Citation Nr: 18154726 Decision Date: 12/04/18 Archive Date: 11/30/18 DOCKET NO. 16-47 024 DATE: December 4, 2018 ORDER Entitlement to service connection for alcohol use, to include as secondary to posttraumatic stress disorder (PTSD), is denied. Entitlement to an initial rating in excess of 30 percent for PTSD is denied. Entitlement to an initial 10 percent rating for residuals of a fracture to the right big toe is granted. FINDINGS OF FACT 1. The Veteran’s alcohol use disorder was not caused or aggravated by his service-connected PTSD. 2. The preponderance of the evidence establishes that the Veteran’s PTSD has manifested in, or has more nearly approximated, occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 3. The Veteran’s fractured, right big toe has been manifested by moderate impairment without evidence of moderately-severe impairment. CONCLUSIONS OF LAW 1. Entitlement to service connection for alcohol use disorder is not warranted. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.303, 3.310 (2018). 2. The criteria for an initial rating in excess of 30 percent for PTSD have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.130, Diagnostic Code (DC) 9411 (2018). 3. Resolving reasonable doubt in favor of the Veteran, the criteria for an initial 10 percent rating, for residuals of a fractured right big toe, have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.71a, DCs 5299-5284 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2009 to November 2011. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) regional office (RO). After certification of the appeal to the Board in November 2016, the Veteran’s attorney attempted to withdraw from this case in August 2017. 38 C.F.R. § 20.608(b)(2). In November 2017 correspondence to the attorney, the Board stated that although the claims file contained documentation that the Veteran revoked the representative’s authority to act on his behalf, the Veteran did not sign the documentation. The Board further stated that the representative would be permitted to withdraw from representation only if a motion to withdraw is granted by the Board. Otherwise, the representative would be required to continue as the Veteran’s representative, and would be recognized as such by VA. The Board noted that the Veteran’s appeal would be held in abeyance for 30 days, or until the representative’s motion was received and considered. However, if the representative did not respond within 30 days of the date of the letter, the Board would assume that the representative wished to remain the Veteran’s representative, and the appeal would be resumed. To date, the representative has not responded to the letter. Therefore, the Board recognizes Attorney John S. Berry as the Veteran’s representative. 1. Entitlement to service connection for alcohol use, to include as due to PTSD A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. § 1110. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Entitlement to service connection requires: (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the in-service disease or injury and the current disability. 38 C.F.R. § 3.303 (a); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for disability shown after service, when all the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be established for any disability which is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310. To prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims stated that “a veteran need only demonstrate that there is an ‘approximate balance of positive and negative evidence’ in order to prevail.” To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996) (citing Gilbert, 1 Vet. App. at 54). Analysis The Veteran contends that his alcoholism is due to military service, to include as secondary to PTSD. As an initial matter, service connection may not be granted for substance abuse based on service incurrence or aggravation. 38 U.S.C. §§ 105, 1110; 38 C.F.R. § 3.301(a); VAOPGCPREC 2-98 (interpreting that direct service connection for disability resulting from a claimant’s own drug or alcohol abuse is precluded for all VA benefit claims filed after October 31, 1990). Thus, entitlement to service connection on a direct basis is denied. Secondary service connection may be found for drug and alcohol abuse if such abuse is found to be secondary to a service-connected disability. See Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001). Compensation may be awarded only “where there is clear medical evidence establishing that alcohol or drug abuse is caused by a veteran’s primary service connected disability, and where the alcohol or drug abuse disability is not due to willful wrongdoing.” Allen, 237 F.3d at 1381. The Veteran has been diagnosed with alcohol use disorder. Service connection is not warranted because the evidence does not show that the disorder was caused by service-connected disability such as PTSD. During his December 2010 Post-Deployment Assessment, the Veteran reported that he did not use alcohol more than he meant to nor did he feel that he wanted to or needed to cut down on his drinking. There was no evidence of alcohol-related problems. In January 2012, the Veteran’s alcohol screening test was negative. When asked how often he had a drink containing alcohol in the past year, the Veteran answered “never.” In February, he stated that he ceased drinking. In September 2012, the Veteran described himself as an alcoholic. He stated that he drank alcohol from immediately after deployment until about March 2012. In September 2013, his alcohol screening test was also negative. The Veteran stated that he drank alcohol monthly or less. Additionally, he typically had one or two drinks a day during the past year. During his February 2014 VA examination, the Veteran stated that he had been drinking alcohol daily and excessively for over five years. He had also been drinking alcohol to help him sleep. The examiner stated that the Veteran’s Alcohol Use Disorder was related to his personal, marital, and social issues rather than with military service issues. During his May 2016 VA examination, conducted by the February 2014 examiner, the examiner stated that Alcohol Use Disorder is usually viewed by psychiatrist as relating to a complex and not specifically determined etiology of biopsychosocial complex factors and was not related to military service issues. Based on the evidence of record, the Board finds that service connection for alcohol use on a secondary basis is not warranted. The Board finds that the VA medical examinations and opinions are well supported, well-reasoned, and entitled to significantly more probative weight than the Veteran’s lay assertions regarding the etiology of his substance abuse. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is inapplicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Therefore, the claim of entitlement to service connection for alcohol use secondary to PTSD must be denied. Increased Rating Disability ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. 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. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. 2. Entitlement to a rating in excess of 30 percent for PTSD The Veteran’s PTSD is rated under 38 C.F.R. § 4.130, DC 9411. Under DC 9411, a 30 percent evaluation is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; and mild memory loss (such as forgetting names, directions, and recent events). 38 C.F.R. § 4.130, DC 9411. A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing effective work and social relationships. Id. A 70 percent rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted for total occupational and social impairment due to such symptoms as: 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; and memory loss for names of close relatives, own occupation, or own name. Id. The use of the term “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms that follow the phrase are not intended to constitute an exhaustive list, but instead are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). When evaluating a mental disorder, VA shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a). VA shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of the disability at the moment of examination. Id. When evaluating the level of disability from a mental disorder, VA will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126(b). Analysis The Veteran contends that his PTSD is severe and warrants a rating higher than 30 percent. In August 2011, the Veteran was afforded a separation exam. The examiner stated that the Veteran’s PTSD and traumatic brain injury (TBI) screening was positive. The Veteran was cooperative. He had no obvious impairments with cognition. His perception was normal, and he was unlikely to be impulsive. He did not exhibit suicidal or homicidal thoughts or intent. From 2012, the Veteran’s treatment records note complaints and treatments for PTSD. During his examinations, the Veteran was well-groomed and casually dressed. He made good eye contact and was polite and/or friendly. His speech was of normal rate, tone, and prosody. His thought processes were logical, sequential, and goal oriented and thought content was normal. He denied suicidal or homicidal ideation and audiovisual and auditory hallucinations. He presented with a slightly depressed mood, and his affect was mood congruent. His insight and judgment were good. He was oriented times three or four. In February 2012, he complained of daily nightmares, panic symptoms, symptoms of depression (i.e., anhedonia, anergia, amotivation), parasomnia, hypervigilance, social isolation, having an exaggerated startle response, and feeling as if he is not understood by others. He also reported intrusive thoughts. In September 2012, the Veteran reported being “angry all the time” and being subject to anger outbursts. In February 2014, the Veteran was afforded a VA examination to determine the nature and severity of his PTSD. The Veteran stated that shortly after returning from Afghanistan, he began to experience depression, anxiety, frequent intrusive memories, and recollections of his combat experience in Afghanistan. He stated that he felt guilty about the death of his two friends. The examiner diagnosed the Veteran with chronic PTSD and alcohol use disorder. The Veteran did not have a TBI diagnosis. Regarding the difference between PTSD and alcohol use disorder, the examiner stated that PTSD was manifested by frequent recollections, nightmares, hypervigilance, and avoidance behavior of triggers. While Alcohol Use Disorder was manifested by periods of intoxication, and sometimes periods of withdrawal. The examiner stated that the Veteran met the criteria for a mild to moderate PTSD that related to combat experience while in Afghanistan and witnessing the death of two of his friends. The Veteran experienced recurrent, involuntary, and intrusive distressing memories of the traumatic events. He avoided or made efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events. He had a persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame); feelings of detachment or estrangement from others; and persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings.). The Veteran was hypervigilant and experienced exaggerated startle response and sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). The PTSD symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The disturbance was not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. The Veteran’s symptoms also included depressed mood, anxiety, and chronic sleep impairment. He did not have any other symptoms attributable to PTSD. He stated that he lost multiple jobs after only short periods of work. At the time of the exam, he was unemployed. Regarding occupational and social impairment, the examiner stated that a mental condition had been formally diagnosed, but symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. The examiner stated that it was possible to differentiate what portion of the occupational and social impairment indicated above was caused by each mental disorder. The examiner explained that PTSD lead to psychological and intrapsychic tension and guilt feelings whereas, alcohol use disorder contributed to marital problem and work problems. The Veteran was capable of managing his financial affairs. In a July 2014 Statement, the Veteran, through his representative, stated that due to PTSD, the Veteran had no motivation to be alive, sometimes. He stated that he neglected personal appearance and had difficulty in stressful circumstances. He had nightmares, chronic depression, panic attacks, shortness of breath, and suicidal ideation. Additionally, he was unable to be in a crowded environment and was unable to hold a steady job. He stated that because of his anger issues, his relationship with his wife was ruined. He stated he got angry for no reason or irritable without provocation. He reported road rage. He stated he does not go out much because his anger escalates to violence. In May 2016, the Veteran was afforded a VA examination to determine the severity of his PTSD. The Veteran served in Afghanistan and was involved in dismantling improvise explosive device (IED’s) and came under repeated firefights. He lost two friends in combat. The Veteran felt survival guilt, depression, and lack of sleep associated with increasing frequency of nightmares and flashbacks. He avoided people and crowds, and felt worthless and anxious and unable to express emotions to his family members due to his emotional numbness. He continued to drink alcohol. The Veteran had been married for five years. His parents were alive, and he saw them from time to time. The examiner confirmed the Veteran’s PTSD and alcohol use disorder diagnoses. He did not have a TBI diagnosis. The examiner stated that it was possible to differentiate what symptoms were attributable to each diagnosis. PTSD is manifested by frequent intrusive thoughts and recollections about combat trauma and the loss of two friends, sleep problems, depression, isolation, lack of motivation, hypervigilance, and hyperstartle reactions. Whereas, alcohol use disorder is manifested by continuing drinking despite negative consequences and marital and family stresses. The Veteran was on time for his examination and was casually dressed. He was friendly, verbal, and cooperative. He had no suicidal, homicidal, or psychotic thought disorder. His thinking was organized, goal directed, and logical. He was well oriented to time, place, person, and situation. There were no cognitive deficits, and his judgement was intact. The Veteran experienced recurrent, involuntary, and intrusive distressing memories of the traumatic events and recurrent distressing dreams in which the content and/or effect of the dream were related to the traumatic events. He avoided or made efforts to avoid distressing memories, thoughts, feelings and external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic events. He had persistent and exaggerated negative beliefs or expectations about himself, others, or the world. He also experienced persistent, distorted cognitions about the cause or consequences of the traumatic events that lead him to blame himself or others. He experienced persistent negative emotional state; markedly diminished interest or participation in significant activities; and persistent inability to experience positive emotions. The Veteran was hypervigilance and had exaggerated startle response and sleep disturbance. The duration of the symptoms lasted more than a month and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The disturbance was not attributable to the physiological effects of a substance or another medical condition. The Veteran’s symptoms included anxiety and chronic sleep impairment. The Veteran experienced occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. He stated that he recently lost several jobs; however, at the time of the exam, he was employed. The Veteran was capable of managing his financial affairs. The Board finds that the VA examination reports provide highly probative evidence against a rating in excess of 30 percent. Neither the examination reports nor the Veteran’s VA treatment records provide medical findings that show occupational and social impairment with reduced reliability and productivity consistent with a 50 percent disability rating. In his July 2014 Statement, the Veteran stated that he had suicidal ideation. Additionally, he reported neglecting personal appearance, and anger issues. However, the examiners and the treatment records note that the Veteran did not experience suicidal or homicidal ideation. His speech was normal. The Veteran was also oriented times three or four. The Board notes that the Veteran had lost many jobs; however, at the time of the 2016 exam, he was employed. His thought processes were logical, sequential, and goal oriented and thought content was normal. His insight and judgment were good. The Veteran’s PTSD symptoms include depressed mode, anxiety, and chronic sleep impairment. The Board finds that the frequency, duration, and severity of the symptoms more nearly approximate occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stressor symptoms controlled by medication. The Board has considered statements from the Veteran and his representative regarding the Veteran’s PTSD. 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 evidence of record, 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 are outweighed by the evidence of record, to include the VA opinions. 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). In sum, the preponderance of the evidence is against the assignment of a rating in excess of 30 percent for PTSD. 3. Entitlement to a compensable rating for fracture, right big toe Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective enervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § § 4.10, 4.40, 4.45; see also DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including during flare-ups. Furthermore, the intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Thus, actually painful, unstable, or malaligned joints, due to healed injury, are as entitled to at least the minimum compensable rating for the joint. The joints 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. See 38 C.F.R. § 4.59. The Veteran’s fracture, right big toe is rated noncompensable pursuant to 38 C.F.R. § 4.71a, DC 5299-5284. The hyphenated rating shows that the disability is rated analogous to DC 5284 for foot injuries, other. See 38 C.F.R. §§ 4.20, 4.27 (unlisted disabilities rated by analogy are coded first by the numbers of the most closely related body part and then “99”). Under DC 5284, a 10 percent evaluation is assigned for foot injuries resulting in a moderate disability; a 20 percent evaluation is assigned for foot injuries resulting in a moderately severe disability; and a 30 percent evaluation is assigned for foot injuries resulting in a severe disability. 38 C.F.R. § 4.71a, DC 5284. The Note following these criteria indicates that disability with actual loss of use of the foot should be rated 40 percent disabling. Id. The terms “moderate,” “moderately severe,” and “severe” are not defined by in the regulations. Rather than applying a mechanical formula, the Board must evaluate all the evidence to the end that its decisions are “equitable and just.” See 38 C.F.R. § 4.6. Under Diagnostic Code 5003, degenerative arthritis established by X-ray findings based on the degree of limitation of motion under the appropriate diagnostic codes. 38 C.F.R. § 4.71a, DC 5003. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic code, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. A 20 percent evaluation may be warranted with X-ray involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating episodes. Id. Analysis The Veteran contends that his disability is more severe than is depicted by the noncompensable rating. In March 2012, the Veteran was afforded a VA examination to determine the nature and etiology of the his big toe condition. The examiner reviewed the claims file. The Veteran stated that in July 2011, a 45-pound weight plate accidentally fell on his right big toe. His foot was placed in a boot. He had foot x-rays before and after removal of walking boot. The fracture healed well. The examiner confirmed the Veteran’s fracture of right big toe diagnosis. The Veteran did not have Morton’s neuroma, metatarsalgia, hallux rigidus, hammer toes, acquired claw foot (pes cavus), or malunion or nonunion of tarsal or metatarsal bones. He did not now have or ever had hallux valgus. He did not have any other foot injuries. There was no evidence of bilateral weak foot. There were no other pertinent physical findings, complications, conditions, signs, and/or symptoms related to the Veteran’s foot condition. Additionally, he did not have any scars related to his condition. The Veteran did not use any assistive devices as a normal mode of locomotion. Functioning was not so diminished that amputation with prosthesis would equally serve the Veteran. The Veteran’s condition did not have an impact on his ability to work. In January 2014, the Veteran was afforded another VA examination to determine the severity of the his big toe condition. The examiner reviewed the claims file and performed an in-person examination. The Veteran stated that he continued to have daily residual pain related to weight bearing. The pain was throbbing and located at the first metatarsophalangeal (MTP) joint. He stated that his work involved prolonged weight bearing and climbing ladders, and this exacerbated his pain. Cold weather also exacerbated the pain. The examiner confirmed the Veteran’s status post right hallux fracture. The Veteran did not have Morton’s neuroma, metatarsalgia, hallux rigidus, hammer toes, acquired claw foot (pes cavus), or malunion or nonunion of tarsal or metatarsal bones. He did not now have or ever had hallux valgus. He did not have any other foot injuries. There was no evidence of bilateral weak foot. The Veteran did not have any scars related to his condition. There were no other pertinent physical findings, complications, conditions, signs, and/or symptoms related to his toe condition. The Veteran’s right hallux had 5/5 plantar flexion and dorsiflexion. He had full range of motion (ROM), and N/V was intact. There was no deformity, swelling, or scarring. There was mild TTP of the MTP joint. His gait was normal. The Veteran did not use any assistive devices as a normal mode of locomotion. Functioning was not so diminished that amputation with prosthesis would equally serve the Veteran. Imaging showed borderline degenerative joint disease (DJD) at right first MTP and interphalangeal (IP) joints, otherwise unremarkable x-rays of the right foot. The examiner stated that pain, weakness, fatigability, incoordination, and/or repetitive use less likely than not significantly limit functional ability during flare-ups or when the joint was used repeatedly over time. The Veteran stated that his occupation required prolonged weight bearing and this exacerbates his hallux pain, but he was still fully capable of performing all his job duties. However, the examiner stated that Veteran’s condition did not have an impact on his ability to work. Based on the evidence of record, the Board finds that a 10 percent rating, and no more, is warranted for the Veteran’s fracture of right toe. The January 2014 VA examiner reported mild TTP of the MTP joint. The Veteran also reported daily residual pain related to weight bearing. He also stated that cold weather exacerbated the pain. Resolving doubt in the Veteran’s favor, these symptoms are more likely “moderate” in nature. As such, a 10 percent rating is warranted. A rating in excess of 10 percent is not warranted because the Veteran’s symptoms do not appear “moderately severe” in nature. He does not use assistive devices. The predominant symptom is pain, but without any substantial limitations. Therefore, there is insufficient evidence to conclude that the Veteran’s fracture right big toe is “moderately severe,” or that there is any sort of malunion of the tarsal or metatarsal bones. Even considering functional loss due to pain and other factors, those findings do not support a compensable rating under DC 5284. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). Accordingly, a rating in excess of 10 percent is not warranted. The Board has considered the potential application of the other provisions of 38 C.F.R., Parts 3 and 4. Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). However, there was no malunion of the tarsal bone, nor was there any evidence of flatfoot, weak foot, claw foot, or malunion/nonunion of the tarsal bones. Therefore, a higher rating under DCs 5276 (acquired flat foot), 5277 (weak foot), 5278 (claw foot (pes cavus)), and 5283 (malunion or nonunion of the tarsal or metatarsal bones) is not warranted. In sum, the Veteran’s fractured right big toe has resulted in impairments that more nearly approximate the criteria for a 10 percent rating under DC 5284. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. § 4.7, 4.71a, DCs 5299-5284. Lastly, the Veteran asserted in July 2014, through his representative, that the VA examinations in this matter were inadequate. (Continued on the next page)   In the VA examination reports of record, the examiners indicated review of the claims file, interviews of the Veteran, and personal examinations of the Veteran. The reports detailed the Veteran’s relevant history. The examination reports set forth detailed examination findings in a manner which allows for informed appellate review under applicable VA laws and regulations. Additionally, the Board notes that the opinions are consistent with the evidence of record. 38 U.S.C. § 5103A(d); 38 C.F.R § 3.159(c)(4). Thus, the Board finds the opinions are adequate for rating purposes and additional examinations are not necessary. CHRISTOPHER MCENTEE Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Henry, Associate Counsel