Citation Nr: 19129231 Decision Date: 04/16/19 Archive Date: 04/15/19 DOCKET NO. 17-30 977 DATE: April 16, 2019 ORDER Entitlement to service connection for parasomnia with recurrent isolated sleep paralysis is denied. Entitlement to service connection for to acquired psychiatric disorder to include mood disorder NOS and a panic disorder is granted. Entitlement to an increased evaluation for cervical strain currently 10 percent disabling is denied. Entitlement to an increased evaluation for thoracolumbar strain currently 10 percent disabling is denied. The appeal requesting an evaluation in excess of 10 percent disabling for the service-connected degenerative arthritis, left knee is dismissed. The appeal requesting an evaluation in excess of 10 percent disabling for the service-connected degenerative arthritis, right knee is dismissed. Entitlement to a compensable evaluation for sinusitis is denied. Entitlement to an increased evaluation for allergic rhinitis in excess of 10 percent is denied. REMANDED Entitlement to service connection for chest pain is remanded. Entitlement to an increased evaluation for left upper extremity scar in excess of 10 percent is remanded. Entitlement to a compensable rating for left wrist injury (also claimed as suicide attempt injury) is remanded. Entitlement to an increased evaluation for right foot hallux valgus is remanded. Entitlement to an increased evaluation for herpes is remanded. FINDINGS OF FACT 1. The most probative evidence of record indicates that the Veteran’s sleep disturbance complaints are a symptom of a psychiatric disorder and not a separately diagnosed sleep disorder. 2. The Veteran’s current acquired psychiatric disorder to include diagnosed mood disorder NOS and a panic disorder did not clearly and unmistakably predate service, were diagnosed during active service, and have continued thereafter. 3. For the entire initial rating period, the symptoms related to the Veteran’s cervical strain have been manifested by range of motion limitation in forward flexion of the cervical spine greater than 30 degrees without muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour; her combined range of motion was above 170 degrees. 4. The Veteran does not have a limitation of the thoracolumbar spine of forward flexion range of motion of 60 degrees or less, nor is the Veteran’s combined range of motion less than 120 degrees. The Veteran’s thoracolumbar spine condition does not have spasms or guarding that cause her to alter her gait or to cause an abnormal spinal contour, nor does the Veteran have objective evidence of radiculopathy related to this condition. 5. Neither the Veteran nor counsel alleged specific errors of fact or law regarding the request for an increased evaluation assigned to the Veteran’s service-connected degenerative arthritis of the left knee. 6. Neither the Veteran nor counsel alleged specific errors of fact or law regarding the request for an increased evaluation assigned to the Veteran’s service-connected degenerative arthritis of the right knee. 7. During the period on appeal, the Veteran had no antibiotic treatment for her sinusitis, did not have least three non-incapacitating episodes per year of sinusitis characterized by the symptoms of headaches, pain, and purulent discharge or crusting, did not have any prescribed bedrest, and did not have surgery for such. 8. The Veteran’s allergic rhinitis did not result in nasal polyps during the period on appeal. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for parasomnia with recurrent isolated sleep paralysis have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for an acquired psychiatric disorder to include diagnosed mood disorder NOS and a panic disorder have been met. 38 U.S.C. §§ 1101, 1110, 1111, 1112, 1113, 1117, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(b) 3.307, 3.309. 3. The criteria for entitlement to an increased evaluation for cervical strain currently 10 percent disabling have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.59, 4.71a, DC 5237. 4. The criteria for entitlement to an increased evaluation for thoracolumbar strain currently 10 percent disabling have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.59, 4.71a, DC 5237 5. The claim of entitlement to an evaluation in excess of 10 percent disabling for the service-connected degenerative arthritis, left knee is dismissed. 38 U.S.C. § 7105(d)(5). 6. The criteria for entitlement to an evaluation in excess of 10 percent for the service-connected degenerative arthritis, right knee have not been met. 38 U.S.C. § 7105(d)(5). 7. The criteria for entitlement to an increased evaluation for sinusitis currently noncompensable have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.97, DC 6513. 8. The criteria for entitlement to an increased evaluation for allergic rhinitis currently 10 percent have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.97, DC 6522. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty service from June 2006 through April 2012 in the United States Army. The appeal of the above issues comes to the Board of Veterans’ Appeals (Board) from a December 2012 rating decision and the May 2017 statement of the case (SOC), with the exception of the claims for increased rating for the bilateral knee disabilities, the rating for which apparently was initially adjudicated in an SOC dated December 2018. The appeal for an earlier effective date for the grant of service connection for the bilateral knee arthritis has been granted below, and thus has been mooted and is no longer on appeal. The Veteran’s January 2013 Notice of Disagreement appealed the denials of an increased evaluation for right foot hallux valgus, an increased evaluation for herpes, and a compensable rating for left wrist injury (also claimed as suicide attempt injury). A March 2017 rating decision granted an increase to the evaluation of the Veteran’s herpes and right foot hallux valgus. However, as the Veteran did not limit her request for increase, and the evaluation assigned was not of the maximum possible for such disabilities, and the appeal was not withdrawn as to these issues, the issues remain on appeal. As noted below, these matters must be remanded for a SOC to be issued, in accordance with Manlincon v. West, 12 Vet. App. 238 (1999). Service Connection To establish direct service connection, there must be competent evidence showing: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the in-service injury incurred or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases may be presumed to have been incurred in or aggravated by service if manifested to a compensable degree within one year of discharge from service. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. § 3.307(a). This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307(d), 3.309(a). A showing of chronicity requires a combination of manifestations sufficient to identify a disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” 38 C.F.R. § 3.303(b). When a disease listed at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was shown in service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Id.; Savage v. Gober, 10 Vet. App. 488, 495-96 (1997); Walker v. Shinseki, 708 F.3d 1331, 1336, 1339 (Fed. Cir. 2013) (explaining that “shown as such in service” means “clearly diagnosed beyond legitimate question”). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker, 708 F.3d at 1338-39. Generally, a claimant has the responsibility to present and support a claim for benefits. All information lay evidence and medical evidence in a case is to be considered by the Board in deciding the claim. When there is an approximate balance of positive and negative evidence regarding any material issue, the claimant is to be given the benefit of the doubt. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahuna v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that “[w]heter lay evidence is competent and sufficient in a particular case is a factual issue.”). The Board has an obligation to provide reasons and bases supporting its decision, but there is no need to discuss, in detail, every piece of evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Board’s analysis is to focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant). 1. Entitlement to service connection for parasomnia with recurrent isolated sleep paralysis is denied. The Veteran seeks service connection for parasomnia with recurrent isolated sleep paralysis. Review of the service treatment records does not show any sleep disorder diagnosed during active service. The Veteran was afforded an August 2012 VA examination (signed in October 2012). The examiner completed a Gulf War Medical Examination Questionnaire, and noted that the Veteran had no diagnosed illnesses for which no etiology was established. The examiner noted that the Veteran reported a sleep disorder where she would feel partially asleep with paralysis. The Veteran reported these occurring four times per night, approximately twice per year. The Veteran reported the first in December 2006, with duration of approximately four times per year. The Veteran was noted to have symptoms of persistent daytime hypersomnolence as attributable to sleep apnea, but it was noted that a September 2012 sleep study did not show any sleep disordered breathing. In the January 2013 Notice of Disagreement, the Veteran included her parasomnia with the request for service connection for a psychiatric condition, but did not provide any specific pleadings. A July 2016 VA sleep medicine consultation noted that the Veteran reported fatigue issues. She was noted to have laboratory results within normal limits from the prior year, and a prior sleep study within normal limits. She denied symptom of sleep apnea other than falling asleep behind the wheel, and endorsed a history of sleep paralysis. The Veteran reported episodes of waking up feeling paralyzed, and some gasping. She reported being fatigued during the day and indicated that her sleep was disturbed by neck and back pain. The clinician did not note any diagnosis, and noted that while narcolepsy was a possibility, it was unlikely; it was noted to be more likely that she had poor sleep quality due to baseline anxiety issues and chronic pain that awakens her during the night. Weighing the evidence, the VA examination was prepared by a competent clinician who considered the Veteran’s claims file and medical history in the report and as such, the examination is adequate to adjudicate the Veteran’s claim and is of high probative value. The other medical evidence associated with the file does not diagnose a sleep disorder, and was consistent with the examiner’s findings. The examiner provided the opinion that the Veteran had no illnesses or symptoms for which no etiology was established. Accordingly, service connection on a presumptive basis under undiagnosed illness or other qualifying, chronic disability pursuant to 38 U.S.C. § 1117 is not warranted. See also 38 C.F.R. § 3.317. There is no other competent evidence or diagnosis of any breathing related sleep disorder or other sleep disorder. The Veteran is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of a sleep disorder. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The August 2012 VA examination for mental disorders noted chronic sleep impairment, exaggerated startle response, hypervigilance, as well as panic attacks as related to her mental disorders. The General Rating Formula for Mental Disorders contemplates such symptoms, and such symptoms will be considered in the evaluation of her service-connected mental disability by the Agency of Original Jurisdiction (AOJ). However, there is no specifically diagnosed sleep condition that warrants service connection. After careful consideration, it is concluded that the evidence preponderates against a finding of a sleep disorder due to lack of diagnosis. As such, service connection for a non-psychiatric sleep disorder is denied. 38 C.F.R. § 3.303. There is no doubt to resolve. 38 C.F.R. § 3.102. 2. Entitlement to service connection for an acquired psychiatric disorder to include mood disorder NOS and a panic disorder is granted. The Veteran seeks service connection for an acquired psychiatric condition. The Veteran’s induction examination did not note any existing psychiatric disorders. The medical records show a significant history of in-service psychiatric symptoms and treatment. The Veteran cut her left wrist during a suicide attempt in May 2008, and needed surgical repair. During in-service psychiatric treatment in 2011, she reported two prior suicide attempts from 2008, including cutting her wrist and overdosing on sleeping pills. The Veteran was prescribed a number of antidepressants, and the record shows diagnoses of anxiety disorder, obsessive compulsive disorder, and borderline personality disorder traits were noted. The Veteran was prescribed Klonopin and Luvox. At the time of her separation examination, she reported that her anxiety level had increased rapidly, and that her mood levels were up and down. During an August 2012 VA examination, current diagnoses of mood disorder NOS, posttraumatic stress disorder, and panic disorder were noted. The Veteran reported a traumatic childhood with significant premilitary mental health problems. She reported molestation at age two, as well as rapes at ages 17 and 21. The Veteran described herself as a loner throughout childhood. She was noted to have been divorced four times. She was noted to have quit school halfway though her senior year, and having earned a GED a year later. The examiner noted that the Veteran was working sporadically as a dancer and using drugs prior to military service, and having enlisted at the age of 21. She was noted to have had no military discipline problems. The Veteran reported pre-service behavioral problems, depression, and difficulty with emotional self-regulation. Regarding treatment, the Veteran was noted to have had one round of counseling after running away from her home at age 16. She reported some self-injury (cutting) in her teen years. She sought counseling for depression in 2008, and had a suicide attempt with prescription medications. She was noted to have been on and off psychiatric services since that time. She reported feeling relatively stable until an NCIOC slapped her butt during a training (“in-service sexual assault”). She reported the incident, but felt the punishment was a slap on the wrist. The Veteran noted an uptick in her symptoms, and began to drink again. The Veteran was thereafter deployed to Iraq, and resumed psychiatric services. She reported having restabilized after her deployment until a new supervisor was put in charge over her. The Veteran reported that the supervisor was harsh on subordinates, and the Veteran was not well-equipped to handle the interpersonal stress. In addition to the suicide attempts during active service, the Veteran was noted to have attempted suicide on May 24, 2012, approximately one month after her discharge. The Veteran was noted to have been diagnosed with OCD, anxiety disorder NOS, anxiety, substance abuse disorder, alcohol dependence, depression, and borderline personality traits during active service. She was going to school, working, and caring for her three-year old daughter. The examiner opined that the Veteran’s psychiatric symptoms overlap, and could not be differentiated. The examiner noted that the Veteran’s PTSD was less likely than not related to service, as the Veteran’s mental health complaints existed prior to service. The examiner noted that the in-service sexual assault triggered a significant increase in PTSD symptoms and depression after it occurred, but her psychological issues preceded the incident. The examiner noted that the Veteran emphasized her premilitary history of neglect and trauma as the most persistent and bothersome parts of her past, and thus her ongoing complaints were not clearly driven by the events of military service. The reported events and treatment noted in the VA examination are generally consonant with the record. However, review of the evidence of record does not reflect that the Veteran was diagnosed with a psychiatric disorder prior to service. The Veteran’s service treatment records include notations of a variety of psychiatric symptoms, and include diagnoses of depression, anxiety, and a panic disorder. As noted by counsel in the January 2013 notice of disagreement, the Veteran is not required to prove that the condition did not predate service; the burden to show the condition predated service lies with the VA. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Here, the Veteran’s July 2005 induction examination did not note any psychiatric disorders, and the Veteran is thus entitled to the presumption that she was taken in sound condition. 38 C.F.R. § 3.304(b). To disturb the presumption, there must be (a) clear and unmistakable evidence that the condition predated service, and (b) clear and unmistakable evidence that service did not aggravate the condition. Id. The VA examiner’s retrospective opinion, alone, is not based on sufficient objective facts to support a finding of any clear and unmistakable pre-service diagnosis of a psychiatric disorder. Although there is evidence of record that shows some significant pre-service trauma and psychiatric symptomatology, the evidence does not clearly show that any psychiatric condition predated service. Further, a careful reading of the examination shows that the examiner did not offer any nexus opinion regarding the Veteran’s other psychiatric conditions, which manifested in service, and were still present at the time of the VA examination some months after service. Service connection for an acquired psychiatric disorder to include mood disorder NOS and a panic disorder is warranted as these conditions were not clearly and unmistakably shown to predate service, were first diagnosed in service, with continuity of symptomatology thereafter, and the appeal is granted in that regard. 38 C.F.R. §§ 3.309, 3.309 There are additional proof requirements for granting service connection for PTSD. Specifically, there are diagnostic requirements for the service connection of PTSD, including a diagnosis linking the claimed in-service stressor to the condition. See 38 C.F.R. § 3.304(f). In this case, there is no diagnosis linking the stressor to the PTSD and as such this diagnosis cannot be granted on appeal. However, it is noted that for compensation purposes, symptoms from all service-connected psychiatric disorders are combined and assigned only one rating for the combined symptoms under the General Rating Formula (38 C.F.R. § 4.130), regardless of the number of separate psychiatric diagnoses. As the VA examiner indicated that the symptoms attributable to the various diagnoses are not able to be distinguished, assignment of a rating based on all noted symptoms should occur. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes (DCs). 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2018). The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1 (2017); Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate for any initial rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to her through her senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Hyphenated codes are intended to show that the Veteran’s service-connected disability is rated by analogy. See 38 C.F.R. § 4.20 (an unlisted condition may be rated under a closely related disease or injury in which the functions affected, anatomical localization, and symptomatology are closely analogous). 3. Entitlement to an increased evaluation for cervical strain currently 10 percent disabling is denied. The Veteran seeks an increase of the 10 percent rating assigned to her cervical strain. On appeal, she contends that the condition causes spasms and aching from the neck into the shoulders. See January 2013 Notice of Disagreement. The Veteran’s cervical strain is rated under DC 5237, which is rated under the General Rating Formula for Diseases and Injuries of the Spine. The Formula provides that with or without symptoms of pain, stiffness, or aching in the area affected by the condition, a 10 percent disability rating is warranted for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, 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 disability rating is assigned for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, 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 disability rating is assigned for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent disability rating is assigned for unfavorable ankylosis of the entire cervical spine. A 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. Id. For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (2); see also 38 C.F.R. § 4.71a, Plate V. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees. 38 C.F.R. § 4.71a, DC 5237, Note (2). Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate DC. 38 C.F.R. § 4.71a, DC 5237, Note 1. An August 2012 VA cervical spine examination noted a 2009 diagnosis of a cervical sprain. The Veteran reported that the pain felt like a tightening or a pull, “continually popping it” and reported stiffness. She reported intermittent soreness mid- C3-4 area; the examiner noted it was deeper in nature and unable to be palpated. She reported pain shooting down the back, and denied radiculopathy to either upper extremity. The Veteran reported flare-ups during certain sitting positions and movement with lateral flexion especially to the left as causing pain to the right side of her upper back. Forward flexion was measured to 45 degrees, with painful motion beginning at 45 degrees or greater; extension was measured to 40 degrees, with no objective evidence of painful motion. Right and left lateral flexion were measured to 30 degrees, with painful motion at 30 degrees. Right and left lateral rotation were measured to 60 degrees, with painful motion to the right only at 60 degrees. Repetitive use testing resulted in no diminished range of motion. Her functional loss was noted to be pain on movement. She was noted not to have localized tenderness or pain to palpation, no guarding or muscle spasm, and her muscle strength (with the exception of her left wrist) was normal. She was noted not to have atrophy, radiculopathy, intervertebral disc syndrome, or scars related to the condition. Diagnostic testing was reviewed, and noted not to show arthritis. The condition was noted to cause a functional impact of pain during sitting down a lot with downward flexion or subtle changes in movement of the neck increase pain. A January 2017 VA cervical spine examination noted that the Veteran had a diagnosis of a cervical strain. The Veteran reported limited range of motion and pain in the middle of the base of the neck, with the pain noted to start at the base of the neck and then up and around to produce pain in the head resembling migraine headaches, which occurred every other day. The Veteran was noted to use a cylinder pillow, to get massages, and to use Aleve and Flexeril as needed. The Veteran was noted not to have had surgery or injections. She denied flare ups. The Veteran’s forward flexion, extension, right and left lateral flexion were each measured and noted to be normal (0 to 45 degrees). Her right and left lateral rotation were both limited to 0 to 60 degrees (normal is 0 to 80 degrees). The range of motion was noted not to contribute to functional loss. The Veteran was noted to have pain at extremes of rotation, and repetitive use was noted not to cause any functional loss. She was noted not to have guarding or muscle spasms. No ankylosis was noted, and no intervertebral disc syndrome was noted. No assistive devices were noted to be used. The Veteran did not exhibit pain on passive motion testing or when used in non-weight bearing. The examiner noted review of diagnostic testing, and noted that arthritis was documented at the C 5-6 level, which was early, minimal, consistent with her age, and unrelated to the cervical strain. The Veteran was noted to work as a hair stylist and her ability to move and turn was affected by her back and neck. She was also noted to drop items (there was no stated rationale for relating this impact to the condition at hand). For this claim, the most probative pieces of evidence in the record are the comprehensive VA examinations on file. There is no dispute on appeal as to the accuracy of these examinations, and the findings therein are considered generally reliable. One notation in the latter examination that the Veteran drops items does not appear supported by any rationale relating such to the disability at hand (review of the record shows the Veteran likely drops items due to the left wrist upper extremity, muscle, and nerve damage), but it also is not significant enough to change the ultimate outcome of the appeal. The Veteran’s cervical spine range of motion does not warrant a higher evaluation. In sum, the Veteran has a slight range of motion restriction that is not close to the thresholds for a higher 20 percent evaluation, as her forward flexion is normal, and combined range of motion on both examinations is well over 170 degrees. The Veteran’s other reported symptoms also do not warrant an increase: her claimed muscle spasm was considered. Even accepting her report of such, arguendo, as factual (no such finding is made) there is no evidence that such causes abnormal gait or spinal contour that would warrant the higher 20 percent evaluation. She does not have any ankylosis (immobility) of the spine. The provisions of 38 U.S.C. § 4.59 dealing with painful motion were carefully considered, as was the functional impact on the Veteran. The findings of the contained in the VA examinations of record is the most probative evidence. In sum, they noted the Veteran has painful motion at the endpoints in certain range of motion measurements, and pain during extensive sitting with certain neck motion. The pain shown on examination does not appear to cause a significant functional loss beyond the range of motion measurements, and does not justify a higher evaluation. The Veteran’s subjective reports of the nature of the pain she experiences elsewhere due to the condition could theoretically warrant a higher evaluation or a separate rating, and as such, were considered. However, she is generally not considered competent to opine on the etiology of her symptoms or to provide an opinion on the symptoms related to her cervical spine condition. Moreover, her reports of such are not reliable: they varied between various treatment records, examinations and pleadings of record. Review of the record shows a variety of conditions that could be related to her complaints of pain: she described her cervical spine pain as migraine-like during one examination, while she is service-connected for exertional headaches and is assigned a 30 percent evaluation. During another examination she described her cervical spine pain as causing pain to go down her spine (she is service-connected for a lumbar spine condition). On appeal, she contends the pain from the neck goes into her shoulders and causes spasms, which were also not shown on either examination. In sum, there is no competent evidence suggesting that her subjective headache-like, shoulder, or lower spine complaints are related to a cervical spine disability, and review of the medical records does not show any medical evidence that headaches are related to (or even reported as originating with) the cervical spine condition. For these reasons, the Veteran’s disability picture related to the cervical spine is appropriately rated at the 10 percent level. The evidence preponderates against the claim for an increased rating, and there is no doubt to resolve. 38 C.F.R. § 4.3. The claim for an increase remains denied. 4. Entitlement to an increased evaluation for thoracolumbar strain currently 10 percent disabling is denied. The Veteran seeks an increased evaluation for her thoracolumbar strain. On appeal, she contended that she experiences spasms and constant aching pain. She reported sharp pain when reaching or turning, and reported that the sharp pain immobilized her approximately three times per month. She reported radiculopathy into her left hip and upper thigh, for which she contends a separate evaluation is warranted. See January 2013 Notice of Disagreement. The Veteran’s thoracolumbar spine condition is currently evaluated under DC 5237. 38 C.F.R. § 4.71a, Diagnostic Codes 5237 is to be rated under General Rating Formula for Diseases and Injuries of the Spine. The formula provides that with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or 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. An evaluation of 20 percent is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine is not greater than 120 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. An evaluation of 40 percent is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. An evaluation of 50 percent requires unfavorable ankylosis of the entire thoracolumbar spine. An evaluation of 100 percent requires unfavorable ankylosis of the entire spine. There are several notes set out after the diagnostic criteria, a summary of which is as follows. Objective neurologic abnormalities are to be rated separately under an appropriate diagnostic code. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). For purposes of VA compensation, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion of 0 to 30 degrees, and left and right lateral rotation are 0 to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is to 240 degrees. Further, the normal ranges of motion for each component of spinal motion are the maximum that can be used for calculation of the combined range of motion. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (2). During an August 2012 VA examination of the thoracolumbar spine, the Veteran was noted to have a diagnosed thoracolumbar strain from 2008. An onset of middle and lower back pain followed the lifting of heavy items. The pain was noted to have worsened since service, and the Veteran was noted to have had sciatic nerve problems in 2008. She denied radiculopathy. The Veteran described flare ups causing her to require repositioning, and to cause increased pain with sleeping on her back or prolonged walking. She noted that the lower left side was worse. Forward flexion was normal at 90 degrees, with objective evidence of painful motion at 70 degrees. Extension was normal at 30 degrees, with painful motion at 30 degrees. Right and left lateral flexion and extension were normal to 30 degrees, with painful motion at the endpoint. Repetitive use testing noted a slight decrease in forward flexion to 80 degrees, with the other measurements remaining the same. The Veteran was noted to have pain on movement, and pain to palpation of the mid- lumbar and left sacroiliac joint, noted as a dull ache. She was noted not to have guarding or muscle spasm. Muscle strength measurements were normal, and no atrophy was noted. Reflexes were normal. The Veteran’s sensory examination noted normal results, and the Veteran was noted not to have radicular pain or other symptoms of radiculopathy. No intervertebral disc syndrome was noted, and the Veteran was noted not to use any assistive devices. Diagnostic tests were noted not to show arthritis. The impact on the Veteran’s ability to work was noted to be “physical movements, lifting, bending, twisting.” A February 2014 VA treatment note indicated the Veteran sought treatment for acute back pain. She reported pain on and off, intermittent, and a dull aching. The pain was noted to be increased by walking, activity, and bending, and reduced by rest and medication. She reported the pain was bearable. The clinician noted no night pain, no gait imbalance. The Veteran denied lower extremity weakness or any sensory or motor changes, or any urinary retention or incontinence. The Veteran was noted to have paraspinal muscle tightness and pain on dull percussion overlying the lumbar spine. Limited flexion range of motion was noted, and limited straight leg elevation was noted due to pain. An assessment of low back pain with radiculopathy was noted. A January 2017 VA examination noted a diagnosis of spondylolisthesis at L5 – S1. The examiner noted that the Veteran reported she “cannot move” and “has a hard time bending over her low back and she feels sharp pains and it can radiate to her chest.” The examiner noted that the Veteran reported pain located “in the middle of the low back a little (sic) the belt line and it goes around the [left] side of the chest to the front.” She was noted to be taking Flexeril only if she has an episode of pain. Normally she was on Aleve. She has not had surgery or injections. She was noted not to have flare-ups. She did not report any functional loss or impairment of the spine. Forward flexion was measured to 75 degrees (90 is normal); extension and right and left lateral flexion and rotation were noted to be normal (to 30 degrees). She was noted to report pain on terminal flexion. No evidence of pain on weight bearing, no pain on palpation, and no additional loss of function or range of motion was noted on repetitive use. Pain, weakness, fatigability and incoordination were noted not to significantly limit functional ability with repeated use over time. NO guarding or spasm was noted. Muscle strength was normal with no atrophy. Reflex and sensory examinations were normal. The Veteran was noted to not have radicular pain or other signs or symptoms due to radiculopathy. The examiner noted the Veteran lost a few degrees of terminal flexion with pain. The examiner noted the diagnosis changed to spondylolisthesis grade I, which was noted to be a congenital condition, less likely than not related to service. Although the change in diagnosis and opinion on etiology is noted, the issue before the Board is not whether the Veteran’s spine condition should no longer be service-connected—it is whether the evidence shows her back disability warranted a higher evaluation on review. As the existing evidence is sufficient to answer this question, further development is not required. 38 U.S.C. § 5103A(d). For this increased rating claim, the most probative evidence in the record are the comprehensive VA examinations on file. There is no dispute on appeal as to the accuracy of these examinations, and the findings therein appear adequate and thorough. The sole February 2014 VA treatment notation of radiculopathy does not appear supported by any rationale or reports of radiculopathy symptoms and the note itself is contradictory: the note indicated that the Veteran did not report any sensory or motor changes or any weakness. Her descriptions of the nature of the pain is too vague and varied to make a finding of radiculopathy or a neurological condition. Additionally, her reports of the severity of the pain appear somewhat exaggerated and contradictory with objective evidence: while she claimed she could not move January 2017 VA examination, the recorded measurements show that she obviously could move and pain was noted not to be a limiting factor until the endpoint of forward flexion. Her report of the condition causing regular immobilization is considered to be a subjective report of pain contemplated by the rating schedule that does not warrant a higher evaluation.. Two comprehensive VA examinations noted no radiculopathy was present based on objective factors, and these comprehensive examinations are given more weight than the Veteran’s subjective lay reports. It is determined that the weight of the evidence does not support a finding of neurological impairment or radiculopathy caused by the Veteran’s service-connected thoracolumbar sprain. Further, a careful reading of the rating criteria requires objective evidence of neurological disability. A separate rating is accordingly not warranted for any neurological disability. Regarding range of motion findings, at no point during the period on appeal does the evidence support a finding of forward flexion range of motion of 60 degrees or less, nor was the Veteran’s combined range of motion less than 120 degrees. While the recorded notation of paraspinal muscle tightness was noted and has been considered, the evidence does not show any objective evidence of symptoms severe enough to have altered her gait or to have caused an abnormal spinal contour. No credible evidence of ankylosis is of record. Moreover, the noted functional loss attributable to the condition appears to be consistent with the range of motion limitations, and the schedular rating is adequate and is considered to have contemplated all symptoms. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. For these reasons, the Veteran’s thoracolumbar spine disability does not warrant a higher evaluation than 10 percent. The evidence preponderates against the claim for an increased rating, and there is no doubt to resolve. 38 C.F.R. § 4.3. 5. Entitlement to an evaluation in excess of 10 percent disabling for the service-connected degenerative arthritis, left knee and 6. Entitlement to an evaluation in excess of 10 percent for the service-connected degenerative arthritis, right knee are dismissed. The Veteran seeks an increased evaluation for her bilateral knee disability. The Veteran is currently assigned a 10 percent evaluation for each knee under DC 5260-5003 for the entire period on appeal. In February 2019, counsel requested a copy of the most recent examination, indicating that absent review of such, the veracity of the VA’s conclusion that an increase was not warranted could not be determined. The examination was sent to counsel with no response. Neither the Veteran nor her counsel provided any specific argument on appeal, either before or after the request for the examination. Congress has provided the Board with the discretionary authority to “dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed.” 38 U.S.C. § 7105A(d)(5). VA regulations also state that appellants should set out specific arguments relating to errors of fact or law made by the agency of original jurisdiction in reaching the determination, or determinations, being appealed and that “the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination, or determinations, being appealed.” 38 C.F.R. § 20.202 (2018). The Board recognizes that it is charged with construing arguments in a liberal manner for determining whether they raise issues on appeal, however both the statute and the regulation also state that “the Board may dismiss any appeal which fails to a specific error of fact or law in the determination” being appealed. If a general assertion of error was sufficient, then the “specific error” element of § 7105A(d)(5) would be meaningless. An interpretation of a statute that renders part of the statutory language superfluous is to be avoided. See Splane v. West, 216 F.3d 1058, 1068-69 (Fed. Cir. 2000) (“canons of construction require us to give effect to the clear language of statute and avoid rendering any portions meaningless or superfluous”). It is clear that more than a general or vague assertion of error in fact or law is required. Unlike Percy v. Shinseki, 23 Vet. App. 37 (2009), the Board is not finding that it lacks jurisdiction over the Veteran’s claim. Further, the additional notice procedures contained in 38 C.F.R. § 21.102(d) addressing when the Board, on its own initiative, raises a question as to a potential jurisdictional defect, do not apply. There is no requirement that the Board notify the appellant that they have not identified any error of law or fact in the rating decision and allow for the submission of additional argument. The appellant was requested to identify such errors in the Notice of Disagreement and in the Substantive Appeal. See also 38 U.S.C. § 7108 (“An application for review on appeal shall not be entertained unless it is in conformity with this chapter.”) In this case, no specific allegations of fact or law are of record with regards to the claim for increase. Boilerplate pleadings indicating that the “appellant hereby takes exception to and preserves for appeal all errors the VA Regional Office may have made or the Board may hereafter make” not specific, and do not salvage an appeal that otherwise warrants dismissal under 38 U.S.C. § 7105(d)(5). Accordingly, the Board is dismissing the Veteran’s claim solely on the basis of the failure of the party to comply with an applicable regulation prescribed by the Secretary and the discretionary authority provided by Congress. Given the lack of apparent error, and given the lack of any allegations of specific error of fact or law, the appeal as to these claims is dismissed. 38 U.S.C. § 7105(d)(5). 7. Entitlement to a compensable evaluation for sinusitis is denied. The Veteran seeks a compensable rating for her sinusitis and an increased evaluation for her allergic rhinitis. On appeal, the Veteran reported taking Claritin which was not managing her symptoms of nasal congestion. The Veteran’s sinusitis is evaluated under 38 C.F.R. § 4.97, DC 6513 chronic maxillary sinusitis at 0 percent (noncompensable) for. Under the rating schedule, chronic maxillary sinusitis is to be rated under the General Rating Formula for Sinusitis. See 38 C.F.R. § 4.97. Under the General Rating Formula for Sinusitis, a noncompensable rating is warranted when sinusitis is detected by X-ray only. A 10 percent rating is warranted for one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or three to six non- incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent evaluation is warranted when there are three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 50 percent evaluation is assigned following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. The maximum evaluation allowable under the general rating formula is 50 percent. A note following this section provides that an incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. 38 C.F.R. § 4.97, DC 6513. An August 2012 VA examination noted that the Veteran was diagnosed with chronic sinusitis and allergic rhinitis. The examiner noted an onset of allergy symptoms prior to service, seasonally, but allergies were noted to have worsened in 2007. The symptoms were runny nose, itchy burning eyes, cough with productive mucus, and post nasal drip. Maxillary and ethmoid sinusitis was noted. The Veteran was noted to have near constant sinusitis, but only the symptom of pain and tenderness of the affected sinus. The Veteran was noted to have had one non-incapacitating episode of sinusitis that was characterized by headaches, pain, and purulent discharge or crusting in the past 12 months. She was noted to have no incapacitating episodes requiring prolonged antibiotic treatment in the past 12 months. She was noted not to have had sinus surgery. Her rhinitis was noted not to have greater than 50 percent obstruction of the nasal passage on either side, but the examiner noted complete obstruction on one side due to rhinitis. A January 2017 VA examination noted diagnoses of allergic rhinitis and sinusitis. The Veteran reported that she had nasal congestion, facial pressure, watery eyes, and a dry cough. She reported being treated with Claritin and loratadine. She was noted to have no sinuses affected by sinusitis on examination, and was noted to have no non-incapacitating episode of sinusitis that was characterized by headaches, pain, and purulent discharge or crusting in the past 12 months. She was noted to have no incapacitating episodes requiring prolonged antibiotic treatment in the past 12 months. The rhinitis and sinusitis were noted to be stable, and the CT scan from March 2015 was noted to show paranasal sinus clear. No antibiotic therapy was noted to have been required. The Veteran reported her rhinitis was seasonal and flared with weather changes. She reported minimal results with over-the-counter medication, and was noted to have been treated with nasal saline and steam inhalation. The VA examinations are the most probative evidence of record, and are afforded significant weight. They are comprehensive, and not contradicted in any pertinent part by the other evidence of record. To summarize, the Veteran does not qualify for a compensable evaluation because she had no (a) antibiotic treatment or (b) at least three non-incapacitating episodes per year of sinusitis characterized by the symptoms of headaches, pain, and purulent discharge or crusting, (c) incapacitating episodes (prescribed bedrest) or (d) surgery. 38 C.F.R. § 4.97, General Rating Formula for Sinusitis. As such, her sinusitis does not warrant a compensable evaluation based on the schedular criteria. Nasal congestion and painful sinuses are symptoms that do not meet the minimum schedular requirements for a compensable evaluation. The evidence preponderates against the claim, and there is no doubt to resolve. 38 C.F.R. § 4.3. The requested increase remains denied. 8. Entitlement to an increased evaluation for allergic rhinitis in excess of 10 percent is denied. The Veteran seeks an increased evaluation for her allergic rhinitis. On appeal, the Veteran reported taking Claritin which was not managing her symptoms of nasal congestion. The Veteran’s rhinitis is evaluated under 38 C.F.R. § 4.97, DC 6522. To warrant an evaluation in excess of 10 percent for allergic or vasomotor rhinitis, there must be polyps. An August 2012 VA examination noted that the Veteran was diagnosed with chronic sinusitis and allergic rhinitis. The examiner noted an onset of allergy symptoms prior to service, seasonally, but allergies were noted to have worsened in 2007. The symptoms were runny nose, itchy burning eyes, cough with productive mucus, and post nasal drip. Her rhinitis was noted not to have greater than 50 percent obstruction of the nasal passage on either side, but the examiner noted complete obstruction on one side due to rhinitis. No polyps were noted. A January 2017 VA examination noted diagnoses of allergic rhinitis and sinusitis. The Veteran reported that she had nasal congestion, facial pressure, watery eyes, and a dry cough. She reported being treated with Claritin and loratadine. No greater than 50 percent obstruction of the nasal passage due to rhinitis on both sides was noted, and complete obstruction on either side was not noted. No polyps were noted. The VA examinations are the most probative evidence of record, and are afforded significant weight. They are comprehensive, and not contradicted in any pertinent part by the other evidence of record. The Veteran’s rhinitis does not present with nasal polyps. As such, her allergic rhinitis does not warrant a higher evaluation based on the schedular criteria. The evidence preponderates against the claim for an increased rating, and there is no doubt to resolve. 38 C.F.R. § 4.3. The claim for an increase remains denied. REASONS FOR REMAND 1. Entitlement to service connection for chest pain is remanded. The Veteran seeks service connection for chest pains. The Veteran’s service treatment records contain recurrent complaints of chest pain. On appeal, she contends that she has breathing problems, and contends that the claim should be broadened. She also requested consideration for service connection under the provisions of 38 C.F.R. § 3.317. See January 2013 Notice of Disagreement. The denial of the claim has been on the basis that pain, alone, is not a disability. The Veteran has not been afforded a VA examination, to date, to determine if Veteran’s pain is a symptom of (or is) a disability, and if so, whether such is related to service. The Board cannot make a fully-informed decision on the issue as to the nature and etiology of the claimed condition as there does not appear to have been comprehensive review by an appropriate clinician. In keeping with the principles set forth under 38 U.S.C. § 5103A(d), remand for a VA examination is required. 2. Entitlement to an increased evaluation for left upper extremity scar in excess of 10 percent, and 3. Entitlement to a compensable rating for left wrist injury (also claimed as suicide attempt injury) is remanded. The Veteran seeks an increased evaluation for her left wrist scar and a compensable rating for left wrist injury. For the reasons discussed below, these claims must be remanded. The residuals of the Veteran’s left wrist disability are evaluated as follows: the scar is currently evaluated at 10 percent, under 38 C.F.R. § 4.118, DC 7801-7804. The Veteran has also been assigned a separate 30 percent rating for muscle disorder, group VII due to left wrist injury, peripheral neuropathy, left upper extremity in an August 2013 rating decision under 38 C.F.R. § 4.73, DC 5307. The Veteran has also been assigned a noncompensable evaluation under 38 U.S.C. § 4.71a, DC 5229-5228 for impairment due to left wrist injury. The Veteran’s counsel contends, on appeal, that a statement of the case has not been issued for the noncompensable evaluation under 38 U.S.C. § 4.71a, DC 5229-5228 for impairment due to left wrist injury, despite such having been addressed in the rating decision on appeal and in the following notice of disagreement. The Veteran contends that the scar is three inches long and one centimeter wide. She contends such causes pain and impairment in the range of motion of the hand, and that she cannot bend her thumb into the palm of her hand. She also reports numbness and weakness of the thumb, index, and middle fingers, which causes her difficulty with holding onto things. A discussion of the relevant evidence is included for clarity as to the nature of the disability. An August 2012 VA hand and finger examination noted that the Veteran’s 2008 suicide attempt cut six tendons and a nerve of her non-dominant left wrist. The Veteran reported constant tingling sensation, and that it went numb while asleep. Her left thumb had a limitation of motion, with the distance of the thumb gap to be less than one inch, with painful motion beginning at the gap of less than one inch. Post repetitive use testing noted more movement than normal, weakened movement, incoordination, pain on movement, and atrophy to the palmar surface of the left hand. The condition was noted to impact the Veteran’s ability to feel, grip, and hold objects, with exacerbation of pain in the left hand and wrist due to repetitive movement. There are August 2012 photographs of the scar are associated with the record. An August 2012 scar examination noted that the Veteran had a painful but not unstable left wrist scar. The scar was noted to measure 10 by 0.5 centimeters. The impact of the scar was noted that the Veteran was unable to feel objects, unable to grip and hold objects, and that repetitive motion promoted pain. Her muscle strength was noted to be 3/5 for the left, 5/5 for the right. A January 2017 VA wrist examination noted that the Veteran had good grip strength, and full range of motion of the left wrist. She had diminished sensation and weakness involving the left thumb, index, and middle finger. Her numbness involved the anterior aspect of those fingers and the front and back tips of same. She had good dorsum sensation otherwise. She had good grip strength and wrist power, with occasional pain at the base of the thumb and front of the wrist and forearm. She was noted to have a 13 by 0.2 centimeter scar. The laceration was noted to have healed and was mobile and non-tender. The examination noted normal left wrist examination and diagnostic images. Also noted was a median nerve palsy with atrophy and loss of function of the left thenar musculature resulting in difficulty in pinch. She was able to complete a fist. Procedurally, as noted by counsel, the Board cannot adjudicate the impairment of the left wrist injury which is currently assigned a noncompensable rating under DC 5229-5228, as a statement of the case has not been issued. Manlincon v. West, 12 Vet. App. 238 (1999). A remand of that issue is therefore necessary. The rating of the other issues stemming from the wrist disability are inextricably intertwined with this outstanding issue for the following reasons. Generally, a Veteran may not receive double compensation for the same symptoms. 38 C.F.R. § 4.14. It appears the Veteran likely has nerve damage related to the wrist injury and/or scar. The issue is before the Board as part and parcel of the scar claim: 38 C.F.R. § 4.118, DC 7805 requires that scars (including linear scars) and other effects of scars rated under DCs 7800, 7801, 7802, and 7804 be rated for any disabling effect(s) not considered in a rating provided under DCs 7800 through 7804 under an appropriate diagnostic code. The AOJ should address the requested increases for all left-wrist and left-hand related disabilities together. It is unclear whether the rating currently assigned the Veteran under DC 5229-5228 is for nerve damage, or whether she has been assigned such for a muscle group disability: 38 C.F.R. § 4.73, DC 5307 is customarily utilized to evaluate muscle disabilities, yet the title of the rated disability describes peripheral neuropathy. Generally, 38 C.F.R. § 4.124a, DC 8515 is used to evaluate paralysis of the median nerve. Accordingly, the claim for an increase of the scar condition is remanded for AOJ consideration along with the other left-wrist related disability ratings and a comprehensive statement of the case. 4. Entitlement to an increased rating for right foot hallux valgus, and 5. Entitlement to an increased rating for herpes are remanded. The Veteran’s January 2013 Notice of Disagreement requested an increased evaluation for right foot hallux valgus and an increased evaluation for herpes. A March 2017 rating decision was a partial grant, as 10 percent evaluations were assigned to each of the disabilities. However, the Veteran did not limit her request for increase to 10 percent for either disability, and such does not represent the schedular maximum. As the Veteran did not withdraw her appeal as to these issues, they remained on appeal, and issuance of a statement of the case was required, partial grant notwithstanding. There has been no statement of the case issued below on these issues. A remand is therefore necessary. Manlincon v. West, 12 Vet. App. 238 (1999). The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate examiner to determine the nature and etiology of her chest pain. The examiner must opine whether there is any current medical condition constituting a disability, and if so, provide an opinion as to whether such is at least as likely as not related to an in-service injury, event, or disease, began during active service, or was noted during service with continuity of the same symptomatology since service. 2. Issue a supplemental statement of the case addressing all ratings pertaining to the left wrist disability. This SOC must specifically acknowledge and address the arguments made by counsel in this case concerning the selection and appropriateness of evaluating the Veteran’s wrist disabilities under the possible applicable Diagnostic Codes. 3. Issue a statement of the case addressing the claims of entitlement to an increased evaluation for right foot hallux valgus and an increased evaluation for herpes. (Continued on next page) The Veteran is hereby notified that, following the receipt of the SOC concerning these issues, she must file a timely substantive appeal if she desires appellate review by the Board. If the Veteran files a timely substantive appeal, the AOJ should return these issues to the Board for appellate review. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. C. King, Associate Counsel