Citation Nr: 21067121 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-44 231 DATE: November 3, 2021 ORDER Entitlement to an effective date of service connection earlier than September 27, 2005, for painful scars on the right hand (Diagnostic Code 7804) is denied. Entitlement to an effective date of service connection earlier than September 27, 2005, for scar residuals of surgery to the right hand (Diagnostic Code 7805) is denied. Entitlement to an initial rating in excess of 20 percent for painful scars on the right hand is denied. Entitlement to an initial compensable rating for scar residuals of surgical to the right hand is denied. Entitlement to an initial 10 percent rating, but no higher, for irritable bowel syndrome (IBS), associated with posttraumatic stress disorder (PTSD) with major depressive disorder (MDD) and panic disorder for the period prior to March 18, 2020 is granted. Entitlement to an initial rating in excess of 10 percent for IBS for the period since March 18, 2020 is denied. FINDINGS OF FACT 1. The Veteran was granted service connection for painful scars on right hand (Diagnostic Code 7804) and a scar residual of surgery to right hand (Diagnostic Code 7804, effective September 27, 2005, the day after his discharge from service. 2. The Veteran's painful scars on the right hand have been characterized by 3 scars which are painful, but not unstable. 3. The Veteran's scar residuals of surgical to the right hand has not been shown to occupy an area or areas of 39 square inches or greater. 4. The Veteran's IBS has been manifested by no more than moderate symptomatology with frequent episodes of bowel disturbance with abdominal distress CONCLUSIONS OF LAW 1. The criteria for assignment of an effective date prior to September 27, 2005, for the award of service connection for painful scars on right hand are not met. 38 U.S.C. §§ 5110, 7105 (2012); 38 C.F.R. §§ 3.151, 3.155, 3.400, 20.302, 20.1103 (2020). 2. The criteria for assignment of an effective date prior to September 27, 2005, for the award of service connection for scar residual of surgery to right hand are not met. 38 U.S.C. §§ 5110, 7105 (2012); 38 C.F.R. §§ 3.151, 3.155, 3.400, 20.302, 20.1103 (2020). 3. The criteria for an initial rating in excess of 20 percent for painful scars on the right hand have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.118, Diagnostic Code 7804 (2020). 4. The criteria for an initial compensable rating for scar residuals of surgical to the right hand not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.118, Diagnostic Code 7805 (2020). 5. For the period prior to March 18, 2020, the criteria for an initial 10 percent rating, and no higher, for IBS have been met. 38 U.S.C. §§ 1155, 5103A, 5107 (2012); 38 C.F.R. §§ 4.114, Diagnostic Code 7319 (2020). 6. For the period since March 18, 2020, the criteria for an initial rating in excess of 10 percent for IBS have not been met. 38 U.S.C. §§ 1155, 5103A, 5107 (2012); 38 C.F.R. §§ 4.114, Diagnostic Code 7319 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 2001 to September 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the Board remanded these issues for additional development. In an April 2020 rating decision, the RO granted an effective date of September 27, 2005 for the award of service connection for painful scars on the right hand and for scar residuals of surgery to the right hand and granted a 10 percent rating for IBS associated with PTSD with MDD and panic disorder, effective March 18, 2020. The Board notes that the Veteran contends that her effective date for her scar of the right hand disabilities should be from when the injury occurred in April 2005. Additionally, the increase from 0 to 10 percent for the IBS disability did not constitute a full grant of the benefits sought. Accordingly, the issues of entitlement to an effective date of service connection earlier than September 27, 2005, for painful scars on right hand and for scar residual of surgery to right hand and entitlement to a rating in excess of 10 percent for IBS for the period since March 18, 2020 remain in appellate status. AB v. Brown, 6 Vet. App. 35, 39 (1993). Earlier Effective Dates Laws and Regulations The assignment of effective dates of awards is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Unless specifically provided otherwise, the effective date of an award based on an original claim or a claim reopened after final adjudication "shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor." 38 U.S.C. § 5110 (a). The implementing regulation clarifies this to mean that the effective date of service connection and compensation based on an original claim or a reopened claim will be the "[d]ate of receipt of claim or date entitlement arose, whichever is later." 38 C.F.R. § 3.400. VA amended its adjudication regulations on March 24, 2015, to require that all claims governed by VA's adjudication regulations be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The amendments, however, are only effective for claims and appeals filed on or after March 24, 2015. Under the old regulations, any communication or action, indicating an intent to apply for one or more benefits under laws administered by VA, from a claimant or the claimant's representative, may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155 (a) (in effect prior to March 24, 2015). There is no set form that an informal written claim must take. All that is required is that the communication indicates an intent to apply for one or more benefits under the laws administered by VA, and identify the benefits sought. Rodriguez v. West, 189 F.3d 1351 (1999). Case law is clear that this means the claimant must describe the nature of the disability for which he is seeking benefits, such as by describing a body part or symptom of the disability. Brokowski v. Shinseki, 23 Vet. App. 79, 86-87 (2009). Factual Background and Analysis On July 22, 2005, VA received a VA Form 21-526 claiming service connection for a right-hand injury. In an October 2005 Rating Decision, the agency of original jurisdiction (AOJ) granted service connection for residuals of the hand injury (assigning 0 percent effective September 27, 2005). However, in that rating decision, the AOJ specifically denied a separate compensable rating for the associated scars. The Veteran did not timely appeal the October 2005 denial of a separate compensable rating for the associated scars and it became final. In July 2014, VA received a VA Form 21-526b claiming service connection for the scars on her right hand. In a February 2015 rating decision, the AOJ granted service connection for scars on the right hand (assigning 20 percent under Diagnostic Code 7804 and 0 percent under Diagnostic Code 7805, both effective on July 25, 2014). However, in the March 2015 Notice of Disagreement, the Veteran contented that she deserved an earlier effective date of service connection for the scars because the scars have existed since April 2005 (implying that there was a clear and unmistakable error [CUE] in the October 2005 rating decision). Per the January 2020 Board remanded instructions, the RO readjudicated the claim in the first instance in the April 2020 rating decision and granted an effective date of September 27, 2005 for the award of service connection for painful scars on right hand and for scar residual of surgery to right hand. As noted above, the Veteran maintains that the effective date of service connection should be from the date of the injury in April 2005. Based upon a review of the evidence, the Board finds that the currently assigned effective date of September 27, 2005, is the earliest effective date assignable for the award of service connection for painful scars on the right hand and for scar residuals of surgery to the right hand disabilities. The Veteran separated from active duty service on September 26, 2005. Her claims for service connection for painful scars on right hand and for scar residual of surgery to right hand were received within one year of separation. Therefore, in accordance with 38 C.F.R. § 3.400, the RO has assigned an effective date of service connection for painful scars on the right hand and for scar residuals of surgery to the right hand disabilities of September 27, 2005, the day after the Veteran's discharge from active duty service. No earlier effective date is assignable under the law. 38 C.F.R. § 3.400 (b)(2) (if a claim was received within one year after separation from service, the date of entitlement shall be the day following separation). Thus, the Board finds that the effective date for the grant of service connection for painful scars on the right hand and for scar residuals of surgery to the right hand disabilities may be no earlier than the currently assigned date of September 27, 2005. Accordingly, the benefit sought on appeal is denied. For the reasons discussed above, the preponderance of the evidence is against the Veteran's claims. As such, the benefit of the doubt doctrine is inapplicable, and the claims must be denied. See 38 C.F.R. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Rating Laws and Regulations The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claims or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claims, in which case, the claims are denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2020). Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2020). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2020). The Veteran's entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1 (2018). Where service connection has already been established, and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, in Fenderson v. West, 12 Vet. App. 119 (1999), it was held that evidence to be considered in the appeal of an initial assignment of a disability rating was not limited to that reflecting the then current severity of the disorder. The Court also discussed the concept of the "staging" of ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. See also Hart v. Mansfield, 21 Vet. App. 505 (2008). The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14 (2018). The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261- 62 (1994). 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 (2020). In this case, the Veteran is competent to testify on factual matters of which he has first-hand knowledge. Washington v. Nicholson, 19 Vet. App. 362 (2005). He is also competent to report symptoms of his scar and IBS disabilities. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). The Veteran is competent to describe his symptoms and their effects on employment or daily activities. Scars Laws and Regulations In a February 2015 rating decision, the RO granted service connection for 3 painful scars on the right hand at an initial 20 percent disability rating under Diagnostic Code 7804 and for a scar residuals of surgery to the right hand at an initial noncompensable evaluation, under Diagnostic Code 7805. In evaluating skin and scar residuals, the Board notes that during the appeal period, changes were made to certain Diagnostic Codes under 38 C.F.R. § 4.118. Effective August 13, 2018, VA amended its regulations governing skin disabilities. VA's intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. 83 Fed. Reg. 32592 (July 13, 2018). As the Veteran filed her claim before the August 13, 2018 effective date, the Board will consider whether either the old or new rating criteria is more favorable to the Veteran. The pre-amended Diagnostic Code 7801 provided disability ratings for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear. 38 C.F.R. § 4.118, Diagnostic Code 7801 (2017). In contrast, the amended Diagnostic Code 7801 contemplates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7801 (August 13, 2018). Both the old and new criteria provide that a 10 percent rating is awarded when the area of the scar(s) covers at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters). A 20 percent rating is warranted when the area of the scar(s) covers at least 12 square inches (77 square centimeters) but less than 72 square inches (456 square centimeters). A 30 percent rating is warranted when the area of the scar(s) covers at least 72 square inches (456 square centimeters) but less than 144 square inches (929 square centimeters). A 40 percent rating is assigned when the area of the scar(s) covers at least 144 square inches (929 square centimeters) or greater. 38 C.F.R. § 4.118, Diagnostic 7801. Note (1) to the pre-amended Diagnostic Code 7801 stated that a deep scar is one associated with underlying soft tissue damage. Prior to August 13, 2018, Diagnostic Code 7802 provided rating criteria for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear. 38 C.F.R. § 4.118, Diagnostic 7802 (2017). The amended version is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7802 (August 13, 2018). Both versions state that a 10 percent disability rating is warranted when the area of the scar covers 144 square inches (929 square centimeters) or greater. Under both the old and new rating criteria, Diagnostic Code 7804 provides disability ratings for scars that are unstable or painful. A 10 percent rating is warranted for one or two scars that are unstable or painful. A 20 percent rating is warranted for three or four scars that are unstable or painful. A 30 percent rating is warranted for five or more scars that are unstable or painful. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, an additional 10 percent should be added to the evaluation based on the total number of unstable or painful scars. Note (3) states that 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 7804. Under the old rating criteria, Diagnostic Code 7805 provided that other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-7804 under an appropriate Diagnostic Code. 38 C.F.R. § 4.118, Diagnostic Code 7805 (2017). The Board notes that this diagnostic code is largely unchanged under the new amendments apart from the replacement of the phrase "(including linear scars)" with "and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804." 38 C.F.R. § 4.118, Diagnostic Code 7805 (August 13, 2018). In every instance where the schedule does not provide a 0 percent rating for a diagnostic code, a 0 percent rating will be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. Factual Background and Analysis The record demonstrates that the Veteran underwent right hand surgery in 2005. The Veteran underwent a VA examination in April 2014. The diagnosis was residuals of a right hand injury. The Veteran had scars related to the right hand disability but none were painful or unstable. The total area of all the related scars was not greater than 39 square cm. On a December 2014 VA examination for a peripheral nerve condition, the examiner noted that the Veteran had surgical scars on his right hand which were well healed. There were scars on her right index and middle fingers but these were not painful and both were mobile. The examiner also noted that the Veteran had scars related to the right hand disability but none were painful or unstable. The total area of all the related scars was not greater than 39 square cm. The Veteran underwent a VA scar examination in December 2014. It was noted that the Veteran had scars on her right hand due to in-service trauma to her right hand. She had 3 painful scars. None of the scars were unstable with frequent loss of covering of the skin over the scar. None of the scars were both painful and unstable. None of the scars were due to burns. The Veteran had 7 scars but only 3 of them were painful. Scar number 1 was a 3cm linear scar that was painful. Scar number 2 was a 2cm linear scar that was painful and scar number 7 was a 1cm linear scar that was painful. The nontender scars (numbers 3, 4, 5 and 8) were 1cm, .5cm, .5cm and 1.5cm in length. There were no superficial deep linear scars and no deep non-linear scars. None of the Veteran's scars impacted her ability to work. The Veteran underwent a VA examination in August 2015. The diagnosis was residuals of a right hand injury post surgery in 2005 where pins and needles were removed. The Veteran had scars related to the right hand disability but none were painful or unstable. The total area of all the related scars was not greater than 39 square cm. Based on the evidence, the Board does not find that the Veteran is entitled to an initial evaluation in excess of 20 percent for painful scars on right hand and is not entitled to an initial compensable rating for scar residuals of surgery to the right hand. Regarding an initial rating in excess of 20 percent for painful scars on the right hand, an increased 30 percent disability rating is warranted under Diagnostic Code 7804 for five or more scars that are unstable or painful. However, the record demonstrates that the Veteran has only 3 painful scars, rather than five or more scars that are unstable or painful. As the Veteran had only 3 painful scars and they did not limit her motion or ability to function, her painful scars on right hand continues to warrant an initial rating of 20 percent under Diagnostic Code 7804. The Board has considered whether other ratings are applicable to the Veteran's painful scars on the right hand. However, there is no basis to assign a compensable rating for the Veteran's painful scars on the right hand under Diagnostic Code 7805. Although the Veteran's December 2014 VA examination indicates the Veteran experiences pain, this symptom is already accounted for under Diagnostic Code 7804. Assigning other ratings based on the same symptom that is already accounted for would be tantamount to pyramiding. 38 C.F.R. § 4.14. The Board notes that the December 2014 VA examination also indicated that there was no functional impairment. The Board additionally notes that Diagnostic Code 7800 is not applicable as it relates specifically to scars of the head, face, or neck. Therefore, an initial rating in excess of 20 percent under 7804 for the painful scars is not warranted, and the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Regarding an initial compensable rating for scar residuals of surgery to the right hand, pursuant to Note (3) of Diagnostic Code 7804, the noncompensable rating for scar residuals of surgery to the right hand may remain in place along with the separate rating for painful scars without violating the rule against pyramiding. As noted above, the scar residuals of surgery to the right hand disability is rated under Diagnostic Code 7805 at an initial noncompensable disability rating. Diagnostic Code 7805 provides that any disabling effects not considered in a rating provided under Diagnostic Codes 7800-7804 are to be considered under an appropriate diagnostic code. 38 C.F.R. § 4.118, Diagnostic Code 7805. As the Veteran's scars are not on the face, head or neck, and are linear, Diagnostic Codes 7800-7802 do not apply in this case, and will not be discussed. 38 C.F.R. § 4.118, Diagnostic Codes 7800-7802. The Board finds that the Veteran is not entitled to a higher, 10 percent rating under Diagnostic Code 7805, because her scars do not have an area of 39 square inches or greater. On the VA examinations in December 2014 and August 2015, the examiners specifically noted that the total area of all the related scars was not greater than 39 square cm. As a result, the Board finds that an initial rating in excess of 20 percent for painful scars on the right hand, under Diagnostic Code 7804 and an initial compensable rating for scar residuals of surgery to the right hand under Diagnostic Code 7805 is not warranted. IBS The September 2016 rating decision granted service connection for IBS at an initial noncompensable evaluation, effective July 25, 2014 under Diagnostic Code 7913. In an April 2020 rating decision, the RO granted an initial 10 percent rating for IBS associated with PTSD with MDD and panic disorder, effective March 18, 2020 under Diagnostic Code 7913. Under Diagnostic Code 7319, which assigns a 0 percent disability rating for mild IBS with disturbances of bowel function with occasional episodes of abdominal distress. Moderate IBS, with frequent episodes of bowel disturbance with abdominal distress, is rated 10 percent disabling. Severe IBS, with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress, is rated 30 percent disabling. 38 C.F.R. § 4.114. The Board also notes that a 30 percent disability rating is the maximum rating allowable under Diagnostic Code 7319. The Board observes that the words "mild," "moderate," "moderately severe," and "severe" as used in the various Diagnostic Codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. The Veteran underwent a VA examination in March 2015. The Veteran reported having chronic constipation since 2003. Continual medication was needed for control of her intestinal condition as she took Dulcolax daily. She reported that unless she took Dulcolax, she did not have a bowel movement. She did not have episodes of bowel disturbance with bowel distress, or exacerbations or attacks of the intestinal condition. She did not have weight loss attributed to an intestinal condition and did not have malnutrition, serious complications or other general health effects attributable to an intestinal condition. The examiner found that the Veteran's intestinal disability did not impact her ability to work. The examiner noted that a review of the Veteran's clinic notes and treatment records did not show complaints indicative of IBS and there was no documentation of treatment for IBS. The Veteran underwent a VA examination in September 2016. The examiner noted a diagnosis of IBS that the Veteran reported had worsened over the past few years. The IBS symptoms were mainly constipation predominant. She reported chronic constipation for which she took Dulcolax for. She reported that at times she was unable to move her bowels more than once per week. She also complained of daily bloating and that she went to a center every other week to have a "colonic". She did had occasional episodes of bowel disturbance and bowel distress. She did not have weight loss attributed to an intestinal condition and did not have malnutrition, serious complications or other general health effects attributable to an intestinal condition. The examiner found that the Veteran's intestinal disability did not impact her ability to work. The examiner noted that the Veteran had symptoms that were compatible with mild IBS, constipation predominant. Per the January 2020 Board remand instructions, the Veteran underwent a VA examination in March 2020. The Veteran reported that she had chronic constipation for which she took Dulcolax for daily. She reported that she had pain in the right side of her stomach with a lot of gas. She hardly went to the bathroom during the week and had a lot of straining, nausea and acid reflux. The Veteran had abdominal distension, nausea, vomiting almost daily and chronic constipation. She did have frequent episodes of bowel disturbance and bowel distress. She did not have weight loss attributed to an intestinal condition and did not have malnutrition, serious complications or other general health effects attributable to an intestinal condition. The examiner found that the Veteran's intestinal disability impacted her ability to work as she had trouble using public bathrooms due to embarrassment. Under the circumstances of this case, and with resolution of all reasonable doubt in the Veteran's favor, the Board concludes that an initial 10 percent disability rating, but no higher, for IBS is warranted for the period prior to March 18, 2020. As noted above, under Diagnostic Code 7319, a noncompensable rating is warranted for mild IBS with disturbances of bowel function with occasional episodes of abdominal distress while moderate IBS, with frequent episodes of bowel disturbance with abdominal distress warrants a compensable 10 percent evaluation. Notably, the evidence demonstrates that for the period prior to March 18, 2020, the Veteran had only occasional episodes of bowel disturbance and bowel distress as evidenced by the September 2016 VA examination. However, during this period, the Veteran also reported a worsening of symptoms over the past few years that were mainly constipation predominant as took Dulcolax on a daily basis. During this period the Veteran also reported that at times she was unable to move her bowels more than once per week and she also complained of daily bloating. As a result, and when affording the Veteran the benefit of the doubt, the Board finds that an initial 10 percent rating, but no higher is warranted for the Veteran's IBS as the Veteran had symptoms commensurate with moderate IBS, with frequent episodes of bowel disturbance with abdominal distress. Thus, for all the foregoing reasons, the Board finds that an initial 10 percent rating for IBS is warranted for the period prior to March 18, 2020. However, after reviewing evidence of record as a whole, the Board finds that the assignment of a disability rating greater than 10 percent for the Veteran's IBS is not warranted. As noted above, the September 2016 VA examiner specifically noted that the Veteran had symptoms that were compatible with mild IBS, constipation predominant while also indicating that the Veteran's intestinal disability did not impact her ability to work. More recently, on VA examination in March 2020, the Veteran reported that she had pain in the right side of her stomach with a lot of gas, she hardly went to the bathroom during the week and had a lot of straining, nausea and acid reflux. The examiner also noted that the Veteran had abdominal distension, nausea, vomiting almost daily and chronic constipation in addition to frequent episodes of bowel disturbance and bowel distress. However, the Board notes that the Veteran did not have weight loss attributed to an intestinal condition and did not have malnutrition, serious complications or other general health effects attributable to an intestinal condition. Based on this evidence, the Board finds that the Veteran's IBS has not reflected a severity to warrant a increased 30 percent disability rating as the Veteran has not shown severe symptoms with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. While the Veteran reported that she experienced abdominal distension, nausea, vomiting and chronic constipation and had frequent episodes of bowel disturbance and bowel distress, the medical evidence does not support a finding of severe symptoms with diarrhea and constant abdominal distress. Notably, the March 2020 VA examination indicates the absence of constant abdominal distress and there are no medical findings to the contrary such that constant abdominal distress is evidenced. As such, the Board finds that an initial rating in excess of 10 percent is not warranted for the Veteran's IBS. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James A. DeFrank, 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.