Citation Nr: 21014990 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 15-37 107 DATE: March 16, 2021 ORDER A disability rating greater than 10 percent for service-connected lumbosacral strain and degenerative disc disease is denied. A disability rating greater than 10 percent for service-connected left knee patellofemoral pain syndrome is denied. A disability rating greater than 10 percent for service-connected right knee patellofemoral pain syndrome is denied. An effective date earlier (EED) than March 26, 2013 for the increased rating for left knee patellofemoral pain syndrome is denied. An effective date earlier (EED) than March 26, 2013 for the increased rating for right knee patellofemoral pain syndrome is denied. A total disability rating due to individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The Veteran's lumbosacral strain and degenerative disc disease has not been manifested by thoracolumbar spine 60 degrees or less; or combined range of motion of the thoracolumbar spine 120 degrees or less; muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, such as scoliosis, reversed lordosis, or abnormal kyphosis; ankylosis; or intervertebral disc syndrome (IVDS). 2. The evidence demonstrates that the Veteran's left knee disability has been manifested, at worst, by range of motion from 0 degrees of extension to 120 degrees of flexion. 3. The evidence demonstrates that the Veteran's right knee disability has been manifested, at worst, by range of motion from 0 degrees of extension to 120 degrees of flexion. 4. Historically, the claims folder reflects that in a claim received on March 26, 2013, the Veteran filed a claim a claim for a TDIU, which was interpreted as a claim for increased ratings for his bilateral knee disability. 5. The current evidence of record is against a finding that the Veteran's service-connected disabilities preclude him from maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for an increased rating in excess of 10 percent for lumbosacral strain and degenerative disc disease have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. § 4.71a, Diagnostic Code 5243. 2. The criteria for an increased rating greater than 10 percent for service-connected left knee patellofemoral pain syndrome have not been met. 38 U.S.C§§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.3, 4.7, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 3. The criteria for an increased rating greater than 10 percent for service-connected right knee patellofemoral pain syndrome have not been met. 38 U.S.C§§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.3, 4.7, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 4. The criteria for entitlement to an effective date for the award of an increased rating for left knee patellofemoral pain syndrome March 26, 2013, have not been met. 38 U.S.C. § 5103, 5103A, 5107(b), 5110; 38 C.F.R. § 3.102, 3.159, 3.400. 5. The criteria for entitlement to an effective date for the award of an increased rating for right knee patellofemoral pain syndrome March 26, 2013, have not been met. 38 U.S.C. § 5103, 5103A, 5107(b), 5110; 38 C.F.R. § 3.102, 3.159, 3.400. 6. The criteria for the award of TDIU benefits have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. § § 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran honorably served on active duty in the United States Army from September 2005 to February 2009. These matters are before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in December 2013 by the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. In August 2018, June 2019, and more recently in September 2020, the Board remanded the claims to the RO for additional development. The appeal has returned to the Board for further appellate consideration. Stegall v. West, 11 Vet. App. 268 (1998) (finding that a remand by the Board confers on a veteran the right to compliance with its remand orders). With respect to the Veteran’s claims decided herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. § 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. § 3.102, 3.156 (a), 3.159, 3.326; see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, 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. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the veteran, as well as the entire history of the veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). 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. 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. The United States Court of Appeals for Veterans Claims has held that “staged” ratings are appropriate for an increased rating claim where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the veteran. Gilbert, 1 Vet. App. at 53. Rating Musculoskeletal Disabilities Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.40 and 4.45, see also DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The factors involved in evaluating, and rating, disabilities of the joints include weakness; fatigability; incoordination; restricted or excess movement of the joint, or pain on movement. 38 C.F.R. § 4.45. Degenerative or traumatic arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent evaluation will be assigned where there is x-ray evidence of involvement of two or more major joints or two or more minor joint groups. A 20 percent evaluation will be assigned where there is x-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010, 5024. 1. Entitlement to an increased rating greater than 10 percent for service-connected lumbosacral strain and degenerative disc disease The Veteran’s service-connected lumbosacral strain and degenerative disc disease has been rated as 10 percent disabling under Diagnostic Code 5243. 38 C.F.R. § 4.71a. The diagnostic code criteria pertinent to spinal disabilities in general are found at 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. Under these relevant provisions, forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees, or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour, or vertebral body fracture with loss of 50 percent or more of the height is rated at 10 percent. A 20 percent evaluation is warranted when there is forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or combined range of motion of the thoracolumbar spine greater 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 evaluation is warranted for forward flexion of the thoracolumbar spine 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. Unfavorable ankylosis of the entire thoracolumbar spine warrants a 50 percent rating. Unfavorable ankylosis of the entire spine warrants a 100 percent rating. In addition, intervertebral disc syndrome may also be evaluated based on incapacitating episodes, depending on which method results in the higher evaluation when all disabilities are combined under § 4.25. The Veteran was afforded a VA examination in May 2013. The examination report reflects the Veteran’s lumbar spine had, at worst, a forward flexion from 0 to 70 degrees, extension from 0 to 20 degrees, bilateral lateral flexion from 0 to 30 degrees, and bilateral lateral rotation from 0 to 30 degrees. The examination noted the Veteran with no ankylosis, no muscle spasms, no radiculopathy, and no IVDS. The Veteran was afforded another VA examination in October 2019. The examination report reflects the Veteran’s lumbar spine had, at worst, a forward flexion from 0 to 80 degrees, extension from 0 to 20 degrees, bilateral lateral flexion from 0 to 20 degrees, and bilateral lateral rotation from 0 to 25 degrees. The examination noted the Veteran with no ankylosis; no muscle spasms resulting in guarding or abnormal gait or abnormal spinal contour; no radiculopathy; and no IVDS. Based on the above, the Board finds that an increased rating in excess of 10 percent for lumbosacral strain and degenerative disc disease is not warranted. A disability rating in excess of 10 percent is not warranted here as the competent credible evidence does not indicate that the Veteran had thoracolumbar spine 60 degrees or less; or combined range of motion of the thoracolumbar spine 120 degrees or less; muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, such as scoliosis, reversed lordosis, or abnormal kyphosis; ankylosis; or IVDS. 2. Entitlement to an increased rating greater than 10 percent for service-connected left knee patellofemoral pain syndrome The Veteran’s service-connected left knee patellofemoral pain syndrome has been rated as 10 percent disabling under Diagnostic Code 5260. 38 C.F.R. § 4.71a. Flexion and Limitation of the Lower Extremity Diagnostic Code 5260 provides a noncompensable rating when flexion is limited to 60 degrees or more. A 10 percent rating is warranted for leg flexion limited to 45 degrees. A 20 percent evaluation is for leg flexion limited to 30 degrees. A 30 percent evaluation is for leg flexion limited to 15 degrees. Diagnostic Code 5261 provides a noncompensable rating when extension is limited to 5 degrees or less. A 10 percent rating is warranted for leg extension limited to 10 degrees. A 20 percent evaluation is for leg extension limited to 15 degrees. A 30 percent evaluation is for leg extension limited to 20 degrees. A 40 percent evaluation is for leg extension limited to 30 degrees. A 50 percent evaluation is for leg extension limited to 45 degrees. In VAOPGCPREC 9 - 2004 (Sept. 17, 2004), it was held that a claimant who had both limitation of flexion and limitation of extension of the same leg must be rated separately under Diagnostic Codes 5260 and 5261 to be adequately compensated for functional loss associated with injury to the leg. As such, if the evidence of record reflects compensable loss of both flexion and extension of either leg, the Veteran would be entitled to the combined evaluation under Diagnostic Codes 5260 and 5261, per the combined ratings table in 38 C.F.R. § 4.25. Instability of the Knee Instability of the knee and limitation of motion of the knee are two separate disabilities. As such, it is permissible to award separate ratings under both a range of motion code and an instability code (Diagnostic Code 5257), without violating the prohibition on pyramiding. See VAOPGCPREC 23-97. Diagnostic Code 5257 is predicated on instability, rather than limitation of motion, therefore, an analysis under DeLuca does not apply. See Johnson v. Brown, 9 Vet. App. 7 (1996). Under Diagnostic Code 5257, for recurrent subluxation or lateral instability of the knee, a 10 percent evaluation is warranted for slight knee impairment. A 20 percent evaluation is warranted for moderate knee impairment. A 30 percent evaluation is warranted for severe knee impairment. Words such as “mild,” “slight,” “moderate,” “marked,” and “severe” are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. A May 2013 VA medical examination of the left knee reflects no joint ankylosis, no instability, no subluxation/dislocation, and no meniscal. The examination further reflects left knee flexion with active motion of 0 to 120 degrees. The examination further noted the Veteran’s left knee leg extension with active motion from 120 to 0 degrees. There was no additional loss of motion on repetitive testing. An October 2019 VA medical examination of the left knee reflects no joint ankylosis, no recurrent subluxation or dislocation, and no meniscal condition. The examination further reflects left knee flexion with active motion of 0 to 130 degrees. The examination further noted the Veteran’s left knee leg extension with active motion from 130 to 0 degrees. The Veteran would be entitled to a rating under Diagnostic Code 5257 if the evidence reflected that he had severe, moderate, or slight recurrent subluxation or lateral instability. Here, on objective instability testing, the Veteran’s left knee was not found to have subluxation/dislocation or lateral instability. As such a rating under Diagnostic Code 5257 is not warranted here. A rating under Diagnostic Code 5258 is not warranted because the evidence does not reflect dislocated semilunar cartilage with frequent episodes of locking, pain and effusion into the joint. A separate rating under Diagnostic Code 5259 is not warranted in regard to the removal of semilunar cartilage with recurrent symptoms. Here, the evidence does not reflect the Veteran with a history of removal of semilunar cartilage or a meniscal condition. A rating in excess of 10 percent under Diagnostic Code 5260 is not applicable. A 20 percent evaluation is for leg flexion limited to 30 degrees. At worst, the Veteran’s left leg flexion is limited at 120. A 10 percent rating is warranted for leg extension limited to 10 degrees. A 20 percent rating is warranted for leg extension limited to 15 degrees. Here, the Board finds that a separate under Diagnostic Code 5261 is not warranted. The clinical evidence reflect that the Veteran’s left leg extension is not limited by 10 degrees. (See October 2019 VA examination). A rating under Diagnostic Code 5262 is not warranted because the evidence does not reflect that the Veteran has malunion or nonunion of the tibia and fibula. A rating under Diagnostic Code 5263 is not warranted because the evidence does not show that he has acquired genu recurvatum. In addition to the clinical findings, the Board has also considered the Veteran’s statements regarding his pain, weakness, and instability. However, the Board finds that the Veteran’s listed disability symptoms do not warrant any additional increased ratings at this time as his impairments are contemplated in the currently assigned ratings. In conclusion, based on the objective clinical evidence, to include the Veteran’s subjective complaints, the Board finds entitlement to a disability rating higher than 10 percent for left knee patellofemoral pain syndrome is not warranted. The Board has considered whether there are any other applicable diagnostic codes which would provide a higher rating, but the Board finds there is not. 3. Entitlement to an increased rating greater than 10 percent for service-connected right knee patellofemoral pain syndrome A May 2013 VA medical examination of the right knee reflects no joint ankylosis, no instability, no subluxation/dislocation, and no meniscal. The examination further reflects right knee flexion with active motion of 0 to 120 degrees. The examination further noted the Veteran’s right knee leg extension with active motion from 120 to 0 degrees. There was no additional loss of motion on repetitive testing. An October 2019 VA medical examination of the right knee reflects no joint ankylosis, no recurrent subluxation or dislocation, and no meniscal condition. The examination further reflects right knee flexion with active motion of 0 to 125 degrees. The examination further noted the Veteran’s left knee leg extension with active motion from 125 to 0 degrees. The Veteran would be entitled to a rating under Diagnostic Code 5257 if the evidence reflected that he had severe, moderate, or slight recurrent subluxation or lateral instability. Here, on objective instability testing, the Veteran’s right knee was not found to have subluxation/dislocation or lateral instability. As such a rating under Diagnostic Code 5257 is not warranted here. A rating under Diagnostic Code 5258 is not warranted because the evidence does not reflect dislocated semilunar cartilage with frequent episodes of locking, pain and effusion into the joint. A separate rating under Diagnostic Code 5259 is not warranted in regard to the removal of semilunar cartilage with recurrent symptoms. Here, the evidence does not reflect the Veteran with a history of removal of semilunar cartilage or a meniscal condition. A rating in excess of 10 percent under Diagnostic Code 5260 is not applicable. A 20 percent evaluation is for leg flexion limited to 30 degrees. At worst, the Veteran’s right leg flexion is limited at 120. A 10 percent rating is warranted for leg extension limited to 10 degrees. A 20 percent rating is warranted for leg extension limited to 15 degrees. Here, the Board finds that a separate under Diagnostic Code 5261 is not warranted. The clinical evidence reflect that the Veteran’s right leg extension is not limited by 10 degrees. (See October 2019 VA examination). A rating under Diagnostic Code 5262 is not warranted because the evidence does not reflect that the Veteran has malunion or nonunion of the tibia and fibula. A rating under Diagnostic Code 5263 is not warranted because the evidence does not show that he has acquired genu recurvatum. In addition to the clinical findings, the Board has also considered the Veteran’s statements regarding his pain, weakness, and instability. However, the Board finds that the Veteran’s listed disability symptoms do not warrant any additional increased ratings at this time as his impairments are contemplated in the currently assigned ratings. In conclusion, based on the objective clinical evidence, to include the Veteran’s subjective complaints, the Board finds entitlement to a disability rating higher than 10 percent for right knee patellofemoral pain syndrome is not warranted. The Board has considered whether there are any other applicable diagnostic codes which would provide a higher rating, but the Board finds there is not. Effective Date 4. Entitlement to an effective date earlier (EED) than March 26, 2013 for the increased rating for left knee patellofemoral pain syndrome 5. Entitlement to an effective date earlier (EED) than March 26, 2013 for the increased rating for right knee patellofemoral pain syndrome The Veteran is seeking an effective date prior to March 26, 2013 for the increased rating for increased rating for right and left knee patellofemoral pain syndrome. Historically, the claims folder reflects that in a claim received on March 26, 2013, the Veteran filed a claim a claim for a TDIU, which the RO took as a claim for increased ratings for his knee disabilities. The Veteran’s bilateral knees increase rating claim was granted at 10 percent for each knee effective March 26, 2013, date claim was received. As noted above, the effective date of an award based on claim for increase benefits shall be the date of receipt of the claim or the date entitlement arose, or the date of increase if the increase is shown within one year prior to filing the claim, whichever is later. 38 U.S.C. § 5110 (a). While the Veteran contends that he is entitled to an earlier effective date prior to March 26, 2013, the claims folder reflects that the Veteran requested TDIU, which was construed as a claim for increased benefits on that date. (See March 26, 2013 Veterans Application for Increased Compensation Based on Unemployability). The March 26, 2013correspondence constitutes as a new claim for entitlement to an increased rating. The Veteran, nor his representative, has asserted clear and unmistakable error (CUE) in regard to any previous decision. Based on the above, the Board finds that there are no statements by the Veteran which would entitle the Veteran to an earlier effective date for an increase rating in excess of 10 percent for left or right knee patellofemoral pain syndrome, as there is no evidence of an earlier claim or of an increase in the year prior to March 26, 2013. As the preponderance of the evidence is against the claims, the benefit of the doubt rule is not applicable. 38 U.S.C. § 5107 (b); Gilbert, supra. 6. A total disability rating due to individual unemployability (TDIU) The Veteran contends that he is unable to obtain or maintain employment due to his service-connected hearing disabilities. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that the veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities. 38 C.F.R. § § 3.340, 3.341, 4.16. A total rating for compensation purposes may be assigned where the schedular rating is less than total, when, in the judgment of the rating agency, the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more service-connected disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 U.S.C. § 1155; 38 C.F.R. § § 3.340, 3.341, 4.16 (a). For a veteran to prevail on a claim for a TDIU rating, the sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is a recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether the veteran can find employment. See 38 C.F.R. § 4.16 (a); Van Hoose v. Brown, 4 Vet. App 361 (1993). A May 2013 VA examination report reflects the Veteran’s service-connected back and bilateral knee disability does his ability to work. Specifically, the disabilities make it difficult to engage in physical employment. In a May 2013 VA mental health examination, the examiner opined that to a reasonable degree of psychological certainty, the veteran is employable with PTSD. The examiner noted that the Veteran was a full-time student who planned on graduating in 2015. Additionally, the examiner stated that he did not see any psychological limitations in the veteran’s ability to work. An April 2016 VA treatment consult notes the Veteran working full-time. An October 2019 VA PTSD VA examination reflects that the Veteran has been and currently is employed at a hotel since 2017. The Veteran reported that he typically works 45-50 hours per week as an assistant manager of engineering. Additionally, in an October 2019 Individual Unemployability Statement reflects the Veteran with no job-related difficulties secondary to service-connected psychiatric disability. Further, another October 2019 Individual Unemployability Statement reflect the Veteran’s ability to perform heavy or strenuous physical work. As noted above, a total rating for compensation purposes may be assigned where the schedular rating is less than total, when, the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more service-connected disabilities, provided at least one disability is ratable at 40 percent or more. Here, the Veteran’s current service-connected disabilities combined is 80 percent. Thus, the Veteran does meet the schedular requirements. However, the medical evidence reflects that while the Veteran’s service-connected disabilities do impair his ability to work, they do not preclude it. This is evident as the claims folder reflects that the Veteran is currently employed full time. Here, the preponderance of the evidence is against a finding that the Veteran is unable to maintain substantially gainful employment during due to his service-connected disabilities. Rather, the claims folder reflects that the Veteran is currently employed. Therefore, the Board finds that TDIU is not warranted. The preponderance of the evidence is against the Veteran’s contention that his service-connected disabilities are of such severity as to preclude his participation in substantially gainful employment. The Board has considered the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); Gilbert, supra. The claim is denied. Other Considerations In making its determinations in this case, the Board has also carefully considered the Veteran’s contentions with respect to the nature of his service-connected disabilities at issue and notes that his lay testimony is competent to describe certain symptoms associated with these disabilities. The Veteran’s history and symptom reports have been considered, including as presented in the medical evidence discussed above, and has been contemplated by the disability ratings that have been assigned. Moreover, the competent medical evidence offering detailed specific findings pertinent to the rating criteria is the most probative evidence with regard to evaluating the pertinent symptoms of the service-connected disabilities at issue. As such, while the Board accepts the Veteran’s testimony with regard to the matters he is competent to address, the Board relies upon the competent medical evidence with regard to the specialized evaluation of functional impairment, symptom severity, and details of clinical features of the service-connected conditions at issue. (Continued on the next page)   The Board has also considered whether staged ratings under Hart, supra, and Fenderson, supra, are appropriate for the Veteran’s service-connected disabilities on appeal herein; however, the Board finds the Veteran’s symptomatology has been stable throughout the periods on appeal. Thus, assigning staged ratings for such disabilities is not warranted. Furthermore, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the rating claims decided herein. See Doucette v. Shulkin, 28 Vet. App. 366 (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). JEREMY J. OLSEN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brandon A. Williams, 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.