Citation Nr: 1323567 Decision Date: 07/24/13 Archive Date: 08/01/13 DOCKET NO. 95-41 397 ) DATE ) ) Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for a cervical, thoracic, and lumbar spine disorder. 2. Entitlement to service connection for headaches. 3. Entitlement to service connection for disability exhibited by urinary frequency. 4. Entitlement to compensation pursuant to 38 U.S.C.A. § 1151 for a cervical, thoracic, and lumbar spine disorder with headaches and urinary frequency. 5. Entitlement to a disability rating higher than 10 percent for sinusitis. REPRESENTATION Appellant represented by: Matthew D. Hill, Attorney at Law WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD C. Fleming, Counsel INTRODUCTION The Veteran had active military service from June 1966 to January 1970. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued in May 1995 and October 1995 that, in pertinent part, denied the Veteran's claims for service connection, as well as his claim for an increased disability rating for his service-connected sinusitis. In addition, in rating decisions dated in May 1997 and April 1998, the RO denied the Veteran's claim for compensation pursuant to 38 U.S.C.A. § 1151 for a cervical, thoracic, and lumbar spine disorder with headaches and urinary frequency. The Board denied the Veteran's appeal in a March 2004 decision. The Veteran appealed the Board's 2004 decision to the United States Court of Appeals for Veterans Claims (Court). In a September 2007 memorandum decision, the Court vacated the Board's decision and remanded the claims for re-adjudication. The Board subsequently remanded the case, most recently in June 2010, for further notification, evidentiary development, and adjudication. The agency of original jurisdiction (AOJ) sent the Veteran the required notice via a September 2010 letter and scheduled him for a VA examination, which was conducted in November 2009. In addition, the AOJ has obtained medical opinions from both VA and outside medical experts. The Veteran was then provided a supplemental statement of the case (SSOC), most recently in March 2010, in which the AOJ again denied the Veteran's claims. Thus, there has been compliance with the Board's remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (noting that where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance). The Board acknowledges that following certification of the appeal by the RO to the Board in November 2010, the Veteran has submitted additional evidence concerning his claims. The Board notes that the Veteran has, on multiple occasions, waived initial RO consideration of this evidence in writing. See 38 C.F.R. § 20.1304 (2012). Thus, the Board will proceed to a decision and will consider this evidence in the first instance. The Veteran testified before a Decision Review Officer (DRO) at a hearing at the RO in May 1997. A transcript of the hearing has been associated with the Veteran's claims file. In September 2011, the Veteran was notified of the time and place of a Board hearing he had requested. See 38 C.F.R. § 20.704(b) (2012). However, he withdrew his hearing request in writing via an October 2011 statement to VA. Accordingly, the Board finds that the Veteran's request for hearing has been withdrawn. 38 C.F.R. § 20.704(d) (2012). FINDINGS OF FACT 1. A cervical, thoracic, and lumbar spine disorder did not have its clinical onset in service and is not otherwise related to active duty; arthritis of the spine was not exhibited within the first post-service year. 2. A headache disorder did not have its clinical onset in service and is not otherwise related to active duty. 3. Disability exhibited by urinary frequency did not have its clinical onset in service and is not otherwise related to active duty. 4. The preponderance of the evidence is against a finding that the Veteran incurred additional disability in the form of a cervical, thoracic, and lumbar spine disorder with headaches and urinary frequency as a result of injury or aggravation of injury suffered during right inguinal hernia surgery performed a VA medical facility in December 1994. 5. The Veteran's service-connected sinusitis is manifested by subjective complaints including constant nasal discharge and headaches; chronic congestion, sinus pressure and tenderness; and post-nasal drip with sore throat; objective findings of clear nasal discharge and occasional mild nasal congestion with swollen and inflamed mucosa and sinus tenderness; and radiographic evidence consistent with chronic sinusitis. There is no objective confirmation of purulent discharge or associated crusting, no evidence of frequent incapacitating episodes of sinusitis, and at most one documented instance per year in which antibiotics have been prescribed. CONCLUSIONS OF LAW 1. A cervical, thoracic, and lumbar spine disorder was not incurred or aggravated in service, and arthritis of the spine may not be presumed to have been incurred therein. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2012). 2. A headache disorder was not incurred or aggravated in service, and headaches may not be presumed to have been incurred therein. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303 (2012). 3. Disability exhibited by urinary frequency was not incurred or aggravated in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303 (2012). 4. Entitlement to compensation pursuant to 38 U.S.C.A. § 1151 for a cervical, thoracic, and lumbar spine disorder with headaches and urinary frequency is not established. 38 U.S.C.A. § 1151 (West 1991); 38 C.F.R. § 3.358 (1994). 5. The criteria for a disability rating greater than 10 percent for sinusitis have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.321, 4.97, Diagnostic Code 6513 (2012); 38 C.F.R. § 4.97, Diagnostic Code 6513 (1996). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Under the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107 and 5126; see also 38 C.F.R. §§ 3.102, 3.156(a), and 3.326(a), VA has a duty to notify the claimant of any information and evidence needed to substantiate and complete a claim, and of what part of that evidence is to be provided by the claimant and what part VA will attempt to obtain for the claimant. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The United States Court of Appeals for Veteran Claims' (Court's) decision in Pelegrini v. Principi, 17 Vet. App. 412 (2004), held, in part, that a VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits. This decision has since been replaced by Pelegrini v. Principi, 18 Vet. App. 112 (2004), in which the Court continued to recognize that typically a VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits. In this case, VA satisfied its duties to the Veteran in VCAA letters issued in November 2003, November 2008, and September 2010. The VCAA letters notified the Veteran of what information and evidence is needed to substantiate his claims of service connection and his claim for increase, as well as his claim for compensation under 38 U.S.C.A. § 1151, and informed him of what information and evidence must be submitted by the claimant and what information and evidence will be obtained by VA. In addition, the November 2008 and September 2010 letters notified the Veteran of the types of evidence necessary to establish a disability rating and effective date. Id.; but see VA O.G.C. Prec. Op. No. 1-2004 (Feb. 24, 2004); see also Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In particular regard to the Veteran's claim for compensation under 38 U.S.C.A. § 1151, the September 2010 VCAA letter provided the Veteran with specific information concerning the establishment of entitlement to compensation under 38 U.S.C.A. § 1151 for claims filed prior to October 1997. The Veteran has received all essential notice, has had a meaningful opportunity to participate in the development of his claims, and is not prejudiced by any technical notice deficiency along the way. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). In any event, the Veteran has not alleged any prejudice with regard to the content of any notice provided to him following the Court's September 2007 memorandum decision. See Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (reversing prior case law imposing a presumption of prejudice on any notice deficiency, and clarifying that the burden of showing that an error is harmful, or prejudicial, normally falls upon the party attacking the agency's determination.) See also Mayfield v. Nicholson, 444 F.3d 1328, 1333-34 (Fed. Cir. 2006). The Board also finds that VA has complied with all assistance provisions of VCAA, to include compliance with the Court's September 2007 memorandum decision. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). The evidence of record contains the Veteran's service treatment records and lay statements of the Veteran, as well as post-service treatment from both private and VA treatment providers. The evidence of record further contains examination requested by VA performed in February 1995, February 1997, June 1998, November 2002, and November 2009. The Board finds that these VA examination reports, as well as the VHA opinion obtained in August 2012 and the outside medical expert opinion obtained in February 2013, together are thorough and contain sufficient information to decide the issues on appeal. McLendon v. Nicholson, 20 Vet. App. 79 (2006). For all the foregoing reasons, the Board concludes that VA's duties to the Veteran have been fulfilled with respect to the issues on appeal. Criteria & Analysis Relevant medical evidence consists of the Veteran's service treatment records as well as records of his post-service treatment with both VA treatment providers. In addition, the Veteran underwent VA examinations in February 1995, February 1997, June 1998, November 2002, and November 2009. Review of the Veteran's service treatment records reflects that he was treated on one occasion, in January 1967, for what was diagnosed as a "back bruise" he incurred when he was struck in the back with a handball. No follow-up treatment was obtained, and at the Veteran's separation medical examination in December 1969, he was found to have no abnormalities of the spine and no abnormalities of the neurologic, genitourinary, or musculoskeletal system. The Veteran has contended that he injured his back in an incident during service in which he lifted a child over an examination table, twisting his spine. No treatment records for any such injury are present in the claims file; however, the Veteran has submitted a letter from the physician who was present at the time, who attests to the occurrence of the incident and specifically noted it as having occurred in "the spring of 1968." The Veteran has stated that he was too busy following the incident to seek treatment but claims that he has experienced back pain from that time. However, records indicate that the Veteran sustained multiple inservice sports-related injuries following the claimed in-service back injury, including both an August 1968 right ankle sprain and a right knee injury in October 1969, which both occurred while the Veteran was playing football. The post-service medical records do not contain any mention of a back disability until October 1994, when an addendum to VA records pertaining to treatment of the sinuses shows that the Veteran was complaining of sharp pain in the lumbar spine. The record indicates that the Veteran claimed the pain had been occurring for the past four years, and had been continuous for the past three years. He filed a claim of service connection for a back disorder in October 1994. At a December 1994 treatment visit, the Veteran reported a "long history of low back pain" that he said began following the in-service incident. He was diagnosed with spondylosis of the lumbar spine. Radiological evaluation at the time noted intervertebral narrowing at T12-L1, an un-unified lamina at L5, and spina bifida occulta at S1. The Veteran underwent surgery for a right inguinal hernia repair at a VA facility in December 1994. While in the post-operative recovery room he suffered muscle spasms in his back, inducing "screaming" and "thrashing," and was treated with multiple doses of Valium. Treatment notes from the post-operative nursing assessment confirm that he complained of low back pain and spasm. Additional records from December 1994 through February 1995 show that the Veteran continued to complain of post-operative pain, including severe back pain. He underwent a second corrective surgery in January 1995 for reasons that do not appear to have been related to his back. Since December 1994, the Veteran has received more or less continuous treatment for his back complaints. To that end, an April 1995 treatment note documented tenderness over the spine and paravertebral muscles and found minimal degenerative joint disease an and L5 laminar defect. The physician assigned a diagnosis of back strain, a diagnosis that was repeated on multiple subsequent treatment visits. At an additional April 1995 visit, the Veteran was diagnosed with mechanical low back pain, which he again reported began in service and had worsened following the 1994 surgery. At an appointment later in April 1995, he was diagnosed with chronic back strain. At a follow-up visit in May 1995, the Veteran was diagnosed with "fibrositis/myofascial pain syndrome." Later, in August 2000 and again in February 2001, the Veteran was assigned a diagnosis of chronic back pain and myofibrositis, which his physician noted was demonstrated in a 1997 CT examination. Radiological evaluation conducted in July 2002 shows minimal to moderate multilevel spondylosis and minimal degenerative joint disease. The Veteran has also sought treatment on multiple occasions for complaints of headaches and sinusitis, and has been noted on multiple occasions to have chronic sinusitis. He complained in May 1995 of sinus headaches and congestion and again was noted to have sinusitis in August 1996, at which time he also complained of headache; however, his treatment provider found his headache to be migraine in nature at that time. He was treated again for sinusitis in February 1998 and May 1999, at which time he was prescribed antibiotics. In addition, the Veteran complained of urinary frequency at a February 2002 treatment visit, although no diagnosis was assigned at that time. The Veteran underwent a VA examination of his sinuses in February 1997. At that time, he complained of constant drainage and headaches, but no discharge or post-nasal drip was noted on examination, although he was noted to be congested. He was diagnosed with rhinitis. At a second VA examination of his sinuses in November 2002, the Veteran again complained of constant post-nasal drip as well as headaches that he related to his sinus problems. The examiner noted that the Veteran's sinusitis has not caused any incapacitating episodes and opined that the Veteran's headaches are not likely related either to sinusitis or to his service, although he failed to offer a rationale for this opinion. CT examination conducted at the time found no active sinus disease. The Veteran also underwent genitourinary examination in February 1997, at which time he again complained of urinary frequency. Upon physical examination, the VA examiner found the urinary frequency to be due not to service but to prostate enlargement. He specifically found there to be no objective findings to explain the Veteran's complaints of frequent urination; physical examination and urethrogram were both negative. A second genitourinary examination was performed in June 1998, at which time he complained of urinary frequency; however, no diagnosis was assigned at the time. The Veteran again underwent VA genitourinary examination in November 2002; at that time, he complained of urinary frequency only since 1994 and reported that he drank two to three liters of fluid per day. The examiner also opined that the Veteran's complained-of urinary frequency was due to prostate enlargement, not to service or any incident therein. The Veteran was given a VA examination concerning his headaches in November 2009. He complained of experiencing sinus headaches beginning on active duty and of a second kind of headaches that began in 1994 and that were related, the Veteran speculated, to his back pain. The examiner noted the Veteran's ongoing treatment for chronic sinusitis and acknowledged that he experienced headaches weekly. He assigned diagnoses of chronic sinus headache and cervical tension headaches. The examiner associated the Veteran's sinus headaches with his service-connected sinusitis but opined that the cervical tension headaches are not likely related to service. In so finding, the examiner pointed to the fact that the headaches had not begun, by the Veteran's own admission, until more than twenty years after his separation from active duty. Thus, the examiner concluded, any relationship between his cervical tension headaches and service was doubtful. The Veteran also underwent a VA examination of his spine in February 1997. At that time, the examiner noted his complaints of having first injured his spine in service, when lifting a child onto an examination table, and having intermittent back pain since then. The examiner found mild paravertebral muscle spasm of the lumbar spine and noted that he had limited and painful motion, with most of the discomfort in rotation. Radiological evaluation of the spine in March 1997 revealed probable chronic cervical myofibrositis, mild hypertrophic spurring at T10-T12 with anterior ligamental calcification, mild hypertrophic spurring at L1-L5, and spondylolysis of L5. The examiner diagnosed the Veteran with hypertrophic spurring of the lumbar spine. No etiological opinion was provided. Neurological examination found no significant neurological disability. The Veteran again underwent VA examination in November 2002, which included a record review. After noting the Veteran's injury in service and his problems following the 1994 surgery, the examiner opined that the Veteran likely suffered lumbar strains on those occasions. He added that the Veteran now had degenerative spondylosis in his cervical, thoracic, and lumbar spine that was unrelated to any history of trauma and was a normal by-product of aging. He further opined that the Veteran's cervical, thoracic, and lumbar spine conditions were not likely related to his active military service, or to any VA medical treatment, hospitalizations, surgery, or examinations. In contrast, a September 2011 record review by a private orthopedic surgeon included a detailed description of the Veteran's medical history from October 1994 to the present, as well as noting the 2006 statement supporting the incurrence of the in-service injury. This doctor diagnosed the Veteran with chronic thoracolumbar mechanical back syndrome (myofasciitis) and opined that his ongoing spine symptoms were due only to the myofasciitis of the soft tissues supporting his thoracolumbar spine region, and were not in any way due to his congenital spinal bifida. Although the examiner did not explicitly relate the current disability to the injury in service, he included an extensive discussion regarding how such an injury to soft tissue can result in symptoms for many years and can predispose one to additional injury. He also submitted a journal article concerning "mechanical low back pain" to support his thesis. The doctor did opine that it was as likely as not that the December 1994 recovery room injury was a significant aggravation of the Veteran's previous back symptoms. The examiner concluded that the Veteran currently experiences mechanical back syndrome, or myofasciitis, due to injuries to the soft tissues surrounding his spine both in 1968 and 1994. Following the submission of the September 2011 opinion, VA obtained a VHA medical opinion in August 2012. At that time, a VA neurosurgeon reviewed the Veteran's extensive claims file, including the September 2011 opinion, and concluded that the Veteran's current back problems are a byproduct of the aging process and unrelated to any in-service or post-surgical injury. In so finding, the examiner acknowledged the in-service incident but pointed out that afterward the Veteran continued to play sports, work multiple jobs, and engage in manual labor on his house. The examiner thus found no evidence of a chronic spinal injury following the in-service incident or the 1994 surgery. Rather, the examiner concluded that there was "no evidence of any acute injury of the cervical, thoracic, or lumbar spine sustained as a result of the surgeries." However, the examiner did not discuss the diagnoses of myofasciitis, myofibrositis, and mechanical back syndrome assigned to the Veteran by both the private physician in September 2011 and his VA treatment providers in May 1995, August 2000, and February 2001. Upon receipt of the VHA opinion, the Veteran obtained a second opinion from the physician who issued the September 2011 opinion. In the addendum, issued in October 2012, the physician reiterated his opinion that the Veteran's back was injured during the 1994 surgery and that his current diagnosis of mechanical low back syndrome is related to that injury, not to degenerative changes associated with the aging process. In so finding, the physician again pointed to the April 1995 VA diagnosis of mechanical low back syndrome and noted that the degenerative changes found in the Veteran's X-rays have been noted to be mild. Pursuant to the Board's January 2013 request, VA obtained an independent medical expert (IME) opinion in February 2013 from an orthopedic surgeon, who also opined that the Veteran's current back disability is not related to service or to his December 1994 surgery. In so finding, the examiner extensively reviewed the Veteran's claims file and medical history, including the in-service incident with the examination table and the December 1994 surgery, and assigned a diagnosis of mild to moderate spondylosis of the cervical, thoracic, and lumbar spine with chronic back pain. In finding that the disorder is not etiologically linked to the Veteran's service, including to the conceded 1968 incident, the examiner reasoned that, notwithstanding the article submitted by the private examiner in September 2011, there is "no definitive medical literature" that establishes a known etiological relationship between soft-tissue injuries such as that likely experienced by the Veteran in service and chronic pain lasting 30-plus years. The examiner also pointed out that the level of degenerative change displayed on radiological evaluation does not necessarily correlate with the level of pain such changes cause, so that individuals with mild degenerative changes may have severe pain, and vice versa. The examiner specifically opined that the Veteran does not have any chronic back disorder related to service, including the 1968 incident, and found that his current back problems are "more likely than not ... due to the natural aging or degenerative processes." The examiner further found that the 1994 surgery incident in which the Veteran woke up "traumatically" from hernia surgery, caused, at most, aggravation of his pre-existing spondylosis of no more than a "short term duration of perhaps a few days." In so finding, the examiner noted that the Veteran had not incurred any serious injury, such as falling out of bed or sustaining a fracture, that would lead to a long-term exacerbation of his pre-existing, age-related spine disorder. Finally, the examiner opined that the Veteran's diagnoses of fibrositis, myofascial pain syndrome, and mechanical back pain syndrome were inaccurate, given that "[n]one of them are specific diagnoses" but rather are merely an attempt to explain muscle pain. The examiner found, rather, that the proper objective diagnosis for the Veteran's complaints was spondylosis, which he again reasoned is related to not to service or to the 1994 surgery but simply to the aging process. In finding that current disorder is not related to service, the examiner pointed particularly to the normal December 1969 separation examination. In finding that any current disorder is not related to the December 1994 surgery, the examiner again noted that there is no consensus in current medical knowledge-the single article submitted by the September 2011 private physician notwithstanding-to establish a link between an acute soft-tissue injury and "long-term soft tissue dysfunction." In response to the February 2013 opinion, the Veteran again obtained an opinion in April 2013 from the private physician who submitted the earlier opinions in September 2011 and October 2012. In the April 2013 opinion, the physician agreed with the February 2013 IME physician's diagnosis of spondylosis of the spine with chronic low back pain. However, the physician again opined that the Veteran's spine disorder is etiologically linked both to service and to the December 1994 surgery. In so finding, the physician first opined that he "place[s] very little value" on the findings of the December 1969 separation medical examination because he believed that "most of the time the exit exams are extremely cursory." He also noted that the Veteran had told him that his spine was not evaluated at the December 1969 examination and that his in-service football injuries occurred in 1967, prior to the in-service back incident. The examiner further pointed out that the Veteran had only "mild" degenerative changes to radiological evaluation in 1995, which he opined argued against a finding that his symptoms, which appear to be severe, are related only to those degenerative changes. In opining that his current problems are linked to the December 1994 surgery, the physician pointed out that the Veteran's complaints of back problems escalated following the surgery. He also stated that it is possible for a chronic soft tissue injury to occur without a co-occurring bone injury, reasoning that such often happens in motor vehicle accidents. Finally, the physician again pointed to the journal article he submitted in September 2011 in arguing that medical literature supports a finding that a soft tissue injury can have long-term effects such as pain. He concluded that "it is at least as likely as not that the 1994 soft tissue incident was the chief antagonist regarding the veteran's chronic low back pain." The Veteran testified before a Decision Review Officer at a hearing in May 1997. At that hearing, the Veteran stated that his back had given him problems since service but that those problems escalated following the December 1994 surgery. The Board further notes that the Veteran has made identical claims in multiple submissions to VA and has submitted statements from two friends, dated in 2006, who attest that the Veteran "appeared to be very severely injured" following the December 1994 surgery. A. Claims for Service Connection The Veteran contends, in part, that he currently experiences a cervical, thoracic, and lumbar spine disorder that is directly etiologically linked to his time in service. He further claims that he has disorders manifested by headaches and urinary frequency that are directly related to his time on active duty. Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in the line of duty or for aggravation of a pre-existing injury or disease in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). If arthritis becomes manifest to a degree of 10 percent or more during the one-year period following a Veteran's separation from active service, the condition may be presumed to have been incurred in service, notwithstanding that there is no in-service record of the disorder. 38 U.S.C.A. §§ 1101, 1112 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.307, 3.309 (2012). Upon consideration of the above evidence, the Board finds that the preponderance of the evidence is against the Veteran's claim of service connection for a cervical, thoracic, and lumbar spine disorder. In that connection, VA, VHA, and IME examinations, as well as private opinion, confirm that the Veteran currently suffers from spondylosis and chronic low back pain. The Board concludes, however, that the greater weight of the evidence is against the claim. Here, even conceding the Veteran's June 1962 in-service diagnosis of muscle strain, the November 2002 VA examiner and the February 2013 IME opinion found no link between any current disability and military service. In particular, the February 2013 IME examiner specifically considered the Veteran's contentions as to the in-service injury and continuity of symptomatology and still found there to be no evidence that his in-service muscle strain caused anything more than temporary back pain that resolved without residuals and did not lead to any permanent back problems. Additionally, there is no medical evidence suggesting that degenerative joint disease of the spine became manifest to a compensable degree within a year of the Veteran's separation from military service. 38 C.F.R. §§ 3.307, 3.309. Noting that the Veteran's separation examination documented a normal spine and musculoskeletal system, the February 2013 IME examiner gave as his expert medical opinion that it was not at least as likely as not that any current back disorder was related to the Veteran's military service. In so concluding, the examiner considered the Veteran's contention that he has continually experienced back pain from his time in service to the present. However, the examiner pointed to the December 1969 normal separation examination in finding that any such continuity of symptomatology was doubtful. Furthermore, the Board finds that the preponderance of the medical evidence does not support a finding of a nexus between the Veteran's service and his current spondylosis of the cervical, thoracic, and lumbar spine. In that connection, the Board notes that the medical opinion submitted by the February 2013 IME examiner acknowledged the Veteran's in-service muscle strain and his complaints of having first experienced back pain in service but nonetheless concluded that it was less likely than not that his current cervical, thoracic, and lumbar spondylosis was in fact due to service. In so finding, the February 2013 IME examiner pointed to the findings of degenerative changes in the Veteran's spine and found that his current spondylosis is related not to service but to his advancing age. Similarly, the examiner found the Veteran's current back strain not to be service-related, pointing to the lack of any consensus medical knowledge relating acute soft-tissue injuries such as the Veteran's likely in-service lumbar strain and his current spondylosis. Absent a persuasive medical opinion relating the Veteran's current back disability to military service, his claim for service connection for a cervical, thoracic, and lumbar spine disorder must be denied. As noted above, the Board acknowledges that the Veteran has reported that he first experienced back problems in service and has experienced similar symptoms from that time to the present. The Veteran is competent to provide testimony concerning factual matters of which he has first-hand knowledge (i.e., experiencing symptoms either in service or after service). See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). However, he is not competent to say that any such symptoms experienced in service were a result of or worsened by any incident in service or were of a chronic nature to which a specific current disability can be attributed. Indeed, competent medical authority has specifically indicated that current diagnoses of spondylosis and chronic back pain are not related to symptoms the Veteran had in service. Opinions in the file from a private treatment provider purport to offer a link between the Veteran's current back disability and service. However, an evaluation of the probative value of medical opinion evidence is based on the medical expert's knowledge and skill in analyzing the data, and the medical conclusion reached. The weight to be attached to such opinions is within the province of the Board. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Greater weight may be placed on one physician's opinion over another depending on factors such as reasoning employed by the physicians and whether or not, and the extent to which, they considered prior clinical records and other evidence. Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994). The probative value of a medical opinion is generally based on the scope of the examination or review, as well as the relative merits of the expert's qualifications and analytical findings, and the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion. See Sklar v. Brown, 5 Vet. App. 140 (1993). For the reasons set forth herein, the Board is satisfied that the February 2013 IME examiner's opinion is adequate for deciding this appeal and is of greater weight than the opinions offered by the private physician in September 2009, October 2012, and April 2013. In so finding, the Board notes that the private physician relied extensively on the Veteran's reported history-a history that, as discussed below, is inconsistent with other evidence and history. Thus, the Board finds that the private opinions fail to take into account the circumstances of the Veteran's in-service complaints. The strongest evidence in favor of the Veteran's claim are the September 2011, October 2012, and April 2013 private opinions, but they are unsupported by a rationale that fully takes the record into account. This evidence is outweighed by the medical evidence from the IME examiner's well-reasoned opinion, based on both the Veteran's reported history and the medical records, that the Veteran's currently diagnosed back disability is not linked to service. Further, the Board notes that the private opinions rely heavily on the examiner's citation to a journal article concerning long-term effects of soft tissue injury. However, the February 2013 IME examiner clearly considered this journal article in his report, pointing out that the single article does not amount to a consensus of medical knowledge concerning any such relationship. In light of the well-reasoned opinion offered by the IME examiner in February 2013, which relied on consideration of the Veteran's entire medical history as well as a thorough explanation of the state of current medical knowledge, the Board finds the statements reflecting a possible link to be of less probative value. See Gabrielson, 7 Vet. App. at 40. The February 2013 IME examiner provided a report that fully considered the Veteran's history, set out his findings in detail, and contained thoroughly articulated reasons for his conclusions that fully addressed the contentions of the private physician. Thus, the Board relies upon the IME examiner's opinion in making its determination. As discussed above, the February 2013 IME opinion specifically addressed causation, clearly indicating that the Veteran's current back disorder is not related to service. The examiner offered a clear and well-reasoned rationale for this opinion, relying on the examination report and his medical expertise, as well as current medical knowledge, in concluding that any etiological relationship was doubtful. For these reasons, the Board concludes that the February 2013 IME examiner's opinion is of greater weight. The Veteran has stated to VA that he first experienced back pain while in service and has experienced that same pain from his time in service to the present. In this regard, the Board notes, first, that it does not question that the Veteran presently suffers from spondylosis and back pain. However, in order for the Veteran's claim to be granted, the record must contain persuasive evidence linking the present disorders to service. The preponderance of the medical evidence does not lead to a conclusion that any current back disability is related to service. The Board has considered the Veteran's contention that his claimed back disorder began in service or otherwise resulted from his time on active duty. The Veteran, however, has not demonstrated that he has any medical expertise to make such an opinion. The Board notes that although the Veteran is competent to report symptoms such as back pain, he does not have medical expertise and therefore cannot provide a competent opinion regarding diagnosis or causation of this disability. As a layperson without the appropriate medical training and expertise, the Veteran is simply not competent to provide a probative opinion on a medical matter such as whether there exists a medical nexus between any current back disorder and service. As for his statements that he has had back problems since service, the Veteran's spine and musculoskeletal system were normal at separation. The January 1967 in-service diagnosis of back bruise is noted, but there was no follow-up treatment and it appears that the bruise was mild and acute. When seen for low back complaints in October 1994, the Veteran indicated that symptoms were of recent onset during only the past four years. The Veteran did not report chronic back pain that related back to service until December 1994, after he filed a claim of compensation for back disability. Further, the Veteran reported to his private physician, as recorded in the April 2013 opinion, that he had stopped playing sports following 1967 in-service injuries to his knees. This is demonstrably not the case-service treatment records, clearly and in detail, document that the Veteran injured his right ankle in August 1968, and his right knee in October 1969, while playing football. Both injuries were incurred following the claimed 1968 injury to his back. Further, the Veteran underwent several VA examinations, and filed several claims for disabilities other than of the back, in the years between his separation from service and his initial complaint of low back pain to VA providers in October 1994. At none of those occasions did he complain of, or even mention, that he was experiencing low back pain. The Board thus does not find any claim that low back pain persisted since service to the present to be credible. The clinical evidence and the Veteran's own statements when seeking both financial benefits and medical treatment from VA contradict any claim that low back symptomatology continued following service. Regarding the Veteran's claims for service connection for disability exhibited by headaches and urinary frequency, the Board finds, upon review of the relevant evidence, that service connection is not warranted for these disorders. As detailed, service treatment records are negative for any complaints of headaches or urinary frequency, and the Veteran's neurological and genitourinary systems were found to be normal at a separation medical examination conducted in December 1969. While the lack of in-service findings of complaints or diagnoses of headaches or urinary frequency in service does not preclude a finding of service connection, as discussed above, headaches and urinary frequency were not shown until 1995, over twenty years after separation from service. The Board finds compelling the absence of any subjective complaints or diagnosis of cervical tension headaches or urinary frequency for more than two decades after discharge from service. The lack of any evidence of continuing headaches or urinary frequency for many years between the period of active duty and the initial findings or documented complaints of headaches or urinary frequency weighs against the claims. As with the back disability, the Veteran underwent several VA examinations, and filed several claims for disabilities other than for headaches and urinary frequency, in the years between his separation from service and his initial claim for pertinent disability in October 1994. At none of those occasions did he complain of headaches (other than sinusitis) and urinary frequency. The Board thus does not find any claim that headaches and urinary frequency persisted since service to the present to be credible. The clinical evidence and the Veteran's own statements when seeking both financial benefits and medical treatment from VA contradict any claim that headaches and urinary frequency continued following service. A prolonged period without medical complaint can be considered, along with other factors concerning the claimant's health and medical treatment during and after military service, as evidence of whether a disability was incurred in service or whether an injury, if any, resulted in any chronic or persistent disability which still exists currently. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Likewise, VA examiners reviewed the claims folder, which included service treatment records, in February 1997, November 2002, and November 2009. As detailed, the examiners opined that the Veteran's current tension headaches and urinary frequency are not due to service. The examiners based these opinion on a thorough review of the claims folder, to include normal neurological and genitourinary systems found on separation from service and no complaints of headaches or urinary frequency for many years thereafter. The opinions of the February 1997, November 2002, and November 2009 VA examiners lead to a finding that the Veteran's cervical tension headaches and urinary frequency are less likely than not related to service. The Board accepts the VA examiners' opinions as being the most probative medical evidence on the subject, as they were based on a review of all historical records and contain detailed rationale for the medical conclusions provided. See Boggs v. West, 11 Vet. App. 334 (1998). Given the depth of the examination reports, and the fact that the opinions were based on a review of the applicable record, the Board finds the VA opinions obtained in this case to be probative and material to the Veteran's claims for service connection for headaches and urinary frequency. See Owens v. Brown, 7 Vet. App. 429 (1995). Importantly, these findings are not contradicted by any medical evidence of record. Thus, the Board concludes that service connection for headaches and for disability exhibited by urinary frequency is not warranted. Further, to the extent that the Veteran was diagnosed by the November 2009 VA examiner as having sinus headaches associated with his service-connected sinusitis, the Board notes that the evaluation of the same "disability," or the same "manifestations" of a disability, under various diagnoses is not allowed. See 38 C.F.R. § 4.14. A claimant may not be compensated twice for the same symptomatology as "such a result would overcompensate the claimant for the actual impairment of his earning capacity." Brady v. Brown, 4 Vet. App. 203, 206 (1993) (interpreting 38 U.S.C.A. § 1155). This would result in pyramiding, contrary to the provisions of 38 C.F.R. § 4.14. In this case, as discussed in more detail below, the Veteran's sinus headaches are clearly contemplated by the rating criteria and disability rating assigned for his service-connected sinusitis. Thus, to separately award service connection for sinus headaches would result in overcompensation for the same manifestations of disability and is thus impermissible under relevant law and regulations. In reaching its conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the Veteran's claims for service connection, that doctrine is not helpful to the Veteran. See 38 U.S.C.A § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). B. Claim for Compensation under 38 U.S.C.A. § 1151 The Veteran seeks compensation pursuant to 38 U.S.C.A. § 1151 for disability incurred as a result of VA medical care. Initially, the Board notes that the RO received the Veteran's claim for such compensation in March 1995. For claims filed at that time, the law required no determination of fault on the part of the service provider in order to confer on the injured veteran entitlement to compensation. Brown v. Gardner, 115 S. Ct. 552, 556 (1994), aff'g 5 F.3d 1456 (Fed. Cir. 1993), aff'g Gardner v. Derwinski, 1 Vet. App. 584 (1991). See Pub. L. No. 104-204, 110 Stat. 2926 (Sept. 26, 1996) (amending 38 U.S.C.A. § 1151 to require negligence as the proximate cause of the death or additional disability effective for claims filed on or after October 1, 1997). For claims filed prior to October 1997, when a veteran suffers additional disability as a result of hospital care, medical or surgical treatment, or an examination furnished by VA, compensation is payable in the same manner as if such disability were due to an injury or disease that he incurred or aggravated during his active military service. See 38 U.S.C.A. § 1151 (West 1991); 38 C.F.R. § 3.358 (1994). For claims filed prior to October 1, 1997, such as this claim, a showing of negligence or fault on the part of VA is not necessary for recovery. Pursuant to 38 C.F.R. § 3.358(b)(2), compensation under Section 1151 is not payable for the continuance or natural progression of disease or injuries for which treatment was authorized. Furthermore, Section 1151 compensation is not payable for the necessary consequences of medical or surgical treatment properly administered with the express or implied consent of the veteran or, in appropriate cases, his representative. "Necessary consequences" are those that are certain to result from, or were intended to result from, the treatment administered. See 38 C.F.R. § 3.358(c)(3. There are three requirements for establishing entitlement to compensation under the version of 38 U.S.C.A. § 1151 in effect at the time the Veteran filed his claim. First, the veteran must incur an injury or aggravation of an injury as the result of hospitalization, medical or surgical treatment, submission to a VA examination, or the pursuit of a course of vocational rehabilitation. 38 U.S.C.A. § 1151; 38 C.F.R. § 3.358(a). In cases of medical care, proof of actual causation between the treatment and the injury is required. 38 C.F.R. § 3.358(c)(1). The "necessary consequences" of properly administered medical treatment to which the veteran consented are not compensable. 38 C.F.R. § 3.358(c)(3). Second, the injury or aggravation cannot be the result of the veteran's own willful misconduct. 38 U.S.C.A. § 1151; 38 C.F.R. § 3.358(c)(4). Third, such injury or aggravation must result in additional disability. 38 U.S.C.A. § 1151; 38 C.F.R. § 3.358(b). The presence of additional injury is determined by comparing the state of the veteran's physical condition immediately preceding the injury with the subsequent physical condition resulting from the injury. 38 C.F.R. § 3.358(b)(1). With respect to surgical treatment in particular, a before-and-after comparison is made of the condition the surgery was designed to relieve. 38 C.F.R. § 3.358(b)(1)(ii). Injury or aggravation that is merely the continuance or natural progression of the condition for which the treatment was authorized is not compensable additional disability. 38 C.F.R. § 3.358(b)(2). In this case, the Veteran alleges that he incurred additional disability, in the form of a cervical, thoracic, and lumbar spine disorder with headaches and urinary frequency, as a result of surgery for a right inguinal hernia performed at the VA Medical Center at Bay Pines, Florida, in December 1994. Specifically, in the March 1995 claim and subsequent statements, the Veteran asserts that he suffered extreme right testicular pain as a result of the surgery, which caused severe muscle spasm or contraction throughout his back and led to major damage to his entire spine. He also claims to have developed headaches as a result of constant testicular and back pain. Finally, during his May 1997 personal hearing and in multiple additional written statements, the Veteran argues that that the inguinal hernia surgery caused some sort of damage or constriction to the bladder, which resulted in his urinary frequency. Upon review of the record, the Board finds that, despite current diagnoses of spinal spondylosis, cervical tension headaches, and urinary frequency, there is no competent evidence to support the contention that these disorders constitute additional disability incurred as the result of injury or aggravation of injury suffered due to VA surgical treatment. As with his claims for service connection, the Veteran's personal opinion that any of these disorders is the result of the December 1994 VA surgery is not competent evidence needed to establish the required causal relationship. In that connection, as noted above, the Veteran has reported that he experienced a sharp increase in his back problems immediately following the December 1994 surgery and has experienced similar symptoms from that time to the present. The Veteran is competent to provide testimony concerning factual matters of which he has first-hand knowledge (i.e., experiencing symptoms following surgery). See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). However, he is not competent to say that any such symptoms represented the onset or permanent increase in the severity of spine disability as a result of the December 1994 surgery. As a lay person without the appropriate medical training or expertise, he simply is not competent to provide a probative opinion on a medical matter, such as relating the etiology of a spinal disorder to a surgery conducted to treat unrelated medical issues. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, evaluating the etiology of a spinal disorder such as spondylosis in the context of surgical treatment falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to, e.g., diagnose cancer). With respect to the spinal disorder, upon consideration of the above evidence, the Board finds that the preponderance of the evidence is against a finding that the Veteran incurred additional disability in the form of a cervical, thoracic, and lumbar spine disorder with headaches and urinary frequency as a result of the December 1994 right inguinal hernia surgery. In that connection, the Board finds that the preponderance of the evidence of record does not support a finding that the Veteran incurred chronic disability or aggravation of chronic disability as the result of hospitalization, medical, or surgical treatment in the form of the December 1994 right inguinal hernia surgery. The VA, VHA, and IME examinations, as well as private opinion, confirm that the Veteran currently suffers from spondylosis and chronic low back pain. The Board concludes, however, that the greater weight of the evidence is against the claim. Here, the August 2012 VHA examiner opined that the evidence did not establish that the Veteran incurred an acute injury of the spine as a result of the December 1994 surgery. Similarly, even conceding that the Veteran experienced a "traumatic" awakening from sedation following the December 1994 surgery, the February 2013 IME opinion found no additional disability to have resulted from the surgery and its aftermath. In particular, the February 2013 IME examiner specifically considered the Veteran's contentions as to the symptoms he experienced following the December 1994 surgery and still found there to be no evidence that the surgery caused anything more than a "short term duration of perhaps a few days" of exacerbation of the Veteran's pre-existing spondylosis. No permanent disability resulted. The medical opinion submitted by the February 2013 IME examiner acknowledged that the Veteran experienced a "traumatic" recovery from his December 1994 surgery but nonetheless concluded that any such short-term effects did not lead to long-term exacerbation of the Veteran's age-related spondylosis. The examiner provided a thorough rationale for this conclusion, relying not only on the Veteran's medical history but also the current state of medical knowledge and considering thoroughly the private physician's findings in rendering his conclusions. In particular, the February 2013 IME examiner pointed to the findings of degenerative changes in the Veteran's spine and found that his current spondylosis is related not to the December 1994 surgery but to his advancing age, reasoning that the actual pain experienced by individuals with spondylosis does not often correlate to the level of severity of the degenerative changes shown on radiological examination. Thus, although the Veteran's degenerative changes appear to be "mild" on radiological examination, it is possible for him to experience "severe" symptoms due to those "mild" changes. Similarly, the examiner considered the private physician's contentions regarding the claimed soft-tissue injury but noted that, notwithstanding the single article referenced by the private physician, there is currently a lack of any consensus medical knowledge relating acute soft-tissue injuries such as any post-surgery lumbar strain and his current spondylosis. Absent a persuasive medical opinion establishing that the Veteran currently experiences additional disability as a result of the December 1994 surgery, his claim for benefits under 38 U.S.C.A. § 1151 for additional disability in the form of a cervical, thoracic, and lumbar spine disorder with headaches and urinary frequency must be denied. In so finding, the Board acknowledges that are opinions in the file from a private treatment provider that purport to offer a link between the Veteran's current back disability and the December 1994 surgery. However, for the reasons set forth herein, the Board is satisfied that the February 2013 IME examiner's opinion is adequate for deciding this appeal and is of greater weight than the opinions offered by the private physician in September 2009, October 2012, and April 2013. See Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994) ; Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993; Sklar v. Brown, 5 Vet. App. 140 (1993). In so finding, the Board notes that the strongest evidence in favor of the Veteran's claim are the September 2011, October 2012, and April 2013 private opinions, but finds that this evidence is outweighed by the medical evidence from the IME examiner's well-reasoned opinion, based on both the Veteran's reported history and the medical records, that the Veteran does not experience an additional disability as a result of the December 1994 surgery. The argument that surgery resulted in "soft tissue injury" and an increase in back pain does not delineate a clear, permanent, measurable increase in back pathology. As the IME pointed out, this likely was an acute exacerbation, with no permanent residuals. Further, the Board notes that the private opinions rely heavily on the examiner's citation to a journal article concerning long-term effects of soft tissue injury. However, the February 2013 IME examiner clearly considered this journal article in his report, pointing out that the single article does not amount to a consensus of medical knowledge concerning any such relationship. In light of the well-reasoned opinion offered by the IME examiner in February 2013, which relied on consideration of the Veteran's entire medical history as well as a thorough explanation of the state of current medical knowledge, the Board finds the conclusions of the private physician regarding additional disability due to the December 1994 surgery to be of less probative value. See Gabrielson, 7 Vet. App. at 40. The February 2013 IME examiner provided a report that fully considered the Veteran's history, set out his findings in detail, and contained thoroughly articulated reasons for his conclusions that fully addressed the contentions of the private physician. Thus, the Board relies upon the IME examiner's opinion in making its determination. As discussed above, the February 2013 IME opinion specifically addressed causation, clearly indicating that the Veteran's current back disorder is not related to the December 1994 surgery. The examiner offered a clear and well-reasoned rationale for this opinion, relying on the examination report and his medical expertise, as well as current medical knowledge, in concluding that any etiological relationship was doubtful. For these reasons, the Board concludes that the February 2013 IME examiner's opinion is of greater weight. Similarly, with respect to headaches, the report of the November 2002 VA neurology examination reflects the opinion that the Veteran's headaches were of two kinds, both tension headaches and headaches associated with his sinusitis. The November 2009 VA examiner reached an identical conclusion. Neither opinion offers an indication that the headaches are the result of injury or aggravation of injury associated with VA surgical care. Similarly, the VHA and IME opinions offer no suggestion that the Veteran's headaches are related to the December 1994 surgery; in addition, the private examiner who offered the September 2011, October 2012, and April 2013 opinions has made no such finding. There is no competent evidence of record that establishes an etiological link between the Veteran's headaches and the December 1994 surgery. Finally, the Board emphasizes that the February 1997 VA genitourinary examiner found no objective evidence of urinary disability. The March 1997 urethrogram was negative. The November 2002 VA genitourinary examiner, after examination of the Veteran and review of the record, concluded that the Veteran's urinary frequency was not due to VA surgery or hospitalization but instead to unrelated prostate enlargement. Again, there is no contrary medical opinion on this issue. Thus, the Board finds that no additional disability of the cervical, thoracic, and lumbar spine with headaches and urinary frequency was caused by the December 1994 right inguinal hernia repair surgery the Veteran underwent at a VA facility. In view of this finding, the Board concludes that entitlement to disability compensation under the provisions of 38 U.S.C.A. § 1151 for additional cervical, thoracic, and lumbar spine disorder with headaches and urinary frequency as a result of VA treatment in December 1994 is not established. In reaching its conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the Veteran's claim for benefits under 38 U.S.C.A. § 1151, that doctrine is not helpful to the Veteran. See 38 U.S.C.A § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). C. Claim for Increase Disability evaluations are determined by comparing a Veteran's symptoms with criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's entire history is reviewed when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern, and VA must address the evidence concerning the state of the disability from the time period one year before the claim for an increase was filed until VA makes a final decision on the claim. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. The Veteran's sinusitis is currently evaluated as 10 percent disabling under Diagnostic Code 6513, chronic maxillary sinusitis. 38 C.F.R. § 4.97. During the pendency of the Veteran's appeal, VA promulgated new regulations amending the rating criteria for respiratory disorders, including sinusitis, effective October 7, 1996. See 61 Fed. Reg. 46,720 (1996) (codified at 38 C.F.R. pt. 4). When amended regulations expressly state an effective date and do not include any provision for retroactive applicability, application of the revised regulations prior to the stated effective date is precluded. 38 U.S.C.A. § 5110(g); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997); VAOPGCPREC 3-2000. Therefore, before October 7, 1996, only the previous version of the rating criteria may be applied. Thereafter, the version more favorable to the Veteran must be applied. The Board notes that the RO considered the amended rating criteria in its February 1997 supplemental statement of the case. Therefore, the Board may proceed to address those criteria without first determining whether doing so would result in prejudice to the Veteran. Bernard, 4 Vet. App. at 392-94. Under the previous version of the rating criteria, a 10 percent rating is assigned for sinusitis when disability is moderate, with discharge or crusting or scabbing, with infrequent headaches. A 30 percent rating is awarded when disability from sinusitis is severe, with frequently incapacitating recurrences, severe and frequent headaches, and purulent discharge or crusting reflecting purulence. 38 C.F.R. § 4.97, Diagnostic Code 6513 (1996). Under the amended version of the rating criteria, a 10 percent evaluation is assigned when there is evidence of one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. When there is evidence of three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting, a 30 percent rating is in order. Notes specify that an incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. On review of the relevant evidence, the Board finds that an evaluation higher than 10 percent for the Veteran's service-connected sinusitis is not warranted. Review of the record reveals that the Veteran has made ongoing subjective complaints regarding his sinusitis symptomatology, including constant nasal discharge, constant headaches, chronic congestion, sinus pressure and tenderness, and post-nasal drip with sore throat. Radiological and CT evaluations have reflected findings consistent with chronic sinusitis. At his February 1997 and November 2002 VA examinations, the Veteran complained of constant drainage and headaches, but no discharge or post-nasal drip was noted on examination. The November 2002 examiner specifically noted that the Veteran's sinusitis has not caused any incapacitating episodes. VA treatment records reflect that the Veteran has been prescribed antibiotic medication to treat his sinusitis on, at most, one occasion per year. The evidence shows that the Veteran primarily uses decongestants, antihistamines, and nasal steroids to treat his sinusitis. Objectively, VA examinations have confirmed only clear nasal discharge and occasional mild nasal congestion with swollen and inflamed mucosa and sinus tenderness. There is no objective confirmation of any purulent discharge or associated crusting. The medical evidence does not suggest that the Veteran experiences frequent incapacitating episodes of sinusitis, or that he has suffered any incapacitating episode of sinusitis that required prolonged antibiotic treatment as contemplated by the rating criteria. Although the Veteran describes having constant headaches, the medical evidence indicates that the headaches are only partially related to the sinusitis. Further, these headaches are contemplated in the 10 percent rating assigned under both prior and current Diagnostic Code 6513. Thus, as there is no evidence of three or more incapacitating episodes per year of sinusitis requiring prolonged antibiotic treatment or more than six non-incapacitating episodes of sinusitis a year characterized by headaches, pain, and purulent discharge or crusting, a higher evaluation of 30 percent is not warranted under current Diagnostic Code 6513. 38 C.F.R. § 4.97 (2012). Further, as there is no evidence of frequently incapacitating recurrences, severe and frequent headaches, and purulent discharge or crusting reflecting purulence, an evaluation higher than 10 percent is not warranted under the prior version of Diagnostic Code 6513. 38 C.F.R. § 4.97 (1996). The Board notes that a separate 10 percent rating may be assigned for complete loss of sense of smell or complete loss of sense of taste, under Diagnostic Codes 6275 or 6276, respectively. 38 C.F.R. § 4.87b (1998); 38 C.F.R. § 4.87a (2012). See Esteban v. Brown, 6 Vet. App. 259 (1994) (veteran is entitled to separate disability ratings for different manifestations of the same disability when the symptomatology of one manifestation is not duplicative or overlapping of the symptomatology of the other manifestations). However, in each instance, a rating may be assigned only when there is an anatomic or pathologic basis for the disorder. 38 C.F.R. § 4.87b, Note (1998); 38 C.F.R. § 4.87a, Note (2012). In this case, although the Veteran complains of diminished sense of both smell and taste, there is no evidence of complete loss and no evidence of anatomic or pathologic basis for loss of these senses. Therefore, no separate rating is in order. The above determination is based upon consideration of applicable rating provisions. For all the foregoing reasons, the Board finds that the claim for a disability rating higher than 10 percent for the Veteran's service-connected sinusitis must be denied. This is so for the entirety of the appeal period. 38 C.F.R. §§ 4.3, 4.7, 4.97, Diagnostic Code 6513. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim for a higher rating, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). The above determinations are based on consideration of the applicable provisions of VA's rating schedule. The Board finds that at no time has the disability under consideration been shown to be so exceptional or unusual as to warrant the referral for consideration of any higher ratings on an extra-schedular basis. See 38 C.F.R. § 3.321(b)(1). Here, there is an absence of evidence of marked interference with employment (i.e., beyond that contemplated in the assigned evaluation), frequent periods of hospitalization, or evidence that the Veteran's service-connected sinusitis, without consideration of other disabilities, has rendered impractical the application of the regular schedular standards. Furthermore, his symptoms are all specifically contemplated by the criteria discussed above. Thus, the criteria for invoking the procedures set forth in 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). It bears emphasis that the schedule is intended to compensate for average impairments in earning capacity resulting from service-connected disability in civil occupations. 38 U.S.C.A. § 1155. Generally, the degrees of disability specified in the rating schedule are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1 (2012). Thus, based on the record before it, the Board does not find that the medical evidence demonstrates any unusual disability with respect to the claim that is not contemplated by the rating schedule. The very symptoms the Veteran experiences are addressed by the rating schedule. Thun v. Peake, 22 Vet. App. 111 (2008). Sinusitis has not required frequent inpatient care or caused marked industrial impairment. As a result, the Board concludes that a remand for referral of the rating issue to the VA Central Office for consideration of extra-schedular evaluation is not warranted. (CONTINUED ON NEXT PAGE) ORDER Entitlement to service connection for a cervical, thoracic, and lumbar spine disorder is denied. Entitlement to service connection for headaches is denied. Entitlement to service connection for disability exhibited by urinary frequency is denied. Entitlement to compensation pursuant to 38 U.S.C.A. § 1151 for a cervical, thoracic, and lumbar spine disorder with headaches and urinary frequency is denied. Entitlement to a disability rating higher than 10 percent for sinusitis is denied. ______________________________________________ THOMAS J. DANNAHER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs