Citation Nr: 18150562 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-28 418 DATE: November 15, 2018 ORDER Entitlement to service connection for degeneration of lumbar or lumbosacral intervertebral disc (hereinafter back condition) is denied. Entitlement to an effective date prior to May 8, 2012, for the grant of service connection for major depressive disorder (MDD) with psychosis and anxiety (hereinafter MDD) disorder is denied. Entitlement to an effective date prior to September 12, 2011, for the assignment of the increased 20 percent evaluation for chronic right trapezius strain with neck pain is denied. Entitlement to a rating in excess of 20 percent for degenerative joint disease (DJD), right shoulder is denied. Entitlement to a rating in excess of 20 percent prior March 31, 2016 and in excess of 10 percent therefrom for chronic right trapezius strain with neck pain is denied. Entitlement to an initial rating in excess of 70 percent for major depressive disorder (MDD) is denied. REMANDED Entitlement to service connection for bilateral knee pain is remanded. Entitlement to service connection migraine headaches is remanded. FINDINGS OF FACT 1. The Veteran’s current back condition did not have its onset during active service, did not manifest within one year of separation from active service, and is not otherwise caused by active service. 2. The Veteran filed a claim for an increased rating for chronic right trapezius strain with neck on September 12, 2011, and his condition is not shown to have increased in severity during the one-year period prior to that date. 3. The Veteran submitted a claim for service connection for MDD on May 8, 2012. 4. At the time of receipt of the May 8, 2012 claim, the was no pending or otherwise unadjudicated claim for entitlement to service connection for MDD. 5. The Veteran’s DJD, right shoulder has been manifested primarily by continuing complaints or pain; forward flexion from zero to 155 degrees; abduction from 115 degrees to zero; and limited functional ability with repeated use over a period of time. 6. Prior to March 31, 2016, the Veteran’s chronic right trapezius strain with neck with damage to Muscle Group XXII is shown to have resulted in no more than a moderately severe disability. 7. From March 31, 2016 the Veteran’s chronic right trapezius strain with neck with damage to Muscle Group XXII is shown to have resulted in no more than a moderate disability. 8. The Veteran’s MDD did not result in manifestations that most nearly approximate total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for service connection for a back condition have not been met. 38 U.S.C. §§ 1112, 1113, 1131, 5107; 38 C.F.R. § 3.303, 3.307, 3.309. 2. The criteria for an effective date earlier than September 12, 2011, for the grant of service connection for chronic right trapezius strain with neck pain have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 3. The criteria for an effective date earlier than May 8, 2012, for the grant of service connection for MDD have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 4. The criteria for a rating in excess of 20 percent for DJD, right shoulder have not been met. 38 U.S.C. §§ 1155, 5103, 5103A; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Codes (DCs) 5201-5203. 5. The criteria for a rating in excess of 20 percent for service-connected chronic right trapezius strain with neck, prior to March 31, 2016 and in excess of 10 percent therefrom, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.56, 4.73, DCs 5301-5237. 6. The criteria for an initial rating in excess of 70 percent for MDD have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.126, 4.130, DC 9434. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1981 to November 1983. In a June 2016 rating decision, the agency of original jurisdiction (AOJ) granted entitlement to a total disability rating based on individual unemployability (TDIU). Therefore, as the issue has been granted in full, it is not before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). 1. Entitlement to service connection for degeneration of lumbar or lumbosacral intervertebral disc Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C. §§ 1110, 1131. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Alternately, service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. Certain chronic diseases, including arthritis, may be service connected if manifested to a degree of 10 percent disabling or more within one year after separation from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. A layperson is competent to report on the onset and continuity of his or her current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency (“a legal concept determining whether testimony may be heard and considered”) and credibility (“a factual determination going to the probative value of the evidence to be made after the evidence has been admitted”). When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). Analysis The Veteran contends that his low back disability is due to his military service. The Veteran has a current diagnosis of degeneration of lumbar or lumbosacral intervertebral disc. As such, element one under Shedden is met. The Veteran’s service treatment records (STRs) do not document complaints, treatments, or diagnosis of a back condition. During his July 1981 Report of Medical History: Enlistment examination, the Veteran’s spine and other musculoskeletal system were normal. There is no separation examination of record. In December 2007, the Veteran was seen for chronic back pain. X-rays revealed mild posterior disc space narrowing at L3-L4. In February 2010, he was diagnosed with hypertrophic and degenerative changes of the lumbar spine with retrolisthesis of L4 over L5 over S1. Based on the evidence of record, the Board finds that service connection for a back condition is not warranted. The Veteran’s STRs do not document complaints, treatments, or diagnosis for a back condition. The first medical evidence of the condition was in 2007, i.e., over 24 years after his discharge from active service. The fact that there were no records of any complaints or treatments involving the Veteran’s back condition for many years weighs against the claim. See Maxson v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (it was proper to consider the veteran’s entire medical history, including a lengthy period of absence of complaints). Regarding presumptive service connection, the Board finds that service connection for the Veteran’s back condition on a presumptive basis is not warranted as the record does not show evidence of back degeneration or a back condition within one year of the Veteran’s separation from active duty. As mentioned above, the first competent evidence suggestive of a back condition was in 2007, i.e., over 24 years after his discharge from service. As there is no competent evidence that the disability manifested to a compensable degree within one year of his active service and was not continuous since service, a presumption of service connection under 38 C.F.R. §§ 3.307, 3.309 is not warranted. The Board has considered the Veteran and his representative’s statements regarding the etiology of the Veteran’s back condition. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, a nexus between the back condition and service, is outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). The Board notes that the Veteran has not been afforded a VA examination for his back condition; however, an examination is not warranted as the duty to assist has not been triggered. See McClendon v. Nicholson, 20 Vet. App. 79 (2006); 38 C.F.R. § 3.159(c)(4). Although McClendon sets a low bar, that bar has not been met here as there is no credible indication of a link between the Veteran’s current condition and his active service. The only evidence of a possible connection between the Veteran’s current disability and his service are the Veteran and his representative’s own broad and conclusory statements that the condition is related to service. In the absence of a nexus, the claim for service connection for back condition is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in the instant appeal. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107(b). Effective Date The statutory guidelines for the determination of an effective date of an award are set forth in 38 U.S.C. § 5110. Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after a final disallowance, or a claim for increase will be the date of receipt of the claim, or the date entitlement arose, whichever is the latter. 38 C.F.R. § 3.400. In cases involving direct service connection, the effective date will be the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service. Otherwise, the effective date will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i). For a claim for increased rating, if the increase is factually ascertainable within one year prior to the receipt of the claim, the rating will be effective as of the date of increase; however, if the increase occurred more than one year prior to receipt of the claim, the increase will be effective on the date of claim. Further, if the increase occurred after the date of claim, the effective date will be the date of increase. 38 U.S.C. § 5110(b)(2); Harper v. Brown, 10 Vet. App. 125 (1997); 38 C.F.R. § 3.400(o)(1), (2); VAOPGCPREC 12- 98 (1998). VA amended its adjudication regulations on March 24, 2015, to require that all claims governed by VA’s adjudication regulations be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The amendments, however, are only effective for claims and appeals filed on or after March 24, 2015. Under the old regulations, any communication or action, indicating an intent to apply for one or more benefits under laws administered by VA, from a claimant or the claimant’s representative, may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155(a) (in effect prior to March 24, 2015). There is no set form that an informal written claim must take. All that is required is that the communication indicates an intent to apply for one or more benefits under the laws administered by VA, and identify the benefits sought. Rodriguez v. West, 189 F.3d 1351 (1999). Case law is clear that this means the claimant must describe the nature of the disability for which he is seeking benefits, such as by describing a body part or symptom of the disability. Brokowski v. Shinseki, 23 Vet. App. 79, 86-87 (2009). 2. Entitlement to an effective date prior to May 8, 2012, for the grant of service connection for MDD The Veteran contends that he is entitled to an effective date earlier than May 8, 2012 for the grant of service connection for MDD. In May 2012, the Veteran submitted a claim for service connection for depression/anxiety. In October 2013, the AOJ granted service connection for MDD and assigned a 70 percent rating effective May 8, 2012. The Veteran filed a Notice of Disagreement (NOD) disagreeing with the award assigned and the effective day. The Board finds that an effective dated earlier than May 8, 2012 for the grant of service connection for MDD is not warranted. The Veteran separated from active service in November 1983 and no claim for MDD was received within one year of separation. As such, service connection for MDD may not date back to the day after separation from active duty. In Servello v. Derwinski, 3 Vet. App. 196, 198 (1992), the United States Court of Appeals for Veterans Claims (Court) addressed the issue of entitlement to an earlier effective date and pointed out that the applicable statutory and regulatory provisions require that the Board look to all communications in the file that may be interpreted as applications for claims, formal and informal, for VA benefits and, then, to all other evidence of record to determine the “earliest date as of which” disability is ascertainable. 38 U.S.C. § 5110(b)(2); see also 38 C.F.R. §§ 3.400(o)(2); 3.155(a); Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). In this case, the Veteran’s claims folder contains no document or writing, formal or informal, showing that a claim for service connection for MDD was received prior to May 8, 2012. The law regarding effective dates is clear. The effective date of an award of compensation will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. Here, the claim for MDD received on May 8, 2012 is the later of the two events giving rise to the grant of service connection. Therefore, an earlier effective date for the grant of service connection for MDD must be denied. Accordingly, the Veteran is not entitled to an effective date earlier than the date of his May 8, 2012 claim. 38 C.F.R. § 3.400(o)(1)(2). For the reasons discussed above, the preponderance of the evidence is against the Veteran’s claim. As such, the benefit of the doubt doctrine is inapplicable, and the claim must be denied. See 38 C.F.R. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to an effective date earlier than September 11, 2011 for the assignment of the increased 20 percent evaluation for chronic right trapezius strain with neck pain The Veteran seeks an effective date earlier than September 11, 2011, for the award of the 20 percent increased evaluation for the service-connected chronic right trapezius strain with neck pain (previously neck and shoulder pain). In August 1987, the Veteran filed a claim for service connection for neck and shoulder pain. In December 1987, the AOJ granted service connection for chronic right trapezius strain with neck and assigned a noncompensable rating effective August 31, 1987. The Veteran did not disagree with the December 1987 rating decision, and it became final. 38 U.S.C. § 7105(b); 38 C.F.R. § 3.104. In February 1996 and September 2007, the Veteran filed claims for increased rating for his chronic right trapezius strain with neck pain. In March 1996 and May 2008 rating decisions, the AOJ continued the noncompensable rating. The Veteran did not disagree with rating decisions, and they became final. Id. In April 2009, the Veteran filed a claim for increased rating for his chronic right trapezius strain with neck pain. In a September 2009 rating decision, the AOJ increased the rating to 10 percent effective September 18, 2007. The Veteran did not disagree with the rating decision, and it became final. Id. In September 2011, the Veteran called in to file a claim for increased rating for his chronic right trapezius strain with neck pain. However, the AOJ did not adjudicate the Veteran’s claim. In May 2012, the Veteran filed another claim for increased rating for his chronic right trapezius strain with neck pain. In an October 2013 rating decision, the AOJ increased the Veteran’s rating to 20 percent effective May 8, 2012, the date the claim was received. In May 2014, the Veteran filed a notice of disagreement disagreeing with, among other things, the effective date assigned. In a June 2016 rating decision, the AOJ awarded an earlier effective date of September 12, 2011, the date the claim for increase was received but not adjudicated. Because the September 2009 rating decision became final, the effective date for an increased rating in this case is the earliest date as of which it is factually ascertainable based on all evidence of record that an increase in disability occurred if a claim is received within one year from such date; otherwise, the effective date for increased rating is the date of receipt of the claim for increase. 38 U.S.C. § 5110 (b)(2); 38 C.F.R. § 3.400(o)(2); Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010). After review of all the lay and medical evidence, the Board finds that the Veteran’s September 12, 2011, informal claim for an increased evaluation constituted the earliest claim for an increased disability rating. This was the earliest communication received after the final September 2009 rating decision that could be construed as a new formal or informal claim for an increased disability rating for the service-connected connected chronic right trapezius strain with neck pain. Moreover, neither the Veteran nor his representative has argued that the Veteran filed a claim for increase prior to September 12, 2011. As noted above, an earlier effective date may be warranted if there was a factually ascertainable increase in disability in the one-year period prior to the date the claim was received. The Board finds that the weight of the evidence does not show that the increase in the Veteran’s chronic right trapezius strain with neck pain occurred during the one-year period prior to the date of the present claim. The Veteran’s disability is rated under DCs 5237-5301. The Veteran’s treatment records note complaints and treatment for shoulder and neck pain. However, the available records do not directly address the rating criteria. Therefore, the appropriate effective date for the award of a 20 percent increased evaluation for the chronic right trapezius strain with neck pain, is September 12, 2011, the date of the increased rating claim for chronic right trapezius strain with neck pain. Accordingly, the Veteran is not entitled to an earlier effective date prior to the date of his claim on September 12, 2011. 38 C.F.R. § 3.400(o)(1)(2). For the reasons discussed above, the preponderance of the evidence is against the Veteran’s claim. As such, the benefit of the doubt doctrine is inapplicable, and the claim must be denied. See 38 C.F.R. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Rating Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which allows for ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. To evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of a Veteran’s condition. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where the question for consideration is the propriety of the initial rating assigned, evaluation of the evidence since the effective date of the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). 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 this decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to a rating in excess of 20 percent for DJD, right shoulder The Veteran’s DJD, right shoulder disability is rated in accordance with 38 C.F.R. § 4.71a, DC 5201-5203. Hyphenated DCs are used when a rating under one code requires use of an additional DC to identify the basis for the rating assigned. 38 C.F.R. § 4.27. The assignment of a particular DC is “completely dependent on the facts of a particular case.” See Butts v. Brown, 5 Vet. App. 532, 538 (1993). Diagnostic Code 5201, relating to limitation of motion of the arm, provides a minimum rating of 20 percent disabling where motion of the arm is limited to shoulder level (and a non-compensable rating for motion of the arm greater than shoulder level). A maximum 40 percent evaluation is warranted for limitation of motion of the arm to 25 degrees from side. 38 C.F.R. § 4.71a. Diagnostic Code 5203 provides ratings for other impairment of the clavicle or scapula. Malunion of the clavicle or scapula is rated as 10 percent for the major shoulder. Nonunion of the clavicle or scapula without loose movement is rated as 10 percent for the major shoulder; nonunion of the clavicle or scapula with loose movement is rated as 20 percent for the major shoulder. Dislocation of the clavicle or scapula with loose movement is rated as 20 percent for the major shoulder. Diagnostic Code 5203 provides an alternative rating based on impairment of function of the contiguous joint. 38 C.F.R. § 4.71a. For rating purposes, a distinction is made between major (dominant) and minor musculoskeletal groups. Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. 38 C.F.R. § 4.69. The record indicates that the Veteran is right-hand dominant; thus, his service-connected right shoulder disability involves his major extremity. Analysis The Veteran contends that his right shoulder condition is worse than the 20 percent rating depicts. From October 2011, the Veteran was treated at the Augusta Uptown Division. He received treatment for chronic shoulder pain. In September 2013, the Veteran was afforded a VA examination to determine the severity of his right shoulder condition. The Veteran stated that symptoms began in 1982. Since onset, the condition has gotten worse. His right shoulder pain is 6/10 with movement. He stated that rest alleviates the pain. His right shoulder is normal. The examiner confirmed the Veteran’s right shoulder DJD diagnosis. The Veteran is right hand dominant. He reported flare-ups that limited movement with he attempted to raise his arm overhead, worse with lying down on the shoulder. His right shoulder flexion was to 155 degrees with painful motion beginning at 155 degrees. Abduction was to 115 degrees with painful motion beginning at 115 degrees. Left shoulder flexion and abduction were to 180 degrees with no objective evidence of painful motion. The Veteran was able to perform repetitive-use testing with three repetitions. After repetitive-use testing, right shoulder flexion was to 155 degrees and abduction to 120 degrees. His left shoulder flexion and abduction were to 180 degrees. The Veteran did not have additional limitation in ROM of the shoulder and arm following repetitive-use testing. He had functional loss and/or functional impairment of the right shoulder and arm, to include less movement than normal and pain on movement. He did not have guarding or localized tenderness or pain on palpation of joints/soft tissue/biceps tendon of either shoulder. Muscle strength testing was normal except for right shoulder abduction which was 4/5. He did not have ankylosis. Hawkins’ Impingement, Empty-can, External rotation/Infraspinatus strength and left shoulder Lift-off subscapularis tests were all negative. However, the Veteran right left lift-off subscapularis test was positive. He did not have a history of mechanical symptoms (clicking, catching, etc.) or recurrent dislocation (subluxation) of the glenohumeral (scapulohumeral) joint. Crank apprehension and relocation tests were negative. He did not have an AC joint condition or any other impairment of the clavicle or scapula. There was no tenderness on palpation of the AC joint. Cross body abduction test was negative. The Veteran did not have joint replacement and/or other surgical procedures. He did not have scars. There were no other pertinent physical findings, complications, conditions, signs, and/or symptoms related to his shoulder condition. Functioning was no so diminished that amputation with prosthesis would equally serve the Veteran. Based on the evidence of record, the Board finds that a higher rating is not warranted. Specifically, the Veteran suffered little limitation of motion of the arm to shoulder level. At worst, the Veteran’s right shoulder flexion was limited to 155 degrees, with painful motion beginning at 155 degrees and abduction was limited to 115 degrees, with painful motion beginning at 115 degrees. The Veteran reported pain in the shoulder. He reported flare-ups that limited movement with trying to raise his arm overhead, worse with lying down on the shoulder. While there was objective evidence of painful motion on movements of the right shoulder, these limitations do not merit an increased rating. The Board recognizes that, under DeLuca v. Brown, 8 Vet. App. 202 (1995), VA must consider “functional loss” of a musculoskeletal disability separately from consideration under the DCs. “Functional loss” may occur because of weakness or pain on motion. Here, the Veteran experienced functional loss and/or functional impairment of the right shoulder and arm, to include less movement than normal and pain on movement. However, there was no additional limitation in motion after repetitive motion. The Board finds that given the extent of shoulder motion, there is no evidence of a disability picture that is commensurate to a limitation of flexion to the extent necessary to establish entitlement to a higher disability rating, even after taking pain into full consideration. See DeLuca, 8 Vet. App. at 204-07; 38 C.F.R. §§ 4.40, 4.45, 4.71a, DC 5201. Additionally, the Board finds that the effects of pain reasonably shown to be due to his right shoulder disability are contemplated in the current 20 percent rating. The Board has also considered the application of DC 5200 for disabilities involving ankylosis of the scapulohumeral articulation, DC 5202 for other impairment of the humerus to include recurrent dislocation, fibrous union, non-union or flail shoulder, and DC 5203 impairment of the clavicle/scapula to include nonunion with loose movement. The evidence does not show that the Veteran’s right shoulder disability manifestations have included ankylosis or impairment of the humerus or clavicle/scapula. Therefore, the Veteran is not entitled to a higher rating under DCs 5200, 5202, and 5203. Additionally, the VA examine noted that the Veteran does not have scars associated with is right shoulder disability. Therefore, a separate rating under 7800, 7801, 7802, 7804, 7805, or 7806 is not warranted. The Board acknowledges that in Correia v. McDonald, 28 Vet. App. 158 (2016), the U.S. Court of Appeals for Veterans Claims (Court) noted the final sentence of § 4.59, which states “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint.” In this case, there is no indication of whether the Veteran was tested for both active and passive motion and in weight-bearing and non-weight bearing. However, the Board finds that the September 2013 examination report adequately document the Veteran’s symptoms as they relate to the rating criteria. Therefore, while it appears that passive range of motion and non-weight-bearing were not tested, it is reasonable to assume that range of motion would be less limiting than active motion and weight bearing, and therefore, the failure to measure passive motion and non-weight bearing is harmless error. See Correia v. McDonald, 28 Vet. App. 158, 170 (2016). The Board acknowledges the Veteran and his representative’s statements regarding the severity of the Veteran’s condition to be both competent and credible. However, as lay persons, they do not have the training or expertise to render a competent opinion which is more probative than the VA examiner’s opinions on this issue, as this is a medical determination that is complex. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994)). Thus, the Board finds that the lay opinions by themselves are outweighed by the VA examiner’s findings. Therefore, the Board finds that the current rating criteria reasonably describe the Veteran’s disability level and symptomatology associated with the right shoulder disability. The Board has also considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim for a higher or separate rating. Therefore, the benefit of the doubt doctrine is not applicable, and the claim for an increased rating in excess of 20 percent must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 5. Entitlement to a rating in excess of 20 percent prior March 31, 2016 and in excess of 10 percent therefrom for chronic right trapezius strain with neck pain The Veteran’s service-connected chronic right trapezius strain with neck pain disability is currently evaluated as 10 percent disabling under DCs 5237-5301. 38 C.F.R. §§ 4.73, 4.118. Diagnostic Code 5237 refers to cervical strain. DC 5301 refers to muscle injuries. Under DC 5237, a 10 percent evaluation is assigned when forward flexion of the cervical spine is greater than 30 degrees but not greater than 40 degrees; the combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or there is muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour, or vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71a. Alternatively, under the IVDS Formula, a 10 percent rating contemplates incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months. A 20 percent evaluation is assigned when forward flexion of the cervical spine is greater than 15 degrees but not greater than 30 degrees; the combined range of motion of the cervical spine is not greater than 170 degrees; or there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Alternatively, under the IVDS Formula, a 20 percent rating contemplates incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 30 percent evaluation is warranted when there is forward flexion of the cervical spine to 15 degrees or less, or favorable ankylosis of the entire cervical spine. There is no equivalent rating under the IVDS Formula. A 40 percent evaluation is assigned for unfavorable ankylosis of the entire cervical spine. Under the IVDS Formula, a 40 percent rating contemplates incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. Alternatively, under the IVDS Formula, a 40 percent rating contemplates incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. Under the IVDS Formula, a 60 percent rating contemplates incapacitating episodes having a total duration of at least six weeks during the past 12 months. There is no equivalent rating under the General Formula A 100 percent evaluation is assigned for unfavorable ankylosis of entire spine. There is no equivalent rating under the IVDS Formula. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Although pain may cause functional loss, pain itself does not constitute functional loss. 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. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40). 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158 (2016). Associated objective neurologic abnormalities are evaluated separately under an appropriate diagnostic code. See 38 C.F.R. § 4.71a (General Formula, Note 1). Under Diagnostic Codes 5301 through 5323, disabilities resulting from muscle injuries shall be classified as slight, moderate, moderately severe or severe. 38 C.F.R. § 4.56(d). A slight muscle injury is a simple wound to the muscle without debridement or infection. Records of the injury are demonstrated by a superficial wound with brief treatment and return to duty, healing with good functional results, and no cardinal signs or symptoms of muscle disability. The objective findings would include a minimal scar, but no evidence of fascial defect, atrophy, or impaired tonus and no impairment of function or metallic fragments retained in muscle tissue. 38 C.F.R. § 4.56(d). The type of injury associated with a moderate muscle disability is a through and through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. A history about this type of injury should include service department evidence or other evidence of in-service treatment for the wound and consistent complaints of one or more of the cardinal signs and symptoms of muscle disability, particularly lowered threshold of fatigue after average use affecting the particular functions controlled by the injured muscles. Objective findings should include entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue and some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. 38 C.F.R. §4.56(d)(2). The type of injury associated with a moderately severe muscle disability is a through and through or deep penetrating wound by a small high-velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. A history about this type of injury should include prolonged hospitalization in service for treatment of wound, consistent complaints of cardinal signs and symptoms of muscle disability, and, if present, evidence of inability to keep up with work requirements. Objective findings should include entrance and (if present) exit scars indicating the track of the missile through one or more muscle groups, and indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with the sound side. Tests of strength and endurance compared with sound side should demonstrate positive evidence of impairment. 38 C.F.R. § 4.56(d)(3). The type of injury associated with a severe muscle disability is a through and through or deep penetrating wound by a small high-velocity missile or large or multiple low-velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, and intermuscular binding and scarring. A history about this type of injury should include prolonged hospitalization in service for treatment of wound, consistent complaints of cardinal signs and symptoms of muscle disability, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. Objective findings should include ragged, depressed, and adherent scars indicating wide damage to muscle groups in missile track, and indications on palpation of loss of deep fascia, muscle substance, or soft flabby muscles in wound area. Also, muscles swell and harden abnormally in contraction. Tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side should indicate severe impairment of function. If present, the following are also signs of severe muscle disability: (A) X- ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of missile; (B) adhesion of scar to one of the long bones, scapula, pelvic bone, sacrum, or vertebrae, with epithelial sealing over the bone, rather than true skin covering in an area where bone is normally protected by muscle; (C) diminished muscle excitability to pulsed electrical current in electrodiagnostic tests; (D) visible or measurable atrophy; (E) adaptive contraction of an opposing group of muscles; (F) atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle; and (G) induration or atrophy of an entire muscle following simple piercing by a projectile. 38 C.F.R. § 4.56(d)(4). Analysis The Veteran contends that his chronic right trapezius strain with neck pain is more severe than the ratings depicts. From 2011, the Veteran was treated at the Augusta Uptown Division. He received treatment for chronic neck pain. In August 2013, the Veteran was afforded VA examinations to determine the severity of the Veteran’s right trapezius strain with neck pain. The Veteran stated that the condition began in 1982 and had gotten worse. He stated that the pain on the right side of his neck travelled up to his eyeballs. He felt the pain lead to migraines. He took medication to help relieve the pain. The examiner confirmed the Veteran’s right trapezius strain with associated neck pain diagnosis. The Veteran was right hand dominant. He did not have a penetrating or a non-penetrating muscle injury such as a gunshot or shell fragment wound. He did not now have or ever had an injury to Muscle Groups I through XXI and XXIII, i.e., of the shoulder girdle or arm; forearm or hand; foot or leg; pelvic girdle or thigh. However, he did have or has had an injury to a Muscle Group XXII, i.e., the muscle group in the neck, i.e., trapezius, sternocleidomastoid, hyoid muscles, sternothyroid, and/or digastric. He did not have a history of rupture of the diaphragm with herniation; an extensive muscle hernia of any muscle without other injury to the muscle; or injury to the facial muscles. There were no scars associated with his muscle injury. The Veteran did not have any known fascial defects or evidence of fascial defects associated with any muscle injuries. He did not have muscle injuries that affected muscle substance or function. Additionally, he did not have any loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, or uncertainty of movement attributable to any muscle injuries. The Veteran’s muscle strength was normal except for his right shoulder abduction which was 4/5. There was no muscle atrophy. His posture and gait were within normal limits. Functioning was not so diminished that amputation with prosthesis would equally serve the Veteran. There were no other pertinent physical findings, complications, conditions, signs, and/or symptoms attributed to the Veteran’s condition. During flare-ups, the Veteran was unable to move without sharp pain in his neck. The Veteran’s forward flexion was from zero to 30 degrees with evidence of pain beginning at 30 degrees. Extension and left lateral flexion ended at 40 degrees with evidence of painful motion beginning at 40 degrees. Right lateral flexion ended at 35 degrees with painful motion beginning at 35 degrees. Right lateral rotation ended at 45 degrees with painful motion beginning at 45 degrees. Left lateral rotation ended at 50 degrees with painful motion beginning at 50 degrees. The Veteran was able to perform repetitive-use testing with at least three repetitions. There was no additional loss of function or ROM after three repetitions. He experienced functional loss and/or impairment which produced less movement than normal and pain on movement. He had localized tenderness or pain to palpation of the right trapezial. His muscle strength testing was normal with no muscle atrophy. The Veteran’s reflex and sensory exams were also normal. He did not have radicular pain or any other signs or symptoms due to radiculopathy. He did not experience guarding, muscle spasms, ankylosis, intervertebral disc syndrome (IVDS), scars, or neurologic abnormalities or findings related to a cervical spine condition (such as bower or bladder problems due to cervical myelopathy). Functioning was no so diminished that amputation with prosthesis would equally serve the Veteran. There were other pertinent physical findings, complications, conditions, signs, and/or symptoms attributed to his disability. The examiner stated that the Veteran’s global limited ROM was related to his trapezial strain. Diagnostic testing revealed no arthritis or vertebral fracture. However, x-ray revealed slight C3-4 retrolisthesis. In April 2016, the Veteran was afforded a VA examination to determine the severity of his right trapezius strain with neck pain. The Veteran stated that in 1982, he was lifting heavy equipment when he began to experience pain and discomfort in his right shoulder and neck. At the time of the exams, the pain was 7/10. He stated that he had throbbing pain that traveled from his right shoulder to his neck and head. To help relieve the pain, he took Hydrocodone. The examiner confirmed the Veteran’s chronic right trapezius strain with cervical strain diagnosis. The Veteran did not have a penetrating or a non-penetrating muscle injury such as a gunshot or shell fragment wound. He did not now have or ever had an injury to Muscle Groups I through XXI and XXIII. However, he had an injury to muscle group XXII. He did not have a history of rupture of the diaphragm with herniation; an extensive muscle hernia of any muscle without other injury to the muscle; or injury to the facial muscles. There were no scars associated with his muscle injury. The Veteran did not have any known fascial defects or evidence of fascial defects associated with any muscle injuries nor did he have muscle injuries that affected his muscle substance or function. Additionally, he did not have loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, or uncertainty of movement that was attributable to his muscle injuries. The Veteran’s muscle strength was normal with was no muscle atrophy. When flare-ups occur, he used a back brace and cane as a normal means of locomotion. Functioning was not so diminished that amputation with prosthesis would equally serve the Veteran. There were no other pertinent physical findings, complications, conditions, signs, and/or symptoms. Additionally, the had cervical flare-ups which he described as throbbing pain that traveled from his right shoulder to his neck and head. He reported functional loss or impairment of the cervical spine which included limited movement due to pain with his right shoulder and neck. The Veteran’s range of motion was all normal, i.e., forward flexion, extension, right and left lateral flexion were from zero to 45 degrees and right and left lateral rotation was from zero to 80 degrees. Pain was noted on forward flexion and extension. The pain caused functional loss. There was no evidence of pain with weight bearing. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the cervical spine (neck). The Veteran was able to perform repetitive-use testing with at least three repetitions. There was no additional loss of function or ROM after three repetitions. The Veteran was examined immediately after repetitive use over time and during a flare-up. Pain, fatigability, and lack of endurance significantly limited functional ability with repeated use over a period of time and during flare-ups. However, the examiner was unable to describe functional loss due to pain, fatigue, and lack of endurance in terms of ROM. The Veteran experienced muscle spasms, but the spasms did not result in abnormal gait or abnormal spinal contour. There were additional factors contributing to the disability, to include limited lifting, pushing, and pulling. His muscle strength testing was normal with no muscle atrophy. The reflex and sensory exams were also normal. The Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. He did not experience ankylosis, IVDS, scars, or neurologic abnormalities or findings related to a cervical spine. Occasionally, the Veteran used a brace and cane as a normal mode of locomotion. Functioning was no so diminished that amputation with prosthesis would equally serve the Veteran. There were no other pertinent physical findings, complications, conditions, signs, and/or symptoms attributed to his disability. Diagnostic testing revealed no arthritis or vertebral fracture with loss of 50 percent or more of height. Upon careful review of the evidence of record, the Board finds that a rating in excess of 20 percent prior to March 31, 2016 for the Veteran’s service-connected chronic right trapezius strain with neck pain disability is not warranted. The Veteran’s chronic right trapezius strain with neck pain with damage to Muscle Group XXII has been evaluated as 20 percent disabling, indicating a moderately severe muscle injury under Diagnostic Code 5322. To warrant a higher 30 percent rating, there must be evidence of a severe muscle injury. However, a severe muscle injury has not been demonstrated by the evidence of record. The Veteran complained of neck pain that caused migraines and travelled up to his eyeballs. The Board notes that the Veteran experienced reduction in muscle strength of the right shoulder abduction. However, there was no loss of deep fascia or muscle substance. Therefore, the Board finds that the injury to Muscle Group XXII was moderately severe in extent, which is squarely the criteria for a 20 percent evaluation under Diagnostic Code 5322. Therefore, based on the “totality of the circumstances,” a higher evaluation based on impairment of Muscle Group XXII under Diagnostic Code 5322 is not warranted as no more than a moderately severe disability is shown. Additionally, the Board finds that a higher rating in not warranted based on limitation of motion. The Veteran stated that due to flare-ups, he was unable to move without sharp pain in his neck. However, the 2013 examiner noted forward flexion to 30 degrees, which exceeds the 15 degrees or less that would merit a 30 percent rating. Additionally, there was no additional functional loss with repetitive use, and he did not have ankylosis or incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. Therefore, a rating in excess of 20 percent under DC 5237 prior to March 31, 2016, is not warranted. The Board notes that the Veteran experienced functional loss and/or impairment which produced less movement than normal and pain on movement. However, such functional impairment has been considered in arriving at the current rating for limitation of motion of the cervical spine based on ROM measurements, to include as due to objective evidence of pain and subjective complaints of painful motion resulting in the functional impairment described above. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca at 206-07. The Board has considered whether separate ratings are warranted for other neurologic abnormalities. See 38 C.F.R. § 4.71a, General Rating Formula, Note (1). As reflected in the reports of the VA spine examinations and other evidence during the appeal period, the evidence does not show any objective neurologic abnormalities associated with the Veteran’s cervical spine disability. Additionally, the Veteran did not have scars related to his cervical spine condition. Therefore, DCs 7800-7805 is not warranted. The Board notes that the Veteran stated that his cervical spine disability caused headaches. As noted above, entitlement to service connection for headaches is being remanded. Considering the objective clinical findings, the Board finds that a rating in excess of 20 percent is not warranted for the cervical spine disability, as the evidence does not show forward flexion less than 15 degrees or less, or favorable ankylosis of the entire cervical spine. As the preponderance of the evidence is against the claim, there is no benefit of the doubt to be resolved in the Veteran’s favor. 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, DC 5237; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). From May 31, 2016, the Board finds that a rating in excess of 10 percent based on impairment of Muscle Group XXII under Diagnostic Code 5322 is not warranted as no more than a moderate disability is shown. To warrant a higher 20 percent rating, there must be evidence of a moderately severe muscle injury. However, a moderately severe muscle injury has not been demonstrated by the evidence of record. The Veteran’s current complaint includes throbbing pain that travels from his right shoulder to his neck and head. The Veteran’s muscle strength was normal with was no muscle atrophy. He did not have a scar. Additionally, there were no cardinal signs and symptoms of muscle disability. 38 C.F.R. § 4.56. Given the lack of impairment to Muscle Group XXII, the Board finds that the injury is properly characterized as moderate. Accordingly, entitlement to a rating in excess of 10 percent for injury to Muscle Group XXII is denied. Considering the foregoing, the Board concludes that based on the “totality of the circumstances,” a higher evaluation based on impairment of Muscle Group XXII under Diagnostic Code 5322 is not warranted as no more than a moderate disability is shown. Additionally, the Board finds that a higher rating in not warranted based on limitation of motion. The Veteran’s forward flexion was normal, i.e., to 45 degrees. There was no additional functional loss with repetitive use. The Veteran stated that he experienced throbbing pain that traveled from his right shoulder to his neck and head. The Veteran experienced muscle spasms, but they did not result in abnormal gait or abnormal spinal contour. Additionally, he did not have ankylosis or incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. Therefore, a rating in excess of 10 percent under DC 5237 from March 31, 2016, is not warranted. The Board notes that the Veteran experienced functional loss and/or impairment which included limited movement due to pain with his right shoulder and neck. Functional loss and/or impairment also limited his ability to lift, push, and pull. However, such functional impairment has been considered in arriving at the current rating for limitation of motion of the cervical spine based on ROM measurements, to include as due to objective evidence of pain and subjective complaints of painful motion resulting in the functional impairment described above. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca at 206-07. The Board has considered whether separate ratings are warranted for other neurologic abnormalities. See 38 C.F.R. § 4.71a, General Rating Formula, Note (1). However, the evidence does not show any objective neurologic abnormalities associated with the Veteran’s cervical spine disability. Additionally, the Veteran did not have scars related to his cervical spine condition. Therefore, DCs 7800-7805 is not warranted. Considering the objective clinical findings, the Board finds that a rating in excess of 10 percent is not warranted for the cervical spine disability, as the evidence does not show forward flexion greater than 15 degrees or but less than 30, or muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour. As the preponderance of the evidence is against the claim, there is no benefit of the doubt to be resolved in the Veteran’s favor. 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, DC 5237; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). The Board has considered the Veteran and his representative’s statements regarding the severity of the Veteran’s cervical spine condition. However, as lay persons, the Veteran and his representative do not have the training or expertise to render a competent opinion which is more probative than the VA examiners’ opinions on this issue, as this is a medical determination that is complex. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994)). Thus, the lay opinions by themselves are outweighed by the VA examiners’ findings. See id.; see also King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (affirming the Court’s conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert’s opinion more probative on the issue of medical causation). 6. Entitlement to an initial rating in excess of 70 percent for MDD The Veteran contends that his MDD is more severe than the 70 percent rating depicts. In 2011, the Veteran post-service treatment records document treatment for his psychiatric condition at the Augusta Uptown Division. During his appointments, the Veteran was casually or neatly dressed and made normal eye contact. His psychomotor movement was normal. He was cooperative and calm. He was oriented times three or four. The Veteran’s speech was of normal volume and tone; the rate ranged from slow to normal. His mood was up and down and depressed on some days. His affect was euthymic, full range. His thought process ranged from slow to logical and goal oriented. The Veteran did not have delusions or hallucinations. He denied suicidal and homicidal ideation. On April 11, 2012, the Veteran appeared disheveled and personal hygiene was poor. In June 2012, he was admitted to Augusta Uptown: Mental Health Physician Note. The Veteran wore pajamas and was cooperative. He was very angry about a statement his brother made. In anger, the Veteran stabbed himself several times. The examiner noted that the Veteran has a significant problem with alcohol dependence and was intoxicated at the time. The Veteran’s emergency room admittance note stated that the Veteran experienced auditory hallucinations telling him to harm others and kill himself. In September 2013, the Veteran was afforded a VA examination to determine the nature and etiology of his psychiatric disorder. The Veteran was divorced and had a slight relationship with his ex-wife. The examiner diagnosed the Veteran with MDD, recurrent, without psychosis; anxiety disorder NOS; and pain disorder related to both psychological factors and to a general medical condition. Because the symptoms overlapped, the examiner was unable to differentiate what symptoms were attributable to each diagnosis. The Veteran’s symptoms included depressed mood; anxiety; suspiciousness; panic attacks that occurred weekly or less often; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; impairment of short-and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks; difficulty in understanding complex commands; disturbance of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or worklike setting; inability to establish and maintain effective relationships; and suicidal ideation. The Veteran had other symptoms attributed to his mental disorders, to include social isolation, issues concentrating, and chronic pain of level eight. He experienced occupation and social impairment with deficiencies is most areas, such as work, school, family, relations, judgment, thinking, and/or mood. The Veteran was capable of managing his own financial affairs. In April 2016, the Veteran was afforded a VA examination to determine the severity of his psychiatric condition. The examiner diagnosed the Veteran with MDD, recurrent, severe, without psychosis; anxiety disorder; and somatic symptom disorder. Because the symptoms overlapped, the examiner was unable to differentiate what symptoms were attributable to each diagnosis. The Veteran’s symptoms included depressed mood; anxiety; panic attacks more than once a week; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; impairment of short-and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks; disturbance of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or worklike setting; inability to establish and maintain effective relationships; and suicidal ideation. The Veteran had other symptoms attributable to his mental disorders, to include social isolation; irritability; some problems with concentration; and chronic pain of level seven in his neck, shoulder, and back. The Veteran experienced occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. He was capable of managing his financial affairs. When considering the totality of his disability picture, the Board finds that the Veteran has not been shown to have such impairment as contemplated by the 100 percent criteria. There is no indication of gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The evidence of record indicates that the Veteran speech was of normal volume and tone; the rate ranged from slow to normal rate. His thought process ranged from slow to logical and goal oriented. The Veteran denied delusions and/or hallucinations. He was oriented times three or four. The Veteran had impairment of short-and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks; however, he did not experience memory loss for names of close relatives, own occupation, or own name. In June 2012, the examiner noted that the Veteran had poor hygiene and was disheveled. Additionally, the Veteran was admitted to the hospital because in anger, he stabbed himself several times, and he had auditory hallucinations. However, the Board finds that the Veteran’s symptoms, as demonstrated in the VA examinations and years of treatment records, do not rise to the level of severity, frequency, and duration contemplated by a 100 percent evaluation under the rating schedule. The Board acknowledges the Veteran and his representative’s statements, but finds they are not competent to provide evidence on the severity of a psychiatric disability. As lay persons, they do not have the training or expertise, particularly in the field of clinical psychiatry or psychology, to render a competent opinion which is more probative than the VA examiners’ opinions on this issue, as this is a medical determination that is complex. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994)). Thus, the lay opinions by themselves are outweighed by the VA examiners’ findings. The Board finds that based on the foregoing, the Veteran’s psychiatric symptoms do not result in more severe manifestations that more nearly approximate total occupational and social impairment. In sum, the evidence does not support a rating higher than 70 percent for MDD. REASONS FOR REMAND The Veteran has been diagnosed with bilateral knee sprain. The Veteran contends that his current knee condition is related to his in-service knee complaints. The Board notes that in December 1982, the Veteran’s STRs document bilateral knee abrasion diagnosis. In August 2013, the Veteran was afforded a VA examination to determine the nature and etiology of his bilateral knee condition. The examiner was asked to opine as to whether it is at least as likely as not that the bilateral knee condition was incurred in or caused by related complaints that occurred in military service. The examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated that there was no evidence of any knee arthritis on x-rays, no pain with ROM testing, no medical records of injury or treatment in service. The examiner further stated that the Veteran has trapezial strain, no pathology in cervical spine either of which are not expected to be sole casual factors of anxiety/depression. The Board notes that the examiner did not provide a rationale for the opinion or directly address whether the Veteran’s bilateral knee condition was/were related to service, to include the December 1982 in-service bilateral knee abrasion. As such, the Board finds the examination to be inadequate and a new exam should be obtained. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120 (2007). The Veteran has been diagnosed with migraine headaches. He asserts that his migraines are due to his military service or in the alternative, his service-connected neck and shoulder disabilities. The Board notes the Veteran has not been afforded a VA examination to determine the nature and etiology of his migraines. See McClendon v. Nicholson, 20 Vet. App. 79 (2006). Therefore, the issue is remanded to afford the Veteran a VA examination to determine the nature and etiology of his migraine headaches. The matters are REMANDED for the following action: 1. Obtain and associate all outstanding VA and private treatment records with the claims file. 2. Contact the Veteran and request that he identify all private providers who have treated him for his bilateral knee condition and migraine headaches. After obtaining authorization, obtain all outstanding records. If the records are unavailable, document the claims file and notify the Veteran in accordance with 38 C.F.R. § 3.159(e). 3. Schedule a VA examination to determine the nature and etiology of the Veteran’s bilateral knee condition and migraine headaches. The complete record, to include a copy of this remand and the claims folder, must be made available to and reviewed by the examiner in conjunction with the examination. The examination report must include a notation that this record review took place. A. Bilateral knee Based on a review of the entire record, the examiner should respond to the following: i. Identify any current knee condition(s). ii. Then, determine if it is at least as likely as not (a 50 percent or greater probability) that any knee condition had its onset during active service or is etiologically related to the Veteran’s active duty service, to include the December 1982 in-service knee diagnosis. B. Headaches i. The examiner should offer an opinion as to whether it is at least as likely as not (probability of 50 percent or greater) that the Veteran’s migraine headaches had its onset in service or is otherwise related to any in-service disease, event, or injury. ii. If the answer to (i) is no, is it at least as likely as not (50 percent or greater probability) that the Veteran’s service-connected neck and shoulder disabilities proximately caused or aggravated (permanently worsened beyond the normal progression of that disease) his migraine headaches? If aggravation is found, the examiner should also state, to the extent possible, the baseline level of disability prior to aggravation. This may be ascertained by the medical evidence of record and the Veteran’s statements as to the nature, severity, and frequency of his observable symptoms over time. The supporting rationale for all opinions expressed must be provided. The examiner should consider the Veteran’s lay statements. 5. Then, readjudicate the issue on appeal. If the benefit sought on appeal remains denied, furnish the Veteran and his representative a Supplemental Statement of the Case and afford them the opportunity to respond before the file is returned to the Board for further consideration. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Henry, Associate Counsel