Citation Nr: 21010902 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 13-35 141 DATE: February 26, 2021 ORDER A rating in excess of 20 percent for a right shoulder disability is denied. A rating in excess of 20 percent for a left shoulder disability is denied. A rating in excess of 10 percent for pseudofolliculitis barbae prior to June 28, 2018, is denied. A rating in excess of 30 percent for pseudofolliculitis barbae effective June 28, 2018, is denied. A compensable rating for pes planus prior to June 28, 2018, is denied. A rating in excess of 30 percent for pes planus effective June 28, 2018, is denied. REMANDED The issue of a compensable rating for a right hand disability is remanded. The issue of a total disability rating based on individual unemployability (TDIU) prior to December 13, 2017, is remanded. FINDINGS OF FACT 1. The Veteran’s right (dominant) shoulder disability is not manifested by arm limitation of motion to midway between the side and shoulder level (flexion and/or abduction limited to 45 degrees). 2. The Veteran’s left (non dominant) shoulder disability is not manifested by flexion and/or abduction limited to 25 degrees from the side. 3. Prior to June 28, 2018, the Veteran’s pseudofolliculitis barbae was not manifested by deep acne (deep inflamed nodules and pus-filled cysts) affecting 40 percent or more of the face and neck; or a scar with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features; or two or three characteristics of disfigurement. 4. Effective June 28, 2018, the Veteran’s pseudofolliculitis barbae is not manifested by a scar with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features; or four or five characteristics of disfigurement. It did not affect more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or require constant or near-constant systemic therapy. 5. Prior to June 28, 2018, the Veteran’s pes planus was manifested by no more than mild symptoms. 6. Effective June 28, 2018, the Veteran’s pes planus has not been pronounced with marked pronation, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. CONCLUSIONS OF LAW 1. The criteria for a disability evaluation in excess of 20 percent for the Veteran’s service-connected right shoulder disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5201. 2. The criteria for a disability evaluation in excess of 20 percent for the Veteran’s service-connected left shoulder disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5201. 3. Prior to June 28, 2018, the criteria for a disability evaluation in excess of 10 percent for the Veteran’s service-connected pseudofolliculitis barbae have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.118, Diagnostic Code 7800-7828. 4. Effective June 28, 2018, the criteria for a disability evaluation in excess of 30 percent for the Veteran’s service-connected pseudofolliculitis barbae have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.118, Diagnostic Code 7800-7828. 5. Prior to June 28, 2018, the criteria for a compensable disability evaluation for pes planus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.10, 4.71a, Diagnostic Code 5276. 6. Effective June 28, 2018, the criteria for a disability evaluation in excess of 30 percent for the Veteran’s service-connected pes planus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.10, 4.71a, Diagnostic Code 5276. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 2007 to August 2009. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an October 2011 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA). This matter was remanded in February 2018 for further development. In its October 2011 rating decision, the RO assigned noncompensable ratings for all the disabilities on appeal. The RO issued a November 2013 rating decision in which it assigned a 10 percent rating for each of the Veteran’s shoulders and for his pseudofolliculitis barbae. All the increases were made effective August 22, 2009 (the day after the Veteran was discharged from service). The RO issued an October 2018 rating decision in which it increased the rating for each of the Veteran’s shoulders to 20 percent (effective August 22, 2009). It also increased the Veteran’s rating for pseudofolliculitis barbae and bilateral pes planus to 30 percent effective June 28, 2018. In February 2018, the Board remanded the issue of a total disability rating based on individual unemployability (TDIU). The RO issued a June 2020 rating decision in which it granted TDIU effective December 13, 2017. The issue of whether a TDIU is warranted prior to December 13, 2017, remains before the Board. Increased Rating Disability evaluations are determined by the application of the Schedule For Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Where, as in the instant case, the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). Ratings in excess of 20 percent for right and left shoulder disabilities are denied. The Veteran’s service-connected shoulder disabilities have been rated under the provisions of Diagnostic Code 5201. Under this regulatory provision, a rating of 20 percent is warranted for arm motion limited to shoulder level (flexion and/or abduction limited to 90 degrees). For arm limitation of motion to midway between the side and shoulder level (flexion and/or abduction limited to 45 degrees), a 30 percent rating is warranted for the major (dominant) arm, and a 20 percent rating is warranted for the minor (non-dominant arm). For flexion and/or abduction limited to 25 degrees from the side, a 40 percent rating is warranted for the major (dominant) arm, and a 30 percent rating is warranted for the minor (non-dominant arm). In the present case, it should also be noted that when evaluating disabilities of the musculoskeletal system, 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. DeLuca v. Brown, 8 Vet. App. 202 (1995). Further, 38 C.F.R. § 4.45 provides that consideration also be given to weakened movement, excess fatigability and incoordination. Both the Veteran’s shoulders have been rated as 20 percent disabling. The Veteran underwent VA examinations in February 2011, January 2015, April 2018, and November 2020. These examination reports reflect that the Veteran is right hand dominant. At the February 2011 VA examination, the Veteran achieved 180 degrees of flexion and abduction, and 90 degrees of external and internal rotation. This constitutes full range of motion. The January 2015 examination was conducted by phone where range of motion testing was not possible. The Veteran submitted a private treatment report, dated December 2017, that reflects that the Veteran achieved 150/155 degrees of flexion in his left/right shoulders respectively. He achieved 125/130 degrees of abduction in his left/right shoulders respectively. He achieved 70/75 degrees of internal rotation in his left/right shoulders respectively. He achieved 65/75 degrees of external rotation in his left/right shoulders respectively. At the Veteran’s March 2018 VA examination, the Veteran reported bilateral shoulder flare-ups in which he was limited by pain in activities such as reaching, forceful pushing, pulling, heavy lifting and carrying. Upon examination, he achieved full range of motion in both shoulders. There was pain noted on examination, including pain with weight bearing. The pain caused functional limitation. The Veteran was able to perform repetitive use testing after which flexion and abduction was limited to 165 degrees in each shoulder. Following repeated use over time, the flexion and abduction was limited to 150 degrees in each shoulder. Regarding flare-ups, the examiner could not render an opinion without resorting to speculation. He explained that objective determination of whether the Veteran is experiencing a flare up can only be determined by someone like a primary care physician who has prior acquaintance with the Veteran’s body and has determined a non-flare up baseline for comparison. He stated that he could neither confirm nor refute flare up status (in all cases, because he only sees the Veteran on one occasion). Therefore, he could not verify if the objective range of motion that he observed after repetitive use represents range of motion during flare-up or not without resorting to speculation. The examiner noted that there was no reduction in muscle strength in either shoulder. There was no ankylosis. The examiner noted that there was objective evidence of pain on passive range of motion and on non-weight bearing testing in both shoulders. The Veteran underwent a final VA examination in November 2020. The Veteran achieved 160 degrees of flexion and abduction, and 80 degrees of external and internal rotation bilaterally. Pain was noted on rest/non-movement. There was no evidence of pain with weight bearing. The Veteran reported that he could not perform repetitive use testing because it was too painful. The examiner stated that the examination was not consistent with functional loss as maximum effort was not utilized. The examiner found that muscle strength in each shoulder was 5/5, and that there was no reduction in muscle strength, nor was there atrophy. In order to warrant a higher rating, the Veteran’s right shoulder must be manifested by arm limitation of motion to midway between the side and shoulder level (flexion and/or abduction limited to 45 degrees). The left shoulder must be manifested by flexion and/or abduction limited to 25 degrees from the side. These criteria have not been met. The greatest level of limited motion noted on any of the VA examinations was that the Veteran’s flexion and abduction would be limited to 150 degrees after repeated use. This was somewhat consistent with the 150/155 degrees of flexion found in the left right/shoulders at the private examination and the 125/130 degrees of abduction in the left/right shoulders at the same examination. Finally, in regards to DeLuca criteria, there is no medical evidence to show that there is any additional loss of motion of either shoulder due to pain or flare-ups of pain, supported by objective findings, or due to excess fatigability, weakness or incoordination, to a degree that supports a rating in excess of 20 percent. The finding of 150 degrees of flexion and abduction at his June 2018 VA examination considered pain, fatigue, weakness, lack of endurance, and incoordination. Only pain was noted, and it was the reason that the Veteran’s range of motion decreased from 180 degrees to 150 degrees. As the preponderance of the evidence is against these claims, the benefit-of-the-doubt doctrine does not apply, and the claims for initial or staged ratings in excess of 20 percent for right and left shoulder disabilities must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A rating in excess of 10 percent for pseudofolliculitis barbae prior to June 28, 2018 is denied. The Veteran’s service-connected pseudofolliculitis barbae has been rated by the RO under the provisions of Diagnostic Code 7828. Under this regulatory provision, a noncompensable rating is warranted for superficial acne (comedones, papules, pustules) of any extent. A 10 percent rating is warranted for deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck, or deep acne other than on the face and neck. A 30 percent rating is warranted for deep acne (deep inflamed nodules and pus-filled cysts) affecting 40 percent or more of the face and neck. Acne may alternately be rated as disfigurement of the head, face, or neck under DC 7800 or for scars under DC 7801, 7802, 7804, or 7805, depending on the predominant disability. VA amended the criteria for rating skin disabilities effective from August 13, 2018; however, Diagnostic Code 7800 was not changed by the August 13, 2018, amendments. Under Diagnostic Code 7800, one characteristic of disfigurement warrants a 10 percent rating. A scar with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement warrants a 30 percent rating. A scar with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement warrants a 50 percent rating. A scar with visible or palpable tissue loss and either gross distortion of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement warrants an 80 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7800 list the eight characteristics of disfigurement: a scar 5 or more inches in length; a scar at least one-quarter inch wide at widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding six square inches; skin texture abnormal in an area exceeding six square inches; underlying soft tissue missing in an area exceeding six square inches; and, skin indurated and inflexible in an area exceeding six square inches. Id. At the Veteran’s February 2011 VA examination, he reported bumps to the nape of the neck which he self-treated with benzyl peroxide. He also described a loss of hair, slight oozing, and raised swelling to the top of his head and under his hair. He was told that he needed to see a plastic surgeon to have the “raised areas removed.” A dermatologist at Mather VA diagnosed cystic structures, scalp and pustular acne to face. Upon examination, there were various stages of acne to the face and around the beard line. There were also numerous small (1 cm) raised bumps to the back portion of nape of neck without erythema or ecchymosis. There were 6-8 multi-sized 1 cm. to the largest 3.5 x 1-inch raised painful slightly draining cystic type lesion to the scalp. They were skin colored, superficial, and were tender with deep palpation. Texture was elevated, irregular, and not atrophic, shiny, scaly, hypo pigmented, unstable, or ulcerated. There was no evidence of inflammation, edema, keloid formation, inflexibility, or adherence to the underlying tissue. There was no evidence of gross distortion, functional impairment, disfigurement, or asymmetry. The facial acne and scalp cysts involved about 2 percent of the exposed areas and 1-2 percent of the total body area. The Veteran underwent another VA examination in December 2014. He had cystic acne, scarring and discharge from pustules on his scalp. The scars were healed, stable, and non-tender. They were not painful. The examiner noted one 10 x 10 cm. scar on the face. There was no distortion of facial features. The disability did not cause functional limitation. The examiner stated that the pseudofolliculitis barbae caused scarring in the form of facial acne, idiopathic cysts to the head and scalp, also shown as hidradenitis of the scalp. There were keloids and scarring covering most of the scalp. It had been treated constantly/near-constantly with topical immunosuppressive medications (lidocaine ointment). It did not result in any debilitating episodes. The examiner stated that the Veteran had acne or chloracne resulting in deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck, and that also affects body areas (scalp) other than the face and neck. It resulted in no functional impact. In order to warrant a rating in excess of 10 percent, the Veteran’s disability needs to be manifested by deep acne (deep inflamed nodules and pus-filled cysts) affecting 40 percent or more of the face and neck (Diagnostic Code 7828) or a scar with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or with two or three characteristics of disfigurement (Diagnostic Code 7800). Prior to June 28, 2018, none of these criteria had been met. As noted above, the December 2014 examiner stated that the deep acne affected less than 40 percent of the face and neck. The disability did not result in palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features. Finally, there were not two or three characteristics of disfigurement. As the preponderance of the evidence is against this claim, the benefit-of-the-doubt doctrine does not apply, and the claim for a rating in excess of 10 percent prior to June 28, 2018 for pseudofolliculitis barbae must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A rating in excess of 30 percent for pseudofolliculitis barbae effective June 28, 2018 is denied. A rating in excess of 30 percent for pseudofolliculitis barbae effective June 28, 2018 is denied. The Veteran underwent another VA examination in June 2018. He stated that he went to the VA hospital where he had been prescribed creams, shampoos, and antibiotics for his condition. He stated that he was also prescribed Tramadol and Percocet for his pain but was currently taking ibuprofen. He had noticed red marks on his back and arms which were not as severe as the condition on his head and scalp. He stated that his disability had gotten worse, as there had been an increase of the pain and an increase of leaking from cysts. The examiner stated that the disability did not cause scarring or disfigurement of the head, face, or neck. The examiner also noted that the Veteran had urticaria that the Veteran described as a redness and an itching all over his body resulting in four or more non-debilitating episodes which were treated with antihistamines or sympathomimetics. He has had constant/near-constant treatment with Benadryl for itching of the entire body, as well as ibuprofen for pain, and Clindamycin and Lidocaine for head and facial acne. The examiner noted that the Veteran also had intensive light therapy for six weeks or more, but not constant, in 2017. Upon examination, the examiner found that the hidradenitis and idiopathic cyst on the Veteran’s scalp affected less than 5 percent of the total body area, and 20-40 percent of exposed areas. Pseudofolliculitis barbae affected less than 5 percent of the total body area, and less than 5 percent of exposed areas. Acne on the posterior trunk affected less than 5 percent of the total body area, and no exposed areas. Acne affected less than 40 percent of the face and neck, but also affected other areas of the body. The Veteran is in receipt of a 30 percent rating. This is the maximum rating under diagnostic code 7828. In order to warrant a rating in excess of 30 percent under Diagnostic Code 7800, the disability would have to be manifested by a scar with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or with four or five characteristics of disfigurement. These criteria have not been met. To the extent that the disability has extended beyond the Veteran’s head, face, and neck, the Board notes that VA amended the criteria for rating skin disabilities, effective August 13, 2018. These new regulations apply to all applications for benefits received by VA, or that are pending before the agency of original jurisdiction, on or after August 13, 2018. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The Secretary of VA has determined that “claims pending prior to [August 13, 2018] will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied.” 83 Fed. Reg. at 32593; see generally VAOPGCPREC 3-2000, 7-2003. The Veteran’s initial rating claim was filed prior to August 13, 2018. Therefore, the initial rating claim for the service-connected pseudofolliculitis barbae must be considered under the rating criteria both before and after August 13, 2018. Under Diagnostic Code 7806 (applicable to dermatitis or eczema), a noncompensable rating is assigned for less than 5 percent of the entire body or less than 5 percent of exposed areas affected; and no more than topical therapy required during the past 12 months. A 10 percent rating is assigned for at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. A 30 percent rating is assigned for 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly during the past 12-month period. A 60 percent rating is assigned for more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near- constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12- month period. Effective August 13, 2018, a new General Rating Formula for the Skin applies to Diagnostic Codes 7806, 7809, 7813 to 7816, 7820 to 7822, and 7824. See 38 C.F.R. § 4.118. Under this formula, a noncompensable rating is assigned for no more than topical therapy required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is assigned for at least one of the following: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12- month period. A 30 percent rating is assigned at least one of the following: characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is assigned for at least one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. Additionally, effective August 31, 2018, VA regulations now explicitly state that systemic therapy is treatment that is administered through any route other than the skin, and topical therapy is treatment that is administered through the skin. 38 C.F.R. § 4.118(a). In order to warrant a rating in excess of 30 percent, the Veteran’s disability must affect more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; require constant or near- constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12- month period. Likewise, a 60 percent rating under the current criteria requires one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. In this case, the Veteran’s pseudofolliculitis does meet any of these criteria. All three examiners found that the deep acne affected less than 40 percent of the face and neck (and therefore less than 40 percent of all exposed areas and of the total body). Additionally, the pseudofolliculitis barbae has not required constant or near- constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12- month period. The Board notes that at his most recent VA examination, the Veteran reported urticaria that was treated with light therapy. The Board first notes that the Veteran’s urticaria has not been service connected. Moreover, the examiner noted that it was treated with intensive light therapy for 6 weeks or more, but not constant, in 2017. As noted above, even if urticaria were deemed part of the Veteran’s pseudofolliculitis barbae, an increased rating would only be warranted if such treatment was constant or near constant (which it was not). As the preponderance of the evidence is against this claim, the benefit-of-the-doubt doctrine does not apply, and the claim for a rating in excess of 30 percent effective June 28, 2018, for pseudofolliculitis barbae must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A compensable rating for pes planus prior to June 28, 2018, is denied. The Veteran’s bilateral pes planus is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5276, for acquired flatfoot. Under Diagnostic Code 5276, a noncompensable rating is warranted for mild acquired flatfoot; symptoms relieved by built-up shoe or arch support. A 10 percent rating is warranted for moderate acquired flat foot; weight-bearing line over or medial to the great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral. A 20 percent rating is assigned for severe unilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is warranted for severe bilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is also warranted for pronounced unilateral acquired flatfoot; 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. A maximum 50 percent rating is warranted for bilateral acquired flatfoot; 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. Prior to June 28, 2018, the Veteran’s pes planus has been rated as noncompensable. In order to warrant a compensable rating, the Veteran’s pes planus must be manifested by moderate acquired flat foot; weight-bearing line over or medial to the great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral. The Veteran underwent a VA examination in February 2011. The Veteran reported having pain to the bottom of his bilateral feet around March 2007 after basic training. While in the military, he was informed that he had flat feet and plantar fasciitis. It was treated with pain medications (Motrin) without side effects; light duty 5-6 times per month; rest, ice, compression, and elevation; and stretching with some relief of pain. He denied physical therapy, crutches, canes, braces, acupuncture, chiropractor, TENS, injections, traction, or surgery. He was able to return to normal duty and pass PT tests. He denied being evaluated by orthopedics, neurologist, chiropractor, podiatry, or pain management for this complaint. Upon examination, there was slight tenderness to plantar aspect of the bilateral feet in the region of the arches without guarding/grimacing. There were no other symptoms. X-rays showed calcaneal pitch angle measured 17 degrees on the right and 18 degrees on the left. It was noted that these measurements were on the lower limits of normal, raising the possibility of mild pes planus. The Veteran underwent another VA examination in January 2015. He stated that since being discharged from service, the soles of his feet have been painful when walking. He stated that he has never been to a podiatrist and has not bought any Dr. Scholl’s shoe inserts over the counter. He had not mentioned his bilateral foot pain to his primary doctor. There were no physical findings in so far as the examination consisted only of a telephone interview. The examiner found that the disability did not impact the Veteran’s ability to perform any type of occupational task (such as standing, walking, lifting, sitting, etc.). The examiner noted that the Veteran never sought any treatment for his mild flat feet or bilateral plantar fasciitis. The examiner deemed the Veteran to be employable once he gets orthotics in his shoes. Both VA examiners described the Veteran’s pes panus symptoms as mild. Moreover, the Veteran had never sought any post service treatment for his symptoms, which consisted of mild pain when walking. There is no evidence that prior to June 28, 2018, that the Veteran’s pes planus was manifested by moderate acquired flat foot; weight-bearing line over or medial to the great toe, inward bowing of the tendo achillis. As the preponderance of the evidence is against this claim, the benefit-of-the-doubt doctrine does not apply, and the claim for a compensable rating for pes planus prior to June 28, 2018, must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A rating in excess of 30 percent for pes planus effective June 28, 2018, is denied. In order to warrant a rating in excess of 30 percent, the Veteran’s pes planus must be manifested by pronounced 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. The Veteran underwent a VA examination in June 2018. He stated that his pes planus had worsened and that the pain in his feet had increased due to being on his feet daily. He described the pain as a constant, sharp pain. He stated that he was no longer able to work out without pain. He was no longer able to run without pain or walk long distances without pain. Upon examination, there was no objective evidence of marked pronation on either foot. There was extreme tenderness on both feet. There was no marked inward displacement and severe spasm of the Achilles tendon. The examiner noted that June 2018 x-rays showed no abnormality in either foot. The examiner deemed the Veteran’s bilateral foot disability to be moderate. Although the Veteran had extreme tenderness on both feet, the examiner found the disability to be moderate, with no objective evidence of marked pronation on either foot, and no marked inward displacement and severe spasm of the Achilles tendon. As the preponderance of the evidence is against this claim, the benefit-of-the-doubt doctrine does not apply, and the claim for a rating in excess of 30 percent for pes planus must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND The issue of a compensable disability rating for a right hand disability is remanded. The Veteran underwent VA examinations in February 2011, January 2015, June 2018, and November 2020. He has consistently reported pain in his right hand. He has also reported that he drops items held in his right hand. At his February 2011 VA examination, the diagnosis was a right hand sprain; however, at his June 2018 VA examination, the diagnosis was changed to flexor tendon laceration DIP joint right 5th finger. The Veteran stated that during service, he had sliced his “pinky and thumb.” He stated that his hand was numb most of the time, and that it tended to lock up when using it. His right hand disability has been rated under 38 C.F.R. § 4.71a, Diagnostic Code 5230, for ring or little finger limitation of motion. Under this code, no compensable rating is warranted. Given the Veteran’s reports of numbness in his hand, and difficulty in holding onto objects, the possibility of nerve damage is raised. The Board finds that a neurological examination is warranted to determine if the Veteran’s symptoms might better be rated under a different diagnostic code. The issue of a total disability rating based on a TDIU prior to December 13, 2017, is remanded. The Veteran’s claim for entitlement to a TDIU prior to December 13, 2017, is dependent on whether the Veteran’s service-connected disabilities render him unable to secure or follow a substantially gainful occupation. As such, the claim is inextricably intertwined with the issue of whether an increased rating is warranted for the Veteran’s service-connected right hand disability. The matters are REMANDED for the following action: Schedule the Veteran for a VA neurological examination to determine the current severity of his service-connected right hand disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. Specifically, the examiner should conduct a neurological examination to determine whether the Veteran’s reported symptoms are due to nerve damage. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Prem, 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.