Citation Nr: 21074173 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 19-13 313 DATE: December 14, 2021 ORDER Entitlement to an initial rating in excess of 30 percent for coronary artery disease is denied. Entitlement to an initial rating in excess of 10 percent prior to February 19, 2021, and a rating of 20 percent thereafter for lumbar degenerative disc disease is denied. REMANDED Entitlement to an initial compensable rating for right eye hyperphoria is remanded. Entitlement to service connection for a pulmonary disorder is remanded. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran's coronary artery disease manifested as METS greater than 5 but not greater than 7 resulting in dyspnea and fatigue, and without more than one episode of acute congestive heart failure in the past year, or; workload of greater than three METs but not greater than five METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; LVEF of 30 to 50 percent. 2. For the appeal period prior to February 19, 2019, the Veteran's lumbar degenerative disc disease was manifested by, at worst, forward flexion of the thoracolumbar spine to 70 degrees and a combined range of motion of 180 degrees even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, IVDS requiring medically prescribed bedrest, associated objective neurological abnormalities or ankylosis of the spine. 3. Beginning February 19, 2019, the Veteran's lumbar degenerative disc disease was manifested by, at worst, forward flexion of the thoracolumbar spine to 50 degrees and a combined range of motion of 115 degrees even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, IVDS requiring medically prescribed bedrest, associated objective neurological abnormalities or ankylosis of the spine. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 30 percent for coronary artery disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.104, Diagnostic Code 7005. 2. The criteria for an initial rating in excess of 10 percent for prior February 19, 2021, in excess of 20 percent thereafter, for lumbar degenerative disc disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237-5242. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from June 1957 to June 1978. These matters come to the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction of this appeal is currently with the RO in Newark, New Jersey. This case was most recently before the Board in November 2020, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. The case has now been returned to the Board for appellate action. In addition, in an October 2021 rating decision, the AOJ granted an increased rating for the Veteran's lumbar degenerative disc disease, and assigned a 20 percent disability rating effective February 19, 2021. However, as this does not represent a full grant of the benefits sought on appeal, the claim remains before the Board, and the Board has reframed the issue to reflect the rating increase. Increased Rating Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 50910 (2007). The Veteran's entire history is considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A review of the recorded history of a disability is necessary to make an accurate rating. 38 C.F.R. §§ 4.2, 4.41. The regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue. Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran's service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The assignment of a particular diagnostic code is dependent on the facts of a particular case. See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis, and demonstrated symptomatology. In reviewing the claim for a higher rating, the Board must consider which diagnostic code or codes are most appropriate for application in the veteran's case and provide an explanation for the conclusion. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claims. The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Coronary Artery Disease The Veteran asserts that he is entitled to a higher rating for his coronary artery disease as his symptoms are worse than those contemplated by the currently assigned ratings. Specifically, the Veteran testified that his heart symptoms include being easily fatigued, difficulty using stairs, swelling, limited physical activity, controlled diet, continuing private treatment, and taking heart medications. See Board hearing transcript, July 21, 2020. During the period on appeal, the Veteran's coronary artery disease is assigned a 30 percent rating under 38 C.F.R. § 4.104, Diagnostic Code 7005, which contemplates arteriosclerotic heart disease. Pursuant to Diagnostic Code 7005, a 10 percent rating is assigned for a workload of greater than seven METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication is required. A 30 percent rating is warranted for a workload of greater than five METs but not greater than seven METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. A 60 percent rating is warranted for more than one episode of acute congestive heart failure in the past year, or; workload of greater than three METs but not greater than five METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; LVEF of 30 to 50 percent. Finally, a 100 percent rating is justified for chronic congestive heart failure, or; workload of three METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; LVEF of less than 30 percent. 38 C.F.R. § 4.104, Diagnostic Code 7005. Diagnostic Code 7006 provides the same rating criteria as Diagnostic Code 7005, except that it recognizes a history of documented myocardial infarction and provides for a 100 percent rating during and for three months following a myocardial infarction, documented by laboratory tests. 38 C.F.R. § 4.104, Diagnostic Code 7006. For rating diseases of the heart, one MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. 38 C.F.R. § 4.104, Note 2. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 38 C.F.R. § 4.104, Note (2). Turning to the evidence, the Veteran was afforded a VA examination in May 2016. At that time, the examiner diagnosed coronary artery disease. The examiner noted that continuous medication was required to control the Veteran's heart condition. The examiner reported that the Veteran had never experienced a myocardial infarction, congestive heart failure, arrhythmia, an infectious heart condition, pericardial adhesions, or a health valve condition. The examiner commented that the Veteran did not have any nonsurgical or surgical procedures for his coronary artery disease; the Veteran had not been hospitalized to treat his coronary artery disease. On examination, heart rate, sound and rhythm were normal. There was no evidence that the Veteran experienced cardiac hypertrophy or cardiac dilation. Echocardiogram showed normal wall motion and normal wall thickness. Coronary artery angiogram showed 100 percent stenosis of the right coronary artery with good collaterals. Interview based METs testing was performed as exercise stress testing was contraindicated. Based on the Veteran's reports, the examiner indicated that his METs level was greater than 5 but not greater than 7 accompanied by dyspnea and fatigue. The examiner reported that the Veteran's heart condition did not impact his ability to work. A review of the record shows that the Veteran receives treatment at the VA Medical Center and from private treatment providers for various disabilities. However, there is no indication from the record that his coronary artery disease symptoms are manifestly different than those reported at the above-mentioned VA examination. Based on the evidence of record, lay and medical, the Board finds that the Veteran's coronary artery disease does not warrant a higher than the initial 30 percent rating currently assigned. In this regard, the May 2016 VA examiner indicated that the Veteran had METS greater than 5 but not greater than 7 resulting in dyspnea and fatigue. The Board affords the Veteran the benefit of the doubt with regard to his symptomatology, as the record shows that the Veteran's heart condition resulted in dyspnea, fatigue, difficulty with physical exertion, and continuous treatment with medication. However, the evidence simply does not show that the Veteran's coronary artery disease resulted in more than one episode of acute congestive heart failure in the past year, or; workload of greater than three METs but not greater than five METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; LVEF of 30 to 50 percent. Rather, the Veteran was not shown to have any episode of acute congestive heart failure, and his physical limitations are described above. Therefore, a 30 percent rating is warranted for the entire period on appeal for the Veteran's coronary artery disease. 38 C.F.R. § 4.104, Diagnostic Code 7005. The Board acknowledges the Veteran's statements that his coronary artery disease is more severe than evaluated. The Veteran is competent to report his symptoms and has presented credible statements in this regard. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board finds, however, that neither the Veteran's statements nor medical evidence demonstrates that the criteria for a rating in excess of 30 percent have been met. The Board also acknowledges that the Veteran's VA treatment records note complaints of and treatment for his coronary artery disease. However, these records do not address the specific rating criteria necessary to determine severity. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. The Board has also considered whether staged ratings under Hart, supra, is appropriate for the Veteran's coronary artery disease. However, the Board finds that his symptomatology has been stable throughout the period on appeal. Therefore, assigning staged ratings for his coronary artery disease is not warranted. Further, the Veteran and his representative have not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to such claim. 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). Additionally, the Board has considered whether an inferred claim for a TDIU has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran's current employment status is unknown. The Veteran has also not alleged, and the record does not suggest, that he is unable to obtain and maintain employment due solely to his service connected coronary artery disease. As such, a Rice claim is not raised. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of an initial rating in excess of 30 percent for coronary artery disease, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 3. Lumbar Degenerative Disc Disease The Veteran asserts that he is entitled to higher ratings for his lumbar degenerative disc disease as his symptoms are worse than those contemplated by the current ratings assigned. Specifically, the Veteran testified his back symptoms resulted in worsening difficulty with bending, standing up straight, using a rollator, impaired social life, constant pain, limited lifting to forty pounds, and limited movement. See Board hearing transcript, July 21, 2020. During the period on appeal, the Veteran's lumbar degenerative disc disease is assigned a 10 percent rating prior to February 19, 2021, and 20 percent rating thereafter under 38 C.F.R. § 4.71a, Diagnostic Code 5242. The Veteran's lumbar degenerative disc disease is rated under the General Rating Formula for Diseases and Injuries of the Spine (General Formula). 38 C.F.R. § 4.71a. Under the General Rating Formula for Rating Diseases and Injuries of the Spine, with or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings will apply: a 10 percent rating is warranted when forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. Id. A 20 percent rating is warranted when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; or, 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. Id. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. Id. A schedular maximum 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Id. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. See Note (2); see also Plate V. A disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in 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. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. 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. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40); see also DeLuca v. Brown, 8 Vet. App. 202, 206-207 (1995). Turning to the evidence of record, the Veteran was afforded a VA examination in May 2016. At that time, the examiner diagnosed lumbar degenerative disc disease. The Veteran reported progressively worsening pain in his low back, that was described as a dull pain and stiffness located in the midline low back, without radiation. He denied numbness, tingling, bowel or bladder incontinence, saddle anesthesia, and only chronic constipation was noted. The Veteran denied flare-ups of the thoracolumbar spine. He reported functional loss as limited heavy lifting. Upon physical examination in May 2016, range of motion measurement results were as follows: forward flexion was to 70 degrees; extension was to 15 degrees; right lateral flexion was to 15 degrees; left lateral flexion was to 20 degrees; and bilateral lateral rotation were to 30 degrees each; for a total combined range of motion of 180 degrees. Range of motion itself did not contribute to a functional loss. Pain was noted on extension but did not result in or cause a functional loss. There was no evidence of pain with weight-bearing. There was no objective evidence of localized tenderness or pain on palpation of the thoracolumbar spine. The Veteran was able to perform repetitive-use testing in May 2016; there was no additional loss of function or range of motion after three repetitions. The Veteran was not examined immediately after repetitive-use over time; the examination was neither medically consistent or inconsistent with the Veteran's statements describing a functional loss with repetitive-use over time. The examiner could not state without resorting to mere speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repetitive-use over time without examining the Veteran after repetitive-use over time. There was no guarding or muscle spasm of the thoracolumbar spine shown. There were no additional factors contributing to the disability. Muscle strength testing in May 2016 was normal; the Veteran did not have muscle atrophy. Reflex examination showed absent deep tendon reflexes in the bilateral ankles. Sensory examination was normal. Straight leg raising test was negative bilaterally. The Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. There was no ankylosis shown. The Veteran did not have any other neurologic abnormalities or findings related to his lumbar degenerative disc disease. He denied the use of any assistive device as a normal mode of locomotion. Functioning was not so diminished that the Veteran was equally well served by amputation with prosthesis. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. Diagnostic imaging documented arthritis without thoracic vertebral fracture with loss of 50 percent or more of height. The examiner noted the Veteran's lumbar degenerative disc disease would impact his ability to work due to limited bending and heavy lifting. The Veteran was afforded a VA examination in February 2021. At that time, the Veteran reported low back pain that was constant and ached in nature, a 5 to 6 out of 10 pain intensity, without radiation, denied numbness, and pain that was increased with prolonged standing or walking. He had some fatigue in his bilateral lower extremities. The Veteran denied bowel and/or bladder problems. His symptoms were alleviated with rest and stretching. The Veteran endorsed the use of a walker. He denied flare-ups of his lumbar degenerative disc disease. He described functional loss or functional impairment as inability to stand or walk for more than five minutes for the past two years, and inability to use stairs due to back pain. Upon physical examination in February 2021, range of motion measurement results were as follows: forward flexion to 60 degrees; extension to 10 degrees; bilateral lateral flexion and bilateral lateral rotation to 20 degrees each, for a total combined range of motion of 150 degrees. Range of motion itself did not contribute to a functional loss. Pain was noted on forward flexion, right lateral flexion, and right lateral rotation. Limitation of motion that was specifically attributable to pain, weakness, fatigability, and incoordination were was follows: forward flexion to 50 degrees, and extension to 5 degrees. Passive range of motion measurement results were as follows: forward flexion to 60 degrees; extension to 10 degrees; and bilateral lateral flexion and bilateral lateral rotation to 20 degrees each, for a total combined range of motion of 150 degrees. Pain was noted on passive range of motion in forward flexion, right lateral flexion, and right lateral rotation. The examiner found evidence of pain in active and passive motion. There was no objective evidence of crepitus. There was local tenderness to the bilateral paraspinal lower lumbar area. The Veteran was able to perform repetitive-use testing in February 2021; there was no additional loss of function or range of motion after three repetitions. The Veteran was not examined immediately after repetitive-use over time; the procured evidence did not suggest pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repetitive-use over time. Pain, fatigability, and weakness were factors shown to cause this functional loss. Estimated range of motion measurements for immediately after repetitive-use over based on information procured were as follows: forward flexion to 50 degrees; extension to 5 degrees; and bilateral lateral flexion and bilateral lateral rotation to 15 degrees each, for a combined range of motion of 115 degrees. The Veteran did not have guarding or muscle spasm. Additional factors contributing to the disability included interference with standing and disturbance of locomotion. Muscle strength testing in February 2021 showed active movement against some resistance in all motions of the right side; the left side was not tested. The Veteran did not have muscle atrophy. Reflex examination showed hypoactive deep tendon reflexes of the right knee and ankle; the left side was not tested. Sensory examination was normal bilaterally. Straight leg raising test was negative bilaterally. The Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. There was no ankylosis shown. The Veteran did not have any other neurologic abnormalities or findings related to his lumbar degenerative disc disease. The Veteran did not have intervertebral disc syndrome (IVDS). The Veteran endorsed the use of a walker as a normal mode of locomotion. Functioning was not so diminished that the Veteran was equally well served by amputation with prosthesis. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. Diagnostic imaging documented arthritis without thoracic vertebral fracture with loss of 50 percent or more of height. The examiner noted the Veteran's lumbar degenerative disc disease would impact his ability to work due to inability to stand or walk more than five minutes for two years, and inability to navigate stairs due to back pain. Additionally, the examiner noted the Veteran required help in the shower by using a shower bench and could not cut his toenails. The examiner remarked there was evidence of pain on passive range of motion testing and no evidence of pain when the joint was used in non-weight-bearing. A review of the record shows that the Veteran receives treatment at the VA Medical Center and from private providers for various disabilities, to include his lumbar degenerative disc disease. A review of the treatment notes of record does not show the Veteran to have symptoms of a spine disability worse than those reported at the VA examinations of record and noted above. Based on the foregoing, the Board finds that an initial rating in excess of 10 percent prior to February 19, 2021 for lumbar degenerative disc disease is not warranted. Forward flexion was found to be 70 degrees and combined range of motion was found to be to 180 degrees, both at worst, in a May 2016 VA examination report. There was no clinical evidence showing limitation in forward flexion to 30 degrees, a combined range of motion of 120 degrees or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour of the thoracolumbar spine during any part of the appeal period, even with consideration of painful motion and other factors discussed in DeLuca. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. None of the clinical records reflect such criteria as required for a higher rating based on range of motion. Id. The Board notes that the Veteran has described painful motion of the thoracolumbar spine and has considered the provisions of 38 C.F.R. §§ 4.40 and 4.45. See DeLuca, supra. However, there is no objective evidence that this painful motion has resulted in measurable functional impairment. In this regard, the Veteran reported pain, difficulty walking and climbing stairs, decreased mobility, problems with certain physical activities, weakness, and fatigue. However, even in considering the Veteran's subjective complaints, the evidence of record does not support any additional limitation of function in response to repetitive motion or flare-ups that would support a rating in excess of the 10 percent assigned prior to February 19, 2021. See DeLuca, supra; Mitchell, supra; 38 C.F.R. §§ 4.40, 4.45, 4.59. For the appeal period beginning February 19, 2021, the Board finds that a rating in excess of 20 percent rating for lumbar degenerative disc disease is not warranted. The Veteran's forward flexion was found to be to 50 degrees, and a combined range of motion of 115 degrees, both at worst, during the February 2021 VA examination, even with consideration of painful motion and other factors discussed in DeLuca. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. None of the clinical records reflect such criteria as required for a higher rating based on range of motion. Id. The Board notes that the Veteran has described painful motion of the thoracolumbar spine and has considered the provisions of 38 C.F.R. §§ 4.40 and 4.45. See DeLuca, supra. In this regard, the Veteran reported pain, difficulty walking and climbing stairs, decreased mobility, problems with certain physical activities, lack of stamina, weakness, fatigue, and decreased ability to walk or stand over the past two years. However, even in considering the Veteran's subjective complaints, the evidence of record does not support any additional limitation of function in response to repetitive motion or flare-ups that would support a rating in excess of the 20 percent assigned for the appeal period from February 19, 2021. See DeLuca, supra; Mitchell, supra; 38 C.F.R. §§ 4.40, 4.45, 4.59. The Board has considered whether a higher evaluation could be assigned for any period on appeal under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. In this case, there is no evidence that the Veteran has had IVDS and/or incapacitating episodes as defined by VA regulations. Rather, the Veteran has not alleged, nor does the evidence show, that the Veteran has a diagnosis of IVDS that resulted in medically prescribed bedrest. Accordingly, a higher or separate rating is not warranted under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. In addition to considering the orthopedic manifestations of a back disability, VA regulations also require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. However, the Veteran has not alleged, and the evidence does not show, that he has bladder impairment or bowel impairment as a result of his service-connected lumbar degenerative disc disease. The Veteran has not been shown to have signs of radicular pain and/or radiculopathy at any time during the period on appeal, and has consistently denied such symptoms. Therefore, the Board finds that, at no time during the appeal period, has the Veteran's service-connected lumbar degenerative disc disease resulted in neurological impairment. Finally, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court of Appeals for Veterans' Claims (Court's) holdings in Correia and Sharp. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016), and Sharp v. Shulkin, 29 Vet. App. 26 (2017). In this case, the VA examiners did not test the opposite joint; however, the spine does not have an opposite joint. The VA examiners indicated there was interference with weight-bearing. Pain was noted on examination. Regarding repeated use over time, the Board notes that VA examiners conducted repetitive-use testing and concluded that there was no additional limitation in range of motion. Regarding flare-ups, the Board acknowledges that the VA examiners were not able to provide an opinion regarding additional functional impairment during flare-ups, however, the Veteran consistently denied experienced flare-ups of his lumbar degenerative disc disease. Therefore, the Board finds that all information required for rating purposes was provided. In this regard, the Board notes that the examiners clearly noted that the Veteran specifically reported pain, limited prolonged sitting, stiffness, and difficulty with certain daily activities, to include lifting, stairs, walking, and bending over. There is no other indication from the record, to include the Veteran's own statements, that he experiences additional decreased range of motion, weakness, or incoordination during flare-ups or following repeated use other than shown above. As the Veteran has not endorsed those symptoms, the Board finds the examinations of record to be adequate for rating purposes. See Correia v. McDonald, supra; see also Sharp v. Shulkin, supra. The Veteran's belief that he is entitled to higher ratings for his lumbar spine disorder is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination report and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran's general belief that he is entitled to higher ratings. The Board acknowledges the statements of the Veteran that his lumbar degenerative disc disease manifests with pain, limited range of motion, stiffness, and interference with certain physical activities. The Veteran is competent to report his symptoms and has presented credible statements in this regard. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). The Board finds, however, that neither the Veteran's statements, nor medical evidence demonstrates that the criteria for higher ratings have been met during any period on appeal. Specifically, as noted above, the Veteran's range of motion is described, and the Veteran has not been shown to have ankylosis of the spine at any time. In addition, the Veteran was able to describe his symptoms following repetitive-use, the impact of his symptoms on his daily life, and the severity, frequency, duration and functional loss manifestations. The Board also acknowledges that the Veteran's VA treatment records note complaints of and treatment for his back. However, these records do not address the specific rating criteria necessary to determine severity. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. Consideration has been given to assigning further staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned, and the disability has been stable throughout each appeal period. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Additionally, the Board has considered whether an inferred claim for a TDIU has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran's current employment status is unknown. The Veteran has also not alleged, and the record does not suggest, that he is unable to obtain and maintain employment due solely to his service connected lumbar degenerative disc disease. As such, a Rice claim is not raised. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of an initial rating in excess of 10 percent for prior to February 19, 2019, in excess of 20 percent from thereafter for lumbar degenerative disc disease, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. REASONS FOR REMAND Increased Rating Right Eye Hyperphoria The Veteran was afforded a VA examination in June 2016. Visual field defect testing at the June 2016 VA examination showed that the Veteran had a visual field defect. Goldmann's equivalent III/4e target testing was performed. The Goldmann charts were not associated with the claims file. Under the regulations in effect prior to May 13, 2018, which are applicable in this case, the results of visual field testing must be recorded on a standard Goldmann chart and the chart must be included with the examination report. See 38 C.F.R. § 4.77. Therefore, a remand is warranted to obtain and associate such Goldmann Chart. Service Connection Pulmonary Disorder The Veteran seeks entitlement to service connection for a pulmonary disorder. Specifically, he asserts that he had exposure to asbestos while aboard the U.S.S. Damato and U.S.S. Robinson in the engine rooms; he testified he saw asbestos on the pipes and evaporators and developed a pulmonary disorder as a result. See Board hearing transcript, July 21, 2020. The Veteran was afforded a VA examination in September 2021. At that time, the examiner diagnosed asbestos exposure with right pulmonary nodules. The examiner noted the condition was diagnosed in March 2020 and began due to asbestos and Agent Orange exposure, and exacerbated by the physical rigors of active service. The September 2021 VA examiner then opined the claimed condition was less likely than not incurred in or caused by active service. In that regard, the examiner noted the previously diagnosed pulmonary nodules had resolved, and chest x-ray results from June 2021 showed no acute pulmonary disease; the examiner indicated most pulmonary nodules resolve after several months or years without sequela. Therefore, the September 2021 VA examiner opined that it was less likely than not that any diagnosed pulmonary disorder during the pendency of the Veteran's claim, to include right pulmonary nodules, had their onset in service or was otherwise directly related to service. The Board finds that the September 2021 VA opinion is inadequate for adjudication purposes. In this regard, the September 2021 VA examination report is internally inconsistent, namely, whether or not the Veteran has a diagnosis related to asbestos and/or Agent Orange exposure during active service. In this regard, the September 2021 VA examiner indicated the diagnosed right pulmonary nodules were due to Agent Orange and/or asbestos exposure, but then later opined that such diagnosis was less likely than not related to the Veteran's service. Additionally, the examiner failed to provide an opinion as to direct service connection as directed in the November 2020 Board remand. Given these deficiencies, the Board is unable to find that substantial compliance with the prior remand has been achieved. See D'Aries, 22 Vet. App. at 105; see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999). As such, remand is again required to obtain additional VA addendum opinions that comply with the Board's prior remand directives. See Stegall v. West, 11 Vet. App. at 268, 271 (1998). The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Obtain and associate with the claims file the clinical and diagnostic tests referenced in the June 2016 VA eye examination report. If such records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 3. Then, schedule the Veteran for a VA examination with an appropriate clinician(s) to determine the etiology of the Veteran's claimed pulmonary disorder. The record, to include a copy of this Remand, should be made available to the examiner, and all indicated tests should be conducted. Further physical examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following question: Is at least as likely as not (50 percent or greater probability) that the appellant's pulmonary disorder had its onset during any period of service, or is otherwise related to such period of service, to include due to asbestos exposure aboard the U.S.S. Damato between 1958 and 1959, as well as the U.S.S. Robinson between 1960 and 1961, and/or herbicide exposure? A RATIONALE FOR ALL OPINIONS EXPRESSED SHOULD BE PROVIDED. A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance. If the examiner opines that any of the above questions cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mariah N. Sim, 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.