Citation Nr: 18158268 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 10-36 225A DATE: December 14, 2018 ORDER Entitlement to an initial rating in excess of 10 percent for patellofemoral syndrome of the right knee is denied. Entitlement to an initial rating in excess of 10 percent for patellofemoral syndrome of the left knee is denied. Entitlement to an initial rating in excess of 10 percent for an umbilical scar is denied. Entitlement to an initial 10 percent rating for hallux valgus deformity of the left great toe is granted, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to an initial rating in excess of 10 percent for hallux valgus deformity of the right great toe with bunionectomy is denied. REMANDED Entitlement to an initial rating in excess of 10 percent for lumbar sprain is remanded. FINDINGS OF FACT 1. The Veteran's patellofemoral syndrome of the right knee does not result in flexion limited to 30 degrees or extension limited to 15 degrees. 2. The Veteran’s patellofemoral syndrome of the left knee does not result in flexion limited to 30 degrees or extension limited to 15 degrees. 3. The Veteran only has one painful umbilical scar. 4. The Veteran's hallux valgus deformity of the left great toe is severe. 5. The Veteran's hallux valgus deformity of the right great toe with bunionectomy does not result in osteoarthritis of more than one group of minor joints. CONCLUSIONS OF LAW 1. The criteria for entitlement an initial rating in excess of 10 percent for patellofemoral syndrome of the right knee have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.71a, Diagnostic Codes (DCs) 5003, 5010, 5020, 5260, 5261. 2. The criteria for entitlement to an initial rating in excess of 10 percent for patellofemoral syndrome of the left knee have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.71a, DCs 5003, 5010, 5020, 5260, 5261. 3. The criteria for an initial rating in excess of 10 percent for an umbilical scar have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.118, DC 7804. 4. The criteria for an initial 10 percent rating for hallux valgus deformity of the left great toe have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.71a, DCs 5003, 5280. 5. The criteria for an initial rating in excess of 10 percent for hallux valgus deformity of the right great toe with bunionectomy have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.71a, DCs 5003, 5280. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from October 2000 to September 2008. This matter is on appeal from April 2009, August 2009 and July 2010 rating decisions. These matters were initially before the Board of Veterans’ Appeals (Board) in December 2012, when the claims for higher ratings for the right and left great toe disabilities were denied, and the remaining claims were remanded. The Veteran thereafter appealed the Board’s denial to the United States Court of Appeals for Veterans Claims (Court). In an Order dated in November 2013, the Court granted a Joint Motion for Partial Remand (JMPR) by the Veteran and VA General Counsel, which was incorporated by reference, to vacate the Board’s decision as to the right and left great toe rating claims and remand the case for readjudication in accordance with the JMPR. Following the JMPR, the claims were again remanded by the Board in May 2014. Additional evidence has been added to the claims file; the Veteran waived RO review of such evidence in November 2018. 38 C.F.R. §§ 19.37, 20.1304(c). Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple (“staged”) ratings may be assigned for different periods of time during the pendency of the appeal. See generally Fenderson v. West, 12 Vet. App. 119 (1999). 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. See 38 C.F.R. § 4.7. In every instance where the rating 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. In determining the degree of limitation of motion, several regulatory provisions are taken into consideration: the provisions of 38 C.F.R. § 4.40 concerning lack of normal endurance, functional loss due to pain, and pain on use and during flare-ups; the provisions of 38 C.F.R. § 4.45 concerning weakened movement, excess fatigability, and incoordination; and the provisions of 38 C.F.R. § 4.10 concerning the effects of the disability on the veteran’s ordinary activity. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. Under 38 C.F.R. § 4.45, functional loss due to weakened movement, excess fatigability, and incoordination must also be considered. See DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Furthermore, 38 C.F.R. § 4.59 recognizes that painful motion is an important factor of disability. Joints that are painful, unstable, or misaligned, due to healed injury, are entitled to at least the minimum compensable rating for the joint. Id. 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. Correia v. McDonald, 28 Vet. App. 158 (2016). Special note should be taken of objective indications of pain on pressure or manipulation, muscle spasm, crepitation, and active and passive range of motion of both the damaged joint and the opposite undamaged joint. Id.; see Burton v. Shinseki, 25 Vet. App. 1 (2011). Pain that does not result in additional functional loss does not warrant a higher rating. See Mitchell v. Shinseki, 25 Vet. App. 32, 42-43 (2011). 1. Entitlement to an initial rating in excess of 10 percent for patellofemoral syndrome of the right knee. The Veteran contends that he should be rated under DC 5257 for instability with separate rating for arthritis under DC 5003 and for locking pain under DC 5278. August 2011 notice of disagreement (NOD); September 2014 substantive appeal. A 10 percent rating is available for degenerative arthritis established by X-ray findings under 38 C.F.R. § 4.71a, DC 5003 based on limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by the limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, involvement of two or more major joints or two or more minor joint groups with occasional incapacitating exacerbations shall be rated as 20 percent disabling, and involvement of two or more major joints or two or more minor joint groups without occasional incapacitating exacerbations shall be rated as 10 percent disabling. The 20 percent and 10 percent ratings based on X-ray findings without limitation of motion will not be combined with ratings based on limitation of motion. The knee is considered a major joint. 38 C.F.R. § 4.45(f). Limitation of motion of the knee is evaluated under DCs 5260 and 5261. Pursuant to 38 C.F.R. § 4.71a, DC 5260, a 10 percent evaluation is warranted when flexion is limited to 45 degrees. A 20 percent evaluation is warranted when flexion is limited to 30 degrees. The highest 30 percent evaluation is warranted when flexion is limited to 15 degrees. Pursuant to 38 C.F.R. § 4.71a, DC 5261, a 10 percent evaluation is warranted when extension is limited to 10 degrees. A 20 percent evaluation is warranted when extension is limited to 15 degrees. A 30 percent evaluation is warranted when extension is limited to 20 degrees. A 40 percent evaluation is warranted when extension is limited to 30 degrees. An even higher rating is warranted for a greater degree of symptomatology. VA’s Office of General Counsel has provided guidance concerning increased rating claims for knee disorders. Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not “duplicative of, or overlapping with, the symptomatology” of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Since the award of service connection, the assigned 10 percent evaluation for the Veteran’s right knee disability fully contemplates the symptomatology, including limitation of motion, experienced by the Veteran. A 20 percent rating requires flexion limited to 30 degrees or extension limited to 15 degrees. The evidence of record, including December 2008, April 2018, and July 2018 fee-based, private and VA examinations consistently indicate flexion to greater than 30 degrees and extension less than 15 degrees. Even with considering pain on motion, flexion has not approximated limitation to 30 degrees or extension to 15 degrees. The 2018 VA examination also meets the requirements of Correia and still does not show limitation of motion warranting a rating higher than 10 percent. Additionally, the examinations do not show occasional incapacitating exacerbations. They also do not show the Veteran has limitation of motion warranting separate ratings for flexion and extension. There accordingly exists no basis for an underlying right knee disability rating in excess of 10 percent. 38 C.F.R. § 4.71, DCs 5003, 5010, 5260, 5261. The Board has considered whether a separate rating is warranted other symptomatology. While the Veteran contends that a separate rating is warranted for recurrent subluxation or lateral instability, the evidence fails to show such. The 2008 fee-based examination showed no sign of laxity. The private April 2018 evaluation shows that there was no evidence of instability in the knee or meniscus injuries. The Veteran specifically denied any locking, catching, swelling or instability. Similarly, the July 2018 VA examination shows that there was no history of recurrent subluxation or lateral instability. Instability tests were normal. Consequently, the evidence fails to show that a separate rating under 38 C.F.R. § 4.71a, DC 5257 is warranted. In reaching this conclusion, the Board has considered the recent decision of the United States Court of Appeals for Veterans Claims (Court) in English v. Wilkie, 17-2083 (Nov. 1, 2018). However, while the Veteran asserted in his NOD that a separate rating was warranted, he specifically denied instability to the private 2018 physician, and also denied a history of recurrent subluxation or lateral instability to the 2018 VA examiner. Treatment records during this appeal have not shown reports of recurrent subluxation or lateral instability. Therefore, in light of the above, the Board reiterates that a separate rating under DC 5257 is not warranted. There is also no evidence of other right knee symptoms such as ankylosis; dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint; symptomatic removal of semilunar cartilage; impairment of the tibia and fibula; and genu recurvatum. While the Veteran reported that his knees lock in his June 2008 report of medical history, dislocated semilunar cartilage has not been shown. Therefore, separate ratings for knee symptomatology not already contemplated for are not warranted. 38 C.F.R. § 4.71a, DCs 5256, 5258, 5259, 5262, 5263. Consequently, the criteria for an initial rating in excess of 10 percent since the award of service connection have not been met. The most pertinent evidence reviewed in reaching this decision includes the 2008 and 2018 examinations, as well as the VA and private treatment records assembled in conjunction with this appeal. In making this determination, the Board has considered whether referral for an extraschedular rating, as argued in the Veteran's September 2014 substantive appeal, is warranted. The case of Thun v. Peake, 22 Vet. App. 111 (2008); aff’d, Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009) articulates in detail a three-step inquiry for determining whether a Veteran is entitled to an extraschedular rating. First, the Board must first determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate the claimant’s level of disability and symptomatology and is found inadequate, the Board must determine whether the claimant’s disability picture exhibits other related factors such as those provided by the regulation as “governing norms.” Third, if the rating schedule is inadequate to evaluate a Veteran’s disability picture, and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran’s disability picture requires the assignment of an extra-schedular rating. The Board has concluded that referral for an extraschedular rating is not warranted. The currently assigned 10 percent rating takes into account functional limitations for increased pain from vigorous activities, i.e., flare-ups. Even with considering any limitations from flare-ups, the evidence of record, including the examinations noted above, fails to show marked interference with employment beyond that contemplated by the schedular criteria. 38 C.F.R. §§ 4.1. The evidence also does not show frequent periods of hospitalization. The 2008 examination reveals that the Veteran had worse pain with vigorous activities. The private 2018 evaluation shows constant pain aggravated with going up and down stairs and with prolonged weightbearing. The 2018 fee-based examination reveals an increase in pain and swelling during flare-ups, as well as difficulty in long-distance walking and standing for long periods of time. The Veteran was employed; he had difficulty climbing stairs, and his job required a lot of long distance walking and standing. The examination report does not reflect that the Veteran missed work due to his right knee disability. The examinations do not reflect that the Veteran missed any work due to his disability, such that marked interference with employment has been shown. These examinations, as well as the VA and private treatment records assembled in conjunction with this appeal, do not show marked interference with employment. The record does not reflect a disability picture that is so exceptional or unusual that the normal provisions of the Rating Schedule would not adequately compensate him for his service-connected disability. Moreover, as the Veteran has not contended, nor does the evidence show that this disability renders him unemployable, the issue of entitlement to a total disability rating based on individual unemployability has not been raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). 2. Entitlement to an initial rating in excess of 10 percent for patellofemoral syndrome of the left knee. The Veteran contends that he should be rated under DC 5257 for instability with separates rating for arthritis under DC 5003 and for locking pain under DC 5278. August 2011 NOD; September 2014 substantive appeal. Since the award of service connection, the assigned 10 percent evaluation for the Veteran’s left knee disability fully contemplates the symptomatology, including limitation of motion, experienced by the Veteran. A 20 percent rating requires flexion limited to 30 degrees or extension limited to 15 degrees. The evidence of record, including December 2008, April 2018, and July 2018 fee-based, private and VA examinations consistently indicate flexion to greater than 30 degrees and extension less than 15 degrees. Even with considering pain on motion, flexion has not approximated limitation to 30 degrees or extension to 15 degrees. The 2018 VA examination also meets the requirements of Correia and still does not show limitation of motion warranting a rating higher than 10 percent. Additionally, the examinations do not show occasional incapacitating exacerbations. They also do not show the Veteran has limitation of motion warranting separate ratings for flexion and extension. There accordingly exists no basis for an underlying left knee disability rating in excess of 10 percent. 38 C.F.R. § 4.71, DCs 5003, 5010, 5260, 5261. The Board has also considered whether a separate rating is warranted for other symptomatology. As with his right knee, the evidence fails to show recurrent subluxation or lateral instability. The findings at the 2008 fee-based examination, private April 2018 evaluation, and July 2018 VA examination discussed above in reference to the Veteran's right knee disability equally apply to his left knee instability and will not be discussed further. Consequently, the evidence fails to show that a separate rating under 38 C.F.R. § 4.71a, DC 5257 is warranted. As with the Veteran's right knee, the Board has considered the Court’s recent decision in English. However, as already discussed, when denying a separate rating for the Veteran's right knee, the same evidence again does not show recurrent subluxation or lateral instability. Therefore, in light of the above, the Board reiterates that a separate rating under DC 5257 is not warranted. There is also no evidence of other left knee symptoms such as ankylosis; dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint; symptomatic removal of semilunar cartilage; impairment of the tibia and fibula; and genu recurvatum. While the Veteran reported that his knees lock in his June 2008 report of medical history, dislocated semilunar cartilage has not been shown. Therefore, separate ratings for knee symptomatology not already contemplated for are not warranted. 38 C.F.R. § 4.71a, DCs 5256, 5258, 5259, 5262, 5263. Consequently, the criteria for an initial rating in excess of 10 percent since the award of service connection have not been met. The most pertinent evidence reviewed in reaching this decision includes the 2008 and 2018 examinations, as well as the VA and private treatment records in the claims file. As with the Veteran's right knee, in making this determination, the Board has considered whether referral for an extraschedular rating as argued in the Veteran’s September 2014 substantive appeal is warranted. The analysis regarding extraschedular consideration for the Veteran's right knee is equally applicable to his left knee, and will not be repeated. Moreover, as the Veteran has not contended, nor does the evidence show, that this disability renders him unemployable, the issue of entitlement to a total disability rating based on individual unemployability has not been raised by the record. Rice, 22 Vet. App. 447. 3. Entitlement to an initial rating in excess of 10 percent for an umbilical scar. The Veteran contends that a higher rating is warranted for his umbilical scar. See, e.g., September 2010 substantive appeal. The Board observes that during the pendency of this appeal, the Schedule for Rating Disabilities that addresses diagnostic codes 7801, 7802, 7805, and 7806 has been amended, which went into effect on August 13, 2018. 83 Fed. Reg. 32592 (July 13, 2018). In this case, the Veteran's umbilical scar is evaluated under DC 7804, which was not revised. A minimum compensable evaluation of 10 percent is available for one or two scars that are unstable or painful under 38 C.F.R. § 4.118, DC 7804. A 20 percent rating is available for three of four scars that are unstable or painful. An even higher rating is warranted for five or more scars. Since the award of service connection, the assigned 10 percent evaluation for the Veteran’s umbilical scar disability fully contemplates the symptomatology experienced by the Veteran. The evidence of record, including an April 2018 VA examination, shows that the Veteran only has one painful umbilical scar. At the examination, the Veteran reported that it was very tender to touch about three to four days out of the month. Considering that the Veteran only has one painful umbilical scar, there accordingly exists no basis for an underlying scar disability rating in excess of 10 percent. 38 C.F.R. § 4.118, DC 7804. Moreover, under the old or current rating criteria, a higher rating under other diagnostic codes is not warranted. Under the old rating criteria, DC 7800 is for application for scars or disfigurement of the head, face or neck, and the only rating available under DC 7802 is 10 percent. Considering the Veteran's scar under diagnostic codes with ratings of 20 percent or higher, no characteristics of disfigurement have been shown; the scar does not involve an area of at least 12 square inches (77sq. cm.) but less than 72 square inches (465 sq. cm.); and it does not have any disabling effects. Therefore, a rating higher than 10 percent is not warranted under other diagnostic codes. 38 C.F.R. § 4.118, DCs 7800, 7801, 7802, 7805 (2008). Under the current rating criteria, DCs 7801, 7802, and 7805 were revised. DC 7801 continues to require that an area of at least 12 square inches but less than 72 square inches be affected; DC 7802 again only provides a rating of 10 percent; and DC 7805 provides for a rating based on disabling effects, which have not been shown. As such, a rating higher than 10 percent other diagnostic codes pursuant to the new criteria under is not warranted. 38 C.F.R. § 4.118, DCs 7801, 7802, 7805. Consequently, the criteria for an initial rating in excess of 10 percent since the award of service connection have not been met. The most pertinent evidence reviewed in reaching this decision includes the 2018 examination report, as well as the VA and private treatment records assembled in conjunction with this appeal. In making this determination, the Board notes that neither the Veteran nor his 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). Moreover, as the Veteran has not contended, nor does the evidence show, that this disability renders him unemployable, the issue of entitlement to a total disability rating based on individual unemployability has not been raised by the record. Rice, 22 Vet. App. 447. 4. Entitlement to an initial compensable rating for hallux valgus deformity of the left great toe. The Veteran contends that a higher or separate rating is warranted for arthritic changes, as the diagnostic code the Veteran is currently rated under does not include limitation of motion. April 2014 representative argument. A 10 percent rating is available for degenerative arthritis established by X-ray findings under 38 C.F.R. § 4.71a, DC 5003 based on limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by the limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, involvement of two or more major joints or two or more minor joint groups with occasional incapacitating exacerbations shall be rated as 20 percent disabling, and involvement of two or more major joints or two or more minor joint groups without occasional incapacitating exacerbations shall be rated as 10 percent disabling. The 20 percent and 10 percent ratings based on X-ray findings without limitation of motion will not be combined with ratings based on limitation of motion. Multiple involvements of the interphalangeal, metatarsal and tarsal joints of the lower extremities are considered groups of minor joints, ratable on a parity with major joints. 38 C.F.R. § 4.45(f). The only rating available under 38 C.F.R. § 4.71a, DC 5280 is 10 percent for unilateral hallux valgus, either operated with resection of metatarsal head or severe, if equivalent to amputation of great toe. Since the award of service connection, when affording the Veteran the benefit of the doubt, the criteria for an initial 10 rating have been met. In this case, the evidence of record, including December 2008, December 2016, and April 2018 fee-based examinations, suggests that the Veteran's left great toe disability is more severe than the currently assigned noncompensable rating. The 2008 examination shows foot pain with gait changes; the 2016 examination reveals excess fatigability, pain on weight-bearing, interference with standing, and lack of endurance; and the 2018 examination indicates pain on movement, pain on weight-bearing; pain on nonweight-bearing; and disturbance of locomotion. Consequently, considering the above symptomatology, the Board finds that the Veteran's left great toe disability is more severe than is currently compensated for, and an initial 10 percent rating is warranted. However, an initial rating in excess of 10 percent is not warranted. While the 2008 examination shows a diagnosis of osteoarthritis of the metacarpal phalangeal (MP) joint, a 20 percent rating under DC 5003 requires involvement of two or more major joints or two or more minor joint groups with occasional incapacitating exacerbations. See Spicer v. Shinseki, 752 F.3d 1367, 1371 (Fed. Cir. 2014). In this case, the evidence does not shown involvement of two or more minor joint groups with occasional incapacitating exacerbations. As noted above, multiple involvements of the interphalangeal, metatarsal and tarsal joints of the lower extremities are considered groups of minor joints; osteoarthritis of only the MP joint has been shown. Furthermore, a rating higher than 10 percent is not warranted under other diagnostic codes. Critically, the Veteran has been diagnosed with hallux valgus throughout the appeal period. As there is a diagnostic code specific to his currently diagnosed condition, he cannot be rated under any other diagnostic codes pertaining to the foot, including DC 5284. Copeland v. McDonald, 27 Vet. App. 333 (2015). There accordingly exists no basis for an initial rating in excess of 10 percent for the Veteran's left great toe disability. 38 C.F.R. § 4.71, DCs 5003, 5280. Consequently, the criteria for an initial 10 percent rating, but no higher, since the award of service connection have been met. The most pertinent evidence reviewed in reaching this decision includes the 2008, 2016, and 2018 examinations, as well as the VA and private treatment records assembled in conjunction with this appeal. In making this determination, the Board notes that neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. 366. Moreover, as the Veteran has not contended, nor does the evidence show, that this disability renders him unemployable, the issue of entitlement to a total disability rating based on individual unemployability has not been raised by the record. Rice, 22 Vet. App. 447. 5. Entitlement to an initial rating in excess of 10 percent for hallux valgus deformity of the right great toe with bunionectomy. The Veteran contends that separate ratings are warranted for arthritic changes as the diagnostic code the Veteran is currently rated under does not include limitation of motion. April 2014 representative argument. As noted above, the only rating available under 38 C.F.R. § 4.71a, DC 5280 is 10 percent. Since the award of service connection, the criteria for an initial rating in excess of 10 percent have not been met. Since the Veteran is receiving the highest rating available for hallux valgus, the Board has considered whether a higher or separate rating is available under other diagnostic codes. The evidence of record, including December 2008, December 2016, and April 2018 fee-based examinations consistently show that the currently assigned 10 percent rating contemplates the symptomatology associated with this disability. In this case, the 2008 examination also shows a diagnosis of osteoarthritis of the MP joint of the right foot. However, the examinations have not shown involvement of two or more minor joint groups. See Spicer, 752 F.3d at 1371. Furthermore, occasional incapacitating episodes have not been shown. Consequently, a separate rating for arthritis or a higher 20 percent rating under DC 5003 is not warranted. Furthermore, a higher rating is not warranted under other diagnostic codes. Critically, he has been diagnosed with hallux valgus throughout the appeal period. As there is a diagnostic code specific to his currently diagnosed condition, he cannot be rated under any other diagnostic codes pertaining to the foot, including DC 5284. Copeland, supra. There accordingly exists no basis for an underlying right great toe disability rating in excess of 10 percent. 38 C.F.R. § 4.71, DCs 5003, 5280. Consequently, the criteria for an initial rating in excess of 10 percent since the award of service connection have not been met. The most pertinent evidence reviewed in reaching this decision includes the 2008, 2016, and 2018 examinations, as well as the VA and private treatment records assembled in conjunction with this appeal. In making this determination, the Board notes that neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. 366. Moreover, as the Veteran has not contended, nor does the evidence show that this disability renders him unemployable, the issue of entitlement to a total disability rating based on individual unemployability has not been raised by the record. Rice, 22 Vet. App. 447. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 10 percent for lumbar sprain is remanded. In the September 2014 substantive appeal, the Veteran's representative argued that the only examination provided to the Veteran in this case in 2008 is too dated for rating purposes. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his lumbar sprain. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination addressing the current severity of his lumbar strain. The most up-to-date Disability Benefits Questionnaire should be utilized. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the lumbar sprain alone and discuss the effect of the Veteran’s lumbar spine disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Barstow, Counsel