Citation Nr: 21001917 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 15-35 956 DATE: January 12, 2021 ORDER A rating higher than 10 percent for bilateral plantar fasciitis prior to September 25, 2020, is denied. A rating higher than 50 percent for bilateral plantar fasciitis as of September 25, 2020, is denied. A rating higher than 10 percent for degenerative joint disease with chondromalacia of the left knee is denied. A compensable rating for dry eye syndrome prior to April 4, 2012, is denied. A rating higher than 30 percent for bilateral glaucoma with glaucomatous optic atrophy and dry eye syndrome as of April 4, 2012, is denied. Service connection for posttraumatic stress disorder (PTSD) is denied. Service connection for major depressive disorder and anxiety disorder is granted. FINDINGS OF FACT 1. Prior to September 25, 2020, the Veteran’s bilateral plantar fasciitis manifested as bilateral foot pain that was exacerbated by prolonged weight-bearing and was treated with prescription pain medication, special shoes, orthotic inserts, steroid injections, and stretching. 2. As of September 25, 2020, the Veteran’s bilateral plantar fasciitis manifests as moderate to severe bilateral foot pain with pes planus that was exacerbated by prolonged weight-bearing and was treated with prescription pain medication, special shoes, orthotic inserts, steroid injections, and stretching. 3. The Veteran’s degenerative joint disease with chondromalacia of the left knee manifests as left knee pain, intermittent swelling, limitation of flexion to no less than 120 degrees, subjective reports of instability, and small, stable, nonpainful scars. 4. Prior to April 4, 2012, the Veteran’s dry eye syndrome manifested as dryness treated with eye drops, results in no other objective symptomatology, visual impairment, or incapacitating episodes. 5. As of April 4, 2012, the Veteran’s bilateral glaucoma with glaucomatous optic atrophy and dry eye syndrome manifests as dryness and decreased visual fields to no less than 42 degrees in the right eye and no less than 37.75 in the left eye. 6. The preponderance of the evidence of record, on balance, is against finding that the Veteran has had posttraumatic stress disorder (PTSD) at any time during or approximate to the pendency of the claim. 7. The Veteran’s major depressive disorder and anxiety disorder are related to racism/discrimination during service in Kuwait. CONCLUSIONS OF LAW 1. Prior to September 25, 2020, the criteria for a rating higher than 10 percent for bilateral pes planus were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code (DC) 5276. 2. As of September 25, 2020, the criteria for a rating higher than 50 percent for bilateral pes planus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code (DC) 5276, 5284. 3. The criteria for a rating higher than 10 percent for degenerative joint disease with chondromalacia of the left knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5010-5260. 4. Prior to April 4, 2012, the criteria for a compensable rating for dry eye syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.75-4.79, Diagnostic Codes 6013-6080. 5. As of April 4, 2012, the criteria for a rating higher than 30 percent for bilateral glaucoma with glaucomatous optic atrophy and dry eye syndrome have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.75-4.79, Diagnostic Codes 6013-6080. 6. The criteria for service connection for posttraumatic stress disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f). 7. The criteria for service connection for major depressive disorder and anxiety disorder are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1987 to July 1987 and from October 2009 to May 2011. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for dry eye syndrome, glaucoma with glaucomatous optic atrophy, bilateral plantar fasciitis, degenerative joint disease with chondromalacia of the left knee, and allergic reaction to anthrax vaccine; established eligibility for treatment; and denied service connection for an acquired psychiatric disability, a dental condition, and rhinitis. In a May 2014 notice of disagreement, the Veteran appealed the initial ratings for degenerative joint disease with chondromalacia of the left knee, bilateral plantar fasciitis, and his eye disability, and the denials of service connection for acquired psychiatric disability and rhinitis. The RO issued a statement of the case in July 2015 and the Veteran perfected his appeal with a September 2015 VA Form 9. In July 2018, the Board remanded this case for further development. In an October 2020 rating decision, the Veteran’s rating for bilateral plantar fasciitis was increased to 50 percent effective September 25, 2020. This is the maximum rating available under Diagnostic Code 5276. The Veteran is presumed to be seeking the maximum benefit available unless he explicitly limits the scope of his appeal. See AB v. Brown, 6 Vet. App. 35 (1993). The Veteran’s bilateral plantar fasciitis is currently rated by analogy under Diagnostic Code 5276, which provides for a maximum 50 percent rating. See 38 C.F.R. § 4.71a. Higher ratings are also potentially available under alternate diagnostic codes since plantar fasciitis is not specifically listed in the VA Rating Schedule. See Copeland v. McDonald, 27 Vet. App. 333, 337 (2015). This rating decision also granted service connection for rhinitis, which is a full grant of the benefit sought and this issue is no longer before the Board. Finally, this rating decision granted service connection for left knee scars. While the Veteran initially claimed service connection for PTSD, VA subsequently recharacterized the claim as service connection for an acquired psychiatric disability pursuant to Clemons v. Shinseki, 23 Vet. App. 1 (2009). Below, the Veteran is ultimately successful with this claim with regard to his depressive disorder and anxiety disorder diagnoses. However, as he specifically claimed PTSD, the Board has separated that diagnosis out to provide clarification for why service connection was not granted under that diagnosis. 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 “staging the ratings.” See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008). 1. A rating higher than 10 percent for bilateral plantar fasciitis The Veteran was originally granted service connection for bilateral plantar fasciitis in the September 2013 rating decision on appeal. At that time, this disability was assigned a 10 percent rating effective May 3, 2011. In an October 2020 rating decision, this rating was increased to 50 percent effective September 25, 2020, resulting in a staged rating. This disability was originally rated under hyphenated diagnostic code 5299-5276. Hyphenated diagnostic codes are used when a rating under one DC requires use of an additional DC to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number is “built up” with the first two digits being selected from that part of the schedule most closely identifying the part, and the last two digits being “99” for an unlisted condition. Id. Under DC 5276, mild flatfoot with symptoms relieved by built-up shoe or arch support is rated as noncompensably (0 percent) disabling. Moderate flatfoot with weight-bearing line over or medial to the great toe, inward bowing of the atendo achillis, pain on manipulation and use of the feet, bilateral or unilateral, is rated 10 percent disabling. Severe flatfoot, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities, is rated 20 percent disabling for unilateral disability, and is rated 30 percent disabling for bilateral disability. Pronounced flatfoot, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation, that is not improved by orthopedic shoes or appliances, is rated 30 percent disabling for unilateral disability, and is rated 50 percent disabling for bilateral disability. 38 C.F.R. § 4.71a. Under DC 5284, other foot injuries are rated 10 percent disabling when moderate, 20 percent disabling when moderately severe, and 30 percent disabling when severe. 38 C.F.R. § 4.71a. DC 5284 refers to “other” foot injuries and applies to foot disabilities for which there is not already a specific diagnostic code, such as in this case. See Copeland v. McDonald, 27 Vet. App. 333, 337 (2015) (holding that when a when a condition is specifically listed in the Schedule, it may not be rated by analogy under Diagnostic Code 5284). As indicated below, the Veteran has been diagnosed with bilateral pes planus, and the Board will therefore focus on the criteria of DC 5276. Words such as “moderate,” “moderately severe,” and “severe” are not defined in the Rating Schedule or in the regulations. Consequently, the Board must evaluate all of the evidence to ensure that its decisions are “equitable and just as contemplated by the requirements of the law.” 38 C.F.R. § 4.6. Under DC 5167, actual loss of use of the foot, warrants a 40 percent rating. 38 C.F.R. § 4.71a. Prior to September 25, 2020 VA and private treatment records from this period show bilateral plantar fasciitis characterized by foot pain and treated with prescription pain medication, special shoes, custom orthotic inserts, steroid injections, and stretching. An April 2012 VA foot disability benefits questionnaire (DBQ) diagnoses bilateral plantar fasciitis. The Veteran reported treatment with custom inserts and pain medication. The Veteran’s symptoms were moderately severe and described as exquisite pain in the soles of his feet. He did not have any associated scars or any other pertinent physical findings, conditions, signs, or symptoms. He constantly used custom inserts for his plantar fasciitis. This disability did not result in functional impairment of an extremity such that no effective function remained other than that which would be equally well served by amputation and prosthesis. Imaging studies found no abnormalities. This disability impacted the Veteran’s ability to work in that he could not stand for more than a half an hour without pain. His current job required six to seven hours of standing, which made working very painful. An August 2017 x-ray found a posterior calcaneal spur with a fracture at the base of the spur. The fracture fragments were nondisplaced. Based on the above, prior to September 25, 2020, the Veteran’s bilateral plantar fasciitis manifested as bilateral foot pain that was exacerbated by prolonged weight-bearing and was treated with prescription pain medication, special shoes, orthotic inserts, steroid injections, and stretching. Functionally, he reported that he could not stand for more than a half hour without pain, which made the five to six hours of standing required for his job very painful. The Veteran’s current 10 percent rating reflects symptoms equal to moderate bilateral pes planus characterized by weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet. See 38 C.F.R. § 4.71a, DC 5276. A higher rating under this diagnostic code would require symptoms equal to severe pes planus in one or both feet, such as objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. See id. None of these symptoms is shown here. While the disability was characterized as moderate to severe, the absence of the symptoms signifying a severe disability renders the disability more properly characterized as moderate in degree. As the Veteran’s bilateral foot disability is characterized by pain that increases with use, it most nearly approximates the criteria for the current 10 percent rating under DC 5276. Therefore, a rating higher than the current 10 percent is not warranted, and this claim is denied. As of September 25, 2020 A September 25, 2020 foot conditions DBQ diagnosed bilateral plantar fasciitis and bilateral pes planus. The Veteran reported sharp pain in the heel and arch area (left worse than right) that was aggravated by prolonged weight-bearing and was worse with the first steps in the morning. He treated this with stretching, orthotic inserts, pain medication, steroid injections, acupuncture, and antiinflammatory gel. The Veteran reported flare ups and functional loss in that this disability limited prolonged weight-bearing. The Veteran had pain on use of both feet that was accentuated with use. He also had pain with manipulation of both feet that was accentuated on manipulation. There was no indication of swelling on use and no calluses characteristic of pes planus. He used orthotics on both feet. He did not have extreme tenderness of the plantar surfaces of either foot. He had decreased longitudinal arch height of both feet on weight-bearing. There was objective evidence of marked deformity and marked pronation in both feet. Pronation was not improved by orthopedic shoes or appliances. Neither foot’s weight-bearing line fell over or medial to the great toe. There was no other lower extremity deformity causing alteration of the weight-bearing line. The Veteran did not have inward bowing, marked inward displacement, or severe spasm of either Achilles’ tendon. The Veteran did not have any other foot injuries or conditions. He had not undergone any foot surgery. Pain was present in both feet during physical examination. His functional impairment included pain with weight-bearing, disturbance of locomotion, and interference with standing. There was additional functional loss due to pain during flare-ups or when the joints were used repeatedly over time in that prolonged weight-bearing was limited. He did not have any associated scars or any other pertinent physical findings, conditions, signs, or symptoms. He did not use an assistive device as a normal means of locomotion. This disability did not result in functional impairment of an extremity such that no effective function remained other than that which would be equally well served by amputation and prosthesis. Imaging studies found no abnormalities. This disability impacted the Veteran’s ability to work in that his bilateral foot disability limited prolonged weight-bearing. Pain was noted during weight-bearing of both feet, which was attributed to plantar fasciitis. No pain was found with nonweight-bearing or with either active or passive motion. As noted above, the Veteran’s bilateral plantar fasciitis was awarded a 50 percent rating for this period under DC 5276 for pes planus, which is the maximum rating available under this diagnostic code. The Veteran has not argued, nor does the record suggest, that this rating does not adequately contemplate his symptoms; he has provided no further argument as to the rating since its recent increase. 38 C.F.R. § 3.321(b)(1). This claim is accordingly denied. 2. A rating higher than 10 percent for degenerative joint disease with chondromalacia of the left knee The Veteran was originally granted service connection for degenerative joint disease with chondromalacia of the left knee in the September 2013 rating decision on appeal. At that time, this left knee disability was rated 10 percent effective May 3, 2011. In an October 2020 rating decision, he was also granted service connection for left knee scars with a noncompensable (0 percent) rating effective May 3, 2011. This left knee disability is rated under hyphenated diagnostic code 5010-5260. Hyphenated diagnostic codes are used when a rating under one DC requires use of an additional DC to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. DC 5010 provides rating criteria for traumatic arthritis. Under DC 5010, traumatic arthritis substantiated by x-ray findings is rated as degenerative arthritis (DC 5003); meaning that a rating under this DC will be based either on limitation of motion of the affected joint under the appropriate diagnostic code or, if only a noncompensable limitation of motion is found, a 10 percent rating will be assigned for each affected major joint or group of minor joints. 38 C.F.R. § 4.71a. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. In the absence of limitation of motion, a 10 percent rating is warranted if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and a 20 percent rating is warranted if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. Id. Under DC 5260 for limitation of flexion of the leg, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.” The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. VA treatment record for this period show complaints of left knee pain, intermittent swelling, limitation of flexion to no less than 120 degrees, and subjective reports of instability. The April 2012 VA knee DBQ diagnoses degenerative joint disease and chondromalacia with laceration scar. The Veteran reported pain and swelling, but not instability. He did not report flare-ups. He had full range of motion in the right knee with no objective evidence of painful motion. In the left knee, he had full range of motion with objective evidence of painful motion beginning at 135 degrees of flexion. He was able to perform repetitive use testing without additional limitation of motion. His functional impairment included pain on movement, swelling, and interference with sitting, standing, and weight-bearing in the left knee. He had tenderness or pain to palpation for joint line or soft tissues of the left knee. He had full muscle strength bilaterally. Stability testing was normal. There was no current evidence or history of recurrent patellar subluxation or dislocation in either knee. He did not currently have, nor had he ever had “shin splints” (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome, or any other tibial and/or fibular impairment. He had not had any meniscal conditions or surgical procedure for a meniscal condition. He had not had total knee replacement, arthroscopic, or other knee surgery. He had an associated scar on the lateral aspect of the left knee measuring 3 centimeters by 3 centimeters, but it was not painful or unstable. He used a left knee brace almost all of the time. This disability did not result in functional impairment of an extremity such that no effective function remained other than that which would be equally well served by amputation and prosthesis. Imaging studies found traumatic arthritis in the left knee, but not evidence of patellar subluxation. An MRI found partial thickness cartilage loss involving the posterior aspect of the lateral femoral condyle, mild Baker’s cyst, and mild edema at the pes anserinus insertion. This disability impacted the Veteran’s ability to work in that standing and walking, which were part of his job, produced left knee pain. A June 2013 VA doctor’s note states that the Veteran was unable to stand for more than one hour at a time on his left knee due to underlying degenerative changes. A May 2014 VA doctor’s note states that the Veteran would be missing work for one week due to his left knee disability. The Veteran underwent arthroscopic surgery of his left knee in December 2014. This surgery included arthroscopic removal of cartilaginous loose bodies and lateral retinacular release of the left knee. A May 2016 VA x-ray found minimal osteoarthritic change involving the patellofemoral compartment and mild spurring along the lateral femoral condyle. An August 2016 VA MRI found mild osteoarthritis changes in the medial compartment, a small nondisplaced tear involving the posterior horn of the medial meniscus, and a small Baker’s cyst. In June 2017, the Veteran underwent a medial meniscectomy and removal of Baker’s cyst. A September 2017 private treatment record noted normal gait and left knee range of motion from zero to 120 degrees. An April 2018 VA treatment record notes a return of knee pain, coinciding with a change in the Veteran’s position at work that resulted in him walking a lot on concrete. After this appointment, the Veteran’s orthopedic surgeon wrote him a note stating that he needed to be out of work until this condition improved. The date of his return to work after that period is not of record. Subsequent records show that the Veteran lost this job in September 2018, reportedly due to interpersonal conflicts with a co-worker that had been present at least since June of that year. He has since found a new job. The September 2020 VA knee DBQ notes the Veteran’s complaints of daily left knee pain that was aggravated by prolonged walking, stairclimbing, bending, and kneeling. He had intermittent swelling. He stated that his left knee gave way, causing him to fall four times. He treated this disability with bracing, pain medication, and injections. The Veteran reported flare-ups with increased activity, which slowed him down and caused him to miss time from work. His functional impairment included limitation to prolonged walking, bending, and stairclimbing. The Veteran had full range of motion in his right knee without objective evidence of pain on examination. He did, however, have localized tenderness or pain on palpation of the right knee joint or associated soft tissue which was not associated with his left knee disability. There was no evidence of pain with weight bearing and no objective evidence objective evidence of pain on non-weight bearing or crepitus. His left knee also had full range of motion, but there was objective evidence of pain with flexion. Additionally, he had moderate localized tenderness or pain on palpation of the left knee joint or associated soft tissue located along the lateral joint line and medial/lateral patellar facet. There was no evidence of pain with weight bearing and no objective evidence of pain on non-weight bearing or crepitus. Passive range of motion was the same as active range of motion for both knees. The Veteran was able to perform repetitive use testing without additional limitation of motion in either knee. The Veteran was not being examined immediately after repetitive use over time or during a flare-up and the examiner found that the examination was neither medically consistent nor inconsistent with the Veteran’s statements describing functional loss with repetitive use over time or during a flare-up. Pain, weakness, fatigability or incoordination did not significantly limit functional ability in the right knee with repeated use over a period of time or during a flare-up. In the left knee, intermittent moderate daily pain caused additional functional loss with repeated use over a period of time or during a flare-up, including difficulty with prolonged walking, negotiating stairs, bending, and kneeling, but the examiner was unable to describe this additional limitation in terms of range of motion. The Veteran had full muscle strength bilaterally without atrophy. There was no ankylosis in either knee. There was no history or recurrent subluxation or lateral instability. The Veteran reported recurrent effusion, but none was present at the time of the examination. Stability testing was performed and all tests results were normal bilaterally. He did not currently have, nor had he ever had “shin splints” (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome, or any other tibial and/or fibular impairment. The Veteran had a history of left medial meniscectomy for a meniscal tear with frequent episodes of joint pain. He did not have any other pertinent physical findings, complications, conditions, signs or symptoms related to his left knee disability. He had an associated scar superlateral to left patella measuring 1 cm by .5 cm and an inferomedial to left patella scar measuring 2 cm by .3 cm. These scars were not painful or unstable. The Veteran regularly wore bilateral knee braces and occasionally used a walking stick as a normal mode of locomotion due to left knee and bilateral foot pain. This disability did not result in functional impairment of an extremity such that no effective function remained other than that which would be equally well served by amputation and prosthesis. The Veteran’s left knee disability impacted his ability to work in that it limited prolonged walking, negotiating stairs, bending, and kneeling. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for degenerative joint disease with chondromalacia of the left knee. This reflects the Veteran’s painful motion that results in a noncompensable degree of limitation of flexion. See 38 C.F.R. § 4.71a, DC 5010. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain, pain during flare-ups, and/or pain during repetitive use over time. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by these statements would not result in limitation of motion more nearly approximating flexion limited to 30 degrees. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). There was no finding of ankylosis, so a rating under DC 5256 is not warranted. Despite subjective complaints of instability, objective stability testing was repeatedly normal, and the Veteran did not have recurrent patellar subluxation/dislocation of the right knee. Any instability that has existed at any time would thus be considered less than “slight” in degree. Therefore, a separate rating under DC 5257 is not warranted. With regard to DC 5259, the Veteran reported a history of episodes of pain and intermittent, not frequent, swelling. The record does not show frequent, or indeed any, episodes of locking. As such, a 20 percent rating under DC 5259 for dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion is not warranted. Limitation of extension, contemplated by DC 5261, has not been shown in this case. Likewise, there was no evidence of malunion or nonunion of the tibia and fibula upon which a rating under DC 5262 could be based. Finally, the record does not show genu recurvatum; thus, DC 5263 is not applicable. The Veteran is currently service connected for associated scar with a noncompensable (0 percent) rating, which he did not appeal. The evidence of record, which shows a small, stable, and not painful scar of the knee does not suggest any symptoms which would warrant reconsideration of that rating. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 10 percent for degenerative joint disease with chondromalacia of the left knee. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 C.F.R. § 4.7. 3. A compensable rating for bilateral glaucoma with glaucomatous optic atrophy and dry eye syndrome The Veteran was originally granted service connection for dry eye syndrome and glaucoma with glaucomatous optic atrophy in the September 2013 rating decision on appeal. At that time, his dry eye syndrome was rated noncompensable (0 percent) effective May 3, 2011, and his bilateral glaucoma was rated 30 percent effective April 4, 2012. These ratings are combined into a single staged rating for bilateral eye disability, which is rated under hyphenated diagnostic code 6013-6080. Hyphenated diagnostic codes are used when a rating under one DC requires use of an additional DC to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye.  89 Fed. Reg. 15,316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. Under the former criteria, DC 6013 instructed the rater to evaluate open-angle glaucoma based on visual impairment with a minimum 10 percent evaluation if continuous medication was required. 38 C.F.R. § 4.79 (2011). Under the current criteria, DC 6013 instructs the rater to evaluate open-angle glaucoma under the General Rating Formula for Diseases of the Eye with a minimum 10 percent evaluation if continuous medication was required. 38 C.F.R. § 4.79. Under the revised criteria, the General Rating Formula for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where there are documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months, a 10 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months, a 20 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition during the past 12 months, a 40 percent rating is warranted. Where there are documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months, a 60 percent rating is warranted. Note (1) indicates that, for the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note (2) indicates that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. Note (3) indicates that, for the purposes of evaluating visual impairment due to a particular condition, refer to 38 C.F.R. § 4.75-4.78 and to § 4.79, DCs 6061-6091. The criteria for visual impairment, including impairments of visual acuity, visual fields, and/or muscle function, have remained unchanged. Impaired visual acuity is rated under diagnostic codes 6061-6066 based on the best corrected distance vision. 38 C.F.R. §§ 4.76, 4.79. Impairment of visual fields are rated under DC 6080-6081 based on the average concentric contraction of the visual field of each eye; asymmetric impairments are converted to their visual acuity equivalents. 38 C.F.R. §§ 4.77, 4.79. Impaired muscle function is rated under DC 6090-6091 with an evaluation for diplopia being assigned to only one eye. 38 C.F.R. §§ 4.78, 4.79. Diagnostic Code 6080 provides that concentric contraction of visual field to 5 degrees warrants a 100 percent disability rating for bilateral loss, a 30 percent disability rating for unilateral loss, or is rated as 5/200 (1.5/60). Concentric contraction of visual field to 15 degrees, but not to 5 degrees, warrants a 70 percent disability rating for bilateral loss, a 20 percent disability rating for unilateral loss, or is rated as 20/200 (6/60). Concentric contraction of visual field to 30 degrees, but not to 15 degrees, warrants a 50 percent disability rating for bilateral loss, a 10 percent disability rating for unilateral loss, or is rated as 20/100 (6/30). Concentric contraction of visual field to 45 degrees, but not to 30 degrees, warrants a 30 percent disability rating for bilateral loss, a 10 percent disability rating for unilateral loss, or is rated as 20/70 (6/21). Concentric contraction of visual field to 60 degrees, but not to 45 degrees, warrants a 20 percent disability rating for bilateral loss, a 10 percent disability rating for unilateral loss, or is rated as 20/50 (6/15). Bilateral loss of the temporal half of the visual field warrants a 30 percent disability rating, unilateral loss warrants a 10 percent disability rating, or is rated as 20/70 (6/21). Bilateral loss of the nasal half of the visual field warrants a 20 percent disability rating, unilateral warrants a 10 percent disability rating, or is rated as 20/50 (6/15).   38 C.F.R. § 4.84a, Diagnostic Code 6080 (2008). The normal visual field extent at eight principal meridians is (expressed in degrees): Temporally: 85, Down temporally: 85, Down: 65, Down nasally: 50, Nasally: 60, Up nasally: 55, Up: 45, Up temporally: 55. The combined sum is 500. To calculate the visual field, determine the average concentric contraction of the visual field of each eye by measuring the remaining visual field (in degrees) at each of eight principal meridians 45 degrees apart, adding them, and dividing the sum by eight. 38 C.F.R. § 4.76a. Dry eye syndrome, also referred to as keratoconjunctivitis sicca, is not a condition specifically listed in the rating schedule, so it should be rated by analogy to a closely related disease or injury. See 38 C.F.R. § 4.20. It is permissible to rate under a closely rated disease or injury in which the functions affected, anatomical location, and symptomatology are closely analogous. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). In this instance, DCs 6000-6091 relate to disabilities of the eye and, therefore, have an analogous anatomical location. Prior to April 4, 2012 VA treatment records from this period show a diagnosis of bilateral dry eye syndrome, bilateral refractive error, and suspected cataracts. His dry eye syndrome was characterized by dryness and irritation and treated with lubricating eye drops. This dryness caused a temporary additional decrease in visual acuity at the time of his December 2011 VA eye appointment, recorded as 20/25 bilaterally, but was not otherwise associated with any visual impairment, such as impairments of visual acuity, visual fields, and/or muscle function. As such, there is no showing of a compensable visual impairment. Likewise, no associated incapacitating episodes were shown. Instead, the Veteran’s dry eye syndrome is characterized by dryness and irritation necessitating regular use of eye drops. These symptoms are not directly contemplated by any of the diagnostic codes related to the eyes. To the extent that these symptoms are inadequately addressed by the rating criteria, the Board has considered whether an extraschedular rating is necessary. In this case, however, the record does not suggest, and the Veteran does not assert, that his decreased color differentiation results in marked interference with employment or frequent periods of hospitalization. See Thun v. Peake, 22 Vet. App. 111 (2008). As such, referral to the Director of Compensation Services for extraschedular consideration is not necessary. See Thun, supra. Thus, a compensable rating for dry eye syndrome prior to April 4, 2012, is not warranted and, to that extent, the Veteran’s appeal is denied. As of April 4, 2012 The April 4, 2012 VA eye DBQ notes that the Veteran’s dry eyes began in service and he treated this disability with lubricating eye drops. His distance visual acuity without correction was 20/60 bilaterally, corrected to 20/25 bilaterally. His near vision was 20/25 bilaterally without correction and 20/20 with correction. His visual fields were full to confrontation testing. He had full motility and no diplopia. His pupils were round and reactive to light. He had no afferent pupillary defect. External examination of the eyes, lids, and lashes was normal for both eyes. Slit lamp examination found inferior nasal superficial punctate keratitis bilaterally, and changes in the meniscal lamellar thickness. The Veteran was diagnosed with bilateral glaucoma with associated visual field loss and glaucomatous optic atrophy, dry eye syndrome, and incipient cataracts that caused decreased visual acuity. He had loss of visual field as described below: Meridian Normal Right Eye Left Eye Up 45 12 10 Up temporally 55 26 20 Temporally 85 53 56 Down temporally 85 71 66 Down 65 63 53 Down nasally 50 48 47 Nasally 60 47 37 Up nasally 55 16 10 Total: 500 336 302 Average: 62.5 42 37.75 The Veteran’s bilateral eye disability did not impact his employment. VA treatment records from this period shows the Veteran’s complaints of dry eyes, visual field constriction despite repeatedly being full to finger count, full extraocular movements, some loss of visual acuity that was correctable to 20/40 or better bilaterally, and normal color vision. He treated his glaucoma and dry eye syndrome with medicated eye drops. These records also suggest left homonymous hemianopsia with a neurologic, not glaucomatous, origin. A May 2012 letter to the Veteran from his VA provider notes that the results of his visual field test were not consistent with previous visual fields. Usually visual fields that show glaucoma are consistent with each other. Therefore, it was necessary to repeat the visual field to determine whether the Veteran needed to start medication or see a glaucoma specialist. The August 2019 eye DBQ notes diagnoses of dry eye syndrome and glaucoma with glaucomatous optic atrophy. The Veteran’s uncorrected near and distance vision were 20/10 bilaterally, all corrected to 20/20 or better. His pupils were round and reactive to light. He had no afferent pupillary defect. He did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. He did not have a corneal irregularity that results in severe irregular astigmatism. He did not have diplopia. External eye examination was normal. Internally, he had cupping and thinning of the optic discs consistent with glaucoma. He had a visual field defect, described below, but not loss of a visual field or scotoma. The Veteran had dry eye syndrome that he treated with both over-the-counter artificial tears and prescription medication. He also had bilateral open-angle glaucoma, which required continuous medication for treatment. His visual impairment was attributable to his glaucoma, not his dry eyes. He had not had any incapacitating episodes attributable to any eye condition within the prior 12 months. This disability did not impact his ability to work. The Veteran had loss of visual field as described below (the fields that exceeded the normal degrees have been listed as the maximum normal measurement): Meridian Normal Right Eye Left Eye Up 45 35 38 Up temporally 55 55 55 Temporally 85 70 40 Down temporally 85 70 28 Down 65 20 20 Down nasally 50 20 40 Nasally 60 38 50 Up nasally 55 50 55 Total: 500 358 326 Average: 62.5 44.75 40.75 Based on the above, the Veteran’s bilateral eye disability manifests as decreased visual field with average concentric contraction to no less than 42 degrees in the right eye and no less than 37.75 in the left eye. This warrants the current 30 percent rating under DC 6080. A higher rating under this diagnostic code would require an average concentric contraction of 30 degrees or less in either eye. The Veteran has no other visual impairment as his corrected visual acuity was consistently 20/40 or better, and he has no impairment of muscle function. Similarly, he has had no incapacitating episodes due to his eye disability. Thus, the Veteran’s bilateral glaucoma with glaucomatous optic atrophy and dry eye syndrome does not warrant a disability rating higher than the current 30 percent, and, therefore, his appeal is denied. 4. Service connection for PTSD The Veteran contends that he has PTSD due to his active duty service. Below, the Veteran is granted service connection for major depressive disorder and anxiety disorder. This section pertains only to the specific diagnosis of PTSD. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) 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 in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of PTSD and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Although VA treatment records list PTSD among his psychiatric diagnoses, neither the August 2013 DBQ nor the July 2019 DBQ find the diagnostic criteria for PTSD to be satisfied. Both DBQ examiners reviewed the claims folder, which includes the VA treatment records, before determining that the Veteran did not meet the DSM criteria for PTSD. Instead, the Veteran was diagnosed with depressive disorder in both, alcohol abuse in the August 2013 DBQ, and anxiety disorder in the July 2019 DBQ. While VA treatment records diagnose PTSD and state that such a diagnosis is based on the DSM criteria, that criteria is not delineated. The DBQs by contrast list each criterion and state where the Veteran’s symptoms or history fall short of that required for a diagnosis of PTSD. Due to the absence of delineated criteria in the treatment records, the Board cannot readily compare their findings to that of the DBQ examiners. Consequently, the Board gives more probative weight to the August 2013 DBQ and July 2019 DBQ examiners’ findings, which diagnose acquired psychiatric disabilities other than PTSD. While the Veteran believes he has a current diagnosis of PTSD, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires complicated diagnostic testing to determine the correct psychiatric diagnosis. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claim of entitlement to service connection for PTSD and his appeal must be denied. There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 5. Service connection for major depressive disorder and anxiety disorder The Veteran contends that his acquired psychiatric disorder is causally related to racism he experienced during active duty service. The Board concludes that the Veteran has a current disability that is related to racism/discrimination during service in Kuwait. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). VA treatment records, the August 2013 DBQ, and the July 2019 DBQ show the Veteran has a current diagnosis of major depressive disorder. VA treatment records and the July 2019 DBQ also show a current diagnosis of anxiety disorder. Thus, the question becomes whether the current disability is related to service. The July 2019 DBQ examiner opined that the Veteran’s major depressive disorder and anxiety disorder were proximately incurred in or caused by the Veteran’s perception of racism/discrimination during his service in Kuwait. In doing so, this examiner inherently found the Veteran’s reports credible. Accordingly, the Board finds that service connection for major depressive disorder and anxiety disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. This claim is granted. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Houbeck 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.