Citation Nr: 21010792 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 17-37 106 DATE: February 25, 2021 ORDER Entitlement to service connection for Parkinson’s disease, including owing to exposure to herbicides, is denied. Entitlement to service connection for bladder cancer, also including owing to exposure to herbicides, conversely is granted. Entitlement to an initial rating higher than 20 percent for a service-connected low back disability (lumbar strain) is denied. FINDINGS OF FACT 1. Parkinson’s disease or “Parkinsonian-like symptoms” have not been shown to exist at any time since the filing of this claim or contemporaneous to that. 2. Service connection has been granted for the Veteran’s prostate cancer on the premise that it is the presumptive result of his presumed exposure to Agent Orange while serving aboard the USS EDSON off the coast of Vietnam, and it additionally is shown he has bladder cancer – which, like his prostate cancer, is now (effectively as of January 2021) a condition that also is presumptively associated with exposure to Agent Orange.   3. Throughout the period on appeal, the preponderance of the evidence indicates that the Veteran’s lumbar spine disability is not manifested by forward flexion of his thoracolumbar spine limited to 30 degrees or less, favorable ankylosis of his entire thoracolumbar spine, or incapacitating episodes of intervertebral disc syndrome (IVDS) having a total duration of at least 4 weeks but less than 6 weeks during the preceding 12 months. CONCLUSIONS OF LAW 1. The criteria are not met for entitlement to service connection for Parkinson’s disease or “Parkinsonian-like symptoms”. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 2. The criteria are met for entitlement to service connection for bladder cancer. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria are not met for entitlement to an initial rating higher than 20 percent for the service-connected lumbar spine disability. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1968 to November 1972 and from September 1990 to April 1991. The Veteran testified in support of these claims during a hearing in March 2020 before the undersigned Veterans Law Judge (VLJ) of the Board. A transcript of the proceeding is of record.   In April 2020, the Board remanded these claims back to the local Regional Office (RO), i.e., back to the Agency of Original Jurisdiction (AOJ), as well as a claim for service connection for prostate cancer, for further development and consideration. The RO was to determine whether the USS EDSON had navigated within the 12-nautical mile territorial sea of the Republic of Vietnam to, in turn, warrant presuming the Veteran was exposed to herbicides during his service, including to the dioxin in Agent Orange. See Procopio v. Wilkie, 913 F.3d 1371 (Fed. Cir. 2019). The RO also was to obtain VA examinations reassessing the severity of the Veteran’s lumbar spine disability and medical nexus opinions regarding the etiology of his additionally claimed Parkinson’s disease, bladder cancer, and prostate cancer (assuming it was not determined these conditions, instead, were presumptively associated with his service). Following a May 2020 VA examination, on remand, the RO granted service connection for prostate cancer on the premise it is the presumptive result of the Veteran’s presumed exposure to Agent Orange off the Coast of Vietnam. And, as expressly required by the governing VA regulation, the RO assigned an initial 100 percent rating for the prostate cancer retroactively effective from November 23, 2016, under the provisions of 38 C.F.R. § 4.115A, Diagnostic Code 7528. This Diagnostic Code mandates this initial rating for the first 6 months pending reassessment of the severity of the disability at that later point in time to determine whether there has been any recurrence or metastasis that, in turn, will determine whether the 100 percent rating continues or is lessened and the disability rated, instead, based on residuals of voiding dysfunction or renal dysfunction, whichever is predominant. If the Veteran disagrees with the initial or any subsequent rating and/or effective date assigned for this now service-connected disability, he must separately appeal these “downstream” issues. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). Thus, only the claims for service connection for Parkinson’s disease and for bladder cancer and for a higher rating for the low back disability are still at issue.   Service Connection Service connection is granted for disability resulting from disease or injury incurred in or aggravated by active military service in the line of duty. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection requires evidence showing: (1) a current disability; (2) incurrence or aggravation of a disease or an injury in service; and (3) a correlation (“nexus”) between the current disability and the disease or injury incurred or aggravated in service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes the disability was incurred in service. 38 C.F.R. § 3.303(d). 1. Entitlement to service connection for Parkinson’s disease Concerning this claim, there simply is no evidence of record indicating the Veteran has been diagnosed with Parkinson’s disease or “Parkinsonian-like” symptoms. Therefore, he has failed to establish he has this claimed condition, much less because of his military service. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (in the absence of proof of a present disability there can be no valid claim). At the very least, the evidence must show that, at some point during the appeal period, the Veteran has the disability for which benefits are being claimed. McClain v. Nicholson, 21 Vet. App. 319 (2007) (a claim for service connection may be granted if a diagnosis of a chronic disability was made during the pendency of the appeal, even if the most recent medical evidence suggests that the disability has resolved). Here, there simply is no suggestion the Veteran has Parkinson’s disease or “Parkinsonian-like” symptoms (Parkinsonism) or that this condition began during his service or is otherwise related or attributable to his service. To the contrary, his post-service treatment records are grossly unremarkable for any diagnoses or treatment of Parkinson’s disease or “Parkinsonian-like” symptoms (Parkinsonism). The evidence of record shows the Veteran experiences tremors, but they have been described by his treating physicians as kinetic tremors. See, e.g., February 2017 Agent Orange Database Examination Consult Note. And, as the May 2020 VA examiner explained, a kinetic tremor is the exact opposite of a Parkinson-type tremor. Parkinson’s tremors are rest tremors, whereas kinetic tremors are action tremors and most commonly called essential tremors, a common neurologic condition that is not covered under Parkinson’s disease or “Parkinsonian-like” symptoms. Furthermore, according this VA examiner, the fact that there have been no additional neurologic symptoms in the three years since the February 2017 Agent Orange protocol examination noting a tremor also indicates that it is either nonpathologic or an essential tremor. This is because, if Parkinson’s disease had, in fact, been present three years ago, it would have progressed to be more obvious and noted in the Veteran’s treatment records by now. Also, significantly, as the May 2020 VA examiner additionally noted, the Veteran has not been diagnosed with Parkinson’s disease, nor do VA treatment records reflect any such concern for a movement disorder. While physical therapy treatment records reflect restricted range of motion due to orthopedic problems, there are no notations of concerns for a neurologically based movement disorder. Consider also that, during the VA examination, the Veteran himself indicated that he recalled discussing the tremors with subsequent care provider and none of them were at all concerned with Parkinson’s disease. As such, the Board finds that the VA treatment records and examination records unambiguously show that no such disability presently exists or has at any time since the filing of this claim or proximate to that, much less because of the Veteran’s military service, and these findings were based upon objective medical evaluation and diagnostic testing that is specific to making this important determination, also consideration of his reported history, and a review of the medical and other evidence in his claims file.   Accordingly, the Board finds that the preponderance of the evidence is against this claim for service connection for Parkinson’s disease or “Parkinsonian-like” symptoms (Parkinsonism). At no time relevant to this claim has a diagnosis of this disability been established. A current disability means a disability shown by competent and credible (i.e., probative) evidence to exist. Chelte v. Brown, 10 Vet. App. 268 (1997). See also Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (considering the application of McClain on a recent diagnosis even predating the filing of a claim). Thus, it is ultimately inconsequential that both Parkinson’s disease and now, effectively since January 2021, also Parkinsonism are presumptively associated with exposure to Agent Orange and that VA conceded the Veteran was exposed to Agent Orange in granting his claim for prostate cancer. Unlike his prostate cancer, his failure to show he additionally has Parkinson’s disease or Parkinsonism necessarily is fatal to this other claim because there necessarily is no means to attribute for all intents and purposes a condition not confirmed to exist to his military service, including even to his presumed exposure to Agent Orange. Since, for the reasons and bases discussed, the preponderance of the evidence is against this claim, the benefit-of-the-doubt rule does not apply, and this claim of entitlement to service connection for Parkinson’s disease or “Parkinsonian-like” symptoms (Parkinsonism) is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to service connection for bladder cancer, including due to herbicide exposure The Veteran contends that his bladder cancer, like his prostate cancer, is from exposure to herbicides during his service. Just as in the case of his prostate cancer, he maintains that he was exposed to Agent Orange while serving off the coast of Vietnam aboard the USS EDSON and that the exposure caused his bladder cancer.   Certain “chronic” disabilities such as malignant (i.e., cancerous) tumors may be presumed to have been incurred in service if they manifested to a compensable degree (generally meaning to at least 10-percent disabling) within one year after discharge from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258 (2015). This presumption is rebuttable by affirmative evidence to the contrary. Service connection for certain diseases also may be granted based on presumed exposure to certain herbicide agents (including the dioxin in Agent Orange), even though there is no record of such disease during service. See 38 C.F.R. § 3.309(e). Presumed exposure to an herbicide applies to a Veteran who had active military, naval, or air service for at least 90 days during the period beginning on January 9, 1962 and ending on May 7, 1975, in the Republic of Vietnam or other locations if the conditions of service involved duty or visitation in Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e), 3.313. Service connection is permissible, as well, on a secondary basis for disability that is proximately due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310(a) and (b); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). In a rather recent holding in Procopio v. Wilkie, 913 F.3d 1371 (Fed. Cir. 2019), the U. S. Court of Appeals for the Federal Circuit held that the phrase “the Republic of Vietnam” in 38 U.S.C. § 1116 includes the 12 nautical mile territorial sea of Vietnam. Therefore, the presumption of exposure to herbicide agents has been extended to Veterans who serve within that designated area. Following the Board’s April 2020 remand, herbicide exposure was conceded based on the Veteran’s nautical service in the offshore eligible waters as defined in the Blue Water Navy Vietnam Veteran Act of 2019, Public Law 116-23. Indeed, as mentioned, because of that concession, it was determined his prostate cancer is a presumptive result of his presumed exposure to Agent Orange off the coast of Vietnam while aboard the USS EDSON.   This is significant because, at the time of the Board’s remand of this claim in April 2020, even at the time of the VA compensation examination the Veteran resultantly had in May 2020, on remand, the list of diseases presumptively associated with exposure to Agent Orange did not include bladder cancer. However, section 9109 of the National Defense Authorization Act of Fiscal Year 2021 added three diseases to this list, including bladder cancer, the addition of which will be codified at 38 U.S.C. § 1116(a)(2)(J). And, although this law did not contain an effective date and has not yet been codified, in the absence of such guidance it must be presumed the law became effective upon its January 1, 2021 enactment. See Gozlon-Peretz v. United States, 498 U.S. 395, 404 (1991) (“It is well established that, absent a clear direction by Congress to the contrary, a law takes effect on the date of its enactment”). There is no disputing the Veteran has bladder cancer, so, absent any persuasive evidence to the contrary, it now must be presumed that his bladder cancer (like his prostate cancer) is the presumptive result of his presumed exposure to Agent Orange during his service. When on remand commenting on the etiology of this bladder cancer, the May 2020 VA examiner stated that the Veteran’s bladder cancer was less likely than not related to, or caused by, his service – including owing to herbicide exposure. The examiner noted that, while it is true that the 2016 Institute of Medicine’s (IOM’s) update on the health effects of Agent Orange concluded that there was limited or suggestive evidence of an association between herbicide exposure and bladder cancer, a case-by-case analysis of the Veteran’s relative risks for bladder cancer is required. And, according to this VA examiner, in this instance, the Veteran’s risk of bladder cancer is from his smoking history (30 packs per year until 1997), as well as his post-service civilian occupation in the pipeline industry, which this VA examiner concluded outweighs his risk from herbicide exposure.   The examiner also considered whether the Veteran’s bladder cancer is secondary to, meaning caused or aggravated by, his claimed Parkinson’s disease and service-connected prostate cancer. However, as already discussed, service connection is not warranted for the Veteran’s Parkinson’s disease. Secondary service connection cannot be established if the underlying (i.e., precipitating) disability is not itself service connected. Therefore, service connection for bladder cancer as secondary to Parkinson’s disease is not warranted. 38 C.F.R. § 3.310. Regarding the issue of whether the Veteran’s bladder cancer is secondary to his service-connected prostate cancer, the Board also finds that service connection is not warranted on this basis. The May 2020 VA examiner determined that the Veteran’s bladder cancer is not as least as likely as not due to his service-connected prostate cancer because the only potential connection would have been if he had radiation treatment for his prostate cancer. However, he did not have radiation treatment for his prostate cancer, therefore, there is no mechanism by which his prostate cancer could have affected his bladder cancer. The fact that the two cancers were diagnosed at the same time (the ultrasound for the evaluation of the prostate cancer also found the bladder tumor) is purely a timing coincidence and not indicative of a physiologic linkage between the two separate cancers. That May 2020 VA examiner’s opinion notwithstanding, circumstances since have changed – effectively as of January 1, 2021 – such that VA now concedes there is a presumptive correlation (“nexus”) between exposure to Agent Orange and eventual development of bladder cancer. Thus, it is as likely as not this occurred in this instance, so this claim must be granted rather than denied by resolving this reasonable doubt in the Veteran’s favor. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996) (indicating "absolute" etiology is not a condition precedent to granting service connection, nor is "definite" or "obvious" etiology). Rather, this need only be an "as likely as not” proposition, which in this instance it is given this Federal agency’s recent recognition of bladder cancer (like prostate cancer) as presumptively associated with exposure to Agent Orange and the concession the Veteran had such exposure while serving aboard the USS EDSON in the coastal waters off the shore of Vietnam. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. When evaluating the severity of a disability, it is essential the disability is considered in the context of its entire recorded history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). But if the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings, then separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as “staged” ratings and is employed for initial or established ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. In general, it is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3.   3. Entitlement to an initial rating higher than 20 percent for the service-connected lumbar spine disability The Veteran’s lumbar spine disability is rated under 38 C.F.R. § 4.71a, Code 5237. Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, DCs 5235-5242. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note (1). For VA purposes, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right lateral rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. Id. at Note (2). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.” The spine has no opposite joint. During the pendency of this appeal, the principal medical evidence material to the claim is contained in the reports of VA spine examinations in October 2016 and May 2020. The remainder of the medical treatment records contain no evidence materially inconsistent with the findings of those examinations as they relate to the severity of the Veteran’s service-connected lumbar spine disability. As reflected in each of the above-cited VA examination reports, the Veteran does not have symptoms that include forward flexion of his thoracolumbar spine limited to 30 degrees or less or favorable ankylosis of his entire thoracolumbar spine. Throughout the period on appeal, his forward flexion of his thoracolumbar spine has been less restricted; his forward flexion has been to 60 degrees or more. During the October 2016 VA examination, the Veteran exhibited forward flexion of 75 degrees, extension to 20 degrees, right and left lateral flexion to 20 degrees each, and right and lateral rotation to 20 degrees each. This is a combined range of motion of 175 degrees. The Veteran experienced pain with repeated use over time and flare-ups, with a minimum estimated range of motion of forward flexion to 60 degrees, extension to 10 degrees, right and left lateral flexion to 10 degrees each, and right and left lateral rotation to 10 degrees each. This is a combined range of motion of 110 degrees in his thoracolumbar spine. The Veteran did not have muscle spasm and guarding. Finally, there was no ankylosis present. During his March 2020 hearing, the Veteran indicated that his lumbar spine disability had worsened appreciably since the prior October 2016 VA examination. It primarily was because of this testimony that the Board determined in April 2020 that this claim needed to be remanded to obtain a new VA examination reassessing the severity of this service-connected lumbar spine disability. To this end, the Veteran consequently underwent an additional VA examination in May 2020, on remand. During this additional examination, he reported that he experiences constant soreness and stiffness. His back pain intensifies with increased activity such as standing, walking, lifting, carrying, and going up and down stairs. He did not take any medications for his back and did not require assistive devices to perform activities of daily living. Upon examination, he exhibited forward flexion to 65 degrees, extension to 20 degrees, right and left lateral flexion to 25 degrees each, and right and left lateral rotation to 25 degrees each. This is a combined range of motion of 185 degrees in his thoracolumbar spine. The examiner clarified that the Veteran experienced pain with repeated use over time and flare-ups, with an estimated minimum range of motion of forward flexion to 60 degrees, extension to 20 degrees, right lateral and left lateral flexion to 25 degrees each, and right and left lateral rotation to 20 degrees each. This is a combined range of motion of 170 degrees in his thoracolumbar spine. Additionally, there was no muscle guarding, spasm, or ankylosis present at that examination. Both VA examinations confirmed the Veteran did not have favorable ankylosis of his thoracolumbar spine or unfavorable ankylosis of entire thoracolumbar spine or entire spine, the latter when additionally considering the adjacent cervical segment of his spine. His spine was not fixed in flexion or extension, so not ankylosed, either favorably or unfavorably. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5242, Note (5). Furthermore, there is no evidence of record indicating he has other symptomatology and consequent functional impairment warranting a higher disability evaluation. Based on the results of that examination most recent examination and other relevant medical and lay evidence in the file, the Board finds that the preponderance of this evidence is against a rating exceeding 20 percent for the Veteran’s lumbar spine disability. The Board acknowledges his lay reports of symptoms and that there was functional loss due to pain, repetitive use, and during flare-ups. However, even considering his lay reports of these symptoms and noted functional loss, the degree of additional limitation reflected by his statements of constant pain, especially on forward flexion, and stiffness does not result in limitation of motion more nearly approximating forward flexion limited to 30 degrees or less. At worst, so even considering his pain, his forward flexion is to at least 60 degrees, so beyond the terminal point permitted for a rating higher than 20 percent. Ultimately, even when considering the extent of his pain and its unfortunate consequent effect on his range of motion, the Veteran still does not have sufficient limitation of motion to warrant granting a higher rating for his lumbar spine disability. In Mitchell v. Shinseki, 24 Vet. App. 32, 33, 43 (2011), the Court held that, although pain may cause functional loss, pain, itself, does not constitute functional loss and is just one factor to be considered when evaluating functional impairment. Id. The Court explained in Mitchell explained that, pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance (§ 4.40), as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing (§ 4.45). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Consequently, in rating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. See Mitchell, 25 Vet. App. at 32. As such, the Board finds that the preponderance of the evidence is against finding that the Veteran has forward flexion of his thoracolumbar spine limited to the required 30 degrees or less or favorable ankylosis of his thoracolumbar spine, certainly not unfavorable ankylosis of his entire thoracolumbar spine or entire spine. Therefore, a higher evaluation of 40 percent is not warranted under the General Rating Formula for Diseases and Injuries of the Spine. Moreover, the Board also has considered whether a higher evaluation is warranted alternatively under Diagnostic Code 5243 for IVDS based on incapacitating episodes. See 38 C.F.R. § 4.71a. IVDS may be evaluated under the General Rating Formula or under the IVDS Formula, whichever method results in the higher evaluation when all disabilities are combined under § 4.25. 38 C.F.R. § 4.71a, General Rating Formula, Note (6). Under the IVDS Formula, a 40 percent disability rating is the next higher rating that is provided for IVDS based on incapacitating episodes. A 40 percent disability rating 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. 38 C.F.R. § 4.71a, Diagnostic Code 5243. An incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note (1). Here, though, there is no suggestion of physician-prescribed bedrest; therefore, by definition, the Veteran has not experienced an incapacitating episode. See, e.g., October 2016 and May 2020 VA Examinations. If he has elected to rest in bed, then that is not tantamount to an incapacitating episode, much less of the required frequency and total duration of at least 4 weeks but less than 6 weeks during the past 12 months to warrant granting a higher rating under the IVDS Formula. As well, the Board has considered whether the Veteran has any associated objective neurological abnormalities owing to his service-connected lumbar spine disability deserving of a separate rating, so additional compensation. 38 C.F.R. § 4.71a, General Rating Formula, Note (1). VA treatment records do not, however, show that he has any neurological abnormalities associated with his lumbar spine disability – such as radiculopathy or sciatic neuropathy affecting his lower extremities. Notably, he has made no report, and review of the electronic file reveals no evidence, of any objective neurologic abnormalities associated with his lumbar spine disability. See e.g., May 2020 VA Examination (Veteran stated that he did not have lower extremity problems, or any loss of sensation or strength in the lower extremities). As such, there is no evidence of record to warrant any separate disability ratings on this basis. Lastly, in adjudicating this claim, the competence and credibility of the Veteran must be considered. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362, 368-69 (2005). He is competent to give evidence about what he observes or experiences. For example, he is competent to report that he experiences certain symptoms, such as pain, and he is credible in this regard. See Layno v. Brown, 6 Vet. App. 465 (1994). His credible belief that his disability is worse than contemplated by the assigned rating, however, is outweighed by the competent and credible medical examinations that evaluated the extent of his impairment based on objective data, in relation to the applicable rating criteria, and coupled with consideration of his lay complaints regarding his symptoms, their severity, and how they impact his life and daily activities. The VA examiners have the training, expertise, and credentials necessary to administer the appropriate tests for a determination on the type and degree of the impairment associated with the Veteran’s complaints. Consequently, greater probative weight is placed on the physical examination findings, and the rating criteria are specific in indicating that some of the criteria must be objectively demonstrated.   For these reasons and bases, the preponderance of the evidence is against the Veteran’s claim for a rating higher than 20 percent for his lumbar spine disability. In making this determination, the Board notes that neither he nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017). KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Mukherjee 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.