Citation Nr: 21004993 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 17-46 195 DATE: January 28, 2021 ORDER Entitlement to a rating in excess of 10 percent for a left wrist disability is denied. Entitlement to a rating in excess of 10 percent for a back disability, prior to January 26, 2017, is denied. Entitlement to a rating of 20 percent, but not higher, for a back disability, from January 26, 2017, to October 31, 2019, is granted. Entitlement to a rating in excess of 40 percent, but not higher, for a back disability, as of November 1, 2019, is denied. Entitlement to a rating in excess of 10 percent prior to November 1, 2019, and in excess of 30 percent as of November 1. 2019, for a bilateral foot disability is denied. FINDINGS OF FACT 1. A left wrist disability was manifested by pain and tenderness, with motion limited at most to palmar flexion to 60 degrees and dorsiflexion to 50 degrees. 2. Prior to January 26, 2017, a back disability was manifested by forward flexion of the thoracolumbar spine of 75 degrees. 3. From January 26, 2017 to October 31, 2019, a back disability was manifested by muscle spasm and abnormal gait. 4. Throughout the appeal period, there was no ankylosis or incapacitating episodes of the low back. 5. Prior to November 1, 2019, a bilateral foot disability was manifested by pain on manipulation and use of the feet. 6. As of November 1, 2019, a bilateral foot disability was manifested by pain on use with pain accentuated on use and swelling on use. CONCLUSIONS OF LAW 1. Throughout the period of appeal, the criteria for a rating in excess of 10 percent for a left wrist ganglion cyst disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.10, 4.3, 4.40, 4.45, 4.59, 4.69, 4.7, 4.71a, Diagnostic Code 5215. 2. The criteria for a rating in excess of 10 percent prior to January 26, 2017, for a lumbar spine disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.10, 4.3, 4.40, 4.45, 4.59, 4.7, 4.71a, Diagnostic Code 5010-5237. 3. The criteria for a rating of 20 percent, but not higher, from January 26, 2017, to October 31, 2019, for a lumbar spine disability are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.10, 4.3, 4.40, 4.45, 4.59, 4.7, 4.71a, Diagnostic Code 5010-5237. 4. The criteria for a rating in excess of 40 percent as of November 1, 2019, for a lumbar spine disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.10, 4.3, 4.40, 4.45, 4.59, 4.7, 4.71a, Diagnostic Code 5010-5237. 5. Prior to November 1, 2019, the criteria for a rating in excess of 10 percent for a bilateral foot disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.59, 4.7, 4.71a, Diagnostic Code 5276. 6. As of November 1, 2019, the criteria for a rating in excess of 30 percent for a bilateral foot disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.59, 4.7, 4.71a, Diagnostic Code 5276. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1987 to July 1991. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2015 rating decision of the Regional Office (RO) of the Department of Veterans Affairs (VA) in Winston-Salem, North Carolina. The Board remanded these matters in January 2019 for additional development of the evidence. The Board finds that there has been substantial compliance with the remand requests. Stegall v. West, 11 Vet. App. 268 (1998). Increased Rating Disability ratings are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). When the appeal arises from an initial assigned rating, consideration must be given to whether staged ratings should be assigned to compensate entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999). However, staged ratings are also appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007). The rating of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. However, that does not preclude the assignment of separate ratings for separate and distinct symptomatology where none of the symptomatology justifying a rating under one diagnostic code is duplicative of or overlapping with the symptomatology justifying a rating under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259 (1994). The rating of a service-connected disability involving a joint rated on limitation of motion requires adequate consideration of functional loss due to pain and functional loss due to weakness, fatigability, incoordination, or pain on movement of a joint. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portrays the anatomical damage, and the functional loss, with respect to these elements. In addition, the regulations state that the functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the veteran undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. When rating the joints, inquiry will be directed as to whether there is less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. 38 C.F.R. § 4.45. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. 1. Entitlement to a rating in excess of 10 percent for a left wrist disability The Veteran's left wrist disability is rated 0 percent as of June 30, 2009, under Diagnostic Code 5015-7819. 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 rating assigned. 38 C.F.R. § 4.27. The disability was rated 10 percent as of July 29, 2015, under Diagnostic Code 5215. Under Diagnostic Code 5215, a 10 percent rating is warranted for both the major and minor extremity if palmar flexion is limited in line with the forearm or if dorsiflexion is less than 15 degrees. That is the maximum scheduler rating for limitation of wrist motion available under Diagnostic Code 5215. A higher rating is available under Diagnostic Code 5214, which requires evidence of ankylosis. With favorable ankylosis in 20 degrees to 30 degrees dorsiflexion, a 20 percent rating is warranted for the minor extremity and a 30 percent rating is warranted for the major extremity. 38 C.F.R. § 4.71a, Diagnostic Code 5214. Normal range of motion of the wrist includes dorsiflexion from 0 to 70 degrees, palmar flexion from 0 to 80 degrees, ulnar deviation from 0 to 45 degrees, and radial deviation from 0 to 20 degrees. 38 C.F.R. § 4.71a. The Veteran is right-handed, so the left wrist is the minor wrist. During a December 2015 VA wrist examination, the Veteran indicates flare-ups affecting the ability to lift, pull or push. Left wrist range of motion testing found palmar flexion to 70 degrees, dorsiflexion to 70, ulnar deviation to 40, and radial deviation to 15 with pain on palmar flexion. The wrist was mildly tender to palpation. The examiner noted objective pain with weight-bearing. Although the examination report stated that pain limited function with repeated use over time, the pain did not cause additional loss of range of motion. The Veteran used a wrist brace regularly. Functional impact of the left wrist disability was limited repetitive use, lifting, pushing, and pulling. At a November 2019 VA wrist examination, the Veteran reported flare-ups when she woke with a throbbing wrist. When lifting, she dropped small objects and lost strength. The wrist had a full range of motion when initially tested. The Veteran had pain on dorsiflexion, but no additional loss of motion. The left wrist was mildly tender on palpation and painful on weight bearing. There was no additional loss of range of motion on repetitive use testing. Range of motion was limited to 60 degrees of palmar flexion, 50 degrees of dorsiflexion, 35 degrees of ulnar deviation, and 15 degrees of radial deviation during flare-ups and with repeated use over time. The Veteran occasionally used a wrist brace. The Veteran had pain with repeated use of the left hand. Based on the evidence of record, the Board finds that the criteria for the assignment of a rating in excess of 10 percent have not been met at any time during the appeal period. The evidence does not show that the left wrist disability is productive of palmar flexion limited in line with the forearm or dorsiflexion of less than 15 degrees. On the December 2015 and November 2019 examinations, palmar flexion of the left wrist was limited at most to 60 degrees and dorsiflexion was limited at most to 50 degrees. That considered repetitive use and flare ups. The Board notes that the VA examinations did not show evidence of ankylosis of any type in the left wrist. A review of the medical evidence shows the Veteran's left wrist disability manifested with abnormal and painful range of motion, flare ups and swelling, but it did not more nearly approximate the next higher rating. The Board finds that the preponderance of the evidence is against the assignment of any higher rating. Therefore, the claim for an increased rating for a left wrist disability must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to a rating in excess of 10 percent for a back disability prior to January 26, 2017 3. Entitlement to a rating of 20 percent, but not higher, for a back disability, from January 26, 2017 to October 31, 2019 4. Entitlement to a rating in excess of 40 percent for a back disability, as of November 1, 2019 The Veteran's lumbar spine disability is rated 10 percent as of July 29, 2015, and 40 percent as of November 1, 2019, under Diagnostic Code 5010-5237. Under Diagnostic Code 5010, traumatic arthritis is rated as degenerative arthritis under Diagnostic Code 5003. Diagnostic Code 5003 provides for rating on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint involved. Disabilities rated under Diagnostic Codes 5235 to 5243 are rated under the General Rating Formula for Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a. The General Rating Formula for Diseases and Injuries of the Spine provides that a 10 percent rating is warranted for 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. A 20 percent rating is warranted 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 is 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 rating is warranted for forward flexion of the thoracolumbar spine of 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 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 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. 38 C.F.R. § 4.71a, Plate V, General Rating Formula for Diseases and Injuries of the Spine, Note (2). The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (4). 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 (0 degrees) always represents favorable ankylosis. The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). Disability of the thoracolumbar and cervical spine segments are to be rated separately, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (6). A review of the private and outpatient VA treatment records shows that the Veteran has been treated for low back pain throughout the appeal period. Treatment records do not show ankylosis or incapacitating episodes having a total duration of at least six weeks during any 12-month period for the duration of the appeal. On December 2015 VA back examination, the Veteran reported back pain and stiffness which were treated with medication. The Veteran had flare-ups which affected the ability to lift and bend. During flare-ups, the Veteran has limited ambulation, climbing, bending, and lifting. Range of motion testing found forward flexion to 75 degrees, extension to 25 degrees, right lateral flexion to 25 degrees, left lateral flexion to 25 degrees, right lateral rotation to 25 degrees, and left lateral rotation to 25 degrees. The range of motion did not contribute to functional loss. There was pain on forward flexion, right lateral rotation, and left lateral rotation. The examiner noted no objective evidence of pain with weight bearing or tenderness to palpation of the joint or associated soft tissue. The Veteran performed repetitive use testing without additional functional loss. The Veteran reported pain with repeated use over time and on flare-ups, but there was no associated loss of range of motion. The Veteran did not have guarding or muscle spasms. There was no ankylosis and no intervertebral disc syndrome. The examiner found that the functional impact of the back condition was to limit lifting, bending, climbing, pushing, and pulling. A January 2017 treatment note from the Veteran’s private physician shows treatment for low back pain and muscle spasm. The Veteran reported back spasms and clinching with walking and stiffness and tightness in the center of the lower back. The Veteran had a slow gait, full range of motion, and tenderness to palpation of the left and medial sacral spine. VA X-ray studies of September 2017 found mild, mid to lower lumbar degenerative changes. During a December 2019 VA examination, the Veteran reported constant throbbing pain, the use of medication, and the use of a TENS unit and heating pad. The spasms and pain were sometimes so severe they prevented going to work. The Veteran had flare-ups of daily pain, which sometimes required medication for relief. During flare-ups, the Veteran went to the hospital twice in the previous year, but “just suffers through” and could not sleep when the lower back flared. It was difficult to walk unassisted without holding onto furniture. Range of motion testing found forward flexion to 60 degrees, extension to 15 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degrees, right lateral rotation to 25 degrees, and left lateral rotation to 25 degrees. The Veteran's range of motion does not contribute to functional loss. There was pain on forward flexion, right and left lateral flexion, and right and left lateral rotation. The examiner found objective evidence of moderate localized tenderness on palpation of the joint or associated soft tissue at L4-L5 and the muscles on each side of the spine. There was objective evidence of pain with weight bearing, but not on nonweight-bearing. The Veteran could perform repetitive use testing without additional functional loss. With repeated use over time, pain limited the Veteran's functional ability with range of motion measuring forward flexion to 30 degrees, extension to 10 degrees, right lateral flexion to 10 degrees, left lateral flexion to 10 degrees, right lateral rotation to 15 degrees, and left lateral rotation to 15 degrees. There was pain on flare-ups with motion measuring the same as after repeated use over time. The Veteran did not have guarding or muscle spasms. Additional factors contributing to disability were interference with standing and difficulty with standing. There was no ankylosis and no intervertebral disc syndrome. Passive range of motion measures the same as active. The examiner concluded that the functional impact of the back condition was to prevent lifting, bending, and stooping. The Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 10 percent for a back disability prior to January 26, 2017. Prior to January 26, 2017, the evidence shows forward flexion of the lumbar spine limited to 75 degrees or less. The combined range of motion of the thoracolumbar spine was 200 degrees. The Board finds that the evidence supports the assignment 20 percent rating, but not higher, for the back disability from January 26, 2017, to October 31, 2019. A January 2017 private treatment note found muscle spasms severe enough to result in an abnormal gait. At no time from January 26, 2017, to October 31, 2019, does the evidence show that a higher rating is warranted. Forward flexion of the thoracolumbar spine was limited to 75 degrees and favorable ankylosis of the entire thoracolumbar spine is not shown. As of November 1, 2019, the Board finds that the preponderance of the evidence is against a rating in excess of 40 percent for a back disability. The November 2019 examination report noted bilateral pain on use with pain accentuated on use and swelling on use. The evidence does not indicate unfavorable ankylosis of the entire thoracolumbar spine at any time during the appeal. The evidence does not show that the back disability more nearly approximates unfavorable ankylosis of the entire thoracolumbar spine. Therefore, a rating greater than 40 percent is not warranted at any time during the appeal period. The Board acknowledges the Veteran's lay reports of symptoms and the functional loss due to pain and flare-ups, and pain during repetitive use over time. However, even considering the Veteran's lay reports of additional limitation of motion or function of the spine due to pain and flare ups, the evidence still does not show that the back disability more nearly approximates the range of motion criteria to support a higher rating under the General Rating Formula. While the Veteran experienced pain during flare-ups, overall, she remained able to function. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board finds that the Veteran is a lay person and is competent to report observable symptoms she experiences through her senses such pain and stiffness. Layno v. Brown, 6 Vet. App. 465 (1994). However, the Veteran is not competent to identify a specific level of disability according to the appropriate diagnostic codes. The determination of the range of motion of the spine requires medical expertise that the Veteran has not shown she possesses. Determining whether the Veteran meets some of the criteria for a higher rating requires medical diagnostic testing. Competent evidence concerning the nature and extent of the Veteran's lumbar spine disability has been provided by the medical examiner who have examined her during the appeal and who have made pertinent clinical findings in conjunction with the examination. The medical findings, as provided in the examination reports, directly address the criteria under which her disability is rated. The Board finds that the objective medical evidence is the most persuasive and outweighs the Veteran's statements in support of the claim. Accordingly, the Board finds that entitlement to a rating in excess of 10 percent, prior to January 26, 2017, must be denied. Entitlement to a rating of 20 percent, but not higher, from January 26, 2017, to November 1, 2019, is granted. Entitlement to a rating in excess of 40 percent, as of November 1, 2019, must be denied. The Board finds that the preponderance of the evidence is against the assignment of any higher rating. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Entitlement to a rating in excess of 10 percent prior to November 1, 2019, and in excess of 30 percent as of November 1. 2019, for a bilateral foot disability The Veteran's bilateral foot disability is rated 10 percent as of July 29, 2015, and 30 percent as of November 1, 2019, under Diagnostic Code 5276. Diagnostic Code 5276 provides that a 10 percent rating is warranted for moderate acquired flat foot with weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral. A 20 percent rating is assigned for severe unilateral acquired flat foot with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is warranted for severe bilateral acquired flat foot with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is also warranted for pronounced unilateral acquired flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. A maximum 50 percent rating is warranted for bilateral acquired flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276. During a December 2015 VA foot examination, the Veteran reported bilateral foot pain, described as soreness and aches. The foot pain was treated with medication, shoe inserts, and immobilization. The Veteran had bilateral foot pain on use and manipulation of the feet. There was no swelling, and the Veteran did not have characteristic calluses. The symptoms continued despite the use of arch supports. The Veteran did not have extreme tenderness of the plantar surfaces, deformity of the foot or lower extremity, marked pronation, inward bowing of the Achilles' tendon, marked inward displacement of the foot, or severe spasm of the Achilles’ tendon. There was pain on examination which caused functional loss. Pain on weight-bearing, disturbance of locomotion, and interference with standing were contributing factors of the disability. The examiner remarked that the Veteran had no recent decline in ambulation or recent changes in activities of daily living performance. Pain significantly limited functional ability during flare-ups or when the feet were used repeatedly over a period of time. The examiner opined that there was functional loss during flare-ups that would make prolonged standing or walking difficult. On November 2019 VA foot examination, the Veteran reports that the feet cramped, causing sharp pain, and the toes locked. The Veteran had flare ups. When driving, the feet started to cramp and toes locked, the Veteran had to pull over and remove both shoes. The flare-ups woke the Veteran at night. For relief the Veteran used massage or “walks it out.” The Veteran had functional loss that manifested as a limited ability to walk or drive during flare-ups. The Veteran had bilateral pain on use with pain accentuated on use. There was swelling on use and the Veteran did not have characteristic calluses. The Veteran has tried arch supports, but the symptoms remained. The examiner found no bilateral extreme tenderness of the plantar surfaces, marked deformity of the feet, marked pronation, weight-bearing line over or medial to the great toe, lower extremity deformity, inward bowing of the Achilles’ tendon, displacement or severe spasm, marked inward displacement of the foot, or severe spasm of the Achilles’ tendon. On physical examination, there was no pain, but pain is noted with prolonged standing. Interference with standing and pain after prolonged standing were contributing factors of the disability. Cramping pain significantly limited functional ability during flare-ups or when the feet were used repeatedly over a period of time. The examiner opined that there was functional loss during flare-ups that would make it difficult to walk or bear weight. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for a bilateral foot disability prior to November 1, 2019. The Board acknowledges the Veteran's lay reports of symptoms and the functional loss due to pain, pain during flare-ups, and pain during repetitive use over time. However, even considering the Veteran's lay reports of symptoms and functional loss, the degree of additional limitation caused by those symptoms does not result in symptoms more nearly approximating severe bilateral or unilateral flatfoot. As of November 1, 2019, the Board finds that the preponderance of the evidence is against a rating in excess of 30 percent for a bilateral foot disability. The November 2019 examination report noted bilateral pain on use with pain accentuated on use and swelling on use. The evidence does not indicate that the foot disability was manifested by marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation, which not improved by orthopedic shoes or appliances. Therefore, the Board finds that the symptoms the Veteran experiences do not more nearly approximate those described under the criteria for a 50 percent rating. Accordingly, the Board finds that the preponderance of the evidence is against the claim for a rating in excess of 10 percent for a bilateral foot disability prior to November 1, 2019, and in excess of 30 percent as of November 1, 2019. Thus, the claim for higher ratings for a bilateral foot disability must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals 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.