Citation Nr: 21069583 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 16-56 474 DATE: November 18, 2021 ORDER Entitlement to service connection for sleep apnea is denied. Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied. Entitlement to service connection for bilateral pes planus is denied. Entitlement to a disability rating in excess of 10 percent prior to September 15, 2016, and in excess of 20 percent from September 15, 2016, for degenerative joint and disc disease, lumbar spine, is denied. FINDINGS OF FACT 1. There is no probative evidence of record showing that the Veteran's current sleep apnea began during his active service or is related to an in-service event, injury, or disease. 2. There is no probative evidence of record showing that the Veteran's current GERD began during his active service or is related to an in-service event, injury, or disease. 3. The preponderance of the evidence is against finding that the Veteran's bilateral pes planus that was noted upon his entrance into active service was aggravated by his active service. 4. Prior to September 15, 2016, the Veteran's low back disability did not manifest by forward flexion of the thoracolumbar spine of 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. 5. From September 15, 2016, the Veteran's low back disability is not manifested by forward flexion of the thoracolumbar spine of 30 degrees or less or by ankylosis of the thoracolumbar spine. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 2. The criteria for entitlement to service connection for GERD have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 3. The criteria for entitlement to service connection for bilateral pes planus have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.306. 4. Prior to September 15, 2016, the criteria for a disability rating in excess of 10 percent for the Veteran's low back disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 5. From September 15, 2016, the criteria for a disability rating in excess of 20 percent for the Veteran's low back disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from June 1986 to June 1990 and from November 1999 to September 2004. These matters come before the Board of Veterans' Appeals (Board) on appeal of a November 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously remanded by the Board in January 2021. A review of the claims file shows that there has been substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The case has been returned to the Board for review. Pursuant to the January 2021 Board remand, the AOJ attempted to schedule the Veteran for VA examinations as to his claims for entitlement to service connection for sleep apnea, gastroesophageal reflux disease, bilateral pes planus, and entitlement to an increased rating for lumbar spine disability. However, the Veteran refused to attend the scheduled hearings and the AOJ cancelled the requests for VA examinations as to those disabilities. Although VA has a duty to assist the Veteran in substantiating his claim, that duty is not a one-way street. Woods v. Gober, 14 Vet. App. 214, 224 (2000); see also Hurd v. West, 13 Vet. App. 449, 452 (2000); 38 C.F.R. § 3.159 (c). The Board will therefore proceed with appellate consideration based on the evidence of record. See 38 C.F.R. § 3.655 (When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be decided based on the evidence of record). In October 2019, the Veteran testified during a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. The Board notes that a complete transcript of the video conference hearing was not able to be produced due to audio malfunctions. In an October 2020 correspondence the Veteran reported that he did not wish to appear at another hearing. As such, this decision is based on the evidence currently of record. In an October 2016 rating decision, the Agency of Original Jurisdiction (AOJ) increased the rating for the Veteran's low back disability to 20 percent, effective September 15, 2016. As the increase did not satisfy the appeal in full, the issue remains on appeal and has been characterized as shown on the title page of this decision. See AB v. Brown, 6 Vet. App. 35 (1993). Neither the Veteran nor his representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issues decided herein. 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). 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, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). A preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 C.F.R. § 3.306. Clear and unmistakable evidence is required to rebut the presumption of aggravation where the preexisting disability underwent an increase in severity during service. However, aggravation may not be conceded where the disability underwent no increase in severity during service. 38 C.F.R. § 3.306 (b). In addition, temporary flare-ups, even in service, will not be considered sufficient to establish an increase in severity unless the underlying condition, as contrasted with the symptoms, is worsened. Hunt v. Derwinski, 1 Vet. App. 292 (1991). 1. Entitlement to service connection for sleep apnea. The Veteran contends that his sleep apnea is directly related to his active service. He has reported that his sleep apnea is due to deviated septum surgery he received during his active service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, although the Veteran did have deviated septum surgery during his active service and the evidence reflects that he has a current diagnosis of sleep apnea, there is no probative evidence of record showing that the current sleep apnea began during service or is otherwise related to an in-service injury, event or disease. The Veteran's service treatment records show that he had surgery for a deviated septum in December 2002. The service treatment records do not show complaints or treatment for sleep apnea during the Veteran's active service. The post-service medical records do not show that the Veteran was diagnosed with sleep apnea until November 2011, several years after his separation from active service. They do not contain any competent medical opinions indicating a causal relationship between the current disability and the in-service surgery. Thus, the medical evidence of record shows that the Veteran had deviated septum surgery during his active service and was diagnosed with sleep apnea several years after his separation from active service, but does not show that there is an etiological link between the Veteran's active service, to include the deviated septum surgery during active service. The Board acknowledges the Veteran's belief that his sleep apnea is related to the in-service deviated septum surgery. However, the Veteran in this case is not considered competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the pathology and likely progression of sleep apnea. Therefore, it is outside the competence of the Veteran because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428 (2011). Consequently, his statements and assertions are not entitled to probative weight. In summary, there is no probative evidence of record showing that the Veteran's current sleep apnea began during his active service or is related to an in-service event, injury, or disease. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claim for entitlement to service connection for sleep apnea. Because the preponderance of the evidence is against the claim, the doctrine of reasonable doubt is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for GERD. The Veteran contends that his GERD is directly related to his active service. He has reported that he had symptoms related to GERD during his active service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, although the Veteran did have gastrointestinal symptoms during his active service and the evidence reflects that he has a current diagnosis of GERD, there is no probative evidence of record showing that the current GERD began during service or is otherwise related to an in-service injury, event or disease. The Veteran's service treatment records show that he had right scapula pain, some gastrointestinal pain and nausea/vomiting in November 2001. The November 2001 service treatment record specifically noted that the Veteran did not have GERD or hiatus hernia. The post-service medical records do not show that the Veteran was diagnosed with GERD until February 2014, several years after his separation from active service. The Veteran's medical records do not contain any competent medical opinions indicating a causal relationship between the current disability and the in-service gastrointestinal complaints. Thus, the medical evidence of record shows that the Veteran had gastrointestinal distress during his active service and was diagnosed with GERD several years after his separation from active service, but does not show that there is an etiological link between the Veteran's active service and his diagnosed GERD, to include the gastrointestinal distress during active service. The Board acknowledges the Veteran's belief that his GERD is related to the in-service gastrointestinal distress. However, the Veteran in this case is not considered competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the pathology and likely progression of GERD. Therefore, it is outside the competence of the Veteran because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428 (2011). Consequently, his statements and assertions are not entitled to probative weight. In summary, there is no probative evidence of record showing that the Veteran's current GERD began during his active service or is related to an in-service event, injury, or disease. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claim for entitlement to service connection for GERD. Because the preponderance of the evidence is against the claim, the doctrine of reasonable doubt is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for bilateral pes planus The Veteran seeks entitlement to service connection for bilateral pes planus. The Veteran contends that the condition was noted upon entrance into active service and was aggravated by his active service. The June 1986 entrance examination reflects that the Veteran had asymptomatic pes planus at that time. Accordingly, the Veteran was noted upon examination for entrance into active service as having pes planus, and the Veteran may only be service connected for pes planus on the basis of in-service aggravation under 38 U.S.C. § 1153 and 38 C.F.R. § 3.306. VA obtained a medical opinion in December 2014 to determine whether the service treatment records reflect an aggravation of the Veteran's preservice pes planus. The examiner noted that the service treatment records noted episodes of plantar fasciitis during his military service which resolved as evidenced by examinations completed after the foot pain complaints. The VA examiner further noted that there was no permanent residual or chronic disability. The examiner's opinion is consistent with the record and was based on the examiner's knowledge and expertise as a medical professional. The examiner's opinion is therefore considered probative evidence that the Veteran's preservice pes planus was not aggravated by his active service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board has considered the Veteran's assertions that his preservice pes planus was aggravated by his active service. The Veteran is competent to report subjective symptoms such as foot pain. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board does not question his credibility in that regard. However, the Veteran is not considered competent to assess the relative severity of pes planus, to include any increase in severity during his active service, as doing so involves medical testing and medical knowledge the Veteran has not been shown to possess. See Kahana, 24 Vet. App. at 435; Buchanan, 451 F.3d at 1336-37. The objective medical evidence of record, as interpreted by the VA examiner, does not show an in-service aggravation of the preservice pes planus. Therefore, in that regard, the Veteran's statements are contradicted by the objective, probative medical evidence of record. In summary, the probative evidence of record indicates that the pes planus noted at the time of the Veteran's examination for entrance into active service did not increase in severity during his active service beyond its natural progression. As the probative evidence is against finding that the preservice pes planus increased in severity during the Veteran's active service, aggravation may not be conceded. 38 C.F.R. § 3.306 (b). The preponderance of the evidence therefore is against the claim, the doctrine of reasonable doubt is not for application, and the claim must be denied. See 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 57. Increased Ratings Disability ratings are determined by the application of VA's Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). In rating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). 4. Entitlement to increased ratings for low back disability The Veteran seeks higher ratings for his service-connected degenerative joint and disc disease, lumbar spine. The Veteran's service-connected low back disability is rated as 10 percent disabling prior to September 15, 2016, and in excess of 20 percent from September 15, 2016, under 38 C.F.R. § 4.71a, Diagnostic Code 5242. The Veteran's increased rating claim was received on September 26, 2015. Therefore, the relevant rating period is from September 27, 2014, one year prior to receipt of the claim, through the present. See, 38 C.F.R. § 3.400 (o) (2). For the one year period prior to his increased rating claim, the Veteran's low back disability was rated as 10 percent disabling. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. See 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. The Board is allowed to consider these changes, although the RO has not yet done so. 38 C.F.R. § 20.904(d)(2) (remand to the AOJ is not necessary for consideration of law not already considered by the AOJ, including regulations). If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Prior to the recent amendment, diagnostic code 5242 provided criteria for degenerative arthritis of the spine, referencing diagnostic code 5003. As of February 7, 2021, the amended version of diagnostic code 5242 provides criteria for degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome, and references diagnostic codes 5003 and 5010. Regardless, both versions of the regulations instruct that diagnostic codes 5235 to 5243 to be evaluated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. Under either version of the General Rating Formula, a 20 percent disability rating is assigned for forward flexion of the lumbar spine greater than 30 degrees, but not greater than 60 degrees; or, combined range of motion of the lumbar 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 disability rating is assigned for forward flexion of the lumbar spine 30 degrees or less; or, favorable ankylosis of the entire lumbar spine. A 50 percent evaluation is assigned for unfavorable ankylosis of the entire lumbar spine. A 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. Additionally, Note 1 following the General Rating Formula specifies that any associated objective neurologic abnormalities including but not limited to bowel or bladder impairment are to be separately evaluated under an appropriate diagnostic code. Note 2 following the General Rating Formal provides that normal forward flexion of the lumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 to 30 degrees. See 38 C.F.R. § 4.71a, DCs 5235 through 5242. Based on the Veteran's disability the Board will also consider ratings under Diagnostic Code 5243, Intervertebral Disc Syndrome (IVDS). 38 C.F.R. § 4.71a (2020). Intervertebral disc syndrome (preoperatively or postoperatively) is evaluated either on the total duration of incapacitating episodes over the past 12 months or by combining under 38 C.F.R. § 4.25 (the combined rating table) separate evaluations of its chronic orthopedic and neurologic manifestations along with evaluations for all other disabilities, whichever method results in the higher evaluation. A 10 percent rating is warranted with incapacitating episodes having a total duration of at least 1 week but less than 2 weeks during the past 12 months. A 20 percent disability rating is warranted with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating is warranted with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating is warranted with incapacitating episodes having a total duration of at least 6 months. The Veteran was provided a VA examination in April 2015. The Veteran reported that he is unable to lift over 25 pounds or twist. He reported flare-ups of the low back 3 to 4 times per week which limit his ability to do physical activity. He did not report loss of range of motion during flare-ups. Upon examination, the Veteran demonstrated forward flexion to 90 degrees, extension to 25 degrees and bilateral lateral flexion and bilateral lateral rotation to 30 degrees. The Veteran was able to perform repetitive use testing without additional loss of range of motion. The Veteran did not have ankylosis of the spine. The VA examiner noted that the Veteran had IVDS that did not require bed rest prescribed by a physician and treatment by a physician in the past 12 months. The Veteran was provided a VA examination in September 2016. The Veteran did not report flare-ups. Upon examination, the Veteran demonstrated forward flexion to 70 degrees, extension to 20 degrees, bilateral lateral flexion to 20 degrees, and bilateral lateral rotation to 30 degrees. Upon repetitive use testing, the Veteran's forward flexion was to 60 degrees and bilateral lower flexion to 10 degrees. The VA examiner noted that the Veteran had IVDS that did not require bed rest prescribed by a physician and treatment by a physician in the past 12 months. He did not demonstrate ankylosis of the spine. The Board finds a 10 percent rating is warranted prior to September 15, 2016. The Veteran's forward flexion at the April 2015 VA examination was 90 degrees. Thus, prior to September 15, 2016, his forward flexion was not less than 60 degrees, as required for a rating higher than 10 percent. Furthermore, his combined range of motion was also above 120 degrees; thus, a 20 percent rating was not warranted based on his combined range of motion because at no point during this period was his combined range of motion less than 120 degrees. He did not have muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour. Consequently, the Veteran's range of motion is best contemplated by the 10 percent rating. The Board has considered the Veteran's report of low back pain and functional loss. See DeLuca v. Brown, 8 Vet. App. 202 (1995). Nevertheless, neither the lay nor clinical evidence demonstrated painful motion that functionally limited the Veteran's range of motion beyond that contemplated by the current evaluation. See 38 C.F.R. § 4.59. Even considering the April 2015 VA examination that reflected the Veteran experiences functional loss due to pain, fatigue, weakness, and lack of endurance, the evidence does not show this functional loss caused his forward flexion to decrease to 60 degrees or his combined range of motion to decrease to 120 degrees as required by the 20 percent rating. From September 15, 2016, the Veteran's disability is best captured by a 20 percent rating. His forward flexion at his September 2016 VA examination, which was at worst 60 degrees, is contemplated by the 20 percent rating. A higher rating is not warranted because he did not have forward flexion limited to 30 degrees or less or have favorable ankylosis of the entire thoracolumbar spine, as required for a 40 percent rating. The Board must also consider the Veteran's functional loss due to pain. See 38 C.F.R. §§ 4.40, 4.45. At the September 2016 VA examination, the Veteran did not report that he experiences flare-ups. While the Veteran experienced decreased range of motion with repetitive use due to pain, his functional limitation was estimated to be forward flexion to 60 degrees. Therefore, even considering the Veteran's functional loss, the Board concludes the Veteran's back disability does not equate to more than the disability picture contemplated by the 20 percent rating already assigned. 38 C.F.R. § 4.71a. The evidence also is against finding that the Veteran has had incapacitating episodes as defined expressly by VA regulation 38C.F.R. §4.71a, Diagnostic Code 5243, Note (1) (meaning acute signs and symptoms due to IVDS requiring bed rest prescribed by a physician and treatment by a physician) having a total duration of at least 4 weeks in a 12 month period. If, as an example, he experiences an acute flare up of symptoms (e.g., pain, etc.) and resultantly takes to bed to try and recuperate, this is not an incapacitating episode because it is at his own election rather than on prescription of a doctor as means or modality of treatment). Thus, a higher rating is not warranted alternatively under the Formula for Rating IVDS Based on Incapacitating Episodes. The Board additionally considered the neurological effects of the Veteran's low back disability. At the April 2015 and September 2016 VA examinations, the Veteran did not demonstrate radicular pain or any other signs or symptoms due to radiculopathy or any bowel or bladder impairment owing to his low back disability. See 38 C.F.R. § 4.71a, diagnostic codes 5235-5242, Note (1). The Board acknowledges that the Veteran reported that his service-connected low back disability had worsened since the most recent VA examination. However, the Board reiterates that the Veteran did not report for a scheduled VA examination, which was scheduled to assess the current nature and manifestations of that condition. Under 38 C.F.R. § 3.655, a decision must be made on the evidence of record. In making its determinations in this case, the Board has carefully considered the Veteran's contentions with respect to the nature and severity of his service-connected low back disability at issue, and notes that his lay testimony is competent to describe certain symptoms associated with this disability. The Veteran's history and symptom reports have been considered, including as presented in the medical evidence discussed above, and are noted to be contemplated by the criteria for the disability rating for which the Veteran has been found entitled by the Board. Moreover, the competent medical evidence offering detailed specific findings pertinent to the rating criteria is the most probative evidence with regard to evaluating the pertinent symptoms of the service-connected disability at issue. As such, while the Board accepts the Veteran's statements with regard to the matters he is competent to address, the Board relies upon the competent medical evidence with regard to the specialized evaluation of functional impairment, symptom severity, and details of clinical features of the service-connected condition at issue. The Board therefore finds that the criteria for a rating in excess of 10 percent prior to September 15, 2016 and in excess of 20 percent from September 15, 2016 for the Veteran's service-connected low back disability have not been met at any time during the rating period. Accordingly, there is no basis for additional staged ratings of the Veteran's low back disability pursuant to Fenderson, 12 Vet. App. at 126-27, and higher ratings must be denied. As the preponderance of the evidence is against the assignment of higher ratings, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Ver. App. 49 (1990). Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. G. LeMoine, 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.