Citation Nr: 21076415 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 16-04 411 DATE: December 23, 2021 ORDER Entitlement to a 10 percent rating for acne and dermatitis of the face, chest, shoulders, and upper back is granted from June 7, 2018 to November 20, 2018. Entitlement to a compensable rating for acne and dermatitis of the face, chest, shoulders, and upper back is denied from November 20, 2018. Entitlement to an initial compensable rating for intermittent bowel incontinence is denied. FINDINGS OF FACT 1. From June 7, 2018 to November 20, 2018, the Veteran's acne and dermatitis of the face, chest, shoulders, and upper back manifested as dermatitis affecting at least 5 percent, but less than 20 percent, of exposed areas; however, it did not manifest as deep acne affecting 40 percent or more of the face and neck, nor did dermatitis cover 20 to 40 percent of the entire body or exposed areas or require systemic therapy for a total duration of six weeks or more, but not constantly, during the preceding 12-month period. 2. From November 20, 2018, the Veteran's acne and dermatitis of the face, chest, shoulders, and upper back has not manifested as deep acne affecting less than 40 percent of the face and neck, or deep acne other than on the face and neck, nor has it manifested as dermatitis affecting at least 5 percent, but less than 20 percent, of the entire body or exposed areas or requiring intermittent systemic therapy for a total duration of less than six weeks during the preceding 12-month period. 3. The Veteran's intermittent bowel incontinence has not manifested as constant slight or occasional moderate leakage. CONCLUSIONS OF LAW 1. The criteria for a 10 percent rating for acne and dermatitis of the face, chest, shoulders, and upper back have been met from June 7, 2018 to November 20, 2018. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Codes 7800, 7801-7805, 7806, 7828. 2. The criteria for a compensable rating for acne and dermatitis of the face, chest, shoulders, and upper back have not been met from November 20, 2018. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Codes 7800, 7801-7805, 7806, 7828. 3. The criteria for an initial compensable rating for intermittent bowel incontinence have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Codes 7332, 7334. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Air Force from January 2004 to January 2010. These matters come to the Board of Veterans' Appeals (Board) on appeal from two rating decisions. In July 2018, the Agency of Original Jurisdiction (AOJ) denied entitlement to a compensable rating for the Veteran's service-connected acne and dermatitis of the face, chest, shoulders, and upper back. In September 2018, the AOJ granted entitlement to service connection for intermittent bowel incontinence and assigned an initial noncompensable rating. These matters were previously before the Board in May 2021 when they were remanded for new Department of Veterans Affairs (VA) examinations, as the Veteran had contended that his symptoms had worsened since his most recent examinations. New examinations were performed in September 2021, and the appeal has now returned to the Board. There has been at least substantial compliance with the Board's remand directives. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268 (1998). In addition to the issues on appeal, the Board has considered whether an inferred claim for a total disability rating for compensation purposes based on individual unemployability (TDIU) has been raised. Rice v. Shinseki, 22 Vet. App. 447 (2009). Although the Veteran has stated that his service-connected disabilities affect his job, he has not alleged, nor does the record show, that they render him unable to secure and follow a substantially gainful occupation. In March 2020, the Veteran reported that he had to leave his job as a firefighter and take an administrative job due to his service-connected left ulnar nerve impairment. Although this suggests that his service-connected disabilities may have affected his work, he has not stated that his service-connected disabilities have prevented him from working. Thus, the Board finds that further consideration of entitlement to a TDIU is not warranted at this time. Increased Rating Disability ratings are determined in accordance with VA's Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. 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. Hart v. Mansfield, 21 Vet. App. 505, 509 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). 1. Entitlement to a Compensable Rating for Acne and Dermatitis of the Face, Chest, Shoulders, and Upper Back The Veteran contends that he is entitled to a 20 percent rating for his service-connected acne and dermatitis of the face, chest, shoulders, and upper back. He maintains that his face is permanently inflamed and scaly with pimples and cysts, and that his neck, back, and chest also experience symptoms. During the pendency of this claim, VA revised the criteria for rating skin disabilities on August 13, 2018. VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the Veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. Therefore, VA must consider the claim for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 32000, 65 Fed. Reg. 33422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). The Board will thus consider the Veteran's claim under the old criteria prior to August 13, 2018 and both the old and new rating criteria from August 13, 2018. The criteria that is more favorable to the Veteran will be applied. In this regard, the Board observes that former regulation 38 C.F.R. § 19.9(b)(2) (now renumbered as 38 C.F.R. § 20.904(d)(2)) provided that the Board has the authority to consider appeals in light of laws, including but not limited to statutes, regulations, and court decisions, that were not previously considered by the AOJ. The United States Court of Appeals for the Federal Circuit has specifically upheld the validity of 38 C.F.R. § 19.9(b)(2). Disabled American Veterans v. Sec. of Veterans Affairs, 327 F.3d 1339, 1349 (Fed. Cir. 2003). As such, pursuant to 38 C.F.R. § 20.904(d)(2), the Board will proceed to adjudicate the Veteran's claim for a compensable rating for acne and dermatitis of the face, chest, shoulders, and upper back. The Veteran's acne and dermatitis of the face, chest, shoulders, and upper back have been assigned a noncompensable evaluation under Diagnostic Code 7828 for acne. This diagnostic code allows for acne to be rated under the specific criteria listed or by analogy to disfigurement of the head, face, or neck (Diagnostic Code 7800) or scars (Diagnostic Codes 7801 to 7805), depending on the predominant disability. In this case, a rating under Diagnostic Code 7800 for disfigurement of the head, face, or neck or Diagnostic Codes 7801 to 7805 for scars is not warranted. Although the Veteran's face is affected, there is no lay or medical evidence suggesting that the condition is considered disfiguring or is manifested by any of the characteristics of disfigurement specified by Diagnostic Code 7800. While the July 2018 VA examiner noted the presence of scarring or disfigurement, the symptoms describedredness of the skin at the right side of the face that can look like an allergic reaction if it is irritated enoughdo not resemble the characteristics of disfigurement as specified by Diagnostic Code 7800. Furthermore, neither the November 2018 nor September 2021 VA examiners indicated disfigurement due to the Veteran's skin conditions. With regard to scarring, none of the three VA examinations found evidence of scarring. In sum, the evidence establishes that the Veteran's acne and dermatitis of the face, chest, shoulders, and upper back manifest predominantly as recurrent acne lesions, rashes, bumps, papules, and pustules rather than disfigurement or scarring. Accordingly, rating the Veteran's skin disability by analogy under Diagnostic Code 7800 or Diagnostic Codes 7801 to 7805 is not appropriate. Furthermore, the Board notes that although the August 13, 2018 revisions affected the rating criteria pertaining to disfigurement and scars, consideration of the previous criteria is not necessary because the Veteran's skin disability does not predominantly manifest as disfigurement or scars. Under Diagnostic Code 7828, a noncompensable evaluation is assigned for superficial acne (comedones, papules, pustules) of any extent. A 10 percent rating is warranted for deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck, or deep acne other than on the face and neck. A 30 percent rating is assigned for deep acne (deep inflamed nodules and pus-filled cysts) affecting 40 percent or more of the face and neck. 38 C.F.R. § 4.118, Diagnostic Code 7828. Diagnostic Code 7828 was not affected by the August 13, 2018 regulatory changes. Under 38 C.F.R. § 4.118, two or more skin conditions may be combined only if separate areas of skin are involved. If two or more skin conditions involve the same area of skin, then only the highest evaluation shall be used. 38 C.F.R. § 4.118(b). Since the Veteran's skin disability is characterized as acne and dermatitis, the Board will also consider whether a higher rating is warranted under Diagnostic Code 7806 for dermatitis. Notably, Diagnostic Code 7806 was changed by the August 13, 2018 revisions to the rating criteria. Prior to August 13, 2018, a 0 percent rating was assigned under Diagnostic Code 7806 if less than 5 percent of the entire body or less than 5 percent of exposed areas were affected, and no more than topical therapy was required during the past 12-month period. A 10 percent rating was warranted where the skin disability covered at least 5 percent, but less than 20 percent, of the entire body; or at least 5 percent, but less than 20 percent of the exposed areas; or intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs were required for a total duration of less than six weeks during the past 12-month period. A 30 percent rating was assigned when the disorder covered 20 to 40 percent of the entire body or of exposed areas; or systemic therapy was required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent rating was assigned when the disorder covered more than 40 percent of the entire body or exposed areas; or where constant or near-constant systemic therapy was required during the past 12-month period. Diagnostic Code 7806 also provided that the disorder could be rated as disfigurement of the head, face, or neck under Diagnostic Code 7800, or as scars under Diagnostic Codes 7801 through 7805, depending upon the predominant disability. The new rating criteria in effect from August 13, 2018 include the addition of 38 C.F.R. § 4.118(a), which states that systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin. Under the new rating criteria, disabilities rated under Diagnostic Code 7806 are evaluated under the General Rating Formula for the Skin (the Formula). A 0 percent rating is assigned under the Formula if no more than topical therapy was required over the past 12-month period and at least one of the following applies: characteristic lesions affect less than 5 percent of the entire body; or characteristic lesions affect less than 5 percent of exposed areas. A 10 percent rating is warranted if at least one of the following applies: characteristic lesions affect at least 5 percent, but less than 20 percent, of the entire body or of exposed areas; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs, was required for a total duration of less than six weeks over the past 12-month period. A 30 percent rating is warranted if at least one of the following applies: characteristic lesions affect 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas; or, systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs, was required for a total duration of six weeks or more, but not consistently, over the past 12-month period. A 60 percent rating is warranted if at least one of the following applies: characteristic lesions affect more than 40 percent of the entire body or more than 40 percent of exposed areas; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs, was required over the past 12-month period. As with acne, the Formula provides that the skin disability may also be rated as disfigurement of the head, face, or neck under Diagnostic Code 7800 or as scars under Diagnostic Codes 7801 through 7805, depending upon the predominant disability. However, as discussed above, the Veteran's acne and dermatitis of the face, chest, shoulders, and upper back did not predominantly manifest as disfigurement or scars. A. From June 7, 2018 to November 20, 2018 The Veteran's first VA examination during the period on appeal occurred in July 2018. The examiner noted that the Veteran first experienced acne on his chest, arms, shoulders, and face beginning in 2007. He further reported that the acne on his arms and face became more erythematic without vesicles over time. The examiner did not indicate the presence of deep acne, instead finding no evidence of nodules or cystic activity. Furthermore, deep acne was not shown in the Veteran's VA treatment records, which instead demonstrate that his acne has been characterized by rashes, bumps, papules, and pustules, which is contemplated by the noncompensable rating currently assigned under Diagnostic Code 7828. Accordingly, compensable rating is not warranted under Diagnostic Code 7828. However, the Board notes that the July 2018 VA examiner concluded that the Veteran's dermatitis affects at least 5 percent but less than 20 percent of exposed areas. He was also treated with ammonium lactate for his dermatitis during the 12-month period prior to the examination. Under both the versions of Diagnostic Code 7806 prior to and after August 13, 2018, a 10 percent rating is warranted for dermatitis where it affects at least 5 percent, but less than 20 percent, of exposed areas. Accordingly, the Board finds that the Veteran is entitled to a 10 percent rating under Diagnostic Code 7806 for the period from June 7, 2018 to November 20, 2018 based on the findings of the July 2018 VA examination. 38 C.F.R. § 4.118, Diagnostic Code 7806. A higher evaluation of 30 percent is not warranted under either version of Diagnostic Code 7806, however. The evidence, including VA examinations and medical records, does not show that the Veteran's dermatitis affected 20 to 40 percent of the body or exposed areas, nor does it show that he required systemic therapy for a total duration of six weeks or more, but not constantly, during the preceding 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7806. The Board has also considered the application of Diagnostic Code 7800 for disfigurement of the head, face, or neck and Diagnostic Codes 7801 to 7805 for scars. However, as discussed above, the evidence, including VA examinations and medical records, does not support a finding that the Veteran's acne and dermatitis of the face, chest, shoulders, and upper back caused disfigurement or scars. Accordingly, a rating in excess of 10 percent is not warranted under those diagnostic codes. B. From November 20, 2018 For the reasons to follow, the Board concludes that the evidence shows that Veteran did not met the criteria for a compensable rating for acne and dermatitis of the face, chest, shoulders, and upper back from November 20, 2018. During the Veteran's November 2018 VA examination, the examiner characterized the Veteran's acne as superficial. She did not note the presence of deep acne, deep inflamed nodules, or pus-filled cysts. The examiner also indicated that the Veteran's dermatitis covered less than 5 percent of his total body area and less than 5 percent of exposed areas. The Veteran's acne and dermatitis were treated constantly or near-constantly with topical over the counter cleansers during the 12-month period preceding the November 2018 VA examination. The Veteran received a third VA examination in September 2021 following the Board's May 2021 remand. Again, the examiner stated that the Veteran's acne was superficial and that he did not experience deep acne, deep inflamed nodules, or pus-filled cysts. There were no indications of the presence of dermatitis over any part of the Veteran's body during this examination. Furthermore, the Veteran was not treated with any medications during the 12-month period prior to the September 2021 VA examination. Based on the November 2018 and September 2021 VA examinations, as well as the Veteran's VA treatment records, the evidence supports a noncompensable evaluation for acne and dermatitis of the face, chest, shoulders, and upper back because it manifested as superficial acne. A 10 percent rating is not warranted under Diagnostic Code 7828, as the Veteran did not experience deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck, or deep acne other than on the face and neck. 38 C.F.R. § 4.118, Diagnostic Code 7828. The Board has considered the Veteran's March 2020 lay statement indicating that his acne condition has resulted in pus-filled cysts. However, this contention is inconsistent with the weight of the competent medical evidence of record, which clearly indicates that the Veteran's acne is superficial in nature and that deep acne is not present. Accordingly, a compensable rating is not warranted under Diagnostic Code 7828. Furthermore, the evidence from November 20, 2018 no longer supports a 10 percent rating for acne and dermatitis of the face, chest, shoulders, and upper back under either version of Diagnostic Code 7806. The evidence shows that the Veteran's dermatitis covered less than 5 percent of the entire body and exposed areas and required no more than topical therapy. Such is contemplated by a noncompensable rating under the versions of Diagnostic Code 7806 in effect both before and after August 13, 2018. Based on the evidence of record, there is no indication that the Veteran's skin condition manifested as dermatitis covering at least 5 percent, but less than 20 percent, of the entire body or exposed areas or requiring intermittent systemic therapy during the period beginning November 20, 2018. 38 C.F.R. § 4.118, Diagnostic Code 7806. The Board has considered other potentially applicable diagnostic codes, including those pertaining to disfigurement of the head, face, or neck (Diagnostic Code 7800) and scars (Diagnostic Codes 7801 to 7805). However, as discussed above, there is no indication that the Veteran's acne and dermatitis of face, chest, shoulders, and upper back manifested as disfigurement or scars. As such, a compensable rating is not warranted under such diagnostic codes. Additionally, the issue of consideration of an extraschedular rating was raised by the November 2021 brief from the Veteran's authorized representative. Under Thun v. Peake, 22 Vet. App. 111 (2008), there is a three-step inquiry for determining whether a veteran is entitled to an extra-schedular rating. First, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Second, if the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology and is found inadequate, the Board must determine whether the Veteran's disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extra-schedular rating. The Board notes that the Veteran's representative has not identified any specific symptoms that are not fully captured by the rating criteria. In addition, the medical evidence in this case does not show such an exceptional disability picture that the available schedular evaluation for the service-connected acne and dermatitis condition is inadequate. Moreover, the Veteran has not submitted evidence demonstrating excessive absence from work or excessive hospitalizations. After a review of the record, the Board finds that a comparison between the severity and symptomatology of the Veteran's acne and dermatitis condition with the established criteria shows that the rating criteria reasonably describes the Veteran's disability level and symptomatology. The Veteran's acne and dermatitis of the face, chest, shoulders, and upper back have been rated under Diagnostic Codes 7806 and 7828 at various points during the pendency of this appeal. The record shows that he has complaints and findings of rashes, bumps, papules, and pustules. While neither Diagnostic Code 7806 nor Diagnostic Code 7828 specifically lists all the Veteran's symptoms, the Veteran's unlisted symptoms of rashes and bumps are reasonably similar to dermatitis and/or superficial acne (comedones, papules, pustules). Here, the manifestations of the Veteran's acne and dermatitis of the face, chest, shoulders, and upper back are reasonably contemplated by Diagnostic Codes 7806 and 7828. The threshold issue under Thun is thus not met, and further consideration of an extraschedular rating is not warranted. See Thun, 22 Vet. App. at 115. Accordingly, the preponderance of the most probative evidence is against the claim for a compensable rating for acne and dermatitis of the face, chest, shoulders, and upper back from November 20, 2018, to include on an extraschedular basis. In reaching this conclusion, the Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990). The claim must be denied. 2. Entitlement to an initial compensable rating for intermittent bowel incontinence. The Veteran maintains he is entitled to a 30 or 40 percent rating for his service-connected intermittent bowel incontinence, as he experiences constant daily leakage. In the alternative, he asserts that he is entitled to a 30 percent rating for rectal prolapse. The Veteran is currently assigned a noncompensable rating for intermittent bowel incontinence under Diagnostic Code 7332 for impairment of sphincter control. Under Diagnostic Code 7332, a noncompensable evaluation is assigned where impairment of sphincter control is healed or slight, without leakage. A 10 percent rating is assigned for constant slight or occasional moderate leakage. A 30 percent rating is warranted where impairment of sphincter control is manifested by occasional involuntary bowel movements, necessitating the wearing of a pad. A 60 percent rating is assigned for extensive leakage and fairly frequent involuntary bowel movements. A 100 percent rating is warranted for complete loss of sphincter control. 38 C.F.R. § 4.114, Diagnostic Code 7332. VA treatment records show that the Veteran first sought treatment for this condition in January 2018. His symptoms were described as a "[m]ucus-like secretion at the anal area usually after doing exercise but also occasionally without any exercise." He did not experience fecal incontinence. In October 2018, he described "having mucousy yellow discharge from his rectum a few times a day" in between bowel movements. The Veteran stated that the discharge seemed like bile but did not contain any blood. A VA gastroenterology note indicated that, while the Veteran complained of frequent mucus discharge from his rectum, "[t]here is no incontinence of feces and his bowel movements are regular and normal." August 2019 VA treatment records also demonstrate that the Veteran was being treated for chronic mucus discharge from the anus and that his symptoms completely resolved after eliminating all alcohol from his diet. The Veteran has also received five VA examinations pertaining to his service-connected intermittent bowel incontinence. These occurred in June 2017, August 2018, November 2018, February 2019, and September 2021. During each of these examinations, the examiners noted the Veteran's history of a mucus-like discharge from the rectum and nevertheless concluded that this was not attributable to his 2016 diagnosis of fecal incontinence. Furthermore, the September 2021 examiner reported that the Veteran's intermittent bowel incontinence resolved spontaneously. In sum, the examiners' combined opinion indicates that the Veteran's symptoms were not attributable to his service-connected intermittent bowel incontinence. Moreover, the Board acknowledges the Veteran's lay statements that he experiences bowel incontinence that forces him to "spend excessive time running to the bathroom" and that he experiences bowel leakage and bile anywhere between three and 30 times per day. However, the weight of the competent medical evidence is against these contentions. While the medical evidence shows that the Veteran has a history mucus-like secretion from the rectum, it also shows that this discharge is not attributable to his service-connected intermittent bowel incontinence and that he did not experience fecal incontinence. As the evidence does not show that the Veteran's intermittent bowel incontinence has manifested as constant slight or occasional moderate leakage, a 10 percent rating is not warranted under Diagnostic Code 7332. The Board concludes that the Veteran's intermittent bowel incontinence most closely resembles healed or slight impairment of sphincter control without leakage, which is contemplated by a noncompensable rating. 38 C.F.R. § 4.114, Diagnostic Code 7332. The Board has also considered the Veteran's contention that he is entitled to a 30 percent evaluation based on rectal prolapse. Under Diagnostic Code 7334, a 10 percent rating is warranted for mild rectal prolapse with constant slight or occasional moderate leakage. A 30 percent rating is warranted for persistent or frequently recurring moderate rectal prolapse. Finally, a 50 percent rating will be assigned for persistent severe or complete rectal prolapse. 38 C.F.R. § 4.114, Diagnostic Code 7334. However, the evidence does not show that the Veteran has been diagnosed with rectal prolapse. Rather, the Veteran's October 2018 VA treatment records indicate that his providers "think that his symptoms may be due to early rectal prolapse." Such is insufficient to show a diagnosis of rectal prolapse because it is too speculative. Furthermore, the Veteran's VA examinations did not indicate that the Veteran experienced rectal prolapse. The February 2019 VA examiner specifically stated that the Veteran "clearly states that he does not have any issues with rectal prolapse." The Veteran's March 2020 lay statement is in accordance with the medical evidence, as he stated that he has "not actually felt a prolapse." Accordingly, a rating under Diagnostic Code 7334 is not warranted. Moreover, although the Veteran's representative raised the theory of entitlement to extraschedular consideration in his November 2021 brief, the Board concludes that the rating criteria adequately contemplate the disability picture caused by his bowel incontinence. While the evidence indicates that the Veteran's history of mucus-like discharge is distinct from fecal incontinence, the level of disability caused by this discharge is similar to that described by Diagnostic Code 7332. Moreover, the Veteran has not submitted evidence demonstrating excessive absence from work or excessive hospitalizations. Additionally, the Board notes that the Veteran's representative has not identified any specific symptoms that are not fully captured by the rating criteria. As such, the threshold issue under Thun has not been met, and further consideration of an extraschedular rating is not warranted here. See Thun, 22 Vet. App. at 115. Thus, the preponderance of the most probative evidence is against the claim of entitlement to an initial compensable rating for intermittent bowel incontinence. In denying such a rating, the Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert, 1 Vet. App. at 58. The claim must be denied. Richard Kettler Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R.M. Sachs, 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.