Citation Nr: 21076334 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 13-33 663 DATE: December 23, 2021 ORDER Service connection for an acquired psychiatric disorder, diagnosed as posttraumatic stress disorder (PTSD) with symptoms of depression and other trauma and stressor-related disorder, is granted. For the appeal period prior to July 31, 2019, a 10 percent rating, but no higher, for hypertension, is granted. Beginning July 31, 2019, a rating in excess of 10 percent for hypertension, is denied. A rating in excess of 20 percent for left shoulder myofascial pain syndrome with tendonitis (left shoulder disability) is denied. For the rating period prior to July 31, 2019, a rating of 40 percent, but no higher, for right upper extremity (dominant side) radiculopathy is granted. For the rating period prior to July 31, 2019, a rating of 30 percent, but no higher, for left upper extremity (non-dominant side) radiculopathy is granted. Beginning July 31, 2019, a rating in excess of 40 percent for right upper extremity (dominant side) radiculopathy is denied. Beginning July 31, 2019, a rating in excess of 30 percent for left upper extremity (non-dominant side) radiculopathy is denied. A compensable rating for a post-ventral hernia repair is denied. REMANDED Entitlement to service connection for a gastrointestinal disorder, claimed as ulcers, is remanded. FINDINGS OF FACT 1. The evidence is in equipoise as to whether the Veteran's claimed stressor of sexual assault in service is corroborated by other evidence of record. 2. The Veteran's currently diagnosed PTSD (with symptoms of depression) and "other trauma and stressor-related disorder" are related to the corroborated in-service events of sexual assault. 3. For the entirety of the appeal period, the Veteran's service-connected hypertension has been manifested by continuous medication shown necessary for the control of hypertension with a history of diastolic pressure of predominantly 100 or more, at worst. 4. The Veteran's left shoulder disability (non-dominant) has not been shown to more nearly approximate limitation of motion to 25 degrees from the side. 5. For the entirety of the appeal period, the Veteran's radicular symptoms and impairment in the Veteran's right and left upper extremities more nearly approximate (at worst) moderate incomplete paralysis of the middle radicular group. 6. For the entirety of the appeal period, the Veteran's post-operative wounds from prior ventral hernia repair are well-healed; there is no current ventral hernia or hernia repair symptoms. 7. The Veteran's service-connected hernia repair scar has not been painful or unstable, does not cover an area of 144 square inches or greater, or areas of at least six square inches but less than 12 square inches. CONCLUSIONS OF LAW 1. The criteria to establish service connection for an acquired psychiatric disorder, to include PTSD and "other trauma and stressor-related disorder," are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. For the appeal period prior to July 31, 2019, the criteria for a 10 percent rating, but no higher, for hypertension are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.104, Diagnostic Code 7101. 3. Beginning July 31, 2019, the criteria for a rating in excess of 10 percent for hypertension are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.104, Diagnostic Code 7101. 4. The criteria for a rating in excess of 20 percent for the left shoulder disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.40, 4.45, 4.71a, Diagnostic Code 5201. 5. For the rating period prior to July 31, 2019, the criteria for a 40 percent rating, but no higher, for radiculopathy of the right upper extremity are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8511. 6. For the rating period prior to July 31, 2019, the criteria for a 30 percent rating, but no higher, for radiculopathy of the left upper extremity are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8511. 7. Beginning July 31, 2019, the criteria for a rating in excess of 40 percent for radiculopathy of the right upper extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8511. 8. Beginning July 31, 2019, the criteria for a rating in excess of 30 percent for radiculopathy of the left upper extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8511. 9. The criteria for a compensable rating for post-ventral hernia repair are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.114, Diagnostic Code 7339. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1980 to July 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from the October 2008, June 2010, January 2013, and September 2013 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. The Veteran and her spouse testified at a March 2018 videoconference hearing before the undersigned Veterans Law Judge. A complete transcript of the hearing is of record. The issues on appeal were previously remanded by the Board for further evidentiary development in June 2018. Other previously remanded issues regarding entitlement to service connection for a thoracolumbar spine disorder, bilateral knee disorder, and entitlement to a total disability evaluation based on individual unemployability (TDIU) for the entire rating period on appeal, were granted by the Agency of Original Jurisdiction (AOJ) in an August 2020 rating decision. As such, those issues are no longer on appeal. Notably, the Veteran has been in receipt of a 100 percent schedular rating (either through her combined service-connected disabilities or as a result of her TDIU award) for the entire rating period on appeal. The Board also notes that, although the AOJ granted higher disability ratings for the Veteran's right and left upper extremity radiculopathy and hypertension disabilities, the claims remain in controversy because the Veteran is not in receipt of the maximum benefit allowable. See A.B. v. Brown, 6 Vet. App. 35 (1993). Service Connection Laws and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Only chronic diseases listed under 38 C.F.R. § 3.309 (a) are entitled to the presumptive service connection provisions of 38 C.F.R. § 3.303 (b). Walker v. Shinseki, 708 F.3d 1331 Fed. Cir. 2013). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57(1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382(1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Acquired Psychiatric Disorder The Veteran maintains that she has an acquired psychiatric disorder as a result being sexually assaulted during service. Specifically, the Veteran has indicated that she was sexually assaulted by males on two separate occasions and spoke with the JAG office at one time and was ultimately transferred. Service connection for PTSD requires medical evidence diagnosing the disorder in accordance with 38 C.F.R. § 4.125 (a); a link, established by medical evidence, between the current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304 (f). In non-combat cases of PTSD involving an allegation of personal assault, more particularized requirements are established to verify whether the alleged stressor actually occurred. Patton v. West, 12 Vet. App. 272, 278-80 (1999). In this regard, evidence from sources other than the Veteran's service records may corroborate the appellant's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, mental health counseling centers, hospitals, or physicians; and/or statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is another type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to, a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. 38 C.F.R. § 3.304 (f)(3). As a general rule, the Board may not determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence of the in-service event. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006). In the context of a sexual assault, the Board also cannot use the Veteran's failure to report an event as evidence against the event occurring as there is no reasonable expectation that such event would have been reported. AZ v. Shinseki, 731 F.3d 1303, 1315 (Fed. Cir. 2014). Here, the Board initially finds that the Veteran is currently diagnosed with PTSD (with symptoms of depression) and "other trauma and stressor-related disorder." See November 2006 VA mental health note (showing DSM IV Axis I diagnosis of PTSD; see also February 2014 VA mental health note (confirming PTSD diagnosis); see December 2020 VA psychiatric examination report (indicating a diagnosis of "other trauma and stressor-related disorder" pursuant to the DSM 5 criteria). The Board next finds that the evidence is in equipoise as to whether the Veteran's reported in-service stressors of sexual assault are corroborated by medical and other evidence of record. The Veteran's service treatment records are absent for any notations of sexual assault or other abuse; however, the evidence shows that the Veteran specifically requested an HIV test, which may be a marker for military sexual trauma. See 38 C.F.R. § 3.304 (f)(5) ("tests for sexually transmitted diseases" may corroborate MST); see also, May 1989 service treatment note. Following service, and even before the filing of her current service connection claim for a psychiatric disorder, the Veteran reported on several occasions that she had suffered sexual trauma while in the military. For example, in a 2002 VA treatment note, the Veteran responded "yes" as to having experienced military sexual trauma. According to a November 2006 VA mental health note, the Veteran reported that she had been severely depressed "for years" and attributed this to having been sexually abused during basic training and in "AIT." She specifically reported being threatened by a drill sergeant that if she did not have sexual intercourse with him, he would make her life miserable. She indicated that she had not been the same since that time and is now unable to respond sexually in a positive manner. The Veteran reported having continued nightmares of her experiences of sexual abuse in the military. In a February 2014 VA mental health note, the Veteran again reported being sexually assaulted during basic training. The relevant evidence of record also includes a statement from the Veteran's friend (W. S.), dated in February 2012. W. S. indicated that he had been caring for the Veteran for approximately 10 years. He indicated that the Veteran "thinks about something that happen[ed] to her in basic training" and would only talk about bits and pieces regarding a sergeant that "did something to her." W. S. noted that the Veteran's cried "about that." Moreover, an August 2021 VA medical opinion indicates that the Veteran meets the DSM criteria for "other trauma and stressor-related disorder and indicates that it is related to the Veteran's military service. A February 2014 VA mental health note indicates that the Veteran's PTSD is attributable to MST (military sexual trauma). A November 2006 VA mental health note indicates that the Veteran had been "severely depressed for years" due to having been sexually abused while was in basic training and in AIT. Upon review of all the evidence of record, the Board finds that the Veteran's in-service stressors of sexual assault that the Veteran has described are reasonably corroborated by medical and other evidence of record. The Veteran's medical treatment records and lay statements suggest, at least in part, some evidence of behavior changes. In this case, the Board finds it reasonable that the Veteran would not have reported the in-service sexual assault to service personnel given the traumatic nature of the assault. Accordingly, the Board finds that the Veteran's reported in-service stressors of sexual assault is corroborated. In sum, the Board concludes that the weight of the competent evidence is at least in relative equipoise on the question of whether the Veteran's currently diagnosed PTSD and "other trauma and stressor-related disorder" are related to the corroborated in-service sexual assault. As such, resolving reasonable doubt in the Veteran's favor, service connection for an acquired psychiatric disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Disability Ratings Laws and Regulations 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 or her 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. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. A veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, where the evidence contains factual findings that show a change in the severity of symptoms during the course of the rating period on appeal, assignment of staged ratings would be permissible. Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria."). It is the intention to recognize actual painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Hypertension Hypertension is rated pursuant to 38C.F.R. § 4.104, Diagnostic Code (DC) 7101, for hypertensive vascular disease (hypertension and isolated systolic hypertension). The Veteran is in receipt of a noncompensable rating for hypertension for the appeal period prior to July 31, 2019, and a 10 percent rating for the period thereafter, under DC 7101. Under DC 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; it is the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent rating is warranted for diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. With diastolic pressure predominantly 120 or more, a 40 percent rating is warranted. 38 C.F.R. § 4.104. Upon review, the Board resolves any reasonable doubt in the Veteran's favor and finds that the evidence supports the assignment of a 10 percent rating for her hypertension for the appeal period prior to July 31, 2019. The evidence supports a finding of continuous medication necessary for the control of hypertension with a history of diastolic blood pressure predominantly 100 or more. For example, the Veteran was seen at the emergency department in June 2009 for a mild headache and blurred vision. Her blood pressure reading at that time was 150/108. In a March 2010 VA treatment record, the Veteran's blood pressure reading was 172/100, despite being on blood pressure medication. In a separate March 2010 treatment note, the Veteran's blood pressure reading was 170/100, and her medication was increased because it was specifically noted that the Veteran's blood pressure was "not controlled" on Ciltiazem. A manual re-check of the Veteran's blood pressure at that time showed a reading of 158/100. In separate March 2010 VA treatment record, the Veteran was found to have been "up all night with a blood pressure elevated 198/127." The Veteran was instructed to go to the emergency department. During a July 2019 VA hypertension examination, the Veteran reported having "recurrent pressure elevations" with multiple emergency room visits for severe blood pressure elevations. The Veteran also reported having diastolic pressure readings between 100 and 110 "2-3 times per week." Blood pressure readings at the time of the examination were noted as 156/102 and 158/100 (x2), with an average reading of 157/101. For these reasons, the Board finds that the evidence supports a finding of continuous medication necessary for the control of hypertension with a history of diastolic blood pressure predominantly 100 or more. Accordingly, the Board finds that a 10 percent rating for hypertension is warranted for the appeal period prior to July 31, 2019. The Board next finds that, for the entire rating period on appeal, a rating in excess of 10 percent for hypertension is not warranted. The weight of the evidence does not demonstrate diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. The Veteran has not reported otherwise. See Veteran's statements in 2019 VA examination report (noting diastolic pressure readings between 100 and 110 two to three times per week). As noted above, there was only one reading where the Veteran had diastolic pressure of 127. See March 2010 VA treatment record VA treatment record. The Board notes that one reading does not rise to the level of predominant diastolic blood pressure of 110 or more as required for a 20 percent rating. Accordingly, the Board concludes that the Veteran's hypertension disability does not more nearly approximate a rating in excess of 10 percent at any time during the appellate period. Left Shoulder Disability Disabilities of the shoulder and arm are rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5200 through 5203 and include ratings based on limitation of motion. For rating purposes, a distinction is made between major (dominant) and minor musculoskeletal groups. Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. The injured hand, or the most severely injured hand, of an ambidextrous individual will be considered the dominant hand for rating purposes. See 38 C.F.R. § 4.69. Here, the evidence shows that the Veteran is right-hand dominant. Therefore, her left shoulder is the non-dominant (minor) extremity. Under Diagnostic Code 5200, which pertains to ankylosis of the scapulohumeral articulation, a 20 percent rating is warranted for favorable ankylosis with abduction to 60 degrees, a 30 percent rating is warranted for ankylosis which is intermediate between favorable and unfavorable, and a 40 percent rating is warranted where there is unfavorable ankylosis with abduction limited to 25 degrees from the side. Limitation of motion of the shoulder joint is rated under Diagnostic Code 5201. Under Diagnostic Code 5201 (minor side), a 20 percent rating is warranted for limitation of arm motion to shoulder level; a 20 percent rating is warranted for limitation of arm motion to midway between the side and shoulder level; and a maximum 30 percent rating is warranted for limitation of arm motion to 25 degrees from the side. 38 C.F.R. § 4.71a. Under Plate I of 38 C.F.R. § 4.71a, normal range of motion of the shoulder is forward elevation (flexion) and abduction to 180 degrees, and internal and external rotation to 90 degrees. Diagnostic Code 5202 provides ratings for other impairment of the humerus. Recurrent dislocations of the humerus at the scapulohumeral joint are rated as 20 percent for the minor shoulder. Fibrous union of the humerus is rated as 40 percent for the minor shoulder. Nonunion of humerus (false flail joint) is rated as 50 percent for the minor shoulder. Loss of head of the humerus (flail shoulder) is rated as 70 percent for the minor shoulder. Under DC 5203 for impairment of the clavicle or scapula, a 10 percent rating is assigned for malunion or for nonunion without loose movement. When there is nonunion with loose movement, a 20 percent rating is assigned. A 20 percent rating is also assigned when there is dislocation of the clavicle or scapula. As indicated above, the Veteran's left shoulder disability is currently rated as 20 percent disabling under 38 C.F.R. § 4.71a Diagnostic Code 5201 for limitation of motion of the non-dominant arm. The Board carefully reviewed the medical evidence, to include the December 2008, June 2010, March 2013, November 2017, and October 2019 VA examination reports, and finds no evidence that the Veteran's left shoulder disability has been characterized by fibrous union of the humerus, or nonunion (false flail shoulder), or loss of the humeral head (flail shoulder) during the period on appeal. The Board further finds that Diagnostic Code 5200 is inapplicable because there is no evidence of ankylosis of the Veteran's left shoulder as required under Diagnostic Code 5200. Likewise, the Board finds that a higher rating under Diagnostic Code 5203 is not applicable as a 20 percent rating is the maximum rating permitted under this code. With respect to Diagnostic Code 5201, the Board finds that a disability rating in excess of 20 percent is not warranted as the Veteran has not shown limitation of left shoulder motion to 25 degrees from the side. Instead, the Veteran's range of motion has been found to be limited to, at worst, 50 degrees in forward flexion and 45 degrees in abduction, to include following repetitive use testing. See December 2008 and June 2010 VA examination reports. Subsequent VA examination reports show an increase in range of motion in the left shoulder. See e. g., July 2019 VA examination report (noting that, during flare-ups, the Veteran's left shoulder would be limited to 70 degrees in flexion and 50 degrees in abduction). The Veteran has also reported difficulty with overhead use (i.e., above 90 degrees) or with heavy lifting. The Board finds that the 20 percent rating currently assigned contemplates any functional impairment that the Veteran experiences in her left shoulder. The claim for a higher schedular rating for the Veteran's left shoulder disability must be denied. In reaching this decision, the Board finds that the preponderance of the evidence is against the claim, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Right and Left Upper Extremity Radiculopathy The Veteran is currently in receipt of separate 20 percent ratings for radiculopathy of the right and left upper extremities for the appeal period prior to July 31, 2019. Beginning July 31, 2019, the Veteran is in receipt of a 40 percent rating for radiculopathy of the right (dominant) upper extremity, and a 30 percent rating for the left (non-dominant) upper extremity based on moderate symptoms. The radiculopathy in the upper extremities is most appropriately rated under DC 8511, which is applicable to the middle radicular group of nerves. See July 2019 VA examination report (noting middle radicular group radiculopathy). Under DC 8511, a 20 percent rating is warranted for mild incomplete paralysis of both the minor and major extremity; a 40 percent rating is warranted for moderate incomplete paralysis of the major extremity and a 30 percent rating is warranted for moderate incomplete paralysis of the minor extremity; a 50 percent rating is warranted for severe incomplete paralysis of the major extremity and a 40 percent rating is warranted for severe incomplete paralysis of the minor extremity; and a 70 percent rating is warranted for complete paralysis of the major extremity with adduction, abduction and rotation of the arm, flexion of the elbow, and extension of the wrist lost or severely affected and a 60 percent rating is warranted for complete paralysis of the minor extremity with adduction, abduction and rotation of the arm, flexion of the elbow, and extension of the wrist lost or severely affected. 38 C.F.R. § 4.124a. The terms "mild," "moderate" and "severe" as used in the various DCs are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. Upon review of the evidence, both lay and medical, the Board finds that the Veteran's radiculopathy in each upper extremity more nearly approximates moderate incomplete paralysis for the rating period prior to July 31, 2019. During a December 2008 VA examination, the Veteran had radiating neck pain to her left shoulder and right trapezius area. During flare-ups, she reported worsening pain which was described as a "9/10" and was associated with increased activity. She also reported intermittent numbness to the hand several times a day. During a March 2013 VA cervical spine examination, the Veteran complained of radiating pain down the left arm. In a November 2017 VA examination, the Veteran specifically reported radiating pain down both arms with tingling to the forearms and upper arms. No relief with physical therapy or injections was reported. A July 2019 VA examination report again indicated pain, numbness, and tingling down the shoulders and arms. The examiner specifically noted that the Veteran had "moderate" symptoms of bilateral upper extremity intermittent pain, paresthesias, and numbness. She was diagnosed with moderate incomplete paralysis of the middle radicular group. The Board finds that the evidence is at least in equipoise as to whether the Veteran's radiculopathy in the upper extremities more nearly approximated moderate symptoms for the appeal period prior to July 31, 2019. In consideration of the Veteran's competent and credible reports of flare-ups and her consistent reports of pain, tingling, and numbness in the upper extremities, the Board resolves any reasonable doubt in her favor, and awards a 40 percent (right extremity) and 30 percent rating (left extremity) for the appeal period prior to July 31, 2019 for moderate incomplete paralysis of the middle radicular nerve group. The Board next finds that ratings higher than 40 and 30 percent for the right and left upper extremity radiculopathies, respectively, are not warranted at any time during the period on appeal. At no point have the Veteran's symptoms been shown to be severe; rather she has indicated that her symptoms are mostly intermittent. See December 2008 VA examination report. Moreover, VA examination reports, to include the most recent examination conducted in 2019, have indicated, at worst, moderate intermittent pain, numbness, and paresthesias. Further, although sensory examinations have shown decreased sensation, the Veteran's sensation was not found to be absent. The Veteran has also not been found to have muscle atrophy or constant pain, which may demonstrate more severe paralysis of the nerves. For these reasons, the Board finds that ratings in excess of 40 and 30 percent for the right and left upper extremity radiculopathy are not warranted for the entire rating period on appeal. Ventral Hernia Repair Disability The Veteran is in receipt of service connection for residuals of a ventral hernia repair, currently rated as noncompensable under Diagnostic Code 7339. Under DC 7339, which addresses postoperative ventral hernia disabilities, ratings of 0, 20, 40, and 100 percent are authorized. A 0 percent rating is warranted when the postoperative wounds are healed, there is no disability, and a belt is not indicated. The next-highest rating of 20 percent is warranted for postoperative ventral hernia that is small, not well supported by a belt under ordinary conditions, or healed ventral hernia or postoperative wounds with weakening of the abdominal wall and indication for a supporting belt. See 38 C.F.R. § 4.114. The Veteran was afforded a VA examination in June 2012 and the examiner noted a ventral hernia with an onset of 1986 with a ventral hernia repair. On examination, no hernia was detected. The Veteran's hernia scar was not found to be painful, unstable, or with a total area of 39 square centimeters. There were no objective findings to support a recurrent incisional hernia. There was no bulging with pressure, and no hernia with supine or upright positions. In an October 2020 VA hernia examination report, the examiner acknowledged the Veteran's history of a ventral hernia repair but indicated that the hernia was post-operative and "healed." The examiner also diagnosed the Veteran with a hiatal hernia with gastroesophageal reflux disease (GERD), which appears to be the cause of the Veteran's current symptoms. The Veteran's scar was not found to be painful, unstable, or with a total area of 39 square centimeters. The Board notes that the Veteran has not been awarded service connection for a hiatal hernia or GERD. The issue regarding service connection for a gastrointestinal disorder (which may include a hiatal hernia and GERD) is being remanded below. If service connection is awarded, the Veteran may seek to pursue a claim for a higher rating, if she so chooses. As it pertains to the Veteran's currently service-connected ventral hernia (status post repair), the evidence of record reflects that the Veteran's post-operative ventral hernia has healed without any indication for a supporting belt or weakening of the abdominal wall, which would warrant a 20 percent rating. The Veteran's hernia repair scar has not been found to be symptomatic or with a total area of 39 square centimeters. Therefore, the Board finds that a compensable rating is not warranted. REASONS FOR REMAND Gastrointestinal Disorder The Veteran maintains that she currently has "attacks" from a hernia, resulting in nausea, reflux, light headedness, hot and cold flashes, and dizziness. The Veteran has been awarded service connection for residuals of a ventral hernia repair. However, an October 2020 VA examination report diagnosed the Veteran with a hiatal hernia with gastroesophageal reflux disease (GERD), which appears to be the cause of the Veteran's current symptoms. Service treatment records include a November 1985 radiological report where it was noted prominent folds were identified in the duodenal bulb "suggestive of duodenitis." The Board notes that duodenitis is inflammation of the first part of the small intestine. In November 1986, the Veteran also complained of epigastric pain. Post-service treatment records show diagnoses of a hiatal hernia with GERD as early as 2004. An opinion as to the etiology of the Veteran's hiatal hernia and GERD has not been obtained, to include whether it is secondary to the service-connected ventral hernia disability. As such, a remand is required. The matters are REMANDED for the following action: 1. Obtain a medical opinion from the October 2020 VA examiner who conducted the examination, which diagnosed the Veteran with a hiatal hernia and GERD. If that examiner is not available, obtain an opinion from another appropriate VA examiner. The need for the Veteran to be re-examined is left to the designee's discretion. The VA examiner is asked to respond to the following: (a.) State whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hiatal hernia and/or GERD first manifested in service, was incurred in service, or is otherwise related to service. (b.) If not related to service, state whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hiatal hernia and/or GERD was either caused or aggravated by her service-connected ventral hernia disability. **Please note that for secondary service connection, "aggravation" need not be permanent in nature. See Ward v. Wilkie, 31 Vet. App. 233, 241-42 (2019). (c.) All opinions should be accompanied by a clear rationale. 2. Then, readjudicate the remanded issue on appeal. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Casadei, 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.