Citation Nr: 20030165 Decision Date: 04/29/20 Archive Date: 04/29/20 DOCKET NO. 16-19 238 DATE: April 29, 2020 ORDER Entitlement to service connection for left elbow lateral epicondylitis (left elbow disability) is granted. Entitlement to service connection for lumbar spine degenerative disc disease and osteoarthritis (lumbar spine disability) is granted. Entitlement to service connection for right foot hallux valgus (right foot disability) is granted. Entitlement to an initial rating higher than 10 percent for right elbow osteoarthritis prior to August 2, 2018 is denied. Entitlement to an initial schedular rating of 10 percent, but no higher, left foot hallux valgus is granted, subject to controlling regulations governing the payment of monetary awards. FINDINGS OF FACT 1. The evidence is at least evenly balanced as to whether the Veteran’s left elbow disability is related to service. 2. The evidence is at least evenly balanced as to whether the Veteran’s lumbar spine disability is related to service. 3. The evidence is at least evenly balanced as to whether the Veteran’s right foot disability is related to service. 4. For the period prior to August 2, 2018, the Veteran’s right elbow osteoarthritis symptomatology did not more nearly approximate limitation of flexion to 90 degrees, to include consideration of additional functional loss. 5. The Veteran’s left foot hallux valgus symptomatology does not more nearly approximate severe unilateral hallux valgus equivalent to amputation of the great toe, or unilateral hallux vagus that has been operated upon with resection of metatarsal head; however, it causes pain and painful motion. CONCLUSIONS OF LAW 1. With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to service connection for left elbow disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to service connection for lumbar spine disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 3. With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to service connection for right foot disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 4. The criteria for an initial rating higher than 10 percent for the period prior to August 2, 2018 for right elbow osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5206, 5207. 5. The criteria for an initial compensable rating for left foot hallux valgus have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71, DC 5280. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1980 to March 1984, March 2003 to August 2003, and August 2010 to July 2011, with service in Southwest Asia. This case comes to the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah which, inter alia, granted service connection for right elbow osteoarthritis and left foot hallux valgus, evaluating each as noncompensable, and denied service connection for left elbow condition, low back condition, and right foot pain. In November 2013, the Veteran filed her notice of disagreement with the ratings assigned for right elbow osteoarthritis and left foot hallux valgus, and the service connection denials, was issued a statement of the case in February 2016, and in April 2016 perfected her appeal to the Board. In an August 2018 rating decision, the RO granted a rating increase for right elbow osteoarthritis with limitation of flexion, evaluating it as 10 percent disabling effective August 1, 2011, and 20 percent disabling from August 2, 2018 creating a “staged” rating. The August 2018 rating decision also granted a separate 10 percent rating for right elbow, painful motion of the forearm, evaluating it as 10 percent disabling effective August 2, 2018. As this does not constitute a full grant of benefits, the issue remains on appeal. See AB v. Brown, 6 Vet. App. 35 (1993) (in an appeal in which the veteran expresses general disagreement with the assignment of a particular rating and requests an increase, the RO and the Board are required to construe the appeal as an appeal for the maximum benefit allowable by law or regulation). However, as noted below, the Veteran requested a 20 percent rating for the left elbow disability in the November 2013 NOD, and the grant of a 20 percent rating from August 2, 2018 has satisfied the appeal for that period of time. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Left elbow, lumbar spine, right foot In a November 2012 statement, the Veteran reported that in December 2010 her body began to “break down” with chronic back pain, muscle spasms, and bilateral elbow pain. She stated that she reported to “sick call” to prevent further injury and continued to seek medical treatment including physical therapy, acupuncture, and chiropractor visits. She states that she still suffers from lower back spinal compression, and that her vertebrae will “lock-up or freeze” causing considerable pain and discomfort. She also reported wearing a brace on her elbows and performing strengthening exercises, but still suffers discomfort and pain. She stated that the bilateral elbow pain was probably due to improper conditioning and repetitive motion, and from carrying heavy gear and hoisting body weight into vehicles. She indicated that her back pain was due to training in improper gear which prevented her from properly strengthening and conditioning her body prior to deployment. The Veteran’s March 1980 medical examination report upon enlistment is normal with no noted disabilities. Service treatment records from August 1983 note the Veteran was treated for low back pain after lifting a laundry basket and lumbar strain. May 2003 service treatment records note the Veteran was treated for severe foot pain including hallus extensor tendonitis. July 2003 service treatment records note the Veteran was treated for tendonitis of the right foot. August 2003 post-service treatment records note the Veteran complained of pain in the medial area of her right foot which she indicated was due to wearing boots of an inappropriate size. July 2005 VA treatment records note a diagnosis of prominent scoliosis. August 2008 post-service treatment notes indicate the Veteran complained of bilateral dorsomedial hallux pain which she stated had its onset in 2003 in the Middle East where she was issued a pair of desert boots that were based on men’s sizes. She stated she was exposed to extreme conditions and wear, and her feet have not been the same. February 2009 service treatment records note the Veteran was diagnosed with spinal scoliosis at the age of 12, and wore a brace for 2 years. A June 2011 in-service medical fitness advice note indicates the Veteran has had developmental scoliosis through the lower thoracic spine which caused a flare-up of pain while the Veteran was deployed. July 2011 post-deployment examination notes indicate the Veteran reported an approximately 10 year history of back pain with exacerbation due to heavy gear. August 2011 post-service treatment records note that the Veteran reported bilateral elbow pain since March 2011 while deployed with greater pain on the left elbow than the right elbow which were treated with steroid injections. A November 2012 VA examination report noted diagnoses of degenerative disc disease from January 2010, scoliosis from 2006, and osteoarthritis from January 2010. The examiner noted the Veteran had a history of scoliosis known prior to military service, and reported the Veteran complained of low back pain that started during deployment to Afghanistan in October 2010 after wearing interceptor body armor on a routine basis. She described the pain as a constant dull ache exacerbated by bending, lifting, and twisting with no numbness or tingling in the lower extremities, and no bowel or bladder control problems. A November 2012 VA examination report noted a diagnosis of lateral epicondylitis of the left elbow, diagnosed in May 2011. The Veteran indicated that her left elbow pain started during deployment in Afghanistan in 2010 while wearing interceptor body armor, and described the pain as a constant dull ache exacerbated by overuse movement such as lifting and pushing. November 2012 post-service treatment records note a diagnosis of bilateral moderate hallux valgus deformity. A November 2012 VA examination report noted the Veteran’s diagnosis of bunions and tendinitis. The Veteran reported foot pain which started during her first deployment to Kuwait in 2003 when she was issued combat boots which were ill-fitting. She currently reports symptoms of constant ache exacerbated by prolonged walking and standing. In a May 2013 examination report, the examiner opined that the Veteran’s scoliosis, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The examiner noted that the Veteran had scoliosis and some back pain while on active duty, and post-discharge x-rays show degenerative joint disease and scoliosis. The examiner stated that back pain would be expected in patients with scoliosis, and the amount the Veteran had is consistent with her scoliosis. However, the Veteran stated that she was not claiming service connection for scoliosis, but was claiming service connection for her lower back pain, numbness, and sciatica due to improper conditioning prior to deployment. Additionally, a Veteran is presumed to have been sound upon entry into active service, except as to defects, infirmities, or disorders noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § § 3.304 (b). In other words, “[w]hen no preexisting condition is noted upon entry into service, the veteran is presumed to have been sound upon entry.” Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). While the Veteran’s March 1980 medical examination report upon entry into service does not note scoliosis or lumbar spine disability symptomatology, February 2009 service treatment records note the Veteran had a diagnosis of scoliosis prior to service. However, while there is clear and unmistakable evidence that the Veteran’s scoliosis pre-existed service, there is no clear and unmistakable evidence within her service treatment records or the claims file which indicates the Veteran’s scoliosis was not aggravated beyond its natural progression by an in-service injury, event, or illness. The May 2013 examiner stated the Veteran’s back pain is consistent with her scoliosis and is the amount that would be expected in patients with scoliosis, but did not provide a thorough rationale addressing how carrying body armor in service as claimed by the Veteran did not aggravate her pre-existing scoliosis beyond its natural progression. Therefore, the presumption of soundness has not been rebutted, and the Veteran is presumed to have been sound upon entry into active duty service. November 2013 post-service treatment records note the Veteran complained of chronic back pain which she believed was related to carrying heavy armor while on active duty in Afghanistan. October 2017 VA treatment records note treatment for complaints of low back pain. The records also note the Veteran’s history of scoliosis and use of a brace. An August 2018 disability benefits questionnaire (DBQ) indicated that there was no pain noted in the Veteran’s left elbow, and that range of motion was normal. An August 2018 DBQ noted right foot pain and swelling. The Veteran reported that the pain contributed to functional loss. The examination report noted that abnormality was found on the right foot, but no diagnosis was rendered as it was not the focus of the DBQ. The evidence noted in the Veteran’s VA treatment records and VA examination reports establish that she has a current left elbow, lumbar spine, and right foot disability, and her statements and service treatment records reflect treatment for her disabilities during service. The dispositive issue is whether there is a nexus between the current disabilities and the in-service injuries. The Veteran has stated that she suffered from left elbow, lumbar spine, and right foot pain in service, service treatment records note treatment for the pain and disabilities, and post-service treatment notes indicate that she continues to seek treatment for her disabilities. The Veteran’s statements regarding left elbow, lumbar spine, and right foot pain since service are competent and there is no indication that the Veteran’s statements lack credibility. Buchanan v. Nicholson, 451 F. 3d 1331, 1337 (Fed. Cir. 2006) (“[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence”). Therefore, the Veteran’s reports of pain suffered in service and continuity of symptomatology since service are afforded significant probative value. To the extent that the grant of service connection in this case is based primarily on lay evidence, “nothing in the regulatory or statutory provisions [relating to evidence to be considered] require both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself.” Buchanan, 451 F.3d at 1335. In Maples v. Wilkie, No. 18-2016 (mem dec. Feb. 11, 2019), the Court vacated the Board’s denial of a claim for service connection for sleep apnea and found that the Veteran’s “lay statements could be evidence sufficient to support his claim, and the mere fact that there is no medical evidence about his snoring does not, by itself, render his lay statements insufficient.” The Board finds the reasoning of this decision to be persuasive. Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain). The Board notes that as there is no medical opinion addressing the etiology of the Veteran’s left elbow, lumbar spine, and right foot disabilities, the Board could remand for a medical opinion. In these circumstances, however, a remand could be construed as obtaining additional evidence for the sole purpose of denying a claim, which is impermissible. 38 C.F.R. § 3.304 (c) (“The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination”). The above evidence is sufficient to decide the claim. For the foregoing reasons, the evidence is at least evenly balanced as to whether the Veteran’s left elbow, lumbar spine, and right foot disability had their onset in service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for left elbow disability, lumbar spine disability, and right foot disability is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Increased Rating Disability ratings are determined by applying the criteria set forth in the 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 evaluations 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. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as “staged” ratings. See Fenderson v. West, 12 Vet. App. 119 (1999). In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. This regulation also requires that, whenever possible, the joints involved are tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology, and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45, but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. Right elbow osteoarthritis The Veteran’s right elbow osteoarthritis is currently rated 10 percent disabling from August 1, 2011, and 20 percent disabling from August 2, 2018 under DC 5010-5206. Hyphenated DCs are used when a rating under one code requires use of an additional DC to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § § 4.27. The Veteran also has a separate 10 percent rating for right elbow, limited and painful motion of the forearm under DC 5213 from August 2, 2018. The evidence of record indicates that the Veteran is right hand dominant. Under DC 5206, a noncompensable rating is warranted for the major and minor elbow where there is limitation of flexion of the forearm to 110 degrees; a 10 percent rating is warranted for the major and minor elbow where flexion is limited to 100 degrees; a 20 percent rating is warranted for the major elbow where flexion is limited to 90 degrees; a 30 percent rating is warranted for the major elbow where flexion is limited to 70 degrees; a 40 percent rating is warranted for the major elbow where flexion is limited to 55 degrees; and a 50 percent rating is warranted for the major elbow where flexion is limited to 45 degrees. Under DC 5207, a 10 percent rating is warranted for the major elbow where extension of the elbow is limited to 60 degrees; a 20 percent rating is assigned where extension of the major elbow is limited to 75 degrees; a 30 percent rating is assigned where extension of the major elbow is limited to 90 degrees; a 40 percent rating is assigned where extension of the major elbow is limited to 100 degrees; and a 50 percent rating is assigned where extension of the major elbow is limited to 110 degrees. Under Diagnostic Code 5213, impairment of supination and pronation of the major and minor forearms are assigned a 10 percent evaluation for limitation of supination to 30 degrees or less. A 20 percent evaluation is warranted for limitation of pronation with motion lost beyond the last quarter of the arc and where the hand does not approach full pronation. For the major elbow, a 30 percent rating is assigned when motion is lost beyond the middle arc, and for the minor elbow, a 20 percent rating is assigned. A 20 percent evaluation is also assigned for loss of supination or pronation (bone fusion) where the hand is fixed near the middle of the arc or moderate pronation in both the major and minor elbow. When the hand is fixed in full pronation, a 30 percent rating is warranted for the major elbow and a 20 percent rating for the minor elbow. When the hand is fixed in supination or hyperpronation, a 40 percent rating is granted for the major elbow. Normal ranges of motion of the elbow are zero degrees of extension to 145 degrees of flexion. See 38 C.F.R. § 4.71, Plate I. Normal ranges of motion of the forearm are 80 degrees of pronation and 85 degrees of supination. A November 2012 VA examination report noted diagnoses of lateral epicondylitis and osteoarthritis of the right elbow. The Veteran reported flare-ups that impact the function of the elbow during overuse movements such as lifting and pushing. Flexion was to 145 degrees or greater with no objective evidence of painful motion, and extension to 0 degrees with no objective evidence of painful motion. There is no additional limitation in range of motion following repetitive-use testing, and the Veteran did not report any function loss or impairment of the right elbow. The Veteran did report localized tenderness or pain on palpation of the joints/soft tissue of the right elbow, but the examination report noted normal muscle strength, no ankylosis, and no flail joint, joint fracture, or impairment of supination or pronation. The examiner noted that the Veteran’s right elbow disabilities did not impact her ability to work. An August 2018 DBQ noted the Veteran’s report that her right elbow osteoarthritis had been progressively getting worse over the last eighteen months, reporting constant pain in her elbow that worsened with gripping. The Veteran stated that she takes Motrin as needed with minimal relief. The Veteran did not report flare-ups, but stated that it was difficult to do anything that required gripping, tying, and lifting. Range of motion measurements were noted as follows: flexion to 90 degrees, extension to 0 degrees, forearm supination and pronation each to 70 degrees with the examiner noting that the Veteran is unable to perform full range of motion due to functional loss. The examination report noted objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue, indicating the lateral aspect of the elbow tenderness rated 10 out of 10 related to the osteoarthritis. There was no additional loss of function or range of motion after three repetitions as noted by the examiner, no reduction in muscle strength, no muscle atrophy, and no ankylosis. The Veteran indicated that her right elbow disabilities impact her ability to work as they cause disturbance of arm movement, and interference with activities that involve pushing and lifting. She reported having lost 1 to 2 weeks of work in the last 12 months. The examination report noted objective evidence of pain on passive range of motion testing, and no objective evidence of pain when the joint is used in non-weight bearing. For the following reasons, an initial rating higher than 10 percent is not warranted for the period prior to August 2, 2018. The November 2012 VA examination report noted the Veteran’s report of flare-ups and pain, but range of motion was normal with flexion to 145 degrees, and extension to 0 degrees. Although the examiner did not specifically indicate the additional loss of motion during flare-ups, the above statements of the Veteran reflect that the severity of the flare-ups was not such that they would result in additional loss of motion more nearly approximating the criteria for a higher rating. The evidence of record therefore does not indicate that the Veteran’s right elbow osteoarthritis symptomatology more nearly approximates limitation of flexion to 90 degrees as contemplated by a 20 percent rating under DC 5010-5206, to include considerations of flare-ups. Thus an initial rating higher than 10 percent is not warranted for the period prior to August 2, 2018. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. For the period from August 2, 2018, a 20 percent “staged” rating has been assigned for the Veteran’s right elbow osteoarthritis under DC 5010-5206. As this was the rating specifically requested by the Veteran as noted in her June 2013 notice of disagreement, discussion with regard to whether a rating higher than 20 percent is warranted for the Veteran’s right elbow osteoarthritis is unnecessary. See AB, 6 Vet. App. at 38. A separate, compensable rating is also not warranted for limitation of extension even with consideration to functional impairments under DC 5207. For the entire period on appeal, the Veteran’s right elbow extension measured to 0 degrees, thus her right elbow osteoarthritis symptomatology does not more nearly approximate that contemplated by at least a 10 percent rating under DC 5207. Therefore, a separate, compensable rating under DC 5207 for limitation of extension is not warranted. The Board has also considered whether a higher rating is warranted under DC 5213 for impairment of supination and pronation. Prior to August 2, 2018, there is no evidence that the Veteran’s right elbow symptomatology more nearly approximated limitation of supination to 30 degrees or less as contemplated by a 10 percent rating under DC 5213. In fact, the November 2012 VA examination report noted no impairment of supination or pronation, thus a separate, compensable rating under DC 5213 is not warranted prior to August 2, 2018. For the period from August 2, 2018, the evidence of record does not suggest that the Veteran’s right elbow symptomatology more nearly approximates that contemplated by a higher than 10 percent rating under DC 5213. The August 2018 VA examination report noted forearm supination and pronation each to 70 degrees noting that the Veteran is unable to perform full range of motion due to functional loss, but did not note limitation of pronation with motion lost beyond the last quarter of the arc and where the hand does not approach full pronation. There is no other evidence of record, and the Veteran does not otherwise suggest, that her right elbow symptomatology more nearly approximates that contemplated by a rating higher than 10 percent under DC 5213. Therefore, for the period from August 2, 2018, a separate rating higher than 10 percent under DC 5213 for limitation of pronation or supination is not warranted. As to other potentially applicable DCs, the Veteran does not have, nor does her disability picture more nearly approximate ankylosis, flail joint, nonunion of the radius and ulna, impairment of the ulna, or impairment of the radius. 38 C.F.R. § 4.71a, DCs 5205, 5208, 5209, 5210, 5211, and 5212). Therefore, these DCs are inapplicable in this case. See Butts v. Brown, 5 Vet. App. 532, 539 (1993) (holding that the Board’s choice of diagnostic code should be upheld so long as it is supported by explanation and evidence). Left foot hallux valgus The Veteran’s left foot hallux valgus is currently rated noncompensable under DC 5280 for unilateral hallux valgus from November 14, 2011. Unilateral hallux valgus that is severe, if equivalent to amputation of great toe, is rated 10 percent disabling. Unilateral hallux valgus that has been operated upon with resection of metatarsal head is rated 10 percent disabling. 38 C.F.R. § 4.71a. The words “mild,” “moderate,” and “severe” are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all the evidence to the end that its decisions are “equitable and just.” See 38 C.F.R. § 4.6. A November 2012 VA examination report noted a diagnosis of hallux valgus from August 2008, and 2006 diagnoses of tendinitis and bunions. The examiner noted the Veteran’s report that her foot pain started during her first deployment to Kuwait in 2003 when she was issued ill fitting boots. The examiner noted mild or moderate hallux valgus symptoms on the left foot. An August 2018 DBQ noted the Veteran’s report that her left foot disability had worsened over the past 24 months. She reported constant pain underneath her left great toe, but denied injuries and stated that she takes Motrin for the pain. The Veteran did not report flare-ups of her left foot, but stated that she cannot walk without pain, or stand for any long period of time. The Veteran reported mild or moderate symptoms due to her hallux valgus condition. The Veteran reported left foot pain that contributed to functional loss, and stated that the left foot disability affects her current employment due to disturbance of movement and interference with walking, standing and weight-bearing, and noted she has lost 0 to 1 week of work in the last 12 months. May 2019 VA treatment records note complaints of cramping, “pins and needles” in both feet and right calf muscle. The Veteran reported chronic pain, improved with orthotics, and worsened with walking. The Veteran’s left foot hallux valgus symptomatology does not more nearly approximate unilateral hallux valgus that is severe or that has been operated upon with resection of the metatarsal head. While the Veteran has reported constant pain underneath her left great toe in her August 2018 DBQ, she described her symptoms as mild to moderate. Additionally, November 2012 VA examiner noted mild or moderate hallux valgus symptoms. The evidence of record does not note symptomatology which could be construed as severe, and the Veteran does not otherwise contend that her left foot hallux valgus symptomatology is severe, or required operation with resection of the metatarsal head. However, the plain language of § 4.59 indicates that it 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 range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346, 354 (2016). In Southall-Norman, the Court found that 38 C.F.R. § 4.59 applies to DC 5280. Moreover, a compensable rating is warranted for joint pain pursuant to 38 C.F.R. § 4.59 for orthopedic disabilities rated under diagnostic codes containing a compensable rating, and the criteria for such a rating can be satisfied with lay and other non-medical evidence. Sowers v. McDonald, 27 Vet. App. 472, 480 (2016); Petitti v. McDonald, 27 Vet. App. 415, 428-29 (2015). As the Veteran has experienced pain and painful motion due to her hallux valgus, the 10 percent rating under DC 5280 is warranted. In addition, “when a condition is specifically listed in the Schedule, it may not be rated by analogy.” Copeland v. McDonald, 27 Vet. App. 333, 337 (2015). Thus, 10 percent is the maximum schedular rating the Veteran may receive. Neither the Veteran or her representative, have raised any other issues, nor have any other issues been reasonably raised by the record for her disabilities. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). While the Veteran has indicated that her left foot hallux valgus affects her current employment, she does not contend that she is unable to follow a substantially gainful occupation, and the question of unemployability due to the Veteran’s service connected disabilities is not otherwise raised by the record. Rice v. Shinseki, 22 Vet. App. 447, 453 (2009). Therefore, no further discussion of a TDIU is necessary. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Maddox, Associate 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.