Citation Nr: 21009864 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 10-06 935 DATE: February 23, 2021 ORDER A 30 percent rating, but no more, for bilateral pes planus with bilateral plantar fasciitis and arthritis, prior to August 14, 2019, is granted, subject to the criteria governing the award of monetary benefits. A rating in excess of 30 percent for bilateral pes planus with bilateral plantar fasciitis and arthritis is denied. A rating in excess of 10 percent for right ankle tendonitis is denied. A rating in excess of 10 percent for left ankle tendonitis is denied. A rating in excess of 20 percent for chronic low back strain prior to November 17, 2018, is denied. A rating in excess of 40 percent for chronic low back strain since November 17, 2018, is denied. FINDINGS OF FACT 1. The Veteran served on active duty from April 1985 to July 1999; he has been 100 percent disabled since August 2019. 2. Prior to August 14, 2019, a bilateral foot disability was manifested by subjective complaints of pain upon prolonged walking and standing; objective findings included pain on use and manipulation accentuated, and characteristic callouses. 3. Throughout the appeal period, a bilateral foot disability has been manifested by pain on use and manipulation accentuated, and some characteristic callouses; pronounced pes planus, marked pronation, or marked inward displacement and severe spasm of the tendo achillis on manipulation not improved by orthopedic shoes or appliances has not been shown. 4. Right and left ankle tendonitis has been manifested by pain, dorsiflexion to 15 degrees, and plantar flexion to 40 degrees. 5. Prior to November 17, 2018, a low back disability strain was manifested by forward flexion to, at worst, 60 degrees; the evidence does not show ankylosis, or incapacitating episodes of intervertebral disc syndrome (IVDS) having a duration of at least 4 weeks but less than 6 weeks during the past 12 months, or forward flexion limited to 30 degrees or less. 6. Since November 17, 2018, a low back strain disability has been manifested by pain and limitation of motion but no evidence of ankylosis or incapacitating episodes of IVDS. CONCLUSIONS OF LAW 1. The criteria for a 30 percent, but no more, for bilateral pes planus with bilateral plantar fasciitis and arthritis prior to August 14, 2019, have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.14, 4.71a, Diagnostic Code (DC) 5276 (2020). 2. The criteria for a rating in excess of 30 percent for bilateral pes planus with bilateral plantar fasciitis and arthritis have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.14, 4.71a, DC 5276 (2020). 3. The criteria for a rating in excess of 10 percent for right ankle tendonitis have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 4.71a, DCs 5024, 5271 (2020). 4. The criteria for a rating in excess of 10 percent for left ankle tendonitis have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 4.71a, DCs 5024, 5271 (2020). 5. The criteria for a rating in excess of 20 percent for chronic low back strain prior to November 17, 2018, have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.7, 4.71a, DC 5237 (2020). 6. The criteria for a rating in excess of 40 percent for chronic low back strain since November 17, 2018, have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.7, 4.71a, DC 5237 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As a procedural matter, in February 2012 the Veteran testified at a hearing held before a Veterans Law Judge (VLJ). A transcript of the hearing is of record. In August 2017, he was informed that the VLJ who conducted his hearing was no longer at the Board and he was offered the opportunity to testify at another hearing; however, he did not respond. As such, the Board may proceed with the appeal. When the case was previously before the Board in April 2012, July 2013, September 2015, November 2017, and September 2018 it was remanded for additional development. Turning to the relevant laws and regulations, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Bilateral Pes Planus Prior to August 14, 2019, the Veteran was assigned a 10 percent rating for bilateral pes planus under DC 5276. To warrant a higher rating, the evidence must show: • severe bilateral flatfoot, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities (30 percent under DC 5276); • claw foot, acquired, bilateral, with all toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads (30 percent under DC 5278); • moderately severe malunion or nonunion of tarsal or metatarsal bones (20 percent under DC 5283); or, • moderately severe foot injuries (20 percent under DC 5284). Turning to the medical evidence, a January 2012 VA examiner indicated that the Veteran had pain on use of the feet. On examination, it was noted that pain was accentuated on use and manipulation of the feet; however, there was no swelling on use. The symptoms were relieved by arch supports or built up shoes/orthotics. There was not extreme tenderness on the plantar surface of either foot. The Veteran had decreased longitudinal arch height on weight-bearing bilaterally. There was not objective evidence of marked deformity or marked pronation of either foot. There was no other deformity (other than pes planus) causing alteration of the weight-bearing line. There was not marked inward displacement and severe spasm of the Achilles tendon on manipulation. A July 2016 VA examiner diagnosed the Veteran with bilateral pes planus with bilateral plantar fasciitis. The Veteran had pain on the balls of his feet as well as midfoot, on the right. Right foot pain was rated at 8 out of 10 and left foot pain was 7 out of 10. It was noted that pain was alleviated by taking Ibuprofen and using bilateral inserts. The Veteran reported that his feet did not affect his daily activities or his job. He reported daily flare-ups which are aggravated by walking extensively. Right foot flare-ups were alleviated by stretching. Left foot flare-ups were alleviated by rest and ice. His flare-ups last from 10 to 15 seconds. The examiner found no functional loss/impairment of the feet. There was bilateral foot pain on use and manipulation of the feet, with pain accentuated on use. There was no swelling but there were characteristic callouses. Arch supports were noted to effectively relieve symptoms bilaterally. There was extreme tenderness to plantar surfaces of both feet. There was decreased longitudinal arch height of one or both feet on weight bearing. There was no objective evidence of marked deformity of one or both feet (pronation/abduction). There was not marked pronation of one or both feet, marked inward displacement and severe spasm of the Achilles tendon on manipulation, or other deformity causing alteration of the weight-bearing line. The examiner stated that there were no other deformities or foot conditions not otherwise described, including hallux valgus, clawfoot, or malunion/nonunion of the tarsal or metatarsal bones. On physical examination, there was bilateral foot pain, but the examiner stated that it did not contribute to functional loss. The Veteran had good range of motion and strength in his feet. He reported that his feet did not affect his daily activities or his job. The examiner also opined that there was not functional loss during flare-ups or when the feet were used repeatedly over a period of time. It was noted that the Veteran regularly used bilateral shoe inserts. Degenerative arthritis of both feet was noted on 2009 X-ray studies. Based on the medical evidence noted above, a 30 percent rating is warranted for this time period because the evidence shows that although there was not marked deformity or swelling, there was pain on manipulation and use accentuated and characteristic callosities. These criteria are listed under DC 5276 for severe pes planus and suffice to warrant a higher, 30 percent rating (two of the four characteristics listed are met). Moreover, December 2009 X-ray studies showed that degenerative arthritis of both feet was present and the August 2019 examiner (noted below) stated that this is a progression of the pes planus. Under the circumstances, a 30 percent rating is warranted for the time period prior to August 14, 2019. The appeal is granted to this extent. For the time period beginning August 14, 2019, the Veteran’s pes planus is rated at 30 percent under DC 5276. To warrant a higher rating, the evidence must show: • foot injury with loss of use of the foot (40 percent, DC 5284) • pronounced bilateral flatfoot with symptoms of marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, which are not improved by orthopedic shoes or appliances (50 percent, DC 5276). An August 2019 VA examiner noted that the Veteran was diagnosed with bilateral pes planus with bilateral plantar fasciitis. He reported that his feet hurt after long walking/standing. He indicated that he received no treatment for his feet but reported flare-ups of foot pain in that he had pain with activity. However, he did not have foot pain during the examination. He stated that flare-ups did not affect the function of the feet. He also denied functional loss/impairment. On examination, there was no bilateral foot pain. The examiner specified that the foot pain occurred during activity. Pain was noted to be accentuated on use of the feet; however, there was no pain on manipulation of the feet. There was also no swelling on use or characteristic callouses. It was noted that he did not use inserts, orthotics or built up shoes. There was extreme tenderness on the plantar surfaces of the feet. The Veteran had decreased longitudinal arch of one or both feet on weight bearing. There was no objective evidence of marked deformity of one or both feet, and there was not marked pronation. The examiner indicated that the Veteran has bilateral pes planus with bilateral plantar fasciitis and degenerative changes from use, wear and tear. The severity of the conditions was described as mild. Additional factors contributing to the disability was functional impairment due to pain on movement and pain with weight bearing. The examiner indicated that the degenerative arthritis was a progression of the pes planus with plantar fasciitis. At no point during the appeal period does the Veteran’s service-connected pes planus disability warrant a rating in excess of 30 percent. In this regard, while the VA examination reports generally reflected that there was extreme tenderness on the plantar surfaces of the feet, there was never marked pronation, marked inward displacement and severe spasm of the Achilles tendon on manipulation, or even consistent use of orthotics. Of note, at the August 2019 examination, he indicated that he received no treatment for his bilateral pes planus, including shoe inserts or orthotics, and the examiner described his pes planus as mild. As such, a rating in excess of 30 percent is not warranted under DC 5276 at any time period on appeal. A higher rating is also not warranted under DC 5284, as there is no evidence of loss of use of either foot. The evidence clearly shows the Veteran has use of his feet and he has not claimed that a higher rating is warranted based on loss of use of the feet. Therefore, a higher rating under DC 5284 is also not warranted. The Board has considered other DCs; however, with regard to the Veteran’s diagnoses of arthritis, the Board notes that the arthritis symptoms are already contemplated in the 30 percent evaluation under DC 5276. Further, a maximum 20 percent evaluation may be awarded for degenerative arthritis where there is X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. As the Veteran has been awarded a 30 percent evaluation under DC 5276, DC 5003 (for degenerative arthritis) does not assist the Veteran. Therefore, a higher or separate evaluation is not warranted under DC 5003. Right and Left Ankle Tendonitis The Veteran’s right and left ankle tendonitis are each rated at 10 percent pursuant to DC 5024 for tenosynovitis. 38 C.F.R. § 4.71a instructs that diseases under DCs 5013 through 5024 will be rated based on limited of motion of the affected parts. Limitation of motion of the ankle is evaluated under DC 5271. A 10 percent evaluation is assigned for moderate limitation of the ankle, and a maximum 20 percent evaluation is assigned for marked limitation of motion. Normal range of motion of the ankle is 20 degrees of dorsiflexion and 45 degrees of plantar flexion. 8 C.F.R. § 4.71a, Plate II. Ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. Lewis v. Derwinski, 3 Vet. App. 259 (1992). Words such as “marked” and “moderate” are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be “equitable and just.” 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. Turning to the medical evidence, an April 2012 VA examiner noted the Veteran’s report that he had ankle pain with walking and pain at night. He reported flare-ups in that he had sharp pain in the ankles when he stood up. Range of motion was right and left ankle plantar flexion to 45 degrees and dorsiflexion to 20 degrees. Objective evidence of pain was not documented. No functional loss/impairment was noted, and range of motion did not change after three repetitions. There was no localized tenderness or pain on palpation of joint/soft tissue of either ankle. Ankle strength was full and stability tests were normal. There was no ankylosis. Imaging studies revealed no abnormal findings. A December 2013 VA examiner diagnosed bilateral ankle sprains. The Veteran denied experiencing flare-ups that impact the function of the ankles. Range of motion was right and left ankle plantar flexion to 45 degrees without pain and dorsiflexion to 20 degrees without pain. After three repetitions, range of motion did not change. The examiner stated that there was no functional loss and/or functional impairment of either ankle. Muscle strength testing was full and stability tests were normal for both ankles. Imaging studies revealed no abnormalities. A December 2018 private chiropractor indicated that the Veteran reported constant bilateral ankle pain rated at 8 out of 10. Examination of the ankles revealed that right and left dorsiflexion was to 10 degrees and right and left plantar flexion was to 20 degrees. Pain was moderate on all excursions. A January 2019 private chiropractor noted that the reported his ankle symptoms were improving. A February 2019 private chiropractor indicated that the symptoms were rated at a 5 out of 10. An August 2019 VA examiner found the Veteran’s report of bilateral ankle pain triggered by activity. It was indicated that he wore a brace on the left ankle but did not wear it to the examination. He denied flare-ups but reported functional loss due to pain, weakness, fatigue and lack of endurance. A diagnosis of bilateral ankle tendonitis was provided. On examination, there was no objective evidence of pain with range of motion in the ankles, no crepitus, no pain with weightbearing, and no ankylosis. His gait was normal. For each ankle, active range of motion for dorsiflexion was to 15 degrees. Plantar flexion was to 40 degrees. After three repetitions there was no additional loss of motion or functional loss. The examiner opined that pain, weakness and lack of endurance limit functional loss with repeated use over time; however, this did not translate into any loss of range of motion. The examiner clarified that it just meant the Veteran exhibited symptoms of pain, weakness, and lack of endurance. It was noted that he was unable to stand or walk for long on any surface. He could not jog, run, jump, hike or bike. There was no objective evidence of pain on non-weight bearing. Passive range of motion was the same as active. Based on the preponderance of evidence, the ratings in excess of 10 percent each for the Veteran’s left and right ankle disabilities are not warranted. Specifically, the evidence does not indicate symptoms more nearly approximating marked limitation of motion of either ankle. On VA examinations, there was no objective evidence of pain and the Veteran had full or near full range of motion of the ankles. In this regard, the most severe loss of range of motion was a loss of five degrees of dorsiflexion and five degrees of plantar flexion at the August 2019 VA examination. This limitation of motion does not suggest “marked” limitation. Further, while the December 2018 private chiropractor indicated that the Veteran exhibited moderate pain on motion and more limited range of motion of the ankles, this single, isolated finding is not sufficient to characterize the ankle disabilities as overall having marked limitation of motion sufficient to grant a higher 20 percent rating. Moreover, this singular finding is contradicted by the VA examiners and subsequent private chiropractor treatment records in 2019 noting improvement in the Veteran’s ankles. Next, although there is some private medical evidence showing objective evidence of pain in both ankles, there was no evidence of functional loss/impairment resulting in additional loss of motion. On the contrary, range of motion remained the same after three repetitions, the VA examiners specifically found that there was no functional loss and/or functional impairment of either ankle or that pain, weakness and lack of endurance did not translate into any additional range of motion loss, and the Veteran denied flare-ups in the ankles. Thus, the medical evidence does not support a finding of more than a moderate impairment. A higher rating is also not warranted under any other DC. In this regard, the medical evidence does not show ankylosis (DCs 5270 and 5272), malunion of the os calcis or astraglus with marked deformity (DC 5273), astragalectomy (DC 5274), or loss of use of either foot (DC 5167). Therefore, higher ratings on these bases is not warranted. Low Back Strain Lumbosacral spine disabilities are rated under the General Rating Formula for Rating Diseases and Injuries of the Spine (General Rating Formula). 38 C.F.R. § 4.71a, DCs 5237-5243. IVDS is rated under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula), whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. The Veteran’s low back disability is rated at 20 percent prior to November 17, 2018 and at 40 percent since, pursuant to DC 5237. The Board will consider all relevant diagnostic codes. A rating in excess of 20 percent will be warranted when the objective medical evidence shows the following: • forward flexion of the thoracolumbar spine 30 degrees or less (40 percent); • favorable ankylosis of the entire thoracolumbar spine (40 percent); • incapacitating episodes of IVDS having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months (40 percent). Turning to the medical evidence, a February 2011 private treatment record noted that the Veteran’s spine had full range of motion. He was also noted to have normal gait. An April 2012 VA examiner noted the Veteran’s report of 8 out of 10 back pain. The examiner stated that the Veteran did not have any diagnosis with respect to the lumbosacral spine. The Veteran denied flare-ups of back pain. Range of motion testing was forward flexion to 65 degrees with pain beginning at 65 degrees, extension to 15 degrees with pain beginning at 15 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30 degrees, right lateral rotation to 30 degrees, and left lateral rotation to 30 degrees. Repetitive motion testing was accomplished and after three repetitions, range of motion did not change. The examiner opined that the Veteran had functional loss/impairment in terms of less movement than normal and pain on movement. The examiner also indicated that there was localized tenderness to palpation to joints/soft tissue of the lumbar spine. There was guarding/muscle spasm severe enough to result in abnormal gait. Muscle strength testing was full. It was noted that the Veteran regularly wore a back brace. Imaging studies were taken and no arthritis was documented. A February 2013 private chiropractor note indicated that the Veteran had chronic low back pain. It was noted that on examination there was bilateral lower paraspinal muscle tenderness, mildly reduced extension and flexion, mildly reduced lateral motion bilaterally and mildly reduced rotation bilaterally. There was normal stability, no atrophy, and normal strength. A December 2013 VA examiner diagnosed lumbosacral strain. The Veteran reported flare-ups that impacted the function of his lumbosacral spine in terms of worsening pain with activity; improvement was noted with rest and nonsteroidal anti-inflammatory medication. Range of motion testing revealed flexion to 90 degrees or greater without objective evidence of painful motion and extension to 30 degrees or greater without objective evidence of painful motion. Right and left lateral flexion and right and left lateral rotation were all to 30 degrees without objective evidence of painful motion. After three repetitions, range of motion did not change, and the examiner stated that there was no functional loss and/or functional limitation of the thoracolumbar spine. The Veteran had no muscle spasm or guarding of the thoracolumbar spine resulting in abnormal gait or abnormal spinal contour. Muscle strength testing was normal. IVDS was not present. It was noted that the Veteran used a back brace occasionally. The remaining medical evidence does not show any more severe symptoms. For the time period prior to November 17, 2018, the Veteran’s low back disability did not warrant a higher, 40 percent rating. As outlined above, the medical evidence does not show forward flexion of the thoracolumbar spine to 30 degrees or less (at worse it was to 65 degrees), ankylosis (not found), or incapacitating episodes of IVDS having a duration of at least 4 weeks but less than 6 weeks during the past 12 months (no incapacitating episodes reported). Therefore, the medical evidence does not support a higher rating. Since November 17, 2018, in order to warrant a rating in excess of 40 percent, the objective medical evidence must show the following: • unfavorable ankylosis of the entire thoracolumbar spine (50 percent) • unfavorable ankylosis of the entire spine (100 percent) • incapacitating episodes of IVDS having a total duration of at least 6 weeks during the past 12 months (60 percent) Turning to the medical evidence during this time period, a November 2018 VA examiner diagnosed lumbosacral strain and IVDS. The examiner stated that the Veteran’s initial injury in service had worsened and he had an exacerbating injury in 2016 at work. He slipped on the floor at work and fell about three times a year now. A December 2018 X-ray study of the thoracolumbar spine was normal. The Veteran reported flare-ups of the thoracolumbar spine in terms of significant increase in pain and stiffness and loss of range of motion. He also reported functional loss/impairment of the thoracolumbar spine in that he could not bend forward. Range of motion testing revealed forward flexion to 30 degrees, extension to 10 degrees, right lateral flexion to 10 degrees, left lateral flexion to 15 degrees, right lateral rotation to 5 degrees and left lateral rotation to 5 degrees. The examiner stated that the range of motion itself contributed to functional loss in that the back was very inflexible. There was pain on all ranges of motion. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the thoracolumbar spine (specifically, moderate to severe lumbar pain on both sides of paraspinous directly related to the strain). There was evidence of pain with weight bearing. After repetitive use testing and during flare-ups, there was additional loss of function or range of motion. In terms of additional loss of range of motion, forward flexion was to 25 degrees, extension to 5 degrees, right lateral flexion to 5 degrees, left lateral flexion to 10 degrees, and right and left lateral rotation to 0 degrees each. Factors that caused this functional loss included pain, weakness, fatigue, lack of endurance, and incoordination. The Veteran had guarding or muscle spasm of the thoracolumbar spine which resulted in abnormal gait or abnormal spinal contour. It was specifically noted that he had tight paraspinous muscles with broad based, cautious shuffling antalgic gait. Muscle strength testing was full (5/5) or near full (4/5). Ankylosis was not present. There was IVDS but there were no acute signs or symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. It was noted that the Veteran used a brace and a cane regularly. There was no thoracic or vertebral fracture. He had problems maintaining balance and fell about three times a year. He had a desk job but could not sit, stand, or ambulate far. He got up frequently to stretch his back. There was objective evidence of pain when the back was used in non-weight bearing. The examiner stated that passive range of motion testing was could not be performed or was not medically appropriate. The examiner opined that IVDS was directly due to or related to the service connected diagnoses (ie., a progression). An August 2019 VA examiner noted that the Veteran had a diagnosis of chronic low back strain. The Veteran reported back pain with activity and receiving a TENS unit therapy. He denied flare-ups but reported functional loss/impairment of the spine regardless of repetitive use, in terms of pain, fatigue, weakness, and lack of endurance. The Veteran reportedly did not want to do range of motion testing because he was afraid it would trigger pain. So, range of motion testing was not accomplished. The examiner indicated that objective evidence of pain was not noted during the examination. There was not objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the thoracolumbar spine. There was no evidence of pain with weight bearing. The examiner opined that pain, weakness, fatigue, and lack of endurance significantly limited functional ability with repeated use over time but the examiner was unable to predict loss of range of motion as the Veteran would not do range of motion testing. The Veteran was noted to have paraspinous muscle spasm (but not guarding) of the thoracolumbar spine; however, it did not result in abnormal spinal gait or abnormal spinal contour. There was no ankylosis. The examiner opined that the Veteran did not have IVDS or incapacitating episodes. The remaining medical evidence does not show any more severe symptoms. Based on the above, the medical evidence does not support a rating in excess of 40 percent since November 17, 2018. As outlined above, the evidence does not show ankylosis of the thoracolumbar spine or ankylosis of the entire spine. While there is limitation of motion, ankylosis is defined as a fixation of the joint. As some level of range of motion has been shown, ankylosis is not shown. Further, the health care providers have diagnosed IVDS but have specifically found that there were no incapacitating episodes, not has the Veteran so reported. Therefore, the medical evidence does not support a higher rating for this period. With respect to all the appeals, the Board has also considered the Veteran’s lay statements that his disabilities are worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of this disorder according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s service-connected disabilities of the feet, ankles and lumbosacral spine has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which the disabilities are evaluated. Moreover, as the examiners have the requisite medical expertise to render medical opinions regarding the degree of impairment caused by the disabilities and had sufficient facts and data on which to base the conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran’s subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable and the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Redman, 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.