Citation Nr: 18154743 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 16-46 690A DATE: November 30, 2018 ORDER Entitlement to an increased rating for a lumbar spine disability, rated as 10 percent disabling prior to June 29, 2017, and as 20 percent thereafter is denied. Entitlement to an increased rating for residuals of left tibia stress fracture, currently rated as 10 percent disabling is denied. Entitlement to an initial compensable rating for hypertension is denied. Entitlement to an increased rating for irritable bowel syndrome (IBS) with fecal leakage status post laparoscopic cholecystectomy, rated as 10 percent disabling prior to June 29, 2017, and as 30 percent thereafter is denied. Entitlement to an increased rating for sciatic nerve impairment of the right lower extremity, currently rated as 10 percent disabling is denied. Entitlement to an increased rating for sciatic nerve impairment of the left lower extremity, currently rated as 10 percent disabling is denied. Since April 2, 2015, entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is granted. REMANDED Entitlement to an increased rating for posttraumatic stress disorder (PTSD) rated as 50 percent disabling prior to June 29, 2017, and as 70 percent thereafter is remanded. FINDINGS OF FACT 1. For the period prior to June 29, 2017, the Veteran’s lumbar spine disability was not shown to be functionally limited to 60 degrees of flexion or less and the combined range of motion of the thoracolumbar spine was functionally greater than 120 degrees; muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour was not shown. The Veteran did not experience incapacitating episodes of intervertebral disc syndrome (IVDS). 2. For the period since June 29, 2017, the Veteran’s lumbar spine disability was not shown to be functionally limited to 30 degrees of flexion or less and favorable ankylosis of the thoracolumbar spine was not shown. The Veteran did not experience incapacitating episodes of intervertebral disc syndrome. 3. The Veteran’s residuals of a left tibia stress fracture most closely approximate impairment of the tibia or fibula with no more than a slight ankle or knee disability. 4. The Veteran’s hypertension is not manifested by diastolic pressure predominantly 100 or more; by systolic pressure predominantly 160 or more; or by a history of diastolic pressure predominantly 100 or more which requires continuous medication for control. 5. Prior to June 29, 2017, the Veteran’s IBS with fecal leakage status post laparoscopic cholecystectomy does not result in diarrhea or alternating diarrhea and constipation with more or less constant abdominal distress. 6. Since June 29, 2017, the Veteran’s IBS with fecal leakage status post laparoscopic cholecystectomy results in diarrhea or alternating diarrhea and constipation with more or less constant abdominal distress. 7. The Veteran’s sciatic nerve impairment of the right lower extremity was manifested by no more than mild sensory deficit. 8. The Veteran’s sciatic nerve impairment of the left lower extremity was manifested by no more than mild sensory deficit. 9. The Veteran is reasonably shown to have been unable to secure of follow a substantial gainful occupation as a result of her service-connected disabilities since April 2, 2015. CONCLUSIONS OF LAW 1. Prior to June 29, 2017, the criteria for a rating in excess of 10 percent for a lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243 (2018). 2. Since June 29, 2017, the criteria for a rating in excess of 20 percent for a lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243 (2018). 3. The criteria for a rating in excess of 10 percent for residuals of a left tibia stress fracture have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5299-5262 (2018). 4. The criteria for an initial compensable rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.31, 4.104, Diagnostic Code 7101 (2018). 5. Prior to June 29, 2017, the criteria for a rating in excess of 10 percent for IBS with fecal leakage status post laparoscopic cholecystectomy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.114, Diagnostic Code 7319 (2018). 6. Since June 29, 2017, the criteria for a rating in excess of 30 percent for IBS with fecal leakage status post laparoscopic cholecystectomy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.114, Diagnostic Code 7319 (2018). 7. The criteria for a rating in excess of 10 percent for sciatic nerve impairment of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.123, 4.124a, Diagnostic Code 8520 (2018). 8. The criteria for a rating in excess of 10 percent for sciatic nerve impairment of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.123, 4.124a, Diagnostic Code 8520 (2018). 9. The criteria for assignment of a TDIU from April 2, 2015, but no earlier, have been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.102. 3.340, 3.341, 4.15, 4.16, 4.18, 4.25 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1997 to May 2001. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO) Additional evidence in the form of VA outpatient treatment reports were associated with the claims file subsequent to a July 2017 Supplemental Statement of the Case (SSOC). However, the evidence has no bearing on the issues decided on appeal. As such the Veteran is not prejudiced by the Board’s adjudication of the issues decided on appeal. See 38 C.F.R. § 20.1304(c). Additionally, with regard to the claim for an increased initial rating for hypertension, the claim was considered after receipt of the new evidence in a May 2018 Statement of the Case (SOC). Additionally, the Veteran’s representative submitted a Vocational Assessment in June 2018 with a waiver of consideration by the Agency of Jurisdiction (AOJ). As such, the Board may consider this evidence in the first instance. Increased Ratings Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. The Board notes that while the regulations require review of the recorded history of a disability by the adjudicator to ensure an accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where an increase in the disability rating is at issue, the present level of the Veteran’s disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). It is also noted that staged ratings are appropriate for an increased rating claim whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Fenderson v. West, 12 Vet. App. 119 (1999), Hart v. Mansfield, 21 Vet. App. 505 (2007). Lumbar Spine Disability The Veteran contends that his service-connected lumbar spine warrants higher ratings. At a July 2015 VA examination, the Veteran reported daily pain with flare-ups which affect lifting, bending, sitting, standing, prolonged walking, running, and sleeping. Range of motion testing revealed that flexion was to 90 degrees with painful motion at 90 degrees, extension to 30 degrees with pain at 30 degrees, right and left lateral flexion to 30 degrees with painful motion at 30 degrees, and right and left lateral rotation to 30 degrees with pain at 30 degrees. The Veteran was able to perform three repetitions of motion with no additional loss of motion. The examiner noted that the Veteran had pain on movement after three repetitions. There was no localized tenderness or pain to palpation of the joints or soft tissue of the thoracolumbar spine and no guarding or muscle spasm of the thoracolumbar spine. Muscle strength testing was normal. The examiner indicated that the Veteran’s intervertebral disc syndrome was quiescent on examination. The claimant’s posture and gait were within normal limits. There was pain, weakness, fatigability, and/or incoordination and an additional loss of five degrees of range of motion in all directions during pain on use or during flare-ups. At a June 2017 VA examination, the Veteran reported painful flare-ups of back pain. She indicated difficulties with climbing, stooping, kneeling, and crouching. Range of motion testing revealed flexion to 50 degrees, extension to 10 degrees, right lateral flexion to 10 degrees, left lateral flexion to 60 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 20 degrees. The Board notes that the range of motion reported with regard to left lateral flexion was beyond the normal range of motion. However, this finding was reported by the examiner. The Veteran had pain in all ranges of motion except left lateral rotation. The Veteran was able to perform repetitive use testing with at least three repetitions and no additional loss of function or range of motion. The examiner indicated that pain significantly limits functional ability with repeated use over time but was unable to describe any additional loss of motion. There was localized tenderness, guarding, or muscle spasm of the thoracolumbar spine. Localized tenderness did not result in any abnormal gait or abnormal spinal contour. There was no guarding. Muscle strength testing was normal. There was no ankylosis of the spine. There were no episodes of acute signs and symptoms due to intervertebral disc syndrome that required bed rest prescribed by a physician and treatment by a physician in the past twelve months. The examiner concluded that there was objective evidence of pain on passive range of motion testing of the back and pain on weight-bearing testing of the back. The VA outpatient treatment reports associated with the claims file do not include any relevant findings pertinent to rating the Veteran’s lumbar spine. The Board notes that during the course of the appeal, the Court of Appeals for Veterans’ Claims (Court) held, in Correia v. McDonald, 28 Vet. App. 158 (2016), that the final sentence of 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 nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Under the General Rating Formula for Disease and Injuries of the Spine, a 10 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, 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. A 20 percent is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation will be assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation will be assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation will be assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. §4.71a, Diagnostic Codes (DCs) 5235 to 5242. Note (1): Evaluate any associated objective neurologic abnormalities, including but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Id. Note (2): For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Diagnostic Code 5243 provides that a 10 percent rating is warranted when the Veteran has incapacitating episodes having a total duration of a least 1 week but less than 2 weeks during the past 12 months. A 20 percent rating is warranted when the Veteran has incapacitating episodes having a total duration of a least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating is warranted when the Veteran has incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A 60 percent rating is warranted when the Veteran has incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. An incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Id., Note (1). Period prior to June 29, 2017 As an initial matter, the Board notes that the evidence does not indicate that the Veteran’s lumbar spine disability was manifested by any incapacitating episodes of IVDS. The Veteran did not report any such episodes at the VA examination conducted during the relevant appeal period. Moreover, the Veteran has not been shown to have been prescribed any bed rest to treat his back during the course of his appeal. As such, an increased rating is not warranted pursuant to Diagnostic Code 5243. With regard to General Rating Formula for Disease and Injuries of the Spine, the Board finds that the Veteran’s lumbar spine disability does not warrant a rating in excess of 10 percent at any time during the relevant appeal period. The only examination conducted indicates that the Veteran’s forward flexion has not been shown to be limited to 60 degrees. As noted, the Veteran demonstrated no less than 90 degrees of flexion at the examination conducted in 2015 and the combined range of motion was 240 degrees. Range of motion findings were not reported in the VA outpatient treatment reports. Moreover, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis was not shown at the VA examination or at VA. There was no muscle spasm on examination and the Veteran was not found to have an abnormal gait or abnormal spinal contour at that time. Therefore, a rating in excess of 10 percent is not warranted based on limitation of the range of motion. In reaching this conclusion, the Board has considered whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca v. Brown, 8 Vet. App. 202 (1995). Functional loss contemplates the inability of the body to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance, and must be manifested by adequate evidence of disabling pathology, especially when it is due to pain. 38 C.F.R. § 4.40. Additionally, painful motion is an important factor of disability; and joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. In this case, although the Veteran reported experiencing back pain at the July 2015 VA examination, there were only five degrees of limitation in range of motion from pain on repetitive use, and no functional loss due to fatigue, weakness, or lack of endurance on repetitive use at the examination. As such, forward flexion exceeded 60 degrees. Consequently, there was no functional impairment due to pain or any other factors which would warrant a rating in excess of 10 percent. Therefore, a rating in excess of 10 percent is not warranted during the relevant time period at issue. Period since June 29, 2017 As an initial matter, the Board notes that the evidence does not indicate that the Veteran’s lumbar spine disability was manifested by any incapacitating episodes of IVDS. The Veteran did not report any such episodes at the VA examinations conducted during the relevant appeal period. Moreover, the Veteran has not been shown to have been prescribed any bed rest to treat her back during the relevant appeal period. As such, an increased rating is not warranted pursuant to Diagnostic Code 5243. With regard to the General Rating Formula for Disease and Injuries of the Spine, the Board finds that the Veteran’s lumbar spine disability does not warrant a rating in excess of 20 percent at any time during the relevant appeal period. The relevant examination in 2017 indicates that the Veteran’s forward flexion has been shown to be limited to 50 degrees and no ankylosis of the thoracolumbar spine was shown at the examination. The combined range of motion was 170 degrees at the 2017 examination. Therefore, a rating in excess of 20 percent is not warranted based on limitation of the range of motion. In reaching this conclusion, the Board has considered whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca supra. In this case, the Veteran did report experiencing some pain with range of motion testing. However, the Veteran’s pain was not found to cause functional limitation to the point that a rating in excess of 20 percent would be warranted. The Board points out that range of motion was tested at the examination with repetitive motion testing. The pain was not shown to result in any functional loss beyond the limited range of motion demonstrated on examination. The Board also points out that although pain may cause a functional loss, pain itself does not constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 36-38 (2011). Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id. at 43; see 38 C.F.R. § 4.40. In this case, it does not. At the relevant VA examination of record, while pain was noted, no additional functional limitations were reported and forward flexion exceeded 30 degrees even in spite of the pain. As noted, there has also been no evidence or allegation that the Veteran had ankylosis in his lumbar spine. As such, a rating in excess of 20 percent is not warranted during the relevant appeal period at issue. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Left Tibia Stress Fracture The Veteran contends that a rating in excess of 10 percent is warranted for her service-connected left tibia stress fracture. As an unlisted condition, the Veteran’s left tibia stress fracture is currently rated as analogous to impairment of the tibia and fibula with knee or ankle disability under DC 5299-5262, which allows for the most favorable rating available. See 38 C.F.R. § 4.7. Under DC 5262, malunion of the tibia and fibula with a slight, moderate or marked knee or ankle disability will warrant a 10, 20 and 30 percent rating, respectively. See 38 C.F.R. § 4.71a. Descriptive words such as “slight,” “moderate” and “marked” as used in the various DCs are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence for “equitable and just decisions.” 38 C.F.R. § 4.6. At a July 2015 VA examination, the Veteran was assessed with shin splints. She reported pain with prolonged walking. Range of motion testing was reported to be normal for the left knee with no additional loss of function or motion on three repetitions. There was mild tenderness of the knee and no evidence of crepitus. There was no pain, weakness, fatigability, or incoordination which limited functional ability with flare-ups. There were also no additional contributing factors of the disability. Muscle strength testing was normal and joint stability testing was normal. There was no history of recurrent effusion. The examiner indicated that the Veteran’s shin splints did not affect the range of motion of the Veteran’s knee or ankle and resulted in tenderness on palpation of the shin of the tibia-fibula. At a June 2017 VA examination, the examiner reported that the Veteran’s left tibia stress fracture was quiescent on examination. The Veteran endorsed difficulty with climbing, stooping, kneeling, and crouching. Range of motion testing of the left knee revealed 20 degrees of loss of motion on flexion. There was no evidence of pain with weight-bearing and no evidence of crepitus. The examiner noted that pain limited functional ability with repeated use over time. Muscle strength testing was normal with no muscle atrophy. There was no ankylosis, no recurrent subluxation, no history of lateral instability, and no history of recurrent effusion. Joint stability testing was normal. The examiner indicated that the stress fracture of the lower leg did not affect the range of motion of the ankle. The examiner concluded that there was no evidence that the Veteran had a currently active stress fracture condition. The examiner concluded that the pain noted on range of motion of the knees was unrelated to the stress fracture and was related to separate and unrelated knee strain. Having reviewed the evidence of record, the Board has determined that the Veteran’s left tibia stress fracture most closely approximate malunion of the tibia and fibula with a slight knee or ankle disability. The Veteran had full range of motion of the knee at the 2015 examination and the loss of range of motion noted at the 2017 examination was attributed to nonservice-connected knee strain. The 2017 examiner specifically found that the Veteran’s left tibia stress fracture was quiescent and did not result in an active condition. In light of these findings, the Board has determined that the disability results in no more than a slight knee disability. No ankle disability was found on either examination. As such, a rating in excess of 10 percent is not warranted at any time during the relevant time period on appeal. In making the above finding, the Board has considered any additional functional loss due to pain or weakness, fatigability, incoordination, or pain on movement of a joint in determining that an increased rating is not warranted. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see also DeLuca v. Brown, 8 Vet. App. 202 (1995). However, even in consideration of the Veteran’s reports of pain and functional loss, the overall evidence does not show a degree of functional limitation which most closely approximates more than a “slight” disability. In other words, at no time has a moderate or severe disability been met or nearly approximated to warrant a higher rating under DC 5299-5260. The Board has considered whether there is any other schedular basis for granting a higher rating other than that discussed above, but has found none. See 38 C.F.R. § 4.71a, Schedule of Ratings-The Knee and Leg, The Ankle. As such, a rating in excess of 10 percent is not warranted during the relevant appeal period at issue. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Hypertension The Veteran contends that a compensable rating is warranted for the service-connected hypertension. The Veteran’s service connected hypertension is rated as noncompensable under Diagnostic Code 7101 for hypertensive vascular disease (hypertension and isolated systolic hypertension). 38 C.F.R. § 4.104. Under Diagnostic Code 7101, a 10 percent rating is warranted where the diastolic pressure is predominantly 100 or more; when the systolic pressure predominantly 160 or more; or when an individual with a history of diastolic pressure predominantly 100 or more requires continuous medication for control. A 20 percent rating is warranted where the diastolic pressure is predominantly 110 or more, or the systolic pressure is predominantly 200 or more. A 40 percent disability rating is warranted for diastolic pressure that is predominantly 120 or more. Finally, a 60 percent rating is warranted when diastolic pressure is predominantly 130 or more. 38 C.F.R. § 4.104. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. The Board notes that words such as predominantly are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Regardless, a basic understanding of predominant would suggest that the diastolic pressure was above a certain level more often than it was below it. At a February 2013 VA examination, the Veteran’s blood pressure was recorded as 104/80, 102/78, and 100/78. The Veteran’s treatment plan included the use of medication for hypertension. She was reported to take Lisinopril. Over a three- day period in February 2013, the Veteran’s blood pressure was reported as 118/76 and 100/67, 183/88 and 115/76, and 105/70 and 125/75. For the time period from 2005 to 2018, VA outpatient treatment reports reflect that the Veteran’s diastolic pressure was predominantly under 100 and her systolic pressure was predominantly under 160. On one occasion in January 2012 her systolic pressure was 161, at the three-day blood pressure check obtained at the time of the VA examination her systolic pressure was 183 on one reading, in January 2014 her systolic pressure was 175 and 182, and in February 2018, her systolic pressure was 163. On all other occasions during the thirteen-year period her systolic pressure was under 160. The Veteran’s diastolic pressure was recorded to be no higher than 99 in February 2014. On all other occasions her diastolic pressure was under 90. The records reflect that the Veteran was prescribed Lisinopril for her hypertension and her hypertension was reported to be well-controlled. Her medication dose was lowered in February 2009. Having reviewed the evidence as reported above, the Board has determined that the Veteran’s service-connected hypertension does not warrant a compensable rating at any time during the pendency of the appeal. The Veteran does not have a history of diastolic pressure predominantly 100 or more or systolic pressure predominantly 160 or more. During the pendency of the appeal the Veteran’s systolic pressure was reported to be over 160 on several occasions. However, at all other times during the relevant thirteen-year period on appeal his systolic pressure was under 160. His diastolic pressure was not over 100 at any time. The records reflect that the Veteran was taking Lisinopril for his blood pressure during the pendency of the appeal. As such, it cannot be said that she had a history of diastolic pressure that was predominantly greater than 100 or a systolic pressure that was predominantly greater than 160. Accordingly, the Board finds that the criteria for a compensable rating have not been met, and the Veteran’s claim is denied. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). IBS The Veteran contends that her IBS warrants rating in excess of 10 percent prior to June 29, 2017, and in excess of 30 percent thereafter. Under Diagnostic Code 7319, a noncompensable rating is warranted for disturbances of bowel function with occasional episodes of abdominal distress. A 10 percent rating is warranted for frequent episodes of bowel disturbance with abdominal distress. A 30 percent rating is warranted for diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. 38 C.F.R. § 4.114. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.114. At a July 2015 VA examination, the Veteran reported that her symptoms include weekly loose stool with occasional fecal incontinence. Medication was not required to control the Veteran’s IBS. The Veteran denied episodes of bowel disturbance with abdominal distress or exacerbations or attacks of the intestinal condition. The Veteran also denied weight loss. There Veteran did not have malnutrition, serious complications, or other general health effects attributable to the intestinal condition. The Veteran was assessed with IBS. At a June 2017 VA examination, the Veteran was assessed with IBS with fecal leakage, status post laparoscopic cholecystectomy. Medication was not required for the control of the Veteran’s intestinal condition and the Veteran has not had surgical treatment for an intestinal condition. The symptoms attributable to the Veteran’s IBS included diarrhea (frequent diarrhea multiple times per day) and abdominal distension (abdomen gets distended and achy during the day). The Veteran endorsed frequent episodes of bowel disturbance with abdominal distress. The Veteran did not have weight loss, malnutrition, serious complications, or other general health effects attributable to the intestinal condition. Prior to June 29, 2017 For the relevant time period on appeal, the Board finds that the Veteran’s IBS is productive of no more than moderate disability. This is so because the Veteran’s IBS is shown to be manifested by weekly loose stool with occasional fecal incontinence. There was no evidence of episodes of bowel disturbance with abdominal distress or exacerbations or attacks of the intestinal condition. The evidence does not indicate that the Veteran had diarrhea or alternating diarrhea and constipation with more or less constant abdominal distress. As such, there is no basis upon which a rating in excess of 10 percent may be assigned. Since June 29, 2017 For the relevant time period since June 29, 2017, the 30 percent rating for IBS is the maximum schedular rating assignable for evaluation of IBS under Diagnostic Code 7319. 38 C.F.R. § 4.114. Therefore, the Veteran is in receipt of the highest schedular rating available for this disability from June 29, 2017, the effective date of her 30 percent rating. As such, a higher rating is not warranted. The Board has considered whether there is any other schedular basis for granting a higher rating other than that discussed above, but has found none. See 38 C.F.R. § 4.118, Schedule of Ratings-Digestive System. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Sciatic Nerves – Right and Left Lower Extremities The Veteran contends that she warrants ratings in excess of 10 percent for the right and left lower extremity sciatic nerve dysfunction. At a July 2015 VA examination, the Veteran had no radicular pain or any signs or symptoms due to radiculopathy. Muscle strength testing was normal. Specifically, there was no constant pain, intermittent pain, paresthesias and/or dysesthesias, or numbness. Straight leg testing was normal. The examiner indicated that the bilateral sciatic nerve dysfunction was quiescent on examination. At a June 2017 VA examination, reflex examination was normal. Sensory examination revealed normal sensation at the upper anterior thigh (L2) and thigh/knee (L3/4) and decreased sensation at the lower leg/ankle (L4/L5/S1), and foot/toes (L5) bilaterally. Muscle strength testing was normal. Straight leg testing was normal. There was not constant pain of either lower extremity and there was mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness of the right and left lower extremities. The examiner indicated that the Veteran’s radiculopathy was mild and involved the sciatic nerve roots. For the sciatic nerve, incomplete paralysis warrants a 10 percent rating when mild, a 20 percent rating when moderate, a 40 percent rating when moderately severe, a 60 percent rating when severe with marked muscular atrophy, and an 80 percent rating for complete paralysis; the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The term “incomplete paralysis” indicates a degree of lost or impaired function that is substantially less than that which is described in the criteria for an evaluation for complete paralysis given with each nerve, whether the less than total paralysis is due to the varied level of the nerve lesion or to partial nerve regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. The Board notes that words such as mild, moderate, and severe are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. At the July 2015 VA examination, the examiner specifically found that the Veteran’s right and left lower extremity sciatic dysfunction was quiescent. Muscle strength testing was normal and straight leg raising was normal. Moreover, there was no radicular pain or any signs or symptoms due to radiculopathy. At the June 2017 VA examination, muscle strength testing was normal and straight leg raising was normal. The Veteran had no constant pain of either lower extremity and there was mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness of the right and left lower extremities. The examiner indicated that the Veteran’s radiculopathy was mild and involved the sciatic nerve roots. In light of the foregoing evidence, the Board finds that the bilateral lower extremity sciatic nerve dysfunction was not more than mild in severity for the entire appeal period at issue. The deficit shown was sensory in nature with normal muscle strength. The disability picture approximates the criteria for mild incomplete paralysis of the sciatic nerve under Diagnostic Code 8520 and warrants no more than a 10 percent rating for the right and left lower extremities. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Entitlement to a TDIU prior to June 29, 2017 Various VA Forms 21-8940 indicate that the Veteran last worked full-time as a bus driver for VA. The Board notes that the Veteran’s last day of full time employment was April 2, 2015. (See VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability, dated in April 2015 and VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, dated in March 2017). Although the Veteran submitted a second VA Form 21-8940 dated in April 2017 and indicated that her last date of employment was in April 2014, as noted, the information provided from her last employer indicates that she was employed until April 2, 2015. Consequently, there is no basis for assigning a TDIU prior to April 2, 2015. As of April 2, 2015, service connection was in effect for PTSD, rated as 50 percent disabling; IBS rated as 10 percent disabling; a lumbar spine disability rated as 10 percent disabling; residuals of a left tibia stress fracture, rated as 10 percent disabling; sciatic nerve impairment of the left and right lower extremity, each rated as 10 percent disabling; hemorrhoids, rated as noncompensably disabling; and hypertension, rated as noncompensably disabling. The Veteran’s combined rating was 70 percent effective March 14, 2011. Thus, effective April 2, 2015, the Veteran met the percentage rating requirements for assignment of a TDIU. See 38 C.F.R. § 4.16(a). Additionally, considering her service-connected disabilities; her educational level and prior work history (i.e. her TDIU claim indicated that she had completed two years of college and had no other education or training before she became too disabled to work); a Vocational Assessment from J. Conrad, MRC, CRC, CLCP who concluded that the Veteran’s service-connected disabilities was unable to secure or follow substantially gainful employment due to her service-connected disabilities since 2014 when she stopped working, and resolving reasonable doubt in her favor, she was reasonably shown to be unable to secure or follow a substantial gainful occupation due to service-connected disabilities effective April 2, 2015. As noted, the Veteran’s last employer reported that she was employed full-time until April 2, 2015, in contrast to the date noted by Ms. Conrad. Accordingly, assignment of a TDIU is warranted effective April 2, 2015. 38 C.F.R. § 4.16(a). REASONS FOR REMAND A review of the claims file reveals that a remand is necessary before a decision on the merits of the remaining claim can be reached. PTSD A Supplemental Statement of the Case (SSOC) was issued in June 2017. Thereafter, additional VA outpatient treatment reports were associated with the claims file and reflect treatment for the Veteran’s service-connected PTSD in January 2018. However, the Agency of Original Jurisdiction (AOJ) did not issue a Supplemental Statement of the Case to address this issue. An SSOC must be furnished to the Veteran and her representative when additional pertinent evidence is received after the most recent SSOC. 38 C.F.R. §§ 19.31, 19.37. As the VA outpatient treatment reports are pertinent to the issue of whether the Veteran’s PTSD warrants a higher rating since June 29, 2017, a remand for consideration of this evidence and issuance of an SSOC is required. The matter is REMANDED for the following action: 1. Issue an SSOC as to the issue of entitlement to increased ratings for PTSD that includes consideration of the January 2018 entry in the VA outpatient treatment records. 2. If the benefit sought on appeal is not granted and after the Veteran has had an adequate opportunity to respond, the appeal should be returned to the Board for appellate review. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Cryan, Counsel