Citation Nr: 18142296 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 16-51 335 DATE: October 15, 2018 ORDER A 50 percent rating for depressive disorder is granted, subject to the laws and regulations governing the award of monetary benefits. A disability rating in excess of 10 percent for left distal clavicle fracture is denied. A 10 percent rating for plantar fasciitis of the left foot is granted, subject to the laws and regulations governing the award of monetary benefits. A 10 percent rating for plantar fasciitis of the left foot is granted, subject to the laws and regulations governing the award of monetary benefits. A compensable rating for sleep apnea is denied. The appeal of the increased rating claim for herpes simplex virus is dismissed. A 10 percent rating for left knee disability is granted, subject to the laws and regulations governing the award of monetary benefits. A 10 percent rating for right knee disability is granted, subject to the laws and regulations governing the award of monetary benefits. A compensable rating for onychomycosis is denied. The appeal of the increased rating claim for scar on right second digit is dismissed. A compensable rating for hypertension is denied. Service connection for tinea pedis is granted. Service connection for asthma is denied. Service connection for epistaxis is granted. Service connection for migraine headaches is denied. Service connection for aphthous ulcer is granted. The appeal of the service connection for Gilbert syndrome is dismissed. REMANDED A disability rating for arteriosclerotic coronary artery disease in excess of 10 percent is remanded for extraschedular evaluation. FINDINGS OF FACT 1. The Veteran’s depressive disorder causes occupational and social impairment with reduced reliability and productivity, but not with deficiencies in most areas or worse. 2. The Veteran has demonstrated full range of motion in his left shoulder with pain noted on movement without causing sufficient functional loss to support a rating higher than 10 percent. 3. The Veteran’s overall symptomatology of bilateral plantar fasciitis in each foot more nearly resembles that of a “moderate” foot injury than a “moderately severe” or “severe” injury with no showing of objective evidence of marked deformity bilaterally. 4. The Veteran does not have persistent day-time hypersomnolence and he does not use CPAP for his sleep apnea. 5. At the May 2018 Board hearing and before the promulgation of a decision in the appeal, the Veteran notified the Board that he wished to withdraw his increased rating claim for herpes simplex virus. 6. The Veteran has full range of motion in his left knee with pain noted on movement without causing sufficient functional loss to support a rating higher than 10 percent. 7. The Veteran has full range of motion in his right knee with pain noted on movement without causing sufficient functional loss to support a rating higher than 10 percent. 8. The Veteran’s affected toenails cover less than 5 percent of his total body area and 0 percent of his total exposed area, and the Veteran has not been taking any systemic treatment for his onychomycosis. 9. At the May 2018 Board hearing and before the promulgation of a decision in the appeal, the Veteran notified the Board that he wished to withdraw his increased rating claim for scar on right second digit. 10. The Veteran’s hypertension requires continuous medication, but his diastolic pressure has been predominantly less than 100, systolic pressure has been predominantly less than 160, and historically his diastolic pressure has been predominantly less than 100. 11. The Veteran’s tinea pedis occurred in service and has been continuously experienced since service. 12. The Veteran has not been shown to have asthma, as symptoms initially thought to be signs of asthma during service have been found by medical professionals to be the results of his heart condition. 13. The Veteran’s epistaxis began occurring in service and he has continued to experience the problem since service. 14. The weight of evidence does not support a finding of current disability of migraine headaches. 15. The Veteran’s aphthous ulcer began occurring in service and he has continued to experience the problem since service. 16. At the May 2018 Board hearing and before the promulgation of a decision in the appeal, the Veteran notified the Board that he wished to withdraw his service connection claim for Gilbert syndrome. CONCLUSIONS OF LAW 1. The criteria for a 50 percent rating for depressive disorder, but not higher, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.130, Diagnostic Code 9434. 2. The criteria for a disability rating in excess of 10 percent for left distal clavicle fracture have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1,4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. 3. The criteria for a 10 percent rating for plantar fasciitis of the left foot, but no higher, have been met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5276, 5284. 4. The criteria for a 10 percent rating for plantar fasciitis of the right foot, but no higher, have been met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5276, 5284. 5. The criteria for compensable rating for sleep apnea have not been met. 38 U.S.C. §1155; 38 C.F.R. §§ §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.97, Diagnostic Code 6847. 6. The criteria for withdrawal of the increased rating for herpes simplex have been met. 38 U.S.C.§ 7105; 38 C.F.R. § 20.204. 7. The criteria for a 10 percent rating for left knee disability, but no higher, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5024, 5256-63. 8. The criteria for a 10 percent rating for right knee disability, but no higher, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5024, 5256-63. 9. The criteria for a compensable rating for onychomycosis have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.118, Diagnostic Codes 7806. 10. The criteria for withdrawal of the increased rating for scar on right second digit have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.204. 11. The criteria for a compensation rating for hypertension have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.104, Diagnostic Code 7101. 12. The criteria for service connection for tinea pedis have been met. 38 U.S.C.§§ 1110, 5107; 38 C.F.R.§§ 3.102, 3.303, 3.304, 3.307, 3.309. 13. The criteria for service connection for asthma have not been met. 38 U.S.C.§§ 1110, 5107; 38 C.F.R.§§ 3.102, 3.303, 3.304, 3.307, 3.309. 14. The criteria for service connection for epistaxis have been met. 38 U.S.C.§§ 1110, 5107; 38 C.F.R.§§ 3.102, 3.303, 3.304, 3.307, 3.309. 15. The criteria for service connection for migraine headaches have not been met. 38 U.S.C.§§ 1110, 5107; 38 C.F.R.§§ 3.102, 3.303, 3.304, 3.307, 3.309. 16. The criteria for service connection for aphthous ulcer have been met. 38 U.S.C.§§ 1110, 5107; 38 C.F.R.§§ 3.102, 3.303, 3.304., 3.307, 3.309. 17. The criteria for withdrawal of the service connection claim for Gilbert syndrome have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.204. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 2007 to August 2015. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a September 2015 rating decision by Department of Veterans Affairs (VA) Regional Office (RO). In connection with this appeal, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge in May 2018. A transcript of that hearing is of record. At the May 2018 Board hearing, the Veteran expressly withdrew his appeal to the issues of increased rating for tinnitus. The Board notes that this issue is not listed on the Notice of Disagreement. Either way, the issue is not on appeal and will not be discussed in this decision. Withdraw Claims The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. Withdrawal may be made by the Veteran or by his authorized representative. Id. In the present case, at the May 2018 Board hearing, the Veteran expressly withdrew his appeal to the issues of (1) increased rating for herpes simplex, (2) increased rating for scar on right second digit, and (3) service connection for gilbert syndrome. No allegations of errors of fact or law for appellate consideration with respect to these specific matters were raised. Accordingly, the Board does not have jurisdiction to review the appeal of these issues and they are therefore dismissed. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C.§ 1110; 38 C.F.R.§ 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service (nexus). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established with certain chronic diseases based upon a legal presumption by showing that the disease manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Further, service connection may also be established under 38 C.F.R. § 3.303(b), where a symptom of a chronic disease is noted in service without diagnosis in service or within one year from service, but chronicity is established by continuity of symptomatology after service. This is an alternative way to establish service connection for the specific chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). 1. Service connection for tinea pedis The Veteran is seeking service connection for tinea pedis (foot fungus). In March 2015, the Veteran was provided a VA examination. The examiner reviewed the Veteran’s service treatment records (STRs) and noted that the Veteran was treated for tinea pedis with topical medication (Lamisil) in service. The examiner inspected the Veteran’s feet and found no evidence of vesicular genital rash or residual scars and no inter-digital erythema or scaling between toes. STRs show that tinea pedis was listed as a chronic problem that the Veteran had during service. At the May 2018 Board hearing, the Veteran credibly testified that he developed tinea pedis while he was in service, and that the condition had continued since. He indicated that he still has fungal infection on his feet, but that it would come and go. He stated that he when the tinea pedis is present, he uses anti-fungal sprays to treat it and keep his feet aired out. Although the VA examiner did not observe any symptom of tinea pedis present at that the time of the examination, the Board finds that the Veteran is competent to provide lay evidence that there has been remissions and recurrence of the fungus infection on his feet since he left the service, as lay persons are competent to give opinions on some medical issues. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). As such, the evidence has established the in-service incurrence of a chronic disease (tinea pedis), and the lay evidence supports the finding of this condition has continued after the separation of service until now. Service connection is granted. 2. Service connection for asthma The Veteran is seeking service connection for asthma. In March 2015, the Veteran was provided a VA examination. The examiner reviewed the Veteran’s service treatment records (STRs) and noted that the Veteran sought treatment for exertional dyspnea and chest pain in service. Initial pulmonary function test (PFT) in 2014 suggested mild asthma (FEV 84 percent of predicted improved to 102 percent of predicted after bronchodilator) and the Veteran was placed on Flovent and albuterol inhalers. The inhalers did not relieve the symptoms. A second set of PFTs was conducted and the result was normal with no improvement on bronchodilators. As chest pain condition became more prominent, the Veteran was referred to cardiology for severe progressive exertional symptoms. In January 2015, cardiology suggested possible lateral wall ischemia. Catheterization showed 80 to 90 percent stenosis of left anterior descending (LAD) and an arterial stent was inserted. Unfortunately, the Veteran continued to experience episodes of atypical chest pain. Exercise cardiac stress testing (EST) was performed which showed normal to 23 METs. The examiner opined that the initial pulmonary test in October 2014 showed a single PFT anomaly (FEV 84 percent of predicted improved to 102 of predicted after bronchodilator) suggesting mild obstruction. Cycle ergometry was normal, with supranormal exercise capacity and oxygen efficiency. Most recent PFTs performed in late November 2014 were normal with no bronchodilator response. The subsequent identification of ischemic heart disease/stenosis makes it less likely than not that there was any pulmonary disease present. Given his lack of response to standard inhaler therapy and currently normal PFTs, evidence suggests there is no current diagnosis of asthma. STRs show that the Veteran had complained to his pulmonary physician that the prescribed inhalers did not work. In February 2014, his pulmonary physician at the Pulmonary Clinic of Navy Medical Center in San Diego opined that the Veteran’s asthma symptoms were likely related to cardiovascular disease than underlying asthma. At the May 2018 Board hearing, the Veteran testified that he was initially diagnosed with asthma in service, but later told that his symptoms were related to cardiac condition, rather than being the result of asthma. He stated that he still had breathing problems and he did not know whether it was linked to asthma or cardiac problem. He stated that he no longer took asthma medications. The Board finds that although the Veteran was provisionally diagnosed with asthma in service and he still has breathing problems, the medical evidence suggests that his breathing problems are related to his heart condition (which has already been service-connected) and not actually diagnostic of asthma. This conclusion was clearly explained by both the VA examiner and the Navy pulmonary physician. Accordingly, the Board finds that asthma was erroneously diagnosed in service, and that the competent evidence does not establish that the Veteran has had asthma during the course of his appeal. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As such, service connection for asthma is denied. 3. Service connection for epistaxis The Veteran is seeking service connection for epistaxis (nosebleed). In March 2015, the Veteran was provided a VA examination. The Veteran reported that he had mild recurrent nosebleeds since shortly after joining the service, but recently, they have become more severe and can last for an hour or two. He reported that he experienced nosebleeds several times per month. The examiner indicated that the Veteran had several years history of nosebleeds that had been aggravated since he started taking medication for his heart disease. STRs show that the Veteran repeatedly sought treatment for nosebleeds and was diagnosed as epistaxis during service. At the May 2018 Board hearing, the Veteran testified that he currently had nosebleeds 2 to 3 times a week. VA treatment records show that in November 2015 (about 3 months after separation from service), the Veteran complained about nosebleeds 4 times a day due to heart medication. The VA treatment records in July 2017 also listed nosebleed as one of the Veteran’s active problems. Additionally, the Veteran’s private treatment records also show that the Veteran complained about serious episodes of nosebleeds to his primary care physician in June 2017. The medical evidence has established the in-service incurrence of a disease (epistaxis). The condition reoccurred within 1 year after service and continued until present. The chronicity of epistaxis has been established by the continuity of symptomatology. As such, the evidence support a finding that a epistaxis began during service and continued after the separation of service. Service connection is granted. 4. Service connection for migraine headaches The Veteran is seeking service connection for migraine headaches. In March 2015, the Veteran was provided a VA examination. The examiner reviewed the Veteran’s service treatment records (STRs) and noted that the Veteran sought treatment for headache and nasal congestion in September 2008. The Veteran reported that he had frequent headaches prior to service, but currently has 1 to 2 headaches per year, not requiring medication or medical attention. The examiner indicated that the Veteran had no diagnosis of headache syndrome at this time. STRs show that the Veteran had sought treatment for headaches on several occasions, usually accompanied with other symptoms such as fever, nasal congestion and nausea. On other occasions, the records show that he denied headaches. The VA treatment records show that the Veteran specifically denied headaches on several occasions in 2015, 2016 and 2017 while seeking emergency treatments for other conditions. At the May 2018 Board hearing, the Veteran testified that he had brutal headaches from hypertension. He also stated that sometimes the headaches came with nosebleeds. The Veteran’s representative indicated that the Veteran had headaches as early as May 2008. According to Beaumont Hospital records in April and September 2017, review of neurological systems shows negative report for headaches. Neurological system reviews in May 2015 and November 2016 from Macomb hospital were negative report for headaches. The Board finds that the weight of evidence does not support a finding of current disability of migraine headaches. While the Veteran clearly experienced headaches in service, the evidence suggests that they were acute in nature and associated with other symptoms, rather than constituting a separate chronic disability. While he may still have headaches occasionally as he reported, the medical records suggest that the Veteran’s headaches are more likely a symptom of other illness than an independently reoccurring condition. He denied headaches multiple times on treatment records, and his recent hospital records show negative reports for headaches. Additionally, the VA examiner concluded that the Veteran is not shown to have been diagnosed with a chronic headache disorder. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Here, the evidence does not support the presence of a chronic headache disability and service connection is denied. 5. Service connection for aphthous ulcer The Veteran is seeking service connection for aphthous ulcer (canker sore). In March 2015, the Veteran was provided a VA examination at which he reported first noticing the mouth sores during active service. He explained that he was diagnosed with aphthous ulcers by a general Navy doctor and prescribed topical medication for symptomatic relief. The examiner indicated that the Veteran has recurrent aphthous ulcers or canker sores, which he acknowledged was a common problem. STRs show that aphthous ulcer was listed as a chronic problem that the Veteran had during service. At the May 2018 Board hearing, the Veteran credibly testified that he experienced canker sores at least once a month. This is a symptom which is readily identifiable by a lay person. The Board finds that the medical evidence has established the in-service incurrence of a chronic disease (aphthous ulcer), and continuation of the chronic condition after the separation of service until now. Service connection is granted. Increased Rating An September 2015 rating decision granted service connections for (1) unspecified depressive disorder with an initial rating of 30 percent, (2) left distal clavicle fracture (non-dominant) with an initial rating of 10 percent, (3) bilateral plantar fasciitis with an initial rating of 10 percent; (4) sleep apnea with periodic limb movement of sleep with an initial an rating of 0 percent; (5) left knee tendonitis with patellofemoral pain syndrome with initial an rating of 0 percent; (6) right knee tendonitis with patellofemoral pain syndrome with an initial rating of 0 percent; (7) onychomycosis with dermatophytosis with an initial rating of 0 percent; and (8) hypertension with an initial rating of 0 percent. The Veteran appealed the initial ratings, seeking higher ratings for each of the above conditions. 1. Depressive Disorder The Veteran is currently rated at 30 percent for his depressive disorder under Diagnostic Code 9434. Under the General Rating Formula for Mental Disorders, a 30 percent evaluation is assigned when a veteran’s mental disability causes occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, Diagnostic Code 9434. A 50 percent evaluation is assigned when a veteran’s mental disability causes occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation is assigned when a veteran’s mental disability causes occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); or an inability to establish and maintain effective relationships. Id. A 100 percent rating is assigned when a veteran’s mental disability causes total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; danger of hurting self or others; intermittent inability to perform activities of living (including maintenance of minimal hygiene); disorientation to time or place; or, memory loss for names of close relatives, occupation, or own name. Id. When determining the appropriate disability evaluation to assign, the Board's primary consideration is the Veteran’s symptoms, but it must also make findings as to how those symptoms impact the Veteran’s occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating, because the use of the term “such as” in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list. See Mauerhan. Nevertheless, as all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran’s impairment must be “due to” those symptoms, a veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. See Vazquez-Claudio. In March 2015, the Veteran was provided a VA examination. The Veteran reported that he had a suicide attempt in 2013 while he was in service but he denied suicidal ideation, plan or intent at the time of the examination. The Veteran reported he had drinking problem during military service but was treated and he had not consumed alcohol since November 2013. He also reported he was married with two children. The examiner found that the Veteran’s current symptoms included depression, irritability, low mood, low energy, hard to be positive, and negative cognitions. The examiner concluded that Veteran’s depressive disorder resulted in occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation, which is consistent with a 30 percent rating. In June 2017, the Veteran’s wife provided a written statement that Veteran told her that he couldn’t keep his thoughts organized and forgot about some of the work tasks. The Veteran was depressed and had constant fear about his health problems and the possibility that he might lose his job. According to the Veteran’s wife, he has difficulty to be around people because he can’t speak logically and the people tend to think the Veteran is weird. His wife stated that the Veteran started drinking again to alleviate his depression. In October 2017, the Veteran was afforded another VA examination for his new claim of PTSD. He reported that he lived with his wife and children, that he had no problem with his marriage. He reported that he talked with friends from college, but had no friends from work. He reported that he was working as a supply chain manager at TACOM for the past 2 years. He struggled with individuals at work and he missed work on several occasions in the past 12 months due to medical reasons. He reported that his mental problems began in 2013. He experienced chest pain, heart palpitations and difficulty with sleep. He reported that he received private mental health treatment. He reported that he had excessive worry and depression and he has attempted suicide in 2013 and as hospitalized for 2 weeks. He reported he had some suicide ideation but had no plan of attempt. On examination, the Veteran appeared anxious. He was engaged during examination and his affect was neutral. The examiner indicated that the Veteran’s symptoms included depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationship, difficulty in adapting to stressful circumstances, including work or a work-like setting. The examiner concluded that the Veteran’s depressive disorder resulted in occupational and social impairment with reduced reliability and productivity, which is consistent with a 50 percent rating for mental disorders. At his May 2018 Board hearing, the Veteran testified that he had performance issues at his job where he was a supply chain manager at TACOM in the Detroit Arsenal. He reported being uncomfortable around people at work. His memory loss affected his work in that he forgot supply orders that had already been filled and he had to use a list to remind him. He reported that he had to leave work early due to health issues. He snapped easily and yelled at people both at work and at home. He reported experiencing panic attacks. He reported that he resorted to alcohol to cope his depression and that he got a DUI in December 2017. The Veteran’s most recent medical records at Rochester Center for Behavioral Medicine in July and August 2018 show that the Veteran is currently live with wife and children. He drinks 3 to 6 times a week. He admitted that he constantly got in physical alterations with other people. He reported felt hopeless about finances, health, and family issues. He is employed full time, although disciplinary issues have been reported. With the new medication, his condition has improved. His wife stated that he was managing his anger better. He had suicidal ideation but has no plan to commit suicide now and he feared death. He reported doing great at work, noting that he was up for a promotion. The Board has considered all evidence of record, to include the Veteran’s private treatment records, VA examination reports, as well as suggest the Veteran’s testimony and his wife’s statements. The Board finds that the Veteran’s overall psychiatric symptomatology approximates the criteria of 50 percent rating for his depressive disorder. That is the Veteran’s depression has caused occupational and social impairment with reduced reliability and productivity. As such, a 50 percent rating is granted. However, a higher rating of 70 percent is not warranted because he does not have occupational and social impairment with deficiencies in most areas. Although he has difficulty in performing his work duties and managing relationship with colleagues and friends, he seems to have a good relationship with his wife and kids. With the help of medication and mental consultation, he is able to maintain his position as a supply chain manager and he performs well enough for a potential promotion. Although he has panic attacks and anxiety, depressed mood, and still drinks to cope his depression, his mental condition has not affected his ability to function independently and appropriately. Moreover, while the Veteran has experienced symptoms such as panic attacks, which can be suggestive of a rating in excess of 50 percent, panic attacks are also a hallmark of a 50 percent rating. While the Veteran did report having suicidal ideation in the past, he has consistently denied any plan to commit suicide during the course of the appeal and he has reported being fearful of death. The evidence suggests that he has deficiencies in some but not most areas in social and occupational settings, such as work, family relations, judgement, thinking and mood. As such, 70 percent rating is not warranted. 2. Left Distal Clavicle Fracture The Veteran is currently rated at 10 percent for his left distal clavicle fracture under DC 5201, which evaluates limitation of motion of affected joints (in this case, his left shoulder) 38 C.F.R. 4.71a. The Veteran is right-handed, as such, his service connected left shoulder is considered his non-dominant shoulder. Under Diagnostic Code 5201 (limitation of arm motion), a 20 percent rating for the minor shoulder requires limitation of motion is at shoulder level or midway between side and shoulder level. A 30 percent rating is assigned for limitation of motion to 25 degrees from side. 38 C.F.R. 4.71a. DC 5201. Normal ranges of motion of the shoulder are flexion (forward elevation) from 0 degrees to 180 degrees, abduction from 0 to 180 degrees, external rotation from 0 to 90 degrees, and internal rotation from 0 to 90 degrees. 38 C.F.R. § 4.71, Plate I. The Veteran was provided a VA examination in March 2015 at which his left shoulder was found to have normal range of motion as he was able to flex and abduct his right arm from 0-180 degrees, with external and internal rotation from 0 to 90 degrees. Additionally, the Veteran was able to perform repetitive testing without any additional loss of motion. The examiner observed pain on palpation of the joint motion, but found that the pain did not functionally limit the range of motion of the left arm. The Veteran did not report any flare-ups. The Veteran also had 5/5 strength on muscle strength tests and no atrophy was found to be present. At the May 2018 Board hearing, the Veteran testified that he had pain in left shoulder and he felt heavy and numb when he tried to extend his left arm. The Veteran’s treatment records have been reviewed but do not show any results that differ from the results found at the VA examination regarding the Veteran’s left shoulder disability. That is, they do not suggest limitation of motion beyond what was shown at his VA examination. The Veteran has suggested that he experiences pain and numbness in his left shoulder, but it is because of those symptoms that he was assigned a 10 percent rating. As noted, the Veteran clearly demonstrated range of motion in his left shoulder to well above shoulder level at his VA examination. Therefore, a rating in excess of 10 percent is not warranted based on range of motion alone. In reaching this conclusion, the Board has considered whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca v. Brown, 8 Vet. App. 202 (1995). A minimum compensable evaluation for a joint disability is warranted for painful motion under 38 C.F.R. § 4.59. However, a rating in excess of the minimum compensable rating must be based on demonstrated functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). Here, the Veteran was able to perform repetitive motion testing without any additional loss of motion. Moreover, he was found to have full strength in the arm and no atrophy was found. As such, the Board concludes that the range of motion in the Veteran’s shoulder was not functionally limited to shoulder level, and a rating in excess of 10 percent is not warranted on this basis. Other Diagnostic Codes related to the shoulder and arm were considered, but none were applicable to the Veteran’s disability as there was no impairment of the humerus, clavicle or scapula and no showing of ankylosis. Here, the Veteran’s left shoulder has full normal range of motion, but was assigned a 10 percent rating in recognition of the pain. This is the highest rating available absent a showing that the pain functionally limits the range of motion of the Veteran’s left shoulder. Accordingly, a rating in excess of 10 percent is denied. 3. Bilateral Plantar Fasciitis The Veteran is currently rated at 10 percent for his bilateral plantar fascitis. The Veteran’s bilateral plantar fasciitis has been rated by analogy to pes planus, (acquired flatfoot) under Diagnostic Code 5276, as the rating codes do not include an entry for plantar fasciitis. 38 C.F.R. § 4.20. Under Diagnostic Code 5276 for pes planus, a noncompensable rating is warranted for acquired flatfoot that is mild in severity, which is relieved by built-up shoe or arch support. A 10 percent rating is warranted for moderate flatfoot with symptoms of the weight-bearing line falling over or medial to the great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, whether presented bilaterally or unilaterally. A 30 percent rating is assigned for severe bilateral pes planus with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated indication of swelling on use, and characteristic callosities. A 50 percent rating, the maximum rating available, is assigned when there is pronounced bilateral pes planus with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, DC 5276. The words “mild,” “moderate,” and “severe,” as used in the various diagnostic codes, are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence for “equitable and just decisions.” 38 C.F.R. § 4.6. Although an element of evidence to be considered by the Board, the use of terminology such as “severe” by VA examiners and others is not dispositive of an issue. The Veteran was provided a VA examination of his foot conditions in March 2015 at which he reported experiencing pain in both feet on the bottom of the heels. He stated that the pain was intermittent and would occur during over excursion over long period of time. He did not report any flare-ups that would impact the function of his feet. The examiner indicated pain on use and on manipulation of both feet, but the pain did not contribute to additional functional loss. The examiner indicated that the Veteran’s foot condition did not chronically compromise weight bearing, and did not require arch supports, custom orthotic inserts or shoe modifications. The examiner indicated that there was no pain, weakness, fatigability or incoordination that significantly limited the Veteran’s functional ability during flare-ups or after repeated use. The examiner indicated that there was no other pertinent physical findings, complications, conditions, signs or symptoms related to the Veteran’s bilateral plantar fasciitis. The examiner concluded that the Veteran’s bilateral plantar fasciitis condition was mild. Veteran’s treatment records do not show any results that differ from the results found at the VA examination regarding the Veteran’s bilateral foot disability. At the May 2018 Board hearing, the Veteran testified that he had contractures (spasms) in both feet, particularly the left foot that sometimes caused needle-like pain or throbbing in his feet. He reported that his symptoms lasted anywhere from 30 seconds to 10 minutes, and he indicated that he would usually rub a tennis ball or golf ball under his feet to alleviate the pain. The Board finds that the overall evidence does not support a rating in excess of 10 percent for the Veteran’s bilateral plantar fasciitis under Diagnostic Code 5276. The VA examination indicates that the Veteran has bilateral pain on manipulation and use. However, there was no objective evidence of other severe disabilities such as marked deformity, swelling on use, or characteristic callosities. While the Veteran reported throbbing pain and spams in his feet, he can still walk, jog and do some laps. In addition, the VA examiner found that the Veteran’s foot condition did not require the use of any arch supports, custom orthotic inserts or shoe modifications and the VA examiner concluded his foot impairment is mild. Given these factors, the Veteran’s overall symptomatology does not resemble that of severe pes planus required by the 30 percent rating criteria under Diagnostic Code 5276. Therefore, applying DC 5276 would not result in an increased rating thus not favorable to the Veteran. Other Diagnostic Codes have been considered. DC 5277 evaluates weak foot, DC 5278 evaluates pes cavus, DC 5279 evaluates metatarsalgia or Morton’s disease, DC 5280 evaluates hallux valgus, DC 5281 evaluates hallux rigidus, DC 5282 evaluates hammer toe, DC 5283 evaluates malunion or nonunion of the tarsal or metatarsal bones, and DC 5284 evaluates other foot injuries. The medical record does not document any of these conditions except for DC 5284. Therefore, these Diagnostic Codes (other than DC 5284) are not applicable and will not be discussed further. Diagnostic Code 5284 is a general diagnostic code under which a variety of foot injuries may be rated. Some injuries to the foot, such as fractures and dislocations for example, may limit motion in the subtalar, midtarsal, and metatarsophalangeal joints; other injuries may not affect range of motion. Depending on the nature of the foot injury, Diagnostic Code 5284 may involve limitation of motion. VAOPGCPREC 9-98. Diagnostic Code 5284 does not apply to the 8 foot conditions (e.g. pes planus, hallux valgus) that are specifically listed under § 4.71. See Copeland v. McDonald, 27 Vet. App. 333, 338 (2015). Bilateral plantar fasciitis is not one the eight listed conditions. Therefore, Diagnostic Code 5284 is potentially applicable to the Veteran’s service connected foot condition. Under Diagnostic Code 5284, a 10 percent evaluation is provided for a “moderate” foot injury. A 20 percent evaluation is provided for a “moderately severe” foot injury. A 30 percent evaluation is provided for a “severe” foot injury. Actual loss of use of the foot warrants a 40 percent rating. 38 C.F.R. § 4.71a. DC 5284. The words “moderate,” “moderately severe,” and “severe” are not defined in Diagnostic Code 5284. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decision is “equitable and just.” 38 C.F.R. § 4.6. The Board finds that the overall evidence supports the assignment of two 10 percent ratings under Diagnostic Code 5284, one for each foot for plantar fasciitis. As noted, the Veteran’s plantar fasciitis causes pain and spams in each foot, but it is not of such severity as to significantly limit his mobility as he can still walk and jog without use of any arch supports, custom orthotic inserts or shoe modifications. There is no impairment on range of motion. Moreover, the VA examiner suggested that the foot impairment as a result of the Veteran’s plantar fasciitis was mild in nature. As such, the Board concludes that a rating in excess of 10 percent is not warranted for either foot as a “moderately severe” foot injury is not shown. 4. Sleep Apnea The Veteran is currently rated at 0 percent for his sleep apnea under Diagnostic Code 6847. Under Diagnostic Code DC 6847, a 0 percent rating is warranted for asymptomatic but with documented sleep disorder breathing; a 30 percent rating is warranted for persistent day-time hypersomnolence; a 50 percent rating is warranted for condition that requires use of breathing assistance device such as continuous airway pressure (CPAP) machine; and 100 percent rating is warranted for chronic respiratory failure with carbon dioxide retention or cor pulmonale, or; requires tracheostomy. 38 C.F.R. § 4.97, DC 6847. In March 2015, the Veteran was afforded a VA examination. A sleep study was conducted. The examiner found that the Veteran had sleep apnea with periodic limb movement in sleep. The examiner noted that that the Veteran’s sleep apnea did not require continuous medication or use of CPAP machine and the condition did not impact his ability to work. Veteran’s treatment records do not show any results that differ from the results found at the VA examination regarding the Veteran’s feet disability. At the May 2018 Board hearing, the Veteran testified that he had difficulty to sleep. He contended that the sleep study conducted in March 2015 VA examination is not accurate because during the night the study was performed, he was constantly interrupted by medical staff and did not sleep for a long time. Nevertheless, the Veteran specifically testified that he did not use CPAP. The main purpose of the sleep study was to determine whether the Veteran had sleep apnea, and regardless of how the Veteran felt the study went, the study was diagnostic of sleep apnea. Therefore, the fact that the sleep study was conducted when the Veteran was in short period of sleep is of no prejudice to the Veteran in adjudicating this claim as the fact that he has sleep apnea is not in dispute. The issue for the Board is whether the Veteran’s sleep apnea is of sufficient severity as to warrant a compensable rating. A 30 percent rating for sleep apnea requires persistent day-time hypersomnolence, which has not been described in the VA examination report, in the treatment records, or in the Veteran’s testimony. “Hypersomnolence” is defined as excessive sleeping or sleepiness, as in any group of sleep disorders with a variety of physical and psychogenic causes. See DORLAND’S Illustrated Medical Dictionary, 31st ed. Here, the Veteran testified that he had a hard time to fall into sleep. But he did not complaint that he had excessive sleepiness during day time. The Veteran’s treatment records also do not reveal symptoms of persistent day-time hypersomnolence. A 30 percent rating is not warranted. Additionally, the Veteran does not need to use CPAP for his sleep disorder as he testified and as the VA examiner indicated, a 50 percent rating is not warranted. Accordingly, a compensable rating for the Veteran’s sleep apnea is denied. 5. Knee disabilities The Veteran is currently receives noncompensable ratings for the tendonitis with patellofemoral pain syndrome in both knees under Diagnostic Code 5257-5024. For rating purpose, the Veteran’s knee disabilities will be evaluated under DC 5024 based on limitation of motion of affected joint. Normal ranges of motion of the knee are to 0 degrees in extension, and to 140 degrees in flexion. 38 C.F.R. § 4.71, Plate II. Diagnostic Code 5014 evaluates osteomalacia, which will be rated on limitation of motion of affected parts. Normal ranges of motion of the knee are to 0 degrees in extension, and to 140 degrees in flexion. 38 C.F.R. § 4.71, Plate II. Diagnostic Code 5256 evaluates ankylosis of the knee. The record contains no evidence of knee ankylosis, and the Veteran has not described symptoms that are suggestive of ankylosis. Therefore, this Diagnostic Code is not applicable and will be discussed no further. Diagnostic Code 5257 evaluates recurrent subluxation or lateral instability of a knee. The record contains no evidence of recurrent subluxation or lateral instability, and the Veteran has not described symptoms that are suggestive of recurrent subluxation or lateral instability. Therefore, this Diagnostic Code is not applicable and will be discussed no further. Diagnostic Codes 5258 and 5259 evaluate impairment of the semilunar cartilage, which is synonymous with the meniscus. The record contains no evidence of a meniscus condition, and the Veteran has not described symptoms that are suggestive of a meniscus condition. Therefore, these Diagnostic Codes are not applicable and will be discussed no further. Diagnostic Code 5260 evaluates limitation of knee flexion. A noncompensable rating is assigned for flexion limited to 60 degrees. A 10 percent rating is assigned for flexion limited to 45 degrees. A 20 percent rating is assigned for flexion limited to 30 degrees or extension limited to 15 degrees. A 30 percent rating is assigned for either flexion limited to 15 degrees or extension limited to 20 degrees. Diagnostic Code 5261 evaluates limitation of knee extension. A noncompensable rating is assigned for extension limited to 5 degrees. A 10 percent rating is assigned for extension limited to 10 degrees. A 20 percent rating is assigned for extension limited to 15 degrees. A 30 percent rating is assigned for extension limited to 20 degrees. A 40 percent rating is assigned for extension limited to 30 degrees. A 50 percent rating is assigned for extension limited to 45 degrees. Diagnostic Code 5262 evaluates impairment of the tibia and fibula. The record contains no evidence of a current impairment of the tibia and fibula, and the Veteran has not described symptoms that are suggestive of an impairment of the tibia and fibula. Therefore, this Diagnostic Code is not applicable and will be discussed no further. Diagnostic Code 5263 evaluates genu recurvatum. The record contains no evidence of left genu recurvatum, and the Veteran has not described symptoms that are suggestive of left genu recurvatum. Therefore, this Diagnostic Code is not applicable and will be discussed no further. The Veteran’s treatment records show he consistently reported knee pain. However, his treatment records do not show range of motion findings consistent with compensable ratings. In March 2015, the Veteran was afforded a VA examination at which he reported noticing pain over the patellar ligaments bilaterally when running and climbing the ladders. On examination, he demonstrated normal flexion to 140 degrees and extension to 0 degrees in both knees, with no objective evidence of painful motion. Repetitive use testing did not result in any additional limitation of motion bilaterally. The Veteran retained normal 5/5 muscle strength bilaterally with no muscle atrophy. The examiner noted no ankylosis, no history of recurrent subluxation, recurrent effusion, or lateral instability in either knee. Joint stability testing showed no evidence of instability in either knee. The examiner indicated no tibial or fibular impairment, meniscus (semilunar cartilage) impairment in either knee. The examiner noted mild tender to palpation over the patella ligament due to mild tendonitis bilaterally. Patellofemoral joint grind and compression test showed normal excursion and slight crepitus bilaterally. The Veteran’s treatment records have been reviewed but do not show any results that differ from the results found at the VA examination regarding the Veteran’s knee disability. That is there was no showing of any range of motion testing. At the May 2018 Board hearing, the Veteran testified that he felt knee cap pain bilaterally every day, especially when he changed his position from sitting down to standing up and walking around. He described the level of knee pain was at 3 or 4 on a scale of 1 to 10 (10 being the highest level). He also reported knee locking up or cramps. Here, the Veteran clearly demonstrated range of motion (both flexion and extension) that greatly exceeded the limitation of motion required for a compensable rating for either knee. However, in considering range of motion ratings, it is important to consider whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca v. Brown, 8 Vet. App. 202(1995). A minimum compensable evaluation for a joint disability is warranted for painful motion under 38 C.F.R. § 4.59. However, a rating in excess of the minimum compensable rating must be based on demonstrated functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). Here, the Veteran testified that he experienced pain in both knees and the VA examiner found both knees to be tender to palpation. As such, a 10 percent rating for each knee is warranted under DeLuca for painful motion. However, a higher rating is not warranted because there is no evidence showing that the pain functionally limits the range of motion of the Veteran’s left knee or right knee. Accordingly, a rating in excess of 10 percent is not warranted. 6. Onychomycosis The Veteran is currently rated at 0 percent for his onychomycosis under Diagnostic Code 7806. VA recently published a final rule amending its regulations on skin disabilities effective August 13, 2018. The amendment, in pertinent part, added a General Rating Formula for the Skin for diagnostic codes 7806, 7809, 7813-7816, 7820-7822, and 7824, and amended diagnostic codes 7801,7802,7817,7819,7825, 7826, 7827,7829. See 83 Fed. Reg. 32,592 (July 13, 2018). The claims pending prior to the effective date will be considered under both old and new rating criteria, and whichever criteria is more favorable to the Veteran will be applied. Under the regulations in effect at the time when the Veteran filed his claim (in February 2015 when he was still in service), Diagnostic Code 7806 provided a 10 percent evaluation if at least 5 percent, but less than 20 percent of the entire body, or at least 5 percent, but less than 20 percent of exposed areas affected, or; when intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs is required for a total duration of less than six weeks during the past 12-month period; A 30 percent evaluation is warranted if the skin condition covers 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; when systemic therapy such as corticosteroids or other immunosuppressive drugs is required for a total duration of six weeks or more, but not constantly, during the past 12-month period; A 60 percent evaluation is warranted if the skin condition covers more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. 38 C.F.R. § 4.118 (2008), Diagnostic Code 7806. Under the new regulations, effective August 2018, Diagnostic Code 7806 will be rated under a General Rating Formula, under which a 10 percent rating will be assign if the disability meets one of the following (i) characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or (ii) At least 5 percent, but less than 20 percent, of exposed areas affected; or (iii) intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. 38 C.F.R. § 4.118 (2018), Diagnostic Code 7806. In March 2013, the Veteran was afforded a VA examination. The examiner indicated that the Veteran has not been treated with oral or topical medications or any other treatments or procedures in the previous 12 months. The examiner noted that the Veteran had no systemic manifestations due to any skin diseases. The examiner indicated that the Veteran had no debilitating episodes in the past 12 months due to urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis, nor had any non-debilitating episodes of urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis in the past 12 months. On examination, the Veteran’s affected area covered less than 5 percent of his total body area and 0 percent of his total exposed area. The Veteran’s treatment records have been reviewed but do not show any results that differ from the results found at the VA examination regarding the Veteran’s onychomycosis. At the May 2018 Board hearing, the Veteran testified that his toe nails got really thick and deformed, and were constantly peeling off. He denied taking any medication for onychomycosis due to his heart medication. The Board finds a compensation rating for the Veteran’s onychomycosis is not warranted under both old and new regulations, because the criteria for a 10 percent rating under both regulations requires either affected skin area covers at least 5 percent of total body area or 5 percent of total exposed area. Here, the Veteran’s total affected skin area (his toe nails) covers less than 5 percent of his total body area and 0 percent of total exposed area according to the March 2015 VA exam. Additionally, the Veteran has not been under any systemic therapy treatment based on the medical records as well as the Veteran’s testimony at the Board hearing. A compensable rating for onychomycosis is denied. 7. Hypertension The Veteran is currently rated at 0 percent for his hypertension. Hypertension is evaluated under Diagnostic Code 7101, for hypertensive vascular disease (hypertension and isolated systolic hypertension). A 10 percent rating is assigned for diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating is assigned for diastolic pressure predominately 110 or more or systolic pressure predominantly 200 or more. A 40 percent rating is assigned for diastolic pressure predominately 120 or more. A 60 percent rating is assigned for diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101. Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. Id. at Note (1). For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90 mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 mm. or greater with a diastolic blood pressure of less than 90 mm. Id. The VA regulations do not define the term “predominantly.” The Merriam Webster dictionary defines the term “predominantly” as “for the most part”. See Predominantly Definition, Merriam-Webster.com, available at https://www.merriam-webster.com/dictionary/predominantly (last visited July 30, 2018) (defining the term “predominantly” as “for the most part”.) In March 2015, the Veteran was afforded a VA examination. The examiner reviewed the Veteran’s military service treatment records (STRs) and indicated that the Veteran had a history of isolated elevated readings in past and he was on medication of Lisinopril 20 mg daily and Norvasc 5 mg daily at the time of the examination. The examiner indicated that the Veteran did not have a history of a diastolic blood pressure (BP) that was predominantly 100 or more. The blood pressure readings at the time of the 2015 exam were 145/83, 148/85, and 146/84. Review of STRs confirms the finding of the March 2015 VA examination that the Veteran did not have a history of a diastolic blood pressure (BP) that was predominantly 100 or more during service. In addition, review of other medical records does not reveal a history of diastolic pressure readings being predominantly 100 or more as concluded by the March 2015 VA examination. Neither the Veteran nor his representative has provided evidence to the contrary. At the May 2018 Board hearing, the Veteran testified that he believed the records did show elevated BP readings. He indicated that his BP readings taken at his private doctor’s office were higher than the BP readings taken at VA medical center because VA may take 3 to 4 times of BP readings and only recorded the lowest readings. Review of Veteran’s private treatment records shows that Veteran’s diastolic pressure readings were not predominantly over 100 and the systolic pressure were not predominantly more than 160. According to the medical records provided by Veteran’s primary physician ( Dr. C.), among 18 BP readings taken between April 2016 to May 2018, no systolic BP reading is above 160 and only 1 diastolic BP reading is at 100. In a Cardio Vascular Study conducted by DMC Cardio Vascular Institute in Michigan in August 2016, 8 BP readings were taken on the same day and none of them shows systolic pressure of 160 or higher or diastolic pressure of 100 or higher. The 8 BP readings are: 146/72, 152/80, 149/80, 147/85, 152/78, 137/70, 141/80 and 149/86. While the Veteran does have elevated blood pressure which requires him to take continuous medication, medical evidence show that his diastolic pressure has been predominantly less than 100, systolic pressure has been predominantly less than 160, and historically his diastolic pressure has been predominantly less than 100. Accordingly, a compensable rating for hypertension is denied. REASONS FOR REMAND The Veteran is currently rated at 10 percent for his arteriosclerotic coronary artery disease under Diagnostic Code 7005. He is seeking a higher rating. At a VA examination in March 2015, the examiner noted that the Veteran had a history of exertional chest pain beginning in January 2012 and had a LAD stent placement in January 2015 after being diagnosed with 80-90 percent stenosis of left anterior descending artery. The examiner indicated the Veteran’s heart disease required continued medication. On examination, the Veteran demonstrated a workload of 23 METs and a left ventricular ejection fraction (LVEF) of greater than 55 percent. While the Veteran’s clinical testing does not support the assignment of a compensable rating on a schedular basis, the Veteran testified at his May 2018 Board hearingthat he was a world class track and field athlete, running 1500 meter races in approximately 3 minutes and 45 seconds. He lamented that while he used to be able to run sub 4.5 minute miles, he could no longer run even 100 meters without experiencing intense chest pain. The Veteran’s problem, as was explained to him was that because of his superior physical fitness, his METs tests would always show normal results regardless of the chest pain he experienced. An internet search confirms the Veteran’s testimony as to the extraordinary athlete he was, showing that he finished 6th in the Men’s 1500 meter and 2nd in the Men’s 10,000 meter races at the 2006 NAIA National Championships. See https://www.athletic.net/TrackAndField/Athlete.aspx?AID=1468933#!/L0 (last visited September 28, 2018). Given the Veteran’s extraordinary athletic capability and fitness, the Board is concerned that his heart condition may not be adequately evaluated under the schedular rating criteria. As such, the Veteran’s claim for a compensable rating for arteriosclerotic coronary artery disease is referred to the Director of the VA Compensation and Pension Service for extraschedular consideration. Therefore, the matters are REMANDED for the following action: Refer the Veteran’s case to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for a determination as to whether the Veteran’s disability picture warrants the assignment of a compensable rating for his heart condition on an extraschedular basis. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Qun Wang, Associate Counsel