Citation Nr: 18154905 Decision Date: 12/04/18 Archive Date: 11/30/18 DOCKET NO. 16-38 397 DATE: December 4, 2018 ORDER Entitlement to an evaluation in excess of 50 percent for a major depressive disorder is denied. For the period prior to May 13, 2015, entitlement to a compensable evaluation for right hand carpal tunnel syndrome is denied. For the period beginning on May 13, 2015, entitlement to an evaluation in excess of 10 percent for right hand carpal tunnel syndrome is denied. For the period prior to May 13, 2015, entitlement to a compensable evaluation for left hand carpal tunnel syndrome is denied. For the period beginning on May 13, 2015, entitlement to an evaluation in excess of 10 percent for left hand carpal tunnel syndrome is denied. For the period prior to May 13, 2015, entitlement to a compensable evaluation for allergic rhinitis is denied. For the period beginning on May 13, 2015, entitlement to an evaluation in excess of 10 percent for allergic rhinitis is denied. Entitlement to a compensable evaluation for hypertension is denied. Entitlement to a compensable evaluation for anemia is denied. REMANDED For the period prior to May 19, 2015, entitlement to an evaluation in excess of 10 percent for right shoulder degenerative changes, status post-surgery, with polymyositis (right shoulder disability) is remanded. For the period beginning on May 19, 2015, entitlement to an evaluation in excess of 20 percent for a right shoulder disability is remanded. For the period prior to May 13, 2013, entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s major depressive disorder is manifested by occupational and social impairment with reduced reliability and productivity; occupational and social impairment with deficiencies in most areas is not shown. 2. For the period prior to May 13, 2015, the Veteran’s right hand carpal tunnel syndrome was not manifested by symptoms of incomplete paralysis. 3. For the period beginning on May 13, 2015, the Veteran’s right hand carpal tunnel syndrome is manifested by symptoms of incomplete paralysis. 4. For the period prior to May 13, 2015, the Veteran’s left hand carpal tunnel syndrome was not manifested by symptoms of incomplete paralysis. 5. For the period beginning on May 13, 2015, the Veteran’s left hand carpal tunnel syndrome is manifested by symptoms of incomplete paralysis. 6. For the period prior to May 13, 2015, the Veteran’s allergic rhinitis was not shown to have manifested by evidence of obstruction of the nasal passages greater than 50 percent on both sides, or complete obstruction on one side, or any polyps. 7. For the period beginning on May 13, 2015, the Veteran’s allergic rhinitis is manifested by evidence of obstruction of the nasal passages greater than 50 percent on both sides, but without any polyps. 8. The Veteran’s hypertension is not shown to be manifested by diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or any history of diastolic blood pressure of predominantly 100 or more and requiring continuous medication for control. 9. The Veteran’s anemia is not shown to be manifested by hemoglobin levels of 10 gm/100 ml or less with findings such as weakness, easy fatigability, or headaches. CONCLUSIONS OF LAW 1. Entitlement to an evaluation in excess of 50 percent for a major depressive disorder is denied. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.130, Diagnostic Code 9434 (2017). 2. For the period prior to May 13, 2015, the criteria for entitlement to a compensable evaluation for right hand carpal tunnel syndrome have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.124a, Diagnostic Code 8515 (2017). 3. For the period beginning on May 13, 2015, the criteria for entitlement to an evaluation in excess of 10 percent for right hand carpal tunnel syndrome have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.124a, Diagnostic Code 8515 (2017). 4. For the period prior to May 13, 2015, the criteria for entitlement to a compensable evaluation for left hand carpal tunnel syndrome have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.124a, Diagnostic Code 8515 (2017). 5. For the period beginning on May 13, 2015, the criteria for entitlement to an evaluation in excess of 10 percent for left hand carpal tunnel syndrome have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.124a, Diagnostic Code 8515 (2017). 6. For the period prior to May 13, 2015, the criteria for entitlement to a compensable evaluation for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.97, Diagnostic Code 6522 (2017). 7. For the period beginning on May 13, 2015, the criteria for entitlement to an evaluation in excess of 10 percent for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.97, Diagnostic Code 6522 (2017). 8. The criteria for entitlement to a compensable evaluation for hypertension have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.104, Diagnostic Code 7101 (2017). 9. The criteria for entitlement to a compensable evaluation for anemia have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.117, Diagnostic Code 7700 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty for training in the U.S. Army from July 1987 to October 1987, and on active duty from January 1989 to October 1996, May 1999 to May 2002, and August 2003 to July 2009. These matters come before the Board of Veteran’s Appeals (Board) on appeal from a July 2012 rating decision by the Regional Office (RO). See Notice of disagreement, May 2013. A February 2017 rating decision granted a TDIU, effective May 13, 2013. Because several increased rating claims are on appeal herein, the Board finds that the issue of entitlement to a TDIU for the period prior to May 13, 2013 is part and parcel to the increased rating claims, and is therefore also on appeal. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). Increased Ratings 1. Entitlement to an evaluation in excess of 50 percent for a major depressive disorder The Veteran’s major depressive disorder is currently assigned a 50 percent rating under Diagnostic Code 9434, effective July 7, 2009. The Veteran seeks an increased rating. See Claim, August 2011. The General Rating Formula for Mental Disorders (DCs 9201 – 9440) provides that the criteria for a 50 percent rating are as follows: 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; difficulty in establishing and maintaining effective work and social relationships. See 38 C.F.R. §4.130 (2017). The criteria for a 70 percent rating are as follows: 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); inability to establish and maintain effective relationships. The criteria for a 100 percent rating are as follows: 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; memory loss for names of close relatives, own occupation, or own name. Ratings are assigned according to the manifestation of particular symptoms. Notably, the term “such as” in 38 C.F.R. § 4.130 precedes lists of symptoms that are not exhaustive, but rather serve as examples of the type and degree of symptoms and their effects that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the evidence considered in determining the level of impairment under 38 C.F. R. § 4.130 is not restricted to the symptoms provided in the diagnostic code. Instead, VA will consider all symptoms of a claimant’s disability that affect the level of occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM IV or V). However, with respect to the 70 percent rating criteria in particular, the Court of the Appeals for the Federal Circuit has clarified that “[e]ntitlement to a 70 percent disability rating requires sufficient symptoms of the kind listed in the 70 percent requirements, or others of similar severity, frequency or duration, that cause occupational and social impairment with deficiencies in most areas such as those enumerated in the regulation.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). The Court further noted that “symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating,” and “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” Id. The Board notes that the DSM-V no longer utilizes global assessment functioning (GAF) scores (as opposed to the DSM-IV). The DSM-V is applicable for appeals certified to the Board on or after August 4, 2014. In this case, because the appeal was certified in August 2016, the DSM-V is applicable. The Veteran was afforded VA examinations in September 2011, July 2013, and May 2015. The September 2011 VA examination report shows the examiner noted a history (prior to the period on appeal) of psychiatric hospitalization in 2009 for suicidal thoughts. The Veteran reported he was presently residing with a friend, and that he had lived with other friends in the recent past. The examiner noted the Veteran was presently being followed at the VA medical center, and that a July 2011 record noted that the Veteran reported improvement in his mood since starting sertraline medication. The Veteran reported to the examiner that he had attended school in the spring but that his computer crashed and he quit attending. When asked about his depressive symptoms, the Veteran reported he felt tired, and gave an example that he had been missing church services and that it was uncharacteristic of him to do so. He reported waking in pain and wishing that the pain would end. He reported he wished to be active bicycling and walking but was unable to do so. The examiner noted that the Veteran sat with his head hung low and his eyes closed several times during the examination. He also reported dreams of his service and sleepwalking. The examiner noted the Veteran was adequately groomed, speech was appropriate, content logical and goal directed, mood was dysphoric, affect was flat. The Veteran denied any hallucinations or delusions, and denied suicidal and homicidal ideation. Regarding any cognitive deficits, the examiner noted that slow processing speed was observed, but no significant memory impairment was observed. Intellect appeared to be in the normal range. Insight was fair to poor. Judgment was unimpaired. The examiner noted that the Veteran’s responses on the Beck Depression Inventory (BDI) suggested moderate to severe levels of depressive symptoms, and the examiner noted that there appeared to be improvement, albeit minimal, since the last VA examination in April 2010. The examiner diagnosed a mood disorder due to multiple medical conditions (pain syndrome and anemia). The July 2013 VA examination report shows the examiner noted that the Veteran has three children who do not reside with him, and that he has minimal contact with them by phone, emailing, or texting. He reported he was living in an apartment on his own, attending church services on Fridays and Saturdays, and that he had church friends with whom he occasionally goes out with. He reported he was attending college courses online in theology. He reported gardening but that it was “not going well.” The examiner noted the Veteran had major depression due to multiple medical conditions. The Veteran denied any suicidal or homicidal ideation, and denied any hallucinations or delusions. The examiner noted symptoms of anxiety, chronic sleep impairment, and mild memory loss. The Veteran reported he was unemployed since his discharge from service, and that he was depressed after his medical discharge from service after 23 years because he had planned a long military career. The examiner opined that the Veteran’s level of occupational and social impairment with regard to all mental diagnoses was best summarized as: occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The May 2015 VA examination report shows the examiner noted the Veteran meets the criteria for a persistent depressive disorder, with pure dysthymic syndrome, mild. The examiner explained that the basis for the change in diagnosis was the fact that the Veteran was not currently consistent with a major depressive episode, but rather, was more of a dysthymic nature (i.e. occurring most days but not all day every day). The Veteran reported living with his best friend, but is easily aggravated by him. He reported he was in regular contact with two of his three children (by three different mothers), but not the youngest (age 5) and that he did not get along with her mother. He reported he is close with his mother, but easily aggravated by her. He reported he naps on and off throughout the day because his medications make him drowsy. He reported attending church services and activities on Fridays and Sundays, that he plays the piano and organ at church, but likely will have to give that up due to pain in his hands, and that he has friends in his church. The examiner noted the Veteran has not worked at all since 2009. The Veteran reported his symptoms had worsened since the last VA examination. He reported he loved music and that it is depressing to think that he might have to give that up due to pain issues. He reported sleeping initially for about three hours, waking, and having difficulty returning to sleep for maybe two hours, with pain issues being the primary barrier to sleep. He reported low energy throughout the day, and the Veteran reported that his pain medications also make him drowsy. The examiner noted that the Veteran was often observed to have his eyes shut during the exam, but he appeared to be awake. The Veteran expressed a loss of interest in doing most activities, and difficulty concentrating depending on his pain level and remembering things. He flatly denied any suicidal ideation or homicidal ideation, plan, or intent, but did express he experiences passive suicidal ideation from time ot time with no plan or intent to act. The examiner noted the Veteran did not appear to be at imminent risk to harm self. The examiner also noted the Veteran’s symptoms include depressed mood, chronic sleep impairment, mild memory loss (such as forgetting names, directions, or recent events), disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Also noted were decreased interest in activities, low energy, difficulty with concentration, and irritability. Examination revealed the Veteran was oriented in all spheres, he was dressed appropriately for the weather and his grooming was good, his speech was logical and goal-directed, his mood was generally depressed, but reported as dependent on his pain level, affect was euthymic, no hallucinations or delusions were shown, he reported variable ability to concentrate, difficulty remembering things, his insight was intact, and judgment was unimpaired. The examiner opined the Veteran currently exhibits mild to moderate impairment in social functioning due to his mental health symptoms as evidenced by limited social contacts and limited social activities, and that the Veteran’s symptoms do not currently contribute to impairment in occupational functioning. The examiner opined that the Veteran’s level of occupational and social impairment with regard to all mental diagnoses was best summarized as: occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Board has carefully reviewed all of the Veteran’s VA treatment records, including his mental health notes, none of which show symptoms more severe than those noted on examination as discussed above. The Board has taken into serious consideration all of the other evidence of record. The Board acknowledges that the Veteran reported in his September 2011 statement symptoms of memory loss such as forgetting simple words or why he walked into a room, and low energy. He reported in a June 2014 statement that he experiences uncontrollable anger, avoids crowds, and forgets and burns food in the microwave. The Board has also carefully reviewed the Veteran’s records from the Social Security Administration (SSA). The Board acknowledges that the Veteran was awarded disability by the SSA in 2011. However, the SSA Determination and the SSA Decision clearly show that the SSA award was based on the Veteran’s right shoulder disability and obesity, not his depression. See SSA Records (set II), received August 2014 at p.2 and 9 of 148. In fact, the Administrative Law Judge (ALJ) who issued that SSA Decision went so far as to note that the mental impairment questionnaire provided in connection with the SSA claim that noted marked difficulties in functioning was “given no weight as it is inconsistent with the medical evidence of record.” In fact, the ALJ “strongly admonishes the claimant to follow his treating physician’s recommendations and to be compliant.” See id. at p.10 of 148. Regardless, an SSA Decision is not binding on VA as to whether the Veteran’s service-connected major depressive disorder meets the criteria for an evaluation in excess of 50 percent. In light of all of the above, the Board finds the preponderance of the evidence is against finding that the Veteran’s depressive disorder symptoms meet or more nearly approximate the next higher 70 percent rating criteria. The Veteran is not shown to have any symptoms of a level of severity similar to those listed in the criteria for a 70 percent rating, such as: obsessional rituals which interfere with routine activities, speech that is 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 worklike setting), and an inability to establish and maintain effective relationships. While the Board acknowledges that the Veteran has reported that his mother and best friend can aggravate him, that he experiences “uncontrollable anger,” and while the May 2015 VA examiner noted symptoms of irritability, the evidence does not show impaired impulse control, such as unprovoked irritability with periods of violence; regardless, even if impaired impulse control such as with unprovoked irritability with periods of violence was shown, the Board finds that this alone would not be sufficient to bring the Veteran’s overall disability picture to more nearly approximate the next higher rating criteria. The records show his speech is appropriate, hygiene is good, that he has lived with his best friend, that he has friends at church, has relationships with his mother and to a degree with two of his children, and has attended college courses. While the Board is sympathetic to the fact that the Veteran experiences depressive symptoms, including due to pain, difficulty playing or inability to play music, and due to his reported inability to be as active as he wishes, his overall disability picture due to his service-connected depressive disorder alone is not of a level of severity to bring it to more nearly approximate the criteria for a 70 percent rating. The Board acknowledges that the Veteran’s representative argues in his April 2018 brief that a 70 percent rating is warranted because, among other things, the Veteran had a hospitalization in 2009 for suicidal ideation, and that the Veteran reported suicidal thoughts at an April 2010 VA examination. The Board notes, however, that these incidents were all prior to the period on appeal – and more than one year prior to the filing of the claim for an increase in August 2011. As noted above, the September 2011 noted that the Veteran’s symptoms had improved since a prior VA examination in April 2010, and since starting certain medication. Also, the May 2015 VA examiner explained that although the Veteran had passive suicidal thoughts, he had no suicidal ideation, no plan, and no intent, and did not pose a risk of harm to himself. The Board also acknowledges that the Veteran’s representative argued in his April 2018 brief that the Veteran reported in a September 2013 statement that he was experiencing significant comprehension problems when attempting to read. The Board finds, however, that the probative value of this statement is diminished by the fact that just two months prior, at the July 2013 VA examination, the Veteran reported taking online college courses in theology, and communicating with his children by email and by text messaging. Likewise, while the Veteran’s representative pointed to the fact that the Veteran reported at the prior September 2011 VA examination that he quit taking college courses when his computer crashed, the Board does not find that such tends to show that the Veteran had any comprehension or reading issues – rather, it shows he discontinued his studies, apparently online courses, due to his computer not working. The Veteran’s representative also argued that the May 2015 VA examiner noted depressed mood, irritability, and difficulty concentrating. In that regard, the Board finds that a depressed mood and some difficulty concentrating are already contemplated by the presently assigned 50 percent rating. Finally, regarding the Veteran’s reported irritability and uncontrollable anger, which is addressed in greater detail above, the Veteran is not shown to have unprovoked irritability, such as with periods of violence, and even if such were shown, it would not be sufficient to bring the Veteran’s overall disability picture to more nearly approximate the next higher 70 percent rating criteria. In summary, the Board concludes that entitlement to an evaluation in excess of 50 percent for the Veteran’s service-connected major depressive disorder is not warranted; because the preponderance of the evidence is against the claim, the benefit of the doubt rule is not for application. In this case, the Veteran has not contended, and the evidence does not suggest, that he has experienced symptoms outside of those listed in the scheduler criteria. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (the Board is not obligated to analyze whether remand for referral for extraschedular consideration is warranted if 38 C.F.R. § 3.321(b)(1) is neither specifically sought by the claimant nor reasonably raised by the facts found by the Board). 2. For the period prior to May 13, 2015, entitlement to a compensable evaluation for right hand carpal tunnel syndrome 3. For the period beginning on May 13, 2015, entitlement to an evaluation in excess of 10 percent for right hand carpal tunnel syndrome 4. For the period prior to May 13, 2015, entitlement to a compensable evaluation for left hand carpal tunnel syndrome 5. For the period beginning on May 13, 2015, entitlement to an evaluation in excess of 10 percent for left hand carpal tunnel syndrome The Veteran’s left and right hand carpal tunnel syndrome are each assigned noncompensable ratings prior to May 13, 2015, and 10 percent thereafter under Diagnostic Code 8515. The Veteran seeks increased ratings. See Claim, August 2011. Diagnostic Code 8515, median nerve, paralysis of, provides a 10 percent rating for mild incomplete paralysis, 30 percent for moderate incomplete paralysis (20 percent for minor extremity), and 50 percent for severe (40 percent for minor extremity). Higher ratings are provided for complete paralysis. See 38 C.F.R. §4.124a (2017). A September 2011 VA examination report shows the Veteran reported symptoms of tingling, stiffness, and numbness in his right hand almost always. He reported experiencing stiffness in his left hand. The examiner noted the Veteran had a history that was significant for polymyositis (involving the right shoulder), confirmed by an EMG study, and for right rotator cuff tendonitis. Examination revealed motor strength of 5/5. Deep tendon reflexes were 2+. Sensory examination revealed normal sensation to pinprick, touch, position sense, and vibration except for the feet. Coordination of finger to nose was normal bilaterally. Tinel’s sign was negative bilaterally at the wrists. The examiner noted that “in summary, this patient suffers with paresthesias in the upper and lower extremities. Etiology of his paresthesias is unknown at present. He suffers with polymyositis at present which is more likely than not contributory to stiffness in his hands. I recommend that Mr. ----- continue workup by his primary doctor for possible etiology of his paresthesias.” A July 2013 VA examination report shows the Veteran reported experiencing intermittent tingling sensations in his right forearm and right hand, and in his left hand. He reported that it started in approximately 2011. The examiner noted that electrodiagnostic studies were completed in 2012 and no evidence of radiculopathy or any nerve problem was found. The examiner noted that the Veteran does have polymyositis and is on treatment for this condition. The examiner noted that the Veteran is right hand dominant. Muscle strength testing of pinch, grip, wrist flexion and extension, and elbow extension and flexion were all 5/5. Deep tendon reflexes were 2+. Phalen’s sign and Tinel’s sign testing was all negative. Examination of the median nerve, radial nerve, ulnar nerve revealed no incomplete or complete paralysis and was noted as all “normal” bilaterally. The examiner opined that he was unable to diagnose any peripheral nerve problem without resorting to mere speculation. The examiner reasoned that although the Veteran reported symptoms of intermittent paresthesias of the right forearm, right hand, and left hand, electrodiagnostic studies did not establish a cause for the paresthesias. A May 2015 VA examination report shows the Veteran reported symptoms of intermittent numbness and tingling of the right arm and right hand, and less frequently over the left hand. He reported his symptoms had worsened and become more frequent. He reported his symptoms are most noticeable when playing the piano or using a computer. He also reported weakness in his left hand and reported he drops things easily. The examiner noted that an EMG study years ago was normal. The examiner checked boxes on the form indicating that the Veteran reported mild constant pain in both upper extremities, moderate intermittent pain in the right upper extremity, mild intermittent pain in the left upper extremity, and mild numbness and paresthesias and/or dysesthesias in both upper extremities. Muscle strength testing of pinch, grip, wrist flexion and extension, and elbow extension and flexion were all 5/5. Deep tendon reflexes were 2+. Sensory examination of the forearms and fingers was all normal. Phalen’s sign and Tinel’s sign testing was negative. The examiner noted mild incomplete paralysis of the median nerve bilaterally. The examiner noted that EMG testing in July 2012 was normal (except polymyositis was noted). A diagnosis of bilateral carpal tunnel syndrome was noted. Regarding whether the functional impact of the Veteran’s symptoms and their effect on his ability to work, the examiner noted the Veteran’s symptoms cause difficulty playing a piano and using a computer due to numbness and tingling. The Board has reviewed all of the other medical evidence of record, none of which shows any symptoms more severe than those noted on examination described above. In fact, none of the Veteran’s VA treatment records show any diagnosed carpal tunnel syndrome. The May 2015 VA examination report shows diagnosed carpal tunnel syndrome with an onset in 2015 (i.e., the date of the examination). In light of the above evidence of record, the Board finds that the preponderance of the evidence is against findings that the criteria for higher ratings have been met or approximated for the Veteran’s right and left hand carpal tunnel syndrome for the entire period on appeal. As shown above, no carpal tunnel syndrome was diagnosed until the May 2015 VA examination. Physical examination of both extremities on prior examinations in September 2011 and July 2013 revealed normal motor strength, normal deep tendon reflexes, and normal sensory examination. Tinel’s sign testing was negative at both examinations. Although the September 2011 examiner’s summary seemed to include paresthesias of the upper and lower extremities, it is inconsistent with his concurrent observation of no dysesthesia other than on the feet and a negative Tinel’s sign at the wrists. No incomplete paralysis was shown until the time of the May 2015 VA examination, at which time the Veteran did report that his symptoms had worsened. As noted above, Diagnostic Code 8515 provides a 10 percent evaluation for symptoms of mild incomplete paralysis. Therefore, for the period prior to May 13, 2015, entitlement to a compensable 10 percent rating is not shown without evidence of incomplete paralysis due to carpal tunnel syndrome. For the period beginning on May 13, 2015, as mild incomplete paralysis was noted on examination in both the right and left upper extremities, the Veteran’s symptoms are squarely contemplated by the currently assigned 10 percent ratings (each for right and left). The criteria for higher 20 percent ratings are clearly not shown, as no moderate incomplete paralysis was ever shown in either upper extremity. The May 2015 VA examiner specifically characterized the Veteran’s incomplete paralysis of both extremities as “mild” and not “moderate.” The Board acknowledges that the May 2015 VA examiner noted that the Veteran’s reported that his right upper extremity symptoms included “moderate” intermittent pain. However, the Board further notes again that the Veteran reported mild constant pain, mild numbness, and mild paresthesias and/or dysesthesias. Thus, the majority of his reported symptoms were specifically noted as “mild” and not “moderate.” Therefore, which the Board acknowledges his one symptom of intermittent pain was noted as “moderate,” the majority of his symptoms were reported to be “mild,” and thus this one notation of moderate intermittent pain is not sufficient to bring the overall disability picture to more nearly approximate the next higher rating criteria. The Board adds that, despite that one notation, the VA examiner likewise found that the Veteran’s right upper extremity paralysis was overall “mild.” In summary, the Board concludes that entitlement to increased ratings for the Veteran’s right and left hand carpal tunnel syndrome are not warranted; as the preponderance of the evidence is against the claims, the benefit of the doubt rule is not for application. In this case, the Veteran has not contended, and the evidence does not suggest, that he has experienced symptoms outside of those listed in the scheduler criteria. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (the Board is not obligated to analyze whether remand for referral for extraschedular consideration is warranted if 38 C.F.R. § 3.321(b)(1) is neither specifically sought by the claimant nor reasonably raised by the facts found by the Board). 6. For the period prior to May 13, 2015, entitlement to a compensable evaluation for allergic rhinitis 7. For the period beginning on May 13, 2015, entitlement to an evaluation in excess of 10 percent for allergic rhinitis The Veteran’s allergic rhinitis is currently assigned a noncompensable rating prior to May 13, 2015, and 10 percent thereafter under Diagnostic Code 6522. The Veteran seeks higher ratings. See Claim, August 2011. Diagnostic Code 6522, allergic or vasomotor rhinitis, provides a 10 percent rating for allergic or vasomotor rhinitis without polyps, but with greater than 50 percent obstruction of nasal passages on both sides or complete obstruction on one side. A 30 percent rating is provided with polyps. See 38 C.F.R. § 4.97 (2017). A September 2011 VA examination report shows the Veteran reported a history of experiencing perennial congestion with difficulty in nasal breathing, and that he was using medications. Examination revealed 40 percent obstruction of the left nasal passageway, and no nasal polyps were found. The examiner recorded a diagnosis of chronic perennial vasomotor rhinitis. See Records, received September 2011 at p.4 of 18. A May 2015 VA examination report shows the Veteran reported he takes allergy medications. Examination revealed greater than 50 percent obstruction of both passages due to rhinitis. No nasal polyps were shown. The examiner opined that the Veteran’s allergic rhinitis does not affect his ability to work. The Board has also reviewed all of the treatment records in the claims file, none of which show any symptoms more severe than those noted above, including no evidence of nasal polyps. For the period prior to May 13, 2015, the Board finds that the preponderance of the evidence is against finding that the Veteran’s allergic rhinitis symptoms meet or approximate the criteria for a compensable rating under Diagnostic Code 6522 because there is no evidence of at least 50 percent nasal obstruction on both sides, no evidence of complete obstruction of one nasal passage, and no evidence of any nasal polyps. For the period beginning on May 13, 2015, the Board finds that the preponderance of the evidence is against finding that the Veteran’s allergic rhinitis symptoms more nearly approximate the criteria for the next higher 30 percent rating under Diagnostic Code 6522 because there is no evidence of nasal polyps. Therefore, the Board concludes that entitlement to a compensable evaluation for the period prior to May 13, 2015, and entitlement to an evaluation in excess of 10 percent thereafter, for the Veteran’s allergic rhinitis is not warranted. As the preponderance of the evidence is against assigning higher ratings, the benefit of the doubt rule is not for application. In this case, the Veteran has not contended, and the evidence does not suggest, that he has experienced symptoms outside of those listed in the scheduler criteria. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (the Board is not obligated to analyze whether remand for referral for extraschedular consideration is warranted if 38 C.F.R. § 3.321(b)(1) is neither specifically sought by the claimant nor reasonably raised by the facts found by the Board). 8. Entitlement to a compensable evaluation for hypertension The Veteran’s hypertension is currently assigned a noncompensable rating under Diagnostic Code 7101, effective July 7, 2009. The Veteran seeks an increased rating. See Claim, August 4, 2011. Hereafter, all blood pressure measurements are noted in units of mmHg. Diagnostic Code 7101 provides a 10 percent evaluation when evidence demonstrates diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more. A minimum of 10 percent is also assigned for an individual with a history of diastolic blood pressure of predominantly 100 or more and who requires continuous medication for control. A 20 percent evaluation is provided with diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. A 40 percent evaluation is provided with diastolic pressure predominantly 120 or more. A maximum scheduler evaluation of 60 percent is provided when there is diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104 (2017). A September 2011 VA examination report shows the examiner noted the veteran had been hypertensive since 2009, and that he was not presently on any antihypertensive medications. The Veteran’s blood pressure readings were 134/80, 123/79, and 118/77, and the examiner noted that the Veteran was currently normotensive. The July 2013 VA examination report shows the Veteran reported a history of elevated blood pressure in 2009. The examiner noted that the Veteran’s blood pressure was normal at the time of the examination - his blood pressure readings were 118/83, 115/75, and 115/79. It was noted that the Veteran had never taken oral medication for control, and that he did not have a history of diastolic blood pressure readings of predominantly 100 or more. The examiner opined that the Veteran’s hypertension did not affect his ability to work. The May 2015 VA examination report shows the examiner noted that the Veteran was normotensive – his blood pressure readings were 132/81, 124/77, and 128/80. It was noted that the Veteran had never taken oral medication for control, and that he did not have a history of diastolic blood pressure readings of predominantly 100 or more. The examiner opined that the Veteran did not presently have hypertension, and that his service-connected hypertension did not affect his ability to work. The Board has reviewed all of the other medical evidence of record, none of which shows any relevant symptoms more severe than those shown on examination. In light of the above evidence, the Board finds that the preponderance of the evidence is against finding that the Veteran’s hypertension symptoms more nearly approximate the criteria for a compensable rating under Diagnostic Code 7101. There is no evidence of diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or any history of diastolic blood pressure of predominantly 100 or more and requiring continuous medication for control. Therefore, the Board concludes that entitlement to a compensable evaluation for the Veteran’s hypertension is not warranted. As the preponderance of the evidence is against assigning a higher rating, the benefit of the doubt rule is not for application. In this case, the Veteran has not contended, and the evidence does not suggest, that he has experienced symptoms outside of those listed in the scheduler criteria. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (the Board is not obligated to analyze whether remand for referral for extraschedular consideration is warranted if 38 C.F.R. § 3.321(b)(1) is neither specifically sought by the claimant nor reasonably raised by the facts found by the Board). 9. Entitlement to a compensable evaluation for anemia The Veteran’s service-connected anemia is currently assigned a noncompensable rating under Diagnostic Code 7700, effective July 7, 2009. The Veteran seeks an increased rating. See Claim, August 2011. Diagnostic Code 7700 provides a noncompensable rating when hemoglobin is 10gm/100ml or less and the anemia is asymptomatic. A 10 percent rating is provided when hemoglobin is 10gm/100ml or less with symptoms such as weakness, easy fatigability, or headaches. A 30 percent rating is provided when hemoglobin is 8gm/100ml or less, with symptoms such as weakness, easy fatigability, headaches, lightheadedness, or shortness of breath. A 70 percent rating is provided when hemoglobin is 7gm/100ml or less, with symptoms such as dyspnea on mild exertion, cardiomegaly, tachycardia (100 to 120 beats per minute) or syncope (three episodes in the last six months). A maximum 100 percent rating is provided when hemoglobin is 5gm/100ml or less, with symptoms such as high output congestive heart failure or dyspnea at rest. 38 C.F.R. § 4.117, Diagnostic Code 7700. A September 2011 VA examination report shows the examiner noted that the Veteran’s hemoglobin was 13.2 gm/100 ml in July 2011, and 12.8 gm/100 ml in September 2011. No symptoms of anemia were noted. The examiner noted that the Veteran’s anemia was “mild.” A May 2015 VA examination report notes a history of diagnosed anemia in 2007 and that he was prescribed folic acid. The examiner noted that the Veteran’s hemoglobin was 13.3 gm/100 ml, and no findings or symptoms of anemia were found on examination. The examiner noted that the Veteran’s anemia was “mild,” and that it did not affect his ability to work. The Board has also reviewed all of the Veteran’s VA and private treatment records, none of which show any signs or symptoms more severe than those noted on VA examination. A July 2014 treatment record from Dr. K.K. shows the Veteran’s hemoglobin was 13.6. See Records, received August 2014 at p.9 of 13. In light of the above evidence, the Board finds that the preponderance of the evidence is against finding that the Veteran’s anemia symptoms more nearly approximate the criteria for a compensable rating under Diagnostic Code 7700. There is no evidence of hemoglobin of 10gm/100ml or less with symptoms such as weakness, easy fatigability, or headaches. Therefore, the Board concludes that entitlement to a compensable evaluation for the Veteran’s anemia is not warranted. As the preponderance of the evidence is against assigning a higher rating, the benefit of the doubt rule is not for application. In this case, the Veteran has not contended, and the evidence does not suggest, that he has experienced symptoms outside of those listed in the scheduler criteria. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). REASONS FOR REMAND 1. For the period prior to May 19, 2015, entitlement to an evaluation in excess of 10 percent for a right shoulder disability is remanded. 2. For the period beginning on May 19, 2015, entitlement to an evaluation in excess of 20 percent for a right shoulder disability is remanded. 3. For the period prior to May 13, 2013, entitlement to a TDIU is remanded. The Veteran’s right shoulder disability is currently assigned a 10 percent rating prior to May 19, 2015, and 20 percent thereafter under Diagnostic Code 5201. The Veteran seeks increased ratings. The Board wishes to note that the Veteran’s right shoulder polymyositis, and his right shoulder disability status-post surgery with degenerative changes, are presently rated together. A February 2017 rating decision granted the Veteran’s claim for a TDIU, effective May 13, 2013. Entitlement to a TDIU prior to May 13, 2013, remains on appeal. The Veteran was last afforded a VA examination relating to his right shoulder in May 2015. Subsequently, a February 2016 VA treatment record indicates the Veteran underwent right shoulder surgery in December 2015 at Froedtert Hospital. See CAPRI, received July 2016 at p.1 of 120. Therefore, the Board finds that this matter should be remanded so that all of the Veteran’s more recent VA treatment records dated since February 2016 may be obtained, so that his private treatment records relating to the December 2015 surgical procedure at Froedtert Hospital may be requested, and so that he may be afforded a new VA examination to address the current severity of his right shoulder disability – both his polymyositis, as well as his right shoulder disability with degenerative changes status-post surgery. At this time, the Board will defer decision on the intertwined TDIU claim. The matters are REMANDED for the following action: 1. Associate with the claims file the Veteran’s more recent VA treatment records dated from February 2016 to present. Associate with the claims file records of the Veteran’s right shoulder surgery at Froedtert Hospital dated from December 2015 to January 2016; in that regard, ask the Veteran to complete a Form 21-4142 authorization. 2. After the above development has been completed, schedule a new VA examination to address the current severity of the Veteran’s service-connected right shoulder disability – including examination of his polymyositis, and of his right shoulder disability status-post surgery with degenerative changes. The claims folder should be made available to the examiner and pertinent documents therein should be reviewed by the examiner. All necessary tests and studies should be accomplished, and all clinical findings should be reported in detail. The examination must comply with the requirements of 38 C.F.R. § 4.59 involving measurements of passive and active range of motion - in both weight bearing and non-weight bearing. The examiner must explain why any of these clinical tests are not appropriate or could not be performed. A complete rationale for any opinions expressed should be provided. The examiner should be asked to note whether there is any weakened movement, excess fatigability, incoordination, or pain on use. If so, the examiner should note whether there are any additional degrees of loss of motion as a result (if it is not feasible to quantify, please explain). If flare-ups are noted, the examiner should note whether pain during flare-ups additionally limits functional ability. The examiner should note whether there are any additional degrees of loss of motion due to pain during flare-ups (if it is not feasible to quantify, please explain). The examiner should also address the effect of the Veteran’s right shoulder disabilities on his occupational functioning and activities of daily living. Any opinion must be accompanied by a complete rationale J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Juliano, Counsel