Citation Nr: 1103096 Decision Date: 01/25/11 Archive Date: 02/01/11 DOCKET NO. 07-24 675 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to an initial rating greater than 20 percent for service-connected degenerative arthritis of the lumbar spine for the time period from November 1, 2006 to August 11, 2008. 2. Entitlement to an initial rating greater than 40 percent for service-connected degenerative arthritis of the lumbar spine since August 12, 2008. 3. Entitlement to an initial compensable rating for service- connected left knee disability, status post arthroscopy, for the time period from November 1, 2006 to August 11, 2008. 4. Entitlement to an initial rating greater than 10 percent for service-connected left knee disability, status post arthroscopy, since August 12, 2008. 5. Entitlement to an initial compensable rating for service- connected left heel disability, status post plantar fasciectomy and calcaneal exostectomy. 6. Entitlement to an initial compensable rating for service- connected right foot disability, status post exostectomy, osteotomy and plantar fascial release. 7. Entitlement to an initial compensable rating for hypertension. 8. Entitlement to an initial compensable rating for scars of the chest and left cheek, status post removal of basal cell carcinoma lesions. 9. Entitlement to an initial rating greater than 10 percent for tinea pedis. 10. Entitlement to service connection for residuals of status post uvulectomy. 11. Entitlement to service connection for hyperlipidemia and hypertriglyceridemia. 12. Entitlement to service connection for benign prostate hypertrophy (BPH) (claimed as an enlarged prostate). 13. Entitlement to service connection for a disorder claimed as insomnia. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD T. Mainelli, Counsel INTRODUCTION The Veteran served on active duty from August 1986 to October 2006. This case comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The Board notes that the Veteran appears to seek compensation for a biopsy scar along his left clavicle line. Similarly, the Veteran appears to seek compensation for dermatitis symptoms involving his upper extremities and chest. These issues, which are not currently before the Board, are referred to the RO for appropriate action. FINDINGS OF FACT 1. For the time period from November 1, 2006 to August 11, 2008, the Veteran's orthopedic manifestations of service-connected thoracolumbar spine intervertebral disc syndrome (IVDS) are not shown to have resulted in limitation of lumbar spine motion of 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. 2. Since August 12, 2008, the Veteran's orthopedic manifestations of service-connected thoracolumbar spine IVDS are not shown to result in unfavorable ankylosis of the entire thoracolumbar spine. 3. Since May 30, 2007, the Veteran has manifested a chronic neurologic manifestation of right lower extremity radiculopathy absent significant motor or functional impairment. 4. Since August 12, 2007, the Veteran has manifested a chronic neurologic manifestation of left lower extremity neuritis absent significant motor or functional impairment. 5. From November 1, 2006 to March 12, 2008, the Veteran's left knee disability was manifested by arthritis absent objective evidence of painful motion or motion loss, instability, subluxation, "locking" or effusion. 6. Since March 12, 2008, the Veteran's left knee disability has been manifested by arthritis with objective evidence of painful motion, limitation of motion no worse than 0 degrees of extension to 115 degrees of flexion, and no evidence of instability, subluxation, "locking" or effusion. 7. The Veteran's service-connected left heel disability, status post plantar fasciectomy and calcaneal exostectomy, is manifested by mild residual impairment absent objective evidence of abnormal weight bearing, skin changes, vascular changes, hammertoes, high arch, clawfoot, malalignment or other deformity. 8. The Veteran's service-connected right foot disability, status post exostectomy, osteotomy and plantar fascial release, is manifested by mild residual impairment absent objective evidence of abnormal weight bearing, skin changes, vascular changes, hammertoes, high arch, clawfoot, malalignment or other deformity. 9. The Veteran's hypertension, which requires continuous medication, is manifested by systolic blood pressure predominately less than 160 absent a history of diastolic pressure predominantly 100 or more. 10. The Veteran's scars of the chest and left cheek are shown to be superficial, stable and nontender which cover an area of less than 144 inches (929 sq. cm), do not have any disfiguring characteristics, and do not result in limiting the function of any part. 11. The Veteran's tinea pedis involves less than 5 percent of the entire body, has not required the need for intermittent systemic therapy, and does not result in any scarring characteristics. 12. The Veteran does not manifest residual disability related to the ameliorative uvelectomy performed in service. 13. The Veteran's hyperlipidemia and hypertriglyceridemia are laboratory test results that are not, in and of themselves, representative of a disability for VA compensation purposes. 14. The Veteran was first diagnosed and treated for BPH during active service. 15. The Veteran's impaired sleep is a symptom only which is not representative of a disability for VA compensation purposes. CONCLUSIONS OF LAW 1. The criteria for an initial rating greater than 20 percent for the service-connected orthopedic manifestations of lumbar spine IVDS for the time period from November 1, 2006 to August 11, 2008 have not been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. §§ 3.321(b), 4.1-4.14, 4.25, 4.26, 4.40, 4.45, 4.71a, Diagnostic Codes (DCs) 5237, 5243 (2010). 2. The criteria for an initial rating greater than 40 percent for the service-connected orthopedic manifestations of lumbar spine IVDS for the time period since August 12, 2008 have not been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. §§ 3.321(b), 4.1-4.14, 4.25, 4.26, 4.40, 4.45, 4.71a, DCs 5237, 5243 (2010). 3. The criteria for a separate 10 percent evaluation for the chronic neurologic manifestation of right lower extremity radiculopathy have been met effective May 30, 2007, and the criteria for a separate 10 percent evaluation for the chronic neurologic manifestation of left lower extremity neuritis have been met effective August 12, 2008. 38 U.S.C.A. §§ 1155, 5107(b) (West 2002); 38 C.F.R. §§ 3.321(b), 4.1-4.14, 4.25, 4.26, 4.124a, DC 8520 (2010). 4. From November 1, 2006 to August 12, 2008, the criteria for an initial compensable rating for left knee disability have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.321(b), 4.1, 4.2, 4.7, 4.10, 4.22, 4.40, 4.45, 4.59, 4.71a, DCs 5003, 5010, 5257, 5259, 5260, 5261 (2010). 5. Since August 12, 2008, the criteria for an initial rating greater than 10 percent for left knee disability have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.321(b), 4.1, 4.2, 4.7, 4.10, 4.22, 4.40, 4.45, 4.59, 4.71a, DCs 5003, 5010, 5257, 5259, 5260, 5261 (2010). 6. The criteria for a compensable rating for service-connected left heel disability, status post plantar fasciectomy and calcaneal exostectomy, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.321(b), 4.1, 4.2, 4.7, 4.10, 4.22, 4.40, 4.45, 4.59, 4.71a, DCs 5276, 5284 (2010). 7. The criteria for a compensable rating for service-connected right foot disability, status post exostectomy, osteotomy and plantar fascial release, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.321(b), 4.1, 4.2, 4.7, 4.10, 4.22, 4.40, 4.45, 4.59, 4.71a, DCs 5276, 5284 (2010). 8. The criteria for an initial compensable evaluation for hypertension have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.321(b), 4.1, 4.2, 4.7, 4.104, DC 7101 (2010). 9. The criteria for a compensable rating for scars of the chest and left cheek have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.321(b), 4.118, DCs 7801-05 (2010). 10. The criteria for a compensable rating for tinea pedis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.321(b), 4.118, DCs 7801-06, 7813 (2010). 11. The criteria for service connection for residuals of status post uvulectomy have not been met. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.306(b)(1) (2010). 12. The criteria for service connection for hyperlipidemia and hypertriglyceridemia have not been met. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2010). 13. The criteria for service connection for BPH have been met. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2010). 14. The criteria for service connection for a disorder claimed as insomnia have not been met. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 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 military service and the residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. If there is disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999). See AB v. Brown, 6 Vet. App. 35 (1993) (a claim for an original or an increased rating remains in controversy when less than the maximum available benefit is awarded). Reasonable doubt as to the degree of disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3. Evaluation of a service-connected disability involving a joint rated on limitation of motion requires adequate consideration of functional loss due to pain under 38 C.F.R. § 4.40 and functional loss due to weakness, fatigability, incoordination or pain on movement of a joint under 38 C.F.R. § 4.45. DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.40 state that disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence of part, or all, of the necessary bones, joints and muscles, or associated structures. It may also be due to pain supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. 38 C.F.R. § 4.40. The factors of disability affecting joints are reduction of normal excursion of movements in different planes, weakened movement, excess fatigability, swelling and pain on movement. 38 C.F.R. § 4.45. Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not "duplicative of or overlapping with the symptomatology" of the other condition. Esteban v. Brown, 6 Vet. App. 259, 262 (1994). The Board observes that the words "slight," "moderate" and "severe" are not defined in the Rating Schedule. 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 use of descriptive terminology by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision. 38 U.S.C.A. § 7104(a); 38 C.F.R. §§ 4.2, 4.6. In every instance where the schedule does not provide a zero percent rating for a diagnostic code, a zero percent rating shall be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection generally requires evidence of a current disability with a relationship or connection to an injury or disease or some other manifestation of the disability during service. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). A disease must be shown to be of a chronic nature in service, or if not chronic, then seen in service with continuity of symptomatology demonstrated after discharge from service. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 494- 97 (1997). Disorders diagnosed after discharge may still be service-connected if all the evidence, including pertinent service records, establishes that the disorder was incurred in service. 38 C.F.R. § 3.303(d); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In general, service connection requires competent evidence showing: (1) the existence of a present disability; (2) in- service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The claimant bears the burden of presenting and supporting his/her claim for benefits. 38 U.S.C.A. § 5107(a). See Fagan v. Shinseki, 573 F.3d 1282 (Fed. Cir. 2009). In its evaluation, the Board shall consider all information and lay and medical evidence of record. 38 U.S.C.A. § 5107(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall give the benefit of the doubt to the claimant. Id. Another way stated, VA has an equipoise standard akin to the rule in baseball that "the tie goes to the runner." Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Notably, the benefit of the doubt doctrine is not applicable based on pure speculation or remote possibility. See 38 C.F.R. § 3.102. A lay claimant is competent to provide testimony concerning factual matters of which he or she has firsthand knowledge (i.e., reporting something seen, sensed or experienced). Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). Under certain circumstances, lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In Barr, the United States Court of Appeals for Veterans Claims (Court) emphasized that when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. In such cases, the Board is within its province to weigh that testimony and to make a credibility determination as to whether that evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. However, there are clearly limitations regarding the competence of a lay claimant to speak to certain matters, such as those involving medical diagnosis and etiology. See Jandreau, 492 F.3d at 1377 (Fed. Cir. 2007) (noting that a layperson not competent to diagnose a form of cancer). As reflected in Fed.R.Evid 701, lay witness testimony is permissible in the form of opinions or inferences when (a) rationally based on the perception of the witness and (b) helpful to a clear understanding of the witness' testimony or the determination of a fact in issue. Otherwise, in matters involving scientific, technical or other specialized knowledge, Fed.R.Evid 702 requires that an opinion be provided by a witness qualified as an expert by knowledge, skill, experience, training or education. Lumbar spine The Board considers several diagnostic codes in evaluating the Veteran's thoracolumbar spine disability. DC 5235 (vertebral fracture or dislocation), DC 5236 (sacroiliac injury and weakness), DC 5237 (lumbosacral or cervical strain), DC 5238 (spinal stenosis), DC 5239 (spondylolisthesis or segmental instability), DC 5240 (ankylosing spondylitis), DC 5241 (spinal fusion), DC 5242 (degenerative arthritis of the spine) (see also, DC 5003), and DC 5243 (IVDS) are evaluated under the General Rating Formula for Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a. The General Rating Formula for Diseases and Injuries of the Spine provides for the assignment of a 20 percent rating where forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating requires forward flexion of the thoracolumbar spine of 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating requires unfavorable ankylosis of the entire thoracolumbar spine. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion is zero to 30 degrees, and left and right lateral rotation is zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id. at Note (2). See also 38 C.F.R. § 4.71a, Plate V. For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note (5). IVDS (preoperatively or postoperatively) will be evaluated under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. 38 C.F.R. § 4.71a, DC 5243. According to the Formula for Rating IVDS Based on Incapacitating Episodes, a 20 percent rating contemplates incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating requires evidence of incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating requires evidence of incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. For purposes of evaluations under DC 5243, an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id. at Note 1. The assignment of a particular DC is "completely dependent on the facts of a particular case" and involves consideration of such factors as an individual's relevant medical history, the current diagnosis, and demonstrated symptomatology. Butts v. Brown, 5 Vet. App. 532, 538 (1993). In rating disability involving injury to the peripheral nerves and their residuals, attention is to be given to the site and character of injury, the relative impairment in motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. 38 C.F.R. § 4.123. The maximum rating which may be assigned for neuritis not characterized by organic changes as noted above will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. Id. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate, incomplete paralysis. 38 C.F.R. § 4.124. In rating diseases of the peripheral nerves, 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. Id. The ratings for peripheral nerves are for unilateral involvement; when bilateral, they are combined with application of the bilateral factor. Id. DC 8520 provides the rating criteria for paralysis of the sciatic nerve, and therefore neuritis and neuralgia of that nerve. 38 C.F.R. § 4.124a, DC 8520. Complete paralysis of the sciatic nerve, which is rated as 80 percent disabling, contemplates foot dangling and dropping, no active movement possible of muscles below the knee, and flexion of the knee weakened or (very rarely) lost. Id. Disability ratings of 10 percent, 20 percent and 40 percent are assignable for incomplete paralysis which is mild, moderate or moderately severe in degree, respectively. Id. A 60 percent rating is warranted for severe incomplete paralysis with marked muscular atrophy. Id. DC 8620 refers to neuritis of the sciatic nerve while DC 8720 refers to neuralgia of the sciatic nerve. An RO rating decision dated September 2007 granted service connection for degenerative arthritis of the lumbar spine, and assigned an initial 20 percent rating effective to the date of claim; November 11, 2006. The Veteran appealed the initial rating assigned. A December 2008 RO rating decision awarded a 40 percent rating for degenerative arthritis of the lumbar spine effective August 12, 2008. Thus, the RO has assigned "staged" ratings in this case. With an inservice history of lumbar spine fusion, lay complaints of radicular-type symptoms in the lower extremities and abnormal neurologic findings, the Board finds that criteria for evaluating IVDS, either based upon combining the chronic orthopedic and neurologic manifestations or based upon incapacitating episodes, apply. It is thus the duty of the Board to address all issues and claims raised by the Veteran during the course of this appeal. Based upon the credible lay and medical evidence of file, the Board makes the following findings of fact: 1) For the time period from November 1, 2006 to August 11, 2008, the Veteran's orthopedic manifestations of service-connected thoracolumbar spine disability are not shown to have resulted in limitation of lumbar spine motion of 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine; 2) Since August 12, 2008, the Veteran's orthopedic manifestations of service-connected thoracolumbar spine disability are not shown to result in unfavorable ankylosis of the entire thoracolumbar spine; 3) Since May 30, 2007, the Veteran has manifested a chronic neurologic manifestation of right lower extremity radiculopathy absent significant motor or functional impairment; and 4) Since August 12, 2007, the Veteran has manifested a chronic neurologic manifestation of left lower extremity neuritis absent significant motor or functional impairment. Historically, the Veteran's service treatment records (STRs) reflect a long-standing history of low back pain with radiation into his buttocks and right leg. He underwent a laminectomy and discectomy at L4-5 in September 2000. Thereafter, he had exacerbations of back and buttock pain. A magnetic resonance imaging (MRI) scan in April 2005 demonstrated previous decompression of L4, mild Grade I retrolisthesis of L3-4, and degenerative disc disease with loss of disc height and desiccation at L3-4, L4-5 and L5-S1. In July 2005, the Veteran underwent an L3-S1 transforaminal lumbar interbody fusion (TLIF). An October 2005 treatment record cleared the Veteran to resume all activities without restriction, noting a near total resolution of back pain and leg numbness. The Veteran underwent a pre-discharge VA Compensation and Pension (C&P) spine examination in June 2006. At this time, the Veteran reported constant low back pain, of 7/10 severity, which radiated into the right hip at times. He described flare-ups of 7-8/10 pain which occurred at least twice a week and lasted 8-12 hours in duration. Precipitating factors included increased activity. With flare-ups, the Veteran reported having to stop for rest. Regardless, the Veteran reported limited mobility due to the prior history of fusion. He treated these symptoms with 15 mg. of Mobic in the morning with a couple of extra strength Tylenol in the afternoon. The examiner indicated that the Veteran's low back disability had no effect on his mobility or activities of daily living. The Veteran could no longer perform activities such as running, hiking with a backpack, and playing with his children. He had difficulty with activities such as yard work and biking. The Veteran denied alteration in bowel or bladder functions. On examination, the Veteran's spine demonstrated no irregularity in curvature, scoliosis, symmetry or posture. Gait was steady and normal. There was no tenderness to palpation of the thoracolumbar spine, paraspinous muscles or supporting thoracolumbar musculature. There was some tenderness of the right sacroiliac joint. The lumbar spine demonstrated flexion to 70 degrees, extension to 10 degrees, lateral flexion to 10 degrees bilaterally and lateral rotation to 10 degrees bilaterally. The Veteran did not have significant pain with range of motion. Rather, he mainly had stiffness and decreased mobility to the fusion. The biggest limiting factor was pain. There was no evidence of neurologic deficits. The examiner indicated that additional limitation of motion due to repetitive use could not be determined without resort to speculation. The examiner offered diagnoses of 1) status post decompression with laminectomy of L4/5 in 2000 and transforaminal lumbar interbody fusion at L3-L4, L4-L5 and L5-S1 in July 2005 and 2) degenerative arthritis of the lumbar spine. Overall, the June 2006 VA C&P examination report provides strong evidence against a rating greater than 20 percent as it fails to show limitation of lumbar spine motion of 30 degrees or less, favorable ankylosis of the entire thoracolumbar spine, chronic neurologic manifestations of IVDS and/or incapacitating episodes of IVDS having a total duration of at least 4 weeks. In this respect, the VA C&P examiner clearly found active range of lumbar spine motion on examination. Furthermore, the Veteran only reported intermittent episodes of right hip pain with examination showing no neurologic impairment of either lower extremity. The Board also notes that the Veteran himself, at this examination, did not describe limitation of motion to 30 degrees or less during exacerbations of back pain. The clinical records contemporaneous in time to this examination also did not suggest limitation of motion to 30 degrees or less during exacerbations of back pain. Even with consideration of the provisions of 38 C.F.R. §§ 4.40 and 4.45, the Board finds that the Veteran has not met his burden of submitting at least an approximate balance of positive and negative evidence in this case to support a finding that the his lumbar spine motion resulted in, or more nearly approximated, forward flexion of 30 degrees or less at this time. In a statement received on May 30, 2007, the Veteran argued that the June 2006 VA C&P examiner's findings regarding range of motion testing were inaccurate, as he self-described an inability to bend at all as a result of his lumbar spine fusion. He argued that, due to his fusion, he had no range of motion in the back let alone the range of motion recorded by the VA examiner in June 2006. For example, the Veteran described an inability to bend his back at all and having to bend his knees and go straight down in a squat to pick items up off the floor. He experienced excruciating pain by the end of the day due to activities such as standing, walking, climbing, etc. He had changed to a sedentary job but still had daily pain and weakness after prolonged use. He indicated that he did not report such symptomatology in service to avoid referral to a medical board. While the Veteran is clearly competent to describe an inability to bend, the Board finds that the VA examiner's clinical findings on range of motion findings hold greater probative value than the Veteran's self-described limitations, as this examiner has greater expertise and training than the Veteran to evaluate actual lumbar spine motion. Further, and perhaps more importantly, the results are consistent with prior medical reports regarding the Veteran's back. Also in the statement received on May 30, 2007, the Veteran argued for the first time that he experienced shooting pains down his right leg to his toes. He stated that this symptom had been present since service, but that he did not report this aspect of disability to avoid referral to a medical board. In September 2007, the Veteran underwent VA C&P examination to evaluate the Veteran's complaint of constant numbness from the right hip to the outer toes along the posterior aspect. The Veteran also reported an inability to sleep at night due to back pain. This examination found no separate right hip disorder, but did provide a diagnosis of lumbar radiculopathy. Thus, the September 2007 VA C&P examination found a diagnosis of right lower extremity radiculopathy which the Veteran reported being chronic in nature on May 30, 2007. Thus, the lay and medical evidence establishes the onset of right lower extremity radiculopathy as of May 30, 2007. The Board acknowledges the Veteran's apparent argument that his right lower extremity symptoms had been chronic since his discharge from service. This statement conflicts with his October 2005 report of a complete resolution of lower extremity numbness and his June 2006 report of right hip pain "at times." Additionally, the Veteran's complaints after May 2007 were different in character, referring to pain extending from the right hip to the toes rather than the previously reported pain limited to the right hip. In resolving this conflict, the Board places greater probative value to the Veteran's statements in service that the right lower extremity pains were not chronic in nature, as they were more contemporaneous in time to the time period in question and more consistent with the June 2006 VA C&P examination report findings of no neurologic deficits. Unfortunately, the September 2007 VA C&P examination did not provide adequate clinical findings to properly evaluate the severity of the right lower extremity radiculopathy. On an August 12, 2008 VA C&P examination, the Veteran complained of chronic low back pain of 7-8/10 severity with intermittent radiation for both lower extremities, more so on the right, associated with paresthesias throughout. He only obtained minimal relief of symptoms with Celebrex. Flare-ups occurred with any standing less than 10 minutes or walking less than a block. The Veteran was unable to run and, due to diminished walking and standing tolerance, he had quit two previous jobs. The Veteran denied instances of falls, but did report episodes of leg give-way. He currently worked as a counselor, but missed 3-4 days per month due to multiple musculoskeletal complaints. His activity level had been curtailed due to constant pain. He was unable to participate in recreational activities. He was self- sufficient at activities of daily living at a slower level, and his driving tolerance was limited to 30 minutes. On physical examination, the Veteran's spine was rigid. His gait was antalgic with a right lateral shift in posture. The examiner indicated that forward flexion and rotation to either side was not possible due to lumbar spine fusion. The lumbar spine did demonstrate 10 degrees of extension and 15 degrees of bilateral flexion. The Veteran experienced end-range pain in all directions with no change in motion upon repetitive testing. There were no muscle spasms, but guarding was moderately severe bilaterally. The lower extremities demonstrated diminished sensation in the L4-5 distribution. Strength was fair minus to fair plus with no muscular wasting. Reflexes were symmetrical but sluggish. The examiner diagnosed moderately severe to severe lumbosacral strain with degenerative arthritis and post surgical lumbar fusion. The August 12, 2008 VA C&P examination report first documented the Veteran's inability to forward bend at all, which has provided the basis for the award of a 40 percent rating by the RO. The Board finds that such an award is proper according to the applicable VA criteria. However, the Board finds that it is not factually ascertainable from the credible lay and medical evidence that such limitation of motion had been present prior to August 12, 2008. The Veteran did describe similar limitations in his May 2007 statement, however that statement referred to these symptoms being present on the 2006 VA C&P examination. Unfortunately, this statement is inconsistent with his reported symptomatology in service and the actual clinical findings during the June 2006 VA C&P examination. Quite simply, the Board does not find that this statement constitutes a reliable source of lay evidence when viewed against the entire evidentiary record. Notably, the Board finds no lay or medical evidence contained in the clinical records which document an actual increased severity of orthopedic symptoms prior to August 12, 2008. Furthermore, the August 12, 2008 VA C&P examination report first described moderately severe guarding of the thoracolumbar spine which had not been previously documented. For these reasons, the Board finds no basis in credible lay or medical evidence for awarding a 40 percent rating based upon limitation of motion prior to August 12, 2008. The Board further finds that, since August 12, 2008, the criteria for a rating greater than 40 percent for the orthopedic manifestations of thoracolumbar spine IVDS have not been met for any time. In this respect, there is no competent lay or medical evidence that the Veteran's entire spine is fixed in flexion or extension resulting in symptoms such as difficulty with walking because of a limited line of vision, restricted opening of the mouth and chewing, breathing limited to diaphragmatic respiration, gastrointestinal symptoms due to pressure of the costal margin on the abdomen, dyspnea or dysphagia, atlantoaxial or cervical subluxation or dislocation, or neurologic symptoms due to nerve root stretching. The Board does find that the August 12, 2008 VA C&P examination report demonstrates, for the first time, a chronic neurologic deficit involving the left lower extremity. In this respect, this examination report clearly documented a neurologic abnormality involving slight diminishment of sensation in the L4- 5 distribution (prior site of surgery) with slight reduction in strength and reflexes which cannot be ignored for rating purposes. With respect to the chronic neurologic manifestations of the Veteran's service-connected lumbar spine IVDS, the August 12, 2008 VA C&P examination described near symmetrical results for the Veteran's right and left lower extremities. In this respect, both extremities demonstrated diminished sensation in the L4-5 distribution, fair minus to fair plus strength, no muscular wasting, and sluggish but symmetrical reflexes. These symptoms clearly have a disabling aspect to the Veteran. As such, the Board finds that the lay and medical evidence supports awarding the minimum 10 percent rating for the right and left lower extremity sensory deficits absent significant motor or functional impairment. The Board finds further finds that the criteria for a rating greater than 10 percent for each extremity have not been met. The medical evidence of record does not describe any significant motor or functional impairment. There is also no lay or medical evidence of organic changes present in either extremity such as muscular atrophy or trophic changes. As such, the Board finds that such symptoms do not meet, or more nearly approximate, the criteria for incomplete paralysis of the sciatic nerve which is moderately disabling in degree. Therefore, the Board finds that the criteria for separate 10 percent ratings, but no higher, for the chronic neurologic manifestations of right and left lower extremity radiculopathy due to IVDS has been met for the entire appeal period. The Veteran does not allege, and the record does not suggest, any additional chronic neurologic manifestations of lumbar spine IVDS. The Board has further considered whether a higher rating could be awarded for any time during the appeal period for incapacitating episodes of IVDS. Notably, the Veteran has not described IVDS episodes having a total duration of at least 4 weeks for any 12- month period. More importantly, the Board has closely reviewed the record, and finds that the Veteran is not shown to have experienced incapacitating episodes IVDS having a total duration of at least 4 weeks in any given 12-month period, as defined by VA regulation (bed rest prescribed by a physician and treatment by a physician). In so deciding, the Board has considered the Veteran's current report of having thoracolumbar spine pain with bilateral leg symptoms to be credible and consistent with the evidentiary record. Clearly, he is competent to describe such symptomatology. However, as addressed above, the Board finds that the Veteran's bilateral leg symptoms have not been chronic present since the inception of the appeal with him providing inconsistent statements of symptomatology. Furthermore, the Veteran's descriptions regarding the severity, frequency and duration of symptoms are somewhat inconsistent. The Board further observes that the Veteran's postservice clinical records do not contain any significant findings favorable to his claims according to the applicable criteria. Regarding the overall severity of his disability, as manifested orthopedically and neurologically, the Board places greater probative value to the findings of the VA C&P examiners, who have greater expertise in evaluating such matters and greater accuracy in determining motion loss with use of a goniometer. The preponderance of the persuasive lay and medical evidence is against any further compensation for this claim. 38 U.S.C.A. § 5107(b). Left knee Included within 38 C.F.R. § 4.71a are multiple DC's that evaluate impairment resulting from service-connected knee disorders, including DC 5256 (ankylosis), DC 5257 (other impairment, including recurrent subluxation or lateral instability), DC 5258 (dislocated semilunar cartilage), DC 5259 (symptomatic removal of semilunar cartilage), DC 5260 (limitation of flexion), DC 5261 (limitation of extension), DC 5262 (impairment of the tibia and fibula), and DC 5263 (genu recurvatum). According to DC 5257, which rates impairment resulting from other impairment of the knee, to include recurrent subluxation or lateral instability of this joint, a 10 percent rating will be assigned with evidence of slight recurrent subluxation or lateral instability of a knee; a 20 percent rating will be assigned with evidence of moderate recurrent subluxation or lateral instability; and a 30 percent rating will be assigned with evidence of severe recurrent subluxation or lateral instability. Pursuant to 38 C.F.R. §§ 4.40 and 4.45, pain is inapplicable to ratings under DC 5257 because it is not predicated on loss of range of motion. See Johnson v. Brown, 9 Vet. App. 7, 11 (1996). Traumatic arthritis is rated analogous to degenerative arthritis under DC 5003. Degenerative arthritis, when established by X-ray findings, will be rated on the basis of limitation of motion under the appropriate DC's for the specific joint or joints involved. When the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate DC's, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion to be combined, not added under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, DC. For purpose of rating disability from arthritis, the knee is considered a major joint. 38 C.F.R. § 4.45(f). The DC's that focus on limitation of motion of the knee are DC's 5260 and 5261. Normal range of motion of the knee is to zero degrees extension and to 140 degrees flexion. See 38 C.F.R. § 4.71a, Plate II. Under DC 5260, a noncompensable rating will be assigned for limitation of flexion of the leg to 60 degrees; a 10 percent rating will be assigned for limitation of flexion of the leg to 45 degrees; a 20 percent rating will be assigned for limitation of flexion of the leg to 30 degrees; and a 30 percent rating will be assigned for limitation of flexion of the leg to 15 degrees. See 38 C.F.R. § 4.71a, DC 5260. Under DC 5261, a noncompensable rating will be assigned for limitation of extension of the leg to 5 degrees; a 10 percent rating will be assigned for limitation of extension of the leg to 10 degrees; a 20 percent rating will be assigned for limitation of extension of the leg to 15 degrees; a 30 percent rating will be assigned for limitation of extension of the leg to 20 degrees; a 40 percent rating will be assigned for limitation of extension of the leg to 30 degrees; and a 50 percent rating will be assigned for limitation of extension of the leg to 45 degrees. 38 C.F.R. § 4.71a, DC 5261. DC 5256, which governs ankylosis of the knee permits a 30 percent rating for favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees, while a veteran will garner a 40 percent rating with flexion between 10 and 20 degrees. The VA Office of General Counsel has stated that compensating a claimant for separate functional impairment under DC's 5257 and 5003 does not constitute pyramiding. VAOPGCPREC 23-97 (July 1, 1997). In this opinion, the VA General Counsel held that a veteran who has arthritis and instability of the knee may be rated separately under DC's 5003 and 5257, provided that a separate rating is based upon additional disability. Subsequently, in VAOPGCPREC 9-98 (Aug. 14, 1998), the VA General Counsel further explained that if a veteran has a disability rating under DC 5257 for instability of the knee, and there is also X-ray evidence of arthritis, a separate rating for arthritis could also be based on painful motion under 38 C.F.R. § 4.59. See also VAOPGCPREC 9-04 (Sept. 17, 2004) (which finds that separate ratings under DC 5260 for limitation of flexion of the leg and DC 5261 for limitation of extension of the leg may be assigned for disability of the same joint). The VA Office of General Counsel has also stated that DC 5259, removal of semilunar cartilage, may result in complications producing loss of motion. As such, limitation of motion is a relevant consideration under DC 5259. VAOPGCPREC 9-98 (Aug. 14, 1998). The RO's November 2006 rating decision established service connection for degenerative arthritis of the left knee, status post arthroscopy, and assigned an initial noncompensable rating effective to the date of claim; November 1, 2006. A December 2008 RO rating decision awarded a 10 percent rating for the left knee disability effective August 12, 2008. Thus, a "staged" rating is in effect for this disability. The Veteran's STRs reflect a longstanding history of left knee problems. An MRI examination in December 2000 was interpreted as showing likely osteochondritis dissecans. The Veteran subsequently underwent arthroscopy with chondroplasty. There is no history that he underwent removal of semilunar cartilage during service. See 38 C.F.R. § 4.71a, DC 5259 (providing specific criteria where a claimant removal of semilunar cartilage). On his June 2006 VA C&P examination, the Veteran denied chronic left knee pain. Rather, he reported experiencing soreness with prolonged standing or walking more than usual. His biggest issue was a self-described weakness, fatigue and limited endurance. For example, he noticed weakness with extended walking, carrying items or walking up hills. He could not kneel due to tenderness. He was also bothered by stairs due to weakness. However, the Veteran denied instability, give-way, "locking," episodes of flare-ups with additional limitation of motion or functional impairment, use of assistive devices, episodes of dislocation or recurrent subluxation, periods of incapacitation, or any effects on his usual occupation or activities of daily living. On examination, the Veteran left knee was visually symmetrical to the right. There was no redness, swelling, effusion, heat, deformity, muscle atrophy, tenderness to palpation, guarding or resistance on examination, or pain with flexion or extension. Gait was steady and even. There was no functional limitation noted with walking or standing. On examination, the left knee demonstrated active and passive motion from 0 to 140 degrees. The medial and collateral ligaments were intact with no laxity of motion to varus/valgus testing. The anterior and posterior cruciate ligaments were also intact. The examiner could not express, without resort to speculation, any additional limitation by pain, fatigue, weakness, or lack of endurance due to repetitive use. The examiner offered a diagnosis of status post left knee arthroscopy with chondroplasty and grade IV chondromalacia indicative of degenerative arthritis. Overall, the pre-discharge June 2006 VA examination report provides highly probative evidence against an initial compensable rating prior to August 12, 2008. This examination found that the Veteran's left knee demonstrated motion from 0 to 140 degrees with no objective evidence of pain. Thus, the clinical findings are well short of the criteria for a compensable evaluation based upon limitation of motion under DC's 5260 and/or 5261. Furthermore, an evaluation under DC 5003-5010 was not warranted as the Veteran's motion loss in either flexion or extension did not meet the minimum criteria for a noncompensable rating under DC's 5260 and/or 5261. Furthermore, the Veteran specifically denied painful motion. In a statement received in May 2007, the Veteran reported that his left knee was frequently painful, generally after extended standing or walking. He further reported weakness and pain after extended use, such as kneeling, bending or walking up inclines. He noted taking prescription medication due to left knee arthritis. The Board acknowledges that this statement refers to left knee pain and weakness exacerbated by use. However, this self- description is inconsistent with his report to the June 2006 VA C&P examiner. At that time, the Veteran self-described "soreness" rather than actual pain on use and specifically denied pain on range of motion testing. The Veteran further denied flare-ups which caused additional limitation of motion or functional impairment, or impairment which had any effects on his usual occupation or activities of daily living. Additionally, as addressed above, the Veteran's May 2007 statement included references to alleged lumbar spine symptomatology demonstrated in June 2006 which the Board has held to be inconsistent with the entire evidentiary record. In short, this statement is not deemed a reliable indicator of actual aspects of disability present. Overall, the Board finds that the Veteran's June 2006 statements, when coupled with the examination findings that included no objective evidence of painful motion, outweighs the inconsistent May 2007 report of symptoms. Overall, the credible lay and medical evidence above showed that the Veteran did not meet the criteria for compensable limitation of motion for either knee under DC's 5260 and 5261, even after considering functional loss due to pain and weakness after repeated use. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, supra. It is important for the Veteran to understand that the credible lay and medical evidence showed no objective evidence of painful left knee motion, for which the noncompensable rating is warranted. Turning to the question of instability, the Board notes that the Veteran was not wearing a knee brace and had not been prescribed a knee brace due to actual instability or subluxation of the left knee. He specifically denied such symptoms on the June 2006 VA C&P examination, and examination at that time demonstrated no clinical evidence of instability or subluxation. Thus, the credible lay and medical evidence is against consideration of a compensable evaluation under DC 5257 prior to August 12, 2008. The Board has also given consideration to the alternative DC criteria for evaluating a knee disability. There was no lay or medical evidence of ankylosis, dislocated semilunar cartilage with "locking" and effusion, history of cartilage removal, impairment of the tibia and fibula, or genu recurvatum. As such, the criteria of DC's 5256, 5258, 5259 and 5263 do not apply. On August 12, 2008, the Veteran underwent additional VA C&P examination of the left knee. At that time, the Veteran described chronic left knee pain of 7-8/10 severity with stiffness. He had occasional swelling. He had flare-ups of disability which occurred with continued standing in excess of 10 minutes and walking more than one block. He did not use assistive devices. The Veteran denied dislocation, recurrent subluxation, or inflammatory arthritis. He missed approximately 3-4 days of work in a month. He was self-sufficient in day-to- day activities at a slower pace. On examination, the Veteran's left knee demonstrated motion from 0 degrees of extension to 115 degrees of flexion with patellar grinding. There was end range pain in both directions with continued pain on repetitive use. However, there was no change of motion. Lachman's test was tender diffusely. Guarding was present with both flexion and extension. Gait was antalgic with right lateral shift. There was no ankylosis. The examiner diagnosed left knee patellofemoral pain syndrome with degenerative arthritis and arthroscopic residuals. Overall, the August 12, 2008 VA examination provides highly probative evidence against a rating greater than 10 percent for the left knee disability for any time since August 12, 2008. This examination found that the Veteran's left knee demonstrated motion from 0 to 115 degrees with pain on motion. Overall, this evidence provides highly probative evidence against even a compensable evaluation based upon limitation of motion under DC's 5260 and/or 5261. However, the Veteran has X-ray evidence of left knee arthritis and objectively demonstrated painful motion on the August 2008 VA examination. On this basis, the RO awarded the currently assigned 10 percent rating effective to the date of the VA examination report. The Board is aware that the Veteran has argued the presence of painful left knee motion prior to this examination. However, as held above, his claimed report of symptomatology present on the June 2006 VA examination was not borne out by actual physical examination and is inconsistent with his own prior statements at that time regarding his symptomatology. Overall, the Board finds that the Veteran's inconsistent statements regarding his left knee symptomatology is insufficient to establish his entitlement to a 10 percent rating prior to the August 12, 2008 VA C&P examination report. The prior VA C&P examination findings outweigh his contentions to the contrary. The Board also acknowledges the Veteran's report of left knee pain with weakness, fatigue and endurance on use. It is important for the Veteran to understand that his assigned 10 percent rating contemplates painful left knee motion. The Veteran has not described, and the evidence does not show, that his reported functional impairment on use is of such severity to equate to, or more nearly approximate, the criteria for a compensable rating for limitation of motion under DC's 5260 and/or 5261. Thus, there is no further basis to award a rating greater than 10 percent pursuant to the considerations identified in 38 C.F.R. § 4.40 and § 4.45. Turning to the question of instability, the Board notes that the Veteran was not wearing a knee brace and had not been prescribed a knee brace due to actual instability or subluxation of the left knee. He specifically denied these symptoms on examination, and demonstrated no clinical evidence of instability or subluxation on examination. Thus, the credible lay and medical evidence is against consideration a separate compensable evaluation under DC 5257 since August 12, 2008. The Board has also given consideration to the alternative DC criteria for evaluating a knee disability. There was no lay or medical evidence of ankylosis, dislocated semilunar cartilage with "locking" and effusion, history of cartilage removal, impairment of the tibia and fibula, or genu recurvatum. As such, the criteria of DC's 5256, 5258, 5259 and 5263 do not apply. In so concluding, the Board has carefully reviewed the Veteran's statements of record, particularly with respect to the onset and increased severity of his various left knee symptoms during the appeal period. His complaints of painful left knee motion were first voiced in a May 2007 statement, but that statement alleged symptomatology purportedly present in June 2006 which conflicted with his statements then of record and the actual clinical findings. In short, this statement is not deemed a reliable indicator regarding the actual symptomatology experienced. As such, the May 2007 lay description of symptoms has not been of sufficient consistency, reliability and credibility to extend the effective date of award for his rating under DC 5003 prior to August 12, 2008. Overall, the credible lay and evidence does not support higher ratings than currently assigned for any differing periods of time during the appeal period. To this extent, his statements are outweighed by the medical evidence which, as a whole, provides evidence against any further compensation. The benefit of doubt rule does not apply as the preponderance of evidence is against this claim. 38 U.S.C.A. § 5107(b); Ortiz, 274 F. 3d. at 1365. Left and right heel The Veteran is service-connected for plantar fasciitis affecting both feet. Notably, plantar fasciitis is not listed as a specific disability under VA's Rating Schedule. Where VA's Rating Schedule does not list a specific disability, the disability is rated under criteria where the functions affected, anatomical localization, and symptomatology are analogous. 38 C.F.R. § 4.20. The Veteran's STRs reflect a longstanding history of bilateral heel pain. In September 2002, he was diagnosed with recalcitrant left plantar fasciitis manifested by pain centrally and medially along the left heel, pain with dorsiflexion of the central aspect of the heel, and dorsiflexion of the toes. In October 2002, the Veteran underwent left plantar fasciectomy and calcaneal exostectomy. In April 2005, he underwent a right exostomy with 1st metatarsal osteotomy with plantar fascia release. The criteria of DC 5276 evaluates acquired flatfoot on a unilateral or bilateral basis. Under this diagnostic code, a noncompensable rating is warranted for mild symptoms relieved by built-up shoe or arch support. A 10 percent rating is warranted for moderate impairment with weight-bearing line over or medial to the great toe, inward bowing of the tendo Achilles, and pain on manipulation and use of the feet, bilateral or unilateral. Under DC 5276, a higher evaluation of 20 percent is assigned for severe unilateral acquired flatfoot, with objective evidence of marked deformity, pain on manipulation and use accentuated an indication of swelling on use, and characteristic callosities. When such symptoms are bilateral, a 30 percent rating is assigned. A 30 percent evaluation is assigned for pronounced unilateral acquired flatfoot, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achilles on manipulation, not improved by orthopedic shoes or appliances. Id. When such symptoms are bilateral, a 50 percent rating is assigned. The Board also acknowledges the potential applicability of DC 5284, which evaluates other foot injuries. Under this diagnostic code, a 10 percent evaluation is warranted for a moderate disability. A 20 percent evaluation is warranted for moderately severe disability, and a 30 percent evaluation for severe disability. Id. Based on the facts of this case and the applicable criteria, the Board finds that it is appropriate to consider either bilateral or unilateral ratings for the service-connected right and left feet according to the most favorable result to the Veteran. Notably, however, the Board finds no basis to alternately consider the criteria of DC 5277 (bilateral weak foot characterized by musculature atrophy, disturbed circulation and weakness), DC 5278 (acquired clawfoot/pes cavus), DC 5279 (anterior metarsalgia [Morton's disease]), DC 5280 (unilateral hallux valgus), DC 5282 (hammer toe), or DC 5283 (malunion or nonunion of the tarsal or metatarsal bones). The Veteran has submitted treatise material generally describing osteotomy and exosectomy procedures. The April 25, 2005 operative report reflects removal of excess bone of the 1st metatarsal joint with cortical screw placed in the 1st metatarsal head to achieve permanent fixation. An amputation was not performed. While the Veteran reports current residuals of the right 1st osteotomy, the operative report does not reflect amputation of any portion of the great toe. As such, there is no basis for a compensable rating under DC 5171, which evaluates great toe amputation residuals. Applying the criteria to the facts of this case, the Board finds that the criteria for a compensable rating for the service- connected left heel disability and a right foot disability have not been met for any time during the appeal period. In this respect, the Veteran's service-connected left heel disability, status post plantar fasciectomy and calcaneal exostectomy, is manifested by mild residual impairment absent objective evidence of abnormal weight bearing, skin changes, vascular changes, hammertoes, high arch, clawfoot, malalignment or other deformity. Additionally, the Veteran's service- connected right foot disability, status post exostectomy, osteotomy and plantar fascial release, is manifested by mild residual impairment absent objective evidence of abnormal weight bearing, skin changes, vascular changes, hammertoes, high arch, clawfoot, malalignment or other deformity. In June 2006, the Veteran underwent a pre-discharge VA examination. At that time, he reported constant left foot pain of 4/10 severity located in the arch of the foot. He denied any swelling, redness, or heat of the left foot. He had right foot pain, after standing, of 5/10 severity located particularly in the 1st MTP with associated weakness and stiffness of the 1st MTP joint. He reported right great toe swelling, but denied heat of the foot. With respect to both feet, the Veteran described fatigability and lack of endurance. He further reported pain with prolonged standing, long periods of walking, walking on uneven surfaces or carrying weight. He denied pain flare-ups of the left foot. With respect to the right foot, the Veteran had flare-ups of the right toe every 3-4 days which lasted the entire day if the foot was not elevated. At these times, his pain intensity was 6-7/10 pain. He further described additional limitation of motion and functional impairment with these flare- ups, wherein he avoided the aggravating activities. He wore arch supports all of the time, and Birkenstock shoes when possible. His condition limited the amount of time he could spend on his feet. On examination, the left foot demonstrated low arches that flattened with full weight bearing. There was a slightly arched 4.5 cm. x 2 mm. scar on the left heel. This area was not tender, red, swollen or deformed. The right foot demonstrated low arches that flattened with full weight bearing. There was a 4 cm. x 2 mm. scar on the right heel, and a 6.5 cm. x. 2 mm. scar along the 1st MTP joint with no residual. With the exception of the right 1st MPT joint, this area was not tender, red, swollen or deformed. The right 1st MTP joint was tender with limited mobility in regard to flexion. With respect to both feet, the Achilles tendons had normal alignment absent valgus/varus angulation of the os calcis in relationship to the long axis of the tibia/fibula. There was no forefoot or midfoot malalignment. Gait was steady and uneven with no functional impairment noted with walking or standing. There was no halgus hallux of the feet. There was no bunion or callous formation at the right 1st MTP. There was also no callous formation along the heels or lateral foot. The Veteran's biggest limiting factor was pain, but the examiner could not express without resort to speculation any additional limitation by pain, fatigue, weakness or lack of endurance due to repetitive use or during a flare-up. The examiner diagnosed status post plantar fasciectcomy and calcaneal exostectomy of the left heel, and status post metatarsophalangeal joint exostectomy with 1st metatarsal osteotomy and plantar fascial release of the right foot. Overall, the June 2006 VA C&P examination report provides strong probative evidence against these claims, failing to reflect objective evidence of significant weight-bearing abnormalities, inward bowing of the Achilles, pain on manipulation of the feet, swelling on use, characteristic callosities, marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achilles on manipulation, or any significant functional impairment with walking or standing. The Veteran underwent additional VA C&P examination in November 2008. At this time, the Veteran reported constant bilateral foot pain of 8/10 severity and intermittent swelling. Pain was present at rest, but worsened with standing or walking. He could experience pain flares to 10/10 severity due to activity, which lasted all day. Generally, he limited the time spent on his feet. For example, the Veteran could stand or walk for 30 minutes before he experienced a significant increase of foot pain. He worked as a prison counselor which required a lot of time on his feet. Nonetheless, the Veteran was able to attend to daily activities. On examination, the Veteran's feet had a normal appearance except for his scars. There was tenderness on deep palpation of the soles of both feet, especially in the area of the arches. The Veteran walked with a left limp. There were no indications of abnormal weight bearing, such as callosities, breakdown, or unusual shoe wear pattern. There were no skin changes, vascular changes, hammertoes, high arch, clawfoot, or other deformity. The weight-bearing and non-weight bearing alignment of the Achilles tendons were normal. There was no valgus, forefoot, or midfoot malaligment. There was active motion in the metatarsophalangeal joints. The VA examiner provided diagnoses of remote left foot fasciectomy and calcaneal exostectomy with mild residuals, and remote right foot plantar fasciectomy and osteotomy with mild residuals. Overall, the November 2008 VA C&P examination report provides strong probative evidence against these claims, failing to reflect objective evidence of significant weight-bearing abnormalities, inward bowing of the Achilles, pain on manipulation of the feet, swelling on use, characteristic callosities, marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achilles on manipulation, or any significant functional impairment with walking or standing. It also includes medical opinion that the overall disability in both feet is mild in degree. The Board acknowledges the Veteran's arguments in this case. He refers to loss of right great toe motion and intermittent swelling which affects the overall functioning of his right foot. He also reports that he experiences pain, swelling and weakness of his feet upon prolonged use. Overall, the Board finds that these complaints are credible and consistent with the evidentiary record. However, the Board finds no schedular basis to award higher ratings for any period of time, whether considering each foot separately or bilaterally. To warrant a compensable evaluation under DC 5276, the Veteran would have to manifest moderate flat foot type of symptoms which are not shown by physical examination. There is no clinical evaluation of any significant abnormality of the feet contained in the accompanying postservice clinical records. Furthermore, the most recent VA C&P examination described the Veteran's overall residual disability as mild in degree in both feet. In addition to this medical description, the recent VA C&P examination found no objective evidence of abnormal weight bearing, skin changes, vascular changes, hammertoes, high arch, clawfoot, malalignment or other deformity. Thus, the objective clinical findings are consistent with the medical description of no more than mild foot disability of both the left and right feet. The postservice clinical records do not show any findings to the contrary. Overall, the credible lay and evidence does not support higher ratings than currently assigned for any differing periods of time during the appeal period. The Board has considered the Veteran's reports of functional impairment on use, see 38 C.F.R. § 4.40 and 4.45, but his descriptions of greater disability are outweighed by the medical evidence which, as a whole, provides evidence against any compensation. The Board places greater probative weight upon the clinical findings and opinions of the VA examiners, as they have greater training and expertise than the Veteran in evaluating his bilateral foot disability. The benefit of doubt rule does not apply as the preponderance of evidence is against these claims. 38 U.S.C.A. § 5107(b); Ortiz, 274 F. 3d. at 1365. Hypertension The RO has rated the Veteran's hypertension as noncompensable under DC 7101. A 10 percent rating contemplates hypertensive vascular disease (hypertension and isolated systolic hypertension) manifested by diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; history of diastolic pressure predominantly 100 or more which is controlled by continuous medication. 38 C.F.R. § 4.104, DC 7101. A 20 percent rating is warranted for hypertensive vascular disease manifested by diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more. Notably, hypertension will be separately evaluated from hypertensive and other heart diseases. 38 C.F.R. § 4.104, DC 7101 Note (3). Hypertensive heart disease is evaluated under the same criteria for evaluating other heart diseases, which includes the results of exercise testing expressed in METs, the presence of congestive heart failure, the ventricular ejection fraction, etc. As such, the criteria of DC's 7005 and 7101 do not overlap, so that separate ratings are not prohibited under 38 C.F.R. § 4.14. Historically, the Veteran's STRs reflect that monitoring for borderline hypertension began in 1994, at which time a blood pressure reading was 149/91. A 5-day blood pressure check in May 1999 demonstrated elevated blood pressure readings, but nonetheless showed systolic pressure predominantly less than 160 and diastolic pressure predominantly less than 100. A 3-day blood pressure check in May 2000 averaged 138/85. The Veteran was prescribed hydrochlorothiazide in December 2005, after a 5- day blood pressure check revealed blood pressure readings of 152/98, 148/100, 154/98, 144/100 and 158/90. Overall, the Veteran's STRs documented systolic pressures predominantly less than 160 and diastolic pressures predominantly less than 100. Overall, the Veteran's STRs provide strong evidence against this claim, reflecting that the Veteran was diagnosed with hypertension and prescribed medication when his systolic pressures were predominantly less than 160 and diastolic pressures were predominantly less than 100. The postservice medical records document that the Veteran's systolic pressures have remained predominantly less than 160 and that his diastolic pressures have remained predominantly less than 100. Overall, the post-service medical records provide highly probative evidence against this claim, showing that the Veteran's systolic blood pressures remained predominately less than 160, and that he has no history of diastolic blood pressure predominantly 100 or more. Notably, there is no evidence that the Veteran manifests hypertensive heart disease. The Board recognizes that the Veteran takes prescription medication for treatment of hypertension. However, the use of anti-hypertensive medication is contemplated by the rating criteria and, by itself, does not support the assignment of a compensable rating. As noted, the competent medical evidence overall fails to show a history of diastolic readings predominantly 100 or more. There is no lay report of diastolic or systolic readings which could form the basis for a compensable rating in this case. In sum, the weight of the credible evidence demonstrates that the Veteran is not entitled to a compensable evaluation for his hypertension at any time during the pendency of this claim. See Fenderson, supra. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C.A. § 5107; Ortiz, 274 F. 3d 1361 (Fed. Cir. 2001). Scars of the chest and left cheek The Veteran seeks compensable ratings for scars involving his chest and left cheek. These separate scars are evaluated under the same criteria. Therefore, the Board will evaluate these scars in the same discussion. As noted in the Introduction, the Veteran's reported biopsy scar of the left clavicle region is referred to the RO for appropriate development and adjudication. DC 7800 rates disfigurement of the head, face, or neck. See 38 C.F.R. § 4.118. A 10 percent rating is warranted for one characteristic of disfigurement. Note 1 of DC 7800 identifies the following eight characteristics of disfigurement for purposes of this evaluation: scar five or more inches in length; scar at least one- quarter inch wide at widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo-or hyper- pigmented in an area exceeding six square inches (39 sq. cm.); skin texture abnormal (irregular, atrophic, shiny, scaly, etc) in an area exceeding six square inches (39 sq. cm.); underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.); or skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.). Under DC 7801, a 10 percent rating is warranted for scars, other than the head, face, or neck, that are deep or cause limited motion in an area or areas exceeding 144 square inches (929 sq. cm.). A deep scar, according to Note 1, is one associated with underlying soft tissue damage. Under Note 2, scars in widely separated areas, as on 2 or more extremities or on anterior and posterior surfaces of extremities or the trunk, will be separately rated and combined in accordance with 38 C.F.R. § 4.25. Under DC 7802, a 10 percent rating is warranted for scars that are superficial, do not cause limited motion, and cover area of 144 inches (929 sq. cm). A superficial scar, as defined in Note 1, is one not associated with underlying soft tissue damage. Again, scars in widely separated areas, as on 2 or more extremities or on anterior and posterior surfaces of extremities or the trunk, will be separately rated and combined in accordance with 38 C.F.R. § 4.25. Under DC 7803, a 10 percent rating is warranted for a scar that is superficial and unstable. An unstable scar is defined at Note 1 as one where, for any reason, there is frequent loss of covering over the scar. Under DC 7804, a 10 percent rating is warranted for superficial scars that are painful on examination. A superficial scar is defined in Note (1) as one not associated with underlying soft tissue damage. Under DC 7805, a scar may also be rated based upon limitation of function of the part affected. During the pendency of this appeal, VA issued a clarifying final rule for evaluating scar disabilities at 73 Fed. Reg. 54708 (Sept. 23, 2008). However, these amendments only apply to applications received by VA on or after October 23, 2008, or if the Veteran expressly requests consideration under the new criteria, which he has not done here. Therefore, the Board has no authority to consider these revisions in deciding this claim. VAOPGCPREC 3-00; 38 U.S.C.A. § 5110(g). Applying the criteria to the facts of this case, the Board finds that the criteria for a compensable rating for scars of the chest and left cheek have not been met for any time during the appeal period. In this respect, the Veteran's scars of the chest and left cheek are shown to be superficial, stable and nontender which cover an area of less than 144 inches (929 sq. cm), do not have any disfiguring characteristics and do not limit the function of any part. Historically, the Veteran had a basal cell carcinoma lesion excised from his mid-chest in December 1999. The specimen sample measured 0.5 x 0.4 x 0.1 cm. No complications were reported. However, the Veteran complained of redness in the superior portion of his chest in April 2000. He was diagnosed with solar elastosis. The scar itself was reported as "nontender." In April 2000, the Veteran had a basal cell carcinoma lesion excised from his left cheek. The specimen sample measured 1.5 x 3 x 0.4 cm. No complications were reported. On his pre-discharge VA examination in June 2006, the Veteran reported an intermittent history of skin lesions which required biopsy. He denied current treatment. Examination demonstrated a 2 x 2. cm. scar at the region of the xiphoid process which was well healed with no residual. He had a 1 cm. x 2 mm. scar on the left upper cheek which was difficult to see, but demonstrated no residual. The examiner found no disfigurement, and found no part of the body affected by a suspicious lesion. The examiner diagnosed status post removal of lesions of the chest and left cheek positive for basal cell carcinoma. Overall, the June 2006 VA C&P examination report provides strong probative evidence against these claims, showing very small, superficial, stable and nontender scars absent any disfiguring characteristics or lay report of pain. The Veteran underwent additional VA C&P examination in November 2008. At this time, the only current symptom reported by the Veteran was some burning pain on the chest scar associated with applying alcoholic deodorant in the morning. On examination, the Veteran demonstrated a scar of the left side of his face measuring 2.5 x .3 cm. The scar on his chest wall, located midway between the suprasternal and retrosternal area, measured 2.5 x. 0.3 cm. For both scars, there was no pain on examination. There was also no adherence to underlying tissue, instability, elevation or depression of the surface contour, inflammation, edema, keloid formation, color irregularity, characteristics of disfigurement, induration, or inflexibility. The scars were further described as superficial, and not causing limitation of any function. Overall, the November 2008 VA C&P examination report provides strong probative evidence against these claims, again showing very small, superficial, stable and nontender scars absent any disfiguring characteristics or lay report of pain. The postservice clinical records associated with the record do not reflect any significant treatment for the chest and cheek scars. The Board again acknowledges the Veteran's arguments in this case. He refers to three biopsy scar sites, one involving a 3 "inch" scar on his left cheek, another involving a long scar on his shoulder, and another involving a round red scar on his chest. He reports recurrent suspicious moles or red patches which have required removal. He has not reported that the chest and cheek scars are tender, unstable, disfiguring, etc. On review of the record, the Board finds the Veteran's description of a 3 "inch" scar on his left cheek to be inconsistent with the record. As noted above, the initial biopsy lesion measured 1.5 x 3 x 0.4 centimeters. The VA examiner in June 2006 measured the remaining scar as 1 cm. x 2 mm., specifically noting that this scar was difficult to see. The VA examiner in 2008 measured this scar as 2.5 x .3 cm. Quite simply, the Veteran's perception of having a 3 inch scar of the left cheek is not borne out by the clinical findings of record, which are deemed more accurate as they were rendered by physicians who used a ruling measure and are trained to evaluate scarring characteristics. Otherwise, the Veteran's remaining complaints do not provide a basis to warrant compensable ratings. In any event, the Board places greater probative weight upon the clinical findings and opinions of the VA examiners, as they have greater training and expertise than the Veteran in evaluating his scar disabilities. The benefit of doubt rule does not apply as the preponderance of evidence is against these claims. 38 U.S.C.A. § 5107(b); Ortiz, 274 F. 3d. at 1365. Tinea pedis The Veteran seeks a rating greater than 10 percent for his service-connected tinea pedis. The Board notes that the RO's coding sheet lists a disability stylized as "TINEA PEDIS, BILATERAL LOWER EXTREMITIES, ECZEMA BILATERAL UPPER EXTREMITIES." However, the RO's rating actions do not reflect adequate evaluation of the upper extremity dermatitis condition which has not been properly appealed, as opposed to the dermatophytosis condition currently before the Board. The RO is currently rating this disorder under 38 C.F.R. § 4.118, DC 7813-7806. Dermatitis or eczema is to be rated under either the criteria for DC 7806 or to be rated as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7803, 7804, or 7805), depending upon the predominant disability. In the Introduction section, the Board has referred to the RO the appropriate rating for the upper extremity dermatitis condition. To the extent these disabilities overlap, the RO can consider a more complete disability picture if necessary upon readjudication of the dermatitis condition. The Board, however, will limit this appeal to the tinea pedis condition appealed to the Board. Under DC 7813, dermatophytosis (including tinea pedis) is rated as disfigurement of the head, face, or neck (DC 7800), scars (DCs 7801, 7802, 7803, 7804, or 7805), or dermatitis (DC 7806), depending upon the predominant disability. Thus, both dermatitis/eczema and dermatophytosis are rated under the same criteria. As such, the Board will consider the Veteran's entitlement to a compensable rating based upon the total bodily involvement of these disorders. Under DC 7806, a noncompensable rating is warranted for dermatitis or eczema that involves less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and; no more than topical therapy required during the past 12- month period. A 10 percent evaluation requires evidence of exposure to at least 5 percent, but less than 20 percent, of the entire body or at least 5 percent, but less than 20 percent, of exposed areas affected; or the need for intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of less than six weeks during the past 12- month period. A 20 percent rating requires evidence of exposure to 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period. Applying the criteria to the facts of this case, the Board finds that the criteria for a compensable rating for tinea pedis have not been met for any time during the appeal period. In this respect, the credible lay and medical evidence shows that the Veteran's tinea pedis involves less than 5 percent of the entire body, has not required the need for intermittent systemic therapy, and does not result in any scarring characteristics. The Veteran's STRs reflect his treatment for tinea pedis treated with Mycelex cream. VA C&P examination in June 2006 described scaling of the 4th and 5th toes consistent with mild athletes foot. VA C&P examination in August 2008 described the Veteran to have a dystrophic toenail with discoloration of the left big toe, and mild dystrophic toenails of the remaining toes. There was pruritis, but no skin lesions present. The overall bilateral tinea pedis disability involved less than one percent of his unexposed bodily area. The Veteran indicated not taking any medication for this disorder. Overall, the June 2006 and August 2008 VA C&P examination reports provide strong probative evidence against this claim, showing that the Veteran's tinea pedis has involved less than 5 percent of the entire body, has not required the need for intermittent systemic therapy, and does not result in any scarring characteristics. The postservice clinical records associated with the record do not reflect any significant lay or medical evidence pertaining to tinea pedis. In support of his claim, the Veteran has reported a long-standing history of tinea pedis exacerbated by wearing boots and non- breathable socks during the military. He reports no resolution of his symptoms using over-the-counter medications. The Board finds this report of history to be credible and consistent with the evidentiary record. This evidence, alone, does not provide a basis for a compensable rating. When viewed in conjunction with the clinical findings of record, the record is clear that the Veteran has not met the criteria for a compensable rating for tinea pedis for any time during the appeal period. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C.A. § 5107; Ortiz, 274 F. 3d 1361 (Fed. Cir. 2001). Extraschedular consideration To accord justice in an exceptional case where the scheduler standards are found to be inadequate, the field station is authorized to refer the case to the Chief Benefits Director or the Director, Compensation and Pension Service for assignment of an extraschedular evaluation commensurate with the average earning capacity impairment. 38 C.F.R. § 3.321(b)(1). The provisions of 38 C.F.R. § 3.321(b) state as follows: Ratings shall be based as far as practicable, upon the average impairments of earning capacity with the additional proviso that the Secretary shall from time to time readjust this schedule of ratings in accordance with experience. To accord justice, therefore, to the exceptional case where the schedular evaluations are found to be inadequate, the Under Secretary for Benefits or the Director, Compensation and Pension Service, upon field station submission, is authorized to approve on the basis of the criteria set forth in this paragraph an extra-schedular evaluation commensurate with the average earning capacity impairment due exclusively to the service- connected disability or disabilities. The governing norm in these exceptional cases is: A finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. In Thun v. Peake, 22 Vet. App. 111 (2008), the Court clarified the analytical steps necessary to determine whether referral for extraschedular consideration is warranted. The Court stated that the RO or the Board must first determine whether the schedular rating criteria reasonably describe the Veteran's disability level and symptomatology. Id. at 115. If the schedular rating criteria do reasonably describe the Veteran's disability level and symptomatology, the assigned schedular evaluation is adequate, referral for extraschedular consideration is not required, and the analysis stops. Id. If the RO or the Board finds that the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology, then either the RO or the Board must determine whether the Veteran's exceptional disability picture includes other related factors such as marked interference with employment and frequent periods of hospitalization. Id. at 116. If this is the case, then the RO or the Board must refer the matter to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for the third step of the analysis, determining whether justice requires assignment of an extraschedular rating. Id. VA's General Counsel has stated that consideration of an extra- schedular rating under 3.321(b)(1) is only warranted where there is evidence that the disability picture presented by the Veteran would, in that average case, produce impairment of earning capacity beyond that reflected in the rating schedule or where evidence shows that the Veteran's service-connected disability affects employability in ways not contemplated by the rating schedule. See VAOPGCPREC 6-96 (Aug. 16, 1996). In Thun, the Court further explained that the actual wages earned by a particular veteran are not considered relevant in the calculation of the average impairment of earning capacity for a disability, and contemplate that veterans receiving benefits may experience a greater or lesser impairment of earning capacity than average for their disability. The Thun Court indicated that extraschedular consideration cannot be used to undo the approximate nature of the rating system created by Congress. The Board is precluded by regulation from assigning an extraschedular rating under 38 C.F.R. § 3.321(b)(1) in the first instance. However, the Board is not precluded from raising this question, see Floyd v. Brown, 9 Vet. App. 88 (1996), and addressing referral where circumstances are presented which the Director of VA's Compensation and Pension Service might consider exceptional or unusual. Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). The Board is aware of the Veteran's complaints as to the effects of his service-connected thoracolumbar IVDS, left knee disability, bilateral foot disability, hypertension, left cheek and chest scars and tinea pedis have had on his activities of work and daily living. In the Board's opinion, all aspects of these disabilities are adequately encompassed in the assigned schedular ratings. With respect to the thoracolumbar spine, the Board has awarded compensation for the orthopedic aspects involving limitation of motion as well as the neurologic impairment involving the lower extremities. Compensation for left knee symptoms have been awarded for when objective evidence of disability was first manifested, and multiple diagnostic criteria were considered ruling out further compensation. The Veteran's functional impairment of the feet has been addressed with reference to two separate diagnostic codes, and higher schedular evaluations are available. The aspect of disability relating to hypertension is directly addressed in the schedular criteria. As to the scars, the Board finds no functional limitations related to these disorders. Finally, with respect to the tinea pedis, the extent and severity of this disorder is insufficient to warrant compensation although the schedular criteria contemplate the potential for a compensable rating. In short, the Board finds that the assigned schedular evaluations are adequate. As such, there is no basis for extraschedular referral in this case. See Thun, 22 Vet. App. 111, 114-15 (2008). Residuals of status post uvulectomy The Veteran's STRs reflect that he was referred for an otolaryngology consultation in October 1999 due to complaint of loud snoring, inability to sleep at night, and frequent awakening. He had a childhood history of nose trauma with deviated septum. A sleep study ruled out a diagnosis of sleep apnea. The Veteran subsequently underwent uvula removal which did not alleviate his problems. Notably, the uvula palatina is the small, fleshy mass hanging from soft palate above the root of the tongue, composed of the levator and tensor palati muscles and the muscle of the uvula, connective tissue, and mucous membrane. DORLAND'S ILLUSTRATED MEDICAL DICTIONARY, 1996 (30th Ed. 2003). The Board also notes that the usual effects of medical and surgical treatment in service, having the effect of ameliorating disease or other conditions incurred before enlistment, will not be considered service-connected unless the disease or injury is otherwise aggravated by service. 38 C.F.R. § 3.306(b)(1). In this case, the record shows that the Veteran underwent uvula removal as a means to alleviate a snoring disorder. There was no assessment of any disease involving the uvula. As noted by the June 2006 VA C&P examiner, this procedure was performed for symptomatic relief of snoring, and did not result in any residual disability. There is no medical opinion to the contrary. The Board acknowledges the Veteran's argument that service connection should be warranted for uvula removal. However, the provisions to 38 C.F.R. § 3.306(b)(1) do not allow a grant of service connection in this case. To the extent he argues that such procedure was not for ameliorating needs and/or worsened during service, the Board places greater weight to the assessments and opinions of the qualified medical examiners in this case. There is no doubt of material fact to be resolved in the Veteran's favor. 38 U.S.C.A. § 5107(b). As such, the claim must be denied. Hyperlipidemia and hypertriglyceridemia A disability for VA compensation purposes refers to an impairment of earning capacity due to a disease or injury, rather than to a disease or injury itself. Allen v. Brown, 7 Vet. App. 439 (1995). By definition, hyperlipidemia is a general term for elevated concentrations of any or all of the lipids in the plasma, including hypertriglyceridemia. DORLAND'S ILLUSTRATED MEDICAL DICTIONARY, p. 795 (28th ed. 1994). Hypertriglyceridemia is excessive triglycerides in the blood. Id. at p. 802. VA has determined that laboratory results are not, in and of themselves, disabilities. See Schedule for Rating Disabilities; Endocrine System Disabilities, 61 Fed. Reg. 20,440 (May 7, 1996). The Board must defer to VA's reasonable interpretation of its own laws and regulations. Chevron U.S.A., Inc., v. Natural Resources Defense Council, Inc., 467 U.S. 837, 843, 104 S.Ct. 2778, 81 L.Ed.2d. 694 (1984). A further review of the record fails to disclose any competent medical evidence that the Veteran has a current disability associated with these laboratory findings, such as symptoms, clinical findings, other manifestations, or any deficits in bodily functioning. Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in a disability. 38 U.S.C.A. § 1110. Hence, in the absence of competent persuasive evidence of disability manifested by, or associated with, the claimed findings of hyperlipidemia and hypertriglyceridemia, the record presents no predicate for a grant of service connection for any such findings. As a matter of law, these claims must be denied. A prostate disorder The Veteran has appealed a November 2006 RO rating decision which denied a claim of service connection for "an enlarged prostate." The medical records associated with the claims folder include a June 2006 private urology consultation to evaluate the Veteran's complaint of nocturia and urinary frequency. Among other things, the Veteran was diagnosed with benign prostatic hypertrophy (BPH) treated with Uroxatrol. It was further noted that the Veteran had an elevated PSA reading which returned to normal after treatment for prostatitis. Overall, the competent medical evidence demonstrates that the Veteran was first diagnosed and treated for BPH during active service. Thus, the criteria for service connection for BPH have been met. The claim, therefore, is granted. Insomnia The Veteran's STRs reflect that he was prescribed medication to treat insomnia prior to his discharge from service. As noted above, the Veteran was referred for an otolaryngology consultation in October 1999 due to complaint of loud snoring, inability to sleep at night, and frequent awakening. A sleep study ruled out a diagnosis of sleep apnea. The Veteran subsequently underwent uvula removal which did not alleviate his problems. An opinion from the June 2006 VA C&P examiner indicated that the Veteran's insomnia was a symptom rather than a diagnosis, explaining that the Veteran demonstrated no evidence of sleep apnea and that he denied mental health issues. See generally 38 C.F.R. § 4.130 (including chronic sleep impairment as part of the criteria for rating a mental disorder). Postservice, the Veteran's private clinical records document him having a "sleep disorder." VA clinical records reflect "insomnia" in the problem list. No cause for this sleep impairment is provided. The Board notes that VA does not generally grant service connection for symptoms alone, without an identified basis for those symptoms. For example, "pain alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted." Sanchez-Benitez v. West, 13 Vet. App. 282 (1999), appeal dismissed in part, and vacated and remanded in part sub nom. Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001); Evans v. West, 12 Vet. App. 22, 31-32 (1998). The notable exception to this rule is 38 C.F.R. § 3.317, which permits, in some circumstances, service connection of signs or symptoms that are objective indications of chronic disability, even though such disability is due to undiagnosed illness. However, this is not claimed or shown in this case. Based on the foregoing, the Board finds that service connection for a disorder claimed as insomnia is not warranted in this case. The Veteran undoubtedly has sleep difficulty, but has not been diagnosed with an underlying disorder that is ratable. To the extent that the Veteran argues that he manifests a service- connectable "disability," the Board places greater probative weight to the opinion of the June 2006 VA C&P examiner who found no underlying disorder other than impaired sleep symptoms. Notably, the Veteran's current providers of treatment also offer no current disorder to account for the impaired sleep symptoms. The claim, therefore, must be denied. The Duty to Notify and the Duty to Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2010). Under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b), when VA receives a complete or substantially complete application for benefits, it will notify the claimant of the following: (1) any information and medical or lay evidence that is necessary to substantiate the claim, (2) what portion of the information and evidence VA will obtain, and (3) what portion of the information and evidence the claimant is to provide. The notification requirements are referred to as Type One, Type Two, and Type Three, respectively. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009). Also, the VCAA notice requirements apply to all five elements of a service connection claim. The five elements are: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473 (2006). With respect to the claims for involving the lumbar spine, the left knee, the left heel, the right foot, hypertension, scars and tinea pedis, the Veteran is challenging the initial evaluations assigned following grants of service connection. In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the Court held that in cases where service connection has been granted and an initial disability rating and effective date have been assigned, the typical service-connection claim has been more than substantiated, it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Id. at 490-91. Thus, because the notice that was provided before service connection was granted was legally sufficient, VA's duty to notify in this case has been satisfied. With respect to the service connection claim involving BPH, this claim has been granted in full. Thus, there is no need to discuss VCAA compliance. With respect to the claim involving service connection for status post uvulectomy, hyperlipidemia, hyperglyceridemia, and insomnia, the Veteran was not provided preadjudicatory VCAA notice. Notably, the Veteran filed his service connection claims prior to his discharge from active service, and was provided a pre- discharge VA C&P examination. Nonetheless, a post-adjudicatory RO letter dated March 2007 fully complied with the VCAA notice content and time requirements as it advised the Veteran of the types of evidence and/or information deemed necessary to substantiate his claims, the relative duties on the part of the Veteran and VA in developing his claims, and the criteria for substantiating the downstream issues of establishing a disability rating and effective date of award. Thereafter, the timing deficiency of this VCAA was cured with readjudication of the claims in the May 2007 statement of the case and December 2008 supplemental statement of the case. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). On review of the record, the Board finds that no prejudicial error has occurred pertaining to the post-adjudicatory RO notice sent to the Veteran in March 2007 as the actions taken by VA after providing the notice have essentially cured the error in the timing of notice. Additionally, the Veteran has been afforded a meaningful opportunity to participate effectively in the processing of his claims and given ample time to respond. For these reasons, it is not prejudicial to the appellant for the Board to proceed to finally decide this appeal as the timing error did not affect the essential fairness of the adjudications. VA has a duty to assist a claimant in the development of the claims. This duty includes assisting the claimant in the procurement of STRs and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). In this case, the RO has obtained the Veteran's STRs and clinical records from private and VA providers of treatment. There no outstanding requests to obtain any VA records, or any private medical records for which the Veteran has identified and authorized VA to obtain on his behalf. There is also no showing that any records exist with the Social Security Administration which would be relevant to the issue on appeal. With respect to the initial rating claims, VA provided the Veteran with a pre-discharge VA C&P examination with additional examinations performed in 2007 and 2008. The most recent VA C&P examinations performed in August 2008 (spine, skin, hypertension and joints) and November 2008 (scars and feet) provide all findings necessary to decide the claims. Notably, the VA examiner has opined that the Veteran's facial scar is difficult to see on examination and is not disfiguring. The Veteran has referred to a longer scar, but has not complained of disfiguring characteristics. On the facts of this case, the Board finds no need for unretouched photographs of the facial scar. Since these last VA examinations, the Board does not find that the lay or medical evidence suggests an increased severity of symptoms to the extent that higher schedular ratings may still be possible. Thus, there is no duty to provide further medical examination on the initial rating claims. See VAOPGCPREC 11-95 (Apr. 7, 1995). With respect to the claims of service connection for hyperlipidemia and hypertriglyceridemia, the Board notes that the medical evidence substantiates the existence of these current laboratory findings. However, no further examination or opinion is warranted as the law does not allow a grant of service connection for laboratory findings alone. With respect to the insomnia claim, a VA C&P examiner in June 2006 provided opinion that the Veteran's insomnia was not considered an actual disability but rather a symptom absent an underlying disorder. This examiner specifically ruled out the potential for an underlying mental disorder. There is no medical opinion to the contrary. As such, there is sufficient evidence to decide this claim. With respect to the uvulectomy claim, there is no lay or medical evidence in this case suggesting disease or injury to the uvula during service. Rather, the STRs showed that the uvula was removed as a potential means to alleviate the Veteran's snoring. The Board finds that, on the unique facts of this case, further medical examination or opinion is not warranted to evaluate the aspects of this ameliorating surgery. Overall, the Board finds that the evidence of record is sufficient to decide the claims on appeal, and that there is no reasonable possibility that any further assistance would aid in substantiating these claims. Significantly, neither the Veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claims. Hence, no further notice or assistance is required to fulfill VA's duty to assist him in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). ORDER The claim for an initial rating greater than 20 percent for the service-connected orthopedic manifestations of lumbar spine IVDS for the time period from November 1, 2006 to August 11, 2008 is denied. The claim for an initial rating greater than 40 percent for the service-connected orthopedic manifestations of lumbar spine IVDS for the time period since August 12, 2008 is denied. The claim for a separate 10 percent evaluation for the chronic neurologic manifestation of right lower extremity radiculopathy effective May 30, 2007 is granted, and the claim for a separate 10 percent evaluation for the chronic neurologic manifestation of left lower extremity neuritis effective August 12, 2008 is granted. The claim for an initial compensable rating for left knee disability prior to August 12, 2008 is denied. The claim for an initial rating greater than 10 percent for left knee disability since August 12, 2008 is denied. The claim for a compensable rating for service-connected left heel disability, status post plantar fasciectomy and calcaneal exostectomy, is denied. The claim for a compensable rating for service-connected right foot disability, status post exostectomy, osteotomy and plantar fascial release, is denied. The claim for an initial compensable evaluation for hypertension is denied. The claim for a compensable rating for scars of the chest and left cheek is denied. The claim for a compensable rating for tinea pedis is denied. The claim for service connection for residuals of status post uvulectomy is denied. The claim for service connection for hyperlipidemia and hypertriglyceridemia is denied. The claim for service connection for BPH is granted. The claim for service connection for a disorder claimed as insomnia is denied. ____________________________________________ JOHN J. CROWLEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs