Citation Nr: 1322885 Decision Date: 07/18/13 Archive Date: 07/24/13 DOCKET NO. 08-34 729 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for an eye disorder (residuals of eye surgery). 2. Entitlement to service connection for sinusitis. 3. Entitlement to service connection for asthma/reactive airway disease. 4. Entitlement to increases in the ratings assigned for migraine headaches (currently 0 percent prior to November 25, 2010, and 10 percent from that date). 5. Entitlement to a compensable rating for right foot plantar fasciitis, status post heel spur repair with scar. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD C. Lawson, Counsel INTRODUCTION The appellant is a Veteran who served on active duty from December 1998 to February 2008. This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2008 rating decision by the Salt Lake City, Utah Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for residuals of eye surgery; sinusitis; and asthma/reactive airways disease; and granted service connection for right foot plantar fasciitis status post heel spur repair with scar, and for migraine headaches, rated 0 percent, each, effective from February 17, 2008 (the day following the date of her discharge from active duty). A December 2012 rating decision increased the rating for migraine headaches to 10 percent, effective November 25, 2010. The Veteran has not expressed satisfaction with the rating, and the matter remains on appeal. AB v. Brown, 6 Vet. App. 35 (1993). The issue is characterized to reflect that staged ratings are assigned, and that both "stages" remain on appeal. The Veteran's claims folder is now in the jurisdiction of the Waco, Texas VARO. FINDINGS OF FACT 1. The record shows that the Veteran has dry eye syndrome as a residual of eye surgery during service. 2. The Veteran is not shown to have a chronic sinusitis disability. 3. The Veteran is reasonably shown to have asthma/reactive airways disease which had its onset in service. 4. Prior to November 25, 2010, the Veteran's migraine headaches are not shown to have been manifested by characteristic prostrating attacks averaging one in 2 months over the last several months, or by symptoms approximating such level of severity. 5. From November 25, 2010, the Veteran's migraine headaches are not shown to have been manifested by characteristic prostrating attacks occurring on an average of once a month over the last several months. 6. At no time since the award of service connection for the Veteran's right foot plantar fasciitis is such disability shown to have been manifested by symptoms or impairment that may reasonably be characterized as more severe than mild flatfoot or mild foot injury. CONCLUSIONS OF LAW 1. Service connection for dry eyes is warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 2. Service connection for sinusitis is not warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 3. Service connection for asthma, reactive airways disease is warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.380 (2012). 4. The Veteran's migraine headaches warrant "staged" ratings of 0 percent prior to November 25, 2010 and 10 percent (but no higher) from November 25, 2010. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.1, 4.7, 4.124a, Diagnostic Code (Code) 8100 (2012). 5. A compensable rating for right foot plantar fasciitis, status post heel spur repair with scar, is not warranted. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.31, 4.71a, Codes 5276, 5284 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). Regarding the claims of service connection for an eye disorder and for asthma/reactive airways disease, as those claims are being granted, there is no reason to belabor the impact of the VCAA on the matters as any notice or duty to assist omission is harmless. As to the other claims, upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and her representative of any information, and any medical or lay evidence, not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). VCAA notice requirements apply to all five elements of a service connection claim: 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/Hartman v. Nicholson, 19 Vet. App. 473, 484-86 (2006), aff'd, 483 F.3d 1311 (Fed. Cir. 2007). VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction decision on a claim. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The Veteran was advised of VA's duties to notify and assist in the development of her claims prior to their initial adjudications. A December 2007 letter explained the evidence necessary to substantiate her claims, the evidence VA was responsible for providing, and the evidence she was responsible for providing. This letter also informed the appellant of disability rating and effective date criteria. She has had ample opportunity to respond/supplement the record, and has not alleged that notice in this case was less than adequate. Regarding the claims for increase, as the rating decision on appeal granted service connection and assigned the initial ratings and effective dates for the awards, statutory notice has served its purpose, and its application is no longer necessary. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), aff'd, Hartman v. Nicholson, 483 F.3d 1311 (Fed, Cir. 2007). The September 2008 statement of the case (SOC) and a December 2008 letter properly provided notice on the downstream issues of entitlement to increased initial ratings. It is not alleged that notice in this matter has been less than adequate. The Veteran's service treatment records (STRs) and postservice treatment records have been secured. The RO arranged for VA examinations in January 2008 and November 2012. The examinations are adequate for rating purposes as they contain the information necessary to properly adjudicate the claims. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (VA must provide an examination that is adequate for rating purposes). The Board finds that the record as it stands includes adequate competent evidence to allow the Board to decide these matters, and that no further development of the evidentiary record is necessary. See generally 38 C.F.R. § 3.159(c)(4). The Veteran has not identified any pertinent evidence that remains outstanding. VA's duty to assist is met. Legal Criteria, Factual Background and Analysis At the outset, the Board notes that it has reviewed all of the evidence in the Veteran's claims file, and in "Virtual VA" (VA's electronic data storage system), with an emphasis on the evidence relevant to the matters on appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence as appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claims. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Service Connection Claims Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). A governing regulation provides, in part, that seasonal and other acute allergic manifestations subsiding on the absence or removal of the allergen are generally to be regarded as acute diseases healing without residuals. The determination as to service incurrence or aggravation must be on the whole evidentiary showing. 38 C.F.R. § 3.380. In order to establish service connection for a claimed disability, there must be evidence of a present disability; evidence of an in-service incurrence or aggravation of a disease or injury; and evidence of 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 determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). Eye Disorder The Veteran's STRs show that during service in November 2005, she underwent photorefractive keratotomy (PRK) eye surgery. On January 2008 VA examination, for residuals of eye surgery, she reported discharge, watering, blurred vision, and photophobia; she was not receiving any treatment for the complaints. After examination, the examiner indicated that for the claimed condition of residuals of eye surgery, the diagnosis was dry eyes bilaterally. The subjective factors were photophobia and mucous, and the objective factors were the examination findings. VA medical records note assessments of dry eyes in January 2009, June 2009, and September 2009. Accordingly, the record shows that the Veteran has a diagnosis of a current eye disorder (dry eye syndrome) and that the etiological factor for such disorder is surgery in service. The requirements for establishing service connection are met, and service connection for dry eye syndrome is warranted. Sinusitis Factual Background and Analysis A STR signed by the Veteran in January 1999, December 1999, September 2000, and August 2001 shows that she reported having sinus problems. In May 2002, she had tender maxillary sinuses, and an upper respiratory infection was assessed. In June 2002, her sinuses were nontender. In September 2002, she reported a history of sinus problems. In approximately 2004, she reported thick nasal congestion that was greenish brown in color; her frontal, ethmoid, and maxillary sinuses were tender. In her October 2007 report of medical history, she denied having or having had sinusitis, and on examination, her sinuses were normal. On January 2008 (during service) VA examination, sinusitis was not detected; a paranasal sinus series showed normal sinuses. Postservice, on April 2008 VA evaluation, the Veteran reported allergies/headache for the past week, with pressure in her sinuses, and an itchy throat. There was no examination reported, and no diagnosis was made. The Veteran has been seen on a number of occasions postservice, including by an otolaryngologist in October 2010; sinusitis has not been diagnosed. A threshold legal requirement for establishing service connection is that the claimed chronic disability must be shown at some point during the pendency of the claim. Here, as the Veteran filed her claim while still in service, the period includes anytime since her separation from service. While the Veteran was noted to have complaints involving the sinuses during service, these resolved, and a chronic sinus disability has not been diagnosed, either on VA examination while she was still in service, or at any time since. See 38 U.S.C.A. § 1110; also see Brammer v. Derwinski, 3 Vet. App. 223 (1992). Accordingly, she has not presented a valid claim of service connection for sinusitis. The preponderance of the evidence is against the Veteran's claim, and the appeal in this matter must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v, Derwinski, 1 Vet. App. 49 (1990). Asthma/Reactive Airways Disease A STR signed by the Veteran in January 1999, December 1999, September 2000, and August 2001 shows that she reported having asthma. In May 2000, she reported that a few weeks prior, she had an episode of wheezing, and had occasionally wheezing with exercise. No family members had asthma, but cousins did. Reactive airway disease was to be ruled out. Albuterol for wheezing, as needed, was prescribed with follow-up to be scheduled if she had more than 2 episodes a week. In June 2000, the Veteran was seen for allergy symptoms; she reported 1 episode of wheezing in the past month. She had been taking Albuterol before exercise and had improved allergy symptoms with daily Zyrtec. The assessment was possible exercise-induced reactive airway. She was to be observed for recurrent wheezing and to have follow-up if wheezing episodes recurred. In April 2001, she reported being on Zyrtec. In July 2001, she reported being on Zyrtec/Allegra. In August 2001, she reported being on Allegra. In June 2002, she indicated that the last time she used Albuterol was about a year and a half prior. She reported a productive cough for 1 month. On examination, her lungs had bilateral wheezing with crackles at the bases. A chest X-ray was within normal limits. The assessment was acute bronchitis, and Albuterol and antibiotics were prescribed. On dental treatment in October 2002, she reported taking Albuterol for asthma. On November 2002 service examination, her lungs and chest were normal. In approximately 2004, the Veteran was seen for nasal congestion and cough. The assessments/differential diagnoses were bronchitis, sinusitis, and upper respiratory infection. On March 2005 service evaluation for allergies, her lungs were clear with good air exchange and no rales, rhonchi, or wheezes. She was using Claritin. Later in March 2005, it was noted that she was allergic to grasses. The impression was, by history, seasonal allergies under good control with current medications. Continued use of medications was planned. In an October 2007 report of medical history, the Veteran reported pollen-related asthma, and that Albuterol had been prescribed. On examination at that time, her lungs and chest were found to be normal. On January 2008 VA examination, the Veteran reported having reactive airways disease diagnosed, and that it had been present since 1999. She reported shortness of breath with running, speed walking, or exercise, and that this occurred most often when she was outside in cold conditions. She stated that she had asthmatic attacks yearly, but did not require physician visits to control them. She used anti-inflammatory medication and bronchodilators by inhalation intermittently. On examination, her breath sounds were symmetric; there were no rhonchi or rales and her lung expiratory phase was within normal limits. A chest X-ray showed a right basilar atelectasis with eventration of the right hemidiagphragm. The examiner stated that for the claimed condition of asthma, reactive airways disease, a diagnosis was not possible because there was no objective evidence of reactive airways disease (on that examination). The examiner noted that a medical note dated in August 2006 mentioned asthma in the past medical history. Most likely this was exercise/cold weather reactive airways disease for which the Veteran was using Albuterol on an as needed basis. On September 2009 VA evaluation, the Veteran requested a refill of Albuterol for exercise-induced asthma, and the physician ordered that Albuterol be refilled for exercise-induced asthma. On May 2011 VA evaluation, it was noted that a prescription for Albuterol had been filled in March 2011, with the orders to take 2 puffs by mouth every 4 hours for shortness of breath. While the record leaves the question of the chronicity of the disability still somewhat open to dispute, the recurring nature of the Veteran's symptoms along with her ongoing use of medication reasonably establish that she has a chronic asthma/ reactive airways disease which had its onset in service. Such disease was first noted in service, and was noted by history on January 2008 VA examination (albeit asymptomatic at the time). The veteran has had recurring episodes of asthma/reactive airways disease diagnosed in the interim; treatment records show she has received prescriptions of medications for flare-ups and requires medication to avoid recurrences. It is reasonably shown that she has a recurrently symptomatic reactive airways disease that had its onset during her active service. Accordingly, service connection for such disease is warranted. Increased Rating Claims - General Criteria In general, disability evaluations are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity caused by a given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Where (as here) the ratings appealed are the initial ratings assigned with a grant of service connection, the entire appeal period is for consideration and separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged" ratings. See Fenderson v. West, 12 Vet. App. 119 (1999). In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. Factual Background and Analysis Migraine Headaches As noted above, the Veteran's migraine headaches are currently rated 0 percent prior to November 25, 2010 and 10 percent disabling from that date. Migraine headaches are rated under Code 8100. With very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability, a 50 percent rating is to be assigned. With characteristic prostrating attacks occurring on an average once a month over the last several months, a 30 percent rating is warranted. With characteristic prostrating attacks averaging one in two months over the last several months, a 10 percent rating is warranted. With less frequent attacks, a 0 percent rating is to be assigned. 38 C.F.R. § 4.124a. On January 2008 VA examination, the Veteran reported headaches described as radiating, dull, and aching types, on average 3 times per month, of 1 hour duration. She indicated that she was able to work when they occurred, but required medication, and was able to perform daily functions during flare-ups. The current treatment was with Excedrin Migraine. On examination, her head and cranial nerves were within normal limits. The diagnosis was migraines. On November 2008 VA evaluation, the Veteran complained of headache for 3 days; on examination, there was no tenderness. The assessment was strep throat. On January 2009 VA evaluation, the Veteran complained of migraine attacks getting worse, with 3 attacks in the last 1 month. The first attack was controlled by Pepsi, but the last 2 were uncontrollable and she was vomiting. She took extra Elavil, but they did not help. She was studying nursing. Zomig for migraines was prescribed as needed. On June 2009 VA evaluation, the Veteran indicated that Zomig had helped her migraines and worked well, but that she continued to have different headaches after not being able to sleep for more than 24 hours. On April 2010 VA evaluation, the Veteran reported that propranolol was very helpful for her headaches; her headaches had been cut down from 2-3 a week to 1-3 a month, and she was happy and satisfied. A CT scan of her head was normal. The assessment was migraine without aura. On August 2010 VA evaluation, the Veteran reported 3 headaches a month, usually relieved by Imitrex. The assessment migraine without aura, partially improved. On November 25, 2010 VA emergency room evaluation, the Veteran reported that a headache started 2 days prior, and that it was typical of her migraines but worse this time. She felt dizzy and had taken medication with no relief. Thorazine and Zomig were given. One-half hour later, the headache was improved, but not completely gone. After another 1.5 hours, she was much better; the headache was mostly resolved. She was sleeping and easily arousable. Forty-five minutes later she felt well and ready to go home. Her pain level at discharge was 0. On early November 2012 VA headaches examination, the Veteran indicated that currently, she was having around 4 headaches per month, typically with sharp pain over the left side of the face, as well as pulsating or throbbing head pain, and with nausea, photophobia, and phonophobia. She denied vomiting. She was taking medication for migraines as needed. Typically, head pain was for less than 1 day. On average, she had had 1 prostrating attack in 2 months, and did not have very frequent prostrating and prolonged attacks of migraine headache pain. Addressing each "stage" of the rating for the Veteran's headaches in turn, the Board notes that to warrant a compensable (10 percent) rating prior to November 25, 2010 the evidence must show that during that time the headaches presented a disability picture consistent with characteristic prostrating attacks occurring once in 2 months over the last several months. Prior to November 25, 2010, the Veteran's headaches were not shown to be manifested by characteristic prostrating attacks occurring once in 2 months over the last several months. In fact, prostrating attacks were not shown at all prior to her November 25, 2010 emergency room visit. In January 2008, she reported headaches averaging 3 times per month. However, they were not prostrating and were generally brief, and she could go to work and perform daily functions. In January 2009, there was vomiting, but the headaches were not reported to be prostrating. Zomig was prescribed; and in June 2009, she reported that Zomig worked well. In April and August 2010, there was no indication that her headaches were prostrating (and she was reported to be happy and satisfied in April 2010). Consequently, a compensable rating for the headaches was not warranted prior to November 25, 2010. At no time since November 25, 2010 are the Veteran's headaches shown to have been manifested by prostrating attacks occurring on an average of once a month over the last several months (the criteria for the next higher, 30 percent, rating). One such headache has been noted during that time. In fact, on November 2012 VA examination, the Veteran herself reported she was experiencing prostrating headaches at a frequency of one in 2 months. Accordingly, the Board finds that a schedular rating in excess of 10 percent is not warranted at any time since November 25, 2010. Right Foot Disability There is no specific Code for right foot plantar fasciitis. It may be rated (by analogy) under 38 C.F.R. § 4.71a, Code 5276 (for flatfoot) or 5284 (as other foot injury). Under Code 5276, for acquired flatfoot which is mild, with symptoms relieved by built-up shoe or arch support, a 0 percent rating is warranted. When it is moderate; with weight-bearing line over or medial to great toe, inward bowing of the tendo Achilles, pain on manipulation and use of the feet, bilateral or unilateral, a 10 percent rating is warranted. When it is severe; with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities, a 20 percent rating is warranted when it is unilateral. Under Code 5284, for other foot injuries, a 10 percent rating is warranted for moderate foot injuries, and a 20 percent rating is warranted for moderately severe foot injuries. When evaluating musculoskeletal disabilities, VA may, in addition to applying schedular criteria, consider granting a higher rating in cases in which functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). The Board notes that the criteria for rating skin disability were revised, effective October 23, 2008. 73 Fed. Reg. 54,708 (Sept. 23, 2008). The announcement of the final regulation specifically states that the new criteria apply "to all applications for benefits received by VA on or after October 23, 2008", but that a Veteran rated under the criteria in effect prior to that date may request review under the revised criteria. The instant claim for increase was received prior to October 23, 2008. Neither the Veteran nor her representative has requested review under the revised criteria; therefore, those criteria are not for consideration. Under the criteria in effect prior to October 23, 2008, scars other than on the head, face, or neck, are rated under 38 C.F.R. § 4.118, Codes 7801-7805. On January 2008 VA examination, the Veteran reported having constant right arch and heel pain that was localized, aching, and sharp and dull at the heel. It was a 3 on a scale from 1-10, with 10 being the worst. It could be elicited by physical activity and was relieved with medication. She could function with the pain without medication. The current treatment was with inserts. On examination, the Veteran's posture and gait were normal and examination of her feet did not reveal any signs of abnormal weight-bearing. Examination of the right foot found no painful motion, edema, weakness, or muscular atrophy. There was active motion in the metatarsophalangeal joint of the right great toe, and her gait was within normal limits. There was no pes planus and the Veteran did not have any limitation with standing and walking. She reported that the symptoms and pain were not relieved by corrective shoes. Gross examination of all other joints and muscles was within normal limits. A July 2009 VA evaluation was negative for muscle pain and weakness, joint aches, joint swelling, and joint stiffness. On November 2012 VA scars examination, it was noted that the Veteran had a surgical scar status post heel spur repair. Examination found a 0.8 cm linear scar on her right medial mid-heel. She denied pain or any other concerns regarding the scar on the right foot, and no pain or other problems were found with the scar. Concerning the foot, the Veteran indicated that she was currently having an aching, nagging, and chronic pain over her right heel and arch, and that it was worse in the morning and after initially rising from prolonged inactivity. She reported that she had to sit and rest after prolonged standing greater than 2 hours, and that she was a nurse and did a lot of standing. She wore custom shoe orthotics and Z-coil shoes which were especially made for plantar fasciitis. She reported taking Excedrin, Aleve, or Advil as needed for foot pain. She did not have metatarsalgia. Imaging studies revealed mild hallux valgus deformity with probable minimal 1st metatarsophalangeal joint degenerative arthritis. There were no other significant diagnostic test findings. The examiner indicated that the Veteran's foot condition had no impact on her ability to work. Considering the criteria under Code 5276 (for flatfoot), the Veteran's right foot disorder may not reasonably be characterized as more than mild, even with 38 C.F.R. §§ 4.40, 4.45 criteria considered. In January 2008, examination of the right foot found no painful motion, weakness, or muscular atrophy. There were no limitations on standing or walking. The July 2009 VA evaluation was negative for muscle pain and weakness, and for joint aches and stiffness. The November 2012 VA examiner found no metatarsalgia, and indicated that the foot condition had no impact on the Veteran's ability to work. Consequently, disability consistent with more than mild flatfoot is not shown, and a compensable rating under these criteria is not warranted. Regarding the criteria in Code 5284 (for other foot disability), symptoms characteristic of more than a mild foot injury are not shown at any time during the evaluation period, including with consideration of 38 C.F.R. §§ 4.40, 4.45. The examination findings and treatment reports note a normal gait and no indication of any abnormal weight-bearing of the foot; and in November 2012, the Veteran indicated that she could stand up to 2 hours and did a lot of standing in her work. The examiner opined that the Veteran's foot disability had no impact on the Veteran's ability to work. While such findings reasonably reflect mild foot injury, the symptoms and associated impairment may not reasonably be considered reflective of moderate foot injury, and a compensable rating is not warranted. See 38 C.F.R. § 4.31. Rating the Veteran's right heel scar under either Code 7801 or 7802 would be inappropriate as the scar is not deep (associated with underlying tissue damage) and does not cause limitation of motion; nor does it involve an area of 144 square inches or more. Hence, these Codes will not be addressed further. See 38 C.F.R. § 4.118 (as in effect prior to October 23, 2009). Providing a compensable rating under Code 7803 would be inappropriate as the Veteran's scar is not unstable according to the Veteran on November 2012examination. Likewise, a compensable rating under Code 7804 would be inappropriate as the disability has not been noted to be painful, including on November 2012 examination. Additionally, rating the scar under Code 7805 (based on limitation of motion of the affected part) is inappropriate as no limitation of function due to the scar is shown. Instead, on November 2012 VA examination, the Veteran had no concerns, and no associated impairment was found. Accordingly, a compensable rating under Codes 7801, 7802, 7803, 7804, or 7805 is not warranted at any time during the rating period. The Board has considered whether referral of either the rating for migraine headaches or right foot plantar fasciitis with scar for extraschedular consideration is warranted. There is no evidence in the record or allegation of symptoms of and/or impairment due to migraine headaches or the right foot disorder not encompassed by the criteria for the schedular ratings assigned. Therefore, those criteria are not inadequate, and referral for extraschedular consideration is not warranted. 38 C.F.R. § 3.321(b); Thun v. Peake, 22 Vet. App. 111 (2008). Finally, as the Veteran either studied nursing or was a nurse throughout the course of the claim, the matter of entitlement to a total rating based on individual unemployability is not raised by the record. See Rice v. Shinseki, 22 Vet. App. 447 (2009). ORDER Service connection for dry eyes and for asthma/reactive airways disease is granted. Service connection for sinusitis is denied. A compensable rating for migraine headaches prior to November 24, 2010 and a rating in excess of 10 percent for migraine headaches from that date are denied. A compensable rating for right foot plantar fasciitis (status post heel spur repair) with scar, is denied. ______________________________________________ George R. Senyk Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs