Citation Nr: 21073999 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 15-39 586 DATE: December 13, 2021 ORDER The appeal for entitlement to a service connection for anemia is dismissed. The appeal for entitlement to a service connection for sleep apnea is dismissed. The appeal for entitlement to a service connection for hypothyroidism is dismissed. Entitlement to a compensable disability rating prior to June 6, 2011 for right foot strain is denied. Entitlement to a separate 10 percent disability rating from August 12, 2011 for right foot arthritis is granted. Entitlement to a disability rating in excess of 30 percent from July 23, 2014 to January 9, 2020 for bilateral pes planus with metatarsalgia left foot is denied. Entitlement to a disability rating of 50 percent from January 9, 2020 for bilateral pes planus with metatarsalgia left foot is granted. Entitlement to a compensable disability rating for hypertension is denied. FINDINGS OF FACT 1. In October 2020, prior to the promulgation of a decision in the appeal, the Board received a letter from the Veteran requesting a withdrawal of her appeal for entitlement to service connection for anemia. 2. In October 2020, prior to the promulgation of a decision in the appeal, the Board received a letter from the Veteran requesting a withdrawal of her appeal for entitlement to service connection for sleep apnea. 3. In October 2020, prior to the promulgation of a decision in the appeal, the Board received a letter from the Veteran requesting a withdrawal of her appeal for entitlement to service connection for hypothyroidism. 4. Prior to June 6, 2011, the Veteran did not have a diagnosis of arthritis, and there was no evidence of moderate symptoms for the Veteran's right foot. 5. From June 6, 2011 the Veteran had a diagnosis of arthritis and pes planus but, there was no evidence of objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. 6. From July 23, 2014 to January 9, 2020 the Veteran's bilateral pes planus manifested as accentuated pain on manipulation and use, but there was no evidence of marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 7. Resolving reasonable doubt in the Veteran's favor, from January 9, 2020 the Veteran's bilateral pes planus manifested as extreme tenderness of plantar surfaces of the feet that was not improved by orthopedic shoes or appliances 8. The Veteran's hypertension did not manifest a diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or higher which required continuous medication for control. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal for entitlement to a service connection for anemia by the Veteran have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for withdrawal of the appeal for entitlement to a service connection for sleep apnea by the Veteran have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 3. The criteria for withdrawal of the appeal for entitlement to a service connection for hypothyroidism by the Veteran have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 4. The criteria for entitlement to a compensable disability rating prior to June 6, 2011 for right foot strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5284. 5. The criteria for entitlement to a separate 10 percent disability rating from August 12, 2011, for right foot arthritis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5284-5010. 6. The criteria for entitlement to a disability rating in excess of 30 percent from July 23, 2014 to January 9, 2020 for bilateral pes planus with metatarsalgia left foot have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5002-5276. 7. The criteria for entitlement to a disability rating of 50 percent from January 9, 2020 for bilateral pes planus with metatarsalgia left foot have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5002-5276. 8. The criteria for entitlement to a compensable disability rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.14, 4.21, 4.104, Diagnostic Code 7101. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Army on active duty from January 1981 to January 1984, from September 1991 to September 1998, from December 2004 to June 2005, and from April 2009 to March 2010. These matters are before the Board of Veterans' Appeals (Board) on appeal of April 2013, August 2014, and July 2017 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran originally requested a hearing. However, the Veteran no longer wants to select a hearing. See May 2020 letter, Form 9. Neither the Veteran nor his representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issues considered in this decision. 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). The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues denied in this decision. The Veteran should not assume that evidence that is not explicitly discussed in this decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). 1. The appeal for entitlement to a service connection for anemia is dismissed. 2. The appeal for entitlement to a service connection for sleep apnea is dismissed. 3. The appeal for entitlement to a service connection for hypothyroidism is dismissed. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. In the present case, the Veteran, requested the withdrawal of the claims for service connection for anemia, sleep apnea, and hypothyroidism. See October 2020 Statement in Support of Claim. Therefore, there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review the appeals for service connection for anemia, sleep apnea, and/or hypothyroidism, and the appeals are dismissed. Increased Rating Disability ratings are determined by the application of VA's Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," in all claims for increased ratings. Hart v. Mansfield, 21 Vet. App. 505, 519 (2007). The rating of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected rating, and the rating of the same manifestation under different diagnoses are to be avoided. Id.; Esteban v. Brown, 6 Vet. App. 259 (1994). 1. Entitlement to a compensable disability rating prior to June 6, 2011 for right foot strain is denied. 2. Entitlement to a separate 10 percent disability rating from August 12, 2011 for right foot arthritis is granted. 3. Entitlement to a disability rating in excess of 30 percent from July 23, 2014 to January 9, 2020 for bilateral pes planus with metatarsalgia left foot is denied. 4. Entitlement to a disability rating of 50 percent from January 9, 2020 for bilateral pes planus with metatarsalgia left foot is granted. The Veteran seeks a higher rating for her right foot disability. The Veteran was originally awarded service connection for her right and left foot strain, with a noncompensable rating, effective March 21, 2010, the day after her discharge. In the April 2013 rating decision, the RO recharacterized the Veteran's left foot strain, and changed it to metatarsalgia and awarded with a 10 percent rating, effective June 6, 2011. In the September 2015 rating decision, the RO characterized the Veteran's bilateral foot disability as, pes planus, bilateral with metatarsalgia left foot, and increased the Veteran's disability rating from 10 to 30 percent, effective July 23, 2014. The applicable rating period is from June 13, 2010, one year prior to the receipt of the claim, through the present. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994) (discussing the one-year "look-back" period for non-initial increased rating claims). The Board acknowledges that the Veteran only appealed her right foot disability. However, as her right and left foot disabilities are intertwined, the Board will evaluate both disabilities, as required. Legal Criteria Under Diagnostic Code 5284, a 10 percent rating is warranted for moderate other foot injuries. A 20 percent rating is warranted for moderately severe other foot injuries. A 30 percent rating is warranted for severe other foot injuries. A Note to Diagnostic Code 5284 instructs that with actual loss of use of the foot rate as a maximum 40 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5284. Terms such as "mild", "moderate", and "marked" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence so that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. Under Diagnostic Code 5276 a 10 percent rating is warranted for unilateral or bilateral pes planus when symptoms are moderate, with weight-bearing line over or medial to the great toe, inward bowing of the tendon achillis, and pain on manipulation and use of the feet. When the pes planus is severe, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities, a 20 percent rating is warranted for unilateral involvement, and a 30 percent rating is warranted for bilateral involvement. When the pes planus is pronounced, with marked pronation, extreme tenderness of plantar surfaces of the feet, and marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances, a 30 percent rating is warranted for unilateral involvement, and a 50 percent rating is warranted for bilateral involvement. During the pendency of the appeal, the criteria for rating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's appeal under the old criteria prior to February 7, 2021, and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. The regulatory changes reworded Diagnostic Code 5010 from "Arthritis, due to trauma, substantiated by X-ray findings" to "Post-traumatic arthritis". Prior to the regulatory change, Diagnostic Code 5010 directed that the disability be rated as degenerative arthritis under Diagnostic Code 5003. Diagnostic Code 5003 directs that a rating shall be awarded on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. If noncompensable limitation of motion is demonstrated, a 10 percent rating is assigned for each major joint or group of minor joints affected. As of February 7, 2021, under the amended criteria, Diagnostic Code 5010 directs that the disability be rated as limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with 38 C.F.R. § 4.25. Summary of the Evidence Relevant to the Increased Right Foot Disability The Veteran's treatment records indicate that she has received ongoing treatment for her feet. In October 2009, the Veteran was afforded a VA examination for her feet. The examination of the feet did not reveal any signs of abnormal weight bearing or breakdown, callosities or any unusual shoe wear pattern. The Veteran did not require any assistive devices for ambulation. The examination of the feet revealed painful motion and tenderness to palpation. The examination of the feet did not reveal edema, disturbed circulation, weakness, atrophy of the musculature, heat, redness or instability. There was active motion in the metatarsophalangeal joint of the right great toe. Alignment of the achilles tendon was normal bilaterally. There was no pes planus, no pes cavus, no hammer toes, no Morton's metatarsalgia, no hallux valgus, and no hallux rigidus. The Veteran did not have any limitation with standing or walking and she did not require any type of support with her shoes. X-rays of the feet revealed normal findings. She was diagnosed was bilateral foot strain. In August 2011, the Veteran was afforded a VA examination for her feet. The Veteran was diagnosed with metatarsalgia for the left foot, and right foot strain. The Veteran reported she had dull pain on the plantar surfaces of both feet. She stated that she thought it was due to wearing boots and jumping off trucks. She went on sick call and was placed on a limited profile. While in the Reserves she began having foot pain on the bottom of her mid-feet bilaterally. The examiner noted that the Veteran's right foot symptoms included "tenderness of arch, 1st metatarsal head, and medial dorsal," and the left foot symptoms included, "tenderness of longitudinal arch, Heel and medial dorsal foot; has dangling arch." Diagnostic testing revealed bilateral pes planus and arthritis. "Pes planus deformity with a calcaneal pitch angle of 15 degrees. Normal is 20 degrees with a range of 17-32 degrees Small plantar calcaneal spur." The examiner also noted osteoarthritic changes. The functional impact includes pain with prolonged standing and walking. In April 2013, the Veteran was afforded a VA examination for her feet. The examiner indicated that the Veteran was diagnosed with pes planus bilaterally and metatarsalgia (no foot was designated but the prior examination noted the left foot). The Veteran reported that she had mentioned having flat feet during service but did not receive any treatment. She reported that foot pain is worse with sitting, not standing or walking. She has swelling on both of her feet primarily noted with sitting. The Veteran reported pain in both feet. The Veteran's symptoms are relieved with arch supports. She has extreme tenderness of plantar surface on both feet which is improved with orthopedic shoes or appliances. The Veteran has decreased longitudinal arch height on weight-bearing on both feet. The weight-bearing line falls over or is medial to the great toe bilaterally. The Veteran's right foot has "tenderness of midline of foot, plantar surface, longitudinal arch and distal dorsal surface of foot," and "tenderness of longitudinal arch and Midline of plantar surface of foot" on the left foot. The Veteran does not have pain accentuated on use or manipulation, and there is no indication of swelling on use, or characteristic calluses. The Veteran does not have objective evidence of marked deformity of the foot (pronation, abduction). The functioning of the Veteran's feet is not so diminished that amputation with prosthesis would equally serve the Veteran. Diagnostic testing revealed that the Veteran has flat feet and arthritis bilaterally. The examiner noted that the Veteran's flat foot condition impacts her ability to work. Specifically, prolonged walking increases foot pain. She may do mild physical labor but should wear inserts in her shoes and avoid standing over one hour. In July 2014, the Veteran was afforded a VA examination for her feet. The Veteran was diagnosed with pes planus bilaterally. The Veteran reported that her feet swell, and she has pain most of the time on the ball of her feet. She describes it as little needles sticking to her. The Veteran reported that she had flare-ups that required her to get off her feet after prolonged standing. The examiner noted that the Veteran has pain in both of her feet, including during manipulation and use which accentuates the pain. The Veteran has decreased longitudinal arch height of one or both on weight-bearing. The examiner noted that there is no indication of swelling on use or characteristic calluses. The Veteran does not have extreme tenderness of plantar surfaces on one or both feet. There is no objective evidence of marked deformity of one or both feet (pronation, abduction etc.). The weight-bearing line falls over or is medial to the great toe bilaterally. There is no inward bowing of the achilles tendon. The Veteran uses inserts regularly. The examiner was asked to provide an aggravation opinion and was told that the Veteran indicated that her pes planus pre-existed service. The examiner then opined that the claimed condition, which clearly and unmistakably existed prior to service, was not aggravated beyond its natural progression by an in-service event, injury or illness. As to the rationale, the examiner explained that the STR's available do not include any notations for foot trouble. However, there were conflicting notes; the 2002 record indicated that the Veteran's arch was normal, and the 2007 report indicated that the Veteran had pes planus, but it was asymptomatic. In addition, the examiner noted that there was no enlistment physical documenting pre-existing pes planus. The examiner also indicated that the Veteran's foot strain was as likely as not secondary to her pes planus. In September 2015, VA secured an addendum opinion regarding the Veteran's right foot condition. The examiner explained that the Veteran has had foot pain that began in service and persisted through the present. The examiner indicated that foot pain can be subjective, and a definitive diagnosis can be difficult to make. The examiner further explained that foot strain was likely diagnosed because no other obvious diagnosis was present, but the pain persisted and worsened and eventually the imaging showed pes planus. The examiner opined that it is at least as likely as not that the Veteran's bilateral foot pain in October 2009 was an early manifestation of eventual pes planus, and bilateral pes planus is a progression of bilateral foot strain. In April 2019, the Veteran was afforded a VA examination for her feet. The examiner noted that the Veteran has a diagnosis of pes planus and metatarsalgia, and arthritis. The Veteran reported flare-ups that resulted in her having difficulty walking more than one block without needing rest. The Veteran has pain that is accentuated on use, but not accentuated on manipulation, and no indication of swelling or characteristic calluses. The Veteran has extreme tenderness of plantar surfaces on both feet. The tenderness is not improved by orthopedic shoes or appliances bilaterally. She does not have decreased longitudinal arch height of one or both on weight-bearing. There is no evidence of marked deformity or marked pronation. The examiner noted that for one or both feet the weight-bearing line does not fall over or medial to the great toe. There is no inward bowing of the achilles tendon and no marked inward displacement or severe spasm of the achilles tendon. The examiner noted that other contributing factors of the disability include excess fatigability, pain on movement, pain on weight-bearing, pain on non-weight-bearing, swelling, interference with standing and lack of endurance. There is pain weakness, fatigability, or incoordination that significantly limits functional ability during flare-ups or when the foot is used repeated over a period of time bilaterally. In January 2020, the Veteran was afforded a VA examination for her feet. The examiner noted that the Veteran had a diagnosis of pes planus, metatarsalgia (left foot), and arthritis. The Veteran reported that she has had bilateral foot strain since 2002, which has been mild in the past. However, the Veteran stated that she has intermittent swelling that feels like she is walking on glass. The Veteran reported her condition has become progressively worse. The Veteran reported the functional impact includes the restriction of running, walking long distances, and standing for an extended amount of time. The Veteran has pain in her feet that is accentuated by use and manipulation. There is no indication of swelling or characteristic calluses. The examiner noted that the Veteran has extreme tenderness of plantar surfaces of both feet that is no longer improved by orthopedic shoes or appliances. She has no decreased longitudinal arch height or objective evidence of deformity or marked pronation. The examiner noted that the Veteran's weight-bearing line does not fall over or medial to the great toe. She does not have inward bowing of the achilles tendon or inward displacement and severe spasm of the achilles tendon. The examiner noted that other contributing factors of the disability include excess fatigability, pain on movement, pain on weight-bearing, pain on non-weight-bearing, and lack of endurance. The examiner noted that there is pain weakness, fatigability, or incoordination that significantly limits functional ability during flare-ups or when the foot is used repeated over a period of time bilaterally. In October 2020, the Veteran was afforded a VA examination for her feet. The examiner noted that the Veteran has a diagnosis of pes planus and metatarsalgia, and arthritis. The Veteran reported pain on the plantar surface of feet with weight bearing, but at times without weightbearing for both feet. The Veteran reported that during flare-ups there is increased plantar pain and noticeable swelling, two times a week, with moderate severity. She reported, "reduced propulsion and difficulty in standing 30 minutes or more. cannot do any impact activities," bilaterally. The examiner noted that the Veteran has pain bilaterally that is accentuated with use, and on manipulation, but no swelling on use or characteristic calluses. The Veteran has extreme tenderness of plantar surfaces on both feet and has longitudinal arch height of one or both on weight-bearing bilaterally. The tenderness is improved by orthopedic shoes or appliances, the Veteran uses arch supports. There is no evidence of marked deformity of one or both feet (pronation, abduction etc.). The weight-bearing line does not fall over or medial to the great toe. There is no inward bowing of the achilles tendon and no marked inward displacement or severe spasm of the achilles tendon. The Veteran's arthritis is moderate bilaterally. The examiner noted that other contributing factors of the disability include excess fatigability, pain on movement, pain on weight-bearing, pain on non-weight-bearing, and lack of endurance. There is pain on weakness, fatigability, or incoordination that significantly limits functional ability during flare-ups or when the foot is used repeated over a period of time bilaterally. The Veteran cannot stand for 30 minutes or more or walk for 30 or more minutes. Prior to June 6, 2011 for right foot strain The Veteran's right foot strain was initially rated under Diagnostic Code 5284. During the October 2009 VA examination, the Veteran's symptoms were mild. The Board acknowledges that the Veteran had painful motion and tenderness to palpation. However, the Veteran did not have any limitation with standing or walking and she did not require any type of support with her shoes. The x-rays of her feet revealed normal findings. The examination of the feet did not reveal any signs of abnormal weight bearing or breakdown, callosities or any unusual shoe wear pattern. The Board finds that there is no evidence in the record prior to June 6, 2011, that warrants a compensable rating. The Board considered 38 C.F.R. § 4.59, but there is no evidence that the Veteran had arthritis. The Board also considered whether Diagnostic Code 5284 would allow a compensable rating. The Board acknowledges that the October 2009 examination of the feet revealed painful motion and tenderness to palpation. However, the evidence also revealed that Veteran did not have any limitation with standing or walking and she did not require any type of support with her shoes. Finally, the Board considered Diagnostic Code 5276, and while the Veteran's service treatment records indicated that the Veteran had pes planus, the condition was asymptomatic during service, and through the October 2009 VA examination. The Veteran may have used arch supports during service, but there was no evidence of moderate symptoms including: weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral. Thus, the Board finds that the preponderance of the evidence is against finding that a compensable rating is warranted prior to June 6, 2011 for the right foot. From June 6, 2011 to July 23, 2014 for right foot disability In the June 6, 2011 rating decision, the RO recharacterized the Veteran's left foot strain, and changed it to metatarsalgia and awarded the Veteran with a 10 percent rating, as the earliest date that the Veteran was diagnosed with metatarsalgia. The Board notes that the Veteran's right foot disability was characterized as a right foot strain from March 21, 2010 to August 10, 2011, until the September 2015 rating decision. At that point, the RO included an ending date of August 10, 2011 for the Veteran's right foot strain disability, and recharacterized the Veteran's bilateral foot disability as, pes planus, bilateral with metatarsalgia left foot, and increased the Veteran's disability rating from 10 to 30 percent, effective July 23, 2014. The Board finds that as of August 12, 2011, the Veteran had a diagnosis of bilateral arthritis in both of her feet, and a 10 percent rating is warranted for the Veteran's right foot disability under Diagnostic Code 5010, utilizing the pre-February 7, 2021 criteria, as the Veteran had a diagnosis of arthritis, and had pain in her right foot. The Board considered Diagnostic Code 5284 but determined that the Veteran's symptoms would be considered moderate. Specifically, the Board acknowledges that the Veteran reported that she had foot pain that was worse when she was sitting than standing, and her feet swelled up, but her symptoms were relieved with arch supports. The Board also considered Diagnostic Code 5276 and acknowledges that the Veteran had extreme tenderness of plantar surface on both feet, but they were improved with orthopedic shoes. The Board also notes that the Veteran had decreased longitudinal arch height on weight-bearing on both feet. The weight-bearing line falls over or is medial to the great toe bilaterally. The Veteran's right foot has "tenderness of midline of foot, plantar surface, longitudinal arch and distal dorsal surface of foot." These symptoms most closely approximate a 10 percent rating, and the Veteran would be better off receiving a separate 10 percent rating under Diagnostic Code 5010 for her right foot, and Diagnostic Code 5279 for her left foot. The Board notes, that there is no evidence in the record that demonstrates that the Veteran had severe symptoms including, objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities prior to July 23, 2014, and thus a rating under 5276 for both feet would not afford the Veteran with a higher rating, as the Veteran would only receive a single 10 percent rating. Thus, the Board finds a separate 10 percent rating is warranted for the Veteran's right foot disability under Diagnostic Code 5010 for arthritis. Cf. Butts v. Brown, 5 Vet. App. 532 (1993) (stating that the Board may choose the diagnostic code to apply provided the choice is supported by reasons and bases, as well as the evidence); see also 38 C.F.R. § 4.20. From July 23, 2014 to January 9, 2020 for bilateral pes planus with metatarsalgia left foot From January 9, 2020 for bilateral pes planus with metatarsalgia left foot In the September 2015 rating decision, the RO characterized the Veteran's bilateral foot disability as, pes planus, bilateral with metatarsalgia left foot, and increased the Veteran's disability rating from 10 to 30 percent, effective July 23, 2014. The Board notes that the RO used the Diagnostic Code 5002-5276. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. In this case, the use of Diagnostic Code 5002-5276 reflects that the condition is rated under Diagnostic Code 5002, which pertains to multi-joint arthritis, with reference to Diagnostic Code 5276, which pertains to flatfoot. Both multi-joint arthritis and flatfoot are rated under the musculoskeletal system. As of July 23, 2014, the Board finds that rating the Veteran's condition under Diagnostic Code 5276 is more appropriate because the Veteran would receive the highest rating. As discussed above, prior to July 23, 2014 the Veteran is receiving a 10 percent rating for her right foot under Diagnostic Code 5010, and a 10 percent rating for her left foot under Diagnostic Code 5279. The Veteran would have received a lower rating under Diagnostic Code 5276 and could not receive a separate rating because of pyramiding. However, as of July 23, 2014 the Veteran was entitled to a 30 percent rating under Diagnostic Code 5276, which results in a higher rating than two separate 10 percent ratings. The July 2014 VA examiner noted that the Veteran had pain in both of her feet, including during manipulation and use which accentuates the pain. The Veteran has decreased longitudinal arch height of one or both on weight-bearing. The Veteran's condition was improved by orthopedic shoes or appliances. The April 2019 VA examiner indicated that the Veteran had extreme tenderness of plantar surfaces on both feet, that was not improved by orthopedic shoes or appliances bilaterally. The Veteran has pain that was accentuated on use, but not accentuated on manipulation, and no indication of swelling or characteristic calluses. The January 2020 VA examiner noted that the Veteran stated that she has intermittent swelling that feels like she is walking on glass. The examiner noted that the Veteran has extreme tenderness of plantar surfaces of both feet that is no longer improved by orthopedic shoes or appliances. The Veteran has pain in her feet that is accentuated by use and manipulation. The October 2020 VA examiner indicated that the Veteran had extreme tenderness of plantar surfaces on both feet and had longitudinal arch height of one or both on weight-bearing bilaterally. The examiner noted that the Veteran has pain bilaterally that is accentuated with use, and on manipulation, but no swelling on use or characteristic calluses. The tenderness is not improved by orthopedic shoes or appliances, the Veteran uses arch supports. The Board finds that at no time during the appeal period that the Veteran's symptoms show that she had marked pronation or marked inward displacement and severe spasm of the tendo achillis on manipulation. However, the Veteran's records demonstrate that she has extreme tenderness of plantar surfaces of the feet, and every other examination indicates that her condition is not improved by orthopedic shoes or appliances. The Board also notes that the Veteran has been diagnosed with rheumatoid arthritis. Resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran's foot disability most closely approximates a 50 percent rating from January 9, 2020 because at that time the Veteran's symptoms include the extreme tenderness of plantar surfaces of the feet, and the Veteran's condition is not improved by orthopedic shoes or appliances. While the examinations have not revealed swelling, the Board finds the Veteran credible in describing symptoms such as swelling, as it is observable by a layperson. The Board considered an earlier effective date because the April 2019 VA examination indicated that the Veteran had extreme tenderness that was not improved by orthopedic shoes or appliances, however this examination also indicated that the Veteran's pain was not accentuated during both use and manipulation. Thus, the Board determined that while the Veteran's condition did not meet all of the criteria for the 50 percent rating, that resolving reasonable doubt in the Veteran's favor her condition has worsened, and that the 50 percent rating is more appropriate as of January 9, 2020. In summary, the Board finds that the preponderance of the evidence is against finding that a compensable rating is warranted prior to August 12, 2011 for the right foot. The Board finds that as of August 12, 2011, the Veteran had a diagnosis of arthritis, and a separate 10 percent rating is warranted for the Veteran's right foot disability under Diagnostic Code 5010. The Board finds that the preponderance of the evidence is against finding a rating in excess of 30 percent from July 23, 2014 to January 9, 2020. Finally, the Board finds that resolving reasonable doubt in the Veteran's favor a 50 percent rating and no higher is warranted from January 9, 2020. 5. Entitlement to a compensable disability rating for hypertension The Veteran seeks a compensable rating for her hypertension disability. The applicable rating period is from April 25, 2016, one year prior to the receipt of the claim, through the present. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994) (discussing the one-year "look-back" period for non-initial increased rating claims). The Veteran's hypertension is rated under 38 C.F.R. § 4.104, Diagnostic Code 7101. Under Diagnostic Code 7101, which relates to hypertensive vascular disease, hypertension, and isolated systolic hypertension, a 10 percent rating is warranted when there is diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; when the individual has a history of diastolic pressure predominantly 100 or more and requires continuous medication for control. A 20 percent rating is warranted when there is diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more. A 40 percent is warranted when there is diastolic pressure predominantly 120 or more. A maximum 60 percent rating is warranted when there is diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101. Although there are no provisions for a noncompensable rating for hypertension, in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. Following a thorough review of the evidence, the Board finds that the criteria for a compensable disability rating for hypertension have not been met. The Veteran's private treatment records from August 2015 to September 2017 show that the Veteran's highest diastolic pressure was 88 and highest systolic pressure was 148. The Veteran's VA treatment records from April 2018 through July 2018 show that the Veteran's highest diastolic pressure was 96, and highest systolic pressure was 147, with an average of a diastolic pressure of 81 and a systolic of 128. Thus, while this does not include every blood pressure reading, the Veteran's treatment records included diastolic pressures below 100 and systolic pressures below 160. In June 2017, the Veteran was afforded a VA examination for hypertension. The examiner indicated that the Veteran's treatment plan included taking continuous medication for hypertension or isolated hypertension. However, the Veteran does not have a history of a diastolic BP elevation to predominantly 100 or more. The Veteran's blood pressure readings were reported as 122/90 on all three readings. In August 2017, the Veteran's blood pressure readings were reported as 132/90, 132/89 and 132/89. In October 2018, the Veteran submitted a correspondence indicating that in 2010 she was taken to the ER for dizziness and was told that her blood pressure was high, and they needed to get it down asap. She was given medication and was "flipped upside down" for about an hour. She indicated that she is on three blood pressure medications now. In April 2019, the Veteran was afforded a VA examination for hypertension. The examiner indicated that the Veteran's treatment plan included taking continuous medication for hypertension or isolated hypertension. However, the Veteran does not have a history of a diastolic BP elevation to predominantly 100 or more. The Veteran's blood pressure readings were reported as 140/88. 142/90 and 138/84. The average blood pressure reading was 140/87. In regard to the Veteran's contention that without continuous medication, her hypertension would elevate to higher levels such that a higher rating would be warranted, the Board acknowledges that it may not consider the effects of relief provided by medication when those effects are not specifically contemplated by the rating criteria. See Jones v. Shinseki, 26 Vet. App. 56, 62-63 (2012). However, in the case of hypertension, Diagnostic Code 7101 expressly contemplates the effects of medication as a factor to be considered when rating the condition. See McCarroll v. McDonald, 28 Vet. App. 267, 271-73 (2016) (holding that Jones does not apply to Diagnostic Code 7101). Accordingly, the ameliorative effects of the Veteran's hypertension medications are for consideration in rating the condition, and a higher rating may not be awarded based on the expected severity of the condition if those ameliorative effects were not considered. Thus, while the Board acknowledges that the Veteran takes medication to control her hypertension, there is no evidence that the Veteran has a current or past history of diastolic pressure predominantly 100 or more. Further, there is no evidence throughout the appeal period that the Veteran's systolic pressure has been predominantly 160 or more. Absent a current or past history of diastolic pressure predominantly 100 or more or current systolic pressure predominantly 160 or more, a compensable rating is not warranted. 38 C.F.R. § 4.104, Diagnostic Code 7101 In summary, although the Veteran is on continuous medication for her hypertension, the evidence of record does not show a history of diastolic pressure predominantly of 100 or greater. As the preponderance of the evidence is against the assignment of a compensable rating, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Quist Associate 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.