Citation Nr: 21077188 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 14-10 739 DATE: December 28, 2021 ORDER Entitlement service connection for residuals of a traumatic brain injury (TBI) is denied. Entitlement to an initial evaluation in excess of 20 percent for a right shoulder disability is denied. Entitlement to an initial evaluation in excess of 10 percent for a cervical spine disability for the period prior to October 6, 2020 is denied. Entitlement to an evaluation in excess of 20 percent for a cervical spine disability for the period beginning October 6, 2020 is denied. Entitlement to an initial evaluation in excess of 10 percent for bilateral acquired pes planus with hallux valgus for the period prior to November 17, 2012 is denied. Entitlement to an evaluation in excess of 30 percent for bilateral acquired pes planus with hallux valgus for the period beginning November 17, 2012 denied. Entitlement to an initial evaluation in excess of 10 percent for sinus infections, status post maxillary sinus operation, for the period prior to May 11, 2018 is denied. Entitlement to an evaluation of 30 percent, but no higher, for sinus infections, status post maxillary sinus operation, for the period from May 11, 2018 to October 5, 2020 is granted. Entitlement to an evaluation of 50 percent, but no higher, for sinus infections, status post maxillary sinus operation, for the period beginning October 6, 2020 is granted. Entitlement to an initial evaluation in excess of 10 percent for gastroesophageal reflux disease (GERD) for the period prior to May 11, 2018 is denied. Entitlement to an evaluation of 30 percent, but no higher, for GERD, for the period beginning May 11, 2018 is granted. Entitlement to an initial evaluation in excess of 10 percent for injury to the maxillary branch (V2) of the trigeminal nerve is denied. Entitlement to an initial evaluation of 10 percent, but no higher, for status post bilateral hernia repair is granted. Entitlement to an initial evaluation of 10 percent, but no higher, for bilateral scars associated with status post bilateral hernia repair for the period prior to October 6, 2020 is granted. Entitlement to an evaluation in excess of 10 percent for bilateral scars associated with status post bilateral hernia repair for the period beginning October 6, 2020 is denied. REMANDED Entitlement service connection for a dental disorder, to include a neurological disorder and a jaw disorder, to include as secondary to service-connected obstructive sleep apnea, is remanded. Entitlement to an initial evaluation in excess of 10 percent for chondromalacia patella of the right knee is remanded. Entitlement to an initial evaluation in excess of 10 percent for chondromalacia patella of the left knee is remanded. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had residuals of a TBI, other than his symptoms of service-connected posttraumatic stress disorder (PTSD) and service-connected obstructive sleep apnea, at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence is against finding that the Veteran's service-connected right shoulder disability has resulted in right shoulder limited to flexion between 25 to 90 degrees at any time during the period on appeal. 3. For the period prior to October 6, 2020, the preponderance of the evidence is against finding that the Veteran's cervical spine disability resulted in forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees, or combined range of motion of the cervical spine not greater than 170 degrees. 4. For the period beginning October 6, 2020, the preponderance of the evidence is against finding that the Veteran's cervical spine disability resulted in forward flexion of the cervical spine 15 degrees or less, or favorable ankylosis of the entire cervical spine. 5. The preponderance of the evidence is against finding that the Veteran's IVDS of the cervical spine resulted in any incapacitating episodes that required bed rest prescribed by a physician and treatment by a physician at any time during the entire period on appeal. 6. For the period prior to November 17, 2012, the preponderance of the evidence is against finding that the Veteran had severe flatfoot affecting at least one foot with objective evidence of marked deformity, pain on manipulation, indication of swelling on use, and characteristic callosities. 7. For the period beginning November 17, 2012, the preponderance of the evidence is against finding that the Veteran has been having pronounced bilateral flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 8. For the period prior to May 11, 2018, the preponderance of the evidence is against finding that the Veteran's service-connected sinus condition resulted in 3 or more incapacitating episodes per year of sinusitis requiring prolonged (lasting 4 to 6 weeks) antibiotic treatment, or; more than 6 non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. 9. Resolving reasonable doubt in the Veteran's favor, for the period from May 11, 2018 to October 5, 2020, the Veteran's sinus condition more nearly approximated more than 6 non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. 10. Resolving reasonable doubt in the Veteran's favor, for the period beginning October 6, 2020, the Veteran's sinus condition more nearly approximates near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. 11. For the period prior to May 11, 2018, the preponderance of the evidence is against finding that the Veteran's GERD symptoms resulted in persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. 12. For the period beginning May 11, 2018, resolving reasonable doubt in the Veteran's favor, the Veteran has been having GERD symptoms equivalent to persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by shoulder pain. 13. The preponderance of the evidence is against finding that the Veteran's injury to the maxillary branch of the trigeminal nerve has been resulting in severe incomplete paralysis of his left side of face. 14. Resolving reasonable doubt in the Veteran's favor, the Veteran's status post bilateral hernia repair condition more nearly approximates postoperative recurrent hernia which is readily reducible and well supported by truss or belt. 15. For the period prior to October 6, 2020, resolving reasonable doubt in the Veteran's favor, the Veteran has had 2 painful scars associated with bilateral hernia repair. 16. The evidence of record does not show that the Veteran has had more than 2 painful or unstable scars associated with bilateral hernia repair at any time during the period on appeal. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of a TBI have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 2. The criteria for an initial evaluation in excess of 20 percent for a right shoulder disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.14, 4.71a, Diagnostic Code 5201 (2020). 3. The criteria for an initial evaluation in excess of 10 percent for a cervical spine disability for the period prior to October 6, 2020 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.14, 4.71a, Diagnostic Code 5243 (2020). 4. The criteria for an evaluation in excess of 20 percent for a cervical spine disability for the period beginning October 6, 2020 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.14, 4.71a, Diagnostic Code 5243 (2020). 5. The criteria for an initial evaluation in excess of 10 percent for bilateral acquired pes planus with hallux valgus for the period prior to November 17, 2012 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.14, 4.71a, Diagnostic Code 5280-5276 (2020). 6. The criteria for an evaluation in excess of 30 percent for bilateral acquired pes planus with hallux valgus for the period beginning November 17, 2012 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.14, 4.71a, Diagnostic Code 5280-5276 (2020). 7. The criteria for an initial evaluation in excess of 10 percent for sinus infections, status post maxillary sinus operation for the period prior to May 11, 2018 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6513 (2020). 8. Resolving reasonable doubt in the Veteran's favor, the criteria for an evaluation of 30 percent, but no higher, for sinus infections, status post maxillary sinus operation for the period from May 11, 2018 to October 5, 2020 have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6513 (2020). 9. Resolving reasonable doubt in the Veteran's favor, the criteria for an evaluation of 50 percent, but no higher, for sinus infections, status post maxillary sinus operation for the period beginning October 6, 2020 have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6513 (2020). 10. The criteria for an initial evaluation in excess of 10 percent for GERD for the period prior to May 11, 2018 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7399-7346 (2020). 11. Resolving reasonable doubt in the Veteran's favor, the criteria for an evaluation of 30 percent, but no higher, for GERD for the period beginning May 11, 2018 have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7399-7346 (2020). 12. The criteria for an initial evaluation in excess of 10 percent for injury to the maxillary branch (V2) of the trigeminal nerve have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8299-8207 (2020). 13. Resolving reasonable doubt in the Veteran's favor, the criteria for an initial evaluation of 10 percent, but no higher, for status post bilateral hernia repair have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7338 (2020). 14. Resolving reasonable doubt in the Veteran's favor, the criteria for an initial evaluation of 10 percent, but no higher, for bilateral scars associated with status post bilateral hernia repair for the period prior to October 6, 2020 have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7804 (2020). 15. The criteria for an evaluation in excess of 10 percent for bilateral scars associated with status post bilateral hernia repair for the period beginning October 6, 2020 have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7804 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1980 to August 1980, from March 1981 to April 1981, and from March 1987 to October 2008. This case is before the Board of Veterans' Appeals (Board) on appeal from September 2009, February 2010, and March 2018 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2018, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the electronic claims file. In October 2018, the Board remanded the matters for additional development. Now the matters are returned to the Board. Service connection The Veteran is seeking service connection for residuals of a TBI and contends that his in-service experiences of IED explosions resulted in his current condition. A veteran is entitled to VA disability compensation if there is disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110, 1131 (2012). To establish an entitlement to service connection for a disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b) (2012). For VA to deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App., at 54. The Board notes that the Veteran has not been formally diagnosed with TBI or residuals of a TBI. The Veteran underwent a VA examination for residuals of TBI in September 2020. The Board notes that a neurologist conducted the examination. The Veteran reported short term memory loss since returning from Iraq and that it may be attributed to IED explosions he had experienced in service. The examiner found a complaint of mild memory loss, attention, concentration, or executive functions, but without objective evidence on testing. The examiner noted that the Veteran's judgment, social interaction, orientation, motor activity with intact motor and sensory system, and visual spatial orientation were all normal. The examiner indicated that the Veteran has subjective symptoms that do not interfere with work, instrumental activities of daily living, or family or other close relationships. The examiner noted that the Veteran has one or more neurobehavioral effects that do not interfere with workplace interaction or social interaction. The examiner observed that the Veteran is able to communicate by spoken and written language and to comprehend spoken and written language, and had normal consciousness. Also, the examiner provided that the Veteran does not have any subjective symptoms of any mental, physical, or neurological conditions or residuals attributable to a TBI. With that, the examiner found that the Veteran does not have or ever had a TBI or any residuals of a TBI. The examiner pointed out that the Veteran reported 4 IED exposures and 1 mortar exposure without loss of consciousness, but received no evaluations or treatments for these events. Further, the examiner opined that the Veteran's symptoms of short term memory loss and insomnia are less likely to be the result of blast injury in service, but more likely consequences of his service-connected PTSD and obstructive sleep apnea. The Board finds the September 2020 VA examiner's finding to be competent and credible evidence and assigns high probative weight as the examiner made the finding after reviewing the Veteran's record in conjunction with an in-person examination of the Veteran. Based on above, the Board finds that the preponderance of the evidence of record is against finding that the Veteran has had residuals of a TBI, other than his symptoms of service-connected PTSD or service-connected obstructive sleep apnea, at any time during or approximate to the pendency of the claim. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply here. Consequently, the Veteran's entitlement to service connection for residuals of a TBI is not warranted. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). Increased ratings The Board notes that the RO increased disability ratings for some of the disabilities during the period on appeal. However, as the highest possible ratings for those disabilities have not been assigned, the appeals continue. See AB v. Brown, 6 Vet. App. 35 (1993). A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule). See generally 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can practicably be determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. See 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2020). Separate diagnostic codes identify the various disabilities. 38 C.F.R. § 4.27 (2020). VA has a duty to acknowledge and to consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. See Schafrath v. Derwinski, 1 Vet. App. 589, 592-93 (1991). Where there is a question as to which of two ratings to apply, VA will assign the higher rating if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7 (2020). Otherwise, it will assign the lower rating. Id. 1. Right shoulder The Veteran is service-connected for right shoulder acromioclavicular degenerative changes. He was assigned initial disability rating of 20 percent under Diagnostic Code 5201. Under Diagnostic Code 5201, in pertinent part, a 30 percent evaluation is warranted for limitation of motion to midway between side and shoulder level (e.g., flexion between 25 to 90 degrees) in the major extremity, and a maximum 40 percent evaluation is warranted for limitation of motion to 25 degrees from the side in the major extremity. 38 C.F.R. § 4.71a, Diagnostic Code 5201 (2020). The record shows that the Veteran is right hand dominant. On February 2009 examination, the Veteran reported chronic right shoulder pain since his in-service injury. He described his pain as dull and aching pain with 4 out of 10 pain level, which flares up to a sharp pain of 8 out of 10. The Veteran stated that the flare-up occurs at least once every day and it lasts 1 to 2 hours. He provided that flare-ups are brought on by cold weather, lifting more than 25 pounds, doing lawn work, and driving more than 2 hours. He also reported that his right shoulder condition reduces his productivity and efficiency at work. After 3 repetitions, the right shoulder flexion was to 170 degrees, abduction was to 120 degrees, external rotation to 85 degrees, and internal rotation to 80 degrees. The Veteran had negative Hawkins test, and there was no redness, warmth, edema, crepitans, or deformity of the right shoulder. The examiner noted that the Veteran had slight tenderness over the anterior shoulder joint. On November 2012 VA examination, the examiner noted the Veteran's diagnosis of right shoulder AC joint arthritis. The Veteran reported flare-ups and stated to pain is much worse with overhead activities. The right shoulder flexion was to 150 degrees with painful motion beginning at 140 degrees, and abduction was to 140 degrees with painful motion beginning at 140 degrees. The Veteran was able to perform repetitive-use testing with 3 repetitions without additional limitation in range of motion. As to the Veteran's functional loss of his right shoulder, the examiner noted less movement than normal and pain on movement. The Veteran had localized tenderness or pain on palpation of right shoulder joint and guarding. The right shoulder muscle strength testing was all normal. The Veteran did not have ankylosis of the shoulder joint. The Veteran had positive Hawkins' Impingement Test for the right shoulder. Empty-can test, external rotation/infraspinatus strength test, and lift-off subscapularis test were all negative. The examiner provided that the Veteran's right shoulder condition does not impact his ability to work. On August 2015 VA examination, the examiner noted the Veteran's diagnoses of right AC joint arthritis and right shoulder degenerative arthritis. The Veteran reported that he has pain in the anterior right shoulder during flare-ups. The right shoulder flexion was to 180 degrees; abduction was to 140 degrees; and both external and internal rotations were to 90 degrees. Pain was noted on right shoulder abduction testing, but the examiner provided that it does not result in or cause functional loss. The Veteran was able to perform repetitive-use testing with at least 3 repetitions without additional functional loss or range of motion afterwards. There was evidence of pain with weight-bearing and localized tenderness or pain on palpation of the right biceps tendon and right AC joint. There was no objective evidence of crepitus. The examiner provided that pain, weakness, and fatigability significantly limit functional ability with flare-ups, and described range of motion during a flare-up as abduction to 140 degrees. The examiner noted that there is a reduction in right shoulder muscle strength (4/5 for abduction), which is entirely due to the service-connected right shoulder disability. No right shoulder ankylosis or rotator cuff condition was found. There was no suspected instability, dislocation, or labral pathology of the right shoulder. The examiner provided that there is no evidence that the Veteran's current right shoulder diagnosis or its flare-ups will result in significant pain, disability, dysfunction, or deformity. On November 2015 VA examination, the examiner noted the Veteran's diagnosis of right AC joint osteoarthritis. It was indicated that the Veteran did not report any flare-ups of the right shoulder or arm, or any functional loss or impairment. The examiner reported that the Veteran's right shoulder range of motion was all normal and pain was not noted on examination. The Veteran was able to perform repetitive-use testing with at least 3 repetitions with no additional functional loss or range of motion after 3 repetitions. There was no pain with weight-bearing or objective evidence of localized tenderness or pain on palpation of the right shoulder joint or associated soft tissue. There was no objective evidence of crepitus or reduction in right shoulder muscle strength. The examiner provided that a right shoulder rotator cuff condition was suspected, but Hawkins' impingement test and empty-can test were both negative. The examiner noted that cross-body adduction test of the right side was positive. The examiner provided that the Veteran's service-connected right shoulder disability does not impact his ability to perform occupational task. During the May 2018 hearing, the Veteran testified that he had a right shoulder surgery in April 2017 to repair the tendons. He provided that he had to have 90 days of physical therapy after the surgery. On October 2020 VA examination, the examiner noted the Veteran's diagnoses of right shoulder impingement syndrome, right shoulder degenerative arthritis, status post right shoulder rotator cuff repair, and right shoulder acromioclavicular degenerative changes. As to current symptoms, the Veteran reported burning and sharp shooting pain and dull achy pain in bilateral shoulders from neck, and a decrease in range of motion in shoulders. The Veteran did not report flare-ups. The examiner noted that the Veteran's functional loss includes his inability to lift over 8 pounds or to lift overhead without having right shoulder pain and decreased range of motion. The right shoulder flexion was to 120 degrees, abduction was to 110 degrees, external rotation was to 45 degrees, and internal rotation was to 55 degrees. Pain was noted on all range of motion testing. The Veteran was able to perform repetitive-use testing with at least 3 repetitions without additional loss of function or range of motion. There was no objective evidence of localized tenderness or pain on palpation of the right shoulder joint or associated soft tissue. No evidence of pain with weight-bearing or crepitus was found. The examiner noted that pain significantly limits functional ability with repeated use of the right shoulder over a period of time. The examiner described such functional loss in range of motion as: flexion to 120 degrees, abduction to 105 degrees, external rotation to 40 degrees, and internal rotation to 50 degrees. The examiner noted the examination was not being conducted during a flare-up, but pain, weakness, fatigability, or incoordination do not significantly limit functional ability with flare-ups. There was a reduction in right shoulder muscle strength for forward flexion (4/5) and abduction (4/5), and the examiner indicated that this is entirely due to the Veteran's service-connected right shoulder disability. No ankylosis of the right shoulder was found. Right shoulder rotator condition was suspected, and Hawkins impingement test, empty-can test, and external rotation/infraspinatus strength test were positive. There was tenderness on palpation of the right shoulder AC joint. The examiner noted that the Veteran had a right shoulder rotator repair surgery in 2015 and its residuals are right shoulder pain with non-painful surgical scar. The examiner noted the Veteran's report of not being able to lift over 8 pounds with right arm and having difficulty with lifting overhead due to shoulder pain as functional impact of his service-connected right shoulder disability. Based on above, the Board finds that the preponderance of the evidence is against finding that the Veteran's service-connected right shoulder disability results in right shoulder limited to flexion between 25 to 90 degrees at any time during the period on appeal. The Board concludes that the 20 percent initial evaluation of the Veteran's right shoulder disability is appropriate considering his functional limitation shown in the evidence of record. Consequently, the Veteran's entitlement to an initial evaluation in excess of 20 percent for a right shoulder disability is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.14, 4.71a, Diagnostic Code 5201 (2020). 2. Cervical Spine The Veteran is currently service-connected for status post cervical fusion of C5-C6 with degenerative disc disease at C7-T1. The Veteran was initially rated at 10 percent for the disability, and the RO has increased the rating to 20 percent from October 6, 2020. The Veteran's cervical spine disability is evaluated under either the General Formula for Diseases and Injuries of the Spine (General Formula) or the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, whichever method results in the higher rating. 38 C.F.R. § 4.71a (2020). Under General Formula, in pertinent part, a 20 percent evaluation is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or combined range of motion of the cervical spine not greater than 170 degrees. A 30 percent evaluation is warranted for forward flexion of the cervical spine 15 degrees or less, or favorable ankylosis of the entire cervical spine; a 40 percent evaluation is warranted for unfavorable ankylosis of the entire cervical spine; and a maximum 100 percent disability rating is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Formula (2020). Under IVDS formula, in pertinent part, a 20 percent evaluation is assigned for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent evaluation is assigned for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a maximum 60 percent evaluation is assigned for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, IVDS Formula (2020). First, the Board will examine whether the Veteran was entitled to an initial evaluation in excess of 10 percent for the period prior to October 6. 2020. On February 2009 VA general examination, the Veteran reported chronic neck pain. He described the pain as dull and aching pain with a 5 out of 10 pain level, which flares up to 9 to 10 out of 10. He reported having pain with suddenly turning his head, sleeping in certain positions, driving more than 2 hours, lifting more than 25 pounds, doing lawn work, or doing computer work for more than 90 minutes. As to his work, the Veteran stated that his neck pain reduces productivity and efficiency because his job generally requires lifting boxes. After 3 repetitions, the cervical spine forward flexion was to 35 degrees, extension was to 0 degrees, both right and left lateral flexions to 45 degrees, right lateral rotation to 65 degrees, and left lateral rotation to 60 degrees. The examiner noted pain on all range of motion testing. On November 2012 VA examination, the Veteran reported that his neck pain is worse with heavy lifting and looking side to side. The cervical spine forward flexion was to 40 degrees with painful motion beginning at 35 degrees, extension was to 40 degrees with painful motion beginning at 40 degrees, both right and left lateral flexions were to 40 degrees with painful motions beginning at 40 degrees, right lateral rotation was to 75 degrees with painful motion beginning at 75 degrees, and left lateral rotation was to 70 degrees with painful motion beginning at 70 degrees. The Veteran was able to perform repetitive-use testing with 3 repetitions. Post-test flexion was to 40 degrees, post-test extension was to 35 degrees, post-test right and left lateral flexions were to 40 degrees, and post-test right and left lateral rotations were to 70 degrees. As to functional loss, the examiner indicated that the Veteran's had less movement than normal and pain on movement. The Veteran did not have localized tenderness or pain to palpation for cervical spine joints. The examiner noted that guarding or muscle spasm of the cervical spine is present, but it does not result in abnormal gait or spinal contour. Muscle strength testing were all normal, no muscle atrophy was found. Reflex examinations and sensory examinations were all normal. The examiner noted that the Veteran had IVDS of the cervical spine, but he has not had any incapacitating episodes over the past months due to IVDS. The examiner provided that the Veteran's cervical spine condition impacts his ability to work because he has pain with neck movement. On November 2015 VA examination for neck conditions, the examiner noted the Veteran's diagnosis of cervical fusion. The Veteran did not report flare-ups of the cervical spine, but reported that he has limitation in neck flexion and is unable to complete chores at home or sit for a prolonged period due to his cervical spine disability. The cervical spine forward flexion was to 40 degrees, extension was to 30 degrees, both right and left lateral flexions were to 45 degrees, and both right and left lateral rotations were to 75 degrees. The Veteran was able to perform repetitive-use testing with at least 3 repetitions without additional loss of function or range of motion after 3 repetitions. The examiner noted that the Veteran had spinal fusion at 2 levels. There was no evidence of pain with weight-bearing or localized tenderness or pain on palpation of the joint or associated soft tissue of the cervical spine. The Veteran did not have localized tenderness, guarding, or muscle spasm of the cervical spine. No ankylosis of the spine was found. The examiner indicated that the Veteran does not have IVDS of the cervical spine. The examiner provided that there is mild limitation to his work because he is not able to perform sustained sitting or standing for greater 1 hour before he has to rest and resume working after a period of rest. Based on above, the Board finds that the preponderance of the evidence is against finding that the Veteran's cervical spine disability resulted in forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees, or combined range of motion of the cervical spine not greater than 170 degrees for the period prior to October 6, 2020. Consequently, the Veteran's entitlement to an initial evaluation in excess of 10 percent for a cervical spine disability is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.14, 4.71a, Diagnostic Code 5201 (2020). Now the Board will examine whether the Veteran is entitled to an evaluation in excess of 20 percent for the period beginning October 6, 2020. On October 2020 VA examination for neck conditions, the examiner noted the Veteran's diagnoses of degenerative arthritis of the spine, IVDS, and status post cervical fusion of C5-C6 with degenerative disc disease at C7-T1. As to functional loss due to the disability, the Veteran reported that he has painful range of motion in neck when moving his head, which requires him to pull out far at an intersection when driving in order to look both ways. Cervical spine forward flexion was to 35 degrees, extension was to 30 degrees, right lateral flexion was to 40 degrees, left lateral flexion was to 35 degrees, right lateral rotation to 50 degrees, and left lateral rotation to 45 degrees. Pain was noted on all range of motion testing. The Veteran was able to perform repetitive-use testing with at least 3 repetitions without additional loss of function or range of motion after 3 repetitions. There was no evidence of pain with weight-bearing or localized pain on palpation of the joint or associated soft tissue of the cervical spine. The examiner noted that pain significantly limits functional ability with repeated use over a period of time. The examiner described such functional loss with the following range of motion: forward flexion to 30 degrees, extension to 25 degrees, right lateral flexion to 40 degrees, left lateral flexion to 30 degrees, right lateral rotation to 45 degrees, and left lateral rotation to 40 degrees. The examiner provided that pain, weakness, fatigability, or incoordination do not significantly limit functional ability with flare-ups. The Veteran had muscle spasm and guarding of the cervical spine, but it did not result in abnormal gait or abnormal spinal contour. The Veteran did not have muscle atrophy or ankylosis of the spine. The examiner noted that the Veteran has IVDS of the cervical spine, but indicated that the Veteran has not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. As to the functional impact of the Veteran's service-connected cervical spine disability, the examiner noted that the Veteran has to take a lot of pain medication for neck pain, which interferes with his alertness at a job. Also, the Veteran reported that moving head in all directions cause neck pain and he cannot type for more than 30 minutes without his hands going numb. Based on above, the Board finds that the preponderance of the evidence is against finding that the Veteran's cervical spine disability resulted in forward flexion of the cervical spine 15 degrees or less, or favorable ankylosis of the entire cervical spine for the period beginning October 6, 2020. The Board also finds that the preponderance of the evidence is against finding that the Veteran's IVDS of the cervical spine resulted in any incapacitating episodes that required bed rest prescribed by a physician and treatment by a physician at any time during the entire period on appeal. As such, evaluating the disability under General Formula is appropriate and more favorable to the Veteran. Consequently, the Veteran's entitlement to an evaluation in excess of 20 percent for a cervical spine disability for the period beginning October 6, 2020 is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.14, 4.71a, Diagnostic Code 5243 (2020). 3. Pes planus with hallux valgus The Veteran is service-connected for bilateral acquired pes planus with hallux valgus. He was initially assigned a 10 percent disability rating, but the RO increased it to 30 percent from November 17, 2012. Thus, the Board will examine whether the Veteran was entitled to an initial evaluation in excess of 10 percent for the period prior to November 17, 2012, and whether he is entitled to an evaluation in excess of 30 percent for the period beginning November 17, 2012. The Board notes that the maximum rating under Diagnostic Code 5280 for hallux valgus is 10 percent. Thus, the Board will apply Diagnostic Code 5276 for acquired flatfoot to evaluate the Veteran's feet disability. Under Diagnostic Code 5276, in pertinent part, a 20 percent evaluation is warranted for severe unilateral flatfoot with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities; a 30 percent evaluation is warranted for severe bilateral flatfoot with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities, or pronounced unilateral flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276 (2020). A maximum of 50 percent evaluation is warranted for pronounced bilateral flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. Id. On February 2009 VA examination, the Veteran reported burning-type of pain especially while standing and walking. He stated that he has never used special shoes or braces for his feet condition, but inserts give him some relief. As to the functional limitations, the Veteran reported that he cannot stand more than 20 minutes or walk more than 40 due to severe feet pain. The examiner observed that the Veteran has falling aches with weight-bearing. The Veteran did not have callus or ulcer, but had hallux valgus deformity on the right at 25 degrees and the left at 20 degrees. He had no tenderness to his foot on manipulation except slight tenderness between the fourth and fifth distal metatarsals on the left foot dorsally. The Veteran did not have plantar tenderness or malalignment of bilateral Achilles tendon. He had no atrophy or spasm, and had normal sensation to monofilament. There was no evidence of Morton neuroma or Charcot joints in either foot. The Veteran had normal wear on both of his shoes that did not have inserts. Bilateral feet X-ray revealed no acute fracture, dislocation, bony destructive lesion, or appreciable degenerative arthritic spurring. A moderate size plantar heel spur was found in the right foot. Based on above, the Board finds that the preponderance of the evidence is against finding that the Veteran had severe flatfoot affecting at least one foot with objective evidence of marked deformity, pain on manipulation, indication of swelling on use, and characteristic callosities for the period prior to November 17, 2012. Thus, the Veteran's entitlement to an initial evaluation in excess of 10 percent for bilateral acquired pes planus with hallux valgus for the period prior to November 17, 2012 is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.14, 4.71a, Diagnostic Code 5280-5276 (2020). On November 2012 VA examination, the examiner noted the Veteran's diagnosis of bilateral pes planus. The Veteran's bilateral feet pain on use of the feet was noted. The examiner indicated that bilateral feet pain is accentuated on use and on manipulation. There was no indication of swelling on use. The Veteran had characteristic calluses affecting both feet. The Veteran's symptoms were not relieved by arch supports. The Veteran did not have extreme tenderness of plantar surface of one or both feet. He had decreased longitudinal arch height on weight-bearing for both feet. There was no objective evidence of marked deformity or pronation of any foot. The weight-bearing line did not fall over or medial to the great toe. There was no lower extremity deformity other than pes planus which causes alteration of the weight-bearing line. The Veteran did not have "inward" bowing of the Achilles' tendon or marked inward displacement and severe spasm of the Achilles' tendon on manipulation. The examiner provided that the Veteran's flat foot condition does not impact his ability to work. On August 2015 VA examination, the examiner noted the Veteran's diagnosis of bilateral flat foot. The Veteran reported foot pain and his inability to walk long distance. The examiner indicated that the Veteran did not have pain on use of the feet or pain on manipulation of the feet. There was no indication of swelling on use. The Veteran did not have characteristic callouses. The examiner noted that the Veteran's use of arch supports provide relief on both feet. The Veteran did not have extreme tenderness of plantar surfaces on one or both feet. The Veteran had decreased longitudinal arch heights of one or both feet on weight-bearing, which affects both feet. There was no objective evidence of marked deformity or marked pronation of one or both feet. The weight-bearing line did not fall over or medial to the great toe, and the Veteran did not have a lower extremity deformity other than pes planus that causes alteration of the weight-bearing line. As to hallux valgus, the examiner noted that the Veteran does not have symptoms due to a hallux valgus condition and did not have a surgery for hallux valgus. The examiner indicated that the Veteran had symptoms due to hallux rigidus. On May 2018 VA examination, the Veteran testified that his feet condition has worsened since his last VA examination. He stated that he has continuous pain his right foot, especially when weight-bearing, as if he has a constant stone in the foot or has a bruise there. The Veteran provided that he was given inserts and boots. He stated that he cannot stand for any length of time and walks with a limp while having to avoid putting weight on the foot. The examiner noted that the Veteran gets mild pain in arch of both feet with long term weight-bearing. The examiner provided that there is no evidence that the Veteran's current bilateral pes planus, flare-ups of the condition, or repetitive use will result in significant pain, disability, dysfunction, or deformity. On October 2020 VA examination, the examiner noted the Veteran's diagnosis of bilateral pes planus, bilateral hallux valgus, and bilateral plantar fasciitis. The Veteran reported that he avoids prolonged standing and walking distances, and weight-bearing activities increase bilateral feet pain. The Veteran had pain in both feet on use of the feet, and it was accentuated on use. The Veteran had bilateral feet pain on manipulation of the feet and the pain was accentuated on manipulation. There was no indication of swelling on use or characteristic calluses. It was noted that the Veteran tried using arch supports and orthotics for both feet, but both feet are still symptomatic. The Veteran did not have extreme tenderness of plantar surfaces on one or both feet. The Veteran had decreased longitudinal arch height of both feet on weight-bearing. There was no objective evidence of marked deformity or marked pronation on one or both feet. The examiner indicated that the Veteran has mild or moderate symptoms due to a hallux valgus condition for both feet, and did not have surgery for hallux valgus. The Veteran did not have symptoms due to hallux rigidus. The examiner noted pain on examination of the both feet, and provided that pain on weight-bearing, non-weight-bearing, and interference with standing as contributing factors of the bilateral feet condition. The examiner provided that the Veteran's bilateral feet condition impacts his ability to work because he cannot stand or walk for prolonged periods. As to the period beginning November 17, 2012, the Board finds that the preponderance of the evidence is against finding that the Veteran has been having pronounced bilateral flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. Consequently, the Veteran's entitlement to an evaluation in excess of 30 percent for bilateral acquired pes planus with hallux valgus for the period beginning November 17, 2012 is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.6, 4.7, 4.14, 4.71a, Diagnostic Code 5280-5276 (2020). 4. Sinus condition The Veteran is service-connected for sinus infections, status-post maxillary sinus operation. He was initially rated at 10 percent disabling under Diagnostic Code 6513. Under Diagnostic Code 6513, chronic maxillary sinusitis is evaluated under General Rating Formula for Sinusitis. Under the general rating formula, in pertinent part, a 30 percent evaluation is warranted for 3 or more incapacitating episodes per year of sinusitis requiring prolonged (lasting 4 to 6 weeks) antibiotic treatment, or; more than 6 non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A maximum 50 percent evaluation is warranted for the condition following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. 38 C.F.R. § 4.97, Diagnostic Code 6513 (2020). On February 2009 VA examination, the Veteran reported getting pain in the left maxillary sinus, especially with acute infections. The examiner noted that the sinus pain correlates with purulent discharge and sometimes with crusting. The examiner stated that such episodes are not considered incapacitating, because the Veteran has not been on any antibiotics treatment for them. As to non-incapacitating episodes, the examiner noted that it occurs 4 to 5 times per year. On December 2012 VA examination, the examiner did not address the Veteran's diagnosis of chronic sinusitis. On July 2015 VA examination, the examiner noted the Veteran's diagnosis of left maxillary sinus disease and cyst. The Veteran reported intermittent pain and abscess formation where the surgery was done and pointed to an area posterior to an old incision site. The examiner noted that the July 2015 CT scan revealed chronic inflammatory and post operative changes of the paranasal sinuses with overall unchanged in appearance from the prior examination. The examiner provided that the Veteran's sinus condition does not impact his ability to work. The examiner also stated that there are no apparent changes in the Veteran's sinus condition since the last examination, and the examiner did not observe abnormality indicating any change or the X-ray showed any change. Based on above, the Board finds that the preponderance of the evidence is against finding that the Veteran's service-connected sinus condition resulted in 3 or more incapacitating episodes per year of sinusitis requiring prolonged (lasting 4 to 6 weeks) antibiotic treatment, or; more than 6 non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting for the period prior to May 11, 2018. Consequently, the Veteran's entitlement to an initial evaluation in excess of 10 percent for sinus infections, status-post maxillary sinus operation for the period prior to May 11, 2018 is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6513 (2020). During the Board hearing conducted on May 11, 2018, the Veteran testified that his sinus infections have worsened in severity. The Veteran stated that he has been getting sinus infections at least two times a month, and has be treated with antibiotics at least 3 to 4 times a year. The Board finds the Veteran competent and credible to report his sinus symptoms and treatments received. As discussed below, further worsening of the Veteran's sinus symptoms were found during the VA examination conducted on October 6, 2020. With that, for the period from May 11, 2018 to October 5, 2020, the Board resolves reasonable doubt in the Veteran's favor and finds that the Veteran's sinus condition more nearly approximated more than 6 non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. Thus, resolving reasonable doubt in the Veteran's favor, the Veteran's entitlement to an evaluation of 30 percent, but no higher, for sinus infections, status-post maxillary sinus operation for the period from May 11, 2018 to October 5, 2020 is warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6513 (2020). The next higher evaluation is not warranted for this period, because the Veteran's near constant sinus symptoms were not manifested following a radical surgery. However, on October 2020 VA examination, the examiner noted the Veteran had his third sinus surgery in 2019. As current symptoms, the Veteran reported maxillary sinus pain, nasal burning, and left side upper teeth pain. The examiner noted that the Veteran experiences episodes of sinusitis about 6 to 7 times a year with symptoms of headaches, sharp pain in the left maxillary sinus, tenderness over left maxillary, and throbbing pain in the left upper teeth. The examiner indicated that the Veteran has not had any non-incapacitating episodes of sinusitis characterized by headaches, pain and purulent discharge or crusting in the past 12 months. Also, the examiner provided that the Veteran has not had any incapacitating episodes of sinusitis requiring prolonged (4 to 6 weeks) of antibiotics treatment in the past 12 months. However, notably, the examiner provided that the Veteran has had 3 radical (open sinus) surgeries repeatedly for his sinus condition, including the latest sinus surgery in 2019. The examiner noted that the Veteran had left maxillary excisions of cyst in 1991 and 1996, and excision of cyst in between left upper teeth and left maxillary in 2019. The Veteran did not have chronic osteomyelitis following the surgery. As to the impact of his sinus condition on his ability to work, the Veteran provided that he avoids going outside in cold or dusty environment to prevent sinusitis. Based on above, the Board resolves reasonable doubt in the Veteran's favor and find that the Veteran's sinus condition more approximates near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries for the period beginning October 6, 2020. Thus, resolving reasonable doubt in the Veteran's favor, the Veteran's entitlement to an evaluation of 50 percent, but no higher, for sinus infections, status post maxillary sinus operation, for the period beginning October 6, 2020 is warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6513 (2020). A higher evaluation for the disability is not warranted as the 50 percent rating is the maximum evaluation available under Diagnostic Code 6513. 5. GERD The Veteran is service-connected for GERD, and he was initially assigned a 10 percent disability rating under Diagnostic Code 7346. Under Diagnostic Code 7346, in pertinent part, a 30 percent evaluation is warranted for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health, and a maximum of 60 percent evaluation is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. 38 C.F.R. § 4.114, Diagnostic Code 7346 (2020). On February 2009 VA examination, the Veteran reported epigastric burning that radiates, but denied having dysphagia. The Veteran stated that he never had epigastric burning that radiates to his arms. He reported that the epigastric burning happens around twice a week with a pain level of 6 out of 10, which lasts up to 2 to 3 hours. The Veteran has not had hematemesis or melanotic stools. The Veteran reported having nausea twice a week and vomiting after reflux once per week. He has never had dilation. On November 2012 VA examination, the Veteran reported that he had heartburn symptoms once in 2 weeks, which are usually nocturnal with acid reflux in his mouth. The examiner noted the Veteran's symptoms of pyrosis (heartburn), reflux, and mild nausea occurring 4 or more times per year. The examiner provided that the Veteran's esophageal condition does not impact his ability to work. On July 2015 VA examination for esophageal conditions, the examiner noted the Veteran's diagnosis of GERD. The Veteran reported that his heartburn symptoms are usually present at night and it includes some regurgitation. The examiner noted that the Veteran's treatment plan includes taking continuous medication for GERD. The Veteran had regurgitation, sleep disturbance caused by esophageal reflux (4 times or more per year), and nausea (4 times or more per year). The Veteran did not have an esophageal stricture, spasm of esophagus, or an acquired diverticulum of the esophagus. The examiner provided that the Veteran's esophageal condition impacts his ability to work because sleep disturbance from the condition affects his focus at work. Based on above, the Board finds that the preponderance of the evidence is against finding that the Veteran's GERD symptoms resulted in persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health for the period prior to May 11, 2018. Consequently, the Veteran's entitlement to an initial evaluation in excess of 10 percent for GERD, for the period prior to May 11, 2018, is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7399-7346 (2020). However, during the Board hearing conducted on May 11, 2018, the Veteran testified that his GERD symptoms have worsened since his last VA examination. He provided that food particles come back up into his throat and mouth at least 2 to 3 times a week. He stated that he has heartburn, indigestion, and problems with swallowing food. The Veteran also testified that the heartburn, indigestion, and reflux symptoms are mainly accompanied with shoulder pains. The Board finds the Veteran competent and credible to testify his GERD symptoms. A July 2020 treatment note contains that the severity of the Veteran's GERD problem is moderate. The location of the GERD symptoms is epigastric, and the associated symptoms include bloating, constipation, heartburn, nausea, and reflux. On October 2020 VA examination, the examiner confirmed the Veteran's GERD diagnosis. As to current symptoms, the Veteran reported daily acid reflux, indigestion, stomach pains, sleep disturbance, and nausea and vomiting at least 4 times a year. The examiner noted the following symptoms of the Veteran's GERD: persistent recurrent epigastric distress, infrequent episodes of epigastric distress, pyrosis, reflux, regurgitation, sleep disturbance caused by esophageal reflux (4 times or more per year with 1 to 9 days of duration), nausea (4 times or more per year with 1 to 9 days of duration), and vomiting (4 times or more per year with 1 to 9 days of duration). The examiner indicated that the Veteran has mild spasm of esophagus where he occasionally feels as if food gets stuck and it does not want to go down. As to the functional impact of GERD on his ability to work, the Veteran stated that indigestion and acid reflux interferes with his sleep, which causes him to be tired during the day. A November 2020 treatment note shows that the Veteran has GERD symptoms including back pain, bloating, constipation, and heartburn. Based on above, as to the period beginning May 11, 2018, the Board resolves reasonable doubt in the Veteran's favor and finds that the Veteran's GERD symptoms have been equivalent to persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by shoulder pain. Thus, resolving reasonable doubt in the Veteran's favor, the Veteran's entitlement to an evaluation of 30 percent, but no higher, for GERD, for the period beginning May 11, 2018, is warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7399-7346 (2020). 6. Injury to the maxillary branch (V2) of the trigeminal nerve 8299-8207 The Veteran is service-connected for injury to the maxillary branch (V2) of the trigeminal nerve associated with sinus infections status post maxillary sinus operation. He was assigned a 10 percent disability rating initially under Diagnostic Code 8207. Paralysis involving cranial nerves is evaluated under Diagnostic Code 8207. In pertinent part, a 20 percent evaluation is warranted for severe incomplete severe paralysis and a maximum of 30 percent evaluation is warranted for complete paralysis. 38 C.F.R. § 4.124a, Diagnostic Code 8207. On October 2009 VA examination, the Veteran's complaints of discomfort and numbness in the left side of the face were noted. The examiner observed that the Veteran did not have "Bell's Palsy." The examiner noted that the Veteran is able to function normally and has normal facial expressions such as frowning, smiling, raising eye brows, and closing eyes tightly. During the May 2018 hearing, the Veteran testified that he has partial paralysis and numbing in the left side of his face. On September 2020 VA examination, the examiner noted the Veteran's diagnosis of trigeminal neuralgia. The Veteran reported cranial nerve pain on the left side of the face, which began after a sinus surgery of the left maxillary. The examiner indicated that the Veteran's condition is involving cranial nerve V (trigeminal). The examiner noted that the Veteran has moderate intermittent pain and moderate numbness in the mid face of the left side. The examiner also indicated that the Veteran has mild difficulty with chewing. The Veteran's muscle strength testing and sensory examination was all normal. The examiner provided that the Veteran has incomplete paralysis of moderate level involving cranial nerve V (trigeminal), affecting his left side. The examiner indicated that the Veteran's cranial nerve condition does not impact his ability to work. Based on above, the Board finds that the preponderance of the evidence is against finding that the Veteran's injury to the maxillary branch of the trigeminal nerve has been resulting in severe incomplete paralysis of his left side of face. Consequently, the Veteran's entitlement to an initial evaluation in excess of 10 percent for injury to the maxillary branch (V2) of the trigeminal nerve is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8299-8207 (2020). 7. Status post bilateral hernia repair The Veteran is service-connected for status post bilateral hernia repair. He was initially assigned a noncompensable disability rating (0 percent) under Diagnostic Code 7338. Under Diagnostic Code 7338, in pertinent part, a 10 percent evaluation is warranted for postoperative recurrent hernia which is readily reducible and well supported by truss or belt. A 30 percent evaluation is warranted for postoperative recurrent small hernia or unoperated irremediable hernia, not well supported by truss, or not readily reducible, and a maximum of 60 percent evaluation is warranted for recurrent postoperative large hernia not well supported under ordinary conditions and not readily reducible, when considered inoperable. 38 C.F.R. § 4.114, Diagnostic Code 7338 (2020). On February 2009 VA examination, the Veteran reported no recurrent hernia since his bilateral inguinal hernia repair. The examiner noted that the Veteran does not wear a truss or use other assistive devices. On November 2012 VA examination, the examiner noted the Veteran's inguinal hernia diagnosis from 1994. The Veteran stated that lifting more than 30 pounds can trigger pain in inguinal area, which may last for an hour and resolves on its own. The examiner observed that no hernias were detected on either side. There was no indication for a supporting belt. The examiner provided that the Veteran's hernia condition does not impact his ability to work. On July 2015 VA examination for hernias, the examiner noted the Veteran's diagnosis of inguinal hernia. The Veteran reported tenderness in the left inguinal area, and lifting heavy boxes more than 30 pounds trigger pain in inguinal area which may last for an hour and resolves on its own. The examiner noted that the Veteran had bilateral hernia surgery in 1994. On examination, the examiner reported that no right hernia was detected and small hernia on the left side was found. The left hernia was readily reducible, and there was no indication for a supporting belt. As to functional impact of the service-connected bilateral hernia, it was noted that the Veteran's left lower quadrant is frequently tender even on heavy pain medications that he takes for his back condition. On May 2018 hearing, the Veteran testified that left side hernia has worsened in severity. He stated that left side hernia will bulge back out with activities such as going to the bathroom and picking up things. He provided that it entails either burning sensation or a bulge, and he is able to lie down and push it back up. On October 2020 VA examination for hernias, the examiner observed that no hernias were detected on either side. The examiner noted that there is indication for support, but no truss or belt was tried or used. The Veteran provided that he would not be able to work on a job that requires lifting because it may cause his hernia to protrude. Based on above, the Board resolves reasonable doubt in the Veteran's favor and finds that the Veteran's status post bilateral hernia repair condition more nearly approximates postoperative recurrent hernia which is readily reducible and well supported by truss or belt. Consequently, resolving reasonable doubt in the Veteran's favor, the Veteran's initial evaluation of 10 percent, but no higher, for status post bilateral hernia repair is warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7338 (2020). The next higher rating of 30 percent is not warranted because the evidence of record does not show that the Veteran has had postoperative recurrent small hernia or unoperated irremediable hernia, not well supported by truss, or not readily reducible. 8. Hernia scars The Veteran is service-connected for bilateral hernia scars. He was initially assigned a noncompensable (0 percent) disability rating, but the RO increased the rating to 10 percent from October 6, 2020. Thus, the Board will examine whether the Veteran was warranted an initial compensable rating for hernia scars for the period prior to October 6, 2020 and whether he is warranted an evaluation in excess of 10 percent for the period beginning October 6, 2020. Under Diagnostic Code 7804, a 10 percent evaluation is warranted for one or two scars that are unstable or painful; a 20 percent evaluation is warranted for three or four scars that are unstable or painful; and a 30 percent evaluation is warranted for five or more scars that are unstable or painful. 38 C.F.R. § 4.118, Diagnostic Code 7804 (2020). An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id., at Note 1. Also, if one or more scars are both unstable and painful, VA is to add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Id., at Note 2. On February 2009 VA general examination, the Veteran reported occasional burning and itching pain of the hernia scars with 3 out of 10 pain level. The Veteran stated that the pain is precipitated by lifting things over 30 pounds. In December 2009, the Veteran stated that his hernia scars are painful. In November 2012 VA examination, the examiner noted that bilateral inguinal scars are barely visible and well-healed. The examiner provided that the scars are not painful or unstable. On July 2015 VA examination for hernias, the examiner noted that the Veteran has scars related to his hernia surgeries. However, the examiner indicated that the Veteran does not have any painful or unstable scars. The Veteran's report of current symptoms did not include any complaints regarding his hernia scars. On VA examination conducted on October 6, 2020, the Veteran reported current symptoms of sharp and burning pain in the bilateral surgical scars. The examiner noted that the Veteran has 2 stable surgical scars that are painful. Based on above, the Board resolves reasonable doubt in the Veteran's favor and finds that the Veteran has had 2 painful scars associated with bilateral hernia repair for the period prior to October 6, 2020. Therefore, resolving reasonable doubt in the Veteran's favor, the Veteran's entitlement to an initial evaluation of 10 percent, but no higher, for bilateral scars associated with status post bilateral hernia repair for the period prior to October 6, 2020 is warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7804 (2020). As to the period beginning October 6, 2020, the Board finds that the evidence of record does not show that the Veteran has more than 2 painful or unstable scars at any time during the period on appeal. Consequently, the Veteran's entitlement to an evaluation in excess of 10 percent for bilateral scars associated with status post bilateral hernia repair for the period beginning October 6, 2020 is not warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7804 (2020). REASONS FOR REMAND Service connection for a dental disorder Pursuant to the October 2018 Board Remand order, the Veteran was afforded a VA examination for oral and dental conditions in June 2021. However, the Board finds that a new examination is necessary to clarify whether the Veteran has a current diagnosis or had had a diagnosis during the pendency of the appeal. In this regard, the Board found an inconsistency in the June 2021 examination report. The Board notes that the June 2021 examiner indicated that the Veteran has mandible (anatomical loss or bony injury) condition. At the same time, the examiner provided that the Veteran does not have or has ever been diagnosed with an oral or dental condition. The Board further notes that no imaging studies or diagnostic procedures have been performed for this examination. The Veteran contends that his teeth condition was caused by his service-connected trigeminal nerve injury and/or service-connected obstructive sleep apnea. See also June 2018 Letter from Dr. J.R. The evidence of record also shows the Veteran's multiple endodontic treatment to left maxillary posterior teeth. See e.g., October 2009 Dental and Oral Examination Report. Thus, the Board finds that a new examination should be obtained to determine the nature and etiology of the Veteran's teeth disorder in order to make a fully informed decision on the matter. Increased ratings for a bilateral knee condition The Veteran underwent a VA examination for knee and lower leg conditions in October 2020. However, the Board found an inconsistency in the October 2020 examination report in regard to the Veteran's symptoms of bilateral knee instability. The October 2020 VA examiner indicated a diagnosis of bilateral knee instability from 2003 and noted the Veteran's current symptoms of bilateral knee instability. Despite that, the examiner gave a negative response to an inquiry for a history of lateral instability. In this regard, the Board finds that a clarification must be obtained as the evidence of knee instability may result in additional disability ratings for the Veteran's service-connected bilateral knee disability. Accordingly, the matter is REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should schedule the Veteran for an examination by an appropriate medical examiner to determine the nature and etiology of the Veteran's current dental disorder. The examiner must review the Veteran's claims file and a copy of this REMAND order in conjunction with the examination. The examiner must provide a complete written rationale for any opinion offered. For any dental, oral, and jaw disorder, the examiner must opine whether it is at least as likely as not (50 percent or greater probability) related to an in-service injury, event, or disease, including in-service Caldwell Luc sinus procedures. If any neurological disorder of the mouth is found, the examiner must indicate whether that disorder is a separate disorder from the injury to the maxillary branch (V2) of the trigeminal nerve. For any dental, mouth, and jaw disorder, the examiner must opine whether it is at least as likely as not (50 percent or greater probability) that each diagnosed disorder is (1) proximately due to service-connected obstructive sleep apnea, or (2) aggravated beyond its natural progression by service-connected obstructive sleep apnea. 2. The AOJ should obtain a clarifying opinion from the October 2020 VA examiner regarding the Veteran's increased ratings claim for a bilateral knee disability. If the October 2020 VA examiner is not available, the requested opinion with rationale should be rendered by another appropriate medical professional. If the new examiner determines that an additional examination is necessary, the AOJ should schedule one for the Veteran. The examiner should review the Veteran's claims file and a copy of this REMAND order before rendering the requested addendum opinion. The examiner must clarify whether the Veteran's current bilateral knee disability includes knee instability. The examiner is asked to address the bilateral knee instability diagnosis from 2003 and Veteran's current symptoms of knee instability noted in the October 2020 examination report with a contrary finding of no history of lateral instability. The examiner asked to provide a complete written explanation to clarify whether the Veteran has been having bilateral knee instability symptoms since 2003. If the examiner finds that the Veteran has had a history of knee instability since 2003, the examiner should attempt to provide the severity of the instability symptoms to the extent possible. 3. After completing the above actions and any other necessary development, the issue on appeal must be readjudicated. If the claim remains denied, a Supplemental Statement of the Case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. E. Kim, 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.