Citation Nr: 18107343 Decision Date: 06/01/18 Archive Date: 06/01/18 DOCKET NO. 14-38 649 DATE: June 1, 2018 ORDER An effective date earlier than December 8, 2013, for the award of service connection for irritable bowel syndrome (IBS) is denied. Service connection for chronic fatigue syndrome is denied. Service connection for Epstein Barr virus is denied. Service connection for lymphadenopathy and leukopenia is denied. Service connection for sinusitis is denied. Service connection for a left hand disorder is denied. Service connection for a right hand disorder is denied. Service connection for erectile dysfunction is denied. Service connection for a left acromioclavicular disorder is denied. An initial compensable rating for epididymitis is denied. An initial rating in excess of 10 percent for temporomandibular joint dysfunction is denied. An initial rating in excess of 10 percent for a cervical spine disability is denied. An initial rating in excess of 10 percent for a thoracolumbar spine disability is denied. A 10 percent rating for a left ankle disability is granted, subject to the regulations governing the award of monetary benefits. A 10 percent rating for a right ankle disability is granted, subject to the regulations governing the award of monetary benefits. An initial compensable rating for allergic rhinitis is denied. An initial compensable rating and a rating in excess of 30 percent from July 2, 2014, for a headache disability is denied. REMANDED Service connection for color vision deficiency is remanded. Service connection for gastroesophageal reflux disease (GERD) is remanded. An initial rating in excess of 10 percent for left shoulder strain is remanded. An initial rating in excess of 10 percent for right shoulder strain is remanded. An increased initial rating for a left hip disorder, currently assigned a combined 10 percent rating for limitation of motion, is remanded. An increased initial rating for a right hip disorder, currently assigned a combined 10 percent for limitation of motion, is remanded. An initial compensable rating for left knee patellofemoral syndrome is remanded. An initial compensable rating for right knee patellofemoral syndrome is remanded. An initial compensable rating for bilateral plantar fasciitis is remanded. An initial rating in excess of 30 percent for a psychiatric disability is remanded. An initial compensable rating for IBS is remanded. FINDINGS OF FACT 1. The claim for service connection for IBS based on which service connection was awarded was received in February 2014, and the Veteran separated from service on December 7, 2013. 2. The Veteran does not have and has not had chronic fatigue syndrome, active Epstein Barr virus or residual of previous Epstein Barr virus, a current disorder manifested by lymphadenopathy and leukopenia, chronic sinusitis, a left or right hand disorder, or erectile dysfunction. 3. The left acromioclavicular disorder was not present until years after discharge from service, is not related to service, and is not secondary to the service-connected left shoulder strain. 4. The epididymitis has not required long-term drug therapy, one to two hospitalizations per year, or intermittent intensive management. 5. The temporomandibular joint dysfunction does not result in limitation of inter-incisal motion to fewer than 31 millimeters (mm). 6. The cervical spine disability does not result in forward flexion to at most 30 degrees; combined range of motion to at most 170 degrees; spasm; guarding; or neurological deficit. 7. The lumbar spine disability does not result in forward flexion to at most 60 degrees, combined range of motion to at most 120 degrees; spasm; guarding; or neurological deficit. 8. The ankle disabilities are associated with pain but not marked limitation of motion. 9. The allergic rhinitis has never been associated with polyps, greater than 50-percent obstruction of each nasal passage, or complete obstruction of one nasal passage. 10. Prior to July 2, 2014, the headache disability did not result in prostrating headaches. From July 2, 2014, the headache disability did not result in very frequent and completely prostrating and prolonged attacks productive of severe economic inadaptability. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than December 8, 2013, for the award of service connection for IBS have not been satisfied. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2017). 2. The criteria for service connection for chronic fatigue syndrome have not been satisfied. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2017). 3. The criteria for service connection for Epstein Barr virus have not been satisfied. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2017). 4. The criteria for service connection for lymphadenopathy and leukopenia have not been satisfied. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2017). 5. The criteria for service connection for sinusitis have not been satisfied. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2017). 6. The criteria for service connection for a left hand disorder have not been satisfied. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2017). 7. The criteria for service connection for a right hand disorder have not been satisfied. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2017). 8. The criteria for service connection for erectile dysfunction have not been satisfied. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2017). 9. The criteria for service connection for left acromioclavicular disorder joint disorder have not been met. 38 U.S.C. §§ 1110, 1112 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2017). 10. The criteria for an initial compensable rating for epididymitis have not been satisfied. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.115a, 4.115b, Diagnostic Code 7525 (2017). 11. The criteria for an initial rating in excess of 10 percent for temporomandibular joint dysfunction have not been satisfied. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.150, Diagnostic Code 9905 (2017). 12. The criteria for an initial rating in excess of 10 percent for the cervical spine disability have not been satisfied. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.59, 4.71a Diagnostic Code 5237 (2017). 13. The criteria for an initial rating in excess of 10 percent for the lumbar spine disability have not been satisfied. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.59, 4.71a Diagnostic Code 5237 (2017). 14. The criteria for an initial rating of 10 percent rating, but no higher, for a left ankle disability have been satisfied. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.59, 4.71a, Diagnostic Code 5271 (2017). 15. The criteria for an initial rating of 10 percent rating, but no higher, for a right ankle disability have been satisfied. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.59, 4.71a, Diagnostic Code 5271 (2017). 16. The criteria for a compensable initial rating for allergic rhinitis have not been satisfied. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.97, Diagnostic Code 6522 (2017). 17. The criteria for an initial compensable rating and a rating in excess of 30 percent rating from July 2, 2014, for migraine headaches have not been satisfied. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.124a, Diagnostic Code 8100 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from December 2009 to December 2013. The Board notes that additional VA treatment records were uploaded into the electronic record in June and 2015 and January and May 2016. The claim for an earlier effective date and claims for service connection for erectile dysfunction and chronic fatigue syndrome were most recently adjudicated in June 2015, and the claims for service connection for the hands, sinusitis, Epstein Barr virus, and lymphadenopathy and leukopenia and increased ratings for the ankles, epididymitis, temporomandibular joint dysfunction, headaches, thoracolumbar spine disorder, allergic rhinitis, and cervical spine disorder were most recently adjudicated in September 2014. The additional evidence not considered in the most recent adjudication is not pertinent to the claims adjudicated herein (any relevant information is cumulative). Thus, there is no need to remand for consideration in the first instance. Earlier Effective Date 1. Effective Date for Award of Service Connection for IBS In February 2014, within a year of separation from service, the Veteran filed a claim of service connection for IBS. Service connection was subsequently granted, and an effective date of December 8, 2013, the date after separation, was assigned. The Veteran disagreed with the effective date assigned but has not presented any specific argument regarding the appeal. In cases where a claim is received within one year after separation from service, the effective date for an award of service connection is the day following the date of separation from active service or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. The proper effective date was assigned for the award of service connection for IBS. The earliest effective date permitted by law is the currently assigned effective date. Thus, as the currently-assigned effective date is the day after the date of separation, an earlier effective date is not available, and the claim is denied. Service Connection Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310(a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310(b). 2. Chronic Fatigue Syndrome Service connection is not warranted for chronic fatigue syndrome. The Board has carefully reviewed the evidence of record but finds no probative diagnosis of chronic fatigue syndrome, and the Veteran has not reported the existence of outstanding diagnostic records. Notably, November 2013 and August 2014 VA examiners determined the Veteran did not have chronic fatigue syndrome, the July 2014 VA “Infectious Disease” examiner determined the fatigue was likely related to the service-connected psychiatric disability, and the VA treatment records reveal no finding of chronic fatigue syndrome. The Veteran’s representative contends that the August 2014 examination record is not probative because the examination record contains contradictory findings. Specifically, the representative argues that the answer to question “6. Functional Impact” and the determination that the Veteran does not have chronic fatigue syndrome are incompatible. The Board finds this argument is without merit; the two findings are not mutually exclusive. On “Question 1. Diagnosis,” the examiner specifically noted that the Veteran did not have and had not been diagnosed with chronic fatigue syndrome. “Question 6. Functional Impact” states: Does the Veteran’s chronic fatigue syndrome impact his or her ability to work? The examiner marked “yes” and noted that the Veteran reported working and hating his job because it caused no sense of self-worth. The Board finds answering a prewritten question containing the term “chronic fatigue syndrome” does not suggest a finding of chronic fatigue syndrome, particularly as the examiner’s response is absent any mention of fatigue. The Board notes that a March 2015 VA medical record reports a “past medical history” of chronic fatigue syndrome diagnosed March 11, 2014, by J.M.B. Review of the March 11, 2014, treatment record reveals no diagnosis of chronic fatigue syndrome, however. Rather, the record reports that it is common to see fatigue as a symptom of the service-connected psychiatric disorder, and the only diagnosis rendered is anxiety. In the absence of corroborative notation of IBS (such as a diagnosis of IBS or new symptoms suggestive of IBS) in the March 2014 record, the Board finds the “past medical history” notation is not probative evidence of chronic fatigue syndrome. Although the evidence reflects the Veteran’s competent history of fatigue, except in circumstances not present here, direct service connection will not be granted for fatigue alone. Notably, the record indicates that the Veteran is not a Persian Gulf Veteran so 38 C.F.R. § 3.317 does not apply. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(e)(2); Cox v. McDonald, 28 Vet. App. 318 (2016) (Afghanistan is not part of the Southwest Asia theater of operations for the purposes of 38 U.S.C. § 1117; 38 C.F.R. § 3.317). Regarding the Veteran’s lay statements, the Board notes that as a general matter, a layperson is not competent to provide evidence as to complex medical questions and, specifically, is not competent to provide an opinion as to diagnoses and etiology in such cases. See 38 C.F.R. § 3.159 (a)(2); see also Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007); Routen v. Brown, 10 Vet. App. 183, 186 (1997). In this case, the Veteran does not have the requisite medical expertise to provide a diagnosis of chronic fatigue syndrome. Consequently, the Veteran's statements are not sufficient to find that he has a current disability. Accordingly, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim. 3. Epstein Barr Virus Service connection is not warranted for Epstein Barr Virus. The Board has carefully reviewed the evidence of record but finds no diagnosis of current Epstein Barr Virus or residual of previous Epstein Barr Virus, and the Veteran has not reported the existence of outstanding diagnostic records. Notably, a November 2013 VA examiner determined the Veteran did not have Epstein Barr Virus and a July 2014 VA “Infectious Disease” examiner determined the Veteran did not have active Epstein Barr Virus and did not have residual of previous Epstein Barr Virus. Accordingly, the claim must be denied. In this case, the Veteran does not have the requisite medical expertise to provide a diagnosis of Epstein Barr Virus. See supra 38 C.F.R. § 3.159 (a)(2); see also Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007); Routen v. Brown, 10 Vet. App. 183, 186 (1997). Consequently, the Veteran’s statements are not sufficient to find that he has a current disability. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim. 4. Lymphadenopathy and leukopenia Service connection is not warranted for lymphadenopathy and/or leukopenia. The Board has carefully reviewed the evidence of record but finds no diagnosis of chronic disorder manifested by lymphadenopathy and/or leukopenia. Although the November 2013 examination record reveals finding of right submandibular lymphadenopathy and leukopenia, each finding is merely a clinical finding that may be an early warning of an actual disability, but is not itself disabling. See Fed. Reg. 20,440 (May 7, 1996). As such, the findings of lymphadenopathy and leukopenia during service do not signify a disability. The record is absent any evidence showing a current diagnosis related to the in-service clinical findings. VA treatment records dated in February and March 2014 reveal negative findings as to lymphadenopathy, and the post-service records include no history or finding indicative of a current disorder manifested by lymphadenopathy or leukopenia. Accordingly, the claim must be denied. In this case, the Veteran does not have the requisite medical expertise to provide a diagnosis of a current disorder manifested by lymphadenopathy or leukopenia. See supra 38 C.F.R. § 3.159 (a)(2); see also Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007); Routen v. Brown, 10 Vet. App. 183, 186 (1997). Consequently, the Veteran’s statements are not sufficient to find that he has a current disability. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim. 5. Sinusitis 6. Left Hand Disorder 7. Right Hand Disorder Service connection is not warranted for sinusitis, or a left or right hand disorder. The Board has carefully reviewed the evidence of record but finds no diagnosis of sinusitis, a left hand disorder, or a current right hand disorder, and the Veteran has not reported the existence of outstanding diagnostic records. Notably, the November 2013 VA examiners determined the Veteran did not have chronic sinusitis or a hand disorder. The Board notes that the Veteran received treatment for a right hand injury in June 2012. However, the records do not reveal diagnosis of a chronic condition, as defined by VA, and examination was normal in November 2013. See 38 C.F.R. § 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Accordingly, the claim must be denied. In this case, the Veteran does not have the requisite medical expertise to provide a diagnosis of sinusitis, or a left or right hand disorder. See supra 38 C.F.R. § 3.159 (a)(2); see also Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007); Routen v. Brown, 10 Vet. App. 183, 186 (1997). Consequently, the Veteran’s statements are not sufficient to find that he has a current disability. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim. 8. Erectile Dysfunction Service connection is not warranted for erectile dysfunction. The Board has carefully reviewed the evidence of record but finds the Veteran does not have a current disorder of erectile dysfunction. Notably, an August 2014 VA examiner determined, after examination and consideration of the Veteran’s history, that the Veteran did not have erectile dysfunction. As explained in an August 2014 medical opinion, the Veteran did not have a function problem but a libido problem; the medical opinion indicates that the Veteran was able to have sexual intercourse. Although the record includes evidence that erectile dysfunction can be a side effect of medications prescribed for the service-connected psychiatric disability and includes the Veteran’s history of erectile dysfunction from the medication, the clinical evidence indicates that the Veteran has not had erectile dysfunction as a result of a service-connected disability. Although the Veteran is competent to report sexual dysfunction, the record indicates that he has provided conflicting histories as to the nature of the sexual dysfunction (i.e. whether it is due to function or libido). The Board finds the August 2014 VA medical findings are more probative than the Veteran’s histories as to whether he has erectile dysfunction because the medical findings are based on a more detailed history from the Veteran regarding the nature of the reported “erectile dysfunction.” Accordingly, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim. 9. Left Acromioclavicular Disorder A March 2015 VA treatment record reveals the Veteran’s history of increased pain and swelling of the left acromioclavicular joint. Service connection is not warranted for a left acromioclavicular (AC) joint disorder, diagnosed as arthritis. After consideration of the evidence, the Board finds the arthritis was not present until more than one year after discharge from service and is not otherwise related to service. The service treatment records reveal no finding of left AC joint arthritis, November 2013 examination revealed no AC joint impairment and attributed the Veteran’s left shoulder complaints to the service-connected left shoulder strain, and radiographic imaging of the left shoulder in November 2013 examination was normal. Furthermore, the initial complaint of specific AC joint impairment in March 2015 dates the onset of the symptoms to three weeks earlier, and the January 2016 VA examiner determined that the AC joint arthritis was not a continuation of the reported in-service shoulder pain. There is no medical evidence linking the AC joint arthritis to service, and the Veteran is not shown to be competent to attribute any left shoulder symptoms to arthritis rather than the service-connected strain. Thus, the Board finds a chronic AC joint disorder is not related to service. The Board further finds the current AC joint disorder is not secondary to the service-connected left shoulder strain. A January 2016 VA examiner determined that the AC joint disorder was not secondary to the service-connected left shoulder strain. The examiner explained that a strain involves the muscles whereas arthritis involves the joint and that a strain would not cause or aggravate joint arthritis. There is no medical evidence linking the AC joint arthritis to service. The Board acknowledges that the Veteran has submitted articles pertaining to degenerative joint disease of the AC joint. The articles do not include any information linking AC joint arthritis to shoulder strain or any incident in service, however. Notably, although the article indicates that arthritis of the AC joint can be due to injury to the AC joint, the record is absent any history or evidence of injury to the Veteran’s AC joint and the Veteran denied known trauma in February 2017. The Veteran does not have the requisite medical expertise to provide an opinion on the etiology of the current left AC joint disorder. See supra 38 C.F.R. § 3.159 (a)(2); see also Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007); Routen v. Brown, 10 Vet. App. 183, 186 (1997). Consequently, the Veteran’s statements are not sufficient to find that he has a current disability. Accordingly, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim. Increased Rating It is the intention of the rating schedule to recognize any painful, unstable or malaligned joint, due to healed injury, by assigning at least the minimum compensable rating for that joint. 38 C.F.R. § 4.59. 38 C.F.R. § 4.59 provides for a minimum 10 percent rating for painful, unstable, or malaligned joints, including for residuals of injuries in non-arthritis contexts. Burton v. Shinseki, 25 Vet. App. 1, 4-5 (2011). Moreover, with respect to all service-connected joint disorders, evidence of pain, weakened movement, excess fatigability, or incoordination must be considered in determining the level of associated functional loss, taking into account any part of the musculoskeletal system that becomes painful on use. 38 C.F.R. §§ 4.40, 4.45; Mitchell v. Shinseki, 25 Vet. App. 32 (2011); DeLuca v. Brown, 8 Vet. App. 202, 206 (1995) (holding that, to adequately portray the functional loss of musculoskeletal disabilities, a medical examination must “express an opinion on whether pain could significantly limit functional ability during flare-ups or when the [joint] is used repeatedly over a period of time”). However, those provisions should only be considered in conjunction with the diagnostic codes predicated on limitation of motion. 38 C.F.R. §§ 4.40, 4.45 (2016); Johnson v. Brown, 9 Vet. App. 7 (1996). 10. Epididymitis Diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these. Where diagnostic codes refer the decision maker to these specific areas of dysfunction, only the predominant area of dysfunction shall be considered for rating purposes. Since the areas of dysfunction described below do not cover all symptoms resulting from genitourinary diseases, specific diagnoses may include a description of symptoms assigned to that diagnosis. 38 C.F.R. §4.115a. Diagnostic Code 7525, which rates chronic epididymo-orchitis, states that the condition should be rated as urinary tract infection. The rating criteria for urinary tract infection provide a 10 percent rating urinary tract infection that requires long-term drug therapy, one to two hospitalizations per year, and/or intermittent intensive management. 38 C.F.R. § 4.115b. The Board finds a compensable rating is not warranted. The evidence, which includes VA and service treatment records, a November 2013 VA examination record, and an August 2014 VA examination record does not suggest that the epididymitis is associated with genitourinary dysfunction, and there is no evidence, including history, that the epididymitis has required medical management at any time during the period of the claim. Accordingly, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim. 11. Temporomandibular Joint Dysfunction Diagnostic Code 9905 rates temporomandibular articulation, limited motion of. Diagnostic Code 9904 provides a 10 percent rating for lateral excursion from 0 to 4mm and inter-incisal range from 31 to 40mm. Higher ratings are available for inter-incisal range limited to at most 30mm. The rating criteria specifies that ratings for limited inter-incisal movement shall not be combined with ratings for limited lateral excursion. 38 C.F.R. § 4.150, Diagnostic Code 9905. The Board finds a rating higher than 10 percent is not warranted at any time. The October 2013 VA examination record reports inter-incisal range to at least 31 mm without pain, and the examiner determined there was no additional loss during flares or after repeated use. There is no history of additional limitation to suggest the November 2013 VA examination record is not an accurate depiction of the Veteran’s temporomandibular joint dysfunction throughout the period of the claim. Accordingly, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim. 12. Cervical Spine Strain 13. Thoracolumbar Spine Strain Disabilities of the thoracolumbar and cervical spine are rated under a General Rating Formula (Formula). 38 C.F.R. § 4.71a. The Formula ratings apply with or without symptoms such as pain, stiffness, or aching. An evaluation of 10 percent is warranted for: forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent evaluation is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; the combined range of motion of the thoracolumbar spine not greater than 120 degrees; the combined range of motion of the cervical spine not greater than 170 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent evaluation is warranted for forward flexion of the cervical spine 15 degrees or less or favorable ankylosis of the entire cervical spine. A 40 percent evaluation is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is warranted for unfavorable ankylosis of the entire thoracolumbar spine, and a 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. The Formula provides for a separate rating for any associated objective neurologic impairment. The Formula for Rating Intervertebral Disc Syndrome (IDS) Based on Incapacitating Episodes provides ratings for incapacitating episodes. An incapacitating episode is defined as a period of acute signs and symptoms due to IDS that requires bed rest prescribed by a physician and treatment by a physician. See 38 C.F.R. § 4.71a, Note (1). November 2013 VA examination records reveal the Veteran’s history of neck and low back pain. The Veteran denied flares. Posture and gait were normal. There was no spasm, guarding, or localized tenderness. Neurological testing was normal, and there was no radicular pain or sign of radiculopathy. The Veteran did not have intervertebral disc syndrome. Range of motion testing of the cervical spine revealed flexion, extension, right lateral flexion, left lateral flexion, and right lateral flexion to 45 degrees or greater and rotation to 80 degrees or better bilaterally. There was no pain with flexion, extension, or rotation, but there was pain with right lateral flexion at 40 degrees and left lateral flexion at 35 degrees. There was no change in range of motion after repetition. The examiner determined the only functional limitation was due to pain on movement. The examiner determined that there would be an additional loss of five degrees of lateral flexion bilaterally due to pain on use or flares. Range of motion testing of the thoracolumbar spine revealed flexion to 90 degrees or greater with pain from 75 degrees, extension to 30 degrees or greater with pain from 25 degrees, right lateral flexion to 30 degrees or greater with pain from 20 degrees, left lateral flexion to 30 degrees or greater with pain at the end degree, right lateral rotation to 30 degrees or greater with pain from 25 degrees, and left lateral rotation to 30 degrees or greater with pain from 30 degrees. There was no change in range of motion after repetition. The examiner determined the only functional limitation was due to pain on movement. The examiner determined that there would be an additional loss of five degrees of flexion, extension, lateral flexion, and rotation due to pain on use or flares. Regarding the cervical spine disorder, the Board finds a rating greater than 10 percent is not warranted at any point during the period of the claim. The record includes no finding or history of spasm or guarding, and the cervical spine disability has never resulted in limitation of forward flexion to 30 degrees or less or combined range of motion to 170 degrees or less. Notably, the Veteran has not reported flares or limitation of motion beyond that depicted in the November 2013 VA examination record; the record is absent any specific evidence that the October 2013 VA examination record is not an accurate depiction of the Veteran’s cervical spine disability throughout the period of the claim. The Veteran has been compensated for the reported pain on use, and there is no evidence indicating that the functional loss ever approximated the limitation of motion required for a higher rating. Thus, the Board finds a schedular rating higher than 10 percent is not warranted for the cervical spine disability at any time. Regarding the thoracolumbar spine disorder, the Board finds a rating greater than 10 percent is not warranted at any point during the period of the claim. Range of motion testing consistently revealed forward flexion to greater than 60 degrees and combined range of motion to greater than 120 degrees, including after repetition, and the record is absent any finding or history of spasm or guarding during the period of the claim. Notably, the Veteran has not reported flares or limitation of motion beyond that depicted in the November 2013 VA examination record, and the record is absent any specific evidence that the November 2013 VA examination record is not an accurate depiction of the Veteran’s thoracolumbar spine disability throughout the period of the claim. The Veteran has been compensated for the reported pain on use, and there is no evidence indicating that the functional loss ever approximated the limitation of motion required for a higher rating. Thus, the Board finds a schedular rating higher than 10 percent is not warranted for the thoracolumbar spine disability at any time. The Board has considered whether there is any other schedular basis to assign a higher or separate rating during this period. There are no histories or findings indicative of neurological deficit associated with the cervical or thoracolumbar spine disorder. There is also no evidence of incapacitating episodes. Therefore, the Board concludes that the cervical and thoracic spine disabilities do not warrant a separate compensable rating for neurological impairment or a higher rating based on incapacitating episodes. See 38 C.F.R. § 4.71, Diagnostic Codes 5235 to 5243, Note 1. Accordingly, the claims must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against each claim. 14. Left Ankle Disability 15. Right Ankle Disability The ankle disabilities are evaluated under Diagnostic Codes 5271. Diagnostic Code 5271 provides a 10 percent rating for moderate limitation of motion of the ankle and a 20 percent rating for marked limitation of motion of the ankle. Normal range of motion of the ankle is 20 degrees dorsiflexion and 45 degrees plantar flexion. Based on the Board’s review of the evidence, the Veteran is entitled to a 10 percent rating for each ankle disability for the entire period of the claim pursuant to 38 C.F.R. § 4.59 and Burton based on the competent and credible evidence of ankle pain, including with motion. Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that the provisions of 38 C.F.R. § 4.59 are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record). The Board finds a rating greater than 10 percent is not warranted at any point during the period of the claim for either ankle disability. The November 2013 VA examination record reveals that the Veteran had normal, painfree range of motion in each ankle. Although the Veteran reported flares at that time, he explained that the flares only limited running, and the examiner determined the Veteran did not have additional limitation of motion from either ankle disability, including during flares or after repeated use. There is no probative evidence of “marked” limitation of motion as required for a higher rating. Notably, the Veteran has not reported limitation of function beyond that reported in the November 2013 VA examination record, and the record is absent any specific evidence that the November 2013 VA examination record is not an accurate depiction of the Veteran’s ankle disabilities throughout the period of the claim. Thus, the Board finds a 10 percent rating, but no higher, is warranted for each ankle disability. 16. Allergic Rhinitis Diagnostic Code 6522, which rates allergic rhinitis, provides a 10 percent rating for rhinitis without polyps but with greater than 50-percent obstruction of each nasal passage or complete obstruction of one nasal passage and a 30 percent rating for rhinitis with polyps. The Board finds a compensable rating is not warranted at any time during the period on appeal. There is no competent evidence of total obstruction of one nasal passage or greater than 50 percent obstruction of both nasal passages at any time. Notably, the November 2013 VA examination record reports that the Veteran did not have greater than 50 percent obstruction of both nasal passages, complete obstruction of one nasal passage, permanent hypertrophy of the nasal turbinate, or nasal polyp, and post-service records reveal no findings or histories indicative of the findings necessary for a compensable rating, and the record is absent any specific indication that the November 2013 VA examination record is not an accurate depiction of the Veteran’s allergic rhinitis throughout the period of the claim. Accordingly, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim. 17. Headache Disability Diagnostic Code 8100, which rates headaches, provides a 10 percent rating for prostrating attacks averaging one in two months over several months. A 30 percent disability rating is warranted for migraine headaches with characteristic prostrating attacks occurring on an average once a month over the last several months. The maximum schedular disability rating of 50 percent is warranted for migraine headaches with very frequent and completely prostrating and prolonged attacks productive of severe economic inadaptability. The rating criteria do not define “prostrating,” nor has the Court. Cf. Fenderson v. West, 12 Vet. App. 119 (1999) (in which the Court quotes Diagnostic Code 8100 verbatim but does not specifically address the matter of what is a prostrating attack.). By way of reference, the Board notes that according to WEBSTER’S NEW WORLD DICTIONARY OF AMERICAN ENGLISH, THIRD COLLEGE EDITION (1986), p. 1080, “prostration” is defined as “utter physical exhaustion or helplessness.” A very similar definition is found in DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1554 (31st Ed. 2007), in which “prostration” is defined as “extreme exhaustion or powerlessness.” The Veteran’s headache disability is rated as noncompensable prior to July 2, 2014, and 30 percent from July 2, 2014, based on the evidence of monthly prostrating headaches as of July 2, 2014, as reported in the July 2014 VA examination record. The record is absent any history or finding of prostrating headaches prior to July 2, 2014. Notably, the examination record indicates that the headaches were not “prostrating.” In the absence of evidence of prostrating headaches prior to July 2, 2014, the Board finds a compensable rating is not warranted. The Board further finds a rating in excess of 30 percent is not warranted at any time from July 2, 2014, because the record is absent any history or finding of “very frequent” and/or completely prostrating attacks that are potentially productive of severe economic inadaptability. Notably, the July 2014 VA examination record reports that the headaches lasted less than one day and occurred once per month, which the Board finds is not “very frequent” and were not productive of severe economic inadaptability. The record is absent any specific indication that the July 2014 VA examination report is not an accurate depiction of the Veteran’s headache disability for the period from July 2, 2014, or that the November 2013 examination record is not an accurate depiction of the headache disability prior to July 2, 2014. Accordingly, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim. REMANDED ISSUES 1. Service connection for color vision deficiency is remanded. The record indicates that there is outstanding VA medical evidence pertaining to the color vision deficiency claim. A March 2015 VA “optometry nonVA care consult result” record reports that nonVA optometry care was provided and the results “attached” as an image. The optometry treatment record is not of record. Further development to obtain the outstanding evidence is required. 2. Service connection for GERD is remanded. The record includes ambiguous findings as to whether the Veteran has GERD. Although VA examination in August 2014 reveals the determination that the Veteran does not have GERD and the VA treatment records do not report a diagnosis of GERD, a January 2016 VA “Joints” examination record reports that “a diagnosis of GERD is established.” The Board finds the record would benefit if medical evidence were obtained to clarify whether the Veteran has GERD. 3. An initial rating in excess of 10 percent for left shoulder strain is remanded. 4. An initial rating in excess of 10 percent for right shoulder strain is remanded. 5. An increased initial rating for a left hip disorder, currently assigned a combined 10 percent rating for limitation of motion, is remanded. 6. An increased initial rating for a right hip disorder, currently assigned a combined 10 percent rating for limitation of motion, is remanded. 7. An initial compensable rating for left knee patellofemoral syndrome is remanded. 8. An initial compensable rating for right knee patellofemoral syndrome is remanded. 9. An initial rating in excess of 30 percent for a psychiatric disability is remanded. 10. An initial compensable rating for IBS is remanded. The record includes VA treatment record associated with the record in June and November 2015, and January and May 2016, that include information pertinent to these claims. These records have not been adjudicated by the originating agency, and the Veteran has not waived his right to have the foregoing evidence initially considered by the originating agency. Accordingly, the issues must be remanded for consideration of the foregoing evidence by the originating agency. In light of the need for remand, the Board finds the record would benefit if examinations were conducted to determine the current severity of the conditions. 11. An initial compensable rating for bilateral feet plantar fasciitis is remanded. The Board finds the record would benefit if a medical opinion were obtained to determine the current severity of the bilateral plantar fasciitis. The matters are REMANDED for the following actions: 1. Undertake appropriate development to obtain any outstanding, pertinent evidence, including the March 09, 2015, nonVA care optometry record, attached as an image. All efforts to obtain additional evidence must be documented in the claims file. 2. Schedule the Veteran for an examination by an appropriate clinician to determine whether the Veteran has GERD. If GERD is diagnosed, the examiner must provide opinion(s) with rationale as to whether it is at least as likely as not that the GERD was incurred in service, is otherwise related to service, is proximately due to service-connected psychiatric disorder, or has been aggravated beyond its natural progression by service-connected psychiatric disorder. 3. Afford the Veteran a VA examination by an examiner with sufficient expertise to fully assess the Veteran’s service-connected bilateral hip, bilateral shoulder, and bilateral knee disabilities. All pertinent evidence of record should be made available to and reviewed by the examiner. Any indicated studies should be performed. If the examiner is unable to conduct the required testing or concludes any required testing is not necessary, he or she must explain why that is so. The examiner must provide all information required for rating purposes, to specifically include both active and passive range of motion testing, as well as weight-bearing and non-weight-bearing range of motion assessments. Further, the examiner must indicate if movement is limited by pain, and if so, at what point. The examiner must provide an assessment of the Veteran’s functional loss during flares, if possible in degrees of motion lost. In doing so, the examiner must consider and discuss all procurable and assembled data such as the frequency, duration, characteristics, precipitating and alleviating factors, and the severity of flare-ups. The examiner must provide a complete rationale for all proffered opinions. If the examiner cannot provide the required opinions without resorting to speculation, he or she must state whether this is based on a personal limitation or on a lack of knowledge among the medical community at large. 4. Afford the Veteran a VA examination by an examiner with sufficient expertise to fully assess the Veteran’s service-connected plantar fasciitis. All pertinent evidence of record should be made available to and reviewed by the examiner. Any indicated studies should be performed. If the examiner is unable to conduct the required testing or concludes any required testing is not necessary, he or she must explain why that is so. The examiner must provide all information required for rating purposes. Further, the examiner should specify, to the extent possible, the degree of severity of each foot and of both feet together. The examiner must provide an assessment of the Veteran’s functional loss during flares, if possible in degrees of motion lost. In doing so, the examiner must consider and discuss all procurable and assembled data such as the frequency, duration, characteristics, precipitating and alleviating factors, and the severity of flare-ups. The examiner must provide a complete rationale for all proffered opinions. If the examiner cannot provide the required opinions without resorting to speculation, he or she must state whether this is based on a personal limitation or on a lack of knowledge among the medical community at large. 5. Afford the Veteran a VA examination by an examiner with sufficient expertise to fully assess the Veteran’s service-connected irritable bowel syndrome. All pertinent evidence of record should be made available to and reviewed by the examiner. Any indicated studies should be performed. If the examiner is unable to conduct the required testing or concludes any required testing is not necessary, he or she must explain why that is so. 6. Afford the Veteran a VA examination by an examiner with sufficient expertise to fully assess the Veteran’s service-connected psychiatric disorder. All pertinent evidence of record should be made available to and reviewed by the examiner. Any indicated studies should be performed. If the examiner is unable to conduct the required testing or concludes any required testing is not necessary, he or she must explain why that is so. (Continued on the next page)   7. Then, readjudicate the issues remaining on appeal, with consideration of all evidence associated with the record since the claims were most recently addressed by the AOJ. If any benefit sought on appeal is not granted to the Veteran’s satisfaction, the Veteran and his representative should be furnished a supplemental statement of the case and provided the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action, if otherwise in order. Lana K. Jeng Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Snyder, Counsel