Citation Nr: 18159435 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 16-56 865 DATE: December 20, 2018 ORDER Service connection for a left shoulder condition is denied. Service connection for a left wrist condition is denied. Service connection for a right wrist condition is denied. Service connection for radiculopathy of the left lower extremity (LLE) is denied. Service connection for radiculopathy of the right lower extremity (RLE) is denied. An initial compensable rating for chronic diarrhea is denied. A 10 percent rating for gastroesophageal reflux disease (GERD) prior to August 25, 2016 is granted. A rating in excess of 10 percent for GERD is denied. A compensable rating prior to August 25, 2016, and higher than 10 percent therefrom, for LLE restless leg syndrome (RLS) is denied. A compensable rating prior to August 25, 2016, and higher than 10 percent therefrom, for RLE RLS is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has a left shoulder disability due to a disease or injury in service, to include from a fall in service. 2. The preponderance of the evidence is against finding that the Veteran has a left wrist condition due to a disease or injury in service, to include from a fall in service. 3. The preponderance of the evidence is against finding that the Veteran has a right wrist condition due to a disease or injury in service, to include from a fall in service. 4. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of LLE radiculopathy. 5. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of RLE radiculopathy. 6. For the entire appeal period, the Veteran’s chronic diarrhea did not more nearly approximate moderate, frequent episodes of bowel disturbance with abdominal distress or moderate, infrequent exacerbations of ulcerative colitis. 7. Prior to August 25, 2016, GERD was more nearly manifested by heartburn (pyrosis) and regurgitation. 8. For the entire appeal period, the Veteran’s GERD did not more nearly approximate persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. 9. Prior to August 25, 2016, RLS of both lower extremity was not more nearly manifested by mild incomplete paralysis. 10. From August 25, 2016, RLS of both lower extremity was not more nearly manifested by moderate incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for service connection for a left shoulder condition are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for a left wrist condition are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for a right wrist condition are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for LLE radiculopathy are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 5. The criteria for service connection for RLE radiculopathy are not met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 6. The criteria for a compensable rating for chronic diarrhea are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code (DC) 7399-7319. 7. The criteria for a 10 percent rating prior to August 25, 2016 for GERD are met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, DC 7399-7346. 8. The criteria for a rating in excess of 10 percent for GERD are not met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, DC 7399-7346. 9. The criteria for a compensable rating prior to August 25, 2016, and higher than 10 percent, thereafter, for LLE RLS are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124(a), DC 8699-8624. 10. The criteria for a compensable rating prior to August 25, 2016, and higher than 10 percent, thereafter, for RLE RLS are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124(a), DC 8699-8624. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1990 to June 1991, from March 2003 to December 2003 and from October 2004 to January 2006. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an March 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for diarrhea at 0%, GERD at 0%, and RLS (bilateral) at 0%. This rating decision also denied service connection for the left shoulder, wrists, and lower extremity radiculopathy. In an October 2016 rating decision, the RO increased the disability ratings for bilateral RLS and GERD and combined the issues of GERD and chronic diarrhea based on the same manifestation of symptoms. The Board finds that separate ratings for GERD and chronic diarrhea are warranted, as reflected above, based on the distinct, documented symptoms of each disability. Service Connection Compensation may be awarded for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131. Service connection basically means that the facts, shown by evidence, establish that an injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally 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 claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a), (d). 1. Left shoulder condition The Veteran contends that he has left shoulder pain caused by a fall down a flight of stairs in service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board notes the Veteran has a service-connected right shoulder disability. The Board concludes that, while the Veteran reported left shoulder pain in October 2003 and February 2004 and had a diagnosis of mild acromioclavicular (AC) degenerative change in December 2005, the preponderance of the evidence is against finding that the Veteran has a left shoulder disability that began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a), (d). Service treatment records (STRs) from October 2003 show the Veteran reported left shoulder pain from a September 2003 fall down a flight of stairs. See Medical Treatment Record (MTR) (June 2013). In December 2005, the Veteran reported pain between the shoulder blades due to a fall two months prior, and x-rays of the left shoulder showed mild degenerative changes in the AC joint. See STR (September 2016). Although the Veteran reported a history of “painful shoulder, elbow, or wrist” on his December 2005 service separation examination, clinical evaluation of the upper extremities was normal. A September 2006 post-deployment health assessment noted shoulder pain but it does not identify the shoulder as right or left. Post active service, VA treatment records contain normal left shoulder x-rays and complaints of left shoulder pain due to nonservice-connected degenerative arthritis of the cervical spine since 2013. The Veteran is competent to report his left shoulder symptoms, including pain and limitation of motion. However, he is not competent to opine that his left shoulder symptoms are etiologically related to service, to include September 2003 and October 2005 falls, as the etiology is not susceptible to lay observation and the Veteran lacks the requisite medical expertise to opine about symptoms and findings first shown roughly a decade after service. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, the Veteran’s statements linking his current symptoms to in-service injury have little probative value. He has not presented a favorable medical opinion linking any current left shoulder condition to service for the Board to weigh in this matter. Notably, VA treatment records attribute the Veteran’s shoulder pain to cervical radiculopathy. See CAPRI (January 2016). Although a December 2005 x-ray during active service shows mild degenerative changes of the AC joint, subsequently dated post service VA x-rays show normal shoulder joint. Thus, left shoulder arthritis is not shown during the appeal period. The post service x-ray findings showing normal left shoulder tends to suggest that the in-service x-ray was mis-read. As such, it has less probative value that the x-rays taken since service discharge and in connection with post service complaints/symptoms. The Board assigns greater probative value to the STRs, which reflect a normal clinical evaluation of the upper extremities on service separation in December 2005. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the claimant). The Board further assigns greater probative value to the many years intervening service and the first documented complaints shown in August 2013. Buchannan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). On balance, the weight of the evidence is against the claim. Accordingly, the claim is denied. 38 U.S.C. § 5107(b). 2. Bilateral wrist condition The Veteran contends that he has bilateral wrist pain caused by two in-service falls in June and September 2003. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran reported right wrist pain in June and October 2003 and had a sprain or strain in October 2003, the preponderance of the evidence is against finding that the Veteran has a left or right wrist disability that began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(a), (d). STRs show the Veteran reported left shoulder pain from a June 2003 fall and a September 2003 fall down a flight of stairs. See MTR (June 2013). A December 2005 report of medical history on demobilization denotes “painful shoulder, elbow, or wrist” pain but does not identify a particular area, and an associated medical assessment did not report wrist pain. February 2004 VA treatment records show right hand fatigue and wrist pain, but no left wrist pain; testing determined it was not carpal tunnel, and examiners theorized it could be referred pain from his shoulder problem. A September 2006 post-deployment health assessment noted pain in the right hand. VA treatment records contain a negative EMG of the upper extremities, and medical opinions link the Veteran’s right wrist pain to his cervical radiculopathy. The Veteran has not reported having experienced symptoms of left or right wrist pain or limitation of motion since service; and he is not competent to opine that current wrist pain is etiologically related to service, to include falls, as the etiology is not susceptible to lay observation and the Veteran lacks the requisite medical expertise to opine about symptoms and findings first shown decades after service. See Jandreau, supra. Therefore, the Veteran’s statements lack probative value. He has not presented a favorable medical opinion to weigh in this matter. Notably, a left wrist injury is not shown in service. The Board assigns greater probative value to the STRs, which reflect a normal clinical evaluation of the upper extremities on service separation in December 2005. See Curry 7 Vet. App. at 68. The Board further assigns greater probative value to the many years intervening service and the first documented complaints shown in June 2013. See Buchannan, 451 F.3d 1331 On balance, the weight of the evidence is against the claims. Accordingly, the claims are denied. 38 U.S.C. § 5107(b). 3. Bilateral lower extremity radiculopathy The Veteran contends that he has intermittent, bilateral radiculopathy of the lower extremities resulting from his service-connected back disability. The question for the Board is whether the Veteran has or had during this appeal bilateral lower extremity radiculopathy. The Board concludes that the Veteran does not have and has not had bilateral lower extremity radiculopathy at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton, 557 F.3d at 1366; Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). At a March 2014 VA back examination, the Veteran reported pain radiating down his legs when he injured his back in Iraq. The examiner found that the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. The examiner opined that the Veteran’s reported radicular type symptoms in his legs and numbness and tingling in his legs to suggest nerve root impingement. A contemporaneous peripheral nerve examination diagnosed normal functioning of the upper, middle, and lower radicular groups with no lower extremity nerves affected. The examiner opined the Veteran’s reported numbness, tingling, and dysesthesias were due to his service-connected RLS. A March 2016 EMG concluded that lower extremity issues were not from the lumbar spine. See CAPRI (September 2016). The Board has considered the Veteran’s reported of radicular symptoms. However, he has not identified any evidence diagnosing radiculopathy or provided a favorable medical opinion supporting his claim. The Veteran is not competent to diagnose himself with radiculopathy as this is not susceptible to lay observation and requires medical training and expertise of the mechanisms of the nerves and lower extremities in the context of subjective symptoms and objective findings. See Jandreau, supra. Therefore, the Board finds that the Veteran’s opinion has no probative value and assigns greater probative value to the March 2014 VA back and peripheral nerve examinations. These examinations were prepared by a skilled, neutral medical professional after examination of the Veteran and review of the record. It is noted that the existence of a current disability is the cornerstone of a claim for VA disability compensation. See 38 U.S.C. § 1131; Degmetich v. Brown, 104 F. 3d 1328 (1997). In the absence of proof of a present disability due to disease or injury, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, the claim is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b). Increased Rating Disability evaluations are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. A disability may require re-evaluation in accordance with changes in a veteran’s condition. It is thus essential, in determining the level of current impairment, that the disability be considered in the context of the entire recorded history. 38 C.F.R. § 4.1. The Board notes that the following claims are rated under hyphenated diagnostic codes. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. 4. Entitlement to an initial compensable rating for chronic diarrhea. The Veteran contends that his chronic diarrhea warrants a compensable rating due to frequent episodes of bowel disturbance with abdominal distress which affect him a couple times a month. The Board concludes that the preponderance of the evidence is against the assignment of a compensable rating for the Veteran’s chronic diarrhea. Neither the lay nor the medical evidence more nearly reflect the criteria for a higher rating during the appeal period. 38 C.F.R. §§ 4.7, 4.114a, DC 7399-7319. Chronic diarrhea is rated under 38 C.F.R. § 4.114, DC 7319 for irritable colon syndrome, which provides a noncompensable rating for mild diarrhea, with disturbances of bowel function with occasional episodes of abdominal distress. A 10 percent rating is assigned for moderate irritable colon syndrome with frequent episodes of bowel disturbances with abdominal distress. A maximum 30 percent rating is assigned when there is severe irritable colon syndrome with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. 38 C.F.R. § 4.114, DC 7319. A March 2014 VA examination reflects complaints of intermittent diarrhea without alternating constipation, abdominal bloating or abdominal pain. The Veteran reported frequency ranging from a couple times per month to several months in between. Upper endoscopies and two flexible sigmoidoscopies done between 2007 and 2009 were normal. A flexible sigmoidoscopy done in 2011was also normal. The examiner opined that the symptoms did not meet the criteria to diagnose irritable bowel syndrome. An August 2016 VA examination report reflects that the Veteran’s chronic diarrhea was stable without changes in severity. The Veteran reported 0-2 bowel movements a day which were erratic in timing and did not depend on what he ate. He treated symptoms with Pepto-Bismol. He denied bowel disturbance with abdominal distress or exacerbations, malnutrition, or weight loss. VA treatment records lack evidence of treatment for diarrhea or constipation or findings of malnutrition, ulcers, or anemia or weight loss due to intestinal issues. The Veteran asserts that he has bowel disturbance with abdominal distress which can often affect him a couple of times a month. See NOD. Compensable ratings based on frequent bowel disturbance with abdominal distress or more or less constant abdominal distress are not supported by the record. The Board finds that abdominal distress is not supported by the credible evidence record, which includes multiple reports by the Veteran of no abdominal distress; a lack of treatment for a bowel disorder, though receiving treatment for other disorders from VA; and multiple medical professionals finding no abdominal distress. Additionally, the criteria for a separate or higher evaluation are not met under any other potentially applicable provision of the schedule. 38 C.F.R. § 4.114, DCs 7321-7327. The Board accepts that the Veteran is competent to report his symptoms. However, whether a disability meets the schedular criteria for the assignment of a higher evaluation is a factual determination by the Board based on the Veteran’s complaints coupled with the medical evidence. Both the lay and medical evidence are probative in this case. Although the Veteran may believe that he meets the criteria for a higher disability rating, his complaints along with the medical findings do not meet the schedular requirements for a higher evaluation, as explained and discussed above. On balance, the weight of the evidence is against the claim for increase. Accordingly, the claim is denied. 38 U.S.C. § 5107(b). 5. GERD – rated at 0% prior to August 25, 2016 and 10% therefrom The Veteran is seeking an initial compensable rating for GERD. His GERD is currently rated as 10 percent disabling, effective August 26, 2016, pursuant to DC 7319-7346. 38 C.F.R. § 4.114. The Board concludes that the evidence supports an evaluation of 10 percent prior to August 25, 2016. The Board further concludes that the preponderance of the evidence is against finding that the Veteran’s symptoms more nearly met the criteria for a rating in excess of 10 percent at any time during the appeal. During the appeal period, GERD has manifested with heartburn (pyrosis) and regurgitation. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.114, DC 7399-7346. The Veteran’s GERD is rated by analogy under DC 7346 to hiatal hernia. DC 7346 provides a 10 percent rating where there are two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent rating is warranted for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. The highest schedular rating of 60 percent rating is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. Although the Veteran’s clinical records throughout the pendency of this claim show GERD on the list of active disorders, the records reflect that the Veteran had not presented for complaints related thereto. A March 2014 VA examination reflects a history of acid reflux since service controlled with medication. The Veteran similarly reported to VA in correspondence that medications controlled heartburn and occasional regurgitation. See NOD (June 2014). The Board accepts that the Veteran is competent to report on his observable symptomatology. An August 2016 VA examination report shows the Veteran reported increased acid reflux and vomiting after eating over the previous 2.5 years. A February 2016 EGD documented a large hiatal hernia in the esophagus. Episodes of vomiting (four or more times per year) were attributed to the hiatal hernia. Regurgitation due to GERD was also noted. The Veteran denied weight loss. In sum, the evidence shows the Veteran had symptoms of regurgitation and heartburn throughout the pendency of this appeal warranting a 10 percent rating. A higher 30 percent rating is unwarranted as dysphagia is not present and the Veteran’s symptoms were not characterized as persistently recurrent or productive of considerable impairment of health. Nor was substernal, arm, or shoulder pain due to GERD indicated. Given that the Veteran has not described with any specificity GERD type symptoms productive of considerable impairment in his health, and considering the medical findings of record coupled with the lack of any ongoing medical care, the Board finds that the criteria for a 60 percent rating are not more nearly met. Although the Veteran may believe that he meets the criteria for a higher disability rating than assigned, his complaints along with the medical findings do not meet the schedular requirements for a higher evaluation, as explained and discussed above. While the evidence warrants the assignment of a 10 percent rating prior to August 25, 2016 for GERD, on balance, the weight of the evidence is against the assignment of a rating in excess of 10 percent for GERD. Although separate evaluations may be assigned for separate periods of time based on the facts found—in other words, the rating may be “staged,” the Board finds that the factual findings do not show a distinct period where the service- connected disability exhibited symptoms that would warrant a different rating. See Hart v. Mansfield, 21 Vet. App. 505 (2007); see also Fenderson v. West, 12 Vet. App. 119, 126 (2001). Accordingly, the claim is for a 10 percent rating is granted prior to August 25, 2016; however, for the entire appeal period, a rating in excess of 10 percent for GERD is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b). 6. Bilateral RLS – rated at 0% prior to August 25, 2016 and 10% therefrom The Veteran is service-connected for bilateral RLS under DC 8699-8624. The Veteran contends that his RLS warrants a higher, analogous rating under DC 6847 for sleep apnea as his periodic leg movement disorder affects his sleep. See NOD (July 2014). It is noted that, to the extent that he seeks compensation for sleep apnea, he is advised that all claims for benefits must be submitted on required forms. Effective on March 24, 2015, VA amended its rules as to what constitutes a claim for benefits; such now requires that claims be made on specific claim form prescribed by the Secretary and available online or at the local Regional Office. This provision effectively removed informal claims from VA’s processes. In this case, the Board concludes that the preponderance of the evidence is against finding that the Veteran’s RLS disability more nearly met the criteria for a compensable rating prior to August 25, 2016, or the criteria for a rating higher than 10 percent therefrom. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.124(a), DC 8699-8624. The Veteran’s RLS is analogously rated under DC 8624, which rates neurologic manifestations of the lower extremities associated with the internal popliteal (tibial) nerve. Under DC 8624, neuritis of the internal popliteal nerve (tibial) is rated as incomplete paralysis. Disability ratings of 10, 20, and 30 percent are warranted, respectively, for mild, moderate, and severe incomplete paralysis of the tibial nerve. A disability rating of 40 percent is warranted for complete paralysis of the tibial nerve. Evidence of complete paralysis includes loss of plantar flexion, impossible frank adduction of the foot, abolishment of flexion and separation of the toes, inability to move the muscle in the sole, and loss of plantar flexion of the foot in lesions of the nerve high in popliteal fossa. 38 C.F.R. § 4.124a. The term “incomplete paralysis,” with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement. 38 C.F.R. § 4.124a. The terms “mild,” “moderate,” and “severe” are not defined in the rating schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. A February 2009 VA sleep study documented periodic leg movement disorder which interrupted the Veteran’s sleep. Prior to August 25, 2016, neither the lay nor the medical evidence more nearly reflects mild incomplete paralysis of the effected nerve. In this regard, March 2014 VA examinations of the back and peripheral nerves reflects a history of past numbness and tingling in the legs, but the Veteran denied current numbness, tingling, or dysesthesias to his bilateral lower extremities and reported past symptoms were seldom in nature. On his back examination, great toe extension was at 5/5 (normal strength). Reflex testing was hypoactive for the bilateral ankles. His sensory examination was normal in all aspects. Straight leg raising test was negative. The VA peripheral nerve examiner found no symptoms attributable to any peripheral nerve conditions, and nerve testing was normal in all aspects. It is noted that, in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. From August 25, 2016, neither the lay nor the medical evidence more nearly reflect moderate symptoms. An August 2016 VA examination reflects complaints of bilateral “lower leg aches and crampyness” that occurred at night. The examiner noted that the Veteran had moderate intermittent pain and mild paresthesias and/or dysesthesias and numbness bilaterally. Motor testing was recorded as 5/5 (normal strength) in the bilateral knees and ankles. No muscle atrophy or weakness was noted. Reflex and sensory examinations were recorded as all normal. The Veteran reported a need to get up and walk around at times. He stated that his current medication had improved but not resolved the aches in his legs. A review of the VA treatment records showed that the Veteran was on medication for his restless leg syndrome which was improved by the application of heat. Higher ratings than assigned are not warranted because the Veteran’s symptoms for his restless leg syndrome have not more nearly approximated the criteria for a greater level of disability. As shown, the disability manifests with subjective symptoms of pain and cramping that is improved with standing, walking around, and applying heat. The motor, reflex, and sensory tests at the March 2014 and August 2016 examinations were all normal. There have been no findings of muscle atrophy or abnormal tone or bulk. The Veteran has not described with any specificity symptoms of the severity, frequency or duration that would meet the criteria for increase. His argument that he has a secondary disorder is not a basis to award a higher rating under the schedular criteria for RLS. The Board accepts that the Veteran is competent to report his symptoms. However, whether a disability meets the schedular criteria for the assignment of a higher evaluation is a factual determination by the Board based on the Veteran’s complaints coupled with the medical evidence. Both the lay and medical evidence are probative in this case. Although the Veteran may believe that he meets the criteria for a higher disability rating, his complaints along with the medical findings do not meet the schedular requirements for a higher evaluation, as explained and discussed above. On balance, the weight of the evidence is against the claims for increase. Accordingly, the claim is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b). C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. E., Associate Counsel