Citation Nr: 21000662 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 16-22 222 DATE: January 5, 2021 ORDER Entitlement to service connection for ocular hypertension is denied. Entitlement to an initial rating higher than 10 percent for adjustment disorder with mood disorder and alcohol dependence prior to December 10, 2019 is denied. Entitlement to a rating higher than 30 percent for adjustment disorder with mood disorder and alcohol dependence from December 10, 2019 is denied. Entitlement to an initial rating higher than 10 percent for bilateral plantar fascial fasciitis and connective tissue strain of right foot (bilateral foot disability) is denied. FINDINGS OF FACT 1. There is no objective evidence to support a current diagnosis of ocular hypertension or a pathological eye disease, nor do the records link an eye disorder to an event, injury or disease process during service. 2. Prior to December 10, 2019, the Veteran's adjustment disorder with mood disorder and alcohol dependence was manifested by mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. 3. From December 10, 2019, the Veteran’s alcohol use disorder has manifested symptoms of depressed mood, chronic sleep impairment, and disturbances of motivation and mood; occupational and social impairment with reduced reliability and productivity is not demonstrated. 4. Throughout the appeal period, the Veteran’s bilateral foot disability is manifested, at worst, by moderate symptoms of pain without evidence of marked deformity, pain on manipulation, swelling on use, or characteristic calluses. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for ocular hypertension have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to a rating higher than 10 percent for adjustment disorder with mood disorder and alcohol dependence prior to December 10, 2019 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.130, Diagnostic Code (Code) 9440. 3. The criteria for entitlement to a rating higher than 30 percent for adjustment disorder with mood disorder and alcohol dependence from December 10, 2019 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.130, Code 9440. 4. The criteria for entitlement to a rating higher than 10 percent for bilateral foot disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.40, 4.45, 4.71a, Code 5276. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from November 2004 to June 2012. These matters were previously before the Board of Veterans’ Appeals (Board) in September 2019 and remanded to a Department of Veterans Affairs (VA) Regional Office (RO) for additional development. In an interim June 2020 rating decision the RO granted service connection for sleep apnea, also claimed as sleep disorder and assigned a 30 percent rating effective June 21, 2012. As this was a full grant of the benefit sought on appeal, that matter is no longer before the Board for appellate consideration. Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish service connection, the evidence generally must show: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Entitlement to service connection for ocular hypertension The Veteran contends service connection for ocular hypertension is warranted because it was prevalent during his active duty service. His service treatment records show that in September 2008 he had an assessment of pre-glaucoma ocular hypertension. That same condition was noted under “Problems” in inservice health records dated October 2008, April 2010, and November 2011. In March 2010 the Veteran was seen for an annual examination at an inservice optometry clinic. He reported a history of increased intraocular pressure. On examination his intraocular pressure was normal. He underwent optometry examinations in November and December 2011, but those reports do not indicate an assessment of ocular hypertension. Borderline glaucoma ocular hypertension was noted under “Problems” in inservice health records in December 2011 and January, February, March and April 2012. The record indicates the Veteran did not undergo a separation examination. (See June 2019 Hearing Transcript). However, based on the foregoing, the Veteran’s ocular hypertension diagnosed only once in service in September 2008 was acute and transitory and resolved without any residual disability. Consequently, service connection for ocular hypertension on the basis it became manifest in service and persisted is not warranted. On further review, the Board observes there is no diagnosis of ocular hypertension found in post-service VA outpatient treatment records, nor do medical records link an eye disorder to an event, injury or disease process during service. In September 2013 the Veteran underwent a VA eye examination. He reported that during active duty he was diagnosed with having ocular hypertension without glaucoma. Following physical examination, the examiner found the Veteran did not have nor had ever been diagnosed with an eye condition other than congenital or developmental errors of refraction. The examiner noted that the Veteran reported having untreated ocular hypertension of 21mmHg [millimeters of mercury] in both eyes; but an examination shows normal intraocular pressure of both eyes, which the examiner noted could be a low measurement as intraocular pressure does tend to be higher in the mornings. In a February 2014 VA medical opinion, a VA optometrist stated, "There is a diagnosis of ocular hypertension from [the Veteran’s] time in service. However, there is no disability associated with this condition. Ocular hypertension increases a patient’s risk of developing glaucoma, it does not cause a disability on its own.” A VA-contract examination was requested and completed in December 2019, along with a medical opinion. The Veteran reported a history of myopia, both eyes and blurred vision without glasses. The Veteran did not have any diagnosis of an eye disorder, other than congenital or developmental errors of refraction. The examiner did not diagnosis ocular hypertension. The examiner noted there were no ocular findings on examination other than myopia. There was no evidence of pre-glaucoma ocular hypertension on examination. In the December 2019 medical opinion, VA optometrist opined that the Veteran’s claimed eye disorder was less likely than not incurred in or caused by an inservice injury, event, or illness. The rationale was that there are no findings of ocular hypertension upon examination. The Board acknowledges the Veteran’s assertions that his ocular hypertension is related to service, and finds that he is not competent to render such an opinion. Although lay persons are competent to provide opinions on some medical issues, as to the specific issue in this case, etiology of ocular hypertension, falls outside the realm of common knowledge of a lay person. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and/or interpretation of complicated diagnostic medical testing. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (2007). As the competent evidence of record does not reflect that the Veteran has a current disability of ocular hypertension, he has not presented a valid claim of service connection for such disability, and the claim must be denied. See Brammer v. Derwinski, 3 Vet. App. 223 (1992). The threshold requirement for substantiating a claim of service connection is that there must be competent evidence of the disability for which service connection is sought. In the absence of any evidence of ocular hypertension during the pendency of the claim or at any time since service separation, the Board must find that service connection for ocular hypertension is not warranted. Accordingly, as the preponderance of the evidence is against the Veteran's claim, the "benefit of the doubt" rule does not apply. The claim is denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. In general, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, consideration also must be given as to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to an initial rating higher than 10 percent for adjustment disorder with mood disorder and alcohol dependence prior to December 10, 2019 2. Entitlement to a rating higher than 30 percent for adjustment disorder with mood disorder and alcohol dependence from December 10, 2019 The Veteran's service-connected adjustment disorder with mood disorder and alcohol dependence is rated under Diagnostic Code 9440, which pertains to chronic adjustment disorder. 38 C.F.R. § 4.130. Almost all mental health disorders (with exceptions not applicable here) are evaluated under the General Rating Formula for Mental Disorders (General Rating Formula), which assigns ratings based on particular symptoms and the resulting functional impairment. Id. Under the General Rating Formula, a 10 percent rating is assigned when there is occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. A 30 percent rating is assigned when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, or recent events). A 50 percent rating is assigned when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is assigned when there is 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; inability to establish and maintain effective relationships.) A 100 percent rating is assigned when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes 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; memory loss for names of close relatives, own occupation, or own name. Id. The symptoms associated with each evaluation under the General Rating Formula do not constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Thus, the evidence considered in determining the appropriate rating of a psychiatric disorder is not restricted to the symptoms set forth in the General Rating Formula. Id. Rather, VA must consider all symptoms of a claimant's condition that affect his occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-5). Id. at 443; see 38 C.F.R. § 4.130. VA implemented the DSM-5, effective August 4, 2014, and the Secretary, VA, determined that DSM-5 applies to claims certified to the Board on or after August 4, 2014. 79 Fed. Reg. 45,093, 45, (Aug. 4. 2014). In this case, the Veteran's appeal was certified to the Board in March 2017 ; hence; the DSM-5 is applicable in this claim. Nonetheless, with the adoption of the DSM-5, the general rating criteria remain the same, aside from no longer assigning a Global Assessment of Functioning score. 38 C.F.R. § 4.126(d). If the evidence demonstrates that the claimant's psychiatric disorder produces symptoms and resulting occupational and social impairment equivalent to that set forth in the criteria for a given rating in the General Rating Formula, then the appropriate, equivalent rating will be assigned. Mauerhan, 16 Vet. App. at 443. In this regard, the Board must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. 38 C.F.R. § 4.126; Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). While VA considers the level of social impairment, it shall not assign an evaluation based solely on social impairment. 38 C.F.R. § 4.126(b). Prior to December 10, 2019 The Veteran seeks a rating higher than 10 percent for his service-connected adjustment disorder with mood disorder and alcohol dependence for the period prior to December 10, 2019. The next higher 30 percent rating is warranted for the Veteran’s psychiatric disorder if his symptoms demonstrate occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). In this case, the Veteran’s psychiatric symptoms prior to December 10, 2019 are described in a September 2013 VA mental disorders examination report. In that report, the examiner explains that the Veteran’s symptoms developed as a response to stressors, which include marital problems and his grandfather’s suicide that occurred during the Veteran’s second deployment. The severity of the Veteran’s symptoms improved with treatment and at the time of the examination were minimal or mild with no reported disruptions in psychosocial functioning. The Veteran related having two close friends from childhood whom he sees regularly. He and his friends go “four wheeling”, have some drinks and sometimes sit around and talk for hours; when they feel like it, they work on vehicles. He also maintains occasional contact with some of the other men from his unit. He stated he keeps in contact with some of them via Facebook, and they plan to get back together when they return from Afghanistan. At the time of the examination, he reported working part-time with a contractor that does decorative concrete. He also reported that he was recently hired as a wire technician for a communications company and is looking forward to going back to work and eventually starting school. When he is not working, he watches movies and rides his motorcycle. In addition, he has gone out on dates. On mental status examination, the Veteran present casually dressed, with adequate hygiene. His speech was a regular rate and rhythm and non-pressured. His mood was reported as “fine”. He stated he was a little stressed because his “GPS got [him] lost”. His affect was appropriately expressive. His short- and long-term memory for history was grossly intact. His thought processes were logical, linear, and goal directed. He denied suicidal or homicidal ideation, plan, or intent. His insight and judgment were adequate. He denied any current alcohol or drug use prior to the examination. The examiner noted that in addition to the Veteran’s physically demanding part-time work, he also engages in yard work and sporadic weightlifting. The examiner summarized the Veteran’s level of occupational and social impairment as mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress or; symptoms controlled by medication. The examiner further noted that the estimation of symptom severity and impairment level is related solely to the Veteran’s diagnosis of adjustment disorder with depressed mood. His reported significant decreased in his alcohol consumption since beginning mental health treatment and any mild or transient difficulties in daily functioning can be attributed to adjustment disorder rather than alcohol dependence. The examiner diagnosed adjustment disorder with depressed mood and alcohol dependence, in partial remission. The Veteran did not report to a VA mental disorders examination scheduled in April 2015. In May 2015 the Veteran was seen at a VA psychiatry outpatient clinic for medication follow-up and assessment. He reported that the medication he takes has helped to take the edge off his anxiety, and he is coping better with stress. He reduced his medication for depression to one pill a day. He is sleeping well, but also working long hours and is exhausted, which at times interferes with sleep. He drinks about 1 to 2 beers a night. He has family support. On examination, the Veteran was cooperative, interactive, alert and oriented times 4. He was well-groomed and dressed appropriately for the weather. His speech was with regular rate, rhythm and volume. His mood was slightly dysphoric, and his affect was blunted. His memory was grossly intact; his thoughts were logical and goal oriented. He denied suicidal or homicidal ideation, plans, or intent. Judgment and insight related to treatment were fair. He denied auditory or visual hallucinations. The diagnoses were adjustment disorder with depressed mood, alcohol abuse, and legal issues. Based on the foregoing, the Board finds that the criteria for a rating higher than 10 percent prior to December 10, 2019 have not been satisfied for the Veteran’s adjustment disorder with mood disorder and alcohol dependence. A VA examiner in September 2013 related that the Veteran’s level of occupational and social impairment is due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress or; symptoms controlled by medication, which is consistent with a 10 percent rating. The symptoms described by the Veteran during the September 2013 VA examination and the May 2015 VA psychiatry outpatient clinic visit more nearly approximate the assigned 10 percent rating for the stated period. A higher rating was not met or approximated prior to December 10, 2019 because there was no demonstration of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). The Veteran described having meaningful and productive relationships with his close friends. He also maintains contact with some of his service buddies. He did not report having any problems or concerns regarding employment. In fact, he was recently hired as a wire technician for a communications company; and was looking forward to going back to work and eventually starting school. As the preponderance of the evidence weighs against an initial rating higher than 10 percent prior to December 10, 2019 for the Veteran's adjustment disorder with mood disorder and alcohol dependence, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. From December 10, 2019 The Veteran seeks a rating higher than 30 percent for his service-connected adjustment disorder with mood disorder and alcohol dependence for the period from December 10, 2019. To warrant the next higher 50 percent rating the Veteran’s psychiatric disorder must be manifest by symptoms that produce occupational and social impairment with reduced reliability and productivity. On December 2019 VA-contract mental disorders examination, the Veteran reported having mood swings; he stated that his mood goes “up and down,” and he has low motivation and is easily irritated. He has been consuming large amounts of alcohol since his fiancé left 2 months ago but stated that he hopes to get back on a routine now that he is working again. When he is not working, he gets up, eats, and pours a drink. He related that he was told that he has nightmares regularly, but he does not remember any. He did report having “on and off” sleep issues. He reported that he was married 2½ years before the marriage ended. He stated that when he came back from deployment, he was hard to get along with, and he would turn little things into big fights. He stated that he always gets along well with peers; he denied any trouble socially or withdrawal from activities of enjoyment. He moved to another state last year and did not know people outside of work; he has a small group of friends he talks to. He denied any occupational trouble. He stated he always did his job well. He likes his current job “a lot,” but has been out for a month receiving worker’s compensation for a broken finger. On mental status and behavioral observation, the examiner noted the Veteran was 15 minutes late for the session. He demonstrated adequate hygiene and personal grooming. He engaged with cooperation and did not demonstrate any impairment in communication. He did not demonstrate any overt symptoms of emotional distress. The Veteran appeared fully oriented and appeared to be a reliable historian. He related that he went to VA once, “maybe because of depression?” He was given medication and provided counseling that he states was not helpful. He denied any psychiatric hospitalization and denied any current medications. He stated his depression is “on and off.” He stated that years ago he cut himself a couple of times due to depression and went to VA to get stitches for the cuts and lied to them about it. He has not “cut” in many years. He denied current suicidal or homicidal ideations. He reported symptoms of depressed mood, chronic sleep impairment, and disturbances of motivation and mood. The examiner indicated in the examination report that the Veteran did not have more than one mental disorder diagnosed. The diagnosis was alcohol use disorder; symptoms of the diagnosis were depressed mood, chronic sleep impairment, and disturbances of motivation and mood. The examiner noted that the Veteran no longer met the criteria for adjustment disorder, as the previous stressors had resolved. He currently meets criteria for alcohol use disorder, which appears to be impacting his mood, sleep, and motivation. Although his alcohol abuse has increased with his fiancé moving away, the Veteran denied any significant anxiety or depression out of the context for that situation. The examiner noted that the new diagnosis is a completely new entity that has developed since the last examination. The Veteran’s alcohol dependence was reported to be associated to his adjustment disorder in the past evaluation. Although the stressors resolved, the Veteran continued drinking in excess despite knowing the negative consequences for his life. The examiner also found that a mental disorder had been formally diagnosed, but symptoms were not severe enough to interfere with occupational and social functioning or to require continuous medication. Moreover, the Veteran stated that he has returned to work, and his mood is much better because of it. He denied feeling any need for psychotherapy or psychotropic medication. He stated that his plan is to reduce the amount of alcohol he consumes and get into a “routine” but currently he is scattered with financial issues, working, and going to school. Based on the foregoing, the Board finds the criteria for a rating higher than 30 percent from December 10, 2019 have not been satisfied for the Veteran’s adjustment disorder with mood disorder and alcohol dependence. On December 2019 VA examination the Veteran’s diagnosis was alcohol use disorder with symptoms of depressed mood, chronic sleep impairment, and disturbances of motivation and mood; but findings from the examination indicate the Veteran’s reported symptoms are not severe enough to interfere with occupational and social functioning or to require continuous medication. The examiner determined the Veteran no longer met criteria for adjustment disorder as the previous stressors had resolved. He currently meets the criteria for alcohol use disorder, which was associated with his adjustment disorder in his past evaluation. The changed diagnosis has impacted the Veteran’s mood, sleep and motivation. There is no evidence that indicates the Veteran’s diagnosed alcohol use disorder is manifested with symptoms productive of occupational and social impairment with reduced reliability and productivity to warrant the next higher 50 percent rating for the period from December 10, 2019. As the preponderance of the evidence weighs against a rating higher than 30 percent from December 10, 2019 for the Veteran’s service-connected adjustment disorder with mood disorder and alcohol dependence, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to an initial rating higher than 10 percent for bilateral foot disability The Veteran's bilateral foot disability was initially granted with a noncompensable rating under Code 5276 in a February 2014 rating decision, effective from June 21, 2012, the day after the Veteran’s discharge from active duty. In a June 2020 rating decision, the noncompensable rating was increased to 10 percent effective the same date, June 21, 2012. The Board notes that the Veteran's bilateral foot disability is rated by analogy under Code 5276. Under Code 5276, bilateral flatfoot warrants a 10 percent evaluation when symptoms present as moderate, with 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. A 30 percent evaluation may be assigned for severe bilateral flatfoot manifested by objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indications of swelling on use, and characteristic callosities. A maximum 50 percent evaluation may be assigned for pronounced bilateral flatfoot manifested by marked pronation, extreme tenderness of the plantar surfaces of the feet, marked inward displacement and severe spasm of the Achilles tendon on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Code 5276. The evidence shows the Veteran’s bilateral foot disability began while in service and is noted sporadically throughout his service treatment records. A November 2008 service treatment record shows the Veteran had bilateral foot pain with weight-bearing. He received diagnoses of plantar fasciitis and flat foot. A February 2012 service treatment record shows he registered complaints of bilateral foot pain and received diagnoses of bilateral plantar fasciitis and plantar fasciosis. Following separation from service, in September 2013, the Veteran underwent a VA foot examination for other than flatfoot/pes planus. During the examination, the Veteran reported that he sustained an acute hyper plantar flexion injury in service while moving heavy equipment. He was eventually seen by podiatry and given a micro fasciotomy (injection) that provided about 50 percent improvement. He stated that since leaving active duty, the improvement is down to 5 percent. He regularly uses an assistive device, that is, molded inserts for his shoes. On diagnostic testing, degenerative or traumatic arthritis was document in multiple joints of his feet. A small retrocalcaneal spur was shown of only the right foot. He reported that his bilateral foot disability impacts his ability to work when it involves a moderate degree of walking, (especially on uneven and hard-surfaced terrain), or prolonged standing or jumping, or involves repetitive stairs or climbing ladders. The diagnoses were connective tissue strain right foot and plantar fascial fibromatosis. On December 2019 VA-contract foot conditions, including flatfoot/pes planus examination, the Veteran reported that he has ongoing intermittent symptoms of pain; pain occurs with certain movement. He stated at times the right foot hurts so much that he cannot bear to put weight on it. The pain comes and goes. Sometimes if he walks “wrong,” he experiences a shooting pain that prevents him from walking during that episode. He described the level of pain at 8-9/10. The pain lasts anywhere from a few seconds to a few minutes. On examination, the Veteran had pain on use of his feet. He tried arch supports but remains symptomatic. He did not have pain on manipulation of the feet, or characteristic calluses. There was no indication of swelling of the feet on use. He did not have extreme tenderness of the plantar surfaces, bilaterally. He did not have decreased longitudinal arch height, bilaterally, on weight-bearing. There was no objective evidence of marked deformity or marked pronation. The weight-bearing line does not fall over or medial to the great toe. He does not have inward bowing of the Achilles tendon or marked inward displacement and severe spasm of the Achilles tendon on manipulation. He does not have Morton’s neuroma, metatarsalgia, hammer toe, hallux valgus, hallux rigidus, or pes cavus. There was pain noted on physical examination, but it did not contribute to functional loss. The Veteran did not have functional loss attributable to his bilateral foot disability. There was pain, weakness, fatigability, or incoordination that significantly limits his functional ability during flare-ups or when his feet are used repeated over a period of time. For example, the Veteran stated that if he walks wrong the pain shoots up and he cannot walk at that time; he has to stand and wait or try to sit down. Degenerative or traumatic arthritis was not shown in the results of imaging studies. The diagnoses were bilateral plantar fascial fasciitis and connective tissue strain of the right foot. The Veteran did not have any foot disability other than those diagnosed. He related that his bilateral plantar fascial fasciitis and connective tissue strain of the right foot impacts his normal function at times, that is, if he walks wrong and experiences severe shooting pain, he cannot walk during the episode. The Veteran did not report current employment, but indicated he lost one to two weeks work in the last 12 months. The Board finds that a rating higher than 10 percent for bilateral foot disability is not warranted. For a higher 30 percent rating, the evidence must show severe bilateral flatfoot manifested by objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indications of swelling on use, and characteristic callosities. Here, the Veteran's symptoms do not warrant higher than a 10 percent evaluation. The examiners reported there was no marked deformity, pain on manipulation, swelling on use, or characteristic calluses. As such, the next higher rating of 30 percent is not warranted. Additional factors that could provide a basis for an increase have also been considered; however, the evidence does not show the Veteran has functional loss, including due to pain, weakness, fatigability, or incoordination beyond that currently compensated. See 38 C.F.R. §§ 4.40, 4.45. The Board notes that the current 10 percent rating assigned for bilateral foot disability contemplates a moderate level of overall foot disability. Thus, although the bilateral foot disability may limit how long the Veteran can stand and how far he can walk and may also result in difficulty with doing work that requires extended standing or walking, such functional limitations are reflected in the current rating assigned. The objective medical evidence in this case provides highly probative evidence against assigning a higher rating for bilateral foot disability. The Board notes that Codes 5277 (weak foot), 5278 (claw foot (pes cavus)), 5279 (anterior metatarsalgia), 5280 (hallux valgus), 5281 (hallux rigidus), 5282 (hammer toe), and 5283 (malunion of the tarsal or metatarsal bones) are not for consideration here, as there is no evidence that the Veteran has any such disorders. The Board has also considered the Veteran’s statements that the bilateral foot disability warrants a higher disability rating. However, while he is competent to report his symptoms to the extent they come from his senses, he is not competent to identify a specific level of disability relating to an appropriate diagnostic code. Other Considerations Pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009), a claim for a total disability rating based on individual unemployability is considered part and parcel of an increased rating claim when the issue of unemployability is raised by the record. In this case, the issue of unemployability is not raised by the record. It appears the Veteran has been employed throughout the pendency of this appeal. During the December 2019 VA-contract mental disorders examination, he reported working in electrical maintenance for a year and quit for a pay increase at another job, which he likes. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017). A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Young, 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.