Citation Nr: 21005091 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 10-20 107 DATE: January 29, 2021 ORDER An initial rating in excess of 10 percent prior to September 17, 2013, in excess of 20 percent from September 17, 2013, to March 28, 2017, and in excess of 40 percent thereafter for chronic lumbosacral strain with slight degenerative disc disease (DDD) is denied. FINDINGS OF FACT 1. For the appeal period prior to September 17, 2013, the Veteran’s chronic lumbosacral strain with slight DDD was manifested by forward flexion greater than 60 degrees and a combined range of motion of the entire thoracolumbar spine greater than 120 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, ankylosis, incapacitating episodes due to intervertebral disc syndrome (IVDS), or associated objective neurologic abnormalities. 2. From September 17, 2013, to March 28, 2017, the Veteran’s chronic lumbosacral strain with slight DDD was manifested by forward flexion greater than 30 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, incapacitating episodes due to IVDS, or associated objective neurologic abnormalities. 3. As of March 28, 2017, the Veteran’s chronic lumbosacral strain with slight DDD is manifested by forward flexion less than 30 degrees, without ankylosis, incapacitating episodes due to IVDS, or associated objective neurological abnormalities. CONCLUSION OF LAW The criteria for an initial rating in excess of 10 percent prior to September 17, 2013, in excess of 20 percent from September 17, 2013, to March 28, 2017, and in excess of 40 percent thereafter for chronic lumbosacral strain with slight DDD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5242-5237. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from October 1970 to October 1976 and from January 2007 to January 2008. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2009 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. In May 2012, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing of record. In February 2013, the Board remanded the case for additional development, and in April 2016, denied the Veteran’s initial rating claim. He subsequently appealed such decision to the United States Court of Appeals for Veterans Claims (Court), which, in October 2016, granted a Joint Motion for Remand (JMR), which vacated the April 2016 decision and remanded the matter to the Board for further consideration. In March 2017, November 2017, and April 2019, the Board remanded the case for additional development and it now returns for further appellate review. Entitlement to an initial rating in excess of 10 percent prior to September 17, 2013, in excess of 20 percent from September 17, 2013, to March 28, 2017, and in excess of 40 percent thereafter for chronic lumbosacral strain with slight DDD. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. 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. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. 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. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The Veteran’s back disability is evaluated pursuant to DC 5242-5237, which pertains to lumbosacral strain and degenerative arthritis of the spine. In this regard, VA regulations specify that such disabilities are evaluated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). Ratings under the General Rating Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. Such provides for a 10 percent rating where forward flexion of the thoracolumbar spine is greater than 60 degrees but no 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 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 to 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. Finally, a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. Note (1): Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. 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 cervical spine is 340 degrees and 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 (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. 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. IVDS (preoperatively or postoperatively) may be evaluated either under the General Rating Formula or under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula), whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. § 4.25 (combined ratings table). The IVDS Formula provides that a 10 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note (1) provides that an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a. Rating in Excess of 10 Percent Prior to September 17, 2013 During the period from January 19, 2008, the date of service connection, to September 16, 2013, the Veteran’s back disability is assigned a 10 percent rating pursuant to the General Rating Formula. Under such criteria, a higher rating of 20 percent requires either that forward flexion of the thoracolumbar spine is limited to 60 degrees or less; or, the combined range of motion be limited to 120 degrees or less; or there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. However, none of the evidence referable to the period from January 19, 2008, to September 16, 2013, shows findings consistent with any of these criteria. In this regard, the Veteran underwent VA spine examinations in March 2009 and February 2011. During the March 2009 VA examination, the Veteran reported that he had flare-ups of back pain three times a week lasting two to three hours, which he rated as 4/10 in severity. The pain did not radiate. Upon physical examination, the Veteran reported slight pain and it was noted that he had a mild dorsal kyphosis. Upon range of motion testing, the Veteran had forward flexion to 90 days with pain at 68 degrees, extension to 30 degrees, bilateral flexion to 30 degrees, and bilateral rotation to 45 degrees, which resulted in a combined range of motion of 270 degrees. There were 1/4 positive Waddell signs. After three repetitions of range of motion, there was no additional limitation of motion. In his May 2010 substantive appeal, the Veteran reported difficulty standing, lifting, sitting, and driving. During the February 2011 VA examination, the Veteran reported that his pain symptoms had progressed since the previous VA examination. He reported complaints of back pain across his lower back that was sharp and dull, and was worse when doing yard work. The pain lasted several hours during the day and ranged from mild to severe. He denied any flare-ups or any incapacitating episodes in the previous 12 months. Other symptoms included stiffness and decreased motion. He denied using a brace or having restrictions on how far he can stand or his activities of daily life. Upon physical examination, when the range of motion findings were most restricted, flexion was from zero to 80 degrees, with pain and a significant amount of guarding beginning at 60 degrees, and the combined range of motion of the thoracolumbar spine was 210 degrees. There was no objective evidence of ankylosis or postural abnormalities. At his May 2012 Board hearing, the Veteran reported that his back disability resulted in pain, which affected his ability to carry items, the need to wear a brace, and needing to switch between sitting and standing every 45 minutes. Thus, based on the foregoing, the Board finds that a rating in excess of 10 percent for the Veteran’s back disability based on limitation of motion is not warranted. In this regard, neither of the two VA examinations conducted during such time period contains range of motion findings showing that forward flexion of the thoracolumbar spine was limited to 60 degrees or less; or, that the combined range of motion was limited to 120 degrees or less, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. In the October 2016 JMR, the parties agreed that the Board erred when it relied upon VA medical examination reports that failed to comply with the Court’s holdings in Mitchell, supra, and DeLuca, supra. In this regard, DeLuca requires that “the medical examiner…be asked to express an opinion on whether pain could significantly limit functional ability during flare-ups or when…used repeatedly over a period of time.” An examiner must portray such determinations in terms of additional range-of-motion loss due to pain on use or during flare-ups, or explain why such detail feasibly could not be determined for an examination to be adequate for rating purposes. See Mitchell, supra; Sharp v. Shulkin, 29 Vet. App. 26, 23 (2017). In the instant case, the parties, as relevant, found that the March 2009 VA examination failed to comply with such provisions. In this regard, the Board observes that, at such examination, the Veteran reported flare-ups of back pain three times a week lasting two to three hours, which he rated as 4/10 in severity. However, while the examiner did not address whether such pain would significantly limit his functional ability expressed in terms of additional range-of-motion loss, the Board observes that the Veteran himself did not report additional functional loss manifested by loss of range of motion when describing such flare-ups and, in fact, denied experiencing flare-ups at the February 2011 VA examination. Moreover, in March 2017, a VA examiner reviewed such examination report and indicated that the range of motion findings showed more range of motion than on the current examination; however, he reported that such findings may vary dependent on the Veteran’s pain complaints at the time and he may have had different symptoms at the time the previous examination was conducted. See Sharp, supra; Jones v. Shinseki, 23 Vet. App. 382 (2010) (a medical opinion that cannot be provided without resort to speculation is adequate only when it is clear that it is predicated on a lack of knowledge among the medical community at large and not the insufficient knowledge of the specific examiner). Thus, the Board finds that the evidence is sufficient to proceeding with the adjudication of the Veteran’s claim for a higher initial rating for the period prior to September 17, 2013. Further, the March 2009 and February 2011 VA examination reports, treatment records, and the Veteran’s lay statements do not suggest that his range of motion would change to the degree required for a higher rating with passive motion, during a flare-up, after repetitive use or repeated use over time, due to pain, or with weight-bearing or nonweight-bearing. Consequently, the Board finds that a rating in excess of 10 percent based on range of motion findings under the General Rating Formula is not warranted. The Board also notes that, while the March 2009 VA examination revealed mild dorsal kyphosis, such was not noted to have resulted from muscle spasm or guarding. In fact, the evidence does not reflect, and the Veteran has not reported, muscle spasms. Additionally, while guarding was noted upon forward flexion at the February 2011 VA examination, there was no objective evidence of postural abnormalities at such time. Thus, the Board finds that a rating in excess of 10 percent on such basis under the General Rating Formula is not warranted. The Board has considered whether a higher rating is warranted under the IVDS Rating Formula. However, while the Veteran reported that he had six incapacitating days in the prior year at the March 2009 VA examination, he indicated that such was not physician prescribed. Furthermore, at the February 2011 VA examination, the Veteran denied having had any incapacitating episodes in the prior 12 months, and the examiner stated that “[IVDS] is not applicable.” Furthermore, there is no clinical evidence, to include as found in the treatment reports of record, during the period prior to September 17, 2013, showing incapacitating episodes during which the Veteran had a period of acute signs or symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician. Therefore, a rating in excess of 10 percent for the Veteran’s back disability is not warranted under the IVDS Rating Formula. The Board has also considered whether separate ratings for associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are warranted pursuant to Note (1) of the General Rating Formula. However, while the Veteran reported a pinprick sensation when he walks and his leg touches the ground for the prior three months at his May 2012 Board hearing, he denied such at the March 2017 VA examination and indicated that he experienced such sensation in his back with prolonged sitting. Further, the objective evidence, to include the March 2009 and February 2011 VA examinations, fail to show that the Veteran’s back disability results in associated objective neurologic abnormalities. Specifically, in March 2009, straight leg raising was negative bilaterally, there were no sensory deficits in the legs, and the examiner found that there were no signs or symptoms of leg neuropathy, and, in February 2011, neurological examination was intact with normal sensation, motor strength, and reflexes. Therefore, separate ratings for objective neurologic abnormalities associated with the Veteran’s back disability are not warranted. Rating in Excess of 20 Percent from September 17, 2013, to March 28, 2017 For the appeal period from September 17, 2013, to March 28, 2017, the Veteran’s back disability is assigned a 20 percent rating based on limitation of motion pursuant to the General Rating Formula. Under such criteria, a higher rating of 40 percent based on limitation of motion requires either that forward flexion of the lumbar spine is limited to 30 degrees or less; or, that there is favorable ankylosis of the entire thoracolumbar spine. However, none of the evidence referable to the period from September 17, 2013, to March 28, 2017, shows findings consistent with either of these criteria. In this regard, the Veteran underwent a VA examination in September 2013, at which time he reported daily back pain without radiation of pain, and flare-ups described as having trouble getting up after bending over, which required him to push up on something to help. On examination, range of motion testing revealed flexion to 35 degrees, with pain beginning at 30 degrees; however, while there was less movement than normal, excess fatigability, pain on movement, and disturbance of locomotion on repetitive use testing, there was no additional loss of flexion. Furthermore, there was no ankylosis. In this regard, the Board notes that, pursuant to the JMR, in March 2017, a VA examiner considered whether the Veteran’s reports of pain at 30 degrees would result in additional loss of range of motion, but indicated that he was unable to comment on such inquiry as he was not present for such examination. See Jones, supra. Nonetheless, the Board notes that, upon the face of the September 2013 VA examination, it is clear that, while the examiner noted that the Veteran experienced pain at 30 degrees, he was still able to flex to 35 degrees. Thus, based on the foregoing, the Board finds that a rating in excess of 20 percent for the Veteran’s back disability based on limitation of motion is not warranted. In this regard, such VA examination does not contain range of motion findings showing that forward flexion of the lumbar spine is limited to 30 degrees or less, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, or ankylosis. In this regard, in the October 2016 JMR, the parties found that, in addition to the March 2009 VA examination, the September 2013 VA examination failed to comply with the Court’s holdings in Mitchell, supra, and DeLuca, supra. See also Sharp, supra. In this regard, the Board observes that, at such examination, the Veteran reported flare-ups described as having trouble getting up after bending over, which required him to push up on something to help. However, while the examiner did not address whether symptomatology would significantly limit his functional ability expressed in terms of additional range-of-motion loss, the Board observes that the Veteran himself did not report additional functional loss manifested by loss of range of motion when describing such flare-ups. Moreover, in March 2017, a VA examiner reviewed such examination report and indicated that the range of motion findings showed more range of motion than on the current examination; however, he reported that such findings may vary dependent on the Veteran’s pain complaints at the time and he may have had different symptoms at the time the previous examination was conducted. See Sharp, supra; Jones, supra. Further, the September 2013 VA examination report, treatment records, and the Veteran’s lay statements do not suggest that his range of motion would change to the degree required for a higher rating with passive motion, during a flare-up, after repetitive use or repeated use over time, due to pain, or with weight-bearing or nonweight-bearing. Consequently, the Board finds that a rating in excess of 20 percent based on range of motion findings under the General Rating Formula is not warranted. The Board has considered whether a higher rating is warranted under IVDS Rating Formula. However, neither the September 2013 VA examination report nor other clinical records reflect that the Veteran has had incapacitating episodes due to IVDS. Specifically, the September 2013 VA examiner indicated that the Veteran did not have IVDS. Therefore, a rating in excess of 20 percent for the Veteran’s back disability is not warranted under the IVDS Rating Formula. The Board has also considered whether separate ratings for associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are warranted pursuant to Note (1) of the General Rating Formula. In this regard, the Veteran denied experiencing bilateral lower extremity symptoms at the September 2013 VA examination. Additionally, on examination, straight leg testing and sensory examinations were normal. Further, the examiner found that Veteran had no radicular pain or other signs or symptoms due to radiculopathy, and had no other neurologic abnormalities or findings related to the thoracolumbar spine condition such as bowel or bladder problems or pathologic reflexes. Therefore, separate ratings for objective neurologic abnormalities associated with the Veteran’s back disability are not warranted. Rating in Excess of 40 Percent as of March 28, 2017 For the appeal period as of March 28, 2017, the Veteran’s back disability is assigned a 40 percent rating based on limitation of motion pursuant to the General Rating Formula. A higher rating of 50 percent requires unfavorable ankylosis of the entire thoracolumbar spine. However, none of the evidence referable to the period beginning March 28, 2017, shows ankylosis of any part of the Veteran’s spine. Specifically, his spine was not assessed as ankylosed, either in a favorable or unfavorable position, during his March 2017, November 2017, or September 2020 VA examinations. Moreover, treatment records consistently show that, while the Veteran experiences pain in his back, he is capable of range of motion, albeit severely limited, in his spine, and such VA examinations show that, while his range of motion is further reduced following repetitive use testing and during flare-ups, he is still capable of range of motion in the thoracolumbar spine. Consequently, as ankylosis is not present, a rating in excess of 40 percent under the General Rating Formula is not warranted. The Board has considered whether a higher rating is warranted under IVDS Rating Formula. However, none of the March 2017, November 2017, and September 2020 examination reports nor other clinical records reflect that the Veteran has had incapacitating episodes due to IVDS. Specifically, such VA examiners indicated that the Veteran did not have IVDS. Therefore, a rating in excess of 40 percent for the Veteran’s back disability is not warranted under the IVDS Rating Formula. The Board has also considered whether separate ratings for associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are warranted pursuant to Note (1) of the General Rating Formula. In this regard, at the March 2017 and November 2017 VA examinations, straight leg testing and sensory examinations were normal. Further, at the former examination the Veteran denied radiating pain and weakness in the muscles of his legs and, while he had mildly hypoactive reflexes, the examiner found that such may be a normal variant. Furthermore, upon examination in March 2017 and November 2017, the Veteran did not have any symptoms of radiculopathy, or bowel or bladder incontinence. Additionally, at the September 2020 VA examination, while straight leg raising testing was positive, muscle strength, reflex, and sensory testing was normal, and the examiner found that Veteran had no radicular pain or other signs or symptoms due to radiculopathy, and had no other neurologic abnormalities or findings related to the thoracolumbar spine condition such as bowel or bladder problems or pathologic reflexes. Therefore, separate ratings for objective neurologic abnormalities associated with the Veteran’s back disability are not warranted. Other Considerations In reaching its conclusions, the Board acknowledges the Veteran’s belief that his symptoms related to his back disability are more severe than as reflected by the currently assigned ratings. The Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). The Board finds the medical evidence in which professionals with medical expertise examined the Veteran’s back, acknowledged his reported symptoms, and described the manifestations of such disability in light of the rating criteria to be more persuasive than his own reports regarding the severity of such disability. The Board has considered whether additional staged ratings under Fenderson, supra, are warranted; however, the Board finds that his symptomatology has been stable throughout each period on appeal. Therefore, assigning further staged ratings is not warranted. Moreover, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, in regard to the initial rating adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). In sum, the Board finds that the preponderance of the evidence is against higher initial ratings for the Veteran’s back disability. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against his claim, such doctrine is inapplicable in the instant appeal and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Koria B. Stanton, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.