Citation Nr: 18149308 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 15-25 568 DATE: November 9, 2018 ORDER As new and material evidence was not received, the request to reopen a claim for entitlement to service connection for a mental disorder (claimed as anxiety), including as secondary to service connected foot disabilities, is denied. Entitlement to a rating in excess of 10 percent for plantar fasciitis with achilles tendonitis, right associated with bilateral pes planus is denied. Entitlement to a rating in excess of 10 percent for plantar fasciitis with achilles tendonitis, left associated with bilateral pes planus is denied. Entitlement to a compensable rating for left foot second digit claw toe, status post surgical correction associated with bilateral pes planus is denied. Entitlement to a compensable rating for left fifth hammer toe deformity associated with bilateral pes planus is denied. REMANDED Entitlement to a compensable rating for Tailor’s bunion left foot associated with bilateral pes planus is remanded. FINDINGS OF FACT 1. In a final October 2008 rating decision, the RO denied the Veteran’s claim for entitlement to service connection for a mental disorder (claimed as depression and previously claimed as stress and anxiety), including as secondary to service-connected foot disabilities. 2. The evidence received since the October 2008 rating decision is either cumulative or redundant of the evidence of record and is not so significant that it must be considered in order to fairly decide the merits of the claim for entitlement to service connection for a mental disorder, including as secondary to service-connected foot disabilities. 3. Throughout the period on appeal, the Veteran’s right foot plantar fasciitis achilles tendonitis associated with bilateral pes planus has more closely approximated a moderate foot injury; a moderately severe or severe injury was not shown. 4. Throughout the period on appeal, the Veteran’s left foot plantar fasciitis achilles tendonitis associated with bilateral pes planus has more closely approximated a moderate foot injury; a moderately severe or severe injury was not shown. 5. Throughout the period on appeal, the Veteran has not been shown to have hammer toes of all toes, without claw foot. CONCLUSIONS OF LAW 1. The October 2008 rating decision denying the Veteran’s claims for entitlement to service connection for a mental disorder, including as secondary to service-connected foot disabilities, is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1100. 2. Evidence received since the October 2008 denial is not new and material; hence, the criteria for reopening the claim for entitlement to service connection for mental disorder, including as secondary to service-connected foot disabilities, have not been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for a rating in excess of 10 percent for right foot plantar fasciitis with achilles tendonitis associated with bilateral pes planus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Code (DC) 5284. 4. The criteria for a rating in excess of 10 percent for left foot plantar fasciitis with achilles tendonitis associated with bilateral pes planus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.71a, DC 5284. 5. The criteria for a compensable rating for claw toe of the left foot second digit have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.3, 4.71a, DC 5282. 6. The criteria for a compensable rating for hammer toe of the left foot fifth digit have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.3, 4.71a, DC 5282. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1984 to November 1984. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an January 2013 rating decision. New and Material Evidence Historically, a November 2006 rating decision denied a claim for service connection for stress/anxiety on the basis that there was no evidence linking the Veteran’s stress/anxiety to his service-connected foot disabilities nor was there any evidence linking his stress/anxiety to his active duty service. An October 2008 rating decision denied service connection for depression (previously claimed as anxiety/stress), including as secondary to the Veteran’s service connected foot disabilities as there was no evidence establishing that the Veteran’s mental disorder was incurred in or caused by his active duty service or that there was a link between the Veteran’s mental disorder and his service connected foot disabilities. The Veteran did not appeal these decisions and they are now final. 38 U.S.C. § 7105. In September 2010, the Veteran sought service connection for anxiety as secondary to his service connected foot disabilities. VA may reopen and review a claim that has been previously denied if new and material evidence is submitted by or on behalf of a Veteran. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a); Hodge v. West, 155 F. 3d 1356 (Fed. Cir. 1998). The Board must consider the question of whether new and material evidence has been received because it goes to the Board’s jurisdiction to reach the underlying claim and adjudicate the claim de novo. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). If the Board finds that no new and material evidence has been offered, that is where the analysis must end. Butler v. Brown, 9 Vet. App. 167 (1996). New evidence is evidence not previously submitted to agency decision makers. Material evidence is 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 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). In determining whether new and material evidence has been received, VA must initially decide whether evidence associated with the claims file since the prior final denial is new. That analysis is undertaken by comparing newly received evidence with the evidence previously of record. After evidence is determined to be new, the next question is whether it is material. The Board must review all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. Evans v. Brown, 9 Vet. App. 273 (1996). For purposes of determining whether new evidence is material, the credibility of the new evidence is presumed. Justus v. Principi, 3 Vet. App. 510 (1992). New and material evidence is not required as to each previously unproven element of a claim. Shade v. Shinseki, 24 Vet. App. 110 (2010). The Board notes that its task is to first decide whether new and material evidence has been received, as opposed to whether the evidence actually substantiates the Veteran’s claim. Pertinent evidence added to the record regarding the Veteran’s claim for a mental disorder since the final October 2008 RO decision includes the Veteran’s statements, a VA examination, VA medical records, and copies of the Veteran’s service treatment records (STRs), which were previously of record. An April 2010 VA medical center (VAMC) record showed the Veteran to have reported feeling stressed due to his daughter losing her disability benefits and his being under financial stress. An April 2011 VAMC record showed the Veteran to have stated that he was stressed due to fighting with VA regarding his disability. He reported his depression began in the 1990’s after having a difficult time with the Post Office after a shoulder injury. He stated he has good and bad days waiting on a decision from VA. He denied symptoms of anxiety, but stated that he was frustrated regarding his claim. An October 2012 private medical record showed the Veteran to have denied any history of anxiety or depression. A subsequent October 2012 private medical record showed the Veteran to have been found to have no diagnosis or symptoms of depression. In December 2012, a VA examination determined that the Veteran had a diagnosis of adjustment disorder with mixed anxiety and depressed mood. The VA examiner stated that the Veteran’s mental health disorder was less likely than not related to his service connected foot disabilities as his prior diagnosis linked his mental health disorders to non-service connected disabilities and legal issues. The examiner found that there was no mention of the Veteran’s service connected foot disabilities being a factor contributing to his depression in his prior treatment and no evidence of aggravation found in his treatment records due to his service connected disabilities. The examiner found that the Veteran was not significantly depressed or anxious at the time of the examination and there was no objective evidence to support the claim of aggravation due to his service connected disabilities as records indicated the Veteran was worried about financial problems. As stated above, the prior October 2008 final rating decision denied the Veteran’s claims for service connection for a mental health disorder (claimed as depression, stress and/or anxiety), including as secondary to his service connected foot disabilities, on the basis that there was no evidence of record linking the Veteran’s disorder to either his active duty service or his service connected foot disabilities. Based on the foregoing, the Board finds that none of the evidence obtained and made a part of the record since the final October 2008 decision established that the Veteran’s diagnosed mental health disorders were either related to his active service or aggravated by his service connected foot disabilities. Indeed, the newly admitted medical evidence showed that the Veteran’s primary concerns regarding his mental health stemmed from financial issues or his dealings with VA in regard to his disability claims. Neither his active duty service nor his service connected foot conditions were mentioned or discussed in regard to his mental health treatment. Thus, while the VA records, private medical records, and the Veteran’s statements are new, they are not material as there is no information contained in them that indicates that the Veteran’s mental health disorders were incurred in or as a result of the Veteran’s active duty service or aggravated by his service connected foot disabilities. The Board finds, then, that the new evidence associated with the claims file since the October 2008 rating decision does not relate to any unproven element of the previously denied claims for service connection for a mental health disorder, including as secondary to service-connected foot disabilities. Accordingly, the Board finds that new and material evidence has not been submitted and the claim for service connection for a mental health disorder (claimed as stress), including as secondary to service connected foot disabilities, are not reopened. Annoni v. Brown, 5 Vet. App. 463 (1993). Increased Ratings Disability ratings are determined by application of the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular Diagnostic Code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Board notes that where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. Factual Background In March 2011, the Veteran sought an increase for his service connected left foot disabilities as well as for plantar fasciitis of his right foot. In addition to the aforementioned right foot plantar fasciitis, the Veteran is service connected for left foot plantar fasciitis, claw toe of the second digit of the left foot, and hammertoe of the fifth digit of the left foot. February 2011 VAMC records show that the Veteran underwent surgery on the fifth digit of his left foot. It was noted that his left fifth toe was stable and healed clinically. In May 2011, a VA examination of the Veteran’s feet indicated that he wore orthotics for his bilateral plantar fasciitis. Upon examination, there was no evidence of swelling, tenderness, instability, weakness, or abnormal weight bearing. There was objective evidence of painful motion and the Veteran reported tenderness with full flexion of the toes. In March 2011, a VAMC record showed the Veteran reported no pain in his left fifth toe. In April 2012, a VA examination of the Veteran’s feet indicated that he reported foot pain with standing and walking and at rest. In May 2012, a private medical record indicated the Veteran presented with a painful lump in his left foot and pain on the outside of his left foot. Foot radiographs showed no spurring or fracture of the fifth metatarsal base. An August 2012 private medical record showed the Veteran to have undergone an injection in his left foot. In September 2012, a private medical examination indicated the Veteran presented with a history of left foot pain. A concurrently performed MRI showed normal findings with midfoot plantar fibroma. It was noted that the injection did not help his foot pain. In November 2014, a private medical record showed the Veteran to have undergone surgery on the fifth toe of his left foot. He was shown to have a post-operative diagnosis of left fifth toe hammertoe. He reported post-surgery that his foot hurt in the surgical area and he was provided a post-operative boot to wear at all times. In March 2015, a VA examination determined that the Veteran had hammertoe of the left fifth toe. His toe was noted to be mildly tender to palpation. His status was noted to be post-surgical. He was also found to have plantar fasciitis and achilles tendonitis of the bilateral feet. The foot condition was noted to be asymptomatic and there was no objective evidence of pain upon palpation of the heel with passive dorsiflexion of the toes. No tightness of the achilles tendon was noted. The Veteran’s plantar fasciitis did not chronically compromise weightbearing and did not require arch supports, custom orthotic inserts, or shoe modifications. In March 2017, a VA examination found the Veteran to have bilateral plantar fasciitis. He reported that his toes would lock at night, he used medication for pain, occasionally used a cane for pain, and that his left foot hurt more than his right. The examiner found the Veteran’s plantar fasciitis to be a foot injury or foot condition which was moderate and affected both the right and left foot. The foot condition required arch supports, custom orthotic inserts, or shoe modifications, but the Veteran reported that supports did not help. The Veteran’s pain was found to be present with weightbearing, caused disturbance of locomotion, and interfered with standing. Diagnostic testing did not show degenerative or traumatic arthritis. Plantar fasciitis The Veteran’s bilateral plantar fasciitis was assigned a 10 percent rating for his right foot pursuant to DCs 5099-5024 and 10 percent for his left foot pursuant to DCs 5299-5024 since the February 2009 grant of service connection. 38 C.F.R. § 4.71a. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. The additional code is shown after a hyphen. Regulations provide that when a disability not specifically provided for in the rating schedule is encountered, it will be rated under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. Pursuant to 38 C.F.R. § 4.27, unlisted disabilities requiring rating by analogy will be coded with the first two numbers of the schedule provisions for the most closely related body part and “99.” The Veteran sought an increase in the rating for his right and left foot plantar fasciitis in March 2011. As plantar fasciitis is not a listed condition under the rating criteria, it has been rated by analogy under DC 5024, which provides that a disability will be rated on limitation of motion of the affected parts, as arthritis, degenerative. The assignment of a particular diagnostic code is “completely dependent on the facts of a particular case.” Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the diagnosis, and the demonstrated symptomatology. See Id. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings, nor will ratings assigned to organic disease and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. Any change in a diagnostic code by a VA adjudicator must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Where a different Diagnostic Code more appropriately reflects the nature of the Veteran’s disability picture, and the change does not reduce the Veteran’s level of compensation, the Board has the authority to change the assigned Diagnostic Code. See Butts, 5 Vet. App. at 539. Thus, based on the foregoing, the Board finds that the Veteran’s right and left foot plantar fasciitis is more accurately reflected by ratings under a Diagnostic Code relating to injuries of the foot, DC 5284, as the evidence demonstrates that the Veteran’s right and left foot plantar fasciitis has, as evidenced by his medical treatment, specifically his March 2017 VA examination, resulted in an analogous foot injury. Additionally, the Board finds that Diagnostic Code 5284 is more appropriate and more favorable for rating the service-connected right and left foot plantar fasciitis because Diagnostic Code 5284 specifically provides subjective and objective rating criteria for the type of injury, contemplates multiple foot diagnoses, symptomatology, and functional impairment resulting from foot injuries rather than the more specific criteria for limitation of motion for degenerative arthritis, which has not been reported in the Veteran’s medical treatment for his right or left foot plantar fasciitis. As the right and left foot plantar fasciitis disability picture discussed above squarely fits within the criteria under Diagnostic Code 5284 for the entire appeal period, this is the most appropriate diagnostic code under which to rate the right and left plantar fasciitis disabilities on appeal and is more favorable to the Veteran in this case. Accordingly, the Board will address the Veteran’s service-connected right and left foot plantar fasciitis disability pursuant to DC 5284. Diagnostic Code 5284 provides a 10 percent rating for impairment of moderate degree, a 20 percent rating for moderately severe impairment, and a 30 percent rating for severe impairment. 38 C.F.R. § 4.71a. Based on the symptomatology, diagnoses, and relevant medical history approximated to a moderate disability of each foot, which warrants a 10 percent rating under DC 5284 for each foot for the entire period on appeal. Thus, a rating in excess of the Veteran’s current 10 percent disability for each foot is denied. The Board observes that the words “slight,” “moderate,” and “severe,” are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. It should also be noted that use of terminology such as “slight” and “moderate” by VA examiners or other physicians, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Throughout the period on appeal, the Veteran has had complaints of pain when walking and standing. He has had reported use of orthotic inserts without relief of pain. However, his May 2011 VA examination found no evidence of swelling, tenderness, instability, weakness, or abnormal weight bearing, and his March 2017 VA examination specifically found that his right and left foot plantar fasciitis was a moderate disability. Thus, considering the pain and impediment that the Veteran undergoes with his right and left foot plantar fasciitis, the Board finds that the criteria for a 10 percent rating each for the Veteran’s right and left plantar fasciitis under DC 5284 is warranted. The Board also finds that the criteria for a 20 or 30 percent rating under DC 5284 is not supported by the evidence of record and have not been met or more nearly approximated for the period on appeal for either the Veteran’s right or left foot plantar fasciitis. Even with consideration of pain on use, there is no other symptomology associated by either objective medical evidence or by the Veteran’s subjective reports, to his right and left foot plantar fasciitis and no indication of any evidence which supported a finding that the Veteran’s right or left foot plantar fasciitis more nearly approximated a moderately severe or severe foot disability. Thus, the Board finds that throughout the period on appeal there have been no findings of such symptomology which would more closely approximate a moderately severe or severe foot disability of either the Veteran’s right or left foot. In this regard, there is no indication that the Veteran has lost any degree of his range of motion of either his right or left foot and also no indication that the Veteran lost functionality of the right and left foot, notwithstanding complaints of pain. He has never complained of stiffness, swelling of weakness nor have there been objective findings of such. Accordingly, the findings and evidence failed to demonstrate limitations of function to warrant a rating for a disability more nearly approximating a moderately severe or severe foot injury. The Board has also considered whether a higher rating is warranted under other diagnostic codes for any period. 38 C.F.R. § 4.20. However, the Board notes that the Veteran is service connected for many other disabilities of his right and left feet and no additional findings warrant any ratings under DCs 5276-5283 that have not already been assigned. The Board also finds that there is no basis for the assignment of any higher rating based on consideration of any of the factors addressed in 38 C.F.R. §§ 4.40, 4.45 and DeLuca, 8 Vet. App. at 204-7. Competent medical evidence reflects that the 10 percent rating for each his right and left foot properly compensates him for the extent of functional loss resulting from any such symptoms. The Board finds the numerous VA examiners’ medical opinions highly probative to the issue of the severity of the Veteran’s right and left foot plantar fasciitis. Specifically, the examiners interviewed the Veteran and conducted a physical examination. Moreover, the examiners had the requisite medical expertise and had sufficient facts and data on which to base their conclusions. As such, the Board accords the VA examination opinions great probative weight. The Board has considered the Veteran’s lay testimony. While the Board finds that the Veteran is a lay person and is competent to report observable symptoms he experiences through his senses such pain and stiffness, the Board also finds that the Veteran is a lay person and has not been demonstrated to identify a specific level of disability according to the appropriate diagnostic codes. Layno v. Brown, 6 Vet. App. 465 (1994). The identification of a foot disability requires medical expertise that the Veteran has not shown he possesses. Determining whether the Veteran meets some of the criteria for a higher rating requires medical diagnostic testing. Competent evidence concerning the nature and extent of the Veteran’s right and left plantar fasciitis has been provided by the medical personnel who have examined him during the current appeal and who have made pertinent clinical findings in conjunction with the examination. The medical findings, as provided in the examination reports, directly address the criteria under which his disability is rated. The Board finds that evidence is the most persuasive and outweighs the Veteran’s statements in support of his claim. In sum, the Board finds that a rating in excess of 10 percent for each his right and left foot plantar fasciitis pursuant to DC 5284 for the entire period on appeal is not warranted or supported by the evidence. Accordingly, as the preponderance of the evidence is against the claim for a rating in excess of 10 percent for each his right and left foot plantar fasciitis, the benefit-of-the-doubt rule is not for application, and the claims must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Claw toe & Hammer toe The Veteran’s left foot second digit claw toe and left foot fifth digit hammer toe were assigned a noncompensable rating from the February 2009 grant of service connection under DC 5282. In March 2011, the Veteran sought an increase in the ratings for his left foot toe disabilities. DC 5282 assigns a noncompensable rating for hammer toe, single toes, and a 10 percent rating for all toes, unilateral without claw foot. Based on the foregoing, the Board finds that a compensable rating for the Veteran’s claw toe and hammer toe is not warranted at any time during the period on appeal. The Board notes that the Veteran was provided a 100 percent disability rating during his period of convalescence post-surgery for his left foot fifth digit from November 2014 to February 2015. As such, a higher disability rating during that period is not available. Additionally, the objective evidence of the entirety record has shown that not all of the Veteran’s toes are hammer toes. Indeed, the numerous VA examinations and his private treatment records all show that only the Veteran’s left foot second and fifth toe are affected. As such, the disabilities of the Veteran’s left foot second and fifth toes do not meet the criteria necessary for a compensable rating under DC 5282. The Board has also considered whether a higher rating is warranted under other diagnostic codes for any period. 38 C.F.R. § 4.20. However, as stated above, the Board notes that the Veteran is service connected for many other disabilities of his left foot and no additional findings warrant any ratings under DCs 5276-5283 that have not already been assigned. The Board finds the numerous VA examiners’ medical opinions highly probative to the issue of the severity of the Veteran’s left foot claw and hammer toes. Specifically, the examiners interviewed the Veteran and conducted a physical examination. Moreover, the examiners had the requisite medical expertise and had sufficient facts and data on which to base their conclusions. As such, the Board accords the VA examination opinions great probative weight. The Board has again considered the Veteran’s lay testimony. While the Board finds that the Veteran is a lay person and is competent to report observable symptoms he experiences through his senses such pain and stiffness, the Board also finds that the Veteran is a lay person and has not been demonstrated to identify a specific level of disability according to the appropriate diagnostic codes. Layno v. Brown, 6 Vet. App. 465 (1994). The identification of a foot disability requires medical expertise that the Veteran has not shown he possesses. Determining whether the Veteran meets some of the criteria for a higher rating requires medical diagnostic testing. Competent evidence concerning the nature and extent of the Veteran’s left foot claw and hammer toes has been provided by the medical personnel who have examined him during the current appeal and who have made pertinent clinical findings in conjunction with the examination. The medical findings, as provided in the examination reports, directly address the criteria under which his disability is rated. The Board finds that evidence is the most persuasive and outweighs the Veteran’s statements in support of his claim. In sum, the Board finds that a compensable rating for each his left foot second digit claw toe and fifth digit hammer toe is not warranted or supported by the evidence of record for the entire period on appeal. Accordingly, as the preponderance of the evidence is against the claim for a compensable rating for each his left foot second digit claw toe and fifth digit hammer toe, the benefit-of-the-doubt rule is not for application, and the claims must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; REASONS FOR REMAND As stated above, the Veteran underwent an examination of his left foot in March 2017. However, the examination failed to provide any evidence regarding or assessment of the severity of his Tailor’s bunion of the left foot. As such, the Board finds the March 2017 VA examination inadequate for adjudication purposes in regard to the Veteran’s Tailor’s bunion of the left foot. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). When an examination is inadequate, the Board must remand the case for further development. Bowling v. Principi, 15 Vet. App. 1 (2001), 38 C.F.R. § 4.2. Accordingly, this matter is REMANDED for the following actions: (Continued on the next page)   Schedule the Veteran for a VA examination to determine the current nature and severity of his left foot Tailor’s bunion. The claims file must be made available to and be reviewed by the examiner. Any indicated evaluations, studies, and tests must be conducted. All pertinent symptomatology and findings must be reported in detail, and in accordance with the VA rating criteria. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Parrish, Associate Counsel