Citation Nr: 21003413 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 15-06 594A DATE: January 21, 2021 ORDER Service connection for a heart disability, to include as a result of herbicide exposure, is denied. A rating in excess of 40 percent for lumbar strain from June 2, 2010, is denied. An initial rating in excess of 30 percent for migraine headaches is denied. An increased rating for status post right foot current soft tissue mass excision with residuals (“right foot residuals”), rated initially as 20 percent disabling, 100 percent disabling from September 24, 2010, to November 30, 2010, and as 20 percent disabling thereafter is denied. An initial rating in excess of 10 percent for right foot scar is denied. A rating in excess of 10 percent for capsulitis, left second metatarsophalangeal joint (“left foot disability”) is denied. An initial compensable rating for allergic rhinitis is denied. REMANDED Entitlement to service connection for a neck disability is remanded. Entitlement to an initial rating in excess of 20 percent for lumbar strain prior to June 2, 2010, is remanded. Entitlement to an initial rating in excess of 10 percent for right knee degenerative joint disease (DJD) is remanded. Entitlement to an increased rating for right ankle sprain, rated initially as 10 percent disabling and as 20 percent disabling from June 2, 2010, is remanded. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance or being housebound is remanded. FINDINGS OF FACT 1. The Veteran has a valvular heart disease diagnosis of aortic stenosis, which is not related to service. 2. For the period of appeal from June 2, 2010, the lumbar strain is manifested by pain, between 30 and 70 degrees of forward flexion, and a combined range of motion between 160 and 210 degrees, without evidence of unfavorable ankylosis of the thoracolumbar spine. 3. For the entire period of appeal, the preponderance of the evidence is against a finding that the migraine headaches manifest with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 4. For the entire period of appeal, the right foot residuals result in no worse than a moderately severe foot injury, and do not result in a severe foot injury or actual loss of use of the foot. 5. For the entire period of appeal, the single right foot scar is painful, stable, and does not result in functional impairment. 6. For the entire period of appeal, the left foot disability results in no worse than a moderate foot injury, and does not result in a moderately severe foot injury. 7. For the entire period of appeal, the allergic rhinitis has not resulted in greater than 50 percent obstruction of nasal passages on both sides, complete obstruction on one side, or polyps. CONCLUSIONS OF LAW 1. The criteria for service connection for aortic stenosis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for a rating in excess of 40 percent for the lumbar strain from June 2, 2010, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 3. The criteria for an initial rating in excess of 30 percent for migraine headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.118, Diagnostic Code 8100. 4. The criteria for a rating in excess of 20 percent for right foot residuals for the period prior to September 24, 2010, and from December 1, 2010, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5284. 5. The criteria for an initial rating in excess of 10 percent for right foot scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.118, Diagnostic Code 7804. 6. The criteria for a rating in excess of 10 percent for the left foot disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5299-5284. 7. The criteria for an initial compensable rating for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.97, Diagnostic Code 6522. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Air Force from September 1970 to September 1973 and from June 1977 to May 1978, and on active duty in the Army from September 1986 to October 1990. In August 2018, the Veteran and his spouse testified at a Board hearing before the undersigned at the RO, and a transcript of that hearing is of record. The Board remanded the issues in March 2020 for further development, including obtaining outstanding treatment records and afford the Veteran VA examinations to determine the current nature and severity of the relevant service-connected disabilities. VA treatment records were subsequently associated with the record and the Veteran was sent a letter in April 2020 requesting that he submit any outstanding treatment records, including from Trinity Hospital and/or East Beach Medical Associates, or authorize VA to obtain the records, and no response has been received. The Veteran had VA examinations of the heart, back, migraine headaches, bilateral feet, and allergic rhinitis in September 2020. The Board therefore finds there has been substantial compliance with the remand directives. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Stegall v. West, 11 Vet. App. 268 (1998). Service Connection To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). A disability may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disease or injury; or, if it is aggravated beyond its natural progress by a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a), (b). 1. Service connection for a heart disability. The Veteran contends that he has a heart condition, which required a heart catheterization (stent placement), due to exposure to Agent Orange in service in Thailand. See the March 2011 supplemental claim, December 2013 report of information. In addition, in the August 2018 Board hearing, the Veteran testified that during an in-service physical, he was told he had a heart “murmur or something,” which he did not follow up with after service because he never felt bad. His current heart condition started in approximately 2010. The medical evidence shows that the Veteran has a current diagnosis of aortic stenosis. Thus, the current disability requirement for service connection for a heart disability is satisfied. If a Veteran was exposed to an “herbicide agent,” such as Agent Orange, used in support of the United States and allied military operations in the Republic of Vietnam from January 9, 1962, to May 7, 1975, then, absent affirmative evidence to the contrary, certain diseases, including ischemic heart disease (IHD), will be presumptively service connected even if there is no record of the disease in service. 38 U.S.C. §§ 1110, 1116, 1131; 38 C.F.R. §§ 3.307(a)(6), (d), 3.309(e). Here, the Veteran had service in Thailand between 1972 and 1973, which the Board previously determined exposed him to herbicide agents. Aortic stenosis, however, is not among the diseases eligible for presumptive service connection. Specifically, aortic stenosis is a type of valvular heart disease and presumptive service connection is limited to ischemic heart disease. See 38 C.F.R. § 3.309(e), Note 2. As such, presumptive service connection for aortic stenosis is not warranted. For disabilities not presumed by regulation to be due Agent Orange exposure, the Veteran may still establish service connection by showing that any such disability is, in fact, directly and causally linked to Agent Orange exposure, or any other incident or injury in service. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). However, the Board finds that service connection for aortic stenosis on a direct basis is not warranted. Service treatment records (STRs) are silent for complaints, diagnosis, or treatment of a heart condition other than a report of a family history of heart problems in a May 1978 separation examination. Treatment records dated between the Veteran’s between the Veteran’s first two periods of active duty, however, indicate that in April 1975 he reported having chest pain for six months. He was noted to have a history of bronchitis and pleurisy. In a VA examination conducted in September 1978, between the Veteran’s second and third periods of active duty, he reported having occasional left side chest pain that was not related to effort. Post-service treatment records indicate that the Veteran was noted to have dyslipidemia in November 2006 and hyperlipidemia in 2008, which are both considered laboratory findings and are not disabilities for VA compensation purposes. See 61 Fed. Reg. 20440, 20445 (May 7, 1996) (diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are actually laboratory results and are not, in and of themselves, disabilities. They are, therefore, not appropriate entities for the rating schedule.). VA treatment records dated in March and June 2003 indicate that the Veteran’s heart was regular without murmur. An August 2009 treatment record indicates that the Veteran had no know heart disease. In May 2010, he was noted to have a “faint systolic murmur.” In an October 2010 private treatment record, the Veteran was noted to have mild aortic stenosis. In January 2014, the Veteran was seen for left side chest pain on exertion. He was noted to have a history of aortic stenosis. Acute coronary syndrome and acute ischemic changes were ruled out. A left heart catheterization procedure was scheduled. In a June 2014 follow-up appointment, the Veteran’s cardiac catheterization was noted to have shown mild aortic stenosis and normal coronary arteries. The treating cardiologist noted that the Veteran had dyspnea that appeared predominantly related to asthma and deconditioning, and there was no evidence of coronary artery disease. The Veteran was afforded a VA heart conditions examination in September 2020. He reported that he was noted to have a heart murmur upon separation from active duty in 1990, and that he went to the Miami VA and was told everything was okay. More recently, an echocardiogram showed severe aortic stenosis. The examiner indicated that the Veteran had a diagnosis of aortic stenosis, which was a type of valvular heart disease, and which required continuous medication for control. The Veteran had not had a myocardial infarction, congestive heart failure, arrhythmia, infectious heart condition, or pericardial adhesions. He did not have any other pertinent physical findings, complications, conditions, signs, or symptoms related to his valvular heart disease. The examiner opined that the diagnosed heart condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that the Veteran was not evaluated or treated for any chronic heart murmur during his active service, and that there was a 27-year delay in the onset of the diagnosis. The examiner also noted that a heart “murmur or something” is less likely of significant value in the diagnosis of valvular heart disease, as murmurs could be innocent or pathologic, and an echo is performed if it is of clinical concern. The Board finds that the VA examiner’s opinion is competent and credible, and as such, entitled to significant probative weight. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). The opinion was rendered after reviewing the Veteran’s STRs and other medical records, soliciting a medical history from the Veteran, and conducting a physical examination and clinical testing of the Veteran. See Prejean v. West, 13 Vet. App. 444 (2000) (factors for assessing the probative value of a medical opinion include the examiner’s access to the claims folder and the Veteran’s history, and the thoroughness and detail of the opinion). The VA examiner provided facts and rationale on which he based his opinion, including expressly discussing STRs and post-service medical records. Furthermore, neither the Veteran nor his representative has produced a medical opinion to contradict the conclusion of the VA examiner. As such, there is no competent medical evidence that relates the current heart diagnosis to military service. The Board also finds that although the Veteran can describe observable symptoms including pain, his statements cannot be used to determine whether a heart diagnosis is related service or to an in-service injury. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (explaining in footnote 4 that a Veteran may be competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions). There is no evidence that the Veteran has the medical education and training required to make competent clinical diagnosis, or to attribute such a diagnosis to specific events or injuries. As such, the Board finds the Veteran’s statements probative with regard to establishing his current symptoms, but finds little probative value with regard to establishing service connection. In any case, their probative value is outweighed by the probative value assigned to an evaluation conducted by a person who has expertise and training pertinent to heart diagnoses. In sum, the weight of the competent and credible evidence of record weighs against the claim for service connection for a heart disability. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Rating Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. 2. Increased rating for lumbar strain from June 2, 2010. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202, 205 (1995). It is essential that the examination on which ratings are based adequately portray the anatomical damage and functional loss with respect to all these elements. Id. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology or evidenced by visible behavior of the claimant undertaking the motion. Id. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Id. The factors involved in evaluating and rating disabilities of the joints include weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.); excess fatigability; incoordination (impaired ability to execute skilled movements smoothly); more movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.); less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.); or pain on movement, swelling, deformity, or atrophy of disuse. 38 C.F.R. § 4.45. Under 38 C.F.R. § 4.59, with any form of arthritis, painful motion is an important factor of disability, the facial expression, wincing, etc., on pressure or manipulation, should be carefully noted and definitively related to the affected joints. The intent of the rating schedule is to recognize painful motion with joint or particular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. In DeLuca v. Brown, 8 Vet. App. 202 (1995), the Court held that for disabilities evaluated on the basis of limitation of motion, VA was required to apply the provisions of 38 C.F.R. §§ 4.40 and 4.45, pertaining to functional impairment. The Court instructed that in applying these regulations, VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, or incoordination. Such inquiry was not to be limited to muscles or nerves. These determinations were, if feasible, to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, or incoordination. In Burton v. Shinseki, 25 Vet. App. 1 (2011), the Court held that consideration of 38 C.F.R. § 4.59 is not limited to cases involving arthritis, thereby providing for the possibility of a rating based on painful motion of a joint, regardless of whether the painful motion stemmed from joint or periarticular pathology. The Court held that pain must affect some aspect of the normal working movements of the body such as excursion, strength, speed, coordination and endurance to constitute functional loss. Mitchell v. Shinseki, 24 Vet. App. 32, 33, 43 (2011). Although pain may cause functional loss, pain, itself, does not constitute functional loss and is just one factor to be considered when evaluating functional impairment. Id. The Court explained in Mitchell that, pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance (38 C.F.R. §§ 4.40), as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing (38 C.F.R. § 4.45). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Consequently, in rating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). The Board notes, however, that the Court has held that 38 C.F.R. § 4.40 does not require a separate rating for pain but rather provides guidance for determining ratings under other diagnostic codes assessing musculoskeletal function. See Spurgeon v. Brown, 10 Vet. App. 194 (1997). Arthritis shown by X-ray studies is rated based on limitation of motion of the affected joint. When limitation of motion would be noncompensable under a limitation-of-motion code, but there is at least some limitation of motion, a 10 percent rating may be assigned for each major joint so affected. 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010. Diagnostic Code 5010 (traumatic arthritis) directs that arthritis be rated under Diagnostic Code 5003 (degenerative arthritis), which states that degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, X-ray evidence of arthritis involving two or more major or minor joint groups will warrant a 10 percent rating, and two or more major or minor joint groups with occasional incapacitating exacerbations will warrant a 20 percent rating. The 10 percent and 20 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003, Note 1. Here, the Veteran’s low back disability has been assigned a 40 percent rating for this period of appeal (from June 2, 2010) under Diagnostic Code 5237. The diagnostic code criteria pertinent to spinal disabilities in general are found at 38 C.F.R. § 4.71a, Diagnostic Codes 5235 - 5243. Under these relevant provisions, forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees, or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour, or vertebral body fracture with loss of 50 percent or more of the height is rated at 10 percent A 20 percent evaluation is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is assigned of unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is assigned for unfavorable ankylosis of the entire spine. Note (1): Evaluate any associated objective neurologic abnormalities, including but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2): For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. Under Diagnostic Code 5243 (Intervertebral Disc Syndrome), a 20 percent disability rating is assigned with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent disability rating is assigned with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a maximum 60 percent disability rating is assigned with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. The Board finds that rating in excess of 40 percent for the low back disability is not warranted at any point during this period of appeal. In a March 2010 VA lumbar spine (back) examination conducted just prior to this period of appeal, the Veteran reported that his foot condition had worsened, which caused his back pain to worsen. He could only walk a few years. The Veteran denied having any radiation or flare-ups of pain. On examination, the Veteran’s spinal posture was normal. There was no lumbar flattening, lordosis, scoliosis, reverse lordosis, or ankylosis. Range of motion measurements included 60 degrees of flexion, 20 degrees of extension, 20 degrees of left lateral flexion, 20 degrees of right lateral flexion, 20 degrees of left lateral rotation, and 20 degrees of right lateral rotation. There was objective evidence of pain with motion and following repetitive motion, but no additional limitations after three repetitions of range of motion. In a March 2011 VA back examination, the Veteran reported his back pain had gotten worse since the last examination. He had been in physical therapy for two months to improve the pain. During flare-ups, which occurred every 1-2 months and lasted for 1-2 days, his pain was severe and caused a 75 percent impairment. On examination, the Veteran’s spinal posture was normal and he had a moderately antalgic gait. There was lumbar flattening, but no lordosis, scoliosis, reverse lordosis, or ankylosis. Range of motion measurements included 60 degrees of flexion, 20 degrees of extension, 30 degrees of left lateral flexion, 30 degrees of right lateral flexion, 30 degrees of left lateral rotation, and 30 degrees of right lateral rotation. There was objective evidence of pain with motion and following repetitive motion, and flexion was limited to 30 degrees after three repetitions of range of motion. In a December 2014 VA back examination, the Veteran reported that his back condition was intermittent with remissions. His current symptoms included sharp back pain with prolonged sitting, standing, or walking. During flare-ups, which occurred 4-5 times per month, pain restricted him from doing anything like getting up or walking. On examination, range of motion measurements included 60 degrees of flexion, 30 degrees of extension, 30 degrees of left lateral flexion, 30 degrees of right lateral flexion, 30 degrees of left lateral rotation, and 30 degrees of right lateral rotation. There was objective evidence of pain with motion and following repetitive motion, but no additional limitations after three repetitions of range of motion. The Veteran did not have guarding or muscle spasm of the thoracolumbar spine, nor were there signs of radicular pain or ankylosis. He used a wheelchair and walker for his back and knee conditions. The Veteran testified in the August 2018 Board hearing that he had constant pain in his back. He wore a back brace, used a cream like Ben-Gay, and used a heating pad. In a September 2020 VA back conditions examination, the Veteran reported that he was seen for pain management at VA. He denied having flare-ups or any functional loss or impairment of the thoracolumbar spine. Range of motion measurements included 70 degrees of flexion, 20 degrees of extension, 20 degrees of left lateral flexion, 20 degrees of right lateral flexion, 20 degrees of left lateral rotation, and 20 degrees of right lateral rotation. There was objective evidence of pain with motion and following repetitive motion, but no additional limitations after three repetitions of range of motion. The Veteran had guarding or muscle spasm of the lumbar spine, which did not result in an abnormal gait or abnormal spinal contour. Straight leg raising tests were negative, but the Veteran had signs of radiculopathy including bilateral lower extremity mild constant pain, moderate intermittent pain. The examiner indicated that the bilateral sciatic nerves were involved and the radiculopathy was mild. The examiner also noted there was no ankylosis of the spine and there were no other neurologic abnormalities or findings related to a back condition. VA treatment records during the period of appeal consistently note that the Veteran had back pain, but are silent for mention of ankylosis. In sum, the Board finds that for the period of appeal from June 2, 2010, the preponderance of the evidence is against the assignment of a disability evaluation in excess of 40 percent for the low back disability. For a 50 percent rating, the evidence must show that there is unfavorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71a, Diagnostic Code 5237. Here, there is no evidence of unfavorable ankylosis at any point during this period of appeal. Unfavorable ankylosis is a condition in which the entire thoracolumbar spine (or the entire spine), is fixed in flexion or extension. It must also result in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Rather, three VA examiners concluded that the Veteran had a range of motion, and as such, did not have any ankylosis of the lumbar spine. In the VA examinations conducted between March 2010 and September 2020, the Veteran was noted to have between 30 and 60 degrees of flexion, 20 degrees of extension, 20 to 30 degrees of left lateral flexion, 20 to 30 degrees of right lateral flexion, 20 to 30 degrees of left lateral rotation, and 20 to 30 degrees of right lateral rotation. As such, the Veteran’s lumbar spine has not been found to be fixed in flexion or extension at any point during this period of appeal. The Board has considered whether higher disability ratings are warranted based on functional loss due to pain or weakness, fatigability, incoordination, or pain on movement of a joint. As discussed above, however, the rating criteria are intended to take into account functional limitations, and therefore the provisions of 38 C.F.R. §§ 4.40 and 4.45 could not provide a basis for a higher evaluation. See 68 Fed. Reg. 51454 -5 (Aug. 27, 2003). In any event, there is no basis for the assignment of additional disability due to pain, weakness, fatigability, weakness, or incoordination. The Board acknowledges that the Veteran’s symptoms include pain and interference with sitting, standing, and/or weightbearing. However, even considering the effects of pain and the effects of flare-ups, the Veteran’s lumbar spine has never been noted to be fixed in flexion or extension. In other words, any additional limitation due to pain and/or flare-ups does not more nearly approximate a finding of favorable ankylosis of the entire thoracolumbar spine. Accordingly, the 40 percent rating contemplates the functional loss due to pain and less movement. There is no basis for the assignment of additional disability due to pain, weakness, fatigability, weakness or incoordination at any point during the period of the appeal from June 2, 2010. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Consideration has also been given to the potential application of the other diagnostic codes for disabilities of the spine. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. However, the Board finds no basis upon which to assign higher evaluations, other than radiculopathy of the lower extremities, for which the Veteran has already been granted service connection. A higher rating is not warranted under Diagnostic Code 5243, for intervertebral disc syndrome (IVDS) based on incapacitating episodes, as the Veteran has never been found to have incapacitating episodes having a total duration of at least 6 weeks during the past 12 months to warrant a higher 60 percent rating. Finally, the Board recognizes the holding in Correia v. McDonald, 28 Vet. App. 158 (2016) as it pertains to VA examinations recording the results of range of motion testing for pain on both active and passive motion in weight-bearing and nonweight-bearing. However, the Veteran has been receiving the maximum schedular rating for motion loss for the lumbar spine for this period of appeal. Although the examinations do not provide range of motion measurements in weight-bearing and non-weight bearing and in active and passive motion, the Board finds that it may nonetheless proceed to adjudication of the claim. The range of motion necessary for a higher evaluation would be no range of motion, or ankylosis of the thoracolumbar spine. The Veteran has not alleged that his lumbar spine is fixed. Thus, a remand for an examination that complies with Correia would merely impose additional burdens on VA with no benefit flowing to the Veteran. See Soyini v. Derwinski, 1 Vet. App. 541 (1991) (finding that strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (holding that remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). As such, there is no evidence that an additional examination is in order. 3. Increased rating for migraine headaches. The Veteran’s migraine headaches disability is rated under Diagnostic Code 8100, for migraine headaches. Under this diagnostic code, a 50 percent rating is assigned for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Lower ratings of 30 percent, 10 percent, and noncompensable (zero percent) are also provided. 38 C.F.R. § 4.124, Diagnostic Code 8100. The rating criteria do not define “prostrating.” However, Dorland’s Medical Dictionary defines “prostration” as “extreme exhaustion or powerlessness.” Dorland’s Illustrated Medical Dictionary 1531 (32nd ed. 2012). The Board finds that rating in excess of 30 percent for the migraine headaches is not warranted at any point during the period of appeal (from August 2, 2010). In a July 2011 VA examination, the Veteran reported that had been getting headaches since returning from Thailand, which occurred once a week, but got worse after he was attacked in a home invasion in 2009. He experienced headaches 2-3 times per week, primarily over the left eye. He had injections in the back of his head last year (occipital block), which eliminated the headaches for about four months at a time. In the past year, the headaches occurred 1-2 times per week after the injection effects wore off, of which less than half were prostrating, and the Veteran took Fioricet to alleviate them. During flare-ups, the Veteran’s usual daily activities were moderately affected. The examiner indicated that the Veteran’s migraine headaches would cause increased absenteeism at work, decreased concentration, and pain. The examiner noted that the Veteran was not employed, but the stated cause was due to right knee and foot pain, not headache pain. In a December 2014 VA examination, the Veteran reported that his headaches were worse since the last examination. Symptoms included sharp pain in the back of the upper neck to left eye. The headaches occurred 4-5 times per month and lasted 45 minutes to 1.5 hours. Other symptoms included sensitivity to light and sound. The Veteran had characteristic prostrating attacks of migraine headache pain that occurred less frequently than one in two months over the last several months. He did not have very prostrating and prolonged attacks of migraines productive of severe economic inadaptability. The headache condition impacted his ability to work by causing pain. The Veteran testified in the August 2018 Board hearing that when he got a migraine, which happened 2-3 times per week lately, he would “go black” because lights bothered him. He also heard bells and felt dizzy and nauseous. In a September 2020 VA examination, the Veteran reported that he took motrin and sumatriptan for his migraine headaches. Symptoms included pain on both sides of his head, accompanied by sensitivity to light and sound. The Veteran had characteristic prostrating attacks of migraine headache pain that occurred less frequently than one in two months over the last several months. He did not have very prostrating and prolonged attacks of migraines productive of severe economic inadaptability. The examiner indicated that the Veteran’s headache condition did not impact his ability to work. VA treatment records during the period of appeal consistently note that the Veteran had migraine headaches that occurred as infrequently as monthly and as frequently as 2-3 times per week. He was prescribed Fioricet, Butalbital, and Imitrex at various points during the period of appeal. VA treatment records indicate that in December 2017, the Veteran was admitted to a private hospital’s emergency department with complaints of headache on the left posterior side of his head and left facial paresthesia, with concerns that he had suffered a stroke. He was assessed as having cervical spondylosis that was causing his headache. Treatment records are otherwise silent regarding the severity of the Veteran’s migraine headaches, including no discussion of the impact of the headaches on the Veteran’s employability. There is evidence that the Veteran has frequent migraine headaches, and that at times they are severe. However, the evidence is insufficient to show that the Veteran’s migraines are productive of severe economic inadaptability at any point during the period of appeal. In this regard, the Board notes that the Veteran reported in the July 2011 VA examination that his activities were moderately impacted only during flare-ups and that he was unemployed for medical reasons that did not include the headaches. Moreover, the December 2014 and September 2020 VA examiners indicated that the Veteran did not have very prostrating and prolonged attacks of migraines productive of severe economic inadaptability. The Board has carefully considered the Veteran’s contentions with respect to the nature of his service-connected migraine headaches and notes that his lay testimony is competent to describe the symptoms associated with such disability. The Veteran’s history and symptom reports have been considered, including as presented in the medical evidence discussed above, and has been contemplated by the 30 percent disability rating that has been assigned. Moreover, the Veteran’s statements are outweighed by the competent medical evidence of record, including VA examination reports and treatment records. In this regard, there is no VA examination or other medical evidence of record during this period of appeal that indicates that the Veteran experienced very prostrating and prolonged attacks productive of severe economic inadaptability to meet the criteria for a rating in excess of 30 percent under Diagnostic Code 8100 and the claim is denied. 4. Increased rating for right foot residuals. The Veteran’s right foot residuals disability was assigned an initial 20 percent rating under Diagnostic Code 5284 (from September 14, 2010). A schedular maximum 100 percent do you rating was assigned effective September 24, 2010, to November 30, 2010. A 20 percent rating was assigned from December 1, 2010. As such, the appeal period does not include the period from September 24, 2010, to November 30, 2010. Diagnostic Code 5284 provides for foot injuries not otherwise provided for in Diagnostic Codes 5276-5283. A 20 percent rating is provided when the injury is moderately severe, a 30 percent rating is provided when the injury is severe, and a 40 percent rating is provided when there is actual loss of use of the foot. 38 C.F.R. § 4.71a, Diagnostic Code 5284. “Loss of use of the foot” exists when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below the knee with the use of a suitable prosthetic appliance. This determination will be made on the basis of the actual remaining function of the foot, whether the acts of balance and propulsion, etc., could be accomplished equally well by an amputation stump with prosthesis. 38 C.F.R. § 4.63. Terms such as “moderately severe” and “severe” are not defined in the Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence so that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. The Board finds that a rating in excess of 20 percent is not warranted at any point during the period of appeal. In a March 2010 VA examination, conducted prior to the period of appeal, the Veteran reported that after he sprained his right ankle a lump appeared on his right foot. The lump was excised but had since returned and it was larger. He had pain and swelling at the surgical site and the pain radiated to the lateral aspect of the leg and caused difficulty walking on the foot. On examination, there was evidence of painful motion, swelling, tenderness, and abnormal weight bearing. There was no evidence of instability, weakness, or other symptoms. On September 24, 2010, the Veteran had a surgical procedure on his right foot to remove the mass and subsequently developed a MRSA wound infection after the surgery and had a second procedure in October 2010 to treat the infection. His VA physician indicated in a November 2010 letter that the Veteran was two months out of surgery and had started to walk more on his foot. He would continue to transition from partial to full weight-bearing in the next two months. In a March 2011 VA examination, the Veteran reported that his right foot pain had spread to a wider area to include his big toe and heel with sharp pains in those areas and decreased mobility due to pain. He got cramps in his foot if he tried to walk more than half a block. Flare-ups occurred 1-3 times per month and lasted for 1-2 days. The Veteran wore a corrective shoe and used a cane and walker for his knees, ankles, and feet. On examination, the right foot showed evidence of painful motion, swelling, tenderness, weakness, and abnormal weight bearing. The examiner indicated that the right foot condition would have significant effects on the Veteran’s occupational activities, including decreased mobility, problems with lifting and carrying, lack of stamina, weakness or fatigue, pain, and decreased strength. The right foot would also cause problems with daily activities including severe effects on exercise and sports; moderate effects on chores, shopping, recreation, traveling, and driving; and mild effects on bathing, dressing, and toileting. In May 2011 VA examination, the Veteran’s right foot showed evidence of painful motion, swelling, tenderness, and abnormal weight bearing. The examiner indicated that the right foot condition would have significant effects on the Veteran’s occupational activities, including decreased mobility, pain, and problems with lifting and carrying. The right foot would cause problems with daily activities including severe effects on sports; moderate effects on shopping, exercise, and traveling; and mild effects on chores and driving. VA treatment records indicate that in July 2011, the Veteran reported having right heel pain where the mass was. He was found to have a muscle herniation and allowed to continue weight-bearing to tolerance with regular shoes. In a December 2014 VA examination, the Veteran reported that he had pain and swelling in his right foot. He indicated that flare-ups were severe and occurred twice per week and lasted 1-2 hours. The examiner noted that the Veteran used shoe inserts for the foot condition and used a rolling walker for the knee and back conditions. The examiner indicated that the right foot condition would impact his ability to perform occupational tasks due to pain and would cause problems with daily activities including mild to severe effects on exercise and sports; mild to moderate effects on chores; and mild effects on shopping, recreation, traveling, and driving. In June 2017, the Veteran was issued new shoe inserts. The Veteran testified in the August 2018 Board hearing that since the MRSA infection, he had not had any recurrent masses, but the area was sensitive and he had swelling. He had shoe inserts and could not wear hard shoes. In a September 2020 VA examination, the Veteran reported that it hurt to stand for a long and he could not run. He denied having flare-ups and denied having any other functional loss or functional impairment of the foot. On examination, the right foot had pain on movement and pain on weight-bearing. The examiner indicated that the right foot residuals disability was mild and would impact his ability to perform occupational tasks including running. As noted above, the criteria for a higher 30 percent rating is warranted when the foot injury is considered “severe.” 38 C.F.R. § 4.71a. Here, the Veteran’s VA examinations do not reflect functional impairment akin to a severe foot injury. The March 2011, May 2011, and December 2014 VA examiners did not indicate the overall severity level of the right foot residuals; however, all three of them indicated that the only severe impairments caused by the right foot were related to sports and exercise. Other impairments, including effects on chores, shopping, recreation, traveling, and driving were noted to be no worse than moderate. In addition, the September 2020 examiner indicated that the right foot residuals disability was mild. The Board acknowledges the Veteran’s testimony regarding pain, sensitivity, and swelling. In this regard, the VA examinations considered the impact of pain. The most recent examination indicates that the Veteran reported being unable to stand for a long time and could not run, but otherwise denied having any functional loss or functional impairment of the right foot. Furthermore, while VA treatment records note that the Veteran had right foot pain and a history of surgeries to remove the recurrent mass, they also do not reflect reports of pain or flare-ups resulting in functional impairment more akin to a severe foot injury. Therefore, a higher 30 percent evaluation is not warranted. Consideration has also been given to the potential application of the other diagnostic codes for disabilities of the foot. See 38 C.F.R. § 4.124a, Diagnostic Codes 5276-5283. However, the Board finds no basis upon which to assign higher evaluations at any point during the period of appeal. The Veteran has not been shown to have any acquired flatfoot, bilateral weak foot, acquired claw foot (pes cavus), anterior metatarsalgia (Morton’s disease), hallux valgus, hallux rigidus, hammer toes, or malunion or nonunion of the tarsal or metatarsal bones. Other diagnostic codes are therefore not applicable. 5. Increased rating for the right foot scar. The Veteran’s right foot scar has been assigned an initial rating of 10 percent (from September 24, 2010) under Diagnostic Code 7804. Diagnostic Code 7804 provides a 10 percent rating for one or two scars that are unstable or painful. Note (1): An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2): If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3): Scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable. 38 C.F.R. § 4.118, Diagnostic Code 7804. The Board finds that a rating in excess of 10 percent is not warranted at any point during the period of appeal. As discussed above, the Veteran had a surgical procedure on his right foot to remove a mass on September 24, 2010. He developed a MRSA wound infection after the surgery and had a second procedure in October 2010 to treat the infection. In a March 2011 VA examination, the Veteran’s right foot was noted to have a 5.5 centimeter (cm) well healed scar over the posterior medial foot with tenderness over the superior portion of the scar. In a May 2011 VA examination, the Veteran was noted to have a well healed surgical scar on his right foot. In a December 2014 VA examination, the Veteran reported having symptoms of swelling and itching of the scar. The examiner indicated that the scar was 5.0 cm long and 0.1 cm wide, and it was not painful or unstable. The scar did not result in any limitation of function. Most recently, in a September 2020 VA examination, the right foot scar was noted to be mildly tender to palpation. It was 5.5 cm long and 0.2 cm wide, and was not unstable or with underlying soft tissue damage. The examiner indicated that the scar did not result in limitation of function. The Board finds that the weight of the evidence is against an initial evaluation in excess of 10 percent for the right foot scar under Diagnostic Code 7804. A rating higher than 10 percent is only warranted for three or more unstable or painful scars or for scars that are both painful and unstable. In this case, the Veteran has been consistently noted to have one scar on his right foot, and it was never noted to be unstable at any point during the period of appeal. In evaluating the Diagnostic Codes potentially applicable to the Veteran’s scar, the Board notes that Diagnostic Code 7800 does not apply because the right foot scar was not of the head, face, or neck. Diagnostic Code 7801 does not apply because the Veteran’s right foot scar is not burn scars, nor is it deep. Diagnostic Code 7802 does not apply because the Veteran’s scar does not cover an area of 144 square inches or more. Diagnostic Code 7805 does not apply because the right foot scar does not cause any functional impairment (such as limitation of motion); rather, the March and May 2011 VA examiners indicated that the scar was well healed, and the December 2014 and September 2020 VA examiners indicated that the scar did not result in any limitation of function. 6. Increased rating for the left foot disability. The Veteran’s left foot disability has been assigned a 10 percent rating under Diagnostic Code 5299-5284 for the entire period of appeal (from June 2, 2010). Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the assigned rating; the additional code is shown after the hyphen. The provisions of 38 C.F.R. § 4.27 provide that unlisted disabilities requiring rating by analogy will be coded with the first two numbers of the schedule provisions for the most closely related body part and 99. Here, capsulitis is not specifically listed in the rating schedule. As such, the hyphenated diagnostic code indicates that the capsulitis is rated as analogous to a musculoskeletal disability (Diagnostic Code 5299) under the criteria for other foot injuries (Diagnostic Code 5284). The Board finds that a rating in excess of 10 percent is not warranted at any point during the period of appeal. In a March 2011 VA examination, the Veteran reported that he had swelling and a knot on his foot with intermittent pain that caused him to limp for a couple of days at a time. On examination, there was objective evidence of painful motion, swelling, and tenderness to palpation. The examiner indicated that the left foot disability would have mild effects on chores, shopping, exercise, sports, recreation, traveling, bathing, and driving. In a December 2014 VA examination, the Veteran reported having intermittent pain with remissions in his left foot. During flare-ups, he was unable to walk. On examination, there was no pain in the left foot. The Veteran had metatarsalgia, but no tenderness to palpation of the first, second, or third metatarsals. There was also no erythema or swelling. X-rays showed arthritis of the left foot. The Veteran was noted to use bilateral shoe inserts and a rolling walker for his bilateral foot, knee, and back conditions. VA treatment records indicate that in January 2015, the Veteran reported having pain in his left first toe that increased with weightbearing. There was no recent injury and no redness or swelling at the site. X-rays showed degenerative arthritis of the first metatarsophalangeal joint (MPJ) with slight progression. There was also mild calcaneal spurring with associated posterior enthesophyte formation. In May 2015, the Veteran had a podiatry consultation for his left foot. Range of motion of the first MPJ appeared normal with no crepitus and minimal discomfort. In the August 2018 Board hearing, the Veteran testified that he had pain and intermittent swelling in his toe. He treated it by resting it and soaking in a warm bath. In a September 2020 VA examination, the Veteran reported that his left foot hurt when he stood a long time and he could not run. He denied having flare-ups or any other functional loss or functional impairment. On examination, the Veteran had pain on movement and on weight-bearing. The examiner indicated that the left foot disability was mild in severity, did not chronically compromise weight bearing, and did not require arch supports or shoe modifications. As noted above, the criteria for a higher 20 percent rating is warranted when the foot injury is considered “moderately severe.” 38 C.F.R. § 4.71a. Here, the Veteran’s VA examinations do not reflect functional impairment akin to a moderately severe foot injury. The March 2011 and December 2014 VA examiners did not indicate the overall severity level of the left foot disability; however, the March 2011 examiner indicated that the left foot disability would have only mild impacts on chores, shopping, exercise, sports, recreation, traveling, bathing, and driving; and the December 2014 examiner indicated that there was no pain on examination. In addition, the September 2020 examiner indicated that the left foot disability was mild. The Board acknowledges the Veteran’s testimony regarding pain and swelling. In this regard, the VA examinations considered the impact of pain. The most recent examination indicates that the Veteran reported being unable to stand for a long time and could not run, but otherwise denied having any functional loss or functional impairment of the left foot. Furthermore, while VA treatment records note that the Veteran had left foot pain and arthritis, they also do not reflect reports of pain or flare-ups resulting in functional impairment more akin to a moderately severe foot injury. Therefore, a higher 20 percent evaluation is not warranted. Consideration has also been given to the potential application of the other diagnostic codes for disabilities of the foot. See 38 C.F.R. § 4.124a, Diagnostic Codes 5276-5283. However, the Board finds no basis upon which to assign higher evaluations at any point during the period of appeal. The Veteran has not been shown to have any acquired flatfoot, bilateral weak foot, acquired claw foot (pes cavus), anterior metatarsalgia (Morton’s disease), hallux valgus, hallux rigidus, hammer toes, or malunion or nonunion of the tarsal or metatarsal bones. Other diagnostic codes are therefore not applicable. 7. Increased rating for allergic rhinitis. The Veteran’s allergic rhinitis has been assigned an initial noncompensable (zero percent) rating (from March 24, 2011) under Diagnostic Code 6522. Under Diagnostic Code 6522, allergic rhinitis with no polyps, but with greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side warrants a 10 percent evaluation. 38 C.F.R. § 4.97. A 30 percent evaluation is assigned when polyps are present. Id. The Board finds that a compensable rating is not warranted at any point during the period of appeal. In a May 2011 VA examination, the Veteran reported that his allergy symptoms had gotten progressively worse and he took an allergy medication nightly. His symptoms included nasal congestion, excess nasal mucous, itchy nose, watery eyes, and sneezing. On examination, there were no signs of nasal obstruction, including polyps, in either nostril. There were swollen/edematous nasal mucous membranes, wet with light bluish pale, indicative of allergy in the nose. VA treatment records indicate that in January 2012, the Veteran had switched medication from flunisolide to fluticasone. He was also taking loratadine. The Veteran indicated that his allergy symptoms had improved. He was noted to have perennial allergy rhinitis and chronic rhino sinusitis. In a December 2014 VA examination, the Veteran reported that since the last evaluation, his condition was worse. His symptoms included nasal dyspnea, post-nasal drip (PND), runny nose, and headaches. On examination, there was not greater than 50 percent obstruction of the nasal passage on both sides due to rhinitis, nor was there complete obstruction of the left or right side due to rhinitis. There was also no evidence of permanent hypertrophy of the nasal turbinates or nasal polyps, and the Veteran did not have any other pertinent physical findings, scars, complications, conditions, signs, and/or symptoms. The Veteran testified in the August 2018 Board hearing that he had symptoms of allergic rhinitis all the time. His nose was always running and he took allergy pills and nasal sprays. In a September 2020 VA examination, the Veteran reported that he was using nasal sprays. On examination, there was not greater than 50 percent obstruction of the nasal passage on both sides due to rhinitis, nor was there complete obstruction of the left or right side due to rhinitis. There was also no evidence of permanent hypertrophy of the nasal turbinates or nasal polyps, and the Veteran did not have any other pertinent physical findings, scars, complications, conditions, signs, and/or symptoms. VA treatment records indicate that the Veteran was followed for his allergic rhinitis and was on various allergy medications, including injections at least once during the period of appeal. However, the treatment records are silent for mention of nasal polyps, greater than 50 percent obstruction of nasal passages on both sides, or complete obstruction on one side. In sum, the Board finds that the Veteran’s allergic rhinitis does not more nearly approximate the level of severity contemplated by an increased 10 percent rating. Under Diagnostic Code 6522, a 10 percent rating is warranted for allergic rhinitis without polyps, but with greater than 50 percent obstruction of nasal passage on both sides or compete obstruction on one side. There is no competent evidence of polyps or a greater than 50 percent obstruction of nasal passages on both sides or complete obstruction on one side. Specifically, VA examiners in May 2011, December 2014, and September 2020 all indicated that the Veteran did not have any nasal obstruction, including polyps, in either nostril. As such an increased 10 percent rating is not warranted under Diagnostic Code 6522. Further, no additional higher or alternative ratings under different Diagnostic Codes for the respiratory system are available under other provisions of the diagnostic code. All potentially applicable Diagnostic Codes have been considered. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). REASONS FOR REMAND 1. Entitlement to service connection for a neck disability is remanded. The Board remanded this issue in March 2020 to obtain a medical opinion on the etiology of the claimed neck disability. The examiner was asked to specify which neck symptoms were attributable to the service-connected migraine headaches, and which were attributable to any diagnosed neck condition. The examiner was asked to then opine on whether it was at least as likely as not that any neck diagnosis was due to the Veteran’s active service. Subsequently, in September 2020, the Veteran was afforded a VA neck (cervical spine) conditions examination. The examiner diagnosed cervical strain and degenerative arthritis of the neck, which were less likely than not incurred in or caused by the Veteran’s active service. The rationale was that there was a “significant silent interval post 1990 discharge,” and that the Veteran’s age was the likely cause of the degenerative arthritis. The examiner did not, however, opine on the likely etiology of the diagnosed cervical strain, nor did he appear to consider or discuss the Veteran’s statements regarding his headache pain being related to his neck pain. As such, the Board finds that there has not been substantial compliance with the remand directives, and corrective action is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that where the remand of the Board or the Court is not complied with, the Board errs as a matter of law when it fails to ensure compliance). 2. Increased rating for lumbar strain prior to June 2, 2010, is remanded. 3. Increased rating for right knee DJD is remanded. 4. Increased rating for right ankle sprain is remanded. The Board remanded these issues in March 2020 to afford the Veteran VA examinations to determine the current nature and severity of the lumbar strain, right knee DJD, and right ankle sprain. The examiner was directed to test ranges of motion actively and passively, in weight-bearing and nonweight-bearing, and after repetitive use. See Correia v. McDonald, 28 Vet. App. 158 (2016). In addition, the examiner was asked whether range of motion measurements for active motion, passive motion, weight-bearing, and nonweight-bearing could be estimated for the period of appeal prior to the examinations. If a retrospective opinion could not be provided, the examiner was asked to explain why in the report. Subsequently, in September 2020, the Veteran was afforded VA back (thoracolumbar spine), knee, and ankle conditions examinations. In each of the three examinations, initial range of motion measurements and results of repetitive-use testing were noted. The examiner also indicated that there was no evidence of pain on passive range of motion or nonweight-bearing testing of the back, right knee, or right ankle. With regard to the claims for increased ratings for the right knee and right ankle, the examination reports do not specifically reflect the Veteran’s active and passive ranges of motion, nor his ranges of motion during weight-bearing and non-weight bearing, as required by Correia. Furthermore, with regard to all three claims, the reports do not indicate whether retrospective opinions could be provided. As such, the Board finds that there has not been substantial compliance with the remand directives, and corrective action is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 5. Entitlement to SMC is remanded. SMC is payable if, as the result of service-connected disability, the Veteran has an anatomical loss or loss of use of both feet, or of one hand and one foot; has blindness in both eyes with visual acuity of 5/200 or less; is permanently bedridden; or is so helpless as to be in need of regular aid and attendance of another person. 38 U.S.C. §§ 1114(l); 38 C.F.R. § 3.350. Aid and attendance means helplessness or being so nearly helpless as to require the regular aid and attendance of another person. See 38 C.F.R. § 3.350(b)(3). For the purposes of 38 C.F.R. § 3.352(a), “bedridden” will be a proper basis for the determination of whether the Veteran is in need of regular aid and attendance of another person. “Bedridden” will be that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. 38 C.F.R. § 3.352(a). In addition, SMC at the housebound rate is warranted if, in addition to having a single permanent disability rated 100 percent disabling under the VA’s Schedule for Rating Disabilities (not including ratings based upon unemployability under 38 C.F.R. § 4.17 of this chapter), the Veteran: has additional disability or disabilities independently ratable at 60 percent or more, separate and distinct from the permanent disability rated as 100 percent disabling and involving different anatomical segments or bodily systems, or, is “permanently housebound” by reason of disability or disabilities. Here, any decision on the increased rating claims being remanded herein may affect the claim for SMC. Consideration of entitlement to SMC based on the need for aid and attendance or housebound must therefore be deferred until the intertwined issues are resolved or prepared for appellate consideration. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Contact the VA examiner who conducted the September 2020 VA neck conditions examination (or if he or she is no longer available, a suitable replacement) and ask the examiner to review the record and prepare an addendum to the medical opinion. The entire claims file, including a copy of this REMAND, must be reviewed by the examiner. Based on this review, the examiner is asked to provide opinions on the following: (a) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s neck strain is related to incident, injury, or event in active service. (b) Whether it is at least as likely as not that any neck condition is proximately due to the service-connected migraine headaches. If not, did any neck condition increase in severity beyond its natural progression by the service-connected migraine headaches? A thorough rationale should be provided for all opinions expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. If the examiner determines that further examination is necessary in order to render any requested medical opinion, the AOJ should schedule the Veteran for such an examination. 2. Contact the examiner who conducted the September 2020 VA back, knee, and ankle examinations (or if he or she is no longer available, a suitable replacement) and ask the examiner to review the record and prepare addendums to the medical opinions. The entire claims file, including a copy of this REMAND, must be reviewed by the examiner. Based on this review, the examiner is asked to provide an assessment of the current nature of the Veteran’s right knee and right ankle disabilities. The examiner should specifically note the right knee and right ankle ranges of motion actively and passively, in weight-bearing and nonweight-bearing. In addition, the examiner should comment on whether the back range of motion measurements for active motion, passive motion, weight-bearing, and nonweight-bearing can be estimated for the period from October 13, 2009, to June 1, 2010; and whether the right knee and/or right ankle range of motion measurements for active motion, passive motion, weight-bearing, and nonweight-bearing can be estimated for the period prior to September 2020. A thorough rationale should be provided for all opinions expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. If the examiner determines that further examination is necessary in order to render any requested medical opinion, the AOJ should schedule the Veteran for such an examination. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Nelson 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.