Citation Nr: 20021063 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 14-39 549 DATE: March 24, 2020 ORDER Entitlement to an initial rating in excess of 70 percent disabling for adjustment disorder with mixed anxiety and chronic depressed mood is denied. Entitlement to an initial rating in excess of 30 percent disabling for bilateral pes planus with plantar fasciitis prior to November 28, 2018, and in excess of 50 percent disabling thereafter, is denied. FINDINGS OF FACT 1. During the period on appeal, the Veteran’s service-connected psychiatric disorder more nearly approximated occupational and social impairment with deficiencies in most areas due to the following symptoms: depressed mood; anxiety; suspiciousness; hypervigilance; panic attacks more than once per week; chronic sleep impairment; impairment of short and long term memory; trouble concentrating; flattened affect; impaired judgement; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a worklike setting; inability to establish and maintain effective relationships; suicidal ideation; impaired impulse control, such as unprovoked irritability with periods of violence; and, neglect of persona appearance and hygiene. 2. Prior to November 28, 2018, the Veteran’s bilateral foot conditions were manifested by pain, painful motion, and pain on weight-bearing which impaired prolonged standing, walking, running, stair-climbing and weight-bearing. The bilateral foot disability was not manifested by marked inward displacement or severe spasm of the Achilles’ tendon, marked pronation, or extreme tenderness of the plantar surfaces. 3. As of November 28, 2018, the Veteran bilateral foot disability was manifested by marked pronation not improved by orthopedic shoes or appliances. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 70 percent disabling for adjustment disorder with mixed anxiety and chronic depressed mood have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1-4.7, 4.14, 4.31, 4.130, Diagnostic Code (DC) 9440. 2. Prior to November 28, 2018, the criteria for a rating in excess of 30 percent disabling for bilateral foot disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.71a, DC 5276. 3. As of November 28, 2018, the criteria for a rating in excess of 50 percent disabling for bilateral foot disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.71a, DC 5276. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1981 to August 1984. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision by a Department of Veterans Affairs Regional Office (RO). In February 2017, the Veteran testified at a Board videoconference hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. In April 2018, the Board remanded this case. During the pendency of the appeal, a November 2019 rating decision granted an increased initial rating for the Veteran’s psychiatric disorder of 70 percent, effective March 19, 2013. In addition, the November 2019 rating decision granted an increased initial 30 percent evaluation for the Veteran’s bilateral pes planus, and a 50 percent evaluation effective November 28, 2018. As these ratings are not the maximum allowable, these issues remain on appeal. AB v. Brown, 6 Vet. App. 35 (1993). In addition, the November 2019 rating decision granted entitlement to a total disability rating based on individual unemployability (TDIU). Therefore, as the AOJ granted the benefit sought on appeal, that issue is no longer before the Board. Shoen v. Brown, 6 Vet. App. 456 (1994). Lastly, the Board notes that an April 2017 rating decision granted entitlement to service connection for lumbar spine disability and assigned a 20 percent evaluation effective March 1, 2017. The April 2017 rating decision also denied service connection for obesity, cervical spine disability, hypertension, right hand condition and sleep apnea. The Veteran filed a timely notice of disagreement in November 2017 with regard to all issues decided in the April 2017 rating decision. Additionally, a DRO Informal Conference Report was issued in April 2018, in which it was noted that the parties agreed that a full review of the claims would be conducted. However, a review of the claims file shows that no further development with regard to these claims has been conducted. Accordingly, as the AOJ is clearly aware of the issues on appeal, those issues are referred to the AOJ for appropriate action. 38 C.F.R. § 19.9(b). Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more nearly approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Adjustment Disorder The Veteran filed a service connection claim for an acquired psychiatric disorder in March 2014. That claim was granted in an August 2014 rating decision which assigned an initial 30 percent evaluation effective March 19, 2013. The Veteran has appealed his initial rating. As noted above, a November 2019 rating decision granted an increased initial rating of 70 percent disabling. The Veteran’s psychiatric disorder has been rated pursuant to 38 C.F.R. § 4.130, DC 9440. Pursuant to DC 9440, a 70 percent rating is assigned for a psychiatric disorder manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood due to such symptoms as suicidal ideation, obsessional rituals which interfere with routine activities, speech intermittently illogical, obscure, or irrelevant, near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively, impaired impulse control (such as unprovoked irritability with periods of violence), spatial disorientation, neglect of personal appearance and hygiene, difficulty in adapting to stressful circumstances (including work or a work-like setting), or an inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, DC 9440. A maximum 100 percent rating is assigned for a psychiatric disorder manifested by total occupational and social impairment due to such symptoms as gross impairment in thought process or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place, and memory loss for names of close relatives, own occupation, or own name. Id. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. If the evidence shows that the veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating will be assigned. Mauerhan v. Principi, 16 Vet. App. 436 (2002); Sellers v. Principi, 372 F.3d 1318 (Fed. Cir. 2004). The evidence of record includes an August 2014 VA examination. The examiner noted a diagnosis for adjustment disorder with mixed anxiety and chronic depressed mood, the severity of which was found manifested by a mental condition formally diagnosed, but with symptoms not severe enough either to interfere with occupational and social functioning or to require continuous medication. The examiner noted symptoms of depressed mood, anxiety, disturbances of motivation and mood, and difficulty in adapting to stressful circumstances, including work or a worklike setting. The Veteran reported transient symptoms of depression including feelings of hopelessness, discouragement, low motivation, low energy, agitation, irritability, anger, restlessness and edginess. The Veteran was noted to have good grooming and hygiene and he demonstrated no evidence of a thought disorder, cognitive deficits, or gross memory impairments. He was fully oriented and denied any active or passive suicidal ideation, delusions or hallucinations. A December 2014 VA psychiatry record shows the Veteran stated that he wanted to see if it was possible to be happy and that he barely felt his life was worth living. In addition, the Veteran reported that he did not get along with people. The Veteran reported passive thought of suicide a few times per week. In addition, the Veteran reported that some days he was unable to leave his bed due to fear of what next terrible thing was going to happen to him. The Veteran reported a history of anxiety. The psychiatrist noted a history of grandiosity, mood swings, being easily angered and paranoia. Other symptoms included depression, sadness, tearfulness, anergia, amotivation, fatigue, anhedonia, concentration and memory problems, feelings of worthlessness and excessive guilt, sleep disturbance, anxiety, being easily annoyed, racing thoughts, and panic attacks 2-6 times per week. The Veteran denied any current suicidal or homicidal ideation or audio or visual hallucinations. The psychiatrist noted no evidence of delusions. The Veteran’s appearance was noted as adequately dressed and groomed. He was found fully oriented. Memory was noted as good and speech had normal rate and rhythm. Insight and judgement were found fair. The Veteran underwent another VA examination in March 2015. The examiner noted diagnoses for bipolar disorder, adjustment disorder with anxiety and depressed mood, and unspecified personality disorder. The Veteran’s psychiatric disorders were found manifested by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily with normal routine behavior, self-care and conversation. The examiner noted the following symptoms: depressed mood; anxiety; panic attacks that occur weekly or less often; chronic sleep impairment; and difficulty in establishing and maintaining effective work and social relationships. Other observations included poor hygiene including being dressed in dirty clothes, agitation, dysthymic mood and tearing up. A March 2015 psychiatric examination conducted in relation to an application for SSA benefits shows the Veteran reported having panic attacks, nightmares and intrusive memories, depressed mood, insomnia, fluctuating appetite, decreased energy, trouble concentrating and decreased interest in normal activities. In addition, the Veteran reported past suicidal ideation, but not presently. The examining psychiatrist noted the Veteran had no difficulty with dressing, bathing or hygiene and he was noted as currently neatly and casually groomed. Thought process was coherent and organized, and thought content relevant and non-delusional. The Veteran denied any plan for self-harm or to harm others. In addition, the Veteran denied any auditory or visual hallucinations. Mood was noted as depressed and affect dysphoric. His speech was normal, and he clearly articulated without stammering, or tangentiality, circumstantiality or loosened or unusual associations. Recent and immediate memory recall was found intact as were insight and judgement. VA medical records dated June and September 2016, and January 2017, noted the Veteran had appropriate affect, normal speech, linear thought, and good insight and judgement. At a February 2017 Board hearing, the Veteran testified that he had a hard time sleeping and that he had morning foot pain which caused severe depression. The Veteran also reported that he spent most of his time by himself and that he did not have any friendships or social relationships. The Veteran further testified that he had pretty regular suicidal ideation. A June 2017 VA psychiatry progress note shows that the Veteran presented with dysthymic mood and tearful with a restricted affect. The Veteran was noted as casually dressed and appropriately groomed. His speech was within normal limits and he made appropriate eye contact. The Veteran was found alert and fully oriented. There was no evidence of any delusions or hallucinations or disturbances in thought processes. His insight and judgement were intact. Another June 2017 VA mental health record shows the Veteran sought mental health services to address issues of self-esteem and wanting to look forward to living. The Veteran reported maintaining relationships and that having confidence moving forward had been difficult. The Veteran reported feeling down or depressed most times, anhedonia, hypersomnia, increased appetite, fatigue, psychomotor retardation, and passive suicidal ideation. The Veteran also reported anxiety related to situational stressors, claustrophobia, recurring intrusive memories/images, hypervigilance, negative affective changes and cognitions, avoidance. He denied nightmares and emotional avoidance. In addition, the Veteran denied audio or visual hallucinations, homicidal ideations, or current suicidal ideations. The Veteran submitted a DBQ in May 2018. The DBQ was authored by Dr. Jindrich, a psychologist, who diagnosed the Veteran with GAD and MDD, and noted that symptoms overlapped. Dr. Jindrich found the Veteran’s diagnosed psychiatric disorder manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking and/or mood. The Veteran was noted as currently residing in section 8 housing and that he had been homeless a great deal of his life due to an inability to work caused by his bilateral foot condition with anxiety and depression. The following symptoms were noted: depressed mood; anxiety; suspiciousness; panic attacks more than once per week; chronic sleep impairment; impairment of short and long term memory; flattened affect; impaired judgement; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a worklike setting; inability to establish and maintain effective relationships; suicidal ideation; impaired impulse control, such as unprovoked irritability with periods of violence; neglect of personal appearance and hygiene; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. In an accompanying letter, Dr. Jindrich, noted that the Veteran displayed persistent and frequently acute worrying, constant irritability and that he occasionally would have violent and angry outbursts. The Veteran was noted to suffer from hypervigilance, crying spells and strong avoidance tendencies of people and public places. Dr. Jindrich further noted that the Veteran spent much of his time in his apartment with the doors locked. Based on the Veteran’s reported symptoms over the past five years as well as a review of the medical evidence of record, Dr. Jindrich found that the Veteran’s diagnosed psychiatric disorders were manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking and/or mood for the past five years. A December 2018 VA social work note shows the Veteran was found alert and fully oriented. His speech was noted as clear and hygiene and grooming were found appropriate. Thought process was noted as linear and thought content non-delusional. The Veteran denied any thoughts of harming himself or others. Lastly, a June 2019 VA medical record noted no hallucinations or delusions. After a review of the evidence of record, the Board finds that a rating in excess of 70 percent is not warranted. Specifically, the Board finds that the evidence establishes that, throughout the period on appeal, the Veteran’s psychiatric disorder was manifested by the following symptoms: depressed mood; anxiety; suspiciousness; hypervigilance; panic attacks more than once per week; chronic sleep impairment; impairment of short and long term memory; trouble concentrating; flattened affect; impaired judgement; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a worklike setting; inability to establish and maintain effective relationships; suicidal ideation; impaired impulse control, such as unprovoked irritability with periods of violence; and neglect of personal appearance and hygiene. The Board notes that the Veteran’s psychiatric disability has not more nearly approximated total occupational and social impairment as he has not exhibited many of the symptoms specifically contemplated by the higher rating including gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, disorientation to time or place, or memory loss for names of close relatives, own occupation or own name. In this regard, while Dr. Jindrich found that the Veteran had symptoms of intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, the Board notes that throughout the period on appeal, other medical record specifically noted the Veteran presented with good grooming and hygiene including the August 2014 VA examination and VA medical records dated December 2014, June 2017. Additionally, a March 2015 SSA psychiatric evaluation found the Veteran did not have any difficulty with dressing, bathing or hygiene. Notably, following the May 2018 private psychiatric assessment, a December 2018 VA medical record further noted the Veteran had appropriate hygiene and grooming. Accordingly, the Bord finds that throughout the period on appeal, symptoms related to the Veteran’s hygiene more nearly approximated neglect of personal appearance and hygiene and not intermittent inability to perform activities of daily living. Additionally, while the Veteran has reported regular suicidal ideation, throughout the period on appeal, the evidence of record routinely show the Veteran denied any intent. The Veteran has also routinely denied any homicidal ideation. Accordingly, the Board finds that the evidence of record does not support a finding of persistent danger of hurting self or others. Although the Board does not diminish the significance of the Veteran’s symptoms, the evidence does not demonstrate total occupational and social impairment. In this regard, the Board finds that throughout the period on appeal, the Veteran’s psychiatric disorder more nearly approximated occupational and social impairment with deficiencies in most areas. Accordingly, the preponderance of the evidence is against the assignment of an initial rating in excess of 70 percent and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.130; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Bilateral Foot Disability The Veteran filed a service connection claim for pes planus in March 2014. That claim was granted in an August 2014 rating decision which assigned an initial 10 percent evaluation for bilateral pes planus with plantar fasciitis effective March 19, 2013. The Veteran has appealed his initial rating. As noted above, a November 2019 rating decision granted an increased initial rating of 30 percent disabling prior to November 28, 2018, and an increased 50 percent rating as of November 28, 2018. The Veteran’s bilateral foot disability has been rated pursuant to 38 C.F.R. § 4.71a, DC 5276. Under DC 5276, a 30 percent disability rating for bilateral flatfoot is assigned where there is a severe disability with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indications of swelling on use, and characteristic callosities. A 50 percent disability rating for bilateral flat feet requires a pronounced disability manifested by marked pronation, extreme tenderness of the plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendon Achilles on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, DC 5276. The evidence of record includes a November 2014 VA medical record noting the Veteran’s major issue was chronic, persistent right foot pain which had been present for over 30 years. The Veteran underwent a VA examination in August 2014. The examiner noted diagnoses for bilateral pes planus and plantar fasciitis. The Veteran reported pain, but denied any flare-ups. In addition, the Veteran denied any functional loss or functional impairment of his feet. The examiner noted pain on use of the feet and pain accentuated on manipulation. There was no indication of swelling. There were no characteristic calluses. No extreme tenderness of the plantar surfaces was found. The Veteran was found to have decreased longitudinal arch height of both feet on weight-bearing. There was no objective evidence of marked deformity of either foot or marked pronation. The weight-bearing line did not fall over or medial to the great toe. Additionally, no lower extremity deformity other than pes planus causing alteration of the weight-bearing line was found, nor was there inward bowing of the Achilles’ tendon. There was no marked inward displacement or severe spasm of the Achilles’ tendon. Lastly, there were no findings as to any other foot disability. In March 2015, the Veteran was assessed with chronic right foot pain likely related to plantar fasciitis. A November 2014 X-ray study was noted as within normal limits. A May 2015 right foot X-ray study revealed osteophytes at site of origin of plantar fascia and mild degenerative hallux valgus. A February 2016 VA medical record noted a history of plantar fasciitis with pain worsening over the past year. Pain was reported as a sharp stabbing pain rated a 5 on a scale to 10. The Veteran also reported some arching and grinding pain at medial malleolus. Pain was reportedly exacerbated with impact and worse with temperature changes. Pain was also reported as worse in the morning and when walking barefoot. In September 2016, a VA medical record noted a foot examination revealing no gross swelling. Tenderness was noted at the medial aspect at the heel and plantar fascia region. The Veteran was assessed with acute exacerbation of chronic foot pain. In addition, a September 2016 X-ray study revealed no evidence for fracture or dislocation. Oteophytes were noted at the site of the origin of the plantar fascia. Mild degenerative hallux valgus was also noted. At a February 2017 Board hearing, the Veteran testified that he had a mild deformity due to bone issues with pain ranging from a 5-9 on a scale to 10. The Veteran stated that his pain was constant which could also be aggravated. In addition, the Veteran reported that his feet would swell and that orthotics did not work. As a result, the Veteran stated that he did not get out that much because activities made his symptoms worse. The Veteran further testified that he had fallen on multiple occasions due to his bilateral foot condition. A May 2018 VA medical record shows the Veteran was evaluated for complaints of foot pain. The physician noted that foot pain was likely secondary to previous ligamentous injuries. At a November 2018 VA examination, the examiner noted diagnoses for bilateral pes planus, right foot hallux valgus, bilateral plantar fasciitis, and bilateral foot arthritis. In addition, the examiner noted diagnoses for bilateral foot lateral deviation of distal phalanx of 2nd toe and plantar calcaneal spur. With regard to the additional bilateral foot diagnoses, the examiner stated that they were “at least as likely as not a progression of the previous diagnoses, based on clinical and radiographic findings.” The Veteran reported bilateral foot arching pain on the plantar aspect of his feet which was exacerbated by weight bearing. The Veteran also reported flare-ups and functional loss resulting in pain and limited activities caused by prolonged standing, walking or running. The examiner noted pain on use of feet, accentuated on use, and pain on manipulation of the feet accentuated by use. The examiner also noted characteristic calluses on both feet. There was no indication of swelling. The examiner also noted that the Veteran tried arch supports but remained symptomatic. The bilateral pes planus was not found manifested by extreme tenderness on the plantar surfaces of the feet. There was decreased longitudinal arch height with both feet on weight-bearing. In addition, the examiner found objective evidence of marked deformity of both feet and marked pronation of both feet which was not improved by orthopedic shoes. The weight-bearing line was not found to fall over the medial to the great toe. No inward bowing of the Achilles’ tendon was found, nor was there a lower extremity deformity other than pes planus causing alteration of the weight bearing line. The examiner further found that the bilateral foot disability was not manifested by marked inward displacement and severe spasm of the Achilles’ tendon on manipulation of one or both feet. With regard to the diagnosed right foot hallux valgus, the examiner found the condition manifested by mild or moderate symptoms with no prior surgery for the condition. The severity of the foot injuries was noted as moderate for the right foot, and mild for he left foot. The bilateral foot condition was found to chronically compromise weight-bearing. The Veteran’s variously diagnosed bilateral foot disabilities have been combined and rated pursuant to DC 5276, acquired flatfoot. In this regard, the Board notes that when a particular service-connected disability, such as plantar fasciitis, is not listed in the rating schedule, it may be rated by analogy to a closely related disease in which not only the functions affected, but also the anatomical location and symptomatology are closely analogous. 38 C.F.R. §§ 4.20, 4.27. The assignment of a particular diagnostic code is “completely dependent on the facts of a particular case.” Butts v. Brown, 5 Vet. App. 532, 538 (1993). To this end, the record shows that the variously diagnosed bilateral foot disabilities have overlapping and interrelated diagnoses including bilateral pes planus, plantar fasciitis and calcaneal spur, early osteoarthritis of the 1st MTP joint and lateral deviation of the distal phalanx of the 2nd toe, and right foot hallux valgus. Moreover, the November 2018 VA examiner did not differentiate between the symptoms associated with the service-connected bilateral foot disabilities. Specifically, the bilateral foot disabilities have been manifested by pain, painful motion and pain on weight-bearing which impair prolonged standing, walking, running, stair-climbing and weight-bearing. Accordingly, as the Veteran’s overlapping bilateral foot symptoms manifest in the same symptomatology, separate ratings based on diagnosed foot conditions such as hallux valgus would constitute prohibited pyramiding and are, therefore, not warranted. 38 C.F.R. § 4.14. In any event, even if the Board were to find that the Veteran’s right foot hallux valgus symptoms were clearly differentiated from the right foot pes planus and plantar fasciitis, a compensable rating for the condition would not be warranted under the pertinent rating criteria. In this regard, pursuant to 38 C.F.R. § 4.71a, DC 5280, a single 10 percent rating is warranted for severe hallux valgus equivalent to amputation of the great toe or if the metatarsal head had been surgically resected. A review of the November 2018 VA examination report shows that the right foot hallux valgus was found manifested by mild to moderate symptoms with no prior surgery for the condition. There is no evidence showing a more severe hallux valgus condition that would warrant a compensable rating. Turning to the period on appeal prior to November 28, 2018, the Board finds that an initial rating in excess of 30 percent disabling is not warranted. In this regard, the Board notes that the August 2014 VA examination specifically found no marked inward displacement or severe spasm of the Achilles’ tendon, marked pronation, or extreme tenderness of the plantar surfaces. The Board further notes that the examination report shows the Veteran denied any flare-ups or functional loss due to his bilateral foot conditions. Importantly, prior to November 28, 2018, the evidence of record does not show a bilateral foot disability that more nearly approximated pronounced acquired flatfoot. The Board has also considered other foot ratings for this period on appeal. In this regard, even if the Board rated the Veteran pursuant to DC 5284, other foot injuries, the highest rating available under that diagnostic code is 30 percent. Therefore, rating the bilateral foot disability under that diagnostic code does not provide the Veteran with a more beneficial outcome. Accordingly, prior to November 28, 2018, the Board finds that the highest rating available based on the documented manifestations of the Veteran’s bilateral foot disability is 30 percent. Turning to the period on appeal as of November 28, 2018, the Board finds that a rating in excess of 50 percent disabling is not warranted. In this regard, the Board notes that a 50 percent rating is the maximum possible schedular rating for a foot disability under DC 5276, or any other diagnostic code pertaining to the feet. While the Veteran received additional bilateral foot diagnoses during the November 2018 VA examination, as noted above, the symptoms associated with these disabilities overlap with the diagnosed bilateral plantar fasciitis and pes planus. Therefore, as the Veteran is already in receipt of the maximum 50 percent rating under DC 5276 and this rating contemplates limitation of function of the feet due to pain, painful motion and pain on weight-bearing which impair prolonged standing, walking, running, stair-climbing and weight-bearing, separate ratings based on the variously diagnosed bilateral foot disabilities would constitute prohibited pyramiding and are not warranted. 38 C.F.R. § 4.14. Accordingly, the Board finds that a rating in excess of 50 percent disabling as of November 28, 2018 for bilateral pes planus and plantar fasciitis is not warranted. The Board has also considered assigning higher disability ratings pursuant to 38 C.F.R. § 4.40 and 4.45. In this regard, the Board acknowledges the Veteran’s reported complaints of pain and painful motion. However, the Veteran’s bilateral foot disability has been rated based on symptoms of pain and functional limitations based on painful motion. As the currently assigned disability ratings take into account functional limitations based on painful motion, there is no basis for the assignment of additional disability due to pain, weakness, fatigability, or incoordination. See 38 C.F.R. §§ 4.40 and 4.45; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). In sum, the Board finds that the preponderance of the evidence is against an initial rating in excess of 30 percent disabling prior to November 28, 2018, and in excess of 50 percent disabling thereafter. The claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.130; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Lamb, 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.