Citation Nr: 21069467 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 20-28 386 DATE: November 18, 2021 ORDER Entitlement to service connection for degenerative disc and joint disease of the lumbar spine, claimed as back injury, is denied. Entitlement to an initial, compensable rating greater than 0 percent from December 3, 2010, to July 16, 2015, an initial, increased rating greater than 10 percent from July 16, 2015, and a subsequent, increased rating greater than 30 percent from August 23, 2021, for bilateral hearing loss is denied. Entitlement to an initial, compensable rating greater than 0 percent from December 3, 2010, to September 6, 2017, and an initial, increased rating greater than 10 percent from September 6, 2017, for degenerative arthritis status post right 5th metacarpal fracture (previously rated as healed right third metacarpal fracture with mild residual tenderness), claimed as broken right hand, is denied. FINDINGS OF FACT 1. The weight of the medical and other evidence of record is against a finding that the Veteran has a diagnosis of degenerative disc and joint disease of the lumbar spine, claimed as back injury, that had its onset in service or is otherwise related to a disease or injury during military service. 2. Degenerative disc and joint disease of the lumbar spine, claimed as back injury, was not manifest to a compensable degree within one year of separation from active-duty service and is not otherwise related to service. 3. From December 3, 2010, to July 16, 2015, the numeric designation of hearing impairment based on Pure-tone threshold average and speech discrimination is a Roman numeral I for both the right and left ears, which does not correspond to a compensable rating. 4. From July 16, 2015, to August 23, 2021, the numeric designation of hearing impairment based on Pure-tone threshold average and speech discrimination is a Roman numeral IV for both the right and left ears, which does not correspond to a higher evaluation than is reflected in current ratings. 5. From August 23, 2021, the numeric designation of hearing impairment based on Pure-tone threshold average and speech discrimination is a Roman numeral VI for the right ear and a Roman numeral IV for the left ear, which does not correspond to a higher evaluation than is reflected in current ratings. 6. The Veteran did not demonstrate an exceptional pattern of hearing loss during the period on appeal. 7. A non-compensable rating from December 3, 2010, to September 6, 2017, most closely approximates the Veteran's symptoms and average impairment in earning capacity resulting from degenerative arthritis status post right 5th metacarpal fracture (previously rated as healed right third metacarpal fracture with mild residual tenderness), claimed as broken right hand. 8. A 10 percent rating from September 6, 2017, most closely approximates the Veteran's symptoms and average impairment in earning capacity resulting from degenerative arthritis status post right 5th metacarpal fracture (previously rated as healed right third metacarpal fracture with mild residual tenderness), claimed as broken right hand. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for degenerative disc and joint disease of the lumbar spine, claimed as back injury, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.310, 4.71a, Diagnostic Code (DC) 5242. 2. The criteria for entitlement to an initial, compensable rating greater than 0 percent from December 3, 2010, to July 16, 2015, an initial, increased rating greater than 10 percent from July 16, 2015, and a subsequent, increased rating greater than 30 percent from August 23, 2021, for bilateral hearing loss have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 3.103, 3.104, 3.159, 3.321, 4.85, 4.86, DC 6100. 3. The criteria for entitlement to an initial, compensable rating greater than 0 percent from December 3, 2010, to September 6, 2017, and an initial, increased rating greater than 10 percent from September 6, 2017, for degenerative arthritis status post right 5th metacarpal fracture (previously rated as healed right third metacarpal fracture with mild residual tenderness), claimed as broken right hand, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.103, 3.104, 3.159, 4.1, 4.3, 4.7, 4.14, 4.40, 4.45, 4.59, 4.71a, DC 5229. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Air Force from April 1955 to May 1958. This matter comes to the Board of Veterans' Appeals (Board) on appeal from June 2013, April 2016, February 2018, and September 2021 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Baltimore, Maryland. The Veteran appeared and testified before the undersigned Veterans Law Judge at a September 2020 Board Central Office hearing. A copy of the transcript is associated with the claims file and evidence of record. The matters were remanded in June 2021to: "afford the Veteran a contemporaneous VA examination to determine the current level of bilateral hearing loss...[s]chedule one or more appropriate VA examinations to determine the nature and severity of the Veteran's service-connected metacarpal disability throughout the entire appeal period...[s]chedule an appropriate VA examination for the Veteran's back condition." See June 2021 BVA Decision. The appeal is now returned to the Board for further consideration. This case has been advanced on the docket pursuant to 38 U.S.C. § 7107(b) and 38 C.F.R. § 20.902(c). Duty to Notify and Assist VA must notify the claimant of any information, including any medical or lay evidence, not previously provided to VA, that is necessary to substantiate the claim. See 38 U.S.C. § 5103 (2012); 38 C.F.R. § 3.159 (2017); see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). VA has satisfied its duties to inform the Veteran in this case. See 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. § 21.1032(a). The duty to notify was satisfied by April 2011 VA VCAA / DTA Letter. See also June 2013 VA Rating Decision Narrative, April 2016 VA Rating Decision Narrative, April 2016 Statement of the Case, August and December 2016 and June 2017 VA Forms 21-0820, Reports of General Information, July 2017 VA Correspondence, January 2018 VA Subsequent Development Letter, February 2018 VA Rating Decision Narrative, March 2020 Statement of the Case, June 2021 BVA Decision, September 2021VA Rating Decision Narrative, and September 2021 Supplemental Statement of the Case. VA's duty to assist functions to aid a claimant in obtaining evidence necessary to substantiate a claim, but VA is not required to provide assistance to a claimant when there is no reasonable possibility that assistance would aid in substantiating the claim. See 38 U.S.C. § 5103A (2012). As for VA's assistance to the Veteran, service treatment records, VA treatment records, and private treatment records were obtained and associated with the claims file and evidence of record. The Veteran has not identified any additional, outstanding records relevant to the claim decided herein. Further, the entire record was available to the October 2012, March 2013, July 2015, February 2019, and August 2021 medical examiners, Back (Spine) Conditions, Hearing Loss and Tinnitus, and Hand and Finger Conditions examinations were performed, and the testing was sufficient to adequately address all potential rating criteria. See 38 U.S.C. § 7104(d)(1); 38 C.F.R. §§ 4.71a, 4.85. Any defects identified in the March 2013, July 2015, and February 2019 VA examinations were cured by the August 2021 examinations. See June 2021 BVA Decision. The Board finds that VA has done everything reasonably possible under 38 C.F.R. § 21.1032(a) and in keeping with principles of basic fairness, in the spirit of the non-adversarial nature of VA benefits adjudication, to assist the Veteran. See Gambill v. Shinseki, 576 F.3d 1307 (Fed. Cir. 2009) (quoting Prickett v. Nicholson, 20 Vet. App. 370, 382 (2006) ("[C]reating a procedural right in the name of fair process principles [for applicants for VA disability benefits] is primarily based on the underlying concept of the VA adjudicatory scheme, not the U.S. Constitution."). All pertinent due process requirements have been met. See 38 C.F.R. § 3.103 (2017). Further development and further assistance by VA are not warranted. The RO's efforts have substantially complied with the instructions contained in the June 2021 remand. See Stegall v. West, 11 Vet. App. 268 (1998). An additional remand for further development of this claim would serve no useful purpose. Accordingly, the Board finds that no prejudice to the Veteran will result from the adjudication of his claim in this Board decision. 1. Entitlement to service connection for degenerative disc and joint disease of the lumbar spine (claimed as back injury). The Veteran contends that service connection for a lumbar spine disability is warranted and requests "100 percent as to [his] back injury." See June 2016 Third Party Correspondence. Service Connection In general, service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish entitlement to service connection, there must be: (1) competent and credible evidence confirming the Veteran has the claimed disability or at least has since filing the claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or injury; and (3) competent and credible evidence of a nexus or link between the in-service injury or disease and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b) (2014); 38 C.F.R. § 3.303(d) (2016). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. See generally 38 C.F.R. § § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Presumptive service connection can satisfy both the elements of an in-service event and a nexus to military service. Chronic diseases listed under 38 C.F.R. § 3.309(a)-(f) that manifest either during active service or subject to the requirements of 38 C.F.R. § 3.307 after discharge or release from military service are sufficient to establish in-service incurrence or aggravation. If a chronic disease enumerated in 38 C.F.R. § 3.309 does not manifest in-service or within the applicable time limits, service connection may be granted based on continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The United States Court of Appeals for the Federal Circuit (Fed Circuit) clarified that the law providing for awards of service connection on the basis of continuity of symptomatology is limited to those "chronic" diseases listed under 38 C.F.R. § 3.309(a). See Id. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran's lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). Although the Veteran is competent to provide a diagnosis of an observable condition such as a headache, varicose veins, or tinnitus, the Veteran is not competent to provide evidence as to more complex medical questions, such as the etiology of diseases of the eye. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Although the credibility of lay evidence may not be refuted solely by the absence of corroborating medical evidence, it is a factor. Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (lay evidence concerning continuity of symptoms after service, if credible, may be competent, regardless of the lack of contemporaneous medical evidence). Other factors are the lapse of time in recollecting events attested to, prior conflicting statements as opposed to consistency with other statements and evidence, internal consistency, facial plausibility, bias, interest, the length of time between alleged incurrence of disability and the earliest or first corroborating medical or lay evidence thereof, and statements given during treatment (which are usually given greater probative weight, particularly if close in time to the onset thereof). After the evidence is assembled, it is the Board's responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a) (2012). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 3.102, 4.3. Factual Background The Veteran reported "good health" and "No Bone, Joint, or Other Deformity" upon his entry into service. See March 1955 Report of Medical History. A physical examination at entry was "Normal," including "Spine, other musculoskeletal." See March 1955 Report of Medical Examination. In November 1956, service records indicate: "Sustained blow to right hand by 'falling to the ground' at 1800 today, on Aslinger AFB, off duty. X-ray reveals a fracture through the neck of the middle metacarpal of right hand. The distal fragment is in fair...alignment. Rx Hand finger cast incapacitating middle finger with splint cast and immobilizing wrist." See November 1956 Chronological Record of Medical Care. A follow up appointment the next day reported: "Sensation and circulation on fingers okay." See November 1956 Chronological Record of Medical Care. A September 1957 service record documented: "Allegedly sprained back this afternoon while pushing a truck. Complains of pain, upper dorsal spine...Has good ROM. No local tenderness. Pain on twisting to right and left. Diagnosis: muscle sprain." See September 1957 Chronological Record of Medical Care. When he separated from service, the Veteran reported "good" health and denied a "Bone, Joint, or Other Deformity." See April 1958 Report of Medical History. A physical examination at separation was "Normal," including "Spine, other musculoskeletal." See April 1958 Report of Medical Examination. An October 2009 private treatment record noted: "His acute symptoms started nine days ago, no specific recent injury he can recall, but he did heavy work for many years...He does have multi-level severe degenerative disc disease associated with multi-level disc / protrusion affecting bilateral neural foraminals and causing mild spinal stenosis at multi levels." See October 2009 Dr. S.S., MD Letter. Pursuant to a duty to assist, the Veteran was provided with a VA medical examination in March 2013. The examining physician reviewed the claims file and evidence of record in preparation for her report. The Veteran was examined in person, and his statements were considered, including a report that: "he got involved in a fight where he was working as a mechanic and fractured his right hand and was casted for about 4 months. At the time, he did not admit the cause of the fracture but said it was because of falling off an airplane wing. In fact, that was only partly true." The examiner also noted that the Veteran worked as a carpenter after separating from service because, "[H]e could not find work as a propeller mechanic...In the 1980s, he began to have more pain after he walked more than an hour...It got worse in the early 1990s." The Veteran was diagnosed with degenerative disc and joint disease of the lumbar spine. See March 2013 VA Back (Spine) Conditions examination report. Regarding direct service connection, the examining physician concluded that the Veteran's degenerative disc and joint disease of the lumbar spine was less likely than not incurred in or caused by the claimed in-service injury. In formulating his opinion, the examiner stated: "Review of the service treatment records reveals that no back problem was identified on his entrance examination 3/1/55. The Veteran was seen for his right-hand fracture at the time of the airplane wing fall on 11/23/56, but no mention was made of a back problem in the available notes. A note dated 9/18/57 stated the Veteran gave a history of straining his back while pushing a truck and had upper dorsal spine pain, diagnosed as a muscle spasm. No further entries are found regarding the back, and no back problem was noted on his exit examination 4/3/58." The examining physician also stated: "[W]hat the Veteran has now is age-related severe degenerative joint and disc disease of the lumbar spine, resulting in a recent complex surgical procedure. The medical literature does not support the contention that this sort of diffuse degenerative disease is brought on or accelerated by back strain or trauma." See March 2013 VA Back (Spine) Conditions examination report. An April 2016 treatment note from a private provider detailed: "[P]rimary complaints of axial low back pain with radiation to the bilateral extremities, which he has had now for approximately 20 years duration." See April 2016 National Spine & Pain Centers Consultation. A January 2017 letter from a private treatment provider described: "[Veteran] has been seen at Newbridge Spine & Pain Center since May 2, 2016...Upon first consultation, [Veteran] attributed the lower back pain to 'many years of lifting and bending'...I saw [Veteran] on 1/25/2017, at his request, to discuss causation of his chronic lower back pain. The patient is of the opinion that a fall suffered while in military service in the year 1956 is the causative factor...The oldest MRI that I have for the patient is from 2009, and this shows multiple lumbar disc herniations. The time frame between the patient's injury (1956) and this MRI (2009) is more than 50 years...Other contributing factors may include age and that the patient is a chronic tobacco user." See January 2017 Newbridge Spine & Pain Center Letter. An additional letter arising from private treatment cited: "It is certainly possible that the [1956] injury triggered and worsened his cascade of progressively severe back symptoms in the subsequent years." See February 2017 Metropolitan Neurosurgery Group Associates Letter. Pursuant to a duty to assist, the Veteran was provided with a medical examination in February 2019. The examining physician reviewed the claims file and evidence of record in preparation for his report. The Veteran was examined in person, and his statements were considered, including a reported injury to his back in 1956. Flare-ups were denied by the Veteran, and functional loss was described as decreased mobility and problems with lifting and carrying. The Veteran was diagnosed with degenerative arthritis of the spine. Weight-bearing, non-weight bearing, active and passive range of motion movements did not produce pain in the Veteran. See February 2019 VA Back (Spine) Conditions examination report. Evidence of guarding, muscle spasm, atrophy, ankylosis, and intervertebral disc syndrome was absent from the examination. Muscle strength, including hip flexion, knee extension, ankle plantar flexion, ankle dorsiflexion and great toe extension were all normal. Sensation, including, upper anterior thigh, thigh / knee, lower leg / ankle, and foot / toes, were all normal. A straight leg raise test was negative. Functional impact on the Veteran's ability to work was documented as decreased mobility and problems with lifting or carrying. Regarding service connection, the examining physician concluded that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In arriving at his opinion, the examiner noted a "[l]ong interval without evaluation, imaging, or treatment." See February 2019 VA Back (Spine) Conditions examination report. Pursuant to the June 2021 Board remand, the Veteran was provided with a medical examination in August 2021. The examining physician reviewed the claims file and evidence of record in preparation for the report. The Veteran was examined in person, and his statements were considered, including a report by the Veteran that he worked as a carpenter after separating from service and would "complain of occasional back pain at the time." Medical records, submitted by the Veteran at the examination, were reviewed by the examining physician. Flare-ups were denied by the Veteran, but he did report functional loss due to repeated use. The Veteran described his functional loss as, "I used to be a real good carpenter but couldn't work long than a week at a time because of the back issues." Diagnoses included degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome, L2-S1 decompressive laminectomy, medical facetectomy and foraminotomies, left C2-C3 microsurgical discectomy, and residual bilateral lower extremity radiculopathy. See August 2021 VA Back (Spine) Conditions examination report. At the August 2021 medical examination, repetitive range of motion testing did not produce additional loss of function or loss of range of motion, and there was no evidence that pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time. There was no evidence of guarding, muscle spasm, localized tenderness, ankylosis, intervertebral disc syndrome, assistive devices, other neurologic abnormalities, or other pertinent physical findings, complications, conditions, signs, or symptoms. Muscle strength, including hip flexion, knee extension, ankle plantar flexion, ankle dorsiflexion, and great toe extension, was 5/5, normal strength. Reflexes, including knee and ankle, were 2+, normal. Lumbar and thoracic spine X-rays, taken in conjunction with this examination, showed "scattered degenerative disc disease and spurring." Functional impact on his ability to work was reported by the Veteran as difficulty with prolonged standing and walking and difficulty lifting heavy things. See August 2021 VA Back (Spine) Conditions examination report. Regarding direct service connection, the August 2021 examining physician concluded that the Veteran's claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. Supporting rationale included: "Previous history from 3/20/2013, and on today's examination, the Veteran claims around 1956 to 1957 he fell off the wing of an airplane and hurt his back. He was given a wrap to wear for about 3 days, and his pain resolved in about 3 to 4 months afterwards. After separation from service, he did quite intense manual labor, including carpentry for many years, as well as outdoor construction for a brief period of time. He reports his symptoms became worse in the 1990s and progressed with time. He would in the 2000s have more significant back pain, and on 5/29/2012 underwent lumbar spine surgery. Review of the service treatment records reveals that no back problem was identified on his entrance examination 3/1/55. The Veteran was seen for his right-hand fracture at the time of the airplane wing fall on 11/23/56, but no mention was made of a back problem in the available notes. A note dated 9/18/57 stated the Veteran gave a history of straining his back while pushing a truck and had upper dorsal spine pain diagnosed as muscle spasm, which is an acute and self-limiting condition, which resolves within days to weeks and does not predispose one to degenerative arthritis or degenerative disc disease of the lumbar spine. See August 2021 VA Back (Spine) Conditions examination report. No further entries are found regarding the back, and no back problem was noted on his exit examination or for years after separation from service. Considering his symptoms started to get worse in the 1990s, and he had been in occupations after service require[ing] intense manual labor, and the Veteran is getting older, the resulting arthritis and degenerative disc disease is from his occupations after service and age-related deterioration of the spine. The evidence on record from service (and considering the Veteran's young age in-service) make the probability of arthritis or degenerative disc disease of the lumbar spine being highly improbable of existing at that time, especially without back complaints noted on the claimed injury event in service (i.e., falling off the wing of a plane)." The examining physician went on to state, "[T]here is no evidence to support the back conditions developed within a year of separation or continued after separation from service." Regarding secondary service connection, the August 2021 examining physician determined that the Veteran's claimed condition was not the result of service-connected tinnitus, hearing loss, or residuals of a 5th metacarpal fracture. Rationale for his opinion included: "There is absolutely no pathophysiological correlation between bilateral tinnitus, bilateral hearing loss and degenerative arthritis of the hand and the development of spinal pathologies." See August 2021 VA Back (Spine) Conditions examination report. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the entire body of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board's analysis will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant). Analysis While the Veteran has a diagnosis to satisfy the first element of service connection and lay testimony regarding an in-service event, the evidence of record is against a finding of element number three, a nexus between the current diagnosis and his military service. Contemporaneous medical evidence has greater probative value than the Veteran's reports of history. See Curry v. Brown, 7 Vet. App. 59 (1994). The contemporaneous medical evidence of record shows: 1) that the Veteran was "off duty" when he fractured his right middle finger in November 1956; 2) no documented in-service complaints, diagnoses, or treatment for a low back condition, including at separation; 3) civilian employment in carpentry and construction for more than 30 years; 4) "occasional back pain" over the years; 5) the onset of symptoms in the 1990s, corroborated by an April 2016 report of symptoms for "20 years duration;" 6) an October 2009 description of "acute symptoms start[ing] nine days ago;" 7) an October 2009 notation of "heavy work for many years;" 8) a March 2013 medical opinion stating, "What the Veteran has now is age-related severe degenerative joint and disc disease of the lumbar spine;" 9) a May 2016 report by the Veteran that his lower back pain is the result of "many years of lifting and bending;" and 10) a January 2017 opinion that the Veteran's age and tobacco use are "contributing factors" to his back condition. There is no evidence in the service records of a low back injury following a fall from the wing of an airplane. The November 1956 service treatment records reference the Veteran "falling to the ground," but the clinical notes also state that the Veteran was "off duty." See November 1956 Chronological Record of Medical Care. The only reference to a back injury during service is a September 1957 "sprain" in the Veteran's upper back "while pushing a truck." See September 1957 Chronological Record of Medical Care. The August 2021 VA medical examiner concluded that "an acute and self-limiting condition, which resolves within days to weeks does not predispose one to degenerative arthritis or degenerative disc disease." See August 2021 VA Back (Spine) Conditions examination report. Service records do not contain additional complaints of, treatment for, or diagnoses related to a back condition, upper or lower. The Veteran denied a back condition at separation, and a physical examination found no evidence of a back condition at separation. See April 1958 Reports of Medical History and Examination. The Veteran reported work in carpentry and construction from the time he separated from service until he retired in the year 2000. See October 2009 Dr. S.S., MD Letter, March 2013 VA Back (Spine) Conditions examination report, January 2017 Newbridge Spine & Pain Center Letter, August 2021 VA Hand and Finger Conditions examination report, and August 2021 VA Back (Spine) Conditions examination report. Based on medical literature, the March 2013 VA medical examiner concluded that the Veteran's diagnosis of degenerative disc and joint disease of the lumbar spine was not the result of trauma, as reported by the Veteran. See March 2013 VA Back (Spine) Conditions examination report. The August 2021 VA Medical examiner attributed the Veteran's "intense manual labor," along with the Veteran's age, to his degenerative disc and joint disease of the lumbar spine. See August 2021 VA Back (Spine) Conditions examination report. Arthritis is included in the list of presumptive diseases enumerated in 38 C.F.R. § 3.309. However, the first documented reference to lower back pain is in 2009, more than 50 years after service, which described the Veteran's symptoms as "acute." See October 2009, Dr. S.S., MD Letter. For these reasons, the Veteran does not meet the requirements for presumptive service connection, either by diagnosis in-service, within the prescribed time limits after service, or through continuity of symptomatology, and he is not entitled to the presumption of an in-service incurrence, aggravation in-service, or nexus to service. Conclusion In summary, while the Veteran has a current diagnosis and lay evidence of an in-service event, a preponderance of the evidence is against a finding of the third element required for service connection, a nexus to military service. The Veteran contends that his current lumbar spine condition is due to his military service. Service treatment records for the Veteran are silent for any complaints, diagnoses, or treatment for a low back condition. At his separation from service, the Veteran denied a back condition, and his physical examination was "Normal." After service, the Veteran worked for more than 30 years in construction. Documented symptoms of a back condition first appear in October 2009, and the Veteran denied any specific injury. At the time, the examining physician noted "heavy work for many years." The Veteran would later attribute his lower back symptoms to "many years of lifting and bending." Because the Veteran was not diagnosed with arthritis in service or within the prescribed time frame after service, and because the Veteran first reported symptoms of a back condition decades after service, he is not entitled to the presumption of service connection. Beyond the complaints of pain in his low back, the Veteran is not competent to provide a diagnosis that requires the application of medical expertise to the facts presented. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). An opinion regarding service connection from the Veteran is of no probative value because he lacks the medical expertise needed to diagnose a lumbosacral spine condition or to attribute it to active military service. The VA examiner opinions provide compelling evidence against the Veteran's claim for service connection. There is no competent, credible evidence to refute the March 2013, February 2019, and August 2021 VA examiner opinions. See 38 C.F.R. § 3.159(a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements, or opinions). Further, the Veteran does not meet the requirements for presumptive service connection. For the reasons set forth above, more weight is given to the contemporaneous medical evidence, including the service medical records, private treatment records, VA treatment records, and the VA examinations. Therefore, the evidence of record is not sufficient to warrant a grant of service connection or a determination that further development of the evidence is required. The evidence of record, aside from any lay statements in support of this claim, weighs against the claim for service connection for a back condition. A clear preponderance of the evidence of record indicates the Veteran does not meet the criteria under 38 C.F.R. § 4.71a, diagnostic code 5242, for entitlement to service connection for degenerative disc and joint disease of the lumbar spine. Therefore, his claim must be denied. The benefit- of-the-doubt rule does not apply when the Board finds that a preponderance of the evidence is against the claim. Ortiz v. Principi, 274 F. 3d 1361, 1365 (Fed. Cir. 2001), Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). 2. Entitlement to an initial, compensable rating greater than 0 percent from December 3, 2010, to July 16, 2015, an initial, increased rating greater than 10 percent from July 16, 2015, and a subsequent, increased rating greater than 30 percent from August 23, 2021, for bilateral hearing loss. The Veteran contends that his "existing disability picture warrants a higher evaluation for service-connected bilateral hearing loss based upon applicable rating tables" and requests "at least 60 percent as regards my hearing." See June 2016 Third Party Correspondence and May 2020 VA Form 9, Appeal to Board of Veterans' Appeals. Increased Ratings Disability evaluations are determined by the application of facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) in 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred in or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Separate, staged ratings are appropriate in adjudicating increased ratings when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 506 (2007). The period of consideration begins one year prior to the claim for increase and extends to the present. In the case of initial ratings, the period for consideration begins with the effective date of service connection. Fenderson v. West, 12 Vet. App. 119, 126 (1999); AB v. Brown, 6 Vet. App. 35 (1993) (holding that a claim for an original or increased rating remains in controversy when less than the maximum available benefit is awarded). Any reasonable doubt as to the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. The Rating Schedule includes Tables to determine evaluation percentages. Beginning with Table VI, a Roman numeral designation (from Levels I through XI) is associated with the Pure-tone threshold average for each ear. "Pure-tone threshold average," as used in Table VI, is the sum of the pure-tone thresholds at 1000, 2000, 3000 and 4000 Hertz (Hz), divided by four. The pure-tone threshold at 500 Hz is not used in determining the evaluation but is used in determining whether a ratable hearing loss exists. Once the appropriate Roman numeral designation is found, by comparing "% of (speech) discrimination" on the vertical axis and "Pure-tone Threshold Average" on the horizontal axis, Table VII is used to assign a rating by comparing the Roman numeral designations, generated in Table VI, for the "better" and "poorer" ear. VA rating criteria for evaluating hearing loss disability provide ratings from 0 (non-compensable) to 100 percent. See 38 C.F.R. § 4.85. An examination for hearing impairment for VA purposes must be conducted by a state licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a Pure-tone audiometry test. Examinations are conducted without the use of hearing aids. 38 C.F.R. § 4.85(a). Factual Background The Veteran was provided with a VA examination in October 2012. Pure-tone threshold testing yielded the following results: Right Ear A B C D E F G 500 Hz* 1000 Hz 2000 Hz 3000 Hz 4000 Hz 6000 Hz 8000 Hz 15 30 55 65 75 X X Left Ear A B C D E F G 500 Hz* 1000 Hz 2000 Hz 3000 Hz 4000 Hz 6000 Hz 8000 Hz 15 25 50 60 70 X X The average Pure-tone threshold for the right ear, columns B E, was 56.25 dB. The average Pure-tone threshold for the left ear, columns B E, was 51.25 dB. Word list speech recognition (Maryland CNC) was scored at 94 percent for the right ear and 94 percent for the left ear. The Veteran reported no functional impact of hearing loss on his ability to work or on his usual daily activities. See October 2012 VA Hearing Loss and Tinnitus examination report. The Veteran was provided with an additional VA examination in July 2015. Pure-tone threshold testing yielded the following results: Right Ear A B C D E F G 500 Hz* 1000 Hz 2000 Hz 3000 Hz 4000 Hz 6000 Hz 8000 Hz 30 40 65 65 70 80 X Left Ear A B C D E F G 500 Hz* 1000 Hz 2000 Hz 3000 Hz 4000 Hz 6000 Hz 8000 Hz 35 35 60 70 75 75 80 The average Pure-tone threshold for the right ear, columns B E, was 60.00 dB. The average Pure-tone threshold for the left ear, columns B E, was 60.00 dB. Word list speech recognition (Maryland CNC) was scored at 76 percent for the right ear and 80 percent for the left ear. The Veteran reported functional impact due to a hearing loss as having to ask others to repeat themselves multiple times, having to focus on the face of the person speaking. See July 2015 VA Hearing Loss and Tinnitus examination report. Finally, the Veteran was provided with a VA examination in August 2021. Pure-tone threshold testing yielded the following results: Right Ear A B C D E F G 500 Hz* 1000 Hz 2000 Hz 3000 Hz 4000 Hz 6000 Hz 8000 Hz 45 60 75 80 90 90 90 Left Ear A B C D E F G 500 Hz* 1000 Hz 2000 Hz 3000 Hz 4000 Hz 6000 Hz 8000 Hz 40 55 70 80 80 80 85 The average Pure-tone threshold for the right ear, columns B E, was 76.25 dB. The average Pure-tone threshold for the left ear, columns B E, was 71.25 dB. The Maryland CNC word list speech discrimination scores, appropriate for use with this Veteran, were 72 percent for the right ear and 76 percent for the left ear. Functional impairment due to hearing loss was reported by the Veteran as: "[P]eople have to double or triple up on what they say, since I can't hear them...my social life has been diminished to zero." See August 2021 VA examination report. Analysis Evaluating the VA audiological test results cited above, the Board finds that when the Pure-tone threshold averages and the speech recognition scores from the VA examination in October 2012 are applied to Table VI (Numeric Designation of Hearing Impairment Based on Pure-tone Threshold Average and Speech Discrimination), the numeric designation of hearing impairment for both the right and left ears is Roman numeral I. See 38 C.F.R. § 4.85, Table VI. The designated numeral "I" represents both the "better ear" and "poorer ear" from the October 2012 VA examination. When applied to Table VII (Percentage Evaluation for Hearing Impairment Diagnostic Code 6100), the evaluation for hearing impairment is 0 percent, the point at which both designated numerals intersect along the bottom row. See 38 C.F.R. § 4.85, Table VII. Therefore, a compensable rating prior to July 16, 2015, is not warranted. When the Pure-tone threshold averages and the speech recognition scores from the VA examination in July 2015 are applied to Table VI (Numeric Designation of Hearing Impairment Based on Pure-tone Threshold Average and Speech Discrimination), the numeric designation of hearing impairment for both the right and left ears is Roman numeral IV. See 38 C.F.R. § 4.85, Table VI. The designated numeral "IV" represents both the "better ear" and "poorer ear" from the July 2015 VA examination. When applied to Table VII (Percentage Evaluation for Hearing Impairment Diagnostic Code 6100), the evaluation for hearing impairment is 10 percent, the point at which both designated numerals intersect along the fourth row and fourth column. See 38 C.F.R. § 4.85, Table VII. Therefore, a rating greater than 10 percent disabling prior to August 23, 2021, is not warranted. As the Pure-tone threshold averages and speech recognition scores from the VA examination in August 2021 are applied to Table VI (Numeric Designation of Hearing Impairment Based on Pure-tone Threshold Average and Speech Discrimination), the numeric designation of hearing impairment for the right ear is Roman numeral VI, and the left ear is Roman numeral IV. See 38 C.F.R. § 4.85, Table VI. The designated numeral "IV" represents the "better ear," and the designated numeral "VI" represents the "poorer ear" from the August 2021 VA examination. When applied to Table VII (Percentage Evaluation for Hearing Impairment Diagnostic Code 6100), the evaluation for hearing impairment is 20 percent, the point at which both designated numerals intersect along the fourth row and the sixth column. See 38 C.F.R. § 4.85, Table VII. Therefore, a rating greater than 30 percent disabling after August 23, 2021, is not warranted. The Board will not disturb the favorable findings of a VA adjudicator. See 38 C.F.R. §§ 3.103, 3.104. It should be noted that "Review for entitlement to special monthly compensation under 38 C.F.R. § 3.350" is appreciable for numerical designations of "XI" from Table VI. See 38 C.F.R. § 4.85, Table VII. In addition, the Board takes note of the fact that the Veteran may be in receipt of an additional rating for adjustment disorder due to "hearing-related problems that have affected his life." See September 2021 VA Mental Disorders examination report. Further, since the Veteran does not meet the Pure-tone threshold requirements of 55 decibels or more at each (emphasis added) of the specified frequencies (1000, 2000, 3000, 4000 Hertz) or 30 decibels or less at 1000 Hertz and (emphasis added) 70 decibels or more at 2000 Hertz, the provisions for exceptional hearing impairment do not apply. See 38 C.F.R. § 4.86. Conclusion Consideration has been given to the Veteran's statements regarding his hearing difficulties, and the Board has not overlooked the Veteran's statements regarding the severity of his hearing loss. In this regard, the Veteran is competent to report on factual matters of which he has firsthand knowledge, i.e., asking speakers to repeat themselves due to difficulty hearing. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). The Veteran has provided lay evidence through VA examination and private treatment throughout the course of his appeal with respect to the presence of hearing loss symptoms and their severity. He is competent to provide such statements, and the Board finds that the Veteran's statements are credible. The Veteran's reported symptomatology has been noted, and the Board has considered the Veteran's reports with respect to this decision. The Veteran contends that his hearing loss is more severe than what is reflected in his current disability ratings. Unfortunately, his opinion is of no probative value because he lacks the medical expertise needed to assess his current level of hearing loss. See Jones v. West, 12 Vet. App. 383, 385 (1999) (holding that where the determinative issue is one of medical causation or diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue). Therefore, the objective medical findings provided by the Veteran's October 2012, July 2015, and August 2021 VA examination reports has been accorded greater probative weight. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) ("[t]he probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches... the credibility and weight to be attached to these opinions [are] within the province of the adjudicator."). The evaluation of hearing loss is determined by the prescribed application of the numeric designations to the percentage evaluations in the Rating Schedule, after audiometric evaluations are recorded. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Further, 38 C.F.R. § 4.85, Table VII, assigns a specific percentage rating to each designated numeral of impairment converted during the rating process. Requirements for a compensable rating due to hearing loss are not based on subjective criteria, including the Veteran's belief about what may be appropriate. In reviewing the record, the Board finds that the Veteran's hearing loss percentage ratings represent the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. The relevant legal authority governing the evaluation of hearing impairment is clear and unambiguous, and the Board is bound by such authority. The overall weight of the evidence is against a finding that the Veteran's degree of bilateral hearing loss meets the standards for a compensable evaluation prior to July 16, 2015, greater than 10 percent disabling prior to August 23, 2021, or greater than 30 percent thereafter. Therefore, additional rating increases are not warranted, and the claim increases for bilateral hearing loss must be denied. In reaching the conclusions stated above, the Board has considered the applicability of the benefit of the doubt doctrine. The rule does not apply when the Board finds that a preponderance of the evidence is against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (2018); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Finally, the Veteran has not indicated, nor has the evidence raised, that his service-connected hearing loss in conjunction with his other service-connected disabilities render him unable to obtain or maintain substantially gainful employment; thus, the Board will not address the issue of entitlement to a total disability rating for individual unemployability herein. 3. Entitlement to an initial, compensable rating greater than 0 percent from December 3, 2010, to September 6, 2017, and an initial, increased rating greater than 10 percent from September 6, 2017, for degenerative arthritis status post right 5th metacarpal fracture (previously rated as healed right third metacarpal fracture with mild residual tenderness), claimed as broken right hand. The Veteran contends that an increased rating for residuals of a right 5th metacarpal fracture disability is warranted and requests "at least 30 percent as regards [his] hand." See June 2016 Third Party Correspondence. Increased Ratings Disability evaluations are determined by the application of facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) in 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred in or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Separate, staged ratings are appropriate in adjudicating increased ratings when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 506 (2007). Generally, the period of consideration begins one year prior to the claim for increase and extends to the present. In the case of initial ratings, the period for consideration begins with the effective date of service connection. Fenderson v. West, 12 Vet. App. 119, 126 (1999); AB v. Brown, 6 Vet. App. 35 (1993) (holding that a claim for an original or increased rating remains in controversy when less than the maximum available benefit is awarded). Any reasonable doubt as to the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. The Veteran's 5th metacarpal fracture disability is currently evaluated under 38 C.F.R. § 4.71a, DC 5003, Degenerative arthritis, other than post-traumatic. See February 2018 VA Rating Decision Codesheet. According to DC 5003: "Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 pct is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as below: With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, 10 [percent]; with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating episodes, 20 [percent]." Additional rating criteria for potential application is found in 38 C.F.R. § 4.71a, DC 5229, Index or long finger, limitation of motion. Under DC 5229, a non-compensable rating is assigned with a gap of less than one inch (2.5 cm.) between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, and; extension is limited by no more than 30 degrees. A 10 percent rating is assigned with a gap of one inch (2.5 cm.) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; extension is limited by more than 30 degrees. See 38 C.F.R. § 4.71a, DC 5229, Index or long finger, limitation of motion. Factual Background Pursuant to a duty to assist, the Veteran was provided with a VA medical examination in March 2013. The examining physician reviewed the claims file and evidence of record in preparation for her report. The Veteran was examined in person, and his statements were considered, including a report that the Veteran hurt his right hand after falling in service, "but his hand function was good enough for [the Veteran] to work as a carpenter until he retired around 2000." The examining physician noted that the Veteran's right hand was casted for several months. The examiner also noted follow up X-rays in December 1956 and January 1957 that showed a "fairly good callus formation around the fracture site...though there was some angulation of the distal fragment on the last X-ray." The Veteran reported no stiffness or flare-ups in his right hand and no pain, "unless the area of the fracture is directly bumped." He was diagnosed with "healed right third metacarpal fracture with mild residual tenderness." See March 2013 VA Hand and Finger Conditions examination report. At the March 2013 medical examination, there was no limitation of motion or functional loss, even with repetitive testing, including the ability to oppose thumb, or evidence of painful motion for any finger or thumb. Muscle strength testing for hand grip was 5/5, normal strength. There was no evidence of ankylosis, assistive devices, or of any other pertinent physical findings, complications, conditions, signs, or symptoms. Bilateral degenerative joint disease of the trapeziometacarpal joint (at the base of the thumbs) was not symptomatic and was not related to his healed injury. The examining physician concluded that the Veteran had "no functional [right] hand impairment." In addition, the Veteran reported no functional impact on his ability to work due to the healed right finger injury. See March 2013 VA Hand and Finger Conditions examination report. Pursuant to a duty to assist, the Veteran was provided with another VA medical examination in July 2015. The examiner reviewed the claims file and evidence of record in preparation for her report. The Veteran was examined in person, and his statements were considered, including a report of a right finger fracture in 1955, while stationed in Korea. Flare-ups were reported as intermittent, sharp pain when grabbing items and opening jars or doors. The Veteran was diagnosed with right, third metacarpal, with residual. Range of motion testing produced no evidence of limitation of motion, even with repetitive testing, including the ability to oppose thumb, or evidence of painful motion for any finger or thumb. Functional loss after repetitive testing was described as weakened movement, excess fatigability, and pain on movement. It was not possible for the examining physician to determine any additional loss of function during flare-ups without resort to speculation. The Veteran reported no pain or tenderness to palpation of joints or soft tissue upon examination. Muscle strength testing, including hand grip, was 4/5, active movement against some resistance, on the right and 5/5, normal strength on the left. There was no evidence of ankylosis, assistive devices, or of any other pertinent physical findings, complications, conditions, signs, or symptoms. No abnormal findings were revealed with imaging. Functional impact on the ability to work was reported by the Veteran as difficulty grabbing items and shaking hands. See July 2015 VA Hand and Finger Conditions examination report. Pursuant to a duty to assist, the Veteran was provided with an additional medical examination in February 2019. The examining physician reviewed the claims file and evidence of record in preparation for his report. The Veteran was examined in person, and his statements were considered, including a reported injury in 1956, with current symptoms described as pain and stiffness. The Veteran denied flare-ups and reported functional loss as decreased manual dexterity, without additional functional loss due to repeated use over a period of time. The Veteran was diagnosed with degenerative arthritis and 5th metacarpal fracture. Active, passive, weight-bearing, and non-weight bearing range of motion measurements were "normal," without a gap between either the pad of the thumb and the fingers or the finger and proximal transverse crease of the hand on maximal finger flexion, and without pain. Repetitive use testing yielded no additional functional loss or loss of range of motion. Muscle strength, including hand grip, was 5/5, normal strength. There was no evidence of ankylosis, assistive devices, or other pertinent physical findings, complications, conditions, signs, or symptoms. A March 2013 X-ray report showed: "Old fracture of the right hand fifth metacarpal is seen. There are bilateral severe degenerative changes of the trapeziometacarpal joint. The soft tissues appeal normal." The examining physician stated that the "arthritis is unrelated to fracture." Functional impact on the ability to work was revealed by the Veteran as decreased manual dexterity. See February 2019 VA Hand and Finger Conditions examination report. Pursuant to the June 2021 Board remand, the Veteran was provided with a fourth medical examination in August 2021. The examining physician reviewed the claims file and evidence of record in preparation for the report. The Veteran was examined in person, and his statements were considered, including a reported fall from 12 feet, landing on his side, and work as a carpenter after service. The Veteran denied flare-ups and reported functional loss as decreased grip strength. The Veteran was diagnosed with healed right 5th metacarpal fracture, bilateral hand trapeziometacarpal degenerative arthritis, and right third finger strain. The examining physician determined that the trapeziometacarpal degenerative arthritis was "unrelated to the previous 5th metacarpal fracture" and was due to "age-related deterioration of the hand," as evidenced by its presence at the base of both thumbs. See August 2021 VA Hand and Fingers examination report. August 2021 active, passive, weight-bearing, non-weight bearing, and repetitive range of motion testing for each finger and thumb was all normal, including flexion endpoint and extension endpoint, without a gap between either the pad of the thumb and the fingers or the finger and proximal transverse crease of the hand on maximal finger flexion, and without a functional loss due to pain. The Veteran did not report limits on functional ability with repeated use over time due to pain, fatigability, weakness, lack of endurance, or incoordination, nor were additional contributing factors reported by the Veteran or recorded by the examining physician. Muscle strength, including hand grip, was measured as 5/5, normal strength. There was no evidence of atrophy, ankylosis, assistive devices, or other pertinent physical findings, complications, conditions, signs, or symptoms. The Veteran reported no functional impact on his ability to work due to a right-hand disability. The examining physician concluded: "There is no evidence of symptoms along the right-hand 5th metacarpal fracture clinically...there is no diagnostic evidence of abnormalities along this metacarpal on X-rays from 2013." See August 2021 VA Hand and Fingers examination report. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the entire body of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board's analysis will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant). Analysis Repetitive, active and passive, weight-bearing and non-weight-bearing testing was completed at the February 2019 and August 2021 VA examinations. The content of the examination fully complied with the requirements of 38 C.F.R. § 21.1032(a)(1)(i). See February 2019 and August 2021 VA Hand and Finger Conditions examination reports. To the extent that the VA Compensation and Pension examinations and other physical examinations discussed herein failed to record passive range of motion and range of motion in non-weight-bearing conditions, the Board finds that the examinations nevertheless are adequate for VA rating purposes. Passive range of motion is the amount of motion possible when an examiner moves a body part with no assistance from the individual being evaluated. It is usually greater than active range of motion because the integrity of the soft tissue structures does not dictate the limits of movement. Comparisons between passive range of motion and active range of motion provide information about the amount of motion permitted by the associated joint structures (passive range of motion) relative to the individual's ability to produce motion at a joint (active range of motion). CYNTHIA NORKIN & D. JOYCE WHITE, MEASUREMENT OF JOINT MOTION: A GUIDE TO GONIOMETRY 8-9 (2016). Testing the joint under weight-bearing conditions involves movement of the body against gravity. J. Randy Jinkins, et al., Upright, Weight-bearing, Dynamic-kinetic Magnetic Resonance Imaging of the Spine: Initial Results, 15 J. Eur. Radiol. 1815-25 (2005). When evaluating range of motion, it is preferable to test in weight-bearing conditions because testing in non-weight-bearing conditions underestimates the degree of pathology present. Id. at 1823. Because there is no indication that the structural integrity of the Veteran's finger is compromised, such that passive range of motion in this case would be more limited than active, and because testing in weight-bearing conditions is more demonstrative of the degree of pathology, the Board finds that the failure to record limitation of motion on passive range of motion and in non-weight-bearing is harmless error and not prejudicial to the Veteran. In addition to the February 2019 and August 2021 VA examination reports, the Board will evaluate the Veteran's range of motion using the available measurements on active range of motion using the March 2013 and July 2015 VA examination reports. Under 38 C.F.R. § 4.7, the Veteran is entitled to the benefit of the rating criteria that will result in the higher evaluation of his disability. Based on range of motion measurements at each of the VA examinations, the Veteran does not meet the evaluation criteria for even a non-compensable rating under 38 C.F.R. § 4.71a, DC 5229, Index or long finger, limitation of motion, at any point during the period on appeal. See March 2013, July 2015, February 2019, and August 2021 VA Hand and Finger Conditions examination reports. There was no evidence of painful motion at either the March 2013, July 2015, or February 2019 medical examinations. See March 2013, July 2015, and February 2019 VA Hand and Finger Conditions examination reports. Bilateral degenerative joint disease of the trapeziometacarpal joint, located at the base of the thumbs, was not related to the healed 5th metacarpal fracture injury. See March 2013, February 2019, and August 2021 VA Hand and Finger Conditions examination reports. Therefore, the rating criteria in 38 C.F.R. § 4.59 regarding "at least the minimum compensable rating for the joint" due to arthritis does not apply to the Veteran's 5th metacarpal fracture. The provisions of 38 C.F.R. § 4.40, Functional loss, have been considered. Functional loss is defined as the "inability...to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance." The regulation cites "absence of part, or all, of the necessary bones, joints and muscles, or associated structures," which does not apply to the Veteran's 5th metacarpal fracture. See March 2013 VA Hand and Finger Conditions examination report ("healed right third metacarpal fracture"). Next, the regulation mentions "deformity, adhesions, defective innervation, or other pathology," which also does not apply to the Veteran's 5th metacarpal fracture. See August 2021 VA Hand and Fingers examination report ("[T]here is no diagnostic evidence of abnormalities along this metacarpal on X-rays."). Also mentioned in 38 C.F.R. § 4.40 is "pain...evidenced by the visible behavior of the claimant." There is no evidence of "wincing" by the Veteran at any VA medical examination. See March 2013, July 2015, February 2019, and August 2021 VA Hand and Finger Conditions examination report. Finally, "weakness" and "atrophy" are mentioned as "evidence of disuse." Muscle strength, including hand grip, was reported as "5/5, normal strength, in March 2013, February 2019, and August 2021. See March 2013, February 2019, and August 2021 VA Hand and Finger Conditions examination reports. There was no evidence of atrophy at any VA medical examination. See March 2013, July 2015, February 2019, and August 2021 VA Hand and Finger Conditions examination reports. The factors addressed in 38 C.F.R. § 4.45, The joints, including ankylosis, nonunion, weakness, fatigability, incoordination, and pain on movement, have also been considered. There is no evidence of ankylosis at any VA medical examination. See March 2013, July 2015, February 2019, and August 2021 VA Hand and Finger Conditions examination reports. Muscle strength was addressed in the preceding paragraph regarding functional loss. The Veteran did describe weakened movement, excess fatigability, and pain on movement as factors contributing to functional loss after repetitive testing in July 2015. See July 2015 VA Hand and Finger Conditions examination report. Painful movement on active and passive movement was recorded at the August 2021 medical examination but did not result in functional loss. See August 2021 VA Hand and Fingers examination report. Incoordination was never reported or recorded as a factor contributing to functional loss with repeated use over time. See March 2013, July 2015, February 2019, and August 2021 VA Hand and Finger Conditions examination reports. The Veteran was provided with a compensable rating for painful motion under 38 C.F.R. § 4.71a, DC 5003, Degenerative arthritis, other than post-traumatic, effective September 6, 2017. The Board will not disturb the favorable findings of a VA adjudicator. See 38 C.F.R. §§ 3.103, 3.104. Under 38 C.F.R. § 4.71a, the Veteran's current ratings reflect the limited range of motion experienced by his reported pain upon movement, without a separate rating for pain. The prohibition against pyramiding of claims prevents compensation for the same manifestation of symptoms, i.e., pain and limitation of range of motion, under multiple diagnostic codes in either 38 C.F.R. § 4.59 or § 4.71a. See 38 C.F.R. § 4.14; see also Brady v. Brown, 4 Vet. App. 206 (1993) (holding that 38 U.S.C. § 1155 means, "the rating schedule may not be employed as a vehicle for compensating a claimant twice (or more) for the same symptomatology; such a result would overcompensate the claimant for the actual impairment of his earning capacity."). The August 2021 examining physician concluded, "There is no evidence of symptoms along the right-hand 5th metacarpal fracture clinically." See August 2021 VA Hand and Fingers examination report; see also March 2013 VA Hand and Finger Conditions examination report ("no functional [right] hand impairment."). Therefore, the Veteran does not meet the evaluation criteria for a compensable rating prior to September 6, 2017, or for a rating greater than 10 percent thereafter. Application of the regular rating schedule standards is not impractical due to an "exceptional or unusual" disability. The record does not contain evidence of "marked interference with employment or frequent periods of hospitalization" for residuals of the Veteran's 5th metacarpal fracture disability. Because it is not reasonably raised from the record or from the appeal, referral for extraschedular consideration under 38 C.F.R. § 3.321 is not warranted. See 38 C.F.R. § 3.321(b)(1). Conclusion In summary, a preponderance of the evidence of record indicates that the Veteran does not meet the relevant diagnostic criteria under 38 C.F.R. § 4.71a, DC 5229, for a non-compensable evaluation due to a 5th metacarpal fracture. The Veteran was evaluated for painful movement under DC 5003, effective September 6, 2017. However, at no point prior to September 6, 2017, did the Veteran meet the relevant diagnostic criteria for a compensable rating, and at no point subsequent to September 6, 2017, did the Veteran meet the relevant diagnostic criteria for a rating greater than 10 percent disabling. The provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59 have been considered. The Veteran does not meet the requirements for a disability rating greater than 0 percent disabling for residuals of a 5th metacarpal fracture prior to September 6, 2017, and greater than 10 percent disabling thereafter. The prohibition against the pyramiding of claims prevents a separate rating for pain, which is already contemplated in the Veteran's schedular ratings. The Veteran's disability does not present such an exceptional or unusual picture as to render the Rating Schedule impractical. Therefore, consideration for extraschedular evaluation is not for application. The Veteran is adequately compensated for the average impairment in earning capacity resulting from diseases or injuries incurred in or aggravated by her active service in his civilian occupation. The Board has carefully reviewed and considered the Veteran's statements regarding the severity of his right middle finger disability. To that end, the Board acknowledges that the Veteran, in advancing this appeal, believes that the residuals of his right middle finger disability are more severe than is reflected in the assigned evaluation rating. The Board is likewise aware of the Veteran's contentions that his residuals of a right middle finger disability impact his daily activities. Moreover, the Board notes that the Veteran is competent to report observable symptoms such as pain and numbness. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). In this case, however, the competent medical evidence offering detailed, specific, and specialized determinations pertinent to the rating criteria, namely, determinations of degree of range of motion, the determination of a gap between the pad of the thumb and fingers, the determination of a gap between the finger and proximal transverse crease of the hand on maximal finger flexion, and the existence of ankylosis, is the most probative evidence with regard to evaluating the pertinent symptoms for the disability on appeal. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The evidence also contemplates the Veteran's descriptions of his symptoms both at VA examinations and in treatment, including his reports of impairment with respect to pain, weakened movement, and fatigability. The lay testimony has been considered together with the probative medical evidence clinically evaluating the severity of the pertinent disability symptoms. The March 2013, July 2015, February 2019, and August 2021 VA examination reports are the most probative evidence of record on the question of entitlement to an increased rating. The opinions were based on an extensive review of all the evidence, including lay statements from the Veteran, were supported by a detailed rationale, provided data to support any conclusions, and each provided a clear and reasoned analysis, the source of the most probative value in a medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Moreover, the March 2013, July 2015, February 2019, and August 2021 VA examiner reports are consistent with the evidence of record, including the Veteran's reports of no functional loss due to pain or limits on functional ability with repeated use over time due to pain, fatigability, weakness, lack of endurance, or incoordination. The VA examiner reports provide compelling evidence against the Veteran's claim for increase. There is no competent, credible evidence to refute the March 2013, July 2015, February 2019, and August 2021 VA examiner reports. The weight of the probative evidence of record is against a finding that the Veteran is entitled to a compensable rating from December 3, 2010, to September 6, 2017, and a rating greater than 10 percent thereafter for degenerative arthritis status post right 5th metacarpal fracture. Consequently, an additional increase is not warranted, and the claim must be denied. In reaching the conclusions stated above, the Board has considered the applicability of the benefit of the doubt doctrine. The rule does not apply when the Board finds that a preponderance of the evidence is against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (2018); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Finally, the Veteran has not indicated, nor has the evidence raised, that his service-connected residuals of a 5th metacarpal fracture in conjunction with his other service-connected disabilities render him unable to obtain or maintain substantially gainful employment; thus, the Board will not address the issue of entitlement to a total disability rating for individual unemployability herein. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Small, Attorney Advisor 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.