Citation Nr: 21015526 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 20-00 138 DATE: March 17, 2021 ORDER Entitlement to a rating in excess of 10 percent rating prior to March 27, 2019 for insomnia and sleep disturbances associated with speech changes due to Parkinson’s disease is denied. Entitlement to a 30 percent rating effective March 27, 2019, but no higher and no earlier, for insomnia and sleep disturbances associated with speech changes due to Parkinson’s disease is granted. Entitlement to a 20 percent rating effective September 13, 2018, but no higher and no earlier, for muscle rigidity and stiffness of the right lower extremity associated with Parkinson’s disease is granted. Entitlement to a 20 percent rating effective September 13, 2018, but no higher and no earlier, for muscle rigidity and stiffness of the left lower extremity associated with Parkinson’s disease is granted. Entitlement to a rating in excess of 20 percent for tremors of the right upper extremity associated with Parkinson’s disease is denied. Entitlement to a rating in excess of 20 percent for tremors of the left upper extremity with muscle rigidity associated with Parkinson’s disease is denied. Entitlement to a rating in excess of 30 percent for speech changes due to Parkinson’s disease is denied. Entitlement to an increased rating for loss of automatic movements of the right side of face associated with Parkinson’s disease, currently rated as noncompensable prior to March 27, 2019, and 10 percent disabling thereafter, is denied. Entitlement to an increased rating for loss of automatic movements of the left side of face associated with Parkinson’s disease, currently rated as noncompensable prior to March 27, 2019, and 10 percent disabling thereafter, is denied. Entitlement to a rating in excess of 10 percent for balance impairment with bradykinesia associated with Parkinson’s disease is denied. Entitlement to an increased rating for constipation associated with Parkinson’s disease, currently rated as noncompensable prior to March 27, 2019 and 10 percent disabling thereafter, is denied. FINDINGS OF FACT 1. For the appeal period prior to March 27, 2019, the Veteran’s insomnia and sleep disturbances associated with speech changes due to Parkinson’s disease manifested as mild sleep disturbances without occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 2. For the appeal period beginning on March 27, 2019, the Veteran’s insomnia and sleep disturbances associated with speech changes due to Parkinson’s disease manifested as moderate sleep disturbances without occupational and social impairment with reduced reliability and productivity. 3. Throughout the period on appeal, the Veteran’s muscle rigidity and stiffness of the right lower extremity associated with Parkinson’s disease manifested as muscle rigidity and stiffness without the loss of reflexes, muscle atrophy, sensory disturbances, and constant pain. 4. Throughout the period on appeal, the Veteran’s muscle rigidity and stiffness of the left lower extremity associated with Parkinson’s disease manifested as muscle rigidity and stiffness without the loss of reflexes, muscle atrophy, sensory disturbances, and constant pain. 5. Throughout the period on appeal, the Veteran’s tremors of the right upper extremity associated with Parkinson’s disease manifested as mild tremors and mild rigidity without the loss of reflexes, muscle atrophy, sensory disturbances, and constant pain. 6. Throughout the period on appeal, the Veteran’s tremors of the left upper extremity with muscle rigidity associated with Parkinson’s disease as mild tremors and mild rigidity without the loss of reflexes, muscle atrophy, sensory disturbances, and constant pain. 7. Throughout the period on appeal, the Veteran’s speech changes due to Parkinson’s disease manifested as mild to moderate speech changes without aphonia. 8. For the period beginning on March 27, 2019, the Veteran’s loss of automatic movements of the right side of face associated with Parkinson’s disease manifested as mild paresthesias and numbness without the loss of reflexes, muscle atrophy, sensory disturbances, and constant pain. 9. For the period beginning on March 27, 2019, the Veteran’s loss of automatic movements of the left side of face associated with Parkinson’s disease manifested as mild paresthesias and numbness without the loss of reflexes, muscle atrophy, sensory disturbances, and constant pain. 10. Throughout the period on appeal, the Veteran’s balance impairment with bradykinesia associated with Parkinson’s disease manifested as dizziness without dizziness with occasional staggering. 11. For the period prior to March 27, 2019, the Veteran’s constipation associated with Parkinson’s disease manifested as mild symptoms without moderate symptoms such as frequent episodes of bowel disturbance with abdominal distress. 12. For the period beginning on March 27, 2019, the Veteran’s constipation associated with Parkinson’s disease manifested as severe symptoms without diarrhea, or alternating diarrhea with constipation, with more or less frequent abdominal distress. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent rating prior to March 27, 2019 for insomnia and sleep disturbances associated with speech changes due to Parkinson’s disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.126, 4.130, Diagnostic Code 9326. 2. The criteria for a 30 percent rating effective March 27, 2019, but no higher and no earlier, for insomnia and sleep disturbances associated with speech changes due to Parkinson’s disease have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.126, 4.130, Diagnostic Codes 9326. 3. The criteria for a 20 percent rating effective September 13, 2018, but no higher and no earlier, for muscle rigidity and stiffness of the right lower extremity associated with Parkinson’s disease have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.123, 4.124a, Diagnostic Code 8520. 4. The criteria for a 20 percent rating effective September 13, 2018, but no higher and no earlier, for muscle rigidity and stiffness of the left lower extremity associated with Parkinson’s disease have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.123, 4.124a, Diagnostic Code 8520. 5. The criteria for a rating in excess of 20 percent for tremors of the right upper extremity associated with Parkinson’s disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.124a, Diagnostic Code 8514. 6. The criteria for a rating in excess of 20 percent for tremors of the left upper extremity with muscle rigidity associated with Parkinson’s disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.124a, Diagnostic Code 8514. 7. The criteria for a rating in excess of 30 percent for speech changes due to Parkinson’s disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.27, 4.97, 4.124a, Diagnostic Codes 8004, 6516. 8. The criteria for an increased rating for the loss of automatic movements of the right side of face associated with Parkinson’s disease, currently rated as noncompensable prior to March 27, 2019 and 10 percent disabling thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.124a, Diagnostic Code 8207. 9. The criteria for an increased rating for the loss of automatic movements of the left side of face associated with Parkinson’s disease, currently rated as noncompensable prior to March 27, 2019 and 10 percent disabling thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.124a, Diagnostic Code 8207. 10. The criteria for a rating in excess of 10 percent for balance impairment with bradykinesia associated with Parkinson’s disease have not been met. 38 U.S.C. §§ 1155, 4107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.87, Diagnostic Code 6204. 11. The criteria for increased ratings for constipation associated with Parkinson’s disease, currently rated as noncompensable prior to March 27, 2019 and 10 percent disabling thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.114, Diagnostic Code 7319. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1965 to June 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a November 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, this rating decision on appeal is for the propriety of the Veteran’s initial rating for Parkinson’s disease and associated sequelae. The Veteran’s initial claim was received on September 13, 2018, so the Board has no jurisdiction to assign a rating earlier than that date; however, the Veteran has continuously prosecuted his claim, as evidenced by his Notice of Disagreement that was received on March 27, 2019. Staged rating increases for the bilateral lower extremities, constipation, and automatic movements of the bilateral sides of the face were awarded in an October 2019 rating decision. The Veteran’s claim then came before the Board on June 16, 2020, and it was remanded for further development. See BVA Remand (June 16, 2020). Another staged rating increase for insomnia was awarded in a December 16, 2020 rating decision. As to all of these issues, i.e.: the ones reflected on the title page of the June 2020 remand, this Board decision, and identified in the aforementioned prior rating decisions, because higher ratings are available throughout the rest of the appellate period, the claims remain on appeal accordingly. See AB v. Brown, 6 Vet. App. 35 (1993). The Veteran was issued a Supplemental Statement of the Case (SSOC) as to all of the above on December 16, 2020. The Board accordingly reasserts jurisdiction as to these issues only, and concludes that the Veteran has been afforded substantial compliance with all previous remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). To the extent that the December 16, 2020 rating decision awards separate entitlements to service connection for other sequelae of Parkinson’s disease (namely, stooped posture on both sides, noncompensable effective March 27, 2019, and difficulty chewing and swallowing, noncompensable effective October 12, 2020), the Board concludes that jurisdiction therein is not proper at this time. If the Veteran should disagree with these ratings or their effective dates, then he is free to file another Notice of Disagreement, which must be received by the Board within one year of the previous rating decision. Additionally, the Board concludes that to the extent that a claim for TDIU and/or special monthly compensation can sometimes be inferred as part and parcel of a claim for increased ratings, see Rice v. Shinseki, 22 Vet. App. 447 (2009); Akles v. Derwinski, 1 Vet. App. 118, 121 (1991); Bradley v. Peake, 22 Vet. App. 280 (2008); 38 U.S.C. § 1114(s); 38 C.F.R. §§ 3.103(a), 4.16, the Board concludes that none of the above apply to the Veteran in this case. The Veteran was granted entitlement to a TDIU in the October 2019 rating decision, effective September 13, 2018. Aside from the Veteran’s disabilities associated with Parkinson’s disease, the Veteran appears to be only 20 percent disabled, with bilateral hearing loss and tinnitus each rated 10 percent disabling. Because the Veteran is not at least 60 percent disabled separately and apart from a totally disabling disorder, TDIU is already granted to its maximum, and derivative entitlements are not reasonably raised by the record. This claim has been advanced on the Board’s docket on account of the Veteran’s advanced age. 38 C.F.R. § 20.900(c); 38 U.S.C. § 7107(a)(2). 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. Where there is a question as to which of two ratings should be applied, the higher rating 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. 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). Generally, when an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). When the appeal arises from an initial assigned rating, consideration must be given to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999). Staged ratings are also for consideration in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505, 510 (2007). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Under Diagnostic Code 8004, a minimum 30 percent rating is assigned when there are ascertainable residuals of paralysis agitans of Parkinson’s disease. 38 C.F.R. § 4.124a, Code 8004. However, VA is also required to consider whether any residuals may be otherwise rated under a separate diagnostic code. If there are identifiable residuals that can be rated under a separate diagnostic code, and the combined disability rating resulting from these residuals exceeds 30 percent, then these separate ratings will be assigned in place of the minimum rating assigned under Code 8004. Throughout the entire period on appeal, the Veteran’s symptoms have been rating under separate diagnostic codes, which have resulted in a combined disability rating in excess of 30 percent. Accordingly, the Board will analyze the severity of the Veteran’s service-connected manifestations of Parkinson’s disease under the appropriate diagnostic codes. Neurological conditions such as Parkinson’s disease are evaluated under the section of the Rating Schedule beginning at 38 C.F.R. § 4.120, conducting evaluations by comparison. 38 C.F.R. § 4.120 provides that disability in this field is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function. The rater is to consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, injury to the skull, etc. In rating such disabilities, the rater is to refer to the appropriate schedule. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances. With partial loss of use of one or more extremities from neurological lesions, the rating is by comparison with mild, moderate, severe, or complete paralysis of peripheral nerves. 38 C.F.R. § 4.120. To be more fully explained below, the Veteran submitted to three examinations to assess the severity of his Parkinson’s symptoms during the period on appeal: November 2, 2018; July 16, 2019; and October 12, 2020. On October 12, 2020, the Veteran also underwent more specific VA examinations as to all disorders identified in the June 2020 remand. The Veteran is right-handed; therefore, to the extent that the symptomatology may be sufficiently severe under a diagnostic code that differentiates, the Veteran’s right side is major or dominant; the left side is minor or non-dominant. All of these examination findings will be discussed in relevant parts below. 1. Entitlement to a rating in excess of 10 percent rating prior to March 27, 2019 for insomnia and sleep disturbances associated with speech changes due to Parkinson’s disease is denied. 2. Entitlement to a 30 percent rating effective March 27, 2019, but no higher and no earlier, for insomnia and sleep disturbances associated with speech changes due to Parkinson’s disease, is granted. The Veteran has generally asserted that a higher rating is warranted for insomnia and sleep disturbances associated with speech changes due to Parkinson’s disease. Specific argument in support of this appeal has not been submitted. The Veteran’s insomnia and sleep disturbance as associated with Parkinson’s disease is rated under Diagnostic Code 9326 (major or mild neurocognitive disorder due to another medical condition or substance/medication-induced major or mild neurocognitive disorder), and is currently evaluated at 10 percent disabling prior to October 12, 2020, and 30 percent thereafter. The General Rating Formula for Mental Disorders at 38 C.F.R. § 4.130 provides the following ratings for psychiatric disabilities: A 10 percent rating is warranted for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. A 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted for total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. When determining the appropriate disability evaluation under the general rating formula, the primary consideration of the Board is a Veteran’s symptoms, but it must also make findings as to how those symptoms impact the Veteran’s occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). A Veteran may only qualify for a given disability rating under the general rating formula by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Id. at 117-18. The symptoms listed are not exhaustive, but rather “serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating.” Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering “not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” Vazquez-Claudio, 713 F.3d at 117; 38 C.F.R. § 4.130. In the November 2018 VA examination, see VA Exam (Nov. 2, 2018), the Veteran was found to exhibit only a mild sleep disturbance. See id. at Question No. 5b. The examiner also concluded that he exhibited no depression, nor cognitive impairment or dementia. See id. at Question No. 4 et seq. Nevertheless, the AOJ awarded an initial 10 percent rating. See Rating Decision (Nov. 13, 2018). The Veteran was subsequently reexamined in July 2019, see VA Exam (July 16, 2019). The Veteran indicated that “He thinks [his Parkinson’s] is getting worse. … He is tired and has problems sleeping. He sleeps approximately 4 hours during the night. He has to take a nap during the day.” See id. at Question No. 8. Even though the Veteran continued to fail to exhibit depression, cognitive impairment, or dementia, see id. at Question No. 4 et seq., the examiner indicated that his sleep disturbance is now “moderate” instead of mild. See id. at Question No. 5b. Finally, the Veteran was examined after remand in November 2020. He submitted to a Parkinson’s examination, see VA Exam (Parkinson’s) ( Oct. 12, 2020 ) (rec’d Nov. 18, 2020), as well as a psychiatric examination, see VA Exam (Mental Disorders) ( Oct. 12, 2020 ) (rec’d Oct. 14, 2020). At this examination, the examiner indicated that his sleep disturbance was merely “mild,” and no longer “moderate.” See VA Exam (Parkinson’s), at Question No. 5b, while the examiner at that same examination once again concluded that the Veteran exhibited no depression, cognitive impairment, or dementia, see id. at Question No. 4 et seq. Meanwhile, at his psychiatric examination, see VA Exam (Mental Disorders) ( Oct. 12, 2020 ) (rec’d Oct. 14, 2020), the examiner concluded that the Veteran exhibits occupational and social impairment with occasional decrease in work efficiency. See id. at Section I, Question No. 3a. The Board notes in passing that the Veteran subjectively reported mental health symptoms but denied “significant difficulty falling asleep.” He also stated that he awakens twice nightly to go to the bathroom but takes a while to fall back asleep due to tremors. He endorsed daytime tiredness and indicated he requires a nap after dinner, but ultimately sleeping five hours through the night. See id. at Section II, Question No. 2f. In short, the Board concludes that at the July 2019 examination, the Veteran’s sleep impairment was more severe than “mild,” but the Veteran already receives a 30 percent rating based on the results of the October 2020 examinations, which is corroborated by chronic sleep impairment and which is more than “mild or transient symptoms” as would be consistent with a 10 percent rating. In other words, to the extent that the Veteran indicated that his Parkinson’s disease got worse since his initial rating, the Board concurs, and concludes that symptoms as of July 2019 appear similar to as of October 2020. Resolving all reasonable doubt in the Veteran’s favor, the Board now grants a 30 percent rating effective from receipt of the notice of disagreement. See 38 C.F.R. § 4.130, Diagnostic Code 9326. The Board however does not find that a rating in excess of 10 percent prior to March 27, 2019 or a rating in excess of 30 percent after March 27, 2019 is warranted. The Veteran has not reported any psychological symptoms or impairments other than insomnia, sleep difficulties or daytime tiredness. There is simply no evidence of record to suggest occupational and social impairment with reduced reliability prior to March 27, 2019 and productivity or occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks after March 27, 2019. The record does not suggest, and the Veteran has not alleged, depression, anxiety, suspiciousness, panic attacks, mild memory loss, flattened affect, difficulty in understanding complex commands, impaired judgment, or difficulty in maintaining effective social relationships. Therefore, a higher rating is not warranted. The Board has also considered whether the Veteran should be entitled to a rating in excess of 10 percent prior to March 27, 2019. Ultimately, the Board concludes to the contrary. The Veteran stated that his Parkinson’s disease had gotten worse, but never indicated that his initial rating was unsatisfactory. See generally VA Exam (July 2019), supra. Meanwhile, the Veteran’s initially mild sleep impairment appears to more closely resemble a 10 percent rating (“due to mild or transient symptoms”), and the first evidence of it becoming more severe than mild was at the July 2019 examination. The Board acknowledges the Veteran's belief that his psychiatric symptoms are more severe than the current rating reflects. While the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability considering the rating criteria to be more persuasive than the Veteran’s reports regarding the severity of his condition. Therefore, the medical opinions hold more probative weight than the Veteran’s assertions. The Board has addressed stage ratings under Hart v. Mansfield, supra and confirms that the Veteran’s symptomatology is consistent with the staged rating on appeal period. Furthermore, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to such claim. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). Overall, based on the totality of the evidence and affording the Veteran all reasonable doubt, the Board finds that a 30 percent rating is warranted from March 17, 2019, so that portion of the claim is granted. Aside from that, the remainder of the claim, i.e.: for a rating for insomnia in excess of 10 percent prior to March 17, 2019 or in excess of 30 percent thereafter, is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 3. Entitlement to a 20 percent rating effective September 13, 2018, but no higher and no earlier, for muscle rigidity and stiffness of the right lower extremity associated with Parkinson’s disease is granted. 4. Entitlement to a 20 percent rating effective September 13, 2018, but no higher and no earlier, for muscle rigidity and stiffness of the left lower extremity associated with Parkinson’s disease is granted. The Veteran has generally asserted that a higher rating is warranted for right and left lower extremity muscle rigidity and stiffness due to Parkinson’s disease. Specific argument in support of this appeal has not been submitted. The General Rating Formula for Diseases of the Peripheral Nerves at 38 C.F.R. § 4.124a provides the following ratings: The term “incomplete paralysis,” with this and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. With respect to paralysis of the lower radicular group, Diagnostic Code 8520: For “complete” paralysis, which is defined as “the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost,” an 80 percent rating is warranted. For “incomplete” paralysis, “severe, incomplete (with marked muscular atrophy)” paralysis is rated at 60 percent; “moderately severe, incomplete” paralysis, 40 percent; “moderate, incomplete” paralysis, 20 percent; and “mild, incomplete” paralysis, 10 percent. The term “incomplete paralysis” with peripheral nerve injuries indicates a degree of loss or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to the varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. See note at “Diseases of the Peripheral Nerves” in 38 C.F.R. § 4.124(a). In rating peripheral nerve disability, neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate incomplete paralysis, or with sciatic nerve involvement, for moderately severe incomplete paralysis. 38 C.F.R. § 4.123. The Board notes that the Veteran was examined on November 2, 2018, July 16, 2019, and October 12, 2020. See VA Exams (Parkinson’s); see also VA Exam (Muscle Injuries) (Oct. 12, 2020) (rec’d Nov. 18, 2020). The Board notes that even though no changes were observed in the bilateral lower extremities between the first two examinations, see VA Exams (Nov. 2, 2018; July 16, 2019), at Question No. 3f-g (respectively showing “mild” muscle rigidity and stiffness in the right lower and left lower extremities, with no tremors present), the AOJ nonetheless awarded a rating increase effective March 27, 2019—which is the date of receipt of the notice of disagreement and which is also in between these two examinations. Therefore, to resolve all reasonable doubt in the Veteran’s favor, the Board awards an initial 20 percent rating throughout the period on appeal, but no higher. The Board considered whether the Veteran is entitled to a rating in excess of 20 percent for his bilateral lower extremities at any time on appeal. The Board concludes that no such increased rating is warranted. After the first two examination of record as recounted above, the Veteran submitted to an examination in October 2020. At this examination, the examiner indicated that the Veteran exhibited some muscle rigidity and stiffness, but paradoxically none in any of his four extremities. See VA Exam (Oct. 2020), at Question No. 3g. Meanwhile, at a separate examination for muscle injuries, the examiner confirmed diagnoses of muscle rigidity of the bilateral lower extremities due to Parkinson’s, but ultimately appeared to deny any other manifestations. See VA Exam (Muscle Injuries) (Oct. 12, 2020) (rec’d Nov. 18, 2020 ). The record does not establish, and the Veteran has not alleged, the loss of reflexes, muscle atrophy, sensory disturbances, and constant pain. There is simply no competent or credible evidence of record to suggest that the Veteran suffered from symptoms more severe than “moderate incomplete paralysis” of the bilateral lower extremities at any time during the appellate period. See also VA Exam (Peripheral Nerves Conditions) (Oct. 12, 2020) (rec’d Nov. 18, 2020), at Section XI. The Board acknowledges the Veteran's belief that his muscle symptoms are more severe than the current rating reflects. While the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, supra. Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability considering the rating criteria to be more persuasive than the Veteran’s reports regarding the severity of his condition. Therefore, the medical opinions hold more probative weight than the Veteran’s assertions. The Board has considered whether a staged rating under Hart, supra is appropriate; however, the Veteran is now awarded more compensation than with his previous staged rating with an initial 20 percent rating, and the Board accordingly concludes that an initial 20 percent rating reflects adequate compensation throughout the period on appeal. Therefore, assigning any further staged ratings beyond as already assigned is not warranted. The Veteran and/or his attorney has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, supra. For the above reasons, the Board resolves all reasonable doubt in the Veteran’s favor and grants a 20 percent rating throughout the period on appeal, effective September 13, 2018. Aside from that, the remainder of the Veteran’s claim for increased ratings for the right and left lower extremity muscle stiffness as caused by Parkinson’s disease is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 5. Entitlement to a rating in excess of 20 percent for tremors of the right upper extremity associated with Parkinson’s disease is denied. 6. Entitlement to a rating in excess of 20 percent for tremors of the left upper extremity with muscle rigidity associated with Parkinson’s disease is denied. The Veteran has generally asserted that a higher rating is warranted for right and left upper extremity tremors associated with Parkinson’s disease. Specific argument in support of this appeal has not been submitted. Paralysis of the radial nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8514. Diagnostic Code 8514 provides that mild incomplete paralysis is rated 20 percent disabling on the major side and 20 percent on the minor side; moderate incomplete paralysis is rated 30 percent disabling on the major side and 20 percent on the minor side; and severe incomplete paralysis is rated 50 percent disabling on the major side and 40 percent on the minor side. Complete paralysis of the radial nerve, with drop of hand and fingers, wrist and fingers perpetually flexed, the thumb adducted falling within the line of the outer border of the index finger; cannot extend hand at wrist, extend proximal phalanges of fingers, extend thumb, or make lateral movement of wrist; supination of hand, extension and flexion of elbow weakened, the loss of synergic motion of extensors impairs the hand grip seriously; total paralysis of the triceps occurs only as the greatest rarity, is rated 70 percent disabling on the major side and 60 percent on the minor side. 38 C.F.R. § 4.124a. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The Board has reviewed all of the Veteran’s VA examinations of record. See VA Exams (Nov. 2018; July 2019; Oct. 2020), supra. These Parkinson’s examinations uniformly conclude that the Veteran’s bilateral upper extremities exhibit no more than mild tremors and mild muscle rigidity throughout the period on appeal. See VA Exams, supra, at Question No. 3f-g, respectively. Furthermore, at a separate VA examination that was ordered post-remand to more specifically rate all of the Veteran’s sequelae of Parkinson’s disease, see VA Exam (Peripheral Nerves Conditions) ( Oct. 12, 2020 ) (rec’d Nov. 18, 2020), the Veteran was found to have had only mild paresthesias and numbness of the upper extremities, see id. at Section III, Question No. 3A, and mild incomplete paralysis of the bilateral ulnar nerves only with normal nerves otherwise, see id. at Section X, Question No. 10C, cf. id. at Question No. 10 et seq. The Veteran has not alleged, and the record does not establish, that there was a loss of reflexes, muscle atrophy, sensory disturbances, and constant pain. There is simply no competent or credible evidence of record to suggest that the Veteran suffered from symptoms more severe than “mild incomplete paralysis” of the bilateral upper extremities at any time during the appellate period. The Board acknowledges the Veteran's belief that his upper extremity symptoms are more severe than the current rating reflects. While the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, supra. Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability considering the rating criteria to be more persuasive than the Veteran’s reports regarding the severity of his condition. Therefore, the medical opinions hold more probative weight than the Veteran’s assertions. The Board has considered whether a staged rating under Hart, supra is appropriate; however, the Board concludes that the Veteran’s right and left upper extremity symptomatology, as caused by his Parkinson’s disease, appears stable throughout the appellate period, and that his initial 20 percent rating reflects adequate compensation throughout the period on appeal. Therefore, the assignment of a staged ratings is not warranted. The Veteran and/or his attorney has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, supra. The Board has considered the doctrine of reasonable doubt but has determined that it is inapplicable because the preponderance of the evidence is against higher ratings for the period in question. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. The Veteran’s claim for a rating in excess of 20 percent for his tremors of the right and left upper extremity associated with Parkinson’s disease must be denied. 7. Entitlement to a rating in excess of 30 percent for speech changes due to Parkinson’s disease is denied. The Veteran has generally asserted that a higher rating is warranted for speech changes due to Parkinson’s disease. Specific argument in support of this appeal has not been submitted. The Veteran’s speech changes due to Parkinson’s disease is rated by analogy under Diagnostic Code 8004-6516. Under Diagnostic Code 8004, paralysis agitans warrants a minimum 30 percent rating. 38 C.F.R. § 4.124a. Under Diagnostic Code 6516, a 10 percent rating is warranted with hoarseness and inflammation of chords or mucous membrane. A maximum 30 percent rating is warranted with hoarseness, with thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes on biopsy. 38 C.F.R. § 4.97. The Veteran has submitted to three examinations to evaluate his residuals of Parkinson’s disease. See VA Exams (Nov. 2018; July 2019; Oct. 2020), supra. The Veteran’s speech changes were initially rated as “moderate” in the earlier two examinations, but then rated as “mild” (a perceived improvement from the previous VA examinations) in the most recent examination of record. See id. at Question No. 3e, respectively. Ultimately, the Board concludes that there is no competent or credible evidence of record to suggest that the Veteran’s speech changes have ever progressed beyond “moderate” or otherwise beyond as initially examined. As a result, there is no evidence of record to suggest that the Veteran’s 30 percent rating for this disorder has ever yielded inadequate compensation. Accordingly, the claim for a rating in excess of 30 percent is denied. The Board has also considered alternative diagnostic codes. Under Diagnostic Code 6519 for aphonia, the constant inability to speak above a whisper is rated as 60 percent disabling and the constant inability to communicate by speech is rated as 100 percent disabling. 38 C.F.R. § 4.97. Incomplete aphonia is to be rated as laryngitis (Diagnostic Code 6516), as has been done in the present case. Given that complete aphonia with constant inability to speak above a whisper has not been demonstrated, a higher or separate rating under this diagnostic code is not warranted. See VA Exam ( Oct. 12, 2020 ) (rec’d Nov. 18, 2020), at Section VIII (“The Veteran’s voice quality [is] strong, is able to verbalize words and be heard from across the room.”). The Board acknowledges the Veteran's belief that his speech symptoms are more severe than the current rating reflects. While the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, supra. Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability considering the rating criteria to be more persuasive than the Veteran’s reports regarding the severity of his condition. Therefore, the medical opinions hold more probative weight than the Veteran’s assertions. The Board has considered whether a staged rating under Hart, supra is appropriate; however, the Board concludes that the Veteran’s speech changes as caused by his Parkinson’s disease, appears stable throughout the appellate period, and that his initial 30 percent rating reflects adequate compensation throughout the period on appeal. Therefore, the assignment of a staged ratings is not warranted. The Veteran and/or his attorney has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, supra. The Board has considered the doctrine of reasonable doubt but has determined that it is inapplicable because the preponderance of the evidence is against higher ratings for the period in question. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. The Veteran’s claim for a rating in excess of 30 percent for his speech changes associated with Parkinson’s disease must be denied. 8. Entitlement to an increased rating for the loss of automatic movements of the right side of face associated with Parkinson’s disease, currently rated as noncompensable prior to March 27, 2019, and 10 percent disabling thereafter, is denied. 9. Entitlement to an increased rating for the loss of automatic movements of the left side of face associated with Parkinson’s disease, currently rated as noncompensable prior to March 27, 2019, and 10 percent disabling thereafter, is denied. The Veteran has generally asserted that a higher rating is warranted for loss of automatic movements of the right and left side of the face associated with Parkinson’s disease. Specific argument in support of this appeal has not been submitted. The Veteran’s impairment of the seventh cranial nerve has been evaluated under Diagnostic Code 8207. 38 C.F.R. § 4.124a. Under that code, a 10 percent rating is assigned where there is evidence of moderate, incomplete paralysis and a 20 percent evaluation is warranted for severe incomplete paralysis of the seventh cranial (facial) nerve. A 30 percent rating, the maximum available, is warranted where there is evidence of complete paralysis. Evaluation of paralysis is dependent upon relative loss of innervation of facial muscles. Diagnostic Code 8207. This disorder has been rated as noncompensable until prior to March 27, 2019, and then 10 percent disabling thereafter. As it pertains to peripheral nerve disabilities the term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. The terms “mild,” “moderate” and “severe” are not defined in VA regulations, and the Board must arrive at an equitable and just decision after having evaluated the evidence. 38 C.F.R. § 4.6. The Board has fully reviewed all available VA treatment records documenting the Veteran’s medical care received. By way of background, there were no neurological abnormal findings prior to the period on appeal, see VA Treatment Record ( Nov. 13, 2012 ) (rec’d Oct. 3, 2018). The only evidence of record pertaining to the Veteran’s cranial nerves during the appellate period is within the Veteran’s VA examinations for Parkinson’s disease. See VA Exams (Nov. 2018; July 2019; Oct. 2020), supra. Ultimately, the Veteran’s losses of automatic movements appear no more severe than “mild” at any time earlier than the Board’s receipt of the Veteran’s notice of disagreement (at which time the Veteran is already in receipt of a 10 percent compensable rating), nor otherwise more severe than “moderate” at any time thereafter on appeal. See id. at Question No. 3d, respectively. Additionally, the Veteran was specifically and separately examined post-remand to evaluate his cranial nerve symptomatology. See VA Exam (Cranial Nerves Diseases) ( Oct. 12, 2020 ) (rec’d Nov. 18, 2020). Pertinent findings as to the seventh cranial nerve appear to be limited to mild paresthesias and numbness, see id. at Section III, Question No. 3D-E, mild muscle strength loss, see id. at Section IV, Question No. 4B, decreased loss of sensation, and incomplete moderate paralysis on the left side, see id. at Section VI, Question No. 6. Throughout the period on appeal, the Veteran’s loss of automatic movements of the right and left sides of face associated with Parkinson’s disease manifested as mild paresthesias and numbness. The record does not establish, and the Veteran has not alleged, the loss of reflexes, muscle atrophy, sensory disturbances, and constant pain. Therefore, a higher rating is not warranted. The Board acknowledges the Veteran's belief that his neurological symptoms are more severe than the current rating reflects. While the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, supra. Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability considering the rating criteria to be more persuasive than the Veteran’s reports regarding the severity of his condition. Therefore, the medical opinions hold more probative weight than the Veteran’s assertions. The Board has considered whether a staged rating under Hart, supra is appropriate; however, the Board concludes that the Veteran’s loss of automatic movements of the right and left sides of face associated with Parkinson’s disease has been stable throughout the appeal period. The Veteran and/or his attorney has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, supra. The Board has considered the doctrine of reasonable doubt but has determined that it is inapplicable because the preponderance of the evidence is against higher ratings for the period in question. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. The Veteran’s claim for a rating in excess of 30 percent for his loss of automatic movements of the right and left sides of face associated with Parkinson’s disease must be denied. 10. Entitlement to a rating in excess of 10 percent for balance impairment with bradykinesia associated with Parkinson’s disease is denied. The Veteran has generally asserted that a higher rating is warranted for balance impairment with bradykinesia associated with Parkinson’s disease. Specific argument in support of this appeal has not been submitted. The Veteran’s balance impairment with bradykinesia has been evaluated under Diagnostic Code 6204—as per peripheral vestibular disorders. Under that code, a 10 percent evaluation is assigned where there is evidence of occasional dizziness, and a 30 percent rating (the maximum available) is warranted where there is evidence of dizziness with occasional staggering. 38 C.F.R. § 4.87. The Board has fully reviewed all available VA treatment records documenting the Veteran’s medical care received. The only evidence of record pertaining to the Veteran’s bradykinesia are confined to within the Veteran’s VA examinations for Parkinson’s disease. See VA Exams (Nov. 2018; July 2019; Oct. 2020), supra. Ultimately, the Veteran’s bradykinesia has been consistently rated by VA examiners as “mild.” See VA Exams, supra, at Question No. 3C, respectively. Additionally, the Veteran was specifically and separately given an ear condition examination post-remand, in order to address the Veteran’s loss of balance. See VA Exam (Ear Conditions) ( Oct. 12, 2020 ) (rec’d Nov. 18, 2020). Of particular importance to the Veteran’s claim herein, the Veteran was specifically found not to suffer from staggering. See id. at Question No. 3; see also id. at Question No. 6D (“unsteady gait, Parkinson’s gait slightly stooped, with a brady.”) The record does not establish, and the Veteran has not alleged, dizziness with occasional staggering. Therefore, a higher rating is not warranted. The Board acknowledges the Veteran's belief that his balance symptoms are more severe than the current rating reflects. While the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, supra. Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability considering the rating criteria to be more persuasive than the Veteran’s reports regarding the severity of his condition. Therefore, the medical opinions hold more probative weight than the Veteran’s assertions. The Board has considered whether a staged rating under Hart, supra is appropriate; however, the Board concludes that the Veteran’s balance impairment with bradykinesia as related to Parkinson’s disease was stable throughout the appellate period, and that his 10 percent rating reflects adequate compensation throughout the period on appeal. Therefore, the assignment of a staged ratings is not warranted. The Veteran and/or his attorney has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, supra. The Board has considered the doctrine of reasonable doubt but has determined that it is inapplicable because the preponderance of the evidence is against higher ratings for the period in question. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. The Veteran’s claim for a rating in excess of 10 percent for his balance impairment with bradykinesia as related to Parkinson’s disease must be denied. 11. Entitlement to increased ratings for constipation associated with Parkinson’s disease, currently rated as noncompensable prior to March 27, 2019 and 10 percent disabling thereafter, is denied. The Veteran has generally asserted that a higher rating is warranted for constipation with Parkinson’s disease. Specific argument in support of this appeal has not been submitted. The Veteran’s constipation has been evaluated under Diagnostic Code 7319, which normally governs irritable colon syndrome. 38 C.F.R. § 4.114. Under that code, a noncompensable rating is assigned for mild symptoms, such as disturbances of bowel function with occasional episodes of abdominal distress. A 10 percent rating is assigned for moderate symptoms, such as frequent episodes of bowel disturbance with abdominal distress. A 30 percent rating, the maximum available, is warranted where there are severe symptoms, such as diarrhea, or alternating diarrhea with constipation, with more or less frequent abdominal distress. This disorder has been rated as noncompensable until prior to March 27, 2019, and then 10 percent disabling thereafter. The Board has fully reviewed all available VA treatment records documenting the Veteran’s medical care received. The only evidence of record pertaining to the Veteran’s constipation during the appellate period is within the Veteran’s VA examinations for Parkinson’s disease. See VA Exams (Nov. 2018; July 2019; Oct. 2020), supra. Ultimately, the Veteran’s constipation appears to be no more severe than “mild” at any time earlier than the Board’s receipt of the Veteran’s notice of disagreement (at which time the Veteran is already in receipt of a 10 percent compensable rating), nor otherwise more severe than “moderate” at any time thereafter on appeal. See id. at Question No. 3d, respectively. In other words, it was deemed “mild” at the first examination and “moderate” at the second and third examinations. Additionally, the Veteran was specifically and separately examined post-remand to evaluate his constipation symptomatology. See VA Exam (Intestinal Conditions) (Oct. 12, 2020) (rec’d Nov. 18, 2020). Whereas the Veteran’s examiner recorded moderate constipation at the Parkinson’s examination, at this more specific examination, the Veteran reported no current constipation, and reported positive effects of medication taken as needed and the incorporation of fresh fruit in his diet. See generally id. at Section II, Questions Nos. 2A, and Section IV, Question No. 4 (occasional episodes of bowel disturbance with abdominal distress). For the appeal period prior to March 27, 2019, the Veteran’s constipation manifested as mild symptoms without moderate symptoms such as frequent episodes of bowel disturbance with abdominal distress. For the appeal period beginning on March 27, 2019, the Veteran’s constipation manifested as moderate symptoms without severe symptoms such as diarrhea, or alternating diarrhea with constipation, with more or less frequent abdominal distress. Therefore, a higher rating is not warranted. The Board ultimately concludes that the Veteran’s constipation only appears to have manifested in compensable symptoms as of the second VA examination, but symptoms have never progressed in severity beyond “moderate.” Nonetheless, the AOJ appears to have awarded a compensable rating to coincide with receipt of the notice of disagreement, in interpreting the Veteran’s arguments that his Parkinson’s disease had progressed after his receipt of an initial rating. As a result, the Board concludes that his constipation, to the extent that it is a distinct symptom of Parkinson’s disease with its own rating, is properly compensated throughout the period on appeal. The Board acknowledges the Veteran's belief that his constipation symptoms are more severe than the current rating reflects. While the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, supra. Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability considering the rating criteria to be more persuasive than the Veteran’s reports regarding the severity of his condition. Therefore, the medical opinions hold more probative weight than the Veteran’s assertions. The Board has considered whether a staged rating under Hart, supra is appropriate; however, the Board concludes that the Veteran’s constipation as related to Parkinson’s disease was stable throughout the appellate period. Therefore, the assignment of a staged ratings is not warranted. The Veteran and/or his attorney has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, supra. The Board has considered the doctrine of reasonable doubt but has determined that it is inapplicable because the preponderance of the evidence is against higher ratings for the period in question. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. The Veteran’s claim for a compensable rating prior to March 27, 2019 and in excess of 10 percent thereafter must be denied. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael B. Engle, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.