Citation Nr: 21076553 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 17-14 781 DATE: December 27, 2021 ORDER Entitlement to a compensable rating for service-connected bilateral athlete's foot prior to September 27, 2021, and a 10 percent rating thereafter is denied. Entitlement to a 10 percent rating for service-connected right shin splint is granted. Entitlement to a 10 percent rating for service-connected left shin splint is granted. Entitlement to a compensable rating for service-connected asthma is denied. Entitlement to a compensable rating for service-connected gastroesophageal reflux disease (GERD) prior to September 27, 2021, and a 10 percent rating thereafter is denied. REMANDED Entitlement to a compensable rating for service-connected lower extremity compartment syndrome prior to September 27, 2021, and a 10 percent rating thereafter is remanded. FINDINGS OF FACT 1. Prior to September 27, 2021, the Veteran's bilateral athlete's foot was treated with topical cream and affected less than 5 percent of the Veteran's body. 2. From September 27, 2021 onward, the Veteran's bilateral athlete's foot was treated with topical cream and affected more than 5 but less than 20 percent of the Veteran's body. 3. Throughout the appeal period, the Veteran's right shin splint has been manifested by painful motion. 4. Throughout the appeal period, the Veteran's left shin splint has been manifested by painful motion. 5. The Veteran's service-connected asthma symptomatology does not more nearly approximate bronchial asthma with forced expiratory volume for the first second (FEV-1) of 71 to 80 percent predicted or less; or, FEV-1/forced vital capacity (FVC) of 71 to 80 percent or less; or intermittent inhalational or oral bronchodilator therapy. 6. For the period prior to September 27, 2021, the service-connected GERD was manifested by pyrosis that was well-controlled by medication. 7. For the period beginning September 27, 2021, the service-connected GERD was manifested by persistent epigastric distress including pyrosis, reflux and nausea. CONCLUSIONS OF LAW 1. For the period prior to September 27, 2021, the criteria for a compensable rating for service-connected bilateral athlete's foot are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.118, Diagnostic Codes 7813, 7806. 2. From September 27, 2021, onward the criteria for a rating in excess of 10 percent for service-connected bilateral athlete's foot are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.118, Diagnostic Codes 7813, 7806. 3. The criteria for entitlement to a 10 percent rating for right shin splint are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5262. 4. The criteria for entitlement to a 10 percent rating for left shin splint are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5262. 5. The criteria for an initial compensable rating for the Veteran's service-connected asthma are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.159, 3.321, 4.3, 4.7, 4.97, Diagnostic Code 6602. 6. Prior to September 27, 2021, the criteria for a compensable rating for GERD are not met. 38 U.S.C. § 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 4.7, 4.20, 4.114, Diagnostic Code 7399-7346. 7. Beginning September 27, 2021, the criteria for a rating in excess of 10 percent for GERD are not met. 38 U.S.C. § 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 4.7, 4.20, 4.114, Diagnostic Code 7399-7346. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 2010 to February 2016. These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2016 rating decision. These matters were previously before the Board, in February 2019 and in August 2021, and were remanded for further development. This development has been completed and the claims are back before the Board. Increased Rating Disability ratings are assigned, under a schedule for rating disabilities, based on a comparison of the symptoms found to the criteria in the rating schedule. 38 U.S.C. § 1155; 38 C.F.R. Part 4. 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 ratings schedule. The degree of impairment resulting from a disability is a factual determination and generally the Board's primary focus in such cases is upon the current severity of the disability. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994); Solomon v. Brown, 6 Vet. App. 396, 402 (1994). However, staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). If there is a question as to which evaluation to apply to the Veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It should also be noted that, when evaluating disabilities of the musculoskeletal system, 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. DeLuca v. Brown, 8 Vet. App. 202 (1995). Further, 38 C.F.R. § 4.45 provides that consideration also be given to decreased movement, weakened movement, excess fatigability, incoordination, and pain on movement, swelling, and deformity or atrophy of disuse. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40; DeLuca, 8 Vet. App. at 205. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology or evidenced by visible behavior of the claimant undertaking the motion. Id. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Id. The factors involved in evaluating, and rating disabilities of the joints include weakness; fatigability; incoordination; restricted or excess movement of the joint, or pain on movement. 38 C.F.R. § 4.45. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually 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. Painful motion is considered limited motion at the point that pain actually sets in. See VAOPGCPREC 09-1998. Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition was not "duplicative of or overlapping with the symptomatology" of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). However, pyramiding, that is the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a Veteran's service-connected disability. 38 C.F.R. § 4.14. 1. Athlete's Foot The Veteran filed a claim for service connection for bilateral athlete's foot in August 2015. Thereafter, in a March 2016 rating decision, the Veteran was granted service connection for such and assigned an initial noncompensable rating. The Veteran filed a notice of disagreement to such rating and perfected an appeal to such. In a subsequent September 2021 rating decision, the RO granted the Veteran a 10 percent disability rating from September 27, 2021 onward. As this rating decision did not constitute a full grant of benefits, the matter is still on appeal. The Veteran's bilateral athlete's foot is currently rated under Diagnostic Code (DC) 7813. Effective August 13, 2018, during the course of the appeal, the criteria for rating skin/scar disabilities were revised. See 83 Fed. Reg. 32592 (July 13, 2018); 83 Fed. Reg. 38663 (Aug. 7, 2018). Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. Therefore, the Board will consider the rating for bilateral athlete's foot under the old criteria prior to August 13, 2018, and the old and new rating criteria from August 13, 2018. Under the old DC 7813, dermatophytosis (ringworm: of body, tinea corporis; of head, tinea capitis; of feet, tinea pedis; of beard area, tinea barbae; of nails, tinea unguium; of inguinal area (jock itch), tinea cruris) is rated for disfigurement of the head, face, or neck under DC 7800; scars under DC 7801, 7802, 7803, 7804, or 7805; or rated for dermatitis under DC 7806, depending upon the predominant disability. The evidence of record reflects that the Veteran has not exhibited any disfigurement or scarring as a result of his dermatophytosis. 38 C.F.R. § 4.118, DC 7813. Therefore, the Veteran has been assigned a noncompensable and 10 percent disability rating under DC 7806. Under the old criteria for DC 7806, a noncompensable rating is assigned for dermatitis or eczema affecting less than 5 percent of the entire body or less than 5 percent of exposed area, and requiring no more than topical therapy during the past 12-month period. 38 C.F.R. § 4.118, DC 7806. A 10 percent rating is warranted for dermatitis or eczema affecting at least 5 percent, but less than 20 percent of the entire body or of the exposed areas or requiring intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of less than six weeks during the past 12-month period. Id. A 30 percent rating is warranted for dermatitis or eczema affecting 20 percent to 40 percent of the entire body or of the exposed areas or requiring systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of six weeks or more, but not constantly, during the past 12-month period. Id. A maximum, 60 percent rating is warranted for dermatitis or eczema affecting 40 percent of the entire body or more than 40 percent of the exposed areas, or constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. Id. Generally, the August 2018 amendments introduce a General Rating Formula for the Skin. Under amended DC 7813, tinea barbae is to be rated under the General Rating Formula for the skin. Under this formula, a noncompensable rating is assigned for no more than topical therapy required over the past 12-month period and at least one of the following: (1) characteristic lesions involving less than 5 percent of the entire body affected; or (2) characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is assigned for at least one of the following: (1) characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or (2) at least 5 percent, but less than 20 percent, of exposed areas affected; or (3) 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 required for a total duration of less than 6 weeks over the past 12- month period. A 30 percent rating is assigned for at least one of the following: (1) characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or (2) systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is assigned for at least one of the following: (1) characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or (2) constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required over the past 12-month period. Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability. 38 C.F.R. § 4.118, General Rating for the Skin for DCs 7806, 7809, 7813-7816, 7820-7822, and 7824. The Veteran was afforded a VA examination for his service-connected bilateral athlete's foot in September 2015. At that examination, the examiner noted the Veteran's diagnosis of bilateral athlete's foot. The Veteran noted that the condition has gotten worse, and that he had dry, cracked, hard skin which peeled off in certain areas. The Veteran was treating his bilateral athlete's foot with topical cream for six weeks or more. The Veteran had not had any non-debilitating episodes in the 12 months prior to the examination. The examiner noted that the Veteran's skin condition did not impact his ability to work. The examiner noted that the Veteran showed flakey skin of the left foot, 0 percent exposed but 5 percent or more of the entire body and the same on the right. The Veteran was afforded another VA examination for his bilateral athlete's foot in September 2021, at which point the examiner noted the Veteran's diagnosis of tinea pedis of the bilateral feet. The Veteran noted that the doctor who gave him creams during service did not help, and that he now uses over the counter Lubriderm. The examiner noted that the Veteran used topical treatment on a constant or near constant basis, with no treatments or procedures other than systemic or topical in the 12 months prior to the examination. The examiner noted that the Veteran's skin disability covered 5 to 20 percent of the Veteran's body. The examiner noted that the Veteran's skin disability did not impact his ability to work. Under the old rating criteria, prior to September 27, 2021, a 10 percent rating requires either 5 to 20 percent of the whole or exposed body to be affected by the Veteran's athlete's foot or systemic treatment with corticosteroids or other immunosuppressive drugs for a period of less than 6 weeks. Under the new criteria, a 10 percent rating requires either characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12- month period. Here, prior to September 27, 2021, the Veteran's athlete's foot was not documented to exceed 5 percent of the whole or exposed body. Further, the Veteran was treated with topical cream and was not treated with a corticosteroid, other systemic therapy, or an immunosuppressive drug. Thus, the criteria for a 10 percent rating under either the old or new criteria are not fully met. From September 27, 2021 onward, a rating in excess of 10 percent, which would be a 30 percent rating, under the old rating criteria would require a 20 to 40 percent of the whole or exposed body to be affected by the Veteran's athlete's foot or systemic treatment with corticosteroids or other immunosuppressive drugs for a period of more than 6 weeks, but not constantly, in the preceding 12 months. Under the new rating criteria, a 30 percent rating requires characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. The Veteran's topical cream treatment is neither a corticosteroid, other systemic therapy, nor an immunosuppressive drug. Additionally, the evidence does not show that the disability involves 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected. Thus, this criteria under the old or new criteria are also not fully met. Therefore, the Veteran's bilateral athlete's foot has not received more than topical treatment. From September 27, 2021 onward, the disability covered more area of the body, but it did not require any other treatment. Therefore, the preponderance of the evidence does not indicate that the Veteran service-connected residuals bilateral athletes foot warrants a compensable rating prior to September 27, 2021, or a disability rating in excess of 10 percent from September 27, 2021. 2. Bilateral Shin Splints The Veteran contends that he is entitled to a compensable evaluation for his service-connected bilateral shin splints. The Veteran was granted service connection for his right and left lower extremity shin splints in a March 2016 rating decision and assigned an initial noncompensable rating. Thereafter, he filed a notice of disagreement in March 2016 and perfected an appeal to such. The Veteran's shin splint of the right and left lower extremities have each been currently evaluated as noncompensable, effective February 23, 2016, under 38 C.F.R. § 4.71a, DC 5257. However, VA is required to evaluate the Veteran's disability under the most appropriate rating criteria that will provide the most benefit to the Veteran. The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." 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, diagnosis, and demonstrated symptomatology. Any change in diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). The Board notes that VA has amended the rating criteria for musculoskeletal system disabilities effective from February 7, 2021. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after February 7, 2021. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma, 341 F.3d 1327. However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. Therefore, the Board will consider the ratings for shin splints under the old criteria prior to February 7, 2021, and the old and new rating criteria from February 7, 2021. With respect to disabilities of the knee, 38 C.F.R. § 4.71a, DCs 5256 through 5263 set forth the relevant provisions. However, in this case, the evidence does not demonstrate ankylosis of the knee (DC 5256), instability (DC 5257), dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint DC 5258), symptomatic removal of semilunar cartilage (DC 5259), or genu recurvatum (DC 5263); thus, the DCs pertaining to such impairments are not applicable. DCs 5260 and 5261 were not changed by the February 7, 2021, amendments. DCs 5260 and 5261 provide for ratings of 0, 10, 20, or 30 percent where there is limitation of flexion of the leg to 60, 45, 30, or 15 degrees, respectively, and for ratings of 0, 10, 20, 30, 40, or 50 percent for limitation of extension of the leg to 5, 10, 15, 20, 30, or 45 degrees, respectively. Normal range of motion of the knee is to zero degrees extension and to 140 degrees flexion. See 38 C.F.R. § 4.71, Plate II. In VAOPGCPREC 9-2004, the Office of General Counsel (OGC) held that separate evaluations under 38 C.F.R. § 4.71a, DC 5260, (limitation of knee flexion) and 38 C.F.R. § 4.71a, DC5261, (limitation of knee extension) can be assigned without pyramiding. Despite the fact that knee flexion and extension both occur in the same plane of motion, limitation of flexion (bending the knee) and limitation of extension (straightening the knee) represent distinct disabilities. Prior to February 7, 2021, DC 5262 rates impairment of the tibia and fibula. A 10 percent rating is assigned for impairment of the tibia and fibula with slight knee or ankle disability. A 20 percent rating is assigned for impairment of the tibia and fibula with moderate knee or ankle disability. A 30 percent rating is assigned for impairment of the tibia and fibula with marked knee or ankle disability. A 40 percent is assigned for malunion of tibia and fibula. A 40 percent is assigned for nonunion of tibia and fibula with loose motion requiring brace. The Board observes that the words "slight," "moderate," and "severe" are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. Use of terminology by VA examiners or other physicians, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Effective February 7, 2021, DC 5262 continues to rate impairment of the tibia fibula and provides new criteria for medial tibial stress syndrome (MTSS) or shin splints. A 40 percent rating is assigned for nonunion of tibia and fibula with loose motion requiring brace. Malunion of the tibia and fibula is evaluated under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation. A 30 percent rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities. A 20 percent rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, one lower extremity. A 10 percent rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to either shoe orthotics or other conservative treatment, one or both lower extremities. A noncompensable rating is assigned for MTSS or shin splints with treatment less than 12 consecutive months, one or both lower extremities. In light of the foregoing, the Board finds that DC 5262 is the most applicable DC to rate the Veteran's bilateral shin splints. The Veteran was afforded a VA examination in September 2015 for his service connected shin splints. The examiner verified the Veteran's shin splint diagnoses of the bilateral shin splints. The Veteran noted his condition comes and goes, and also noted that he gets sharp pains in the shin area. The Veteran reported flare ups of the condition, specifically described as sudden pain up his right and left leg with tingles. The Veteran was not examined during a flare up. The examiner did not note any additional contributing factors to the disability. No ankylosis was noted on either side. Thereafter, in September 2021 the Veteran was afforded another VA examination for his bilateral shin splints. The Veteran's bilateral shin splints were diagnosed again by the examiner. The Veteran stated he still has symptoms when he runs or walks long distances. He noted the date of the examination he had mild pain in his shins. The Veteran reported flare ups of the knees, specifically described as increased pain upon running and walking long distances. He noted that the flare ups usually lasted an hour and rest made it better. The Veteran reported functional loss and impairment of difficulty walking long distances. The examiner noted that the examination was not being conducted during a flare up. The Veteran noted that pain and lack of endurance contributed to the Veteran's functional loss. No muscular atrophy, ankylosis or instability of the joint was noted. There was no noted prescription needed by a medical provider for patellar instability. The examiner did not note use of any assistive devices. The examiner noted that his disability affected his employment, specifically he was not able to walk or run long distances. During the pendency of this appeal, the record reflects the Veteran's bilateral shin splints with painful motion. Accordingly, at least a 10 percent rating, for each lower extremity, is warranted for his shin splints of the right and left lower extremity due to his pain. 38 C.F.R. § 4.59. However, the Board finds that the Veteran is not entitled to a higher disability rating. Indeed, in considering the criteria of DC 5262 prior to February 7, 2021, the Board notes that the Veteran's disability is no more than slightly disabling during the above time period. Considering the results of the VA examinations in light of the Veteran's overall disability picture as shown in the record, including the lay evidence of record, the disability does not more nearly approximate the criteria for the 20 percent evaluation for the above appeal period. Additionally, in considering the rating criteria of DC 5262 from February 7, 2021, as discussed above, a 20 percent rating is warranted for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, one lower extremity. The VA examinations discussed above do not reflect such criteria are met, and there is no evidence contrary to the VA examinations. Accordingly, the Board finds that evaluations in excess of 10 percent are not warranted. Thus, Board finds that an evaluation of 10 percent, and no higher, for the Veteran's right leg shin splint and left leg shin splint each, is warranted. The Board notes that that no other diagnostic codes provide a basis for any higher or additional ratings for the Veteran's bilateral shin splints. See Butts, 5 Vet. App. at 539 (holding that the Board's choice of diagnostic code should be upheld so long as it is supported by explanation and evidence). 3. Asthma The Veteran was granted service connection for asthma in a March 2016 rating decision and assigned an initial noncompensable rating. The Veteran filed a notice of disagreement to such rating and perfected an appeal to such. The Veteran's asthma is currently rated noncompensable under 38 C.F.R. § 4.97, DC 6602 for asthma. Pursuant to 38 C.F.R. § 4.97, DC 6602, a 10 percent disability rating is warranted for bronchial asthma with FEV-1 of 71 to 80 percent predicted; or FEV-1/FVC of 71 to 80 percent; or intermittent inhalational or oral bronchodilator therapy. A 30 percent disability rating is warranted for bronchial asthma FEV-1 of 56 to 70 percent predicted, or the ratio of FEV-1/FVC of 56 to 70 percent; or, daily inhalational or oral bronchodilator therapy, or inhalational anti-inflammatory medication. A 60 percent disability rating is warranted for bronchial asthma with FEV-1 of 40 to 55 percent predicted, or FEV-1/FVC of 40 to 55 percent, or at least monthly visits to a physician for required care of exacerbations, or intermittent (at least three per year) courses of systemic (oral or parenteral) corticosteroids. A 100 percent rating is warranted for FEV-1 less than 40 percent of predicted value, or FEV-1/FVC less than 40 percent, or diffusing capacity of the lungs for carbon monoxide (DLCO) (SB) less than 40 percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or cor pulmonale (right heart failure), or; right ventricular hypertrophy, or pulmonary hypertension (shown by Echo or cardiac catheterization), or episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy. 38 C.F.R. § 4.96(d)(4) provides that post-bronchodilator studies are required when pulmonary function test scores (PFTs) are done for disability evaluation purposes except when the results of pre-bronchodilator PFTs are normal or when the examiner determines that post-bronchodilator studies should not be done and states why. Moreover, VA has indicated that post-bronchodilator findings for PFTs are the standard in pulmonary assessment and are the values reported in this decision. See 61 Fed. Reg. 46720, 46723 (Sept. 5, 1996) (VA assesses pulmonary function after bronchodilation; test results after optimum therapy reflect the best possible functioning of an individual). In September 2015 the Veteran was afforded a VA examination for his service connected asthma. At that examination it was noted that the Veteran's asthma did not require the use of oral or corticosteroid medication or the use of inhaled medication. Further, his condition did not require the use of oral bronchodilators or antibiotics. The Veteran had a history of asthmatic attacks but did not have any asthmatic attacks or exacerbations in the 12 months prior to the examination. The examiner noted that imaging studies were performed and in September 2015 a chest x-ray showed imaging within normal limits. PFT results in September 2015 showed pre bronchodilator results of FEV-1 at 101 percent predicted, FVC at 100 percent predicted, and FEV-1/FVC at 100 percent predicted. Post bronchodilator testing was not indicated, as the examiner found that pre-bronchodilator tests were normal. The examiner found that the FEV-1/FVC percentage test most accurately reflects the Veteran's current pulmonary function. The Veteran was not shown to have multiple respiratory conditions. The examiner found that the Veteran's respiratory condition impacted his ability to work, specifically causing him to become short of breath and to wheeze upon exertion. The Veteran was afforded another VA examination for his asthma in September 2021. At that examination the examiner noted the Veteran's history of diagnosis of asthma. The examiner noted that the Veteran did not take any medication and was not under a doctor's care. The Veteran did not have any symptoms at the time of the examination. The Veteran's respiratory condition did not require the use of oral or corticosteroids or the use of inhaled medications, or oral bronchodilators. The examiner noted that the Veteran's respiratory condition did not impact his ability to work, and the Veteran did not have a diagnosis of asthma at the time of the examination, as his symptoms and examination findings were normal. The evidence of record reflects that a compensable rating for the Veteran's service connected asthma is not warranted. The evidence does not show post bronchodilator results of FEV-1 of 71 to 80 percent predicted; or, FEV-1/ FVC of 71 to 80 percent, as discussed above. Additionally, the Veteran stated that he does not require use of inhaled medications, or oral bronchodilators. Therefore, there is no evidence that the Veteran's symptoms require use of intermittent inhalational or oral bronchodilator therapy. Accordingly, the Veteran's service connected asthma symptomatology does not more nearly approximate the criteria for a compensable disability rating under DC 6602. The Board acknowledges the Veteran's contentions that his asthma warrants a compensable rating. While veterans are competent to opine on some medical matters, the degree of disability of the Veteran's asthma is a complex, non-observable process that is of the type that the courts have found to be beyond the competence of lay witnesses. Compare Jandreau, 492 F.3d at 1376 (lay witness capable of diagnosing dislocated shoulder); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (unlike varicose veins or a dislocated shoulder, rheumatic fever is not a condition capable of lay diagnosis). While the Veteran may feel that his asthma is worse than reflected by the schedular rating, he is not competent as to issues relating to PFT test scores. The above determinations are based on consideration of the applicable provisions of VA's rating schedule. The Veteran has not raised any other issues, nor has the record reasonably raised any other issues, with respect to this claim. See Doucette v. Shulkin, 28 Vet. App. at 369-70 (2017). For the foregoing reasons, the preponderance of the evidence is against a compensable rating at any time throughout the appeal period. The benefit of the doubt doctrine is therefore not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 4. GERD The Veteran was granted service connection for GERD in March 2016 rating decision and assigned an initial non compensable rating. He filed a notice of disagreement to the assigned rating and perfected an appeal to such. The RO increased the Veteran's disability rating to 10 percent effective September 27, 2021, in a September 2021 rating decision. As this does not constitute a full grant of benefits, the issue remains on appeal. Under DC 7346, a 10 percent rating is warranted when there are two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent disability evaluation is warranted for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain and productive of considerable impairment of health. A 60 percent evaluation is warranted where there are symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia, or other symptom combinations productive of severe impairment of health. See 38 C.F.R. § 4.114, DC 7346. Dysphagia is defined as difficulty in swallowing. Dorland's Illustrated Medical Dictionary (Dorland's) 579 (32nd Edition, 2012). Pyrosis is defined as heartburn. Id., 1563. Hematemesis is defined as the vomiting of blood. Id., 831. Melena is defined as the passage of dark-colored feces stained with blood pigments or with altered blood. Id., at 1126. The Veteran was afforded a VA examination for his GERD in September 2015. At that examination, the examiner noted the prior diagnosis of GERD, and acknowledged the Veteran's report of symptomatology of heartburn. The Veteran reported that he was taking Tums to treat the heartburn. His only reported symptom at the examination was heartburn. Thereafter, in September 2021, the Veteran was afforded another VA examination for his GERD. At that VA examination, the examiner noted the Veteran's prior diagnosis of GERD in 2011. He also noted the Veteran treated his heartburn with over the counter Rolaids. The Veteran's reported symptoms were persistently recurrent epigastric distress, pyrosis, reflux and nausea occurring four or more times a year. The Veteran's GERD was not noted as impacting his work. Given the foregoing, a noncompensable evaluation under DC 7346 is appropriate, as the Veteran's dyspepsia, GERD, prior to September 27, 2021, was manifested by only one of the symptoms of the 30 percent evaluation-here, pyrosis. Even characterizing the pyrosis as persistent-which is consistent with the need for continuous daily medication-the disability picture does not more nearly approximate the 10 percent criteria under the DC. 38 C.F.R. §§ 4.7, 4.114, DC 7399-7346. With regard to the Veteran's disability from September 27, 2021, onward, his symptoms as reported at his September 2021 VA examination do not warrant a higher 30 percent evaluation. While the evidence shows symptoms of persistent epigastric distress consisting of pyrosis, reflux and nausea, the medical evidence does not show that the condition is productive of considerable impairment of health. Rather, the symptoms are shown to be well controlled with over the counter medication. In addition, the medical evidence presents no findings of hematemesis, melena, anemia or material weight loss. In weighing the foregoing evidence, the Board notes that the Veteran is competent to report his symptoms of epigastric distress. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 20016); Barr v. Nicholson, 21 Vet. App. 303 (2007). According, the Board finds that an initial evaluation greater than zero percent is not warranted at any time prior to September 27, 2021, and an initial evaluation greater than 10 percent is not warranted at any time beginning September 27, 2021, in the present case. There is no benefit of the doubt to be resolved. The evidence reflects that prior to September 27, 2021, the Veteran's service-connected dyspepsia was manifested by pyrosis, well controlled by medication. Beginning September 27, 2021, the Veteran's service-connected GERD has been manifested by persistent epigastric distress consisting of pyrosis, reflux and nausea, well controlled with over the counter medication, and absent hematemesis, melena, anemia or material weight loss. As a preponderance of the evidence is against the assignment of a compensable disability rating for the Veteran's GERD, prior to September 27, 2021, or a rating in excess of 10 percent thereafter, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b). REASONS FOR REMAND The issue of entitlement to an increased rating for lower extremity compartment syndrome was remanded in August 2021 to afford the Veteran a VA examination to determine the current severity of the disability. Thereafter, the Veteran was afforded a VA examination for such in September 2021 and a Supplemental Statement of the Case (SSOC) was issued in September 2021, following this examination. Following this SSOC, the Veteran was afforded another examination for his peripheral nerves in November 2021, which addressed the disability of lower extremity compartment syndrome. After the November 2021 examination of the nerves, no SSOC was issued addressing that issue. Accordingly, the claim must be remanded so that a SSOC that includes consideration of the November 2021 VA peripheral nerve examination (and all other evidence added to the record since the September 2021 SSOC) may be issued. See 38 C.F.R. §§ 19.31, 19.37. The matters are REMANDED for the following action: Readjudicate the claim for an increased rating for a lower extremity compartment syndrome in light of all additional evidence added to the record since the September 2021 SSOC, to specifically include the November 2021 VA peripheral nerve examination. L. BARSTOW Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Nadia Kamal, 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.