Citation Nr: 21067314 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-17 624 DATE: November 3, 2021 ORDER Entitlement to an increased disability evaluation for right hand tendonitis, currently rated as noncompensable, is denied. Entitlement to an increased, 10 percent disability evaluation for right lateral epicondylitis is granted. Entitlement to an increased, 10 percent disability evaluation for right shoulder rotator cuff tendonitis is granted. Entitlement to an increased, 30 percent disability evaluation for gastroesophageal reflux disease (GERD) is granted. Entitlement to an increased, 20 percent disability evaluation for thoracolumbar spine spondylosis with degenerative disc disease, for the rating period prior to February 28, 2014, is granted. Entitlement to an increased disability evaluation for thoracolumbar spine spondylosis with degenerative disc disease, rated as 20 percent disabling from February 28, 2014, is denied. Entitlement to an increased, 10 percent disability evaluation for right wrist tenosynovitis, for the rating period prior to September 30, 2016, is granted. Entitlement to an increased disability evaluation for right wrist tenosynovitis, rated as 10 percent disabling since September 30, 2016, is denied. Entitlement to an increased, 30 percent disability evaluation for bilateral plantar fasciitis, for the rating period prior to October 12, 2020, is granted. Entitlement to an increased disability evaluation for bilateral plantar fasciitis, rated as 50 percent disabling since October 12, 2020, is denied. Entitlement to service connection for a right thigh disorder, including as secondary to service-connected thoracolumbar spine spondylosis, is denied. Entitlement to service connection for a left thigh disorder, including as secondary to service-connected thoracolumbar spine spondylosis, is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted, effective September 1, 2013. FINDINGS OF FACT 1. The Veteran's right hand tendonitis is not productive of limitation of motion with a gap between the fingertip of the index finger and the palm; the Veteran does not experience pain on motion. 2. The Veteran's right lateral epicondylitis is productive of normal range of motion, with pain on motion. 3. The Veteran's right shoulder rotator cuff tendonitis (major) is productive of normal range of motion, with pain on motion. 4. For the entire rating period on appeal, the Veteran's GERD causes recurrent epigastric distress with pyrosis and regurgitation, with substernal pain; there are no complaints of weight loss, anemia, hematemesis, melena, or impairment of health. 5. For the entire rating period on appeal, the Veteran's thoracolumbar spine spondylosis with degenerative disc disease is manifested by pain on motion, with functional loss due to pain upon movement. Forward flexion is limited to no worse than 65 degrees, and the Veteran does have intervertebral disc syndrome or ankylosis; the Veteran has been prescribed bed rest of at least 2 weeks, but not more than 4 months, in a year. 6. For the entire rating period on appeal, the Veteran's right wrist tenosynovitis is productive of normal range of motion with pain on motion. 7. For the rating period prior to October 12, 2020, the Veteran's bilateral plantar fasciitis is manifested by pain on use. 8. For the rating period since October 12, 2020, the Veteran's bilateral plantar fasciitis is productive of extreme tenderness of plantar surfaces of the feet and accentuated pain on use and manipulation of the feet, without relief from orthopedic shoes and appliances. 9. The Veteran does not have a right thigh disorder. 10. The Veteran does not have a left thigh disorder. 11. Since September 1, 2013, the Veteran's service-connected PTSD renders the Veteran unable to engage and retain substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for a compensable disability rating for right hand tendonitis are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5229 (2020). 2. The criteria for a 10 percent disability rating, but no higher, for right lateral epicondylitis have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5299 5206 (2020). 3. The criteria for a 10 percent disability rating, but no higher, for right shoulder rotator cuff tendonitis have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5201 5024 (2020). 4. The criteria for a 30 percent disability rating, but no higher, for GERD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.113, 4.114, Diagnostic Codes 7399 7346 (2020). 5. The criteria for a disability evaluation of 20 percent, but no higher, for lumbar spine spondylosis with degenerative disc disease for the rating period prior to February 28, 2014, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5235 5243 (2020). 6. The criteria for a disability evaluation in excess of 20 percent for lumbar spine spondylosis with degenerative disc disease for the rating period since February 28, 2014 have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5235 5243 (2020). 7. The criteria for a 10 percent disability rating, but no higher, for right wrist tenosynovitis for the rating period prior to September 30, 2016 have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5024 5215 (2020). 8. The criteria for a disability evaluation in excess of 10 percent for right wrist tenosynovitis for the rating period since September 30, 2016 have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5024 5215 (2020). 9. The criteria for a disability evaluation of 30 percent, but no higher, are met for bilateral plantar fasciitis for the rating period prior to October 12, 2020, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5276 (2020). 10. The criteria for a disability evaluation in excess of 50 percent for bilateral plantar fasciitis, for the rating period since October 12, 2020, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5276 (2020. 11. The criteria for service connection for a right thigh disorder have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2020). 12. The criteria for service connection for a left thigh disorder have not been met. 38 U.S.C. §§ 1101, 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2020). 13. Since September 1, 2013, the criteria for TDIU are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16, 4.18 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from September 1997 to August 2013. These matters come before the Board of Veterans' Appeals (Board) on appeal from February 2014, March 2014, and January 2017 rating decisions issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The February 2014 rating decision, in pertinent part, granted service connection for the Veteran's GERD, right lateral epicondylitis, right wrist tenosynovitis, and thoracolumbar spine tendonitis; the March 2014 rating decision, in pertinent part, granted service connection for the Veteran's bilateral plantar fasciitis and denied service connection for the Veteran's right and left thigh disorders, and the January 2017 rating decision, in pertinent part, denied the Veteran's claim of entitlement to TDIU. During the pendency of the appeal, in a January 2015 rating decision, the Veteran was awarded an increased, 10 percent disability evaluation for his GERD, effective September 1, 2013, and an increased, 20 percent disability evaluation for his thoracolumbar spine spondylosis with degenerative disc disease, effective February 28, 2014. In a January 2017 rating decision, the Veteran was granted an increased, 10 percent disability evaluation for her right wrist tenosynovitis, effective September 30, 2016. As the Veteran has not been granted the maximum benefits allowed, the claims of entitlement to increased disability ratings remain on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). In June 2020, the Board remanded this appeal for further development. A supplemental statement of the case was most recently issued in January 2021. The Board finds that there was substantial compliance with its remand orders. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). Duties to Notify and Assist Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Increased Rating Disability evaluations are determined by application of the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be staged. Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In addition, when assessing the severity of a musculoskeletal disability that is rated on the basis of limitation of motion, VA must also consider the extent that the veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent ("flare-ups") due to the extent of his pain (and painful motion), weakness, premature or excess fatigability, and incoordination. See DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. When evaluating musculoskeletal disabilities, VA must consider whether a higher evaluation is warranted, where the claimant experiences additional functional loss due to pain, weakness, excess fatigability, or incoordination, to include with repeated use or during flare-ups. See 38 C.F.R. § § 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996). Nevertheless, pain itself does not rise to the level of functional loss as contemplated by the VA regulations applicable to the musculoskeletal system. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Moreover, functional impairment must be supported by adequate pathology. Id.; Johnson v. Brown, 9 Vet. App. 7, 10 (1996) (both citing to 38 C.F.R. § 4.40). Notably, during the appeal period, changes were made to 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5201, 5242, and 5243; separate diagnostic criteria, Diagnostic Code 5269, for plantar fasciitis, was added to the rating schedule. Effective February 7, 2021, VA amended its regulations governing the schedule of rating musculoskeletal disabilities. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5201, 5269). 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. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). 1. Entitlement to an increased disability evaluation for right hand tendonitis, currently rated as noncompensable. The Veteran is currently assigned a noncompensable disability evaluation for his right hand tenonitis pursuant to Diagnostic Code 5229. Limitation of motion in the index or long finger is rated under Diagnostic Code 5229. A maximum 10 percent rating is assigned when there is a gap of one inch or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. Only a noncompensable rating is available for limitation of motion in the ring finger or little finger. The rating criteria under these diagnostic codes is the same for the both the major and minor fingers. The Board finds that the Veteran's disability picture more nearly approximates the criteria for the current noncompensable disability rating for right hand tendonitis. In this regard, there is no evidence of treatment sought or received for right hand or finger-related symptoms during the rating period on appeal. Likewise, the June 2013 and October 2020 VA hand and finger examination reports reflect that all range of motion testing was normal, with no evidence of pain on motion, and no loss of range of motion with repetitive use testing. The Veteran reported no flareups. He demonstrated full grip strength bilaterally, and there was no evidence of ankylosis of any digit. Significantly, the October 2020 VA examiner found that the Veteran's right hand tendonitis is considered resolved, as there was no inflammation or pathology present. As the evidence preponderates against the claim, entitlement to an increased, compensable disability rating for right hand tendonitis must be denied. Gilbert v. Derwinski, 2 Vet. App. 49, 53 (1990). 2. Entitlement to an increased disability evaluation for right lateral epicondylitis, currently rated as noncompensable. In this case, documents of record establish that the Veteran is right handed; the Veteran reported that his dominant hand is his right hand at the June 2013 and October 2020 VA examinations. See 38 C.F.R. § 4.69. The Veteran is currently afforded a noncompensable disability rating for right lateral epicondylitis pursuant to 38 C.F.R. § 4.71a, Diagnostic Codes 5299 5206. See 38 C.F.R. § 4.27 (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 evaluation assigned; disabilities requiring rating by analogy will be coded first the numbers of the most closely related body part and "99"). The appropriate diagnostic codes for evaluating limitation of motion of the elbow joint are Diagnostic Codes 5206 and 5207, applicable to limitation of flexion and extension of the elbow, respectively. Under Diagnostic Code 5206, a 10 percent rating is warranted for either the major or minor elbow where there is forearm limitation of flexion to 100 degrees. Under Diagnostic Code 5207, a 10 percent rating is warranted for either the major or minor elbow where there is forearm limitation of extension to either 45 or 60 degrees. For a higher, 20 percent disability evaluation, there must be limitation of forearm flexion to 90 degrees (Diagnostic Code 5206), or limitation of forearm extension to 75 degrees (Diagnostic Code 5207). See 38 C.F.R. § 4.71a, Diagnostic Codes 5206-5207. The Board finds that the Veteran's disability picture more nearly approximates the criteria for an increased, 10 percent disability rating, but no higher for right lateral epicondylitis. According to the June 2013 and October 2020 VA examinations, the Veteran had range of motion to 145 degrees flexion and 0 degrees extension; supination and pronation were also normal. Although the VA examination did not objectively show that the Veteran had pain on motion, the Veteran reported experiencing pain on motion. However, the fact that he had pain does not warrant an evaluation in excess of 10 percent unless that pain actually limits motion or functional use. Here, the lay and medical evidence establishes that he retained full functional motion of the right elbow. Thus, an increased rating is not warranted under any of the applicable diagnostic codes. With regard to functional loss, the Veteran is already being compensated for his painful motion of the elbow as part of his current 10 percent evaluation, and the evidence does not demonstrate any other functional loss. See 38 C.F.R. §§ 4.40, 4.45, 4.59 (2020). For the foregoing reasons, the preponderance of the evidence reflects that the Veteran's symptoms more nearly approximated the criteria for a rating of 10 percent, but no higher, for right lateral epicondylitis. 3. Entitlement to an increased disability evaluation for right shoulder rotator cuff tendonitis, currently rated as noncompensable. The Veteran is currently rated for his service-connected right shoulder rotator cuff tendonitis pursuant to the provisions of 38 C.F.R. § 4.71a, Diagnostic Codes 5024 5201. See 38 C.F.R. §§ 4.20, 4.27. The Board notes that, effective February 7, 2021, Diagnostic Code 5024 was revised from tenosynovitis alone to tenosynovitis, tendinitis, tendinosis, or tendinopathy. Under both the regulations prior and subsequent to February 7, 2021, the Note for Diagnostic Code 5024 directed that diseases under Diagnostic Codes 5013 through 5024 should be evaluated as degenerative arthritis, based on limitation of motion of the affected parts. The Board notes that the amended Diagnostic Code 5003, effective February 7, 2021, is substantively unchanged. To this point, the Board notes that Diagnostic Code 5003 was revised to reflect that this Diagnostic Code only applies to degenerative arthritis. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76460 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5003). Diagnostic Code 5003 provides that degenerative arthritis substantiated by x-ray findings is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When limitation of motion is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each major joint or group of minor joints affected by limitation of motion. A 20 percent evaluation is warranted for x-ray evidence of involvement of 2 or more major or minor joints, with occasional incapacitating exacerbations. See 38 C.F.R. § 4.71a, Diagnostic Code 5003. However, the Veteran has not reported experiencing any incapacitating exacerbations with regard to his right shoulder. Diagnostic Code 5201 provides that limitation of motion of the arm at the shoulder level is rated 20 percent for the major shoulder and 10 percent for the minor shoulder; limitation of motion of the arm midway between the side and shoulder level is rated as 30 percent for the major shoulder and 20 percent for the minor shoulder; and limitation of motion of the arm to 25 degrees from the side is rated as 40 percent for the major shoulder and 30 percent for the minor shoulder. 38 C.F.R. § 4.71a, Diagnostic Code 5201. The Board notes that effective February 7, 2021, the regulations pertaining to shoulders and arms were amended to state that Diagnostic Code 5201, governing limitation of the motion of the arm, includes flexion or abduction and to provide specific range of motion measurements; midway between side and shoulder level is defined as 45 degrees and at shoulder level is defined as 90 degrees. See 85 Fed. Reg. 76462 (Nov. 30, 2020) (effective 2/7/2021). The Board notes that this change does not impact the evaluation in this case. Normal ranges of motion of the shoulder are flexion (forward elevation) from 0 degrees to 180 degrees, abduction from 0 degrees to 180 degrees, external rotation from 0 degrees to 90 degrees, and internal rotation from 0 degrees to 90 degrees. See 38 C.F.R. § 4.71, Plate I (2019). In this case, documents of record establish that the Veteran is right-handed; the Veteran reported that his dominant hand is his right hand at the June 2013 and October 2020 VA examinations. See 38 C.F.R. § 4.69. The Board finds that the Veteran's disability picture more nearly approximates the criteria for a 10 percent disability evaluation, but no higher, for right shoulder rotator cuff tendonitis for the entire rating period on appeal. According to the most recent, October 2020 VA examination report, the Veteran had full range of motion in flexion, abduction, and in external and internal rotation. The Veteran reported functional loss due to an inability to do overhead work as a result of pain, but the Veteran did not have additional loss of motion or functional loss upon repetitive use testing. At the June 2013 VA examination, he had full flexion, abduction, and external and internal rotation. VA and private treatment records reflect treatment for right shoulder pain, but none show specific range of motion findings. The Board has considered whether additional functional impairment due to factors such as pain, weakness and fatigability demonstrate additional limitation of motion or function to warrant a higher rating. See 38 C.F.R. §§ 4.40, 4.45, 4.59 and DeLuca at 206-07. The Board acknowledges that the Veteran reported at his VA examinations that he had difficulty lifting objects above his shoulder and pain with lifting due to his left shoulder strain; however, to the extent that the Veteran claims that his pain upon motion is the equivalent of limited motion, the Board finds that the Veteran's subjective complaints of pain have been contemplated in the current rating assignment, as the current rating is based on the Veteran's report of pain on motion, which were not shown upon examination. See Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). The October 2020 VA examination report does not show that additional pain or limitation of motion on repetitive use testing, and pain on active motion/passive motion/in weight-bearing/nonweight-bearing resulted in functional loss warranting the assignment of any higher evaluation for the right shoulder during the appeal period. See Correia v. McDonald, 28 Vet. App. 158 (2016). The Board finds that the criteria for a disability rating of 10 percent, but no higher, for the right shoulder have not been met or more nearly approximated for any part of the rating period on appeal. There is no evidence of ankylosis, muscle atrophy, malunion of the humerus with deformity, or loss of head, nonunion, or fibrous union of the humerus during the rating period on appeal. Thus, a higher rating for the left shoulder, based on Diagnostic Codes 5200 and 5202, are not warranted. 4. Entitlement to an increased disability evaluation for GERD, currently rated as 10 percent disabling. The Veteran's GERD is currently evaluated as 10 percent disabling pursuant to 38 C.F.R. § 4.114, Diagnostic Codes 7399 7346. See 38 C.F.R. § 4.27 (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 evaluation assigned; disabilities requiring rating by analogy will be coded first the numbers of the most closely related body part and "99"). This hyphenated diagnostic code may be read to indicate that an unlisted digestive system disorder is the service-connected disorder, and it is rated as if the residual condition is hiatal hernia under Diagnostic Code 7346. Under Diagnostic Code 7346, a 10 percent disability evaluation is warranted for hiatal hernia where there are two or more of the symptoms for a 30 percent disability evaluation, of less severity. A 30 percent disability evaluation is warranted for hiatal hernia where there is persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, which is productive of considerable impairment of health. A 60 percent disability evaluation requires pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severely impaired health. See 38 C.F.R. § 4.114, Diagnostic Code 7346. For purposes of evaluating conditions in 38 C.F.R. § 4.114, the term "substantial weight loss" means a loss of greater than 20 percent of the individual's baseline weight, sustained for three months or longer; and the term "minor weight loss" means a weight loss of 10 to 20 percent of the individual's baseline weight, sustained for three months or longer. 38 C.F.R. § 4.112. The term "inability to gain weight" means that there has been substantial weight loss with inability to regain it despite appropriate therapy. "Baseline weight" means the average weight for the two-year-period preceding onset of the disease. After review of the evidence of record, the Board finds that a 30 percent disability rating, but no higher, is warranted for the Veteran's service-connected GERD for the entire rating period on appeal. The November 2014 and May 2016 VA esophageal examination reports reflect that the Veteran experienced persistent, recurring epigastric distress with pyrosis, dysphagia, nausea, and regurgitation, but without vomiting, material weight loss, hematemesis or melena with moderate anemia, or other symptom combinations symptoms productive of severe impairment of health; the Veteran also reported experiencing substernal pain. At the May 2016 VA examination, the Veteran reported that his symptoms were controlled with medication. The October 2020 VA esophageal examination report noted that the Veteran experienced regurgitation, recurrent epigastric distress, reflux, pyrosis, substernal pain, and sleep disturbance. Likewise, the November 2014, May 2016 and October 2020 VA esophageal examiners found that the Veteran did not have esophageal stricture, spasm or acquired diverticulum of the esophagus, and his abdomen had no rigidity, rebound or guarding. As the Veteran has substernal pain, the Board finds that the Veteran has met the rating criteria for a 30 percent disability evaluation for the entire rating period on appeal. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). However, neither the medical evidence of record, nor the Veteran's statements support a disability rating in excess of 30 percent during the rating period on appeal, as there was no evidence of material weight loss, hematemesis, or melena with moderate anemia; or other symptom combinations productive of severely impaired health. Specifically, neither of the VA examination reports or available treatment records reflect that the Veteran had weight loss encompassing over 10 percent of his baseline weight for three months or longer. The May 2016 and October 2020 VA examiners noted that the Veteran's GERD does not impact his ability to work. As such, a 60 percent rating under Diagnostic Code 7346 is not warranted. The Board has considered other applicable rating criteria. See 38 C.F.R. § 4.114 (which stipulates that ratings under DCs 7301 to 7329 inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other). However, there is no basis for an additional separate rating. Based on the Veteran's disability picture, Diagnostic Codes 7200 to 7205, and 7330, 7332 to 7340, 7343, 7344, 7351, and 7354 are not applicable here. There is no evidence of injuries of the mouth, tongue, or esophagus, fistula of the intestines, impairment or other disability of the rectum or anus, inguinal or ventral hernia, or liver transplant or hepatitis. As such, the Board finds that the Veteran's service-connected GERD is entitled to a disability evaluation of 30 percent, but no higher, for the entire rating period on appeal. 38 C.F.R. § 4.3, 4.7. 5. Entitlement to an increased disability evaluation for thoracolumbar spine spondylosis with degenerative disc disease, rated as 10 percent disabling for the rating period prior to February 28, 2014. 6. Entitlement to an increased disability evaluation for thoracolumbar spine spondylosis with degenerative disc disease, rated as 20 percent disabling from February 28, 2014. The Veteran is assigned a 10 percent disability rating for his thoracolumbar spine spondylosis with degenerative disc disease, for the rating period prior to February 28, 2014 pursuant to the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5237. For the rating period since February 28, 2014, the Veteran is in receipt of a 20 percent disability rating for his thoracolumbar spine spondylosis with degenerative disc disease pursuant to the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5243. However, the Board observes that the Veteran has not been diagnosed with IVDS, and that, as will be explained below, the applicable diagnostic code is Diagnostic Code 5242. Lumbosacral and cervical spine disabilities are rated under the General Rating Formula for Rating Diseases and Injuries of the Spine ("general rating formula"). 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5242. Intervertebral disc syndrome (IVDS) is rated under the General Rating Formula for Rating Diseases and Injuries of the Spine or the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. See 38 C.F.R. § 4.71a, Diagnostic Code 5243. The Formula for Rating IVDS Based on Incapacitating Episodes provides for ratings from 10 to 60 percent based on the frequency and duration of incapacitating episodes, defined in Note 1 as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. The maximum 60 percent schedular rating is warranted for incapacitating episodes having a total duration of at least 6 weeks during the previous 12 months. The Board notes that effective February 7, 2021, the spine regulations were amended to state that Diagnostic Code 5243 governing intervertebral disc syndrome should only be assigned when there is disc herniation with compression and/or irritation of the adjacent nerve root, and that Diagnostic Code 5242 should apply to all other disc diagnoses. See 85 Fed. Reg. 76462 (Nov. 30, 2020) (effective 2/7/2021). The Board acknowledges that the Veteran was initially granted a 20 percent disability evaluation under Diagnostic Code 5243 on the basis that a flare-up of his service-connected thoracolumbar spine spondylosis with degenerative disc disease was treated with 2 weeks of bed rest. However, as the Veteran has not been diagnosed with intervertebral disc syndrome, the more appropriate rating criteria is found under Diagnostic Code 5242. Because Diagnostic Code 5242 is degenerative arthritis under the version in effect prior to February 7, 2021 and disc disease other than intervertebral disc syndrome under the version in effect since February 7, 2021, an alternative diagnostic code is not appropriate. See Copeland v. McDonald, 27 Vet. App. 333, 337 (2015). As such, the Board is amending the Diagnostic Code assigned for the Veteran's thoracolumbar spine spondylosis with degenerative disc disease to reflect that Diagnostic Code 5242 more accurately evaluates the Veteran's disability. See Butts v. Brown, 5 Vet. App. 532, 538 (1993); see also Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). As will be discussed below, this has no practical effect on the disability rating assigned. The Notes following the General Rating Formula for Diseases and Injuries of the Spine provide further guidance in rating diseases or injuries of the spine. Note 1 provides that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate diagnostic code. Note 2 provides that, for VA compensation purposes, 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. Note 4 provides that range of motion measurements are to be rounded to the nearest five degrees. Note 5 defines unfavorable ankylosis as 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 provides that 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. According to the general rating formula, a 10 percent evaluation is to be assigned 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 evaluation is to be assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation is to be assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is to be assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is to be assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Diagnostic Code 5235 for vertebral fracture or dislocation; 5236 for sacroiliac injury and weakness; 5237 for lumbosacral strain; Diagnostic Code 5238 for spinal stenosis; Diagnostic Code 5239 for spondylolisthesis or segmental instability; Diagnostic Code 5240 for ankylosing spondylitis; Diagnostic Code 5241 for spinal fusion; Diagnostic Code 5242 for degenerative arthritis of the spine; and Diagnostic Code 5243 for intervertebral disc syndrome. The Veteran contends that he is entitled to a higher rating because his current disability evaluation does not property account for the severity of his symptoms. After a review of all the evidence, the Board finds that the Veteran's disability picture more nearly approximates the criteria for a 20 percent disability evaluation, for the entire rating period on appeal, for his service-connected thoracolumbar spine spondylosis with degenerative disc disease. At the June 2013 VA examination, the Veteran had full range of motion in flexion, extension, lateral flexion, and lateral rotation; however, the Veteran had pain on movement resulting in functional loss. There was no muscle spasm, guarding, atrophy, or tenderness on palpation; there was also no evidence of ankylosis. X-rays showed a vertebral fracture at T6-7 with 15 percent loss of vertebral height and spondylosis at T6-8. The VA examiner indicated that the Veteran did not have IVDS or experience incapacitating episodes. A March 2014 letter from the Veteran's treating physician VA indicates that the Veteran's degenerative disc disease causes pain, which worsens through the course of the day; the physician noted that the Veteran's pain required bed rest but that such pain interfered with his sleep. A February 2015 letter indicated that the Veteran had chronic pain and requires bed rest following exacerbations of his pain; the physician did not specify the source of his pain. The November 2014 VA examination report reflects that the Veteran had normal range of motion in all directions, with pain on motion and on weightbearing. The Veteran reported that flareups were caused by driving, bending, or lifting; the Veteran reported that he had to hire help on his farm because his back pain prevented him from doing any heavy lifting. The Veteran had localized tenderness and guarding, without muscle spasm, which did not result in abnormal gait or abnormal spinal contour. Muscle strength and reflexes were normal and there was no evidence of muscle atrophy or ankylosis. The VA examiner stated that the Veteran had intervertebral disc syndrome but did not experience incapacitating episodes. The VA examiner noted that there were no signs of weakness, fatigability, incoordination, or instability on examination, but acknowledged that could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. At the October 2020 VA examination, the Veteran had forward flexion to 70 degrees, extension to 20 degrees, right and left lateral flexion to 20 degrees, and right and left lateral rotation to 20 degrees. The examination report reflects that that the Veteran experienced pain on all planes of motion, without range of motion reduced by 5 degrees in each plane of motion. There was no pain on weight-bearing or tenderness to palpation; there was also no evidence of muscle spasm, guarding, or muscle atrophy. The VA examination report indicates that there was pain on motion, without incoordination or weakness; strength and reflex testing was normal. The VA examiner found that the Veteran does not have IVDS, and that he does not experience incapacitating episodes. The VA examiner also noted that the Veteran does not require use of an assistive device. Private treatment records dated throughout the rating period on appeal reflect that the Veteran was treated for back pain. The lay and medical evidence demonstrates that the Veteran's symptoms do not result in additional functional limitation to a degree that would support a rating in excess of a 20 percent disability rating at any time during the appeal period. The evidence shows that the Veteran experiences forward flexion of the thoracolumbar spine which is better than 30 degrees which is required for a higher rating based on limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Codes 5235 5242. Here, the lay evidence has been considered; however, that evidence when accepted as correct does not establish that he is functionally limited to 30 degrees or less forward flexion. Further, the evidence does not show favorable or unfavorable ankylosis of the entire thoracolumbar spine during the rating period on appeal. Additionally, the Veteran does not experience incontinence or bowel complaints as a result of his service-connected thoracolumbar spine spondylosis with degenerative disc disease. The Board has considered whether additional functional impairment due to factors such as pain, weakness and fatigability demonstrate additional limitation of motion or function to warrant a higher rating. See 38 C.F.R. §§ 4.40, 4.45, 4.59 and DeLuca at 206-07. The evidence shows no atrophy or decrease in strength. To the extent that the Veteran claims that his pain upon motion is the equivalent of limited motion, the Board finds that the Veteran's subjective complaints of pain have been contemplated in the current rating assignment, as the current rating is based on the objectively demonstrated reduced motion and impairment, including during a flare-up. See Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). See also Sharp v. Shulkin, 29 Vet. App. 26, 32 (2017). Moreover, the available medical findings do not show that painful motion, limitation of motion on repetitive use testing, or pain or limitation of motion on active motion/passive motion/in weight-bearing/nonweight-bearing resulted in functional loss warranting the assignment of any higher evaluation for the thoracolumbar spine during the entire appeal period. See Correia v. McDonald, 28 Vet. App. 158 (2016). To the extent that the Veteran reports flare-ups limiting his ability to bend and lift objects, as well as complaints of difficulty with prolonged activity, the Board finds that the Veteran's flare-ups, especially in light of their frequency, do not show that the evidence more nearly approximates a disability picture with forward flexion of the spine limited to 30 degrees or less. 38 C.F.R. §§ 4.7, 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Therefore, the lay and medical evidence demonstrates that the Veteran's symptoms do not result in additional functional limitation to a degree that would support a rating in excess of a 20 percent disability rating at any point during the rating period on appeal. With respect to a higher evaluation based on incapacitating episodes under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, as noted earlier, although the Veteran was been diagnosed with IVDS at the November 2014 VA examination, and the Veteran's treating provider indicated that the Veteran had chronic pain requiring bed rest, the medical evidence clearly demonstrates that the Veteran does not have IVDS which is productive of incapacitating episodes requiring physician prescribed best rest having a total duration of at least 4 weeks during a 12-month period as contemplated by a higher evaluation. With consideration of the provisions of Note (1) of the General Rating Formula for Diseases and Injuries of the Spine, the Veteran was granted service connection for peripheral neuropathy of the right and left lower extremities and assigned separate disability evaluations for each lower extremity. As the Veteran is separately evaluated for his lower extremity neurological deficits, it is not for consideration here. As such, the Board finds that the evidence of record reveals manifestations consistent with a 20 percent evaluation, but no higher, for the entire rating period on appeal for service-connected thoracolumbar spine spondylosis with degenerative disc disease. 7. Entitlement to an increased disability evaluation for right wrist tenosynovitis, rated as noncompensable prior to September 30, 2016. 8. Entitlement to an increased disability evaluation for right wrist tenosynovitis, rated as 10 percent disabling since September 30, 2016. The Veteran's service-connected right wrist tenosynovitis is rated as noncompensable prior to September 30, 2016, and 10 percent disabling thereafter, pursuant to 38 C.F.R. § 4.71a, Diagnostic Codes 5024 5215. See 38 C.F.R. § 4.27. The Board notes that, effective February 7, 2021, Diagnostic Code 5024 was revised from tenosynovitis alone to tenosynovitis, tendinitis, tendinosis, or tendinopathy. Under both the regulations prior and subsequent to February 7, 2021, the Note for Diagnostic Code 5024 directed that diseases under Diagnostic Codes 5013 through 5024 should be evaluated as degenerative arthritis, based on limitation of motion of the affected parts. The Board notes that the amended Diagnostic Code 5003, effective February 7, 2021, is substantively unchanged. To this point, the Board notes that Diagnostic Code 5003 was revised to reflect that this Diagnostic Code only applies to degenerative arthritis. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76460 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5003). Diagnostic Code 5003 provides that degenerative arthritis substantiated by x-ray findings is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When limitation of motion is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each major joint or group of minor joints affected by limitation of motion. A 20 percent evaluation is warranted for x-ray evidence of involvement of 2 or more major or minor joints, with occasional incapacitating exacerbations. See 38 C.F.R. § 4.71a, Diagnostic Code 5003. However, the Veteran has not reported experiencing any incapacitating exacerbations. Diagnostic Code 5215 provides for a 10 percent rating, for either the major or minor extremity, where there is dorsiflexion of less than 15 degrees or palmar flexion limited in line with the forearm. No higher disability rating is provided under this Code. However, higher disability ratings are available under other Diagnostic Codes. Under Diagnostic Code 5212, a 20 percent disability rating is available for impairment of the radius, of either the major or minor extremity, with nonunion in the upper half. Diagnostic Code 5213 provides for a 20 percent rating, for either the major or minor wrist, where there is loss of pronation beyond the last quarter of arc or there is bone fusion with hand fixed near the middle of the arc or moderate pronation. Under Diagnostic Code 5214, a 30 percent disability rating is provided for favorable ankylosis of the (major) wrist, with 20 to 30 degrees dorsiflexion. See 38 C.F.R. § 4.71a, Diagnostic Codes 5212-5215. The June 2013, October 2016, and October 2020 VA examination reports indicate that the Veteran is right-hand dominant. In considering all of the evidence, the Board finds that the Veteran's right wrist tenosynovitis most closely approximates the criteria for a 10 percent disability evaluation for the entire rating period on appeal. The Board observes that the Veteran had pain on motion as a result of his right wrist tenosynovitis, without decreased range of motion. The Veteran had normal range of motion at his June 2013, October 2016, and October 2020 VA examinations s. These measurements were unchanged after repetitive use testing and there was no evidence of atrophy. The clinical evidence of record does not show that the Veteran experienced loss of pronation, bone fusion with the hand fixed, moderate pronation, or impairment of the radius with nonunion in the upper half. Likewise, VA examination reports and VA treatment records reflect that the Veteran does not experience ankylosis. Thus, on this record, the Board finds that the right wrist tenosynovitis does not meet the criteria for the assignment of a rating higher than 10 percent for any part of the period on appeal. The Board has considered the lay evidence of pain. However, as previously discussed, that evidence does not establish that there is ankylosis as required for a higher rating; the Veteran did not have reduced range of motion. To the extent that the Veteran claims that his pain upon motion is the equivalent of limited motion, the Board finds that the Veteran's subjective complaints of pain have been contemplated in the current rating assignment, as the current rating is based on the objectively demonstrated reduced motion. See Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). Further, he claims that his pain limits motion but does not prevent all motion, thus, it does not equate to ankylosis. Chavis v. McDonough, Vet.App. , No. 18-2928, 2021 WL 1432578, at *1 (Apr. 16, 2021) (the Court explained that the ankylosis requirement "can be met with evidence of the functional equivalent of ankylosis during a flare."). As such, the Board finds that the Veteran is entitled to a disability rating of 10 percent, but no higher, for service-connected right wrist tenosynovitis for the entire rating period on appeal. 9. Entitlement to an increased disability evaluation for bilateral plantar fasciitis, rated as noncompensable prior to October 12, 2020. 10. Entitlement to an increased disability evaluation for bilateral plantar fasciitis, rated as 50 percent disabling since October 12, 2020. The Veteran is in receipt of a noncompensable (0 percent) disability evaluation for his bilateral plantar fasciitis for the rating period prior to October 12, 2020 pursuant to Diagnostic Code 5276. Effective October 12, 2020, the Veteran's bilateral plantar fasciitis is rated as 50 percent disabling. Under Diagnostic Code 5276, a noncompensable disability evaluation is assigned for mild flat foot with symptoms relieved by a built-up shoe or arch support. A 10 percent rating is assigned for moderate flat foot with the weight-bearing line over or medial to the great toe, inward bowing of the tendon Achilles, and pain on manipulation and use of the feet. A 20 percent rating is assigned for unilateral severe flat foot with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated indications of swelling on use, and characteristic callosities. A 30 percent rating for unilateral flat foot requires a pronounced condition manifested by marked pronation, extreme tenderness of the plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achilles on manipulation, not improved by orthopedic shoes or appliances. See 38 C.F.R. § 4.71a, Diagnostic Code 5276. The Board notes that, effective February 7, 2021, plantar fasciitis is now rated under Diagnostic Code 5269 of the Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); amended 86 Fed. Reg. 8142 (Feb. 4, 2021) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5269). Under Diagnostic Code 5269, a 30 percent disability rating is warranted for plantar fasciitis with no relief from both non-surgical and surgical treatment, bilateral. A 20 percent disability rating is warranted for plantar fasciitis with no relief from both non-surgical and surgical treatment, unilateral. A 10 percent disability rating is warranted for all other circumstances, unilateral or bilateral. Note (1): With actual loss of use of the foot, rate at 40 percent. Note (2): If a Veteran has been recommended for surgical intervention, but is not a surgical candidate, evaluate under the 20 percent or 30 percent criteria, whichever is applicable. 38 C.F.R. § 4.71a, Diagnostic Code 5269. Prior to October 12, 2020 After a review of the lay and medical evidence, the Board finds that the Veteran's service-connected bilateral plantar fasciitis most closely approximates the criteria for a 30 percent disability rating, but no higher, for the rating period prior to October 12, 2020. The June 2013 VA examination report and the Veteran's VA treatment records indicate that the Veteran reported experiencing pain, and the Veteran's VA treatment records reflect that the Veteran required the use of orthotics for treatment of his bilateral plantar fasciitis. VA treatment records also reflect that the Veteran reported that his pain worsened with prolonged standing or sitting. Upon examination in June 2013, there was no inward bowing, inward displacement, or spasm of the Achilles tendon, deformity (other than pes planus), pronation, or weight-bearing over or medial to the great toe. The Board finds that the Veteran's subjective complaints of pain have been contemplated in the current rating assignment, as the current rating is based on the objectively demonstrated pain on use. His symptoms are not so severe as to be equivalent to symptoms required for a 50 percent disability rating. See 38 C.F.R. §§ 4.40, 4.45, 4.59 and DeLuca at 206-07. See also Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). Therefore, the lay and medical evidence demonstrates that the Veteran's symptoms do not result in additional functional limitation to a degree that would support a rating in excess of the 30 percent disability rating assigned for the rating period prior to October 12, 2020. The Board notes that Diagnostic Code 5284, governing foot injuries - other, or any other foot Diagnostic Code is not applicable in the present case because the Veteran's service-connected condition, plantar fasciitis, is one of the foot condition specifically listed in 38 C.F.R. § 4.71a, and that to rate his plantar fasciitis under DC 5284 or any other foot Diagnostic Code would constitute an impermissible rating by analogy. Copeland v. McDonald, 27 Vet. App. 333, 338 (2015). In conclusion, the Board finds that the evidence supports a disability rating of 30 percent, but no higher, for bilateral plantar fasciitis for the rating period prior to October 12, 2020. Since October 12, 2020 The Board finds that the preponderance of the evidence is against a disability rating in excess of 530 percent for plantar fasciitis for the rating period since October 12, 2020. At the October 2020 VA examination, he reported experiencing pain on use and manipulation, as well as tenderness of the plantar surfaces of both feet. However, examination did not show marked pronation, weight-bearing over or medial to the great toe, decreased longitudinal arch height on weight-bearing, inward bowing of the Achilles tendon, or marked deformity. Nevertheless, his bilateral plantar fasciitis compromised weight-bearing; there was pain on movement and weightbearing. Functional loss due to pain included an inability to stand and walk for more than 5 minutes. The Veteran did not report using an assistive device as a normal mode of locomotion. The Board finds that the Veteran's subjective complaints of pain have been contemplated in the current rating assignment. The VA examination reports indicate that the Veteran complained of pain, but physical examination did not demonstrate any additional limitations in response to pain; there was no weakness or fatigability beyond which was reflected in the examination report. See 38 C.F.R. §§ 4.40, 4.45, 4.59 and DeLuca at 206-07. See also Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). Therefore, the lay and medical evidence demonstrates that the Veteran's symptoms do not result in additional functional limitation to a degree that would support a rating in excess of the 50 percent disability rating assigned for plantar fasciitis for the rating period since October 12, 2020. The Board observes that, in accordance with Diagnostic Code 5269, the Veteran is entitled to a 30 percent disability rating since February 7, 2021 because he does not have loss of use of his feet and he has no relief from both non-surgical and surgical treatment, bilateral. However, the Veteran has been rated at a 50 percent disability rating (above the schedular maximum for plantar fasciitis under Diagnostic Code 5269) since October 12, 2020; as a higher rating is not available under the revised Diagnostic Code, the Board will not disturb the Veteran's disability rating as the applied Diagnostic Code is more favorable. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § §§ 1110, 1131; 38 C.F.R. § 3.303(a) (2020). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during servicethe so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. For chronic diseases, if chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § § 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310. At the outset, the Board acknowledges that the Veteran was exposed to combat during service. As such, the provisions of 38 U.S.C. § 1154 are applicable in this case. Nevertheless, the Board observes that hat the Veteran does not allege, and the evidence does not show, that the Veteran's claimed thigh disorder is related to his combat exposure during service. 11. Entitlement to service connection for a right thigh disorder, including as secondary to service-connected thoracolumbar spine spondylosis. 12. Entitlement to service connection for a left thigh disorder, including as secondary to service-connected thoracolumbar spine spondylosis. Based on the evidence of record, the Board finds that the Veteran's claims of entitlement to service connection for right and left thigh disorders, including as secondary to service-connected disabilities, namely his service-connected thoracolumbar spine spondylosis, are denied. The Board observes that the Veteran does not contend that his right and left thigh disorder began in service; instead, the Veteran alleges that his right and left thigh disorders are the result of his service-connected disabilities. The Board notes that whether service connection is claimed on direct or secondary basis, a necessary element for establishing such a claim is the existence of current disability. In this case, the Veteran must show that he currently has a right and/or left thigh disorder due to an event, disease, or injury in service. The Board finds that the weight of the evidence is against the existence of right and left thigh disorders. There is no evidence reflecting that he has been treated for or diagnosed with a right and/or left thigh disorder. Moreover, although the Veteran reports right and left thigh pain in the years since service, there is no evidence of any related disability. The Board points out that the Veteran, at a March 2014 VA examination, denied an in-service injury or event related to his right and left thighs. The Board acknowledges that the Veteran complained of "aching" in his right and left thighs, but points out that the Veteran's VA examination reports and treatment records reflect normal physical and neurological evaluations; radiology reports are also devoid of findings. Further, the evidence has not demonstrated that the Veteran's right and/or left thigh pain causes functional impairment. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has noted that in order for a veteran to qualify for entitlement to compensation under those statutes, he or she must prove existence of a disability, and one that has resulted from a disease or injury that occurred in the line of duty. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability). Here, we are faced with related complaints, without any competent evidence of post-service pathology (diagnosis). The Board finds that the preponderance of the evidence is against the claim for service connection of right and left thigh disorders. TDIU 13. Entitlement to TDIU. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that a veteran is precluded, by reason of his service- connected disabilities, from obtaining and maintaining any form of gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. A TDIU may be granted only when it is established that the service-connected disabilities are so severe, standing alone, as to prevent the retaining or obtaining of substantially gainful employment. If there is only one service-connected disability, it must be ratable at 60 percent or more to qualify for benefits based on individual unemployability. If there are two or more such disabilities, there must be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For purposes of this section, disabilities of both upper or lower extremities will be considered a single disability. 38 C.F.R. § 4.16(a)(1). Veterans who, in light of their individual circumstances, but without regard to age, are unable to secure and follow a substantially gainful occupation as the result of service-connected disability shall be rated totally disabled, without regard to whether an average person would be rendered unemployable by the circumstances. Thus, the criteria include a subjective standard. Unemployability is synonymous with inability to secure and follow a substantially gainful occupation. VAOPGCPREC 75-91; 57 Fed. Reg. 2,317 (1992). "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. § 4.16(a) (2020). The Veteran seeks entitlement to TDIU based on his service-connected disabilities. The Veteran submitted a completed VA Form 21-8940 (Application for Increased Compensation Based on Unemployability) in September 2016. The Veteran indicated that he had a college education and stopped working as a pastor in September 2016. The Veteran indicated that he stopped working due to his service-connected disabilities. The Veteran also indicated that he has not sought employment or additional training since becoming too disabled to work. The Veteran is in receipt of a 70 percent disability evaluation for posttraumatic stress disorder (PTSD) effective September 1, 2013; a 100 percent disability evaluation was assigned effective September 30, 2016. The Veteran is also in receipt of a 50 percent disability evaluation for bilateral plantar fasciitis effective October 12, 2020 (previously rated as 30 percent disabling effective September 1, 2013: a 30 percent disability evaluation for exercise induced asthma, effective September 30, 2016 (previously rated as 10 percent disabling effective September 1, 2013); a 20 percent disability evaluation for thoracolumbar spine spondylosis with degenerative disc disease, effective September 1, 2013 (as granted herein); a 10 percent disability evaluation for tinnitus, effective September 1, 2013; a 30 percent disability evaluation for GERD, effective September 1, 2013 (as granted herein); a 10 percent disability evaluation for right lower extremity peripheral neuropathy, effective September 1, 2013; a 10 percent disability evaluation for right wrist tenosynovitis, effective September 1, 2013); a 10 percent disability evaluation for right ulnar neuropathy, effective August 22, 2018 (previously rated as 20 percent disabling, effective August 27, 2015); a 10 percent disability evaluation for right shoulder rotator cuff tenderness (as granted herein); and a 10 percent disability evaluation for right lateral epicondylitis (as granted herein). Noncompensable disability evaluations are assigned for right hand tendonitis, right knee patellofemoral pain syndrome, right ear hearing loss, and athlete's foot, effective September 1, 2013. The Veteran had a combined disability evaluation of 80 percent, effective September 1, 2013, and a combined disability evaluation of 90 percent, effective February 28, 2014; a combined 100 percent disability evaluation was assigned, effective September 30, 2016. A bilateral factor has been in effect for his combined ratings since August 27, 2015. See 38 C.F.R. § 4.25. the Veteran met the schedular criteria for TDIU under section 4.16(a) for the entire rating period on appeal, effective September 1, 2013. VA's General Counsel has concluded that the controlling VA regulations generally provide that Veterans who, in light of their individual circumstances, but without regard to age, are unable to secure and follow a substantially gainful occupation as the result of service-connected disability shall be rated totally disabled, without regard to whether an average person would be rendered unemployable by the circumstances. Thus, the criteria include a subjective standard. It was also determined that "unemployability" is synonymous with inability to secure and follow a substantially gainful occupation. VAOPGCPREC 75-91; 57 Fed. Reg. 2,317 (1992). For a Veteran to prevail on a claim based on unemployability, it is necessary that the record reflect some factor which places the claimant in a different position than other Veterans with the same disability rating. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is a recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the particular Veteran is capable of performing the physical and mental acts required by employment, not whether that Veteran can find employment. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Based on the evidence of record, the Board finds that, as of September 1, 2013, the Veteran's service-connected disabilities render the Veteran unable to obtain or sustain substantially gainful employment for the rating period on appeal. The Board acknowledges that the October 2016 VA TDIU opinion indicates that the VA examiner found that the Veteran's service-connected disabilities did not render him unemployable, and that the Veteran is able to sustain a gainful occupation with reasonable accommodations; however, the Board observes that this VA examiner explicitly did not consider the Veteran's service-connected PTSD or the total effects of the Veteran's service-connected disabilities. To this point, the Board observes that the March 2014 and October 2016 VA PTSD examiners found that the Veteran's PTSD renders him unable to obtain to obtain and maintain gainful employment. Likewise, a review of the Veteran's treatment records and VA examination reports indicates that the Veteran's service-connected disabilities, in combination, are productive of symptomatology that contribute to his difficulty performing occupational tasks. The Board acknowledges that, effective September 30, 2016, the issue of entitlement to TDIU is moot, as the Veteran was awarded a 100 percent disability evaluation for PTSD, as well as special monthly compensation pursuant to 38 U.S.C. § 1114(s) effective September 30, 2016. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). As such, the Board finds that the evidence of record reflects symptomatology that supports the Veteran's contentions that he is unable to perform the physical and mental acts required to be employable as of September 1, 2013. See Van Hoose, supra. As a result, the Veteran's service-connected disabilities prevent him from obtaining and maintaining substantial gainful employment. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Brokowsky, 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.