeal, as the examiners possess the requisite expertise to render competent medical opinions. In this respect, the Board finds that the medical examinations, based upon consideration of the Veteran's testimony against the relevant regulations, are fully adequate and supports the determinations offered herein. Earlier Effective Dates Finally, the Veteran is pursuing earlier effective dates (1) for the award of a 20 percent rating for right lower extremity sciatic nerve radiculopathy, and (2) the award of a TDIU. As these appeals require similar analyses, they will be addressed simultaneously herein. In claims for increased disability compensation, including a TDIU, the effective date will be the earliest date as of which it is factually ascertainable that an increase in disability has occurred, if the claim is received by VA within one year after that date. Otherwise, the effective date will be the date of receipt of claim or date entitlement arose, whichever is later. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). With respect to the radiculopathy appeal, the Veteran's disability is properly rated against the criteria for DC 8720 during the period on appeal. Here, the earliest date on which it is factually ascertainable that an increase in the Veteran's disability had occurred is April 24, 2015, corresponding with a VA examination which reports moderate and incomplete paralysis of the right lower extremity sciatic nerve. The claim for an increased rating was received more than one year later, on August 2, 2016. Thus, the assigned effective date corresponds with the date the claim was received, and the Veteran is in receipt of the earliest effective date under VA laws and regulations. For these reasons, the appeal is denied. With respect to the TDIU appeal, the record is in controversy as to the final date of the Veteran's employment, in part due to his prior occupation as a self-employed truck driver. However, his November 2019 VA Form 21-8940 shows meaningful employment until June 2017. 38 C.F.R. § 4.16(a); Moore v. Derwinski, 1 Vet. App. 356, 358 (1991); see also Poverty Thresholds, U.S. Census Bureau, http://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html (last visited January 24, 2023). A November 2019 argument from the Veteran's representative similarly identifies this as the Veteran's end date of employment. Thus, the Board accepts June 2, 2017, as the first date of unemployment. Accordingly, the Veteran lacks the legal grounds to establish entitlement to a TDIU prior to this date. See Sabonis v. Brown, 6 Vet. App. 426 (1994) (holding that in cases in which the law and not the evidence is dispositive, a claim for entitlement to VA benefits should be denied or the appeal to the Board terminated because of the absence of legal merit or the lack of entitlement under the law). The appeal is hereby denied. (Continued on next page) Of final note, 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 (2017) (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). Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Kovarovic, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.