Citation Nr: 19138564 Decision Date: 05/17/19 Archive Date: 05/17/19 DOCKET NO. 17-63 498 DATE: May 17, 2019 ORDER Entitlement to service connection for tinnitus is granted. Entitlement to an initial rating in excess of 10 percent for a lumbosacral strain is denied. Entitlement to an initial compensable rating for sinusitis is denied. REMANDED Entitlement to an initial compensable rating for residuals of a traumatic brain injury (TBI) is remanded. Entitlement to an initial rating in excess of 70 percent for posttraumatic stress disorder (PTSD) is remanded. FINDINGS OF FACT 1. Tinnitus has been shown to be causally related to an in-service injury or disease. 2. For the entire period on appeal, the Veteran’s low back disability has been manifested by pain, soreness, flare-ups, forward flexion limited to 65 degrees at worst, and combined range of motion limited to 160 degrees at worst; but not by limitation of flexion to 60 degrees or less, a combined range of motion of 120 degrees or less, guarding or spasms resulting in altered gait, ankylosis, or incapacitating episodes. 3. For the entire period on appeal, the Veteran’s sinusitis has been manifested by sinusitis, nosebleeds and difficulty breathing; but not by incapacitating or non-incapacitating episodes, polyps, obstruction of the nasal passages, chronic osteomyelitis, or near constant sinusitis. CONCLUSIONS OF LAW 1. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1101, 1110, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for an initial rating in excess of 10 percent for a low back disability have not been met or approximated. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.15, 4.16, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 3. The criteria for an initial compensable rating for sinusitis have not been met or approximated. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.15, 4.16, 4.97, Diagnostic Code 6513. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 2013 to November 2015. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in May 2017 by a Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Generally, to establish service connection a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Davidson v. Shinseki, 581 F.3d 1313, 1315–16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the 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 the disease identity is established, there is no requirement of evidentiary showing of continuity. Id. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. Id. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. Id. Continuity of symptomatology is only applicable to those diseases recognized as chronic for VA purposes. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336–37 (Fed. Cir. 2006). 1. Entitlement to service connection for tinnitus. The Veteran has reported that he currently has tinnitus, which he is competent to diagnose. Charles v. Principi, 16 Vet. App. 370, 374 (2002). Tinnitus is considered to be an organic disease of the nervous system and is therefore a chronic disease for VA purposes. 38 C.F.R. § 3.309(a); see also Fountain v. McDonald, 27 Vet. App. 258, 271–72 (2015). As such, service connection may be awarded based on continuity of symptomatology. Concerning an in-service injury, the Veteran’s service treatment records are silent for any complaints of or treatment for tinnitus. However, the Veteran has reported that he was exposed to loud noise from firing weapons and using grenades during basic training. The Veteran has also reported that he was part of a crew assigned to a rocket launcher, which also resulted in significant noise exposure. The Veteran’s assignment to a rocket launcher crew is corroborated by his DD-214, and the reported gunfire exposure is generally consistent with the nature of his service. Based on the foregoing, the Board finds that the Veteran had noise exposure in service, and therefore an in-service injury has been shown. 38 U.S.C. § 1154(a). During the course of the appeal, the Veteran has asserted that his tinnitus has been persistent since service. These statements are competent and there is no evidence that they are not credible. Jandreau, 492 F.3d 1372. As such, they are entitled to significant probative weight as to the continuity of tinnitus since service. VA obtained a medical opinion concerning tinnitus in February 2017. The examiner stated that the reported tinnitus was less likely than not related to the Veteran’s service, based on the lack of hearing threshold shifts in service. However, this rationale did not address the Veteran’s repeated statements that his tinnitus had its onset during his period of service or the Veteran’s alleged noise exposure. Dalton v. Peake, 21 Vet. App. 23 (2007). As such, the Board finds that the opinion is entitled to no probative weight. Post-service treatment records are silent for any opinions concerning the etiology of the Veteran’s tinnitus. Based on the foregoing, the only competent and credible evidence of record concerning a nexus are the Veteran’s statements, which establish that he has continuously experienced tinnitus since its onset in service. Therefore, service connection for a tinnitus is granted. 38 C.F.R. §§ 3.102, 3.303(b). Increased Rating Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. If the evidence for and against a claim is in equipoise, the claim will be granted. 38 C.F.R. § 4.3. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When evaluating disabilities of the musculoskeletal system, functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements must be considered. See 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202 (1995). Consideration must also be given to weakened movement, excess fatigability and incoordination. 38 C.F.R. § 4.45. 2. Entitlement to an initial rating in excess of 10 percent for a lumbosacral strain. The Veteran’s low back disability is rated under Diagnostic Code 5237. All spine disabilities covered by Diagnostic Codes 5235 to 5242 are rated according to the General Rating Formula for Diseases and Injuries of the Spine (General Formula) based on limitation of motion. 38 C.F.R. § 4.71a, General Formula. Under the General Formula, the spine is evaluated 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. Id. Under the General Formula, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees, muscle spasm, guarding or localized tenderness not resulting in abnormal gain or spinal contour, or vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71a, General Formula. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, combined range of motion of the thoracolumbar spine not greater than 120 degrees, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine of 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine, and a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Id. Concerning disabilities affecting the spine, any associated objective neurologic abnormalities are evaluated separately under an appropriate Diagnostic Code. 38 C.F.R. § 4.71a, General Formula, Note 1. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. Id. at Note 2. 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 lateral rotation, with the normal combined range of motion of the thoracolumbar spine being 240 degrees. Id. Unfavorable ankylosis is a condition in which the entire thoracolumbar spine is fixed in flexion or extension, and the ankylosis results in one of more of the following: difficulty walking because of a limited line of vision, restricted opening of the mouth and chewing, breathing limited to diaphragmatic respiration, gastrointestinal symptoms due to pressure of the costal margin on the abdomen, dyspnea or dysphagia, atlantoaxial or cervical subluxation or dislocation, or neurologic symptoms due to nerve root stretching. Id. at Note 5. Fixation of a spinal segment in neutral position always represents favorable ankylosis. Id. Back disabilities may also be evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (Incapacitating Episodes Formula), which applies to Intervertebral Disc Syndrome (IVDS). See 38 C.F.R. § 4.71a, Incapacitating Episodes Formula. An “incapacitating episode” for purposes of totaling the cumulative time is defined as “period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.” 38 C.F.R. § 4.71a, Diagnostic Code 5243, Incapacitating Episodes Formula, Note 1. During the period on appeal, the Veteran reported that he experiences persistent pain in his low back, with the pain being severe approximately three to five days per week. He has further stated that the pain is at its worst when laying down. These statements are competent, and there is no evidence they are not credible. Jandreau, 492 F.3d 1372. As such, they are entitled to probative weight as to the severity of the Veteran’s low back disability during the period on appeal. The Veteran was provided with VA spine examinations in May 2016 and February 2017. In May 2016 the Veteran reported experiencing flare-ups characterized by soreness, which he stated were usually brought on by prolonged laying down or standing. On examination, the Veteran had full range of motion in all planes, and therefore a normal combined range of motion. The examiner noted that pain was present on motion, but that the pain resulted in no functional or range of motion loss. No further loss of motion was present after repetitive testing and there was no evidence of pain on weightbearing. The examiner stated that the Veteran was being examined after repeated use over time as well as during a flare-up and indicated that there was no further functional loss during flares or repeated use over time. Sharp v. Shulkin, 29 Vet. App. 26, 34–36 (2017). There was no evidence of guarding, localized tenderness or spasm. Finally, the examiner found no ankylosis, IVDS, or loss of use. During the February 2017 examination, the Veteran reported experiencing pain when bending, during heavy lifting and carrying, and when performing strenuous activities. He also reported flare-ups when engaging in those types of activities. The examiner noted the Veteran had forward flexion to 75 degrees, extension to 15 degrees, bilateral lateral flexion to 20 degrees and bilateral lateral rotation to 20 degrees, resulting in a combined range of motion of 170 degrees. Pain was noted to be present on forward flexion. No further range of motion loss was present after repetitive testing. While present on active motion, no pain was present on passive motion, weightbearing or non-weightbearing. Correia v. McDonald, 28 Vet. App. 158, 168 (2016). The examiner noted that the Veteran was not being examined following repeated use over time but estimated that the Veteran would have no additional functional or range of motion loss after repetitive use over time. The examiner also noted that the Veteran was not being examined during a flare-up. Based on the Veteran’s statements, the examiner estimated that during a flare-up the Veteran would have an additional loss of 10 degrees of forward flexion. Sharp v. Shulkin, 29 Vet. App. 26, 34–36 (2017). Thus, during a flare-up the Veteran would have flexion to 65 degrees, extension to 15 degrees, bilateral lateral flexion to 20 degrees and bilateral lateral rotation to 20 degrees, resulting in a combined range of motion of 160 degrees. The examiner found no evidence of guarding, spasms or localized tenderness, and noted that the Veteran did not have IVDS, ankylosis, or loss of use. There is no evidence that either of the above examiners were not competent or credible. Further, the evaluations of the Veteran’s disability were based on the Veteran’s own reports of his symptoms as well as the examiners’ own objective examinations. As such, the Board finds that each examination report is entitled to significant probative weight as to the severity of the Veteran’s disability during the period on appeal. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Post-service VA treatment records reflect on-going treatment for a low back disability and intermittent reports of low back pain. Chiropractic records submitted by the Veteran also note on-going treatment and reports of low back pain. However, none of these records indicate that the Veteran has an altered gait due to spasms or guarding, nor do the VA or private treatment records contain additional range of motion testing. Based on the foregoing, the preponderance of the evidence is against a finding that a rating in excess of 10 percent is warranted during the period on appeal. While the Veteran experiences pain and limitation of motion, the medical evidence of record clearly reflects that the Veteran does not have forward flexion limited to 60 degrees or less or have a combined range of motion limited to 120 degrees or less. Further, both examiners specifically noted that the Veteran does not have spasms, guarding or localized tenderness resulting in an altered gait. Further, there is no evidence that the Veteran has ankylosis of any potion of the spine, or that his disability is productive of any kind of loss of use. As such, the preponderance of the evidence is against a finding that an increased rating in excess of 10 percent is warranted. 38 C.F.R. §§ 4.3, 4.71a, Diagnostic Code 5237. In evaluating the Veteran’s current level of disability for the period on appeal, functional loss was considered. 38 C.F.R. §§ 4.40, 4.45. The evidence shows that the Veteran has, at different times, complained of pain and flare-ups that result in difficulty bending, lifting, carrying and prolonged laying down and standing. Jandreau, 492 F.3d 1372. However, both VA examiners specifically considered the Veteran’s statements concerning his symptoms and functional loss, including during flare-ups, with the first noting that there was no further loss during flare-ups and with the second noting that the Veteran likely had forward flexion limited to 65 degrees and combined range of motion limited to 160 degrees during flare-ups. Thus, even when considering additional functional or range of motion loss due to pain or flare-ups, the Veteran does not more nearly approximate the severity of limitation of motion contemplated by a 20 percent rating. 38 C.F.R. §§ 4.40, 4.45, 4.59. Instead, the Veteran’s additional functional loss due to pain and flare-ups is fully contemplated by the currently assigned 10 percent rating. No additional higher or alternative ratings under different Diagnostic Codes can be applied. Both VA examiners noted that the Veteran does not have IVDS, and post-service treatment records do not reflect a diagnosis of IVDS. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Incapacitating Episodes Formula, Note 1. Further, the Veteran has not alleged, and the medical evidence does not show, that he has at any point been prescribed bed rest for his low back disability. Id. As such, an increased rating based on incapacitating episodes is not warranted. Id. When evaluating disabilities of the spine, any associated objective neurologic abnormalities are to be rated separately under an applicable Diagnostic Code. 38 C.F.R. § 4.71a, General Formula, Note 1. Here, no neurologic abnormalities have been noted as being associated with the Veteran’s low back disability. Indeed, both VA examiners noted that the Veteran’s neurologic examination was completely normal, and VA and private treatment records are silent for any notations of neurologic abnormalities, including bowel or bladder impairment, associated with the low back disability. As such, additional separate compensable ratings for associated neurologic abnormalities are not warranted at this time. 38 C.F.R. § 4.71a, General Formula, Note 1. The Board notes that the Veteran has reported symptoms such as difficulty with prolonged walking, lifting, bending and carrying. However, all of these difficulties are directly attributable to the Veteran’s low back pain, which is contemplated by the currently assigned 10 percent rating for pain and the loss of both range of motion and function attributable to that pain. As such, the Veteran’s reported symptoms are contemplated by the currently assigned rating of 10 percent. Thun v. Peake, 22 Vet. App. 111 (2008). Further, there is no evidence that the low back disability results in frequent hospitalizations or marked interference with employment. The record is devoid of any indication the Veteran has been hospitalized for his low back disability. While the Veteran is in receipt of a total disability rating based on individual unemployability (TDIU), the Veteran based his application for TDIU solely on his PTSD and TBI residuals, not on his low back disability. Further, one VA examiner noted that the back disability resulted in no interference with work functioning, while the other only noted some interference with prolonged standing. As such, the low back disability, on its own, does not result in marked interference with employment. Thus, referral for extraschedular consideration is not warranted in this case. Id. All potentially applicable Diagnostic Codes have been considered. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The preponderance of the evidence is against an initial rating in excess of 10 percent for the Veteran’s service-connected low back disability. As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. For these reasons, the claim is denied. 3. Entitlement to an initial compensable rating for sinusitis. The Veteran’s sinusitis is rated pursuant to Diagnostic Code 6513. Diagnostic Codes 6510 through 6514 are rated according to the General Rating Formula for Sinusitis. Under the General Rating Formula for Sinusitis, a noncompensable rating is warranted for sinusitis that is detected by x-ray only. 38 C.F.R. § 4.97, General Rating Formula for Sinusitis. A 10 percent rating is warranted for one or two incapacitating episodes per year 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. Id. A 30 percent rating is warranted for three or more incapacitating episodes per year 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. Id. A 50 percent rating is warranted for radical surgery with chronic osteomyelitis, or near constant sinusitis characterized by headaches, pain and tenderness of the affected sinus and purulent discharge or crusting after repeated surgeries. Id. An incapacitating episode means an episode that requires bed rest and treatment by a physician. Id., Note 1. During the period on appeal, the Veteran has generally stated that his sinusitis is worse than currently rated. However, he has not submitted any lay statements detailing his precise symptoms or their frequency. As such, this issue will be decided based on the medical evidence of record. The Veteran was provided with VA examinations in April 2016 and February 2017. In April 2016, the examiner noted that the Veteran had both sinusitis and rhinitis. The examiner noted that the Veteran experienced headaches and pain of the affected sinus, but that he did not experience any non-incapacitating episodes or incapacitating episodes of sinusitis in the past twelve months. The examiner further noted that the Veteran had no history of radical surgery, and that there was no evidence of obstruction of the nasal passages, polyps, hypertrophy of the turbinates or granulomatous conditions. Finally, the examiner noted that the disability did not results in scars, loss of part of the nose, or other disfigurement. In February 2017, the Veteran reported that he has occasional nosebleeds and has difficulty breathing through is nose. The examiner diagnosed both sinusitis and rhinitis. No symptoms attributable to sinusitis were noted. The examiner noted that the Veteran had not had any incapacitating or non-incapacitating episodes of sinusitis in the past twelve months, and that he did not have a history of radical surgery. The examiner noted that there was no evidence of obstruction of the nasal passages, polyps, hypertrophy of the nasal turbinates, granulomatous conditions, scars, loss of part of the nose, or other disfigurement. There is no evidence that the examiners were not competent or credible. Further, the evaluations were based on the Veteran’s own reports of his symptoms as well as the examiners’ own objective examinations of the disability. As such, the Board finds that each respective examination report is entitled to significant probative weight as to the severity of the Veteran’s disability during the period on appeal. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Both VA and private treatment records from this period are silent for any complaints of or treatment for sinusitis or any other nasal disabilities or symptoms. As such, these records are of no probative value. Based on the foregoing, the preponderance of the evidence is against a finding that a compensable rating is warranted in this case. While the Veteran has been formally diagnosed with both sinusitis or rhinitis, all of the medical evidence reflects that the Veteran does not have incapacitating or non-incapacitating episodes of sinusitis, nor is there evidence of nasal passage obstruction or polyps. The Board acknowledges that the April 2016 examiner noted that the Veteran experienced headaches and nasal passage pain attributable to the sinusitis. However, the Veteran is already separately service-connected and compensated for headaches associated with his in-service TBI. As such, consideration of the Veteran’s headaches when rating his sinusitis would constitute impermissible pyramiding, as the same disability or symptom would be compensated under two separate codes. 38 C.F.R. § 4.14. Further, both examiners agreed that the Veteran does not experience non-incapacitating episodes of sinusitis, and there is no evidence that the Veteran’s sinusitis is manifested by purulent discharge or crusting, which is also a required symptom for an increased rating. 38 C.F.R. § 4.97, General Rating Formula for Sinusitis. Based on the foregoing, the Veteran’s overall disability picture does not more nearly approximate the level of severity contemplated by the higher available ratings. As such, a compensable rating is not warranted. 38 C.F.R. §§ 4.3, 4.97, Diagnostic Code 6513. No additional higher or alternative ratings under different Diagnostic Codes may be assigned. The Board notes that the medical evidence shows the Veteran has also been diagnosed with rhinitis. However, that evidence also reflects that the Veteran does not have nasal passage obstruction, polyps, granulomatous conditions, or hypertrophy of the turbinates. As such, a higher rating under the Diagnostic Code applicable to rhinitis is not warranted. 38 C.F.R. § 4.97, Diagnostic Codes 6522–6524. Likewise, as there is no evidence of nasal passage obstruction a higher evaluation based on deviation of the nasal septum is not warranted. 38 C.F.R. § 4.97, Diagnostic Code 6502. All of the evidence reflects that the Veteran does not have scars or loss of part of the nose. 38 C.F.R. § 4.97, Diagnostic Code 6504. Finally, the Veteran has not been diagnosed with any disabilities of the larynx or pharynx. 38 C.F.R. § 4.91, Diagnostic Code 6515–6521. The Board notes that the Veteran has reported that he experiences periodic nose bleeds associated with his sinus disability, which is a symptom not contemplated by the diagnostic criteria. However, there is no evidence that the sinusitis results in frequent hospitalizations or marked interference with employment. There is no evidence that the Veteran has at any point been hospitalized for his sinus disability. Further, there is no evidence showing that the sinus disability, on its own, results in marked interference with employment. Both examiners specifically noted that the sinus condition resulted in impairment of the Veteran’s ability to work. While as noted previously the Veteran is in receipt of TDIU, that award and the Veteran’s application therefore was based solely on his PTSD and TBI residuals, not the sinusitis. As such, the evidence does not show that the sinusitis, on its own, results in marked interference with employment. Thus, referral for extraschedular consideration is not warranted in this case. Thun, 22 Vet. App. 111. All potentially applicable Diagnostic Codes have been considered. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The preponderance of the evidence is against an initial rating in excess of 10 percent for the Veteran’s service-connected low back disability. As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. For these reasons, the claim is denied. REASONS FOR REMAND 1. Entitlement to initial increased ratings for residuals of a TBI and PTSD is remanded. Following the issuance of the statement of the case, but prior to certification and transfer of the current appeal to the Board, the RO associated an October 2017 VA TBI examination with the file. This examination is relevant to both the claim for an increased rating for PTSD and the claim for an increased rating for residuals of a TBI. When relevant evidence is received by the agency of original jurisdiction prior to the transfer of the appeal to the Board, and that evidence was not considered in a previously issued statement of the case or supplemental statement of the case and is not duplicative of already considered evidence, a supplemental statement of the must be furnished to the Veteran and their representative. 38 C.F.R. § 19.37. As such, the issues of entitlement to increased ratings for PTSD and residuals of a TBI must be remanded so that a supplemental statement of the case re-adjudicating those issues may be issued. The matters are REMANDED for the following action: (Continued on the next page)   Readjudicate the issues of entitlement to increased ratings for residuals of a TBI and entitlement to an increased rating for PTSD. If the determination remains unfavorable to the Veteran, he and his representative should be furnished a supplemental statement of the case and afforded the applicable time period to respond. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Wendell, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.