Citation Nr: 18148915 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 98-14 261 DATE: November 8, 2018 ORDER Whether new and material evidence has been received to reopen a claim for service connection for carpal tunnel syndrome, left wrist is denied. Entitlement to service connection for sinusitis is denied. Entitlement to service connection for obstructive sleep apnea is denied. Entitlement to service connection for coronary artery disease (CAD) is denied. Entitlement to a rating more than 10 percent for left knee disability is denied. Entitlement to a rating more than 30 percent for right knee disability is denied. Entitlement to a compensable rating for left foot disability is denied. Entitlement to a compensable rating for right foot disability is denied. Entitlement to an initial compensable rating for bilateral hearing loss is denied. Entitlement to a rating more than 10 percent for tinnitus is denied. Entitlement to a rating more than 10 percent for sliding hiatal hernia with associated gastroesophageal reflux disease (GERD) with noncardiac chest pain is denied. (The issue of entitlement to service connection for the cause of the Veteran’s death is the subject of another decision under a different docket number.) FINDINGS OF FACT 1. In a final May 2003 rating decision, the Regional Office (RO) denied entitlement to service connection for carpal tunnel syndrome, left wrist. 2. Evidence received since the May 2003 rating decision is not new and material. 3. Prior to the Veteran’s death, the most probative evidence is against a finding that he had a chronic sinusitis attributable to service. 4. Prior to the Veteran’s death, the most probative evidence of record did not show that obstructive sleep apnea was related to his active service. 5. Prior to the Veteran’s death, the competent medical evidence is against finding that CAD began during active service or within a year of service discharge, or is otherwise related to an in-service injury, event, or disease. 6. Prior to the Veteran’s death, his left knee was painful, but did not result in limitation of motion, instability, or other limiting factor as to warrant a higher rating. 7. Prior to the Veteran’s death, his right knee was manifested by painful motion with functional limitation of flexion to 120-140 degrees and extension to 0 to 20 degrees, without ankylosis. 8. Prior to the Veteran’s death, he had not had an operation with resection of the metatarsal head for his right or left hallux valgus; and the most probative evidence of record did not show that the right or left hallux valgus was severe and equivalent to amputation of the great toe at any time during the relevant rating period. 9. Prior to the Veteran’s death, his bilateral hearing loss did not manifest to a compensable rating. 10. The Veteran’s tinnitus has been assigned a 10 percent disability rating, which is the maximum rating under the applicable schedular criteria. 11. Prior to the Veteran’s death, his sliding hiatal hernia with associated GERD with noncardiac chest pain manifested by recurrent epigastric distress with pyrosis and regurgitation, without any substernal arm or shoulder pain and not productive of considerable impairment of health. CONCLUSIONS OF LAW 1. The May 2003 RO decision that denied entitlement to service connection for carpal tunnel syndrome, left wrist is final. 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. 2. New and material evidence has not been received since the May 2003 rating decision, and the Veteran’s claim for entitlement to service connection for carpal tunnel syndrome, left wrist cannot be reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for service connection for sinusitis have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 4. The criteria for service connection for obstructive sleep apnea have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for CAD have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for a rating more than 10 percent for left knee disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1-4.3, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (Code(s)) 5003, 5260. 7. The criteria for a rating more than 30 percent for right knee disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1-4.3, 4.40, 4.45, 4.59, 4.71a, Codes 5260 - 5261. 8. The criteria for a compensable rating for left foot disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.14, 4.21, 4.71a, Code 5280. 9. The criteria for a compensable rating for right foot disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.14, 4.21, 4.71a, Code 5280. 10. The criteria for an initial compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.85, 4.86, Code 6100. 11. There is no basis for the assignment of a rating higher than 10 percent for tinnitus. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.87, Code 6260; Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). 12. The criteria for a rating more than 10 percent for sliding hiatal hernia with associated GERD with noncardiac chest pain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.114, Code 7346. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty for more than 20 years prior to his retirement in November 1993. He passed away in February 2017. In April 2017, the appellant, the Veteran’s surviving spouse, was properly substituted as claimant regarding the above claims that were pending before the Board of Veterans Appeals (Board) at the time of the Veteran’s death. These matters were remanded by the Board in April 2001, December 2003, January 2008, June 2010, and April 2012. In May 2000, the Veteran testified regarding the sinusitis service connection claim. In February 2018, the appellant was informed that the Veterans Law Judge who held that hearing is no longer employed at the Board. She was offered the opportunity to have an additional hearing; however, in February 2018 correspondence, she indicated that she did not want another hearing. New and Material evidence Prior to his death the Veteran indicated that his left wrist disability was related to his military service or a service-connected disability. In a May 2003 rating decision, the RO denied the Veteran’s claim for service connection for left wrist carpal tunnel syndrome as there was no evidence of a chronic disability that was related to service or a service-connected disability. The Veteran did not file an application for review on appeal, nor was new and material evidence received within one year of the decision. Therefore, such decision is final. Thereafter, the RO received his petition to reopen the claim in June 2005. In a July 2006 rating decision, the RO denied reopening the left wrist service connection claim. The RO found that no new and material evidence had been received to reopen the service connection claim. Generally, a claim which has been denied in an unappealed Board decision or an unappealed RO decision may not thereafter be reopened and allowed. 38 U.S.C. §§ 7104(b), 7105(c). The exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). For establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). At the time of the May 2003 rating decision, the evidence associated with the claims file included the service treatment records (STRs) that show no treatment for a left wrist disability; the November 1993 separation examination where the Veteran denied any left wrist complaints; and a normal clinical evaluation of the upper extremities. Also associated with the file were VA treatment records that shows no indication that any left wrist disability was related to service or a service-connected disability. The instant claim for service connection for left wrist disability was received in June 2005. The July 2006 rating decision denied reopening the claim, as no new and material evidence had been received. Review of the record shows that, the evidence associated with the claims file includes: the current claim in June 2005, VA as well as private treatment records that show left wrist disability, and various statements from the Veteran prior to his death that his left wrist disability was due to his military service. The current claim provided no new information as to the left wrist disability. He did not provide any new statements in support of the left wrist disability claim, other than his wrist was painful, and it was due to his military service. The treatment records from VA and private providers show no evidence the left wrist was because of his military service, to include any incident therein; or in the alternative, due to a service-connected disability. The Board finds that the evidence added to the claims file since the prior final rating decision in May 2003 fails to demonstrate, suggest, or raise a reasonable possibility that the current left wrist disability was incurred in, or aggravated by the Veteran’s military service; or a service-connected disability. In summary, even when considering the newly submitted evidence together with the previous evidence of record, the evidence does not raise a reasonable possibility of substantiating the Veteran’s claim of service connection for carpal tunnel syndrome, left wrist. Accordingly, new and material evidence has not been received sufficient to reopen the previously denied claim, and the petition to reopen such claim is denied. There is no doubt to be resolved as to this issue. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v Derwinski, 1 Vet. App. 49 (1990). Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection may also be granted for certain chronic diseases when such disability is manifested to a degree of 10 percent or more within one year of discharge from service. See 38 U.S.C. §§ 1101, 1112(a); 38 C.F.R. §§ 3.307, 3.309; see Fountain v. McDonald, 27 Vet. App. 258 (2017); 38 C.F.R. § 3.309(a). When chronic diseases are at issue, the second and third elements for service connection may alternatively be established by showing continuity of symptomatology. See Walker v. Shinseki, 701 F.3d 1331 (Fed. Cir. 2013). Entitlement to service connection for sinusitis At the time of the Veteran’s death, he had a pending service connection claim for sinusitis. He indicated that his disability was due to his in-service complaints. STRs reveal the Veteran was seen on several occasions for congestion and runny nose. During a November 1993 service retirement examination, the Veteran’s sinuses were normal. In October 2012, the Veteran was examined by VA to determine the nature and etiology of any sinus disorder found to be present. The Veteran reported a history of congestion, facial pain and headaches dating back to service. Although the examiner indicated sinusitis, she found no evidence of sinusitis during the examination. The examiner diagnosed rhinitis. Further, the examiner reviewed the private treatment records and indicated there were no findings suggestive of acute or chronic sinusitis. The examiner stated that it was less likely than not that sinusitis was related to service. The Veteran has presented no competent, credible evidence of chronic sinusitis in service or since service. Moreover, there is no competent evidence linking a current sinus disorder to service. Therefore, the Board finds the preponderance of the evidence to be against his claim, and service connection for sinusitis is denied. Entitlement to service connection for obstructive sleep apnea At the time of the Veteran’s death, he had a pending service connection claim for obstructive sleep apnea. He indicated that his current disability was due to his military service. The Board concludes that, although prior to his death, the Veteran had a current diagnosis of severe obstructive sleep apnea, the preponderance of the evidence weighs against finding that the obstructive sleep apnea began during service or was otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303(a), (d). The STRs show no complaints of or treatment for a sleep disorder. Although the Veteran was competent to report having experienced symptoms of loud snoring, episodes of choking while snoring, daytime somnolence, dyspnea, tiredness, fatigue, and decreased stamina, he was not competent to determine that these symptoms were manifestations of sleep apnea related to his military service. The issue is medically complex, as it requires knowledge of medical causation and the interpretation of complicated diagnostic medical testing. Further, the October 2012 VA examiner opined that the Veteran’s obstructive sleep apnea is not at least as likely as not related to an in-service injury, event, or disease. The rationale provided by the examiner was that there was no evidence of sleep apnea during service. She indicated that the Veteran’s sleep apnea was not diagnosed until many years post-service and that his disability is most likely related to personal risk factors including body habitus and obesity. The October 2012 VA examiner’s opinion is the most probative evidence of record, because it is based on a review of the Veteran’s medical history, medical literature, the clinical findings made on examination, and the symptomatology reflected in the medical and lay evidence of record. Nieves-Rodriguez, 22 Vet. App. at 304. Consequently, the benefit-of-the-doubt rule does not apply, and service connection for obstructive sleep apnea is denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 55. Entitlement to service connection for CAD Prior to his death, the Veteran had a pending service connection claim for CAD. He indicated that his heart disability was related to his military service, to include his noted in-service complaints of chest pain. For the reasons stated below, the Board finds that service connection for this condition is not warranted. The Veteran’s STRs reveal he was seen in 1992 for chest pain. He was diagnosed with non-cardiac chest wall pain that was more likely attributed to mild reflux. Post-service treatment records reveal the Veteran was diagnosed with CAD in 2005 and subsequently had heart surgery. During the October 2012 VA examination, 3-vessel CAD was diagnosed. The examiner reviewed the file, examined the Veteran and found that his current heart disease was not related to his military service, to include the in-service chest complaints. She reasoned that the in-service chest pain was non-cardiac and that diagnostic testing done at the time showed no ischemic changes. She opined that the Veteran’s heart disease manifested many years after service discharge and that the disability was most likely related to his personal risk factors. Although the Veteran was competent to report on his history of cardiovascular symptomatology, including experiencing chest pains and shortness of breath, he was not competent to provide a diagnosis in this case or conclude that his cardiovascular symptomatology was attributable to service. The issue is medically complex, as it requires the interpretation of complicated diagnostic medical testing. The October 2012 VA examiner’s opinion is the most probative evidence of record, because it is based on a review of the Veteran’s medical history, medical literature, the clinical findings made on examination, and the symptomatology reflected in the medical and lay evidence of record. The Board further finds that as the Veteran’s heart disability manifested in 2005, over a decade post-service, service connection is not warranted for chronic disability. Consequently, the benefit-of-the-doubt rule does not apply, and service connection for CAD is denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 55. Increased Rating Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Rating Schedule. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Staged ratings are appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating musculoskeletal disabilities, VA must consider granting a higher rating in cases in which the Veteran experiences functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination (to include during flare-ups or with repeated use), and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the Code predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In Burton v. Shinseki, 25 Vet. App. 1 (2011), the Court held that consideration of 38 C.F.R. § 4.59 is not limited to cases involving arthritis. The Court held that pain must affect some aspect of the normal working movements of the body such as excursion, strength, speed, coordination and endurance to constitute functional loss. Mitchell v. Shinseki, 24 Vet. App. 32, 33, 43 (2011). Although pain may cause functional loss, pain, itself, does not constitute functional loss and is just one factor to be considered when evaluating functional impairment. Id. Increased ratings for knees Under Code 5257 pertaining to recurrent subluxation or lateral instability of a knee, a 10 percent disability rating is assigned where evidence supports slight recurrent subluxation or lateral instability; a 20 percent disability rating is assigned where evidence supports moderate recurrent subluxation or lateral instability; and a highest 30 percent disability rating is assigned where evidence supports severe recurrent subluxation or lateral instability. The Board notes that the terms “slight,” “moderate,” and “severe,” as used in under Code 5257 are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all the evidence to ensure an “equitable and just” decision. 38 C.F.R. § 4.6. When semilunar cartilage is dislocated with frequent episodes of locking, pain and effusion into the joint a 20 percent rating is assigned. 38 C.F.R. § 4.71a, Code 5258. When semilunar cartilage has been removed, but remains symptomatic, a 10 percent rating is assigned. 38 C.F.R. § 4.71a, Code 5259. The normal range of motion for the knee is 140 degrees flexion and 0 degrees extension. 38 C.F.R. § 4.71, Plate II. Under Code 5260 pertaining to limitation of flexion, a 10 percent rating is assigned when flexion is limited to 45 degrees; a 20 percent rating is assigned when flexion is limited to 30 degrees; and a highest 30 percent rating is assigned when flexion is limited to 15 degrees. 38 C.F.R. § 4.71a, Code 5260. Under Code 5261 pertaining to limitation of extension, a zero percent rating is assigned when extension is limited to 5 degrees; a 10 percent rating is assigned when extension is limited to 10 degrees; a 20 percent rating is assigned when extension is limited to 15 degrees; a 30 percent rating is assigned when extension is limited to 20 degrees; a 40 percent rating is warranted for extension limited to 30 degrees; and a 50 percent rating is assigned when extension is limited to 45 degrees. 38 C.F.R. § 4.71a, Code 5261. Separate ratings under Code 5260 and Code 5261 may be assigned for disability of the same knee joint. See VAOPGCPREC 9-2004. In evaluating musculoskeletal disabilities, the Board recognizes that a veteran may be entitled to separate ratings where manifestations of such disability have not already been compensated for by the assigned evaluation under a different code. As such, due consideration is also given to the applicability of other Codes pertaining to disability of the knee, e.g., 5262 (impairment of the tibia and fibula), and 5263 (genu recurvatum). Lastly, the “amputation rule” provides that the combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, where amputation is performed. 38 C.F.R. § 4.68. In this case, as it is the Veteran’s right and left knee, respectively, that are affected by his service-connected disabilities, a 60 percent combined disability rating is the maximum allowable under the “amputation rule,” regardless of the individual ratings assigned for disability. 38 C.F.R. §§ 4.25, 4.68, 4.71a, Codes 5162-5163 (providing that amputation of the middle or lower thirds of the leg; or thigh amputation recommended with defective stump, all warrant a 60 percent rating). Right knee At the time of his death, the Veteran was in receipt of a 30 percent disability rating for right knee disability based on limitation of extension under 38 C.F.R. § 4.71. Code 5261. As indicated, a 30 percent rating is assigned when extension is limited to 20 degrees. Id. Based on a review of the evidence, the Board finds that an increased disability rating more than 30 percent for the Veteran’s service-connected right knee disability based on limitation of extension is not warranted at any point during the pendency of appeal prior to the Veteran’s death because the evidence of record does not reflect the Veteran’s extension was limited to 30 degrees; had ankylosis or a tibia and/or fibula impairment. In making this finding, the Board accords significant probative weight to the VA examinations of record conducted in June 2014 and October 2016, collectively. The record reflects the examiners reviewed the Veteran’s pertinent medical history, documented his current complaints, and rendered findings and diagnoses consistent with the remainder of the evidence of record, and therefore, the examinations are adequate for adjudication purposes. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); Correia, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). Here, report of the July 2014 VA examination reflects, in pertinent part, that range of motion (ROM) testing measured forward flexion of the right knee to 100 degrees, and extension to 20 degrees, with pain. The Veteran reported flare-ups precipitated by repetitive-use over time. In terms of ROM, there was no additional impairment. No evidence of ankylosis was noted. Similarly, report of the October 2016 VA examination reflects, in pertinent part, that ROM testing measured forward flexion of the right knee to 140 degrees, and extension to 0 degrees, without pain. Similar findings were noted after repetitive use testing. No evidence of ankylosis was noted. Because the Veteran’s right knee disability is productive of painful motion with extension limited to, at worst, 20 degrees after repetitive use and/or flare ups, without evidence of ankylosis or tibia and/or fibula impairment, a 30 percent disability rating under Code 5261 is appropriate. Additionally, the Board finds that the Veteran is not entitled to a separate disability rating under Code 5260 because the evidence of record overwhelmingly reflects flexion to 100-140 degrees. As the manifestations such as pain have already been compensated for by the assigned evaluation under another Code, a compensable rating would amount to pyramiding. See Mitchell, 25 Vet. App. at 36; 38 C.F.R. § 4.14. Next, the Board finds the Veteran is not entitled to a separate disability rating under Code 5257 based on recurrent lateral instability; as there was no probative evidence showing the Veteran had right knee instability. Based on a review of the evidence, the Board finds that an increased disability rating more than the schedular 30 percent for the Veteran’s service-connected right knee disability based on limitation of extension is not warranted at any point during the pendency of appeal because the evidence of record neither reflects, nor did the Veteran endorse symptoms not contemplated by the currently assigned schedular disability rating. 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 rating higher than 30 percent for right knee impairment based on limitation of extension, or entitlement to a separate rating for limitation of flexion, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Left knee If the knee condition involves arthritis, the knee disability may be rated under provisions for evaluating arthritis. Arthritis due to trauma is rated as degenerative arthritis according to Code 5003. Under Code 5003, degenerative arthritis established by x-ray findings will be rated based on limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, the disability is to be rated as follows: with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, 20 percent; with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, 10 percent. 38 C.F.R. § 4.71a, Code 5003. At the time of the Veteran’s death, his left knee disability was rated based on painful limitation of motion. Based on a review of the evidence, the Board finds that an increased disability rating more than 10 percent for the Veteran’s service-connected left knee disability based on painful motion is not warranted at any point during the pendency of appeal prior to the Veteran’s death because the evidence of record does not reflect the Veteran’s painful motion exhibited extension limited to 15 degrees or flexion limited to 30 degrees; had instability; had ankylosis or a tibia and/or fibula impairment. During the July 2014 VA examination, the left knee disability ROM was 130 degrees of flexion and 5 degrees of extension with objective evidence of painful motion. The Veteran reported flare-ups precipitated by repetitive-use over time. In terms of ROM, there was no additional impairment. No evidence of ankylosis was noted. During the October 2016 VA examination, the left knee disability report reflects, in pertinent part, that ROM testing measured forward flexion of the left knee to 140 degrees, and extension to 0 degrees, without pain. Similar findings were noted after repetitive use testing. No evidence of ankylosis was noted. As noted above, prior to his death, the Veteran had consistently demonstrated slight limitation of motion in the left knee throughout the course of his appeal, as well as pain. Under Code 5260, a rating of 10 percent is warranted when the range of motion of a knee is functionally limited to 45 degrees or less. However, given that the Veteran’s forward flexion was not limited to at least 45 degrees, he is not entitled to a separate compensable rating. Because of his reported pain on motion, the Veteran had already been granted a 10 percent rating under Code 5003. Further, a separate rating under Code 5261 is also not warranted in this case because at no point during the appeal did the Veteran demonstrate compensable limited extension in the left knee. In reaching this conclusion, the Board considered whether a higher disability evaluation was warranted based on 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). Functional loss contemplates the inability of the body to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance, and must be manifested by adequate evidence of disabling pathology, especially when it is due to pain. 38 C.F.R. § 4.40. Additionally, painful motion is an important factor of disability; and joints that are painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Here, as noted, the Veteran’s range of motion was most limited at his July 2014 VA examination when flexion was limited to 130 degrees. However, even then, the Veteran could complete repetitive motion testing without experiencing additional pain or additional loss of flexion, and the examiner noted that pain, weakness, fatigability and incoordination did not significantly limit the functional ability of either knee with repeated use over a period. Regarding the left knee, the Veteran consistently demonstrated flexion to at least 130 degrees and it was not suggested that repetitive motion or flare-ups so limited the left knee as to warrant a higher rating. As such, the Board does not find the range of motion in either knee to be functionally limited beyond what was shown on clinical testing. Although the Veteran undoubtedly experienced pain in the left knee, pain alone is not sufficient to warrant a higher rating, as pain may cause a functional loss, but pain itself does not constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id. As discussed here, the Veteran’s pain limited his range of motion, but it did not so functionally limit the range of motion in the right knee as to approximate the criteria for higher rating based on limited motion. Entitlement to compensable ratings for right and left foot disabilities At the time of the Veteran’s death, his bilateral foot disability was rated under 38 C.F.R. § 4.71a, Code 5280, which pertains to hallux valgus. Under Code 5280, a maximum 10 percent rating is warranted for each unilateral hallux valgus that has been operated upon with resection of the metatarsal head or that is severe, if equivalent to amputation of the great toe. The pertinent medical treatment evidence of record does not show that the Veteran had undergone an operation with resection of the metatarsal head for his right or left hallux valgus. It also does not contain any competent evidence showing that the right or left hallux valgus was severe and equivalent to amputation of the great toe at any time during the relevant rating period. The Veteran was provided a VA foot conditions examination in October 2016. The VA examiner reviewed the record, interviewed and examined the Veteran. At the examination, he did not report pain in his feet or that flare-ups impact the function of his feet. Physical examination was unremarkable. The examiner opined that the Veteran did not have symptoms due to the bilateral hallux valgus, had not had surgery for the disabilities, and did not have functional loss attributable to the disabilities. The Board finds that the Veteran was not entitled to a compensable rating for his service-connected bilateral hallux valgus. The record does not show, and the Veteran had not contended, that he had a resection of the metatarsal head of either foot. In addition, there is no probative evidence of record reflecting that the symptoms relating to the bilateral hallux valgus was severe and equivalent to amputation of the great toe at any time during the relevant rating period. The October 2016 VA examiner opined that the Veteran did not have any symptoms or functional loss attributable to the bilateral hallux valgus. Therefore, the symptoms did not manifest to a degree that more nearly approximates the criteria for a compensable disability rating for bilateral hallux valgus. See 38 C.F.R. § 4.71a, Code 5280. The Board notes that 38 C.F.R. § 4.71a, Code 5284, provides criteria for ratings of up to 30 percent for “foot injuries, other.” However, when a condition is specifically listed in the Schedule, it may not be rated by analogy. Rather, a condition listed in the Schedule should be rated under the diagnostic code that specifically pertains to it. See Copeland v. McDonald, 27 Vet. App. 333, 338 (2015). Because the Veteran’s service-connected disability of hallux valgus is specifically contemplated under Code 5280, Code 5284 is not for application in this case. Entitlement to a compensable rating for bilateral hearing loss The Veteran was in receipt of a noncompensable rating for bilateral hearing loss. Prior to his death, he indicated that his bilateral hearing loss was worse than contemplated by the disability rating current assigned, and that an increased rating was warranted. Hearing loss is evaluated under 38 C.F.R. §§ 4.85, 4.86, Code 6100, Tables VI, VIA, and VII of VA’s rating schedule. The Rating Schedule provides a table for rating purposes (Table VI) to determine a Roman numeral designation (I through XI) for hearing impairment, established by a state-licensed audiologist, including a controlled speech discrimination test (Maryland CNC), and based upon a combination of the percent of speech discrimination and the pure tone threshold average, which is the sum of the puretone thresholds at 1000, 2000, 3000, and 4000 Hertz divided by four. 38 C.F.R. § 4.85. Table VII is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment of each ear. The horizontal row represents the ear having the poorer hearing and the vertical column represents the ear having the better hearing. Id. Ratings for hearing impairment are derived by the mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345 (1992). There are certain exceptional patterns of hearing impairment. When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, or when the puretone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, the Roman numeral designation for hearing impairment will be determined from either Table VI or Table VIa, whichever results in the higher numeral. Each ear is evaluated separately. 38 C.F.R. § 4.86. In Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007), the Court of Appeals for Veterans Claims (Court) held that, in addition to providing objective test results, a VA audiological examination report must address the functional effects caused by a hearing disability because an extraschedular rating under 38 C.F.R. § 3.321(b) “does not rely exclusively on objective test results to determine whether a referral for an extraschedular rating is warranted.” The Court also noted that VA’s policy requiring VA audiologists to describe the effect of a hearing disability on occupational functioning and daily activities facilitates extraschedular determinations by requiring VA audiologists to provide such information. Martinak, 21 Vet. App. at 455. Historically and pursuant to the April 2001 Board decision, the Veteran was awarded service connection for bilateral hearing loss with a noncompensable rating assigned. He subsequently disagreed with the rating assigned. During the November 2001 VA audiological evaluation, puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 45 50 50 50 60 LEFT 55 65 55 45 65 Utilizing the numbers set forth above, the examiner found that the Veteran’s average right ear decibel loss was 52.5dB and left ear decibel loss was 57.5dB. See November 2001 VA examination report, p.3. The Maryland CNC word list showed 96 percent speech discrimination in the right ear and 100 percent speech discrimination in the left ear. The examiner indicated that the bilateral hearing loss had an impairment on the ordinary conditions of daily life, as the Veteran reported he had difficulty in listening environments. During July 2008 VA audiological evaluation, the Veteran reported that his hearing loss disability made it difficult to communicate with family and others. Puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 25 30 40 60 85 LEFT 25 35 45 50 70 Utilizing the numbers set forth above, the examiner found that the Veteran’s average right ear decibel loss was 54dB and left ear decibel loss was 50dB. See July 2008 VA examination report, p.3. The Maryland CNC word list showed 94 percent speech discrimination in the right ear and 92 percent speech discrimination in the left ear. During January 2015 VA audiological evaluation, the Veteran reported that his hearing loss disability made it difficult to communicate with family and others. He indicated that he must continually ask people to repeat themselves. Puretone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 15 15 15 35 LEFT 15 25 25 10 30 Utilizing the numbers set forth above, the examiner found that the Veteran’s average right ear decibel loss was 20dB and left ear decibel loss was 23dB. See January 2015 VA examination report, p.1. The Maryland CNC word list showed 96 percent speech discrimination each in both ears. Utilizing Table VI listed in 38 C.F.R. § 4.85, the above audiological findings show Level I hearing acuity in the right ear and Level I-II hearing acuity in the left ear. Using Level I hearing and Level I or II hearing under Table VII in 38 C.F.R. § 4.85, these findings warrant a 0 percent rating. Based on the results of the audiological evaluation discussed above, and in the absence of any additional medical evidence showing a more severe hearing disability, the hearing loss has not approximated the criteria for a compensable (10 percent) evaluation at any time during this appeal. Although the Board sympathizes with the Veteran’s belief that he should have been assigned a compensable rating on the basis that his hearing loss had increased in severity, the Board has no discretion in this matter and must predicate its determination based on the results of the audiology studies of record. Thus, the assignment of a compensable rating is not warranted. Although the Veteran was competent to report that he had difficulty hearing, was not competent to report that his hearing acuity was of sufficient severity to warrant increased compensation under VA’s tables for rating hearing loss disabilities because such an opinion requires medical expertise (training in evaluating hearing impairment), which he had not been shown to have. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Despite the foregoing, the Board acknowledges the Veteran’s past reports regarding the severity of his bilateral hearing loss, to include difficulty with communication. After considering such contentions as to the effects of the disability on his daily life, the Board finds that the criteria for additional compensation other than that to which he was found to be entitled to above are not met. Entitlement to a rating more than 10 percent for tinnitus Under Code 6260, recurrent tinnitus warrants a maximum 10 percent rating. See also Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006) (holding that 38 C.F.R. § 4.25(b) and Code 6260 limits a veteran to a single disability rating for tinnitus, regardless whether the tinnitus is unilateral or bilateral). Prior to the Veteran’s death, he indicated that an increased rating for tinnitus was warranted. In this case, the disability was assigned the maximum schedular rating available. 38 C.F.R. §4.87, Code 6260. There is thus no legal basis upon which to award more than a single 10 percent schedular rating and the appeal as to this claim must be denied as a matter of law. Sabonis v. Brown, 6 Vet. App. 426 (1994). Entitlement to a rating more than 10 percent for sliding hiatal hernia with associated GERD with noncardiac chest pain Prior to his death, the Veteran requested an increased rating for his service-connected hiatal hernia disability. An October 2016 rating decision continued the 10 percent rating. The Veteran’s disability is rated under Code 7346, which rates hiatal hernia. Code 7346 provides a 60 percent evaluation for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia, or other symptom combinations productive of severe impairment of health. A 30 percent evaluation is warranted when there is persistently recurrent epigastric distress with dysphasia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 10 percent evaluation when the evidence shows two or more of the symptoms for the 30 percent evaluation of less severity. 38 C.F.R. § 4.114. The VA Schedule for Rating Disabilities provides that there are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress, or pain, anemia and disturbances in nutrition. Thus, certain coexisting diseases of the digestive system do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in section 4.14. 38 C.F.R. § 4.113. Ratings under Codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.114. The pertinent evidence includes an October 2016 VA examination. During the October 2016 VA examination, the Veteran denied any current signs or symptoms regarding his GERD/hernia disability. Evidence during the appeal period, including the October 2016 VA exam findings, only support a 0 percent evaluation for this condition. Thus, the Veteran’s GERD/hernia disability for the increased rating period did not more nearly approximate the criteria for a higher rating of 30 percent under Code 7346. Additionally, there was no probative evidence of stricture, spasm, or diverticulum of the esophagus, thus, a rating under Codes 7203, 7204, or 7205 is not warranted. 38 C.F.R. § 4.114. Other Considerations Neither the appellant nor her representative has raised any other issues regarding the rating for the service-connected disabilities, nor have any other such issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017). The Board therefore concludes that the criteria for entitlement to increased ratings have not been met at any time during the rating period. Accordingly, there is no basis for staged rating of the Veteran’s service-connected disabilities, and increased ratings must be denied. As the preponderance of the evidence is against the assignment of increased ratings, the benefit-of-the-doubt doctrine is not for application, and the claims must be denied. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. McPhaull, Counsel