Citation Nr: 21072771 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 16-02 430 DATE: December 6, 2021 ORDER Entitlement to an evaluation in excess of 30 percent for migraine headaches is denied. Entitlement to an evaluation in excess of 20 percent for lumbar degenerative disc disease (previously rated as lumbosacral strain) is denied. FINDINGS OF FACT 1. The Veteran's migraine headaches are not manifested by frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 2. The Veteran does not have forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 30 percent for migraine headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.124a, Diagnostic Code 8100. 2. The criteria for an evaluation in excess of 20 percent for lumbar degenerative disc disease 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 Codes 5242-5237. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1993 to May 1996. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In that decision, the agency of original jurisdiction (AOJ) increased the evaluation for the migraine headaches to 30 percent and the lumbar spine disability to 20 percent (reclassifying it under Diagnostic Codes 5242-5237) effective from the date of the claim for an increased evaluation. In an August 2017 written statement, the Veteran withdrew other issues that had been on appeal, as acknowledged in a July 2018 AOJ letter. The Veteran also perfected an appeal as to claims for service connection for posttraumatic stress disorder (PTSD) and depression, which were granted with an adjusted effective date in July 2018 rating decisions; the Veteran did not express disagreement with those determinations. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997). A hearing was held before the undersigned Veterans Law Judge in August 2018. A transcript of the hearing is of record. The Board remanded the case for further development in March 2019. While the case was in remand status, the AOJ granted service connection for left and right lower extremity radiculopathy of the femoral and sciatic nerves as secondary to the lumbar spine disability in an April 2019 rating decision. The Veteran did not express disagreement with those determinations. See Grantham, supra. In June 2020, the Board remanded the case again for additional development. That development was completed, and the case has since been returned to the Board for appellate review. Law and Analysis Initially, the Board notes that additional evidence was received by VA following the issuance of the November 2020 and December 2020 supplemental statements of the case (SSOC) for the appeal herein. Specifically, such additional evidence consists of VA treatment records and an August 2021 VA examination for PTSD. The Veteran did not waive review by the AOJ of this additional evidence. See 38 C.F.R. § 20.1304(c). However, if new evidence is submitted with or after a substantive appeal received on or after February 2, 2013, then it is subject to initial review by the Board unless the Veteran explicitly requests AOJ consideration. Here, although the Veteran's substantive appeal was filed after February 2, 2013, specifically in January 2016, the Board note that the automatic waiver provision applies only to evidence submitted by the Veteran. The record does not reflect that the additional evidence was submitted by the Veteran. Nevertheless, the November 2020 SSOC explicitly referenced review of the Veteran's VA treatment records from the Houston, Texas, VA Medical Center (VAMC) through November 6, 2020. Thus, the only new VA treatment records obtained in March 2021 are the records subsequently dated after November 2020, and those additional VA treatment records and the August 2021 PTSD examination, are either not relevant or duplicative of the previously obtained evidence. In fact, the most recent VA treatment records pertain to a laryngoscopy and maxillary osteotomy and are not relevant the issues before the Board. Thus, there is no prejudice to the Veteran in proceeding with appellate review. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). Neither the Veteran nor her representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where a veteran appeals the denial of a claim for an increased disability rating for a disability for which service connection was in effect before he filed the claim for increase, the present level of the veteran's disability is the primary concern, and past medical reports should not be given precedence over current medical findings. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994). However, where VA's adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or "staged" ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all of these elements. In evaluating 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. Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of "the normal working movements of the body," such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. See Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011). 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. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Migraine Headaches The Veteran is currently assigned a 30 percent evaluation for migraine headaches, pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100. Under Diagnostic Code 8100, a 30 percent rating is assigned for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. The maximum 50 percent rating under Diagnostic Code 8100 is warranted for very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability. The Rating Schedule does not define "prostrating." However, "prostration" has been defined as "complete physical or mental exhaustion." Merriam-Webster's New Collegiate Dictionary 999 (11th ed. 2007). "Prostration" has also been defined as "extreme exhaustion or powerlessness." Dorland's Illustrated Medical Dictionary 1554 (31st ed. 2007). According to Stedman's Medical Dictionary, 27th Edition (2000), p. 1461, "prostration" is defined as "a marked loss of strength, as in exhaustion." See, e.g., Eady v. Shinseki, No. 11-3223, 2013 WL 500460 (Vet. App. Feb. 12, 2013). Additionally, the terms "productive of severe economic inadaptability" have not been clearly defined by regulations or by case law. The Court has noted that "productive of" can either have the meaning of "producing" or "capable of producing." Pierce v. Principi, 18 Vet. App. 440, 445 (2004). Thus, migraines need not actually "produce" severe economic inadaptability to warrant the 50 percent rating. Id. at 445-46. Further, "economic inadaptability" does not mean unemployability, as such would undermine the purpose of regulations pertaining to TDIU. Id. at 446; see also 38 C.F.R. § 4.16. The Board notes, however, that the migraines must be, at a minimum, capable of producing "severe" economic inadaptability. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to an increased evaluation for her service-connected migraine headaches. As set forth above, the applicable rating criteria link ratings for migraine headaches to two elements: severity and frequency. As to frequency, during a December 2013 VA headaches examination, the Veteran reported experiencing intermittent headaches. She indicated that the duration of her typical head pain was one to two days and that she averaged prostrating attacks of migraine headache pain more frequently than once per month. During a December 2019 VA examination, the Veteran reported having headaches usually five to seven times per week lasting two or three hours. The examiner indicated that she had characteristic prostrating attacks of migraine headache pain more frequently than once per month. Regarding the severity of the headaches, during the December 2013 VA examination, the Veteran reported that symptoms included pulsating or throbbing head pain, pain on both sides of the head, and pain worse with physical activity. Non-headaches symptoms included nausea, vomiting, light and sound sensitivity, changes in vision, and sensory changes. She also having reported very frequent prostrating and prolonged attacks of migraine headache pain. There were no other pertinent physical findings, signs, or symptoms related to her headaches. The functional impact was described as decreased concentration with headaches. In addition, during the December 2019 VA examination, the Veteran's symptoms were reported as pulsating or throbbing head pain, pain on both sides of the head, and pain worse with physical activity. She also experienced non-headache symptoms associated with headaches, which were described as light and sound sensitivity. There were no other pertinent findings or symptoms. The Veteran stated that her headaches can cause incapacity approximately three times per month. The December 2019 examiner noted that her headaches were stable and did not appear to be worsening. The functional impact of her headache disability was described as "symptoms can cause poor concentration on specific work activities which can reduce work productivity...." However, the examiner indicated that the Veteran did not have very prostrating and prolonged attacks of migraines productive of severe economic inadaptability. The Board finds that a rating in excess of 30 percent is not warranted for migraine headaches under Diagnostic Code 8100. There is evidence that the Veteran had frequent migraines and that they are prostrating at times. However, the evidence does not show that the Veteran's migraines have been productive of severe economic inadaptability. The VA treatment records document complaints of headaches with nausea/vomiting, light and sound sensitivity, causing difficulty sleeping. See, e.g., October 2012 and August 2013 VA treatment records. The December 2013 VA examiner found that the Veteran had very frequent prostrating and prolonged attacks of migraine headache pain, but did not indicate that they were productive of severe economic inadaptability. That examiner only stated that her headaches would cause decreased concentration. The December 2019 VA examiner also found that, during migraine headaches, the Veteran could have poor concentration on specific work activities, reducing work productivity. Although that examiner found that she had characteristic prostrating attacks of migraine headache pain more frequently than once per month, he also stated that the Veteran did not have very prostrating and prolonged attacks of migraines productive of severe economic inadaptability. During the August 2018 hearing, the Veteran testified that her migraine headaches "are making it difficult to work, and I've missed a lot of work." She was given the opportunity to submit documentation showing how much work she missed due to migraine headaches, but did not provide such evidence. The Veteran also testified that she had been working for the same employer for five years and had never had disciplinary action due to the disability, including the need to take leave. During a March 2019 VA examination for PTSD, the Veteran stated that she loves her work as a veterans' advocate, but often has to leave work early due to migraines. In March 2020, she reported that she was in the process of being equipped to work from home and believed she would be able to successfully maintain employment during the Covid-19 pandemic. In July 2020, she also reported working from home and indicated that the home environment was tense, but improving. See March 2020 and July 2020 VA treatment records. Thus, while the Veteran's migraine headaches have caused some functional impairment, the record as a whole does not demonstrate that they have caused severe economic inadaptability. Based on the foregoing, there is insufficient evidence to show that the Veteran's migraines are of such frequency and severity to meet the criteria for a rating in excess of 30 percent under Diagnostic Code 8100. In particular, the record does not demonstrate that her migraine headaches were productive of severe economic inadaptability. The Bord concludes that the preponderance of the evidence is against a finding of entitlement to an evaluation in excess of 30 percent for the Veteran's migraine headaches. As the preponderance of the evidence is against the award of an increased evaluation, the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Lumbar Degenerative Disc Disease The Veteran is currently assigned a 20 percent evaluation for lumbar degenerative disc disease, pursuant to 38 C.F.R. § 4.71a, Diagnostic Codes 5242-5237. Diagnostic Code 5237 indicates that a lumbosacral strain should be evaluated under either the General Rating Formula for Diseases and Injuries to the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation. Diagnostic Code 5242 states that degenerative arthritis of the spine should be evaluated under the General Rating Formula for Diseases and Injuries to the Spine (General Rating Formula). Under the General Rating Formula, with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, a 20 percent evaluation is contemplated when there is forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is assigned for unfavorable ankylosis of the entire thoracolumbar spine, and a 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a , General Rating Formula for Diagnostic Codes 5235-5243. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be rated separately, under an appropriate diagnostic code. 38 C.F.R. § 4.71a , General Rating Formula, Note (1). For VA compensation purposes, normal range of motion for the thoracolumbar spine is 90 degrees of forward flexion, 30 degrees of extension, 30 degrees of left and right lateral flexion, and 30 degrees of left and right lateral rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees, consisting of the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right lateral rotation. See 38 C.F.R. § 4.71a , General Rating Formula, Note (2) and Plate V. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 20 percent evaluation is contemplated for incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent evaluation is warranted for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent evaluation is assigned for incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (1). If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of chronic orthopedic and neurologic manifestations or incapacitating episodes, whichever method results in a higher evaluation for that segment. Id., Note (2). The Board notes that, 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. 85 Fed. Reg. 230 (Nov 30, 2020). 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); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). 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, and the criteria that are more favorable to the Veteran will be applied. Effective February 7, 2021, Diagnostic Code 5242 provides that Diagnostic Codes 5003 and 5010 should also be considered for degenerative arthritis and degenerative disc disease other than intervertebral disc syndrome (IVDS). Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76462 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5242). The rating criteria under the general rating formula remained unchanged. The revised criteria also state that Diagnostic Code 5243 should only be applied when there is disc herniation with compression and/or irritation of the adjacent nerve root and that Diagnostic Code 5242 should be considered for all other disc diagnoses. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to an increased evaluation for lumbar degenerative disc disease. The evidence does not show that the Veteran has forward flexion of the thoracolumbar spine limited to 30 degrees or less. In fact, an October 2013 chiropractic record documented lumbar flexion to 50 degrees with pain, and in March 2014, it was noted that her range of motion in the thoracic and lumbar regions had improved. A December 2013 VA examination report also shows that the initial range of motion test revealed 40 degrees of forward flexion, and there was no additional limitation in range of motion following repetitive-use testing. A January 2016 private physical therapy record noted full range of motion of the lumbar spine with pain on movement. A February 2019 VA examination further found the Veteran to have forward flexion to 80 degrees, and passive and active range of motion were the same. There was no additional loss of function or range of motion after three repetitions. A December 2019 VA examination again found the Veteran to have 80 degrees of forward flexion during both active and passive range of motion testing. The examiner indicated that there was no additional loss of function or range of motion after three repetitions and commented that, although, repeated use over time would cause pain, there would be no appreciable change in range of motion. The evidence also does not show that the Veteran has favorable ankylosis of the entire thoracolumbar spine. Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, surgical procedure." Lewis v. Derwinski, 3 Vet. App. 259 (1992) (internal medical dictionary citation omitted). Based on the aforementioned range of motion findings, the record shows that the Veteran's thoracolumbar spine is not fixated or immobile. Moreover, the February 2019 and December 2019 VA examiners specifically stated that there was no ankylosis of the spine. In addition, the Board notes that the Veteran has been assigned a 20 percent rating for her lumbar spine disability, which contemplates painful motion. There is no x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. In addition, evaluations for arthritis based on x-ray findings cannot be combined with ratings based on limitation of motion. 38 C.F.R. § 4.71a , Diagnostic Code 5003, Note 1. Thus, a separate or higher evaluation is not warranted under Diagnostic Codes 5003 and 5010. The Board has also considered whether the Veteran is entitled to an evaluation in excess of 20 percent under the rating criteria for evaluating intervertebral disc syndrome (IVDS). However, in this case, the Board finds that the criteria have not been met. In this regard, there is no indication that the Veteran has IVDS with incapacitating episodes having a total duration of at least 4 weeks during the past 12 months. In fact, the December 2013, February 2019, and December 2019 VA examiners noted that the Veteran did not have IVDS of the thoracolumbar spine. Thus, the Board finds that an increased evaluation is not warranted under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. See 38 C.F.R. § 4.71a, Diagnostic Code 5243. The Board further finds that a separate disability rating is not warranted at any time during the appeal period because the evidence does not demonstrate that the Veteran suffers from a separate neurological disability distinct from her already service-connected lumbar spine disability and radiculopathy of the right and left lower extremities. See Bierman v. Brown, 6 Vet. App. 125, at 129-32 (1994). Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not "duplicative of or overlapping with the symptomatology" of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). In fact, the December 2013, February 2019, and December 2019 VA examiners indicated that the Veteran does not have any other neurologic abnormalities or findings related to her service-connected disability (such as bowel or bladder problems/pathologic reflexes). The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. However, an increased evaluation for the Veteran's lumbar spine disability is not warranted on the basis of functional loss due to pain or weakness in this case, as the Veteran's symptoms are supported by pathology consistent with the assigned 20 percent evaluation, and no higher. In this regard, the Board observes that the Veteran complained of pain on numerous occasions. However, the effect of the pain in the Veteran's lumbar spine is contemplated in the currently assigned evaluation. The Veteran's complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant an increased evaluation. As set forth above, none of the VA examiners found additional loss of function or range of motion with repetitive use. The Board does acknowledge the December 2013 VA examiner's estimation that, during pain on use or flare-ups, the Veteran's forward flexion decreased approximately 10 degrees. However, there was no indication as to how frequently or how long such a decrease would occur. Thus, it is unclear as to how often the Veteran would experience such a decrease or whether it occurred during a significant period of time to more closely approximate the criteria for a higher evaluation. Moreover, in providing the estimation, the examiner stated that there is additional limitation of functional ability of the thoracolumbar spine during flare-ups or repeated use over time, yet as noted above, there was no additional limitation of motion after repetitive-use testing during that examination, and the examiner indicated that there was objective evidence of pain beginning only at 40 degrees of forward flexion during initial range of motion testing and repetitive-use testing. Thus, the December 2013 VA examination findings appear to be internally consistent, and the estimation appears to be based on speculation. In addition, an October 2013 chiropractic record documented lumbar flexion to 50 degrees even with pain shortly prior to the December 2013 VA examination, and a January 2016 private physical therapy record later noted full range of motion of the lumbar spine with pain on movement. The Veteran also later denied having any flare-ups during the February 2019 and December 2019 VA examinations, despite her reports of worsening since the December 2013 VA examination. For these reasons, the December 2013 VA examiner's estimation regarding a decrease with pain on use and during flare-ups appears to be speculative and inconsistent with the other evidence of record, including his other findings in the report itself. It is also inadequate to assess how often such a decrease would occur. The Board finds that the preponderance of the evidence weighs against a finding that the Veteran more nearly approximates forward flexion limited to 30 degrees or less or ankylosis. Accordingly, the Board concludes that a higher evaluation is not warranted for the Veteran's service-connected disability under DeLuca. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (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). J.W. ZISSIMOS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.S. Chilcote 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.