Citation Nr: 21070531 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 17-45 594 DATE: November 24, 2021 ORDER Entitlement to service connection for a disability manifested by insomnia, including as due to a service-connected disability, is denied. Entitlement to service connection for a bilateral hip disability, including as due to a service-connected disability, is denied. Entitlement to an initial 30 percent rating effective May 21, 2021, for a left knee disability is granted. Entitlement to an initial 40 percent rating effective May 21, 2021, for radiculopathy of the right lower extremity is granted. Entitlement to an initial 40 percent rating effective May 21, 2021, for radiculopathy of the left lower extremity is granted. Entitlement to an initial 20 percent rating prior to May 21, 2021, for a lumbosacral spine disability is granted. Entitlement to an initial compensable rating prior to March 1, 2019, an initial rating greater than 10 percent prior to May 21, 2021, and greater than 40 percent thereafter, for hypertension is denied. Entitlement to an initial rating greater than 30 percent prior to May 11, 2019, and greater than 50 percent thereafter, for migraine headaches is denied. Entitlement to an initial rating greater than 10 percent prior to May 21, 2021, and greater than 30 percent thereafter, for a cervical spine disability is denied. Entitlement to an initial rating greater than 10 percent for gastroesophageal reflux disease (GERD) is denied. REMANDED Entitlement to service connection for a disability manifested by chest pains is remanded. Entitlement to service connection for a right knee disability, including as due to a service-connected left knee disability, is remanded. Entitlement to service connection for a bilateral eye disability, including as due to a service-connected disability, is remanded. FINDINGS OF FACT 1. The record evidence shows that the Veteran does not experience any current disability due to his claimed disability manifested by insomnia or bilateral hip disability which could be attributed to active service or any incident of service, including as due to a service-connected disability. 2. The record evidence shows that prior to May 21, 2021, the Veteran's service-connected left knee disability is manifested by, at worst, moderate disability. 3. The record evidence shows that, effective May 21, 2021, the Veteran's service-connected left knee disability is manifested by, at worst, marked disability. 4. The record evidence shows that, prior to May 21, 2021, the Veteran's service-connected radiculopathy of the right lower extremity is manifested by, at worst, mild incomplete paralysis of the sciatic nerve. 5. The record evidence shows that, effective May 21, 2021, the Veteran's service-connected radiculopathy of the right lower extremity is manifested by, at worst, moderately severe incomplete paralysis of the sciatic nerve. 6. The record evidence shows that, prior to May 21, 2021, the Veteran's service-connected radiculopathy of the left lower extremity is manifested by, at worst, mild incomplete paralysis of the sciatic nerve. 7. The record evidence shows that, effective May 21, 2021, the Veteran's service-connected radiculopathy of the left lower extremity is manifested by, at worst, moderately severe incomplete paralysis of the sciatic nerve. 8. The record evidence shows that, prior to May 21, 2021, the Veteran's service-connected lumbosacral spine disability is manifested by, at worst, complaints of low back pain and forward flexion to 60 degrees with pain. 9. The record evidence shows that, effective May 21, 2021, the Veteran's service-connected lumbosacral spine disability is manifested by, at worst, forward flexion to 40 degrees. 10. The record evidence shows that, prior to March 1, 2019, the Veteran's service-connected hypertension does not result in any compensable disability. 11. The record evidence shows that, between March 1, 2019, and May 21, 2021, the Veteran's service-connected hypertension required continuous medication for control. 12. The record evidence shows that, effective May 21, 2021, the Veteran's service-connected hypertension is manifested by, at worst, diastolic pressure predominantly 120 or more. 13. The record evidence shows that, prior to May 11, 2019, the Veteran's service-connected migraine headaches are manifested by, at worst, characteristic prostrating attacks occurring on average once a month over several months. 14. The record evidence shows that, effective May 11, 2019, the Veteran's service-connected migraine headaches are manifested by, at worst, very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 15. The record evidence shows that, prior to May 21, 2021, the Veteran's service-connected cervical spine disability is manifested by, at worst, forward flexion to 40 degrees with pain. 16. The record evidence shows that, effective May 21, 2021, the Veteran's service-connected cervical spine disability is manifested by, at worst, forward flexion to 10 degrees. 17. The record evidence shows that the Veteran's service-connected GERD is manifested by, at worst, dysphagia, pyrosis, reflux, and regurgitation, substernal arm pain, and episodes of sleep disturbance or nausea which occur 4 or more times a year lasting less than 1 day at a time. CONCLUSIONS OF LAW 1. The criteria for service connection for a disability manifested by insomnia, including as due to a service-connected disability, have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2020). 2. The criteria for service connection for a bilateral hip disability, including as due to a service-connected disability, have not been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2020). 3. The criteria for an initial 30 percent rating effective May 21, 2021, for a left knee disability have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5259-5262 (2020). 4. The criteria for an initial 40 percent rating effective May 21, 2021, for radiculopathy of the right lower extremity have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.124a, DC 8520 (2020). 5. The criteria for an initial 40 percent rating effective May 21, 2021, for radiculopathy of the left lower extremity have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.124a, DC 8520 (2020). 6. The criteria for an initial 20 percent rating prior to May 21, 2021 for a lumbosacral spine disability have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5242-5243 (2020). 7. The criteria for an initial compensable rating prior to March 1, 2019, an initial rating greater than 10 percent prior to May 20, 2021, and greater than 40 percent thereafter, for hypertension have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.104, DC 7101 (2020). 8. The criteria for an initial rating greater than 30 percent prior to May 11, 2019, and greater than 50 percent thereafter, for migraine headaches have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.124a, DC 8100 (2020). 9. The criteria for an initial rating greater than 10 percent prior to May 21, 2021, and greater than 30 percent thereafter, for a cervical spine disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5243-5242 (2020). 10. The criteria for an initial rating greater than 10 percent for GERD have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.114, DC 7399-7346 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 2010 to December 2013. This appeal has a long procedural history. It comes before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision. The Board notes that the Agency of Original Jurisdiction (AOJ) adjudicated this Veteran's claims as part of the Benefits Delivery at Discharge (BDD) program (now known as the Pre-Discharge Program or Joint VA/Department of Defense Disability Evaluation System (DES)). The Veteran appointed his current service representative to represent him before VA by filing a completed VA Form 21-22 at the AOJ in December 2018. The AOJ assigned higher initial ratings to the Veteran's service-connected migraine headaches, lumbosacral spine disability, radiculopathy of the left lower extremity, and hypertension in a July 2019 rating decision. It also granted service connection for radiculopathy of the right lower extremity, assigning an initial 10 percent rating effective March 1, 2019. The Board acknowledges that, in the July 2019 rating decision, the AOJ assigned a higher initial 50 percent rating effective May 11, 2019, for the service-connected migraine headaches. The AOJ noted that this rating is the highest schedular rating available for this disability. The record evidence shows that no argument has been presented regarding entitlement to an extraschedular rating for migraine headaches. Nor has this issue been raised by the record. Thus, the Board finds that referral to the Director, Compensation Service, for consideration of entitlement to an initial rating greater than 50 percent effective May 11, 2019, for migraine headaches on an extraschedular basis is not warranted. See Thun v. Peake, 22 Vet. App. 111, 116 (2008), and Chudy v. O'Rourke, 30 Vet. App. 34 (2018). A virtual Board hearing was held in November 2020 before the undersigned Veterans Law Judge and a copy of the hearing transcript has been added to the record. In March 2021, the Board remanded, in pertinent part, the currently appealed claims to the AOJ for additional development. A review of the claims file shows that there has been substantial compliance with the Board's remand directives. The Board directed that the AOJ obtain updated treatment records for the Veteran and schedule him for examinations to determine the current nature and severity of his service-connected disabilities. Additional records subsequently were associated with the claims file. And the requested examinations occurred in May 2021. See Stegall v. West, 11 Vet. App. 268 (1998); see also Dyment v. West, 13 Vet. App. 141 (1999) (holding that another remand is not required under Stegall where the Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (2002). In a June 2021 rating decision, the AOJ assigned higher initial ratings for the Veteran's service-connected lumbosacral spine disability, hypertension, and cervical spine disability. Having reviewed the record evidence, the Board finds that the issues on appeal should be characterized as stated above. Because the Veteran lives within the jurisdiction of the Regional Office (RO) in Roanoke, Virginia, that facility has jurisdiction in this appeal. The Board finally acknowledges that the rating criteria for evaluating musculoskeletal disabilities were revised effective February 7, 2021. As relevant to the claims adjudicated in this decision, the revised DC 5262 provides a 20 percent rating for impairment of the tibia and fibula requiring treatment for no less than 12 consecutive months and unresponsive to surgery and either shoe orthotics or other conservative treatment in one lower extremity. A 30 percent rating is assigned for impairment of the tibia and fibula requiring treatment for no less than 12 consecutive months and unresponsive to surgery and either shoe orthotics or other conservative treatment in both lower extremities. See 38 C.F.R. § 4.71a, DC 5262 (revised effective February 7, 2021). No substantive changes were made to the rating criteria for spine disabilities. Service Connection 1. Entitlement to service connection for a disability manifested by insomnia and for a bilateral hip disability, each including as due to a service-connected disability The Board finds that the preponderance of the evidence is against granting the Veteran's claims of service connection for a disability manifested by insomnia and for a bilateral hip disability, each including as due to a service-connected disability. The Veteran essentially contends that he incurred each of these claimed disabilities during active service and experienced continuous post-service disability. He alternatively contends that a service-connected disability caused or aggravated each of these claimed disabilities. The record evidence does not support the Veteran's lay assertions regarding the existence of current disability due to either of these claimed disabilities which could be attributed to active service. It shows instead that he does not experience any current disability due to either of these claimed disabilities which is related to active service. For example, the available service treatment records show that, on outpatient treatment in June 2013, the Veteran's complaints included "feeling tired all the time. States he only gets 4 5 hours of sleep nightly. He goes to bed at 10pm but never falls asleep until about 3am." The diagnoses included insomnia. He was referred to a sleep hygiene clinic. He subsequently reported an in-service history of trouble sleeping at his separation physical examination in November 2013 prior to his separation from service in December 2013. The Board notes that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Barr v. Nicholson, 21 Vet. App. 303 (2007). The post-service evidence also does not support granting service connection for a disability manifested by insomnia or for a bilateral hip disability, each including as due to a service-connected disability. It shows instead that the Veteran does not experience any current disability due to either of these claimed disabilities which could be attributed to active service. For example, on VA psychiatric examination in April 2013, the Veteran's complaints included "difficulty sleeping because of pain," snoring, and feeling fatigue daily. He denied any significant mental health problems. The VA examiner concluded that the Veteran did not meet the diagnostic criteria "for any mental illness." On VA joints examination later in April 2013, it was noted that the Veteran's bilateral hips were normal. A service connection claim must be accompanied by evidence which establishes that the claimant currently has a disability. Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is not warranted in the absence of proof of current disability. The Board has considered whether the Veteran experienced either a disability manifested by insomnia or a bilateral hip disability during the pendency of this appeal. Service connection may be granted if there is a disability at some point during the claim even if it later resolves or becomes asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007). In this case, there is no evidence other than the Veteran's lay assertions and Board hearing testimony that he experiences current disability due to either of these claimed disabilities which could be attributed to active service. The Board finds it highly significant that, when examined for DES purposes in April 2013 prior to his separation from service in December 2013, the Veteran's bilateral hips were normal. He otherwise has not identified or submitted any evidence demonstrating his entitlement to service connection for a disability manifested by insomnia or for a bilateral hip disability, each including as due to a service-connected disability. In summary, the Board finds that service connection for a disability manifested by insomnia and for a bilateral hip disability, each including as due to a service-connected disability, is not warranted. Increased Rating 2. Entitlement to an initial 30 percent rating effective May 21, 2021, for a left knee disability The Board finds that the evidence reasonably supports assigning a higher initial 30 percent rating effective May 21, 2021, for the Veteran's service-connected left knee disability. Consistent with his lay assertions and Board hearing testimony, the record evidence shows that the symptomatology attributable to this disability worsened on VA knee and lower leg conditions Disability Benefits Questionnaire (DBQ) conducted on this date. This examination documented the presence of marked disability and supports assigning a higher initial 30 percent rating effective May 21, 2021, for the service-connected left knee disability under DC 5259-5262. See 38 C.F.R. § 4.71a, DC 5259-5262 (2020). The Board notes that, since the former DC 5262 is more favorable to the Veteran, this rating criteria was used in adjudicating this claim. Prior to May 21, 2021, the record evidence shows that the service-connected left knee disability is manifested by, at worst, moderate disability (i.e., a 20 percent rating under DC 5259-5262). Id. It is undisputed that the Veteran incurred a left knee disability during active service, had surgery to treat this disability, and was discharged from service due to this disability. The post-service medical evidence shows that, on VA examination in April 2013 completed as part of the DES process, the Veteran's complaints included sharp left knee pain. A history of in-service left knee surgery was noted. Physical examination of the left knee showed tenderness to palpation in the patellar tendon and tibial tuberosity, and no swelling, laxity, or crepitus. Range of motion testing of the left knee showed flexion to 120 degrees with pain starting at 110 degrees. None of the DeLuca factors were present. An magnetic resonance imaging (MRI) scan of the left knee showed post-surgical changes consistent with a high tibial osteotomy, likely medial meniscus debridement, and anterior cruciate ligament (ACL) repair with the majority of the ACL graft appearing intact. The diagnoses included left ACL insufficiency and left varus knee alignment. On VA knee and lower leg conditions DBQ in March 2019, the Veteran's complaints included increased knee "cracks when he bends it and it hurts him more often." The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran described flare-ups of his left knee pain as constant left knee pain which worsened in cold weather. He reported functional impairment or functional loss which he described as, "No bending or kneeling like before." Range of motion testing of the left knee showed flexion to 120 degrees with pain not causing functional impairment or loss and no additional limitation of motion on repetitive testing. Physical examination of the left knee showed mild tenderness to palpation in the anterior knee, no evidence of pain with weight bearing, no objective evidence of crepitus, disturbance of locomotion, difficulty with prolonged standing and walking, leg length discrepancy, 5/5 muscle strength, no muscle atrophy, ankylosis, history of recurrent subluxation or lateral instability, and no joint instability. None of the DeLuca factors were present. There was no evidence of pain on passive range of motion testing or in non weight bearing of the left knee. The diagnosis was residuals, status-post ACL and meniscus tear/reconstruction, debridement, tibial osteotomy with varus malalignment of the left knee with limited painful motion, laxity, and left leg length shortening. Contrary to the Veteran's lay assertions and Board hearing testimony, the record evidence shows that, prior to May 21, 2021, his service-connected left knee disability is manifested by, at worst, moderate disability. VA examinations conducted during this time period document the Veteran's complaints of left knee pain. Range of motion testing showed flexion to 120 degrees with pain beginning at 110 degrees but not causing functional loss or impairment. Physical examination showed mild left knee tenderness to palpation with no evidence of pain on weight bearing, passive range of motion, or in non weight bearing. Taken together, the record evidence dated prior to May 21, 2021, shows that the symptomatology attributable to the service-connected left knee disability resulted in, at worst, moderate disability. These physical examination findings support the 20 percent rating currently and initially assigned for this disability under DC 5259 5262. Id. There is no indication that, prior to May 21, 2021, the service-connected left knee disability resulted in marked disability such that an initial rating greater than 20 percent is warranted during this time period. Id. The Veteran otherwise has not identified or submitted any evidence demonstrating his entitlement to an initial rating greater than 20 percent prior to May 21, 2021, for his service-connected left knee disability. Thus, the Board finds that the criteria for an initial rating greater than 20 percent prior to May 21, 2021, for a left knee disability have not been met. In contrast, the record evidence supports the assignment of a higher initial 30 percent rating effective May 21, 2021, for the service-connected left knee disability under DC 5259-5262. Id. VA knee and lower leg conditions DBQ on May 21, 2021, showed that the symptomatology attributable to this disability had worsened and resulted in marked disability. This examination documented the Veteran's complaints of difficulty with left knee pain, walking, standing, and with weight bearing. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. A history of left knee surgeries was noted. The Veteran denied experiencing flare-ups of left knee pain. He experienced functional loss or impairment which he described as difficulty with walking, kneeling, and weight bearing. Range of motion testing of the left knee showed flexion to 30 degrees with pain and no additional limitation of motion on repetitive testing. Physical examination of the left knee showed pain with weight-bearing, non weight-bearing, and on active and passive motion, and pain causing functional loss which reflected difficulty walking, kneeling, and weight bearing, objective evidence of crepitus, tenderness to palpation in the inferior medial aspect of the patella which he rated as 7/10 on a pain scale which reflected residuals of knee surgeries, interference with sitting and standing, swelling, disturbance of locomotion, weakened movement, no muscle atrophy or ankylosis, no recurrent subluxation or persistent instability, a leg length discrepancy, a meniscal tear, frequent episodes of "locking," pain, and joint effusion, and increased instability in walking up and down stairs. He constantly used a brace. The VA examiner concluded that the Veteran's symptoms had worsened. The diagnosis was residuals, status-post ACL and meniscus tear/reconstruction, debridement tibial osteotomy with varus malalignment of the left knee with limited painful motion, laxity, and left leg length shortening. Consistent with the Veteran's lay assertions and Board hearing testimony, the record evidence shows that the symptomatology attributable to his service-connected left knee disability worsened on VA examination on May 21, 2021, and supports the assignment of a higher initial 30 percent rating for this disability on that date under DC 5259-5262. Id. This examination documented functional loss or impairment due to the left knee disability which the Veteran described as difficulty with walking, kneeling, and weight bearing. Left knee flexion was limited to 30 degrees with pain and no additional limitation of motion on repetitive testing. There also was pain with weight-bearing, non weight-bearing, and on active and passive motion, and pain causing functional loss which reflected difficulty walking, kneeling, and weight bearing. The VA examiner concluded that the service-connected left knee disability symptomatology had worsened. The Board agrees. Taken together, the record evidence supports the assignment of a higher initial 30 percent rating effective May 21, 2021, for the service-connected left knee disability under DC 5259-5262. Id. There is no indication that the Veteran experienced nonunion of the tibia and fibula with loose motion such that an initial rating greater than 30 percent is warranted under DC 5259-5262. Id. In summary, and after resolving any reasonable doubt in the Veteran's favor, the Board finds that the criteria for an initial 30 percent rating effective May 21, 2021, for a left knee disability have been met. 3. Entitlement to initial 40 percent ratings effective May 21, 2021, for radiculopathy of the right lower extremity and for radiculopathy of the left lower extremity The Board next finds that the evidence reasonably supports assigning initial 40 percent ratings effective May 21, 2021, for the Veteran's service-connected radiculopathy of the right lower extremity and for radiculopathy of the left lower extremity. He contends that each of these disabilities is more disabling than currently (and initially) evaluated. The Board agrees, finding that the record evidence shows that, effective May 21, 2021, each of these disabilities is manifested by, at worst, moderately severe incomplete paralysis of the bilateral sciatic nerves such that higher initial 40 percent ratings are warranted on this date under DC 8520. See 38 C.F.R. § 4.124a, DC 8520 (2020). It also shows that, prior to this date, the service-connected radiculopathy of the right lower extremity and service-connected radiculopathy of the left lower extremity are manifested by, at worst, mild incomplete paralysis of the sciatic nerves (i.e., a 10 percent rating under DC 8520). Id. For example, on VA peripheral nerves conditions DBQ in March 2019, the Veteran's complaints included numbness. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran was ambidextrous. He had no pain, paresthesias and/or dysesthesia, or numbness in the right lower extremity and mild intermittent pain and mild numbness in the left lower extremity. Physical examination showed 5/5 muscle strength throughout, no muscle atrophy, normal deep tendon reflexes, decreased sensation in the thighs/knees and feet/toes, a normal gait, and mild incomplete paralysis of the bilateral sciatic nerves. The diagnosis was residuals, status-post ACL tear/reconstruction, meniscus tear/debridement, tibial osteotomy with impairment of lateral cutaneous peripheral nerve. Contrary to the Veteran's lay assertions and Board hearing testimony, the record evidence shows that, prior to May 21, 2021, his service-connected radiculopathy of the right lower extremity and service-connected radiculopathy of the left lower extremity are manifested by, at worst, mild incomplete paralysis of the bilateral sciatic nerves. These findings on VA examination in March 2019 support the 10 percent ratings currently (and initially) assigned prior to May 21, 2021, for each of these disabilities under DC 8520. Id. There is no indication that, prior to May 21, 2021, the Veteran experiences at least moderate incomplete paralysis of the right sciatic nerve or the left sciatic nerve as is required for an initial rating greater than 10 percent during this time period under DC 8520. Id. He otherwise has not identified or submitted any evidence demonstrating his entitlement to initial ratings greater than 10 percent prior to May 21, 2021, for his service-connected radiculopathy of the right lower extremity or service-connected radiculopathy of the left lower extremity. In summary, the Board finds that the criteria for initial ratings greater than 10 percent prior to May 21, 2021, for radiculopathy of the right lower extremity and for radiculopathy of the left lower extremity have not been met. In contrast, the record evidence supports the assignment of higher initial 40 percent ratings effective May 21, 2021, for the service-connected radiculopathy of the right lower extremity and service-connected radiculopathy of the left lower extremity. The Board finds that, on VA back (thoracolumbar spine) conditions DBQ on May 21, 2021, the symptomatology attributable to each of these disabilities worsened significantly and resulted in moderately severe incomplete paralysis of the bilateral sciatic nerves (i.e., a 40 percent rating under DC 8520). Id. At this examination, the Veteran's complaints included persistent pain with radiculopathy of the bilateral lower extremities and difficulty with walking, standing, and weight bearing. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran experienced severe constant pain, moderate paresthesias and/or dysesthesias, and moderate numbness of the bilateral lower extremities. Physical examination showed no muscle atrophy. The diagnoses included radiculopathy of the right lower extremity and radiculopathy of the left lower extremity. Consistent with the Veteran's lay assertions and Board hearing testimony, the record evidence shows that the symptomatology attributable to his service-connected radiculopathy of the right lower extremity and service-connected radiculopathy of the left lower extremity worsened on VA examination on May 21, 2021, and resulted in moderately severe incomplete paralysis of the bilateral sciatic nerves. This supports the assignment of higher initial 40 percent ratings effective May 21, 2021, for the service-connected radiculopathy of the right lower extremity and service-connected radiculopathy of the left lower extremity under DC 8520. Id. The Board acknowledges that the Veteran's symptoms included severe constant pain of the bilateral lower extremities at this examination. Physical examination showed no muscle atrophy, however, so initial ratings greater than 40 percent are not warranted for the service-connected radiculopathy of the right lower extremity or for service-connected radiculopathy of the left lower extremity under DC 8520 as a 60 percent rating requires both severe incomplete paralysis of the sciatic nerve and marked muscular atrophy. Id. In summary, and after resolving any reasonable doubt in the Veteran's favor, the Board finds that the criteria for initial 40 percent ratings effective May 21, 2021, for radiculopathy of the right lower extremity and for radiculopathy of the left lower extremity have been met. 4. Entitlement to an initial 20 percent rating prior to May 21, 2021, for a lumbosacral spine disability The Board next finds that the evidence reasonably supports assigning a higher initial 20 percent rating prior to May 21, 2021, for the Veteran's service-connected lumbosacral spine disability. Consistent with his lay assertions and Board hearing testimony, the record evidence shows that, prior to May 21, 2021, this disability is manifested by, at worst, complaints of low back pain and forward flexion to 60 degrees with pain. These findings on physical examination support the assignment of a higher initial 20 percent rating prior to May 21, 2021, for the service-connected lumbosacral spine disability under DC 5242-5243. See 38 C.F.R. § 4.71a, DC 5242-5243 (2020). For example, on VA examination in April 2013 completed as part of the DES process, the Veteran's complaints included mild constant back pain, stiffness, and weakness. He experienced moderate daily flare-ups lasting for 30 minutes at a time. Range of motion testing of the lumbosacral spine showed forward flexion to 70 degrees with pain beginning at 60 degrees and no additional limitation of motion on repetitive testing. Physical examination showed normal spinal curvature, no muscle spasm or guarding, negative straight leg raising bilaterally, and paralumbar spinous tenderness to palpation. The diagnoses included lower back strain. On VA back (thoracolumbar spine) conditions DBQ in March 2019, the Veteran's complaints included constant low back pain and stiffness. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran experienced flare-ups of low back pain which he described as, "Any wrong move triggers the pain." He experienced functional loss or impairment which he described as limited movements and "some tingling on my feet many times a day." Range of motion testing of the lumbosacral spine showed forward flexion to 60 degrees with pain not resulting in or causing functional loss and no additional limitation of motion on repetitive testing. Physical examination of the lumbosacral spine showed mild tenderness to palpation in the lower lumbar spine, no pain with weight bearing, no guarding or muscle spasm, 5/5 muscle strength throughout, no muscle atrophy, normal deep tendon reflexes, decreased sensation in the thighs/knees and feet/toes, positive straight leg raising bilaterally, and no ankylosis, other neurologic abnormalities, or intervertebral disc syndrome. There was no evidence of pain on passive range of motion testing or in non weight bearing. The diagnosis was thoracolumbar intervertebral disc degeneration also diagnosed as referred as lumbar strain with sacroiliitis. Consistent with the Veteran's lay assertions and Board hearing testimony, the record evidence shows that, prior to May 21, 2021, his service-connected lumbosacral spine disability is manifested by, at worst, complaints of low back pain and forward flexion to 60 degrees with pain. These findings on physical examination support the assignment of a higher initial 20 percent rating prior to May 21, 2021, for the service-connected lumbosacral spine disability under DC 5242-5243. Id. VA examinations conducted in April 2013 and in May 2019 showed forward flexion limited to 60 degrees with pain. These examinations also documented the Veteran's complaints of low back pain and found tenderness to palpation in the lumbosacral spine. The record evidence does not support assigning an initial rating greater than 20 percent prior to May 21, 2021, for the service-connected lumbosacral spine disability, however. The March 2019 VA examination specifically found no ankylosis in the lumbosacral spine and ankylosis is required for an initial rating greater than 20 percent under DC 5242-5243. Id. This examination also found no intervertebral disc syndrome present in the lumbosacral spine so a higher initial rating is not warranted under DC 5243. In summary, and after resolving any reasonable doubt in the Veteran's favor, the Board finds that the criteria for an initial 20 percent rating effective prior to May 21, 2021, for a lumbosacral spine disability have been met. In contrast, the Veteran is not entitled to an initial rating greater than 40 percent effective May 21, 2021, for his service-connected lumbosacral spine disability. The Board acknowledges that the symptomatology attributable to this disability worsened on VA back (thoracolumbar spine) conditions DBQ conducted on May 21, 2021. At that examination, forward flexion of the lumbosacral spine was limited to 20 degrees (i.e., a 40 percent rating under DC 5242-5243). Id. There is no indication, however, that the Veteran experienced ankylosis of the lumbosacral spine (whether favorable or unfavorable) as is required for an initial rating greater than 40 percent under DC 5242-5243. Id. The May 21, 2021, VA examination specifically found no ankylosis in the lumbosacral spine. The Veteran otherwise has not identified or submitted any evidence demonstrating his entitlement to an initial rating greater than 40 percent effective May 21, 2021, for his service-connected lumbosacral spine disability. In summary, the Board finds that the criteria for an initial rating greater than 40 percent effective May 21, 2021, for a lumbosacral spine disability have not been met. 5. Entitlement to an initial compensable rating prior to March 1, 2019, an initial rating greater than 10 percent prior to May 21, 2021, and greater than 40 percent thereafter, for hypertension The Board next finds that the preponderance of the evidence is against granting the Veteran's claim of entitlement to an initial compensable rating prior to March 1, 2019, an initial rating greater than 10 percent prior to May 21, 2021, and greater than 40 percent thereafter, for hypertension. Contrary to his lay assertions and Board hearing testimony, the record evidence shows that his service-connected hypertension is not more disabling than currently (and initially) evaluated during any of the time periods at issue in this appeal. It shows instead that, prior to March 1, 2019, the service-connected hypertension did not result in any compensable disability. For example, on VA examination in April 2013 completed as part of the DES process, the Veteran's blood pressure was 135/92, 175/92, and 128/87. There is no indication that, prior to March 1, 2019, the Veteran's service-connected hypertension resulted in diastolic pressure predominantly 100 or more or systolic pressure predominantly 160 or more or that he had a history of diastolic pressure predominantly 100 or more and required continuous medication for control as is required for a minimum compensable 10 percent rating under DC 7101. See 38 C.F.R. § 4.104, DC 7101 (2020). It shows instead that his systolic pressure was 135, 175, and 128 and his diastolic pressure was 92, 92, 87 when his blood pressure was taken on an April 2013 examination. He otherwise has not identified or submitted any evidence demonstrating his entitlement to an initial compensable rating prior to March 1, 2019, for his service-connected hypertension. In summary, the Board finds that the criteria for an initial compensable rating prior to March 1, 2019, for hypertension have not been met. The Veteran also is not entitled to an initial rating greater than 10 percent prior to May 21, 2021, for his service-connected hypertension. Contrary to his lay assertions and Board hearing testimony, the record evidence shows that this disability is not more disabling than currently (and initially) evaluated between March 1, 2019, and May 21, 2021. The Board acknowledges that VA hypertension DBQ on March 1, 2019, showed that the symptomatology attributable to his service-connected hypertension had worsened. At this examination, his complaints included lightheadedness and dizziness which he attributed to his hypertension. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran's treatment plan for hypertension included taking continuous medication for control. He had no history of diastolic blood pressure elevation to predominantly 100 or more. His current blood pressure readings were 168/98, 154/98, and 142/98, with an average blood pressure reading 160/90. The finding that continuous medication is required for control of the service-connected hypertension on VA examination on March 1, 2019, supports the 10 percent rating currently (and initially) assigned between March 1, 2019, and May 20, 2021, under DC 7101. Id. The March 1, 2019, VA examiner specifically found no history of diastolic blood pressure elevation to predominantly 100 or more. And systolic pressure at this examination was 168, 154, and 142, with an average systolic reading of 160. In other words, there is no evidence that, between March 1, 2019, and May 20, 2021, the Veteran experienced diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more as is required for a higher initial 20 percent rating for hypertension under DC 7101. Id. He otherwise has not identified or submitted any evidence demonstrating his entitlement to an initial rating greater than 10 percent prior to May 21, 2021, for his service-connected hypertension. In summary, the Board finds that the criteria for an initial rating greater than 10 percent prior to May 21, 2021, for hypertension have not been met. The Veteran finally is not entitled to an initial rating greater than 40 percent effective May 21, 2021, for his service-connected hypertension. The Board again acknowledges that VA hypertension DBQ on May 21, 2021, demonstrated that the symptomatology attributable to this disability had worsened. At this examination, the Veteran reported that his blood pressure "remains elevated and difficult to control." The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran's treatment plan included being on continuous medication for control of hypertension. He had a history of diastolic blood pressure elevation to predominantly 100 or more which the VA examiner stated was "severely constant." His blood pressure readings were 165/121, 161/124, 164/121. The diagnosis was hypertension. Contrary to his lay assertions and Board hearing testimony, the record evidence does not support assigning an initial rating greater than 40 percent effective May 21, 2021, for his service-connected hypertension. The Board acknowledges that VA examination on May 21, 2021, showed that his diastolic pressure was predominantly 120 or more. The blood pressure readings obtained at this examination support the 40 percent rating currently (and initially) assigned effective May 21, 2021, for the service-connected hypertension under DC 7101. Id. There is no indication, however, that the Veteran's hypertension resulted in diastolic pressure predominantly 130 or more as is required for the maximum 60 percent rating under DC 7101. Id. He otherwise has not identified or submitted any evidence demonstrating his entitlement to an initial rating greater than 40 percent effective May 21, 2021, for his service-connected hypertension. In summary, the Board finds that the criteria for an initial rating greater than 40 percent effective May 21, 2021, for hypertension have not been met. 6. Entitlement to an initial rating greater than 30 percent prior to May 11, 2019, and greater than 50 percent thereafter, for migraine headaches The Board next finds that the preponderance of the evidence is against granting the Veteran's claim of entitlement to an initial rating greater than 30 percent prior to May 11, 2019, and greater than 50 percent thereafter, for migraine headaches. Contrary to his lay statements and Board hearing testimony, the record evidence shows that this disability is not more disabling than currently (or initially) evaluated during either time period at issue in this appeal. It shows instead that, prior to May 11, 2019, this disability is manifested by, at worst, characteristic prostrating attacks occurring on average once a month over several months. For example, on VA examination in April 2013 completed as part of the DES process, the Veteran's complaints included 12-15 headaches per month. His headaches were bilateral, sharp or knife-like, and located in the frontal, occipital, and post-orbital area. They were accompanied by photophobia, phonophobia, nausea, and vomiting. He described them as severe and reported that 90 percent of them were prostrating. His current treatment was Maxalt 5 mg at the start of a headache which resulted in a good response and caused drowsiness as a side effect. The diagnoses included migraine headaches. On VA headaches DBQ on March 1, 2019, the Veteran's complaints included headaches which interfered with his job. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran's treatment plan included taking continuous medication (Maxalt). He experienced pain localized to one side of the head, nausea, vomiting, and sensitivity to light as a result of headaches. His typical head pain lasted 1 2 days and was located on both sides of the head. He did not have characteristic prostrating attacks of migraine/non-migraine headache pain or very prostrating and prolonged attacks of migraine/non-migraine headache pain productive of severe economic inadaptability. The diagnosis was migraine headaches. Despite the Veteran's assertions to the contrary, the record evidence shows that, prior to May 11, 2019, his service-connected migraine headaches are manifested by, at worst, characteristic prostrating attacks occurring on average once a month over several months. He specifically reported at VA examination in April 2013 that he experienced multiple headaches every month and 90 percent of them were prostrating. This finding supports the 30 percent rating currently (and initially) assigned prior to May 11, 2019, for the Veteran's service-connected migraine headaches under DC 8100. See 38 C.F.R. § 4.124a, DC 8100 (2020). There is no indication, however, that he experienced very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability as a result of his service-connected migraine headaches prior to May 11, 2019, such that an initial rating greater than 30 percent is warranted for this time period. Id. The March 2019 VA headaches DBQ examiner specifically found that the Veteran did not experience very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability as a result of his service-connected migraine headaches. The Veteran otherwise has not identified or submitted any evidence demonstrating his entitlement to an initial rating greater than 30 percent prior to May 11, 2019, for his service-connected migraine headaches. Thus, the Board finds that the criteria for an initial rating greater than 30 percent prior to May 11, 2019, for migraine headaches have not been met. The Veteran also is not entitled to an initial rating greater than 50 percent effective May 11, 2019, for his service-connected migraine headaches. The Board acknowledges that VA headaches DBQ examination on May 11, 2019, showed that the symptomatology attributable to the service-connected migraine headaches had worsened and supported the assignment of a higher initial 50 percent rating on that date. Id. At this examination, the VA examiner stated that he reviewed the medical records and conducted a telephone interview with the Veteran as part of the ACE process without conducting an in-person examination. The Veteran stated that he experienced intermittent headaches "occurring several times per week with nausea, blurred vision, and light sensitivity." He had missed 1 week of work in the previous year due to his headaches. His treatment plan included taking medication (Maxalt) for his headaches. He described his headache pain as pulsating or throbbing head pain on both sides of his head and worsened with physical activity. His non-headache symptoms associated with headaches were nausea, vomiting, sensitivity to light and sound, and changes in vision. His typical head pain lasted less than 1 day and was located on both sides of his head. He had characteristic prostrating attacks of migraine/non-migraine headache pain once every month and very prostrating and prolonged attacks of migraine/non-migraine headache pain productive of severe economic inadaptability. The VA examiner concluded that the Veteran's headaches had worsened. The diagnosis was migraine including migraine variants. The Board notes that the Veteran already is in receipt of the maximum 50 percent rating effective May 11, 2019, for his service-connected headaches under DC 8100. Id. This rating is fully supported by the examination findings obtained on VA headaches DBQ conducted on May 11, 2019, when he reported that he experienced very prostrating and prolonged attacks of migraine/non-migraine headache pain productive of severe economic inadaptability. As noted in the Introduction, the issue of entitlement to an initial rating greater than 50 percent effective May 11, 2019, for migraine headaches on an extraschedular basis was not raised by the record. Thus, the Board finds that the claim for an initial rating greater than 50 percent effective May 11, 2019, for migraine headaches must be denied as a matter of law. See also Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). 7. Entitlement to an initial rating greater than 10 percent prior to May 21, 2021, and greater than 30 percent thereafter, for a cervical spine disability The Board next finds that the preponderance of the evidence is against granting the Veteran's claim of entitlement to an initial rating greater than 10 percent prior to May 21, 2021, and greater than 30 percent thereafter, for a cervical spine disability. He essentially contends that this disability is more disabling than currently (and initially) evaluated before and after May 21, 2021. The record evidence does not support his assertions. It shows instead that this disability is not more disabling than currently (and initially) evaluated during either time period at issue in this appeal. For example, prior to May 21, 2021, this disability is manifested by, at worst, forward flexion to 40 degrees with pain (i.e., a 10 percent rating under DC 5243-5242) as seen on VA examinations conducted during this time period. See 38 C.F.R. § 4.71a, DC 5243-5242 (2020). VA examination in April 2013, conducted as part of the DES process, showed that there was paracervical spinous tenderness to palpation. Range of motion testing of the cervical spine showed forward flexion to 45 degrees with pain beginning at 40 degrees and no additional limitation of motion on repetitive testing. X-rays of the cervical spine showed mild degenerative disease at C5-6 and minimal grade 1 retrolisthesis at several upper cervical spine levels. The diagnoses included mild cervical degenerative disc disease. On VA neck (cervical spine) conditions DBQ in March 2019, the Veteran's complaints included more frequent neck (cervical spine) pain. He was ambidextrous. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. He described flare-ups of cervical spine pain as painful to the touch. He experienced functional impairment or loss because he was no longer able to do certain moves and pain when touching his cervical spine. Range of motion testing of the cervical spine showed forward flexion to 40 degrees with pain not resulting in or causing functional loss and no additional limitation of motion on repetitive testing. Physical examination showed mild tenderness to palpation at the base of the neck, no pain with weight bearing, no guarding or muscle spasm, 5/5 muscle strength throughout, normal deep tendon reflexes and sensation, and no ankylosis, other neurologic abnormalities, or intervertebral disc syndrome. There was no pain on passive range of motion testing or non weight bearing. The diagnosis was cervical degenerative disc disease at C5-6 with minimal grade 1 retrolisthesis at several upper cervical spine levels. Contrary to the Veteran's lay assertions and Board hearing testimony, the record evidence shows that, prior to May 21, 2021, his service-connected cervical spine disability is manifested by, at worst, forward flexion to 40 degrees with pain. This consistent finding on physical examinations conducted in April 2013 and in March 2019 supports the 10 percent rating currently (and initially) assigned for the service-connected cervical spine disability during this time period under DC 5243 5242. Id. There is no indication, however, that the Veteran's cervical spine forward flexion was limited to 30 degrees or less as is required for an initial rating greater than 10 percent under this DC. Id. He otherwise has not identified or submitted any evidence demonstrating his entitlement to an initial rating greater than 10 percent prior to May 21, 2021, for his service-connected cervical spine disability. In summary, the Board finds that the criteria for an initial rating greater than 10 percent prior to May 21, 2021, for a cervical spine disability have not been met. The Veteran also is not entitled to an initial rating greater than 30 percent effective May 20, 2021, for his service-connected cervical spine disability. The Board acknowledges that VA neck (cervical spine) conditions DBQ on May 20, 2021, showed that the symptomatology attributable to this disability had worsened and supported assigning a higher initial 30 percent rating as of that date under DC 5243-5242. Id. At this examination, the Veteran's complaints included decreased range of motion of the neck with pain on hyperextension and lateral rotation. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. He denied experiencing flare-ups of neck pain or functional loss or impairment. Range of motion testing of the cervical spine showed forward flexion to 10 degrees with pain causing functional loss and no additional limitation of motion on repetitive testing. Passive range of motion was the same as active range of motion. Physical examination showed no objective evidence of crepitus, tenderness to palpation at C4-5, localized tenderness not resulting in an abnormal gait or spinal contour, no muscle spasm or guarding, interference with sitting, swelling, weakened movement, normal reflexes, decreased sensation in the hands/fingers, no ankylosis or other neurologic abnormalities, intervertebral disc syndrome without signs or symptoms requiring bed rest or treatment by a physician in the previous 12 months. The VA examiner stated that the Veteran's intervertebral disc syndrome was "a progression" of the service-connected cervical spine disability "and associated breakdown of vertebral disk causing laxity and impingement of [the] spinal cord" which led to guarding, discomfort, and neuropathic pain which radiated to the bilateral upper extremities. The diagnoses included cervical degenerative disc disease with minimal grade 1 retrolisthesis at several upper cervical spine levels. Despite the Veteran's lay assertions and Board hearing testimony to the contrary, the record evidence shows that, effective May 21, 2021, his service-connected cervical spine disability is manifested by, at worst, forward flexion to 10 degrees as seen on VA examination conducted on this date. This finding supports the 30 percent rating currently (and initially) assigned effective May 21, 2021, for the service-connected cervical spine disability under DC 5242-5243. Id. There is no indication, however, that the Veteran experiences unfavorable ankylosis of the cervical spine or the entire spine as is required for an initial rating greater than 30 percent under this DC. Id. The May 21, 2021, VA neck (cervical spine) conditions DBQ examiner specifically found no ankylosis in the Veteran's cervical spine. This examiner also found that, although intervertebral disc syndrome was present and marked a "progression" of the service-connected cervical spine disability due to "associated breakdown of vertebral disk causing laxity and impingement of [the] spinal cord," there were no signs or symptoms of intervertebral disc syndrome requiring bed rest or treatment by a physician in the previous 12 months. Thus, an initial rating greater than 30 percent is not warranted under DC 5243 based on intervertebral disc syndrome alone. The Veteran otherwise has not identified or submitted any evidence demonstrating his entitlement to an initial rating greater than 30 percent effective May 21, 2021, for his service-connected cervical spine disability. In summary, the Board finds that the criteria for an initial rating greater than 30 percent effective May 21, 2021, for a cervical spine disability have not been met. 8. Entitlement to an initial rating greater than 10 percent for GERD The Board finally finds that the preponderance of the evidence is against granting the Veteran's claim of entitlement to an initial rating greater than 10 percent for GERD. Despite his lay assertions and Board hearing testimony to the contrary, the record evidence shows that his service-connected GERD is manifested by, at worst, dysphagia, pyrosis, reflux, and regurgitation, substernal arm pain, and episodes of sleep disturbance or nausea which occur 4 or more times a year lasting less than 1 day at a time. These findings on physical examinations conducted during the appeal period support the 10 percent rating currently (and initially) assigned for the service-connected GERD under DC 7399-7346. See 38 C.F.R. § 4.114, DC 7399-7346 (2020). There is no indication that he experiences persistently recurrent epigastric distress accompanied by other symptoms productive of considerable impairment of health as is required for an initial rating greater than 10 percent under this DC. For example, on VA examination in April 2013, conducted as part of the DES process, the Veteran's complaints included a burning sensation in his chest, gas, and nausea or occasional vomiting. He experienced epigastric stomach pain "upon eating spicy, acidic foods," dysphagia, and diarrhea, but no constipation. He was under no current treatment for his reported heartburn which did not affect his activities of daily living. The diagnoses included GERD. On VA esophageal conditions DBQ in March 2019, the Veteran's complaints included vomiting more often and an inability to eat foods that he used to eat. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. His treatment plan included taking continuous medication (Ranitidine HCl 150 mg). He experienced dysphagia, pyrosis, reflux, and regurgitation. The diagnosis was GERD. On VA esophageal conditions DBQ in May 2021, the Veteran's complaints included continued heartburn and chest pain and reflux symptoms experienced in the middle of the night. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. His treatment plan did not include taking continuous medication. He experienced pyrosis, reflux, regurgitation, substernal arm pain, sleep disturbance caused by esophageal reflux 4 or more times per year lasting less than 1 day at a time, and nausea 4 or more times per year lasting less than 1 day at a time. His GERD did not impact his ability to work. The diagnosis was GERD. Contrary to the Veteran's lay assertions and Board hearing testimony, the record evidence shows that his service-connected GERD is manifested by, at worst, dysphagia, pyrosis, reflux, and regurgitation, substernal arm pain, and episodes of sleep disturbance or nausea which occur 4 or more times a year lasting less than 1 day at a time. These findings support the 10 percent rating currently (and initially) assigned for this disability under DC 7399-7346. Id. There is no indication, however, that he experienced persistently recurrent epigastric distress accompanied by other symptoms productive of considerable impairment of health as is required for an initial rating greater than 10 percent under this DC. Id. The Board acknowledges that he reported experiencing additional symptoms as a result of his service-connected GERD at VA examinations in March 2019 and in May 2021. The VA examiners who saw the Veteran at each of these examinations found that this disability did not interfere with his activities of daily living and did not impact his ability to work. The esophageal reflux and nausea reported at the May 2021 VA examination also lasted less than 1 day at a time although these symptoms occurred 4 or more times per year. Taken together, the record evidence as a whole does not suggest that the Veteran's service-connected GERD is productive of considerable impairment of health at any time during this appeal period as is required for an initial rating greater than 10 percent under DC 7399-7346. Id. He otherwise has not identified or submitted any evidence demonstrating his entitlement to an initial rating greater than 10 percent for his service-connected GERD. In summary, the Board finds that the criteria for an initial rating greater than 10 percent for GERD have not been met. REASONS FOR REMAND Entitlement to service connection for a disability manifested by chest pains, a right knee disability, including as due to a service-connected left knee disability, and for a bilateral eye disability, including as due to a service-connected disability, is remanded. The Veteran finally contends that he incurred a disability manifested by chest pain, a right knee disability, and a bilateral eye disability during active service and experienced continuous post-service disability. He alternatively contends that his service-connected left knee disability caused or contributed to his current right knee disability. He also alternatively contends that a service-connected disability caused or contributed to his current bilateral eye disability. The Board acknowledges that these claims have been remanded previously in March 2021. Having reviewed the record evidence, and although the Board is reluctant to contribute to "the hamster-wheel reputation of Veterans law" by remanding this appeal again, additional development is required before these underlying claims can be adjudicated on the merits. Cf. Coburn v. Nicholson, 19 Vet. App. 427, 434 (2006) (Lance, J., dissenting) (finding that repeated remands "perpetuate the hamster-wheel reputation of Veterans law"). The Board notes that a review of the record evidence shows that the Veteran complained of and sought treatment for each of these claimed disabilities in recent years. For example, the May 2021 VA knee and lower leg conditions DBQ indicated that the Veteran's right knee is damaged and he experienced right knee strain. It is unclear from a review of this examination report whether the Veteran's right knee was examined. His voluminous post-service VA outpatient treatment records also show that he complained of and sought treatment for right knee pain on multiple occasions. These records further suggest that a bilateral eye disability may be related to his service-connected hypertension. The Board notes in this regard that the threshold for providing Veterans with examinations is a low one. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Thus, the Board finds that, on remand, the Veteran should be provided with examinations which address these matters. The matters are REMANDED for the following action: 1. Conduct any appropriate development to obtain the Veteran's updated treatment records. 2. Schedule the Veteran for examination to determine the nature and etiology of his claimed disability manifested by chest pains. The claims file should be provided for review. Based on a review of the claims file and the results of the Veteran's examination, the clinician is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that a disability manifested by chest pains, if diagnosed, is related to active service. The clinician next is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's complaints of chest pains result in functional impairment. A rationale must be provided for any opinion(s) expressed. 3. Schedule the Veteran for examination to determine the nature and etiology of his claimed right knee disability. The claims file should be provided for review. Based on a review of the claims file and the results of the Veteran's examination, the clinician is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that a right knee disability, if diagnosed, is related to active service. The clinician next is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's service-connected left knee disability caused or aggravated his right knee disability. The clinician also is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's complaints of right knee pain result in functional impairment. A rationale must be provided for any opinion(s) expressed. 4. Schedule the Veteran for examination to determine the nature and etiology of his claimed bilateral eye disability. The claims file should be provided for review. Based on a review of the claims file and the results of the Veteran's examination, the clinician is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that a bilateral eye disability, if diagnosed, is related to active service. The clinician next is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's service-connected hypertension caused or aggravated a bilateral eye disability. A rationale must be provided for any opinion(s) expressed. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael T. Osborne, 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.