Citation Nr: 20022528 Decision Date: 04/01/20 Archive Date: 04/01/20 DOCKET NO. 14-00 129 DATE: April 1, 2020 ORDER Entitlement to service connection for cervical spine condition is denied. Entitlement to service connection for left hip condition is denied. Entitlement to service connection for right hip condition is denied. Entitlement to service connection for left ankle condition is denied. Entitlement to service connection for right ankle condition is denied. Entitlement to an initial compensable rating for pes planus is denied. The appeal of the issue of entitlement to an initial rating higher than 10 percent for left knee chondromalacia for the period April 14, 2017 forward is dismissed. The appeal of the issue of entitlement to an initial rating higher than 10 percent for right knee chondromalacia for the period April 14, 2017 forward is dismissed. Entitlement to an initial rating higher than 10 percent for hiatal hernia with gastroesophageal reflux disease (GERD), esophagus stricture, and esophagus spasm the period prior to April 14, 2017 is denied. The appeal of the issue of entitlement to an initial rating higher than 30 percent for GERD for the April 14, 2017 forward is dismissed. The appeal of the issue of entitlement to an initial compensable rating higher than 20 percent for the period April 14, 2017 forward for thoracolumbar spine disorder, to include degenerative disc disease (DDD) and intervertebral disc syndrome (IVDS), is dismissed. The appeal of the issue of entitlement to an initial rating higher than 20 percent for left (minor) shoulder calcific tendonitis the period April 14, 2017 forward for is dismissed. REMANDED Entitlement to an initial compensable rating for the period prior to April 14, 2017 for right knee chondromalacia is remanded. Entitlement to an initial compensable rating for the period prior to April 14, 2017 for left knee chondromalacia is remanded. Entitlement to an initial compensable rating for the period prior to April 14, 2017 for thoracolumbar spine disorder, to include DDD and IVDS, is remanded. Entitlement to an initial compensable rating for the period prior to April 14, 2017 for left (minor) shoulder calcific tendonitis is remanded. FINDINGS OF FACT 1. The evidence of record is against a finding of a currently diagnosed cervical spine disorder, or that cervical spine pain causes an impairment in earning capacity. 2. The evidence of record is against a finding of a currently diagnosed bilateral hip disorder, or that bilateral hip pain causes an impairment in earning capacity. 3. The evidence of record is against a finding of a currently diagnosed bilateral ankle disorder, or that bilateral hip pain causes an impairment in earning capacity. 4. The preponderance of the evidence of record shows that the symptoms of the Veteran’s bilateral pes planus are relieved by shoe inserts. 5. The Veteran has withdrawn his appeal of the initial rating for his right knee disability for the period from April 14, 2017 forward. 6. The Veteran has withdrawn his appeal of the initial rating for his left knee disability for the period from April 14, 2017 forward. 7. The Veteran has withdrawn his appeal of the initial rating for his left shoulder disability for the period from April 14, 2017 forward. 8. For the period prior to April 14, 2017, the preponderance of the evidence of record shows the Veteran’s hiatal hernia with GERD with esophageal stricture and spasm did not manifest with considerable impairment of health. 9. The Veteran has withdrawn his appeal of the initial rating for his hiatal hernia with GERD with esophageal stricture and spasm for the period April 14, 2017 forward. 10. The Veteran has withdrawn his appeal of the initial rating for his lumbar spine disability for the period April 14, 2017 forward. CONCLUSIONS OF LAW 1. The requirements for entitlement to service connection for a cervical spine disorder have not been met. 38 U.S.C. §§ 1110, 1131, 1154, 5107(b) (2014); 38 C.F.R. §§ 3.159, 3.303 (2019). 2. The requirements for entitlement to service connection for a left hip disorder have not been met. 38 U.S.C. §§ 1110, 1131, 1154, 5107(b); 38 C.F.R. §§ 3.159, 3.303. 3. The requirements for entitlement to service connection for a right hip disorder have not been met. 38 U.S.C. §§ 1110, 1131, 1154, 5107(b); 38 C.F.R. §§ 3.159, 3.303. 4. The requirements for entitlement to service connection for a left ankle disorder have not been met. 38 U.S.C. §§ 1110, 1131, 1154, 5107(b); 38 C.F.R. §§ 3.159, 3.303. 5. The requirements for entitlement to service connection for a right ankle disorder have not been met. 38 U.S.C. §§ 1110, 1131, 1154, 5107(b); 38 C.F.R. §§ 3.159, 3.303. 6. The requirements for an initial compensable rating for bilateral pes planus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.10, 4.31, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5276. 7. The criteria for withdrawal of the appeal of the issue of an initial rating higher than 10 percent for right knee chondromalacia for the period from April 14, 2017 forward have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205. 8. The criteria for withdrawal of the appeal of the issue of an initial rating higher than 10 percent for left knee chondromalacia for the period from April 14, 2017 forward have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205. 9. The requirements for an initial rating higher than 10 percent for hiatal hernia with GERD, esophagus stricture, and esophagus spasm the period prior to April 14, 2017 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.114, DC 7346. 10. The criteria for withdrawal of the appeal of the issue of an initial rating higher than 30 percent for hiatal hernia with GERD, esophagus stricture, and esophagus spasm for the period from April 14, 2017 forward have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205. 11. The criteria for withdrawal of the appeal of the issue of an initial rating higher than 20 percent for thoracolumbar spine DDD with IVDS for the period from April 14, 2017 forward have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205. 12. The criteria for withdrawal of the appeal of the issue of an initial rating higher than 20 percent for the period from April 14, 2017 forward for left (minor) shoulder calcific tendonitis have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS On initial review of the Veteran’s appeal, in a March 2018 decision, the Board denied an increase for an initial 10 percent rating for GERD, allowed an initial 10 percent rating for the left shoulder disability, both for the period prior to April 14, 2017; and, denied initial compensable ratings for the lumbar spine, bilateral knee, and headaches disabilities, the former for the period prior to April 14, 2017. The decision also denied entitlement to service connection for the cervical spine, bilateral hip, and bilateral ankle disorders. The Board remanded the initial ratings for the period beginning on April 14, 2017 for GERD, left shoulder, lumbar spine, and bilateral knee disabilities for additional development. See 03/27/BVA Decision. The Veteran appealed the March 2018 Board decision to the Court of Appeals for Veterans Claims (Court). While the appeal was pending, the Veteran, through counsel, and the Secretary, VA, entered into a July 2019 Joint Remand Motion (JMR) to vacate the March 2018 Board decision in part and remand it to the Board for further appellate review consistent with the JMR. In an Order also dated in July 2019, the Court granted the JMR, vacated the March 2018 Board decision in part and remand it to the Board for further appellate review consistent with the JMR. See 08/15/2019 CAVC, P. 2-9, 11. The Veteran abandoned his appeal of the Board’s decision on the initial rating for his headaches disability and, pursuant to his request, the Court dismissed it. Id., P. 3, 11. Hence, that issue is not before the Board and will not be mentioned or addressed in the decision below. As noted above, the Board in March 2018 remanded for current examinations of the shoulder, knees, lumbar spine, and GERD. Service Connection Applicable Legal Requirements Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an 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, the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). See also 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). “Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology.” Savage v. Gober, 10 Vet. App. 488, 495-97 (1997); (citing Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (distinguishing between competency (“a legal concept determining whether testimony may be heard and considered”) and credibility (“a factual determination going to the probative value of the evidence to be made after the evidence has been admitted”). In relevant part, 38 U.S.C. § 1154(a) requires that VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim for disability or death benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). The Board must fully consider the lay evidence of record. Davidson, 581 F.3d 1313. A layperson is competent to report on the onset of disability and, when applicable, continuity of his or her current symptomatology. See Layno, 6 Vet. App. at 470 (stating that a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient to establish a diagnosis if (1) the 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. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is 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. Kahana v. Shinseki, 24 Vet. App. 428 (2011). The Board is charged with the duty to assess the credibility and weight given to evidence. Wensch v. Principi, 15 Vet. App. 362, 367 (2001). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, and consistency with other evidence submitted on behalf of the Veteran, and the Veteran’s demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza, 7 Vet. App. at 511, aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Entitlement to service connection for cervical spine, bilateral hip, and bilateral ankle conditions. At the Board hearing, the Veteran testified that his neck clicked. He testified further that at the July 2010 VA fee-basis examination, he told the examiner that it clicked. The Veteran testified that he had to wear a CVC helmet during his active service. Concerning the remaining joint disorders, and in particular the hips, the Veteran testified to the stress of load bearing during his active service. He testified that a clicking started in the 1980s, and that his hips were always sore. He testified that he sustained a severe left ankle strain in 2008, and that he had plantar fascitis. He did not remember being placed on a Profile for the ankle. He testified further that he pronates when he walks. See 04/14/2017 Hearing Testimony. At the July 2010 examination (09/30/2010 C&P Exam, 5th Entry) the Veteran was furnished a pre-exam Questionnaire to complete, and he reported that he completed it as well as he could. He reported a history of pain since 1986 that ran from the neck to his lumbar spine area. He reported complaints of bilateral hip pain since 2006, and bilateral ankle pain since 2007. The Veteran attributed the hip pain to efforts to maintain his physical fitness, as well as the activities of military exercises and missions. He underwent a regimen of physical therapy for the ankles but denied any other treatment. See id., P. 4-5. Physical examination revealed that other than being overweight, the Veteran appeared to be in good health and looked his stated age. His posture and gait were normal. Examination of the cervical spine revealed no evidence of guarding, muscle spasm, tenderness, or radiating pain. The examiner noted that range of motion (ROM) was normal in all planes (see 38 C.F.R. § 4.71a, Plate V), and that all movements were done without evidence of pain. Exam Report, P. 14-15. Examination of the hips revealed no detectible alteration in form or function. There was no sign of edema, weakness, tenderness, effusion, redness, heat, or abnormal movement. ROM on flexion was 0 to 125 degrees, and on abduction, 0 to 45 degrees, both bilaterally, which the examiner noted were normal. See 38 C.F.R. § 4.71a, Plate II. Parenthetically, the Board notes that the examiner noted testing hip ROM in other planes, but the ones the Board lists are among those on which a disability rating is based. See 38 C.F.R. § 4.71a, DCs 5251-5253. The examiner noted that all movements were done without evidence of pain. Exam Report, P. 12-13. Examination of the ankles revealed no sign of edema, weakness, tenderness, effusion, redness, heat, or abnormal movement. The examination did not reveal any deformity in dorsiflexion, plantar flexion, inversion, or eversion. ROM on dorsiflexion was 0 to 20 degrees, and on plantar flexion, 0 to 45 degrees, both without evidence of pain, and both of which the examiner noted was within normal limits. See 38 C.F.R. § 4.71a, Plate II. The examiner noted further that there was no evidence of instability or guarding movements. Exam Report, P. 14. The examiner noted that x-rays of the cervical spine, bilateral hips, and bilateral ankles were read as negative. Exam Report, P. 19. Regarding the diagnoses, the examiner diagnosed no pathology identified on clinical examination, negative x-rays, for the cervical spine, bilateral hips, and bilateral ankles. See 09/30/2010 C&P Exam, 5th Entry, P. 22. On initial review of this appeal, the Veteran asserted that certain facets of the 2010 examination were inadequate, which the Board rejected. He did not pursue that basis for a remand before the Court. Hence, the Board will not again address such contentions. The January 2014 examination report need not be discussed at length. The report reflects that the examiner conducted a thorough review of the claims file, including the service treatment records (STRs), and took, recorded, and considered the Veteran’s lay reported history of his claimed disorders. The examiner opined that the objective findings on clinical examination of the hips and ankles, to include negative x-rays, revealed no pathology on which to diagnose a disorder. See 08/11/2014 VA Examination, P. 27-34, 42-48. There was no indication that the claimed disorders had any impact on employment; it was noted that the Veteran worked in Human Resources. Discussion Part of a viable claim is that a currently diagnosed disease or disorder must exist presently or existed at the time of the filing of a claim, or at any time during the adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319 (2007). This is necessary, as the first requirement for service connection is a disease or injury that occurred in service or is otherwise connected to active service. 38 C.F.R. § 3.303. As discussed earlier, the Veteran underwent an examination of the cervical spine, and two examinations of the hips and ankles, and no disorder was diagnosed at either examination, to include negative findings on x-rays. The Board, as did the examiners, notes the entries in the STRs where the Veteran complained of pain, as well as his written submissions and testimony at the hearing. Nonetheless, the medical examiners determined that there are no currently diagnosed cervical spine, bilateral hips, or bilateral ankle disorders. As noted, the examiners reviewed the claims file, considered the Veteran’s reported history, and examined him and ordered x-rays. Based on these multiple factors, the Board finds the examiner’s opinion highly probative and affords it significant weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301-04 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Moreover, no other clinical evidence refutes the examination findings. In this regard, the Board acknowledges references in outpatient treatment reports such as “hip pain,” which as noted above, does not constitute a diagnosed disability. Likewise reference to “Achilles tendinitis” is not accompanied by any objective findings and appears to be based solely on the Veteran’s reported history. In the JMR, the consensus of the parties was that the Board decided this issue prior to the Court of Appeals for the Federal Circuit decision in Saunders v. Wilkie, 886 F.3d 1356, 1362-64 (Fed. Cir. 2018). Hence, a remand was in order so that the Board could apply the ruling of that case to the Veteran’s appeal. In Saunders the Federal Circuit addressed “the legal issue [of] whether pain without an accompanying pathology can constitute a “disability” under [38 U.S.C.] § 1110.” (overruling the Veterans Court’s holding in Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999)). In Saunders the Federal Court held that the Veterans Court erred “as a matter of law in holding that pain alone, without an accompanying diagnosis or identifiable condition, cannot constitute a ‘disability’ under [38 U.S.C.] § 1110, because pain in the absence of a presently-diagnosed condition can cause functional impairment.” Id. The Federal Circuit “conclude[d] that pain is an impairment because it diminishes the body’s ability to function, and that pain need not be diagnosed as connected to a current underlying condition to function as an impairment.” Id. Further, the Federal Circuit held that “[w]e do not hold that a veteran could demonstrate service connection simply by asserting subjective pain to establish a disability, the veteran’s pain must amount to a functional impairment. To establish the presence of a disability, a veteran will need to show that pain reaches the level of a functional impairment of earning capacity.” Id. The Board has set forth the Veteran’s subjective symptoms to which he testified, testimony which he is fully competent to give. See 38 C.F.R. § 3.159(a)(2). Nonetheless, the Board has considered the evidence in light of Saunders and finds no evidence of functional impairment due to neck, hip, or ankle pain. The evidence of record shows that the Veteran is gainfully employed, as noted at the recent hearing and the examination findings showed no decrease in range of motion and no gait disturbances or objective findings of pain that would interfere with employment. Thus, since the preponderance of the evidence shows that there is not a current chronic neck, bilateral hip, or bilateral ankle disability nor functional impairment due to pain from either, the criteria for establishing service connection for a knee disability have not been established. 38 C.F.R. § 3.303; Saunders, 886 F.3d 1356, 1362-64. Since the preponderance of the evidence is against the claim of service connection for a neck, bilateral hip, or bilateral ankle disability, there is no reasonable doubt to resolve. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Increased Ratings Disability ratings are intended to compensate for impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. Separate diagnostic codes identify the various disabilities. 38 C.F.R. § 4.27. It is necessary to rate the disability from the point of view of the Veteran working or seeking work, see 38 C.F.R. §§ 4.1, 4.2, and to resolve any reasonable doubt regarding the extent of the disability in the Veteran’s favor. 38 C.F.R. § 4.3. Evaluations are based on functional impairments which impact a veteran’s ability to pursue gainful employment. 38 C.F.R. § 4.10. If there is a question as to which disability rating to apply to the Veteran’s disability, the higher rating 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. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; see Peyton v. Derwinski, 1 Vet. App. 282 (1991). In general, the degree of impairment resulting from a disability is a factual determination, and generally the Board’s primary focus in such cases is upon the current severity of the disability. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994). Nonetheless, separate, or staged, ratings can be assigned for separate periods during the initial rating period on appeal based on the facts found. See O’Connell v. Nicholson, 21 Vet. App. 89, 91-92 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). Musculoskeletal Disabilities In addition to the general provisions for increased ratings set forth earlier, disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202, 205-08 (1995); 38 C.F.R. §§ 4.40, 4.45. In DeLuca, the Court stated that increased symptomatology due to weakness, fatigue, etc., where possible, should be, where possible stated by examiners in terms of additional loss of range of motion. DeLuca, 8 Vet. App. at 205. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The Court has held that the final sentence of § 4.59 creates a requirement that certain range of motion and other testing be conducted whenever possible in cases of joint disabilities. 1. Entitlement to an initial compensable rating for bilateral pes planus. Rating Criteria Pes planus is rated under DC 5276 (flat foot, acquired). See 38 C.F.R. § 4.71a. Those criteria provide that pronounced flatfoot, which manifests with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achillis on manipulation, not improved by orthopedic shoes or appliances, warrants the maximum rating of 50 percent when present bilaterally, and 30 percent for unilateral manifestation. Severe, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities, warrants a 30 percent rating for bilateral presence, and 20 percent for unilateral. Moderate; weight-bearing line over or medial to great toe, inward bowing of the tendo Achillis, pain on manipulation and use of the feet, bilateral or unilateral, warrants a 10 percent rating. Mild; symptoms relieved by built-up shoe or arch support warrants a noncompensable rating. Id. Discussion The July 2010 examination report reflects a history of plantar fasciitis diagnosed in 2007. The examination report reflects complaints of intermittent sharp aching pain of 5/10 intensity triggered by activity, and relieved by rest and medication. He described his functional impairment as decreased mobility and having to walk slowly without inserts. Physical examination of the feet and toes revealed no signs of painful motion, edema, disturbed circulation, weakness, muscle atrophy, or tenderness. The arches were low, obscured by obesity; the examiner noted that they would be examined further by x-rays under weightbearing. Palpation of the plantar surfaces did not reveal any tenderness, and the Achilles tendons showed good alignment. There was no evidence of claw feet, hammer toes, hallux valgus, or hallux rigidus. The examiner diagnosed pes planus based on examination findings with negative x-rays. (09/30/2010 C&P Exam, 9th Entry, P. 7, 15-16, 23). The January 2014 examination report reflects that the Veteran reported continued pain on the bottom of the feet. The examiner noted that there was no pain on use of the feet. Examination revealed accentuated pain on manipulation of the feet. There was no indication of swelling on use or the presence of characteristic calluses. The examination also disclosed that there was no extreme tenderness of the plantar surfaces, that the examiner noted that the Veteran’s symptoms were relieved by arch supports. (08/11/2014 VA Examination, P. 50-52). The examination report reflects that the examiner indicated the absence of all symptoms that would warrant a compensable rating. The examiner noted that the Veteran did not demonstrate flattened arches on examination; and, that the Veteran’s posture and gait were within normal limits. The examiner confirmed the diagnosis of record of bilateral pes planus. The consensus of the parties in the JMR was that the Board failed to discuss whether the Veteran’s reported, and noted, pain warranted a compensable rating under 38 C.F.R. § 4.59. The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Id. Additionally, the Court has held that the plain language of § 4.59 indicates that the regulation is not limited to the evaluation of musculoskeletal disabilities under DCs predicated on ROM measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The Court held that § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable, or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is being evaluated is predicated on ROM measurements. Id. The Board acknowledges that § 4.59 was not discussed in the March 2018 decision as it applied to the pes planus issue. Nonetheless, application of that provision does not advance the Veteran’s appeal for a compensable rating. As set forth above, the objective findings on clinical examination at the September 2010 examination revealed no active symptoms. Further, commenting on the credibility of the Veteran’s effort at the examination, the examiner specifically noted that the Veteran was able to walk with a normal gait, and stand from a sitting or lying position. (09/30/2010 C&P Exam, 9th Entry, P. 17). Hence, the Board finds that the preponderance of the evidence showed no impairment as of the September 2010 examination. The Board acknowledges the presence of pain, including accentuation of pain on manipulation, noted on the August 2014 examination report. However, that was the only positive symptom noted by the examiner. The rating criteria require other accompanying symptoms in order to warrant a compensable rating. See 38 C.F.R. § 4.71a, DC 5276. In any event, the August 2014 examination report reflects that the Veteran did not use any assistive device but noted that gait was within normal limits. August 2014 Exam Report, P. 53. At the hearing, the Veteran testified to plantar fascitis, and that he did not have prescribed orthotic inserts; rather, he used over-the-counter inserts. He testified further that they provided relief of his symptoms. Lay persons are competent to describe symptoms and to diagnose certain conditions, such as varicose veins. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In this case, the evidence of record shows that the Veteran does not have the necessary medical training to diagnose plantar fasciitis. See 38 C.F.R. § 3.159(a). He has consistently described his foot symptoms as due to plantar fasciitis, but medical examiners have diagnosed pes planus. Nonetheless, a Veteran’s claim is determined by symptoms, not labels. See generally Lanyo v. Brown, 6 Vet. App. 465 (1994). Hence, the Board finds that the preponderance of the evidence shows that the Veteran’s foot disorder of record is bilateral pes planus. The Board finds further that the evidence of record fails to show functional impairment due to his pes planus, and that his symptoms are relieved by shoe inserts. Thus, the pes planus is properly rated as noncompensable. 38 C.F.R. §§ 4.31, 4.71a, DC 5276. 2. Entitlement to an initial rating higher than 10 percent each for left and right knee chondromalacia for the period April 14, 2017 forward. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Withdrawal may be made by the appellant or by his or her authorized representative. Id. In the present case, in his response to the February 2020 SSOC, the Veteran stated that he was satisfied with the evaluation granted by the AOJ, and that he has withdrawn his appeal. See 03/04/2020 BVA Decision. Hence, there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review the appeal and, as noted above in the Order, it is dismissed. 3. Entitlement to an initial rating higher than 10 percent for hiatal hernia with GERD, esophagus stricture, and esophagus spasm for the period prior to April 14, 2017. On initial review of this issue the Board affirmed the assigned 10 percent rating for the period prior to April 14, 2017 and remanded the period beginning on that date for additional development. Consistent with the July 2019 JMR, however, the Board’s decision as it concerned the GERD rating was vacated. As discussed below, the Board adheres to a finding of no more than a 10 percent rating for the initial part of the rating period. The April 2011 rating decision reflects that the RO rated the Veteran’s hiatal hernia, GERD (with mild Schatzki’s ring with esophageal stenosis and stricture), and IBS as one disorder and rated it under DC 7346. See 38 C.F.R. § 4.114. (04/20/2011 Rating Decision-Codesheet). Rating Criteria Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.114, Schedule of ratings-digestive system. The July 2010 examination report reflects a history of complaints of dysphagia and throat problems since 1986, with episodes of difficulty swallowing. At the examination, the Veteran reported difficulty swallowing, pain above the stomach, heartburn, pain behind the breastbone, reflux, and regurgitation. He reported further that he had to eat mild foods in order to avoid those symptoms. He did not report any specific functional impairment due to the disorder. There was no history of vomiting, diarrhea, or melena. Physical examination revealed no evidence of malnutrition or anemia. The abdomen was soft, with no organomegaly present or tenderness on palpation. The examiner noted that the Veteran’s CBC was within normal limits. The examiner noted further, that due to complaints of acid reflux, the Veteran underwent a diagnostic procedure in April 2010. The procedure was interpreted as having revealed gastroesophageal reflux; a mild Schatzki’s ring with esophageal stenosis and stricture (dilation performed at the procedure); and, reflux esophagitis. The examiner opined that the findings were consistent with a history of painful swallowing, difficulty swallowing (dysphagia), hiatal hernia, and regurgitation. Hence, the examiner diagnosed as noted, and observed that there was no evidence of malignant disease, anemia, or malnutrition. (09/30/2010 C&P Exam, 5th Entry, P. 6-7, 11, 21). In light of the objective findings on clinical examination, the Board affirmed the initial rating assigned by the RO. 38 C.F.R. §§ 4.10, 4.114, DC 7346. A higher rating was not met or approximated, as while two or more of the 30-percent rating were identified, the symptoms identified by the examiner were in fact less severe than those listed in the criteria for a 30-percent rating. The examiner did not find that the Veteran had considerable impairment of health. In his NOD, the Veteran referenced his 2010 procedure, during which his esophagus was dilated. He also asserted that he continued to modify his eating habits, and that he was awakened at night choking from reflux. He asserted further that the situation was very stressful because he could not breathe through his nose due to his sinus disorder. (06/11/2011 NOD). The April 2011 rating decision had already considered the history of the Veteran’s reflux as of that date. Hence, an August 2013 rating decision continued the 10 percent rating. (08/02/2013 Rating Decision-Narrative). In light of the Veteran’s assertion of choking at night, however, another examination was arranged. The January 2014 examination report (08/11/2014 C&P Exam) reflects that the examiner conducted a review of the claims file and the Veteran’s electronic records. The examiner noted diagnoses of GERD, esophageal stricture, and esophageal spasm. The Veteran reported his breathing problems while asleep due to reflux, and that he took daily medication to control his symptoms. The examiner determined that the current symptoms of the Veteran’s disability were pyrosis; sleep disturbance 4 or more times a year that lasted less than 1 day; and, recurring episodes of nocturnal esophageal spasm or moderate severity. The examiner opined that the Veteran’s GERD had no occupational impairment. The examiner noted further that the Veteran’s CBC was normal, and that the noted diagnoses were made on the bases of the Veteran’s lay reports of his history and the examiner’s review of the Veteran’s records. Further, the examiner noted that the Veteran’s disability was active, since he was on prescription acid blockers. Id., P. 1-5. The Board in 2018 found that the Veteran’s GERD with esophageal spasm and stricture had more nearly approximated the assigned 10 percent rating throughout the part of the rating period on appeal, which was prior to April 14, 2017. 38 C.F.R. §§ 4.1, 4.7, 4.10, 4.114, DC 7346. The Veteran’s hearing testimony suggested an increase in his symptoms. Hence, the Board closed that part of the rating period on the day before the hearing, April 13, 2017. The JMR found that the Board’s reasons and bases in the March 2018 decision were not sufficient because the Board not fully address how it determined that the earlier part of the rating period would close on the day prior to the hearing. The parties in the JMR pointed to the Veteran’s hearing testimony that he had increased his medication 6 months prior to the hearing due to increased symptoms. The JMR suggested the prospect that the Veteran’s testimony raised the potential that the rating period prior to April 14, 2017 was not sufficiently developed for an informed decision. See 08/15/2019 CAVC, P. 5 (citing 38 C.F.R. § 19.9(a) [redesignated 20.904 (Feb. 19, 2019) and referencing McGraft v. Gober, 14 Vet. App. 28, 35 (2000) which held that the date on which evidence is submitted is irrelevant). The Board finds that a remand is not necessary to address the concerns of the JMR, since further discussion of the Board’s reasons and bases is adequate to cure the error noted in the JMR. First, the Board notes that the parties’ emphasis on the Veteran’s hearing testimony is misplaced. Read in its entirety as it related to his GERD, while the Veteran did testify that his non-VA physician had increased his medication dosage from once to twice a day, the vast majority of his testimony related to how he believed his reflux caused sleep difficulty and even vasovagal syncope. See Hearing Testimony, P. 2-7. The first increase, combined with a change in his prescribed medication, occurred in 2014 after an EGD, see 04/14/2017 Medical Treatment-Non-Government Facility, P. 12-13, which the 2014 VA examiner noted. Further, the records of the Veteran’s then most recent visit to his non-VA physician were in fact before the Board, and they reflect that the Veteran’s dosage was twice a day in a February 2017 entry, and this report also noted the Veteran’s symptoms. Id., P. 2. The entry does not reflect that the Veteran’s symptoms were productive of considerable impairment of health, which is a required criterion for the next higher rating of 30 percent. In other words, there is no showing of a disability picture meeting the requirements for the next-higher rating that corresponds with the date the Veteran’s medications were increased, or any other date prior to the Board hearing, for that matter. In addition to the above, the Board notes that the threshold evidence to trigger an an examination, to include one to assess the current severity of a disability, is low. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Further, since the Veteran is competent to testify to his symptoms, that satisfied the low threshold for an examination, which the Board noted as the reason for the March 2018 remand. That threshold was triggered as of the date of the Veteran’s testimony. It does not, however, follow that his GERD manifested symptoms commensurate with the next higher rating as of the date his physician increased the dosage of his medication. The Board found that the preponderance of the evidence did not show that his symptoms were productive of considerable impairment of health. As noted, his non-VA physician did not note such an assessment. Thus, the Board finds no error in closing the prior rating period as of the day prior to the Board’s hearing. 4. Entitlement to an initial rating higher than 30 percent for hiatal hernia with GERD, esophagus stricture, and esophagus spasm for the April 14, 2017 forward. The Veteran has withdrawn his appeal of this issue. The discussion in 2, above, is incorporated here by reference. 5. Entitlement to an initial compensable rating higher than 20 percent for the period April 14, 2017 forward for thoracolumbar spine disorder, to include DDD and IVDS. The Veteran has withdrawn his appeal of this issue. The discussion in 2, above, is incorporated here by reference. 6. Entitlement to an initial rating higher than 20 percent for the period April 14, 2017 forward for left (minor) shoulder calcific tendonitis. The Veteran has withdrawn his appeal of this issue. The discussion in 2, above, is incorporated here by reference. REASONS FOR REMAND The issues of entitlement to an initial compensable rating for the period prior to April 14, 2017 for right and left knee chondromalacia, and thoracolumbar spine disorder, to include DDD and IVDS, are remanded. The consensus of the parties in the JMR is that the September 2010 examination of the knees, left shoulder, and the thoracolumbar spine was inadequate. Specifically, the examiner comply with Correia in that the examination report does not indicate that PROM testing and ROM testing on weight and non-weight bearing was conducted. Hence, the case must be remanded to inquire of the examiner. The matters are REMANDED for the following action: Send the claims file to the examiner who conducted the September 2010 examination of the knees, left shoulder, and lumbar spine examination. Ask the examiner to provide an addendum wherein the examiner advises if PROM testing and ROM testing on weight and non-weight bearing was conducted? If so, the examiner should indicate the values were. If the testing was not done, ask the examiner to explain why it was not. CONTINUED ON THE NEXT PAGE   If the examiner who conducted the September 2010 examination is no longer available, refer the file to the examiner who conducted the August 2014 examination of the referenced joints. Ask the examiner to review September 2010 examination report and to advise whether it can reasonably be determined or estimated from the noted ROM values what PROM, and ROM on weight- and non-weight bearing would have been. Please provide an explanation for the answer. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W. T. Snyder 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.