Citation Nr: 18123799 Decision Date: 08/07/18 Archive Date: 08/03/18 DOCKET NO. 16-19 133A DATE: August 7, 2018 ORDER Entitlement to an increased rating greater than 10 percent for service-connected left wrist status post fracture is denied. Entitlement to an increased rating greater than 20 percent for service-connected lumbar spondylosis, levoscoliosis, and discogenic disease is denied. Entitlement to an increased rating greater than 10 percent for service-connected status post fracture of the right knee lateral tibial plateau is denied. Entitlement to an increased compensable rating for right ear hearing loss is denied. Entitlement to an increased rating greater than 10 percent for a service-connected left-hand scar residual is denied. Entitlement to an increased rating greater than 10 percent for service-connected tinea versicolor is denied. FINDINGS OF FACT 1. At no point during the period on appeal did the Veteran’s left wrist status post fracture manifest symptoms of ankylosis. 2. For the entire period on appeal, the Veteran’s service-connected lumbar spine disability manifested as forward flexion limited to, at most, 35 degrees and no evidence of ankylosis. 3. For the entire period on appeal, the Veteran’s right knee disability has been manifested by, at worst, extension to 0 degrees and flexion to 110 degrees with pain, but no ankylosis, subluxation, meniscus disabilities, or lateral instability. 4. The Veteran’s non-service-connected left ear is assigned Level I hearing; and, audiometric testing for the service-connected right ear has shown average pure tone thresholds of 26-30 decibels with speech recognition scores of 100 percent, resulting in Level I hearing impairment. 5. The Veteran has one, six-centimeter-long, non-linear, painful scar, with no evidence of instability or other disfigurement. 6. There is no evidence the Veteran’s tinea versicolor encompasses more than 20 percent of his entire body or 20 percent of exposed areas affected, or that he uses any type of medication, topical or systemic, to treat his skin condition. CONCLUSIONS OF LAW 1. The criteria for an increased rating greater than 10 percent for service-connected left wrist status post fracture have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5215 (2017). 2. The criteria for an increased rating greater than 20 percent for service-connected lumbar spondylosis, levoscoliosis, and discogenic disease have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.3, 4.6, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242 (2017). 3. The criteria for entitlement to an increased rating greater than 10 percent for service-connected status post fracture of the right knee lateral tibial plateau have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003-5260 (2017). 4. The criteria for entitlement to an increased compensable rating for right ear hearing loss have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.27, 4.85; Diagnostic Code 6100 (2017). 5. The criteria for entitlement to an increased rating greater than 10 percent for a service-connected left-hand scar with onychomycosis have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.14, 4.27, 4.118, Diagnostic Code 7802 (2017). 6. The criteria for entitlement to an increased rating greater than 10 percent for service-connected tinea versicolor have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.7, 4.118, Diagnostic Code 7820-7806 (2017); 83 FR 32592 (July 13, 2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1972 through February 1975 and from December 1991 through July 2010. In reviewing the Veteran’s appeal for increased ratings, the Board has not overlooked the holding of Rice v. Shinseki, 22 Vet. App. 447 (2009). In Rice, the United States Court of Appeals (Court) held that a claim for a total disability rating based on individual unemployability (TDIU) can be inferred as part of the original claim for an increased rating in certain circumstances. In this case, however, the Veteran has not asserted that he is unemployable, and there is no evidence in the claims file that he is unable to gain or maintain substantially gainful employment due to his service-connected disabilities. As such, the Board finds that Rice is not applicable to this appeal and the current decision need not consider whether the Veteran meets the criteria for entitlement to a TDIU. Additional VA treatment records were obtained after the issuance of the February 2017 supplemental statement of the case. Generally, a supplemental statement of the case (SSOC) must be issued by the Agency of Original Jurisdiction (AOJ) when new evidence is received. An exception to this general rule is when the additional evidence is either duplicative or not relevant to the issue on appeal. 38 C.F.R. 20.1304(c). In the present case, the Board finds that the newly obtained evidence is not relevant to the issues on appeal. The additional records pertain solely to the Veteran’s hypertension, which is not on appeal before the Board. Accordingly, the Board may proceed with the adjudication of the pending claims as a SSOC is not required. Increased Rating The Board notes that the Veteran’s last VA examination for his service-connected left-hand scar residuals was in November 2014. Additionally, he has not been afforded a VA examination to evaluate his service-connected tinea versicolor since February 2011. The mere passage of time between the examination and the Board’s review does not, in and of itself, trigger a remand for another more contemporaneous examination. See Palczewski v. Nicholson, 21 Vet. App. 174 (2007) (holding that a remand was not required solely due to the passage of time since the most recent VA examination); VAOPGCPREC 11-95 (1995). Although the Veteran generally claimed in his VA Form 9 that all his disabilities had increased in severity since his last VA examinations, he has not provided any arguments specifically stating that his tinea versicolor or left hand-scar residuals had worsened. See Snuffer v. Gober, 10 Vet. App. 400 (1997) (holding that a Veteran was entitled to a new examination because two years had passed since his last VA examination and he contended his disability had increased in severity). None of the Veteran’s more recent VA treatment records indicate he receives treatment for his left-hand scar residuals or his tinea versicolor or provide any evidence of worsening of these disabilities. 1. Entitlement to an increased rating greater than 10 percent for service-connected left wrist status post fracture The Veteran asserts that his left wrist fracture warrants a higher rating than 10 percent. The Veteran’s left wrist fracture is rated as 10 percent disabling under Diagnostic Code 5215, applying to limitation of motion of the wrist. A 10 percent rating is the highest rating available under Diagnostic Code 5215. The Veteran is right handed. The Veteran would be entitled to an increased disability rating under Diagnostic Code 5214, applying to ankylosis of the wrist. However, to warrant an increased, 20 percent, disability rating for ankylosis of the minor hand, the evidence would have to reflect the Veteran’s left wrist disability manifested as favorable ankylosis in 20 to 30 degrees of dorsiflexion. After a complete review of the record in conjunction with the applicable laws and regulations, the Board finds that entitlement to an increased rating greater than 10 percent for a service-connected left wrist status post fracture is not warranted. The Veteran was afforded a VA examination to evaluate the severity of his left wrist disability in November 2014. Results of range of motion testing reflected palmar flexion to 60 degrees, dorsiflexion to 40 degrees, ulnar deviation to 35 degrees, and radial deviation to 10 degrees. The limitation in range of motion contributed to the Veteran’s loss of hand grip. The examiner noted objective evidence of pain at rest and during range of motion testing. After three repetitions, the Veteran’s range of motion was further limited to 40 degrees of dorsiflexion and 35 degrees of ulnar deviation. He reported that he experienced severe weekly flare-ups of pain after repetitive motion. The examiner noted that there was no evidence of weakness or incoordination identified during the examination, and it would be speculative to provide additional limitation due to pain in terms of degrees of additional range of motion, as any additional limitation due to pain should be noted during a positive flare period. Neurological testing reflected the Veteran had reduced strength with flexion and extension, but the examiner noted the reduction in strength was not entirely due to the Veteran’s service-connected left wrist disability. There was no evidence of ankylosis. The Veteran was afforded another VA examination in January 2017 to evaluate the severity of his left wrist disability. He reported occasional left wrist pain exacerbated by lifting heavy objects, but did not report experiencing flare-ups. Results of range of motion testing reflected palmar flexion to 60 degrees, dorsiflexion to 55 degrees, ulnar deviation to 45 degrees, and radial deviation to 20 degrees. The examiner noted objective evidence of pain during the examination did not cause functional loss. There was no additional functional loss after three repetitions. Neurological testing reflected normal muscle strength and no muscle atrophy. There was no evidence of ankylosis. VA treatment records contain no complaints of, or treatment for, the Veteran’s left wrist disability. The record contains no evidence that the Veteran’s left wrist disability manifested as favorable ankylosis in 20 to 30 degrees of dorsiflexion. Neither the November 2014 nor the January 2017 VA examiners found any evidence of ankylosis. The normal ranges of motion of the wrist are: radial deviation from zero to 20 degrees; ulnar deviation from zero to 45 degrees; dorsiflexion from zero to 70 degrees; and palmar flexion from zero to 80. The November 2014 and January 2017 VA examinations noted the Veteran’s palmar flexion was limited by 20 degrees, dorsiflexion limited by at most 30 degrees after repetition, ulnar deviation was limited by at most 10 degrees after repetition, and radial deviation was limited by at most 10 degrees. The Board cannot find these minor reductions in range of motion for the identified planes more nearly approximate ankylosis. In forming this decision, the Board has considered the Veteran’s complaints of pain in the left wrist. For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45 (2017), pertaining to functional impairment. These provisions are not applicable where, as in this case, the maximum rating for limitation of motion has been awarded. Johnston v. Brown, 10 Vet. App. 80, 85 (1997); 38 C.F.R. § 4.59. The Board notes that in adjudicating a claim, the competence and credibility of the lay statements must be considered. See Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). The Board acknowledges that the Veteran is competent to give evidence about what he experiences. For example, he is competent to report that he experiences symptoms such as pain, and he is credible in this regard. See, e.g., Layno v. Brown, 6 Vet. App. 465 (1994). The Veteran’s competent and credible belief that his disability is worse than the assigned disability rating, however, is outweighed by the competent and credible medical examination that evaluated the true extent of impairment based on objective data coupled with the Veteran’s lay complaints. For these reasons, greater evidentiary weight is placed on the physical examination findings than the lay statements. In summary, the Veteran’s left wrist disability results in painful motion that more nearly approximates the criteria corresponding to the currently assessed compensable 10 percent rating. The preponderance of the evidence is against a rating in excess of 10 percent, even after all reasonable doubt is resolved in favor of the Veteran. Further, as the severity of the left wrist disability has remained stable, and it appears his range of motion has improved, throughout the period on appeal, staged ratings are not warranted. Hart v. Mansfield, 21 Vet. App. 505 (2007). 2. Entitlement to an increased rating greater than 20 percent for service-connected lumbar spondylosis, levoscoliosis, and discogenic disease The Veteran contends that his service-connected lumbar spine disability warrants an increased rating greater than 20 percent. His lumbar spine disability is rated as 20 percent disabling under Diagnostic Code 5242. After a full review of the record, in conjunction with the applicable laws and regulations, the Board finds that an increased, 20 percent disability rating for the Veteran’s service-connected lumbar spine disability is not warranted. The Veteran was afforded a VA examination in November 2014 to evaluate the severity of his lumbar spine disability. He reported experiencing flare-ups when stooping and during prolonged ambulation and standing. Results of range of motion testing reflected the Veteran had forward flexion to 35 degrees with pain beginning at five degrees, extension to 15 degrees with pain beginning at five degrees, right and left lateral flexion to 15 degrees with pain beginning at 5 degrees, and left and right lateral rotation with pain beginning at 5 degrees. The Veteran’s range of motion was not further limited after repetitive use testing. There was localized tenderness to the lumbar spine are and evidence of muscle spasm and guarding that did not result in abnormal gait or abnormal spinal contour. Muscle strength and neurological testing was normal with no evidence of radiculopathy. There was no ankylosis or other neurological condition and the Veteran did not use assistive devices. The examiner noted that pain at the lumbar spine could significantly limit functional ability during flare-ups or when the joint is used over a period of time; however, there was no evidence of fatigability, weakness, or incoordination during the examination, and it was not possible to express any additional limitation in terms of degrees because the Veteran was not experiencing a positive flare episode during the examination. In April 2016, the Veteran was afforded a second VA examination to evaluate the severity of his service-connected lumbar spine disability. He reported experiencing localized lower back pain without radicular symptoms that worsened when bending at the waist, lifting heavy objects, and prolonged ambulation and standing. Results of range of motion testing reflected the Veteran had forward flexion from zero to 40 degrees, extension from zero to 15 degrees, right and left lateral flexion from zero to 15 degrees, and right and left lateral rotation from zero to 15 degrees. Pain was noted during physical examination but the VA examiner noted it did not cause functional loss. The Veteran’s range of motion remained the same after repetitive use testing. The examiner noted that pain, weakness, fatigability, or incoordination could limit the functional ability of an individual with a musculoskeletal pathology during a flare-up; however, it would be mere speculation to classify the functional limitation in terms of significant, mild, moderate, or severe in the absence of a flare-up. There was no evidence of muscle spasm, but there was evidence of tenderness and guarding that did not result in abnormal gait or abnormal spinal contour. His muscle strength was normal and there was no evidence of neurological defects or radiculopathy. There was no evidence of ankylosis. The Veteran reported he regularly used a lumbar brace for support. VA treatment records reflect the Veteran underwent physical therapy to treat his lumbar spine disability in 2016. The Veteran’s forward flexion and extension were noted to be limited by pain and the Veteran reported he avoided moving during a September 2016 physical therapy appointment. An October 2016 physical therapy note indicated he had a positive right sided straight leg raise test, but he was not diagnosed with radiculopathy. A December 2016 physical therapy note reflected he had full active range of motion of the spine. Straight leg raise, hamstring tightening, facet loading, Gaenslen’s, and Patrick’s tests were negative. Muscle strength testing reflected reduced strength at the proximal lower extremity, pain inhibited, but otherwise he had full strength. Sensation was decreased along the lateral patellar region, but his deep tendon reflexes were normal. The Veteran was afforded a final VA examination to evaluate the severity of his lumbar spine disability in January 2017. He reported experiencing constant pain that was exacerbated by sitting or standing for long periods of time. He reported that during flare-ups he was unable to bend, had difficulty getting in and out of bed, and had difficulty standing up. Results of range of motion testing reflected the Veteran had forward flexion from zero to 45 degrees, extension from zero to 20 degrees, right and left lateral flexion from zero to 20 degrees, and right and left lateral rotation from zero to 20 degrees. The examiner noted that pain during the examination did not result in functional loss. His range of motion was not further limited after three repetitions. The examiner noted that all musculoskeletal disorders could potentially cause functional limitations during repetitive use over time, but it would be speculative to describe any functional limitation in terms of severity based on a possible future event. The examiner also noted that it would be speculative to determine whether pain, weakness, fatigability, or incoordination significantly limited the Veteran’s functional ability during flare-ups, as the examination needed to be conducted during a flare-up to determine any additional functional loss. Muscle strength testing reflected normal muscle strength and there were no neurological deficits noted when testing deep tendon reflexes or sensation to light touch. There was no evidence of radiculopathy or ankylosis. To warrant an increased rating of 40 percent under the General Rating Formula for Diseases and Injuries of the Spine, the Veteran’s service-connected lumbar spine disability would have to manifest as limitation of forward flexion to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. Initially, the Board notes that the November 2014 VA examination recorded range of testing results of forward flexion to 35 degrees with pain beginning at five degrees. However, the Board does not find the results of this examination to be analogous to forward flexion limited to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. Note (5) to the General Rating Formula for Diseases and Injuries of the Spine provides that favorable ankylosis is fixation of a spinal segment in neutral position. The Veteran could forward flex to 35 degrees with pain at five degrees, reflecting his thoracolumbar spine was not fixed in a neutral position. Moreover, none of the Veteran’s other VA treatment records or VA examinations noted that his pain caused functional limitation, or that pain began at five degrees. The rating percentage represents the average impairment of earning capacity resulting from the Veteran’s service-connected lumbar spine disability. See 38 C.F.R. 4.1. As such, one exam noting pain beginning at 5 degrees, in light of the overwhelming medical evidence that the Veteran’s range of motion is not limited to five degrees by pain, is not illustrative of the Veteran’s average impairment of earning capacity. There is no evidence that the Veteran’s lumbar spine disability manifested as limitation of forward flexion to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine to warrant an increased, 40 percent, disability rating. The Veteran’s forward flexion was limited to at most 35 degrees throughout the appeal period, and the April 2016 and January 2017 VA examinations noted the Veteran’s forward flexion was limited to 40 degrees and 45 degrees, respectively, and he had full range of motion noted in a December 2016 VA treatment record. Additionally, none of his VA treatment records or the VA examinations noted the Veteran’s lumbar spine disability was ankylosed. The Board has considered whether the Veteran could be granted a higher rating under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. The record does not reflect that the Veteran has ever been prescribed bed rest by a physician due to incapacitating episodes. While he may voluntarily choose to limit activity due to increased pain, that is not how VA defines an incapacitating episode. Additionally, the Board has considered whether the Veteran would be entitled to a separate compensable rating for radiculopathy. An October 2016 VA treatment record reflected the Veteran had a positive straight leg raise test on the right side, suggesting radiculopathy. However, the Veteran’s straight leg raise tests conducted in December 2016 and during the January 2017 VA examination were negative. Moreover, the Veteran has not reported any radicular symptoms, and his sensory testing conducted during the January 2017 VA examination was normal. Accordingly, as there is no evidence the Veteran has been diagnosed with radiculopathy, a separate compensable rating is not warranted. In considering these rating criteria, the Board has considered functional loss due to pain, fatigability, incoordination, pain on movement, and weakness. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 206-7 (1995). In making this determination, the Board considered the Veteran’s statements regarding his symptoms, VA examination reports, and VA treatment records. While the record shows low back pain and difficulty with prolonged ambulation and standing, the evidence does not show that his symptoms and flare-ups produce functional loss that is manifested by adequate evidence of disabling pathology for higher ratings. See 38 C.F.R. § 4.40; Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). Indeed, the Veteran did not experience additional limitation of motion after repetitive use testing and his disability rating is already based on the extent to which his symptoms reduce range of motion. In light of the Veteran’s reported symptoms and the medical evidence, the Board finds that the Veteran is not entitled to a higher rating for his lumbar spine disability.   Entitlement to an increased rating greater than 20 percent for service-connected lumbar spondylosis, levoscoliosis, and discogenic disease is not warranted. As the preponderance of the evidence is against assignment of any higher rating, the benefit-of-the doubt doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to an increased rating greater than 10 percent for service-connected status post fracture of the right knee lateral tibial plateau The Veteran asserts that his service-connected right knee status post fracture of the lateral tibial plateau warrants a rating greater than 10 percent. His right knee disability is rated as 10 percent disabling under Diagnostic Code 5003-5260. After a full review of the claims file, in conjunction with the applicable laws and regulations, the Board finds that entitlement to an increased rating greater than 10 percent for a right knee disability is not warranted. The Veteran was afforded a VA examination in November 2014 to evaluate the severity of his right knee disability. He reported experiencing loss of tolerance for ambulation, and flare-ups when kneeling, climbing stairs, and prolonged ambulation. Physical examination reflected the Veteran had flexion from zero to 120 degrees, and extension from 120 degrees to zero. The examiner noted the Veteran experienced pain at rest and with weight bearing. Range of motion measurements were the same after repetitive use testing. It was noted the Veteran had weekly, severe flare-ups that lasted hours. The examiner noted that there was no evidence of weakness or incoordination identified during the examination, and it would be speculative to provide additional limitation due to pain in terms of degrees of additional range of motion, as any additional limitation due to pain should be noted during a positive flare period. Muscle strength testing reflected slightly reduced strength with flexion and extension, but there was no muscle atrophy. There was no evidence of ankylosis or recurrent subluxation, and all ligamentous testing was negative for instability. The examiner noted that the Veteran’s knee did not impact his ability to perform any type of occupational task. The Veteran was afforded another VA examination to evaluate the current severity of his service-connected right knee disability in April 2016. He reported that he continued to experience knee pain and flare-ups with kneeling, climbing stairs, and prolonged ambulation. Results of range of motion testing reflected the Veteran had flexion from zero to 120 degrees and extension from 120 degrees to zero. The examiner noted that pain was noted, but it did not result in functional loss, and there was no noted pain with weight bearing. There was no additional reduction in range of motion after repetitive use testing. The examiner noted that pain, weakness, fatigability, or incoordination could limit the functional ability of an individual that has a musculoskeletal pathology during a flare-up, but to classify the functional limitation in the absence of the flare-up as significant, mild, moderate, or severe would be mere speculation. Muscle strength testing reflected normal strength with flexion and extension and there was no evidence of muscle atrophy. There was no evidence of ankylosis or recurrent subluxation, and all ligamentous testing was negative for instability. The examiner noted the Veteran occasionally used a knee brace, but that the Veteran’s knee did not impact his ability to perform any type of occupational task. The Veteran was afforded a final VA examination in January 2017 to evaluate his right knee disability. The Veteran reported right leg numbness, muscle cramps, and edema. He reported flare-ups caused limitation of standing and ambulation, and that he avoided running. Results of range of motion testing reflected he had flexion from zero to 110 degrees and extension from 110 degrees to zero. The examiner noted pain, but the pain did not result in functional loss, and there was no pain with weight bearing. There was no evidence of pain during passive range of motion testing and when used in non-weight bearing positions. The examiner noted that pain could significantly limit functional ability during flare-ups or when the joint is used repeatedly over a period of time; however physical examination revealed no evidence of fatigability, incoordination, muscle weakness, or pain. The examiner also noted it was not possible and would be purely speculative to express additional limitation due to pain during flare-ups because no flare-ups were observed during physical evaluation. Muscle strength testing reflected normal muscle strength with no evidence of muscle atrophy. There was no evidence of ankylosis, subluxation, or effusion. Ligament stability testing revealed no instability. The Veteran had no history of meniscus disabilities. The examiner noted the Veteran’s right knee disability impacted his ability to stand and walk. VA treatment records reflect the Veteran continued to report right knee pain. A December 2016 treatment record indicated he reported intermittent numbness along the lateral knee region and cramping. A sensory examination conducted at the time noted decreased sensation at the lateral patellar region. None of the records contain the results of range of motion testing. In consideration of the medical and lay evidence, the Board finds that a rating in excess of 10 percent is not warranted under Diagnostic Codes 5003-5260. The Veteran’s right knee disability manifested as x-ray evidence of degenerative joint disease, but very slight limitations of motion. The evidence throughout the entire period on appeal does not show compensable limitation of motion, or flexion limited to 45 degrees. The evidence shows that his flexion was, at worst, limited to 110 degrees with pain. Accordingly, only a 10 percent rating is warranted for painful limitation of motion. Moreover, the Veteran has had normal extension throughout the period on appeal; therefore, a separate rating based on limitation of extension is not warranted. The Board has considered whether the Veteran would be entitled to a separate compensable rating under any other diagnostic code applying to the knees. Diagnostic Codes 5258 and 5259 are not applicable as the Veteran does not have any meniscus disabilities. Diagnostic Code 5257 is not applicable because the Veteran has not reported any episodes of “giving way” and ligamentous testing throughout the period on appeal has shown no objective evidence of lateral instability or subluxation. Finally, Diagnostic Code 5256 is not applicable as there is no evidence the Veteran’s right knee disability manifests as ankylosis, or that his symptoms are severe enough to be analogous to ankylosis. While the Veteran reported he experienced flare-ups of pain when kneeling, climbing stairs, or during prolonged ambulation, he never reported that the pain further limited his range of motion. The November 2014, April 2016, and January 2017 VA examiners all noted his reported flare-ups of pain limited prolonged standing and walking, but could not provide additional functional impairment in terms of limitation of motion without resorting to mere speculation. The Board notes that the Veteran complained of numbness to his right knee in December 2016 and during the January 2017 VA examination. Although the December 2016 physical therapy spine evaluation noted sensory loss along the lateral patellar region, the physical therapist did not relate the numbness to his right knee disability. The January 2017 VA examination found no sensory deficits along the Veteran’s right knee and thigh, despite his complaints of numbness. Moreover, there is no evidence in the record suggesting the Veteran’s numbness, which has not been noted to be a symptom of his right knee disability, causes any functional limitation. Accordingly, the Board finds the Veteran’s right knee disability is fully compensated by his assigned 10 percent rating. The Board additionally considered whether the Veteran is entitled to a higher rating due to functional impairment under the provisions of 38 C.F.R. §§ 4.40 and 4.45. See DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). In making this determination, the Board considered the Veteran’s statements regarding his symptoms, VA examination reports, and VA treatment records. While the record shows knee pain, muscle cramps, and reduced sensation, and difficulty with prolonged standing, walking, and bending, the evidence does not show that his symptoms and flare-ups produce functional loss that is manifested by adequate evidence of disabling pathology for higher ratings. See 38 C.F.R. § 4.40; Mitchell vv. Shinseki, 25 Vet. App. 32, 38 (2011). Indeed, the Veteran did not experience additional limitation of motion after repetitive use testing and his disability rating is already based on the extent to which his symptoms reduce range of motion and impair stability. In light of the Veteran’s reported symptoms and the medical evidence, the Board finds that the Veteran is not entitled to a higher rating for his right knee disability. Entitlement to an increased rating greater than 10 percent for a service-connected status post fracture of the right knee lateral tibial plateau is not warranted. As the preponderance of the evidence is against assignment of any higher rating, the benefit-of-the doubt doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); Gilbert, 1 Vet. App. at 49. 4. Entitlement to an increased compensable rating for service-connected right ear hearing loss The Veteran contends he is entitled to a compensable evaluation for his service-connected right ear hearing loss. After a full review of the record in conjunction with the applicable laws and regulations, the Board finds that entitlement to a compensable rating for service-connected right ear hearing loss is not warranted. Initially, the Board notes that the Veteran is only service-connected for right ear hearing loss. Pursuant to 38 C.F.R. § 4.85 (f), if impaired hearing is service-connected in only one ear, in order to determine the percentage evaluation from Table VII, the nonservice-connected ear will be assigned a Roman Numeral designation for hearing impairment of I. However, if impaired hearing is service-connected in only one ear, the impairment in both ears will be considered in rating the disability if the impairment in the service-connected ear is to a degree of 10 percent or more and the impairment in the nonservice-connected ear qualifies as a disability under 38 C.F.R. § 3.385. See 38 C.F.R. § 3.383 (a)(3). In this regard, in order for the right ear hearing loss to be considered 10 percent disabling, it must reach Level X or XI (which are the Roman Numeral designations for hearing loss of a severity that it would equate to a 10 percent rating when the nonservice-connected ear is assigned Level I hearing impairment). However, as will be discussed below, the Veteran’s right ear hearing loss results in no worse than Level I hearing impairment. As such, for the entire appeal period, his nonservice-connected left ear is assigned a Level I hearing impairment designation. The Veteran was afforded a VA examination to evaluate his hearing acuity in November 2014. Results of audiometric testing reflected the following puretone thresholds:   HERTZ 500 1000 2000 3000 4000 Avg RIGHT 10 15 5 35 50 26 The Veteran’s controlled speech discrimination score (Maryland CNC) was 100 percent. Application of 38 C.F.R. § 4.85 Table VI to the November 2014 measurements result in assignment of Roman Numeral I in the right ear. Applying the percentage ratings for hearing impairment found in Table VII, level I hearing in the right ear and level I hearing in the nonservice-connected left ear results in a noncompensable rating. 38 C.F.R. § 4.85. In May 2016, the Veteran was afforded a VA examination to evaluate his current level of right ear hearing loss. Results of audiometric testing revealed the following puretone thresholds: HERTZ 500 1000 2000 3000 4000 Avg RIGHT 20 15 20 35 45 29 His controlled speech discrimination score (Maryland CNC) was 100 percent. Application of 38 C.F.R. § 4.85 Table VI to the May 2016 measurements result in assignment of Roman Numeral I in the right ear. Applying the percentage ratings for hearing impairment found in Table VII, level I hearing in the right ear and level I hearing in the nonservice-connected left ear results in a noncompensable rating. 38 C.F.R. § 4.85. The Veteran was afforded another VA examination to evaluate the severity of his right ear hearing loss in January 2017. Audiometric testing reflected the following puretone thresholds: HERTZ 500 1000 2000 3000 4000 Avg RIGHT 25 20 20 40 40 30 The Veteran’s controlled speech discrimination score (Maryland CNC) was 100 percent. Application of 38 C.F.R. § 4.85 Table VI to the January 2017 measurements result in assignment of Roman Numeral I in the right ear. Applying the percentage ratings for hearing impairment found in Table VII, level I hearing in the right ear and level I hearing in the nonservice-connected left ear results in a noncompensable rating. 38 C.F.R. § 4.85. The results of all the VA examinations show that the Veteran does not have exceptional hearing loss pattern in either ear as contemplated in 38 C.F.R. § 4.86. The record contains no other results of audiometric testing. Considering the evidence in light of the criteria above, the Board finds that, for the entire period on appeal, the Veteran’s non-service-connected left ear is assigned Level I hearing, and, as he had no worse than Level I hearing in the right ear, he is not entitled to a compensable rating for his right ear hearing loss. The Veteran’s lay statements and testimony have been considered in this decision. However, as a layperson, the Veteran is without the appropriate medical training and expertise to offer an opinion on a medical matter, including the current level of hearing loss. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).   Thus, the Board finds that a compensable rating for bilateral hearing loss, on a schedular basis must be denied. As the preponderance of the evidence is against assignment of any higher rating, the benefit-of-the doubt doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); Gilbert, 1 Vet. App. at 49. 5. Entitlement to an increased rating greater than 10 percent for a service-connected left-hand scar residual The Veteran asserts his service-connected left-hand scar with onychomycosis is worse than what is reflected by a 10 percent disability rating. The Veteran’s left-hand scar is rated as 10 percent disabling under Diagnostic Code7804 applying to scars that are unstable or painful. To warrant an increased, 20 percent disability rating, the Veteran would have to have three or four scars that are unstable or painful. After a full review of the record in conjunction with the applicable laws and regulations, the Board finds that an increased rating greater than 10 percent for a service-connected left-hand scar with onychomycosis is not warranted. The Veteran was afforded a VA examination in November 2018 to determine the severity of his left-hand scar. The examiner noted the Veteran had one, six-centimeter-long, half a centimeter wide, superficial, non-linear scar. The Veteran reported that it itched and burned. There was no evidence the scar was unstable. There is no evidence the Veteran has more than one service-connected scar. Accordingly, an increased rating under Diagnostic Code 7804 is not warranted because the Veteran does not have three or four service-connected scars that are painful or unstable. The Board has considered whether the Veteran would be entitled to a separate compensable rating under any other Diagnostic Code. Diagnostic Code 7800 is not applicable because there is no evidence the Veteran has a service-connected scar of his head, face, or neck. Similarly, Diagnostic Code 7801 is not applicable because there is no evidence the Veteran’s scar is deep and nonlinear, as it was noted to be superficial during the November 2014 VA examination. Diagnostic Code 7802 is not applicable because there is no evidence the Veteran’s scar is 144 square inches (949 square centimeters) or greater, as it was noted that his car was six centimeters long by half a centimeter wide during the November 2014 VA examination. In summary, entitlement to an increased rating greater than 10 percent for a service-connected left hand residual scar is not warranted. In reaching this decision, the Board considered the doctrine of reasonable doubt. However, since the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply and the claim must be denied. 38 U.S.C. § 5107(b) (2012); Gilbert, 1 Vet. App. at 49. 6. Entitlement to an increased rating greater than 10 percent for service-connected tinea versicolor The Veteran asserts that his service-connected tinea versicolor warrants a rating greater than 10 percent. His tinea versicolor is rated as 10 percent disabling under Diagnostic Code 7820-7806. After a full review of the record in conjunction with the applicable laws and regulations, the Board finds that an increased rating greater than 10 percent for tinea versicolor is not warranted. None of the Veteran’s VA treatment records reflect he receives treatment for tinea versicolor. Tinea versicolor is not listed on his active problems list, and he is not prescribed any skin creams or other medications to treat any skin condition. Diagnostic Code 7820 applying to infections of the skin not listed elsewhere, including bacterial, fungal, viral, treponemal and parasitic diseases, should be rated as disfigurement of the head, face or neck; scars; or dermatitis depending on the predominant disability. Under the revised regulations, discussed more below, Diagnostic Code 7820 indicates that such conditions are evaluated under the general rating criteria for skin diseases. To warrant an increased, 30 percent, rating under Diagnostic Code 7806 applying to dermatitis, the Veteran’s tinea versicolor would have to manifest as encompassing 20 to 40 percent of the Veteran’s entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, during the past 12-month period. 38 C.F.R. § 4.118 (2017). Under the recently amended regulations, which can also be applied to the Veteran’s appeal, VA is adopting a general rating formula for skin diseases. The 30 percent rating still applies to a skin disease that encompasses 20 to 40 percent of the Veteran’s entire body or 20 to 40 percent of exposed areas affected, but the definition of systemic therapy has been expanded to include not only corticosteroids or other immunosuppressive drugs, but also (but not limited to) phototherapy, retinoids, biologics, photochemotherapy, or PUVA, but the requirement is still that such treatment cover a total duration of 6 weeks or more, but not constantly, over the past 12-month period. See 83 FR 32592 (July 13, 2018), to be codified at 38 C.F.R. § 4.118. As there is no evidence the Veteran has any active outbreak of tinea versicolor, there is no evidence his tinea versicolor encompasses 20 to 40 percent of his entire body or 20 to 40 percent of exposed areas. The Veteran has not submitted any lay statements indicating that he has experienced an outbreak of tinea versicolor or that his condition had worsened. The Veteran is not prescribed any treatment for a skin condition during the appeal period, to include tinea versicolor. Accordingly, there is no evidence he uses a systemic therapy or any of the listed treatments to warrant an increased rating. Entitlement to an increased rating greater than 10 percent for service-connected tinea versicolor is not warranted. In reaching this decision, the Board considered the doctrine of reasonable doubt. However, since the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply and the claim must be denied. 38 U.S.C. § 5107(b) (2012); Gilbert, 1 Vet. App. at 49. Finally, with respect to all the claims on appeal, the Board notes that the Veteran’s representative has raised the issue of entitlement to extraschedular ratings for the Veteran’s service connected left wrist disability, lumbar spine disability, right knee disability, right ear hearing loss, left hand scar residuals, and tinea versicolor. The Veteran has provided no lay statements arguing that the rating criteria do not reasonably describe his disability level and symptomatology or that he has an exceptional disability picture that exhibits other related factors such as marked interference with employment or frequent hospitalization. See Thun v. Peake, 22 Vet. App. 111, 115 (2008), aff’d sub nom. Thun v. Shinseki, 572 F. 3d 1366 (Fed. Cir. 2009). The Veteran’s representative has made no specific arguments on this point. In reviewing the claims file, the Board has considered whether the Veteran’s symptomatology is contemplated by the rating schedule and found no evidence that the rating schedule does not adequately compensate his disabilities. The Veteran’s left wrist, lumbar spine, and right knee disabilities manifest as limited range of motion and pain, symptoms which are adequately compensated by the assigned rating criteria, as explained above. There is no evidence the Veteran’s painful left-hand scar, right ear hearing loss, or tinea versicolor manifest as symptoms not adequately compensated under their assigned rating criteria. Accordingly, the Board finds that extraschedular consideration is not warranted in this case. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Parsons, Associate Counsel