Citation Nr: 21023519 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 14-04 279 DATE: April 20, 2021 ORDER An initial rating in excess of 10 percent for degenerative arthritis and intervertebral disc syndrome (IVDS) of the thoracolumbar spine prior to September 30, 2020, is denied. The assignment of a separate rating for radiculopathy of the left lower extremity (LLE), evaluated as 10 percent disabling as of April 21, 2016, prior to September 30, 2020, is proper; the appeal is denied. An initial compensable rating for hypertension is denied. An initial compensable rating for residual surgical scars of the right foot is denied. FINDINGS OF FACT 1. For the entire appeal period prior to September 30, 2020, the Veteran’s degenerative arthritis and IVDS of the thoracolumbar spine was manifested by forward flexion greater than 60 degrees and a combined range of motion for the entire thoracolumbar spine greater than 120 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour, ankylosis, incapacitating episodes due to IVDS, or associated objective neurological abnormalities, other than radiculopathy of the LLE as of April 21, 2016. 2. As of April 21, 2016, the Veteran’s degenerative arthritis and IVDS of the thoracolumbar spine was manifested by radiculopathy of the LLE that resulted in no more than incomplete paralysis of the sciatic nerve prior to September 30, 2020. 3. For the entire appeal period, the Veteran’s hypertension required continuous use of medication for control, but is not manifested by diastolic pressure predominantly 100 or more, or a history thereof, or systolic pressure predominantly 160 or more. 4. For the entire appeal period, the Veteran’s residual surgical scars of the right foot are superficial and linear, and are not associated with underlying soft tissue damage, unstable, or painful, of a size warranting a compensable rating, or result in any disabling effects. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for degenerative arthritis and IVDS of the thoracolumbar spine prior to September 30, 2020, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5242. 2. The assignment of a separate rating for radiculopathy of the LLE, evaluated as 10 percent disabling as of April 21, 2016, prior to September 30, 2020, is proper. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.124a, DC 8520. 3. The criteria for an initial compensable rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.104, DC 7101. 4. The criteria for an initial compensable rating for residual surgical scars of the right foot have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, DC 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1980 to July 1984, and from October 1984 to September 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2015, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. In December 2015 and November 2018, the Board remanded the issues on appeal, as well as claims for higher initial ratings for the Veteran’s bilateral hip disabilities, for additional development. By way of rating decisions issued in May 2016 and November 2020 that awarded separate and increased ratings for the manifestations of his right and left hip disabilities, he has been in receipt of at least 20 percent combined ratings for his such disabilities since October 1, 2010, the date of service connection. As the Veteran limited his appeal to a 20 percent rating for such disabilities in his April 2011 notice of disagreement and January 2014 substantive appeal, and such have been awarded for the entire appeal period, his claims have been granted in full. AB v. Brown, 6 Vet. App. 35, 38 (1993). Thus, they are no longer before the Board. The Board also notes that the November 2020 rating decision awarded an increased rating of 40 percent for the Veteran’s back disability as of September 30, 2020, and separate ratings for radiculopathy of the right lower extremity (RLE) and LLE associated with such disability. Specifically, a separate 10 percent rating for radiculopathy of the LLE affecting the sciatic nerve as of April 21, 2016, was awarded. As of September 30, 2020, such was increased to 20 percent, and separate 20 percent ratings were awarded for radiculopathy of the RLE affecting the sciatic nerve, and radiculopathy of the LLE and RLE affecting the femoral nerves. As the Veteran limited his appeal to a 20 percent rating for his back disability in his April 2011 notice of disagreement and January 2014 substantive appeal, and such has been awarded for the appeal period beginning September 30, 2020, such matters are no longer before the Board. AB, supra. However, as the propriety of the assigned rating for the Veteran’s back disability prior to such date is still on appeal, the Board will also consider the propriety of the separately assigned rating for his radiculopathy of the LLE, which is evaluated as 10 percent as of April 21, 2016, prior to September 30, 2020. See General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), Note (1); Chavis v. McDonough, No. 18-2928 (Vet. App. Apr.16, 2021). The case now returns for further appellate review. Finally, the Board observes that an August 2015 rating decision, as relevant, denied service connection for carpal tunnel syndrome of the right and left wrists. Thereafter, the Veteran entered a notice of disagreement as to such denials in August 2016 and a statement of the case was issued in August 2019. However, as he did not file a timely substantive appeal, such issues are not properly before the Board. In this regard, the Board notes that, in April 2020, VA received a substantive appeal (VA Form 9) dated November 26, 2019, addressing the denial of service connection carpal tunnel syndrome of the right and left wrists. However, as such must have been received within 60 days of the issuance of the statement of the case on August 26, 2019, i.e., by October 25, 2019, it is untimely. Thus, the Board lacks jurisdiction over such issues. Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. 1. Entitlement to an initial rating in excess of 10 percent for degenerative arthritis and IVDS of the thoracolumbar spine prior to September 30, 2020. The basis of disability evaluation 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. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in 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. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The Veteran’s back disability is evaluated as 10 percent disabling as of October 1, 2010, the date of service connection, until September 30, 2020, pursuant to DC 5242-5243, which, in turn, is evaluated under the General Rating Formula or the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Rating Formula), whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. § 4.25. In this regard, ratings under the General Rating Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. Such provides for a 10 percent rating for 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. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. Finally, a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Note (1) to the rating formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. The IVDS Rating Formula provides that a 10 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note (1) provides that an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Turning to the evidence of record, the Veteran underwent a VA examination for his back disability in July 2010. At such time, he reported that he could walk without limitation, had not experienced falls due to such disability, and denied experiencing spasms, paresthesia, weakness, bowel or bladder problems, or erectile dysfunction in relation to his back disability. However, the Veteran indicated that such disability resulted in stiffness, fatigue, decreased motion, and weakness, and reported experiencing constant pain that could be exacerbated by prolonged sitting. However, during such flare-ups, he experienced neither functional impairment nor any limitation of motion of the joint. The Veteran had never been hospitalized or had any surgery for his back disability, and, in the previous 12 months, such had not resulted in any incapacitation. Further, he did not experience any overall functional impairment due to his back disability. Range of motion (ROM) testing revealed forward flexion to 90 degrees, with pain at 50 degrees, extension to 25 degrees, with pain at 15 degrees, and bilateral lateral flexion and bilateral rotation to 30 degrees in all planes, with pain at 20 degrees on left lateral flexion and 15 degrees on right rotation. There was no additional limitation of ROM following repetitive testing, and the examiner noted that the Veteran’s spine was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. There was no evidence of radiating pain on movement, muscle spasms, tenderness, guarding of movement, or weakness. Muscle tone was normal, straight leg raising was negative bilaterally, and there was no ankylosis. Neurological examination revealed no sensory deficits of S1 or L1-L5, and reflexes were normal. There was no sign of IVDS with chronic and permanent nerve root involvement. Private treatment records dated in February 2011 reflect the Veteran’s complaints of back pain with flexion to 70 degrees with pain. He also had decreased extension and bilateral rotation with pain, but no ROM measurements were reported. Straight leg raising on the left was positive, but negative on the right. However, sensation was normal on objective testing. In April 2011, the Veteran complained of pain with a diagnosis of lumbar degenerative disc disease/radiculopathy/lumbago/ lumbar spondylosis/facet syndrome, and injections were prescribed. In January 2012, the Veteran reported back pain that radiated to his legs. On examination, he had flexion to 80 degrees. In January 2013, he reported low back and left leg pain; however, objective examination revealed that he was neurologically intact. Records dated through May 2015 continue to reflect treatment with injections. The Veteran was afforded another VA examination in April 2016, at which time he reported that his back disability was being managed and treated with injections, which were temporarily helpful. He denied ever having back surgeries. The Veteran reported experiencing back pain with random episodic sharp, shotting pains down both legs. He reported the following functional limitations/aggravating factors: mowing yard/lawn (push mower), doing dishes, and prolonged walking. He denied limitations from lifting/carrying, and flare-ups. Upon examination, ROM revealed forward flexion limited to 80 degrees, extension limited to 25 degrees, normal right lateral flexion to 30 degrees, left lateral flexion limited to 25 degrees, and normal bilateral rotation to 30 degrees. He was also noted to have pain on forward flexion, right lateral flexion, and left lateral flexion; however, such did not result in/cause functional loss. The Veteran’s impaired ROM was noted to not cause functional loss in and of itself; there was no evidence of pain with weight-bearing; and no objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine. The examiner indicated that pain, weakness, fatigability, or incoordination did not significantly limit the Veteran’s functional ability with repeated use over a period of time. She further indicated that Veteran did not have guarding/muscle spasm, and muscle strength testing, straight leg raising test, and reflex examination were normal. However, he had decreased sensation in the left foot/toes, and was assessed with mild LLE radiculopathy affecting the sciatic nerve. There was no RLE radiculopathy, or other neurologic abnormalities or findings related to the Veteran’s back disability, to include bowel or bladder problems. There was no ankylosis. The examiner noted a diagnosis of IVDS; however, there were no incapacitating episodes. The Board finds the July 2010 and April 2016 VA examinations, which considered the Veteran’s lay statements and completed, to the extent necessary, all testing required by the Court, highly probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Dalton v. Nicholson, 21 Vet. App. 23 (2007); VAOPGCPREC 20-95. In this regard, the Board notes that, while the examinations do not reflect passive ROM testing, the evidence does not suggest, and the Veteran has not argued, that his range of motion would be further limited in such capacity. Moreover, as a general matter of course, active ROM testing usually results in further limitation than passive ROM testing. See Massie v. Shinseki, 25 Vet. App. 123, 131 (2011); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015). Furthermore, the September 2020 VA examiner indicated that it is not feasible to do in a safe and reasonable manner. Additionally, at the September 2020 VA examination, it was noted that the Veteran had pain on passive ROM and nonweight-bearing, which the Board will accept as being consistent throughout the appeal period. Based on the foregoing, the Board finds that an initial rating in excess of 10 percent for the Veteran’s back disability prior to September 30, 2020, is not warranted. In this regard, at no time did such disability result in forward flexion limited to 60 degrees or less, or a combined ROM of the thoracolumbar spine limited to 120 degrees or less, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. Specifically, the Veteran’s forward flexion was limited to 70 degrees at worst, while his combined ROM was limited to 220 degrees at worst. Moreover, at no point was he found to have ankylosis, or muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour. Moreover, while the Veteran was found to have IVDS, such did not result in incapacitating episodes during the appeal period. Rather, his functional impairment manifests by painful movement, which is explicitly considered in the currently assigned 10 percent rating. With respect to Note (1) of the General Rating Formula, the Board notes that, for the period prior to September 30, 2020, a separate rating for radiculopathy of the LLE, evaluated as 10 percent disabling as of April 21, 2016, has been awarded, the propriety of which will be addressed in the next section. However, for the period prior to September 30, 2020, the Board finds that the Veteran’s back disability did not result in any additional associated objective neurologic abnormalities, to include radiculopathy of the RLE, bladder or bowel impairment, or erectile dysfunction. In this regard, while the Veteran has reported radiating pain down his RLE, such is explicitly contemplated in his currently assigned rating under the General Rating Formula. Moreover, such was not objectively shown until the September 30, 2020, VA examination. Consequently, additional separate ratings for objective neurologic abnormalities associated with the Veteran’s back disability prior to September 30, 2020, are not warranted. 2. Propriety of the separate rating for radiculopathy of the LLE, evaluated as 10 percent disabling as of April 21, 2016, prior to September 30, 2020. As noted previously, the Veteran has been awarded a separate rating for radiculopathy of the LLE, which is evaluated as 10 percent disabling as of April 21, 2016, prior to September 30, 2020. Such disability is evaluated pursuant to DC 8520, which addresses paralysis of the sciatic nerve, and provides a 10 percent rating for mild incomplete paralysis of the sciatic nerve and a 20 percent rating for moderate incomplete paralysis of the sciatic nerve. Moderately severe incomplete paralysis warrants a 40 percent rating, while severe incomplete paralysis, with marked muscular atrophy, warrants a 60 percent rating. An 80 percent rating is assigned when there is complete paralysis with foot dangles and drops, no active movement possible of muscles below the knee, flexion of the knee weakened or (very rarely) lost. 38 C.F.R. § 4.124a. Initially, the Board finds that a separate rating for radiculopathy of the LLE is not warranted prior to April 21, 2016, which is the date of the VA examination where such manifestation was first objectively demonstrated. In this regard, while the Veteran reported radiating pain down his LLE prior to such date, such is explicitly contemplated in his currently assigned 10 percent rating under the General Rating Formula. Specifically, the July 2010 VA examination revealed no neurologic impairment and, while a February 2011 treatment record reflected positive straight leg raising on the left, sensation was normal on objective testing. Similarly, while private treatment records included a diagnosis of radiculopathy prior to April 21, 2016, such was not objectively shown by examination or testing, which is required under Note (1) of the General Rating Formula. Furthermore, objective examination revealed that he was neurologically intact in January 2013. Thus, a separate rating for radiculopathy of the LLE is not warranted prior to April 21, 2016. The Board further finds that, as of such date, a rating in excess of 10 percent for such disability is not warranted. Specifically, at the April 2016 VA examination, strength and reflex testing were normal and, while the Veteran had decreased sensation in his left foot/toes, such was not absent. Furthermore, upon consideration of such objective test results and the Veteran’s subjective report of mild intermittent pain, with the denial of constant pain, paresthesias and/or dysesthesias, and numbness, the April 2016 VA examiner determined that his radiculopathy of the LLE affecting the sciatic nerve was only mild in nature. Furthermore, the remainder of the evidence fails to reflect that such disability more nearly approximated moderate incomplete paralysis of the sciatic nerve at any point between April 21, 2016, and September 30, 2020. Thus, a rating in excess of 10 percent for radiculopathy of the LLE is not warranted. Consequently, based on the foregoing, the Board finds that the assignment of a separate rating for radiculopathy of the LLE, evaluated as 10 percent disabling as of April 21, 2016, prior to September 30, 2020, is proper. 3. Entitlement to an initial compensable rating for hypertension. For the entire appeal period, which stems from October 1, 2010, the date of service connection, the Veteran’s hypertension has been assigned a noncompensable rating pursuant to DC 7101. 38 C.F.R. § 4.104. Under DC 7101, a 60 percent rating is warranted for hypertension if the diastolic pressure is predominantly 130 or more; a 40 percent rating is assigned if the diastolic pressure is predominantly 120 or more; a 20 percent rating is warranted when the diastolic pressure is predominantly 110 or more or systolic pressure is predominantly 200 or more; and a 10 percent rating is assigned if the diastolic pressure is predominantly 100 or more or systolic pressure is predominantly 160 or more, or minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. Notes to DC 7101 provide that hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic pressure of less than 90mm. Additionally, such direct that hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, should be evaluated as part of the condition causing it rather than by separate evaluation. Finally, hypertension should be evaluated separately from hypertensive heart disease and other types of heart disease. By way of history, the Veteran’s service treatment records reveal blood pressure readings of 146/93, 128/84, 147/91, 118/90, 120/96, 132/71, 124/72, 130/86, 110/76, 116/86, 112/62, 110/70, 120/84, 124/80, 108/70, 120/80, 120/100 (August 1989), 130/78, 108/78, 120/72, 140/98, 124/58, 137/90, 133/98, 124/89, 131/87, 135/85, 134/82, 149/100 (December 2008), 136/78, 142/90, 138/92, 110/82, 138/76, 142/86, 122/62, 142/90, 128/94, 130/82, 138/76, 140/86, 122/60, 118/75, 124/86, 139/90, 135/94, 152/105 (June 2006), 126/84, 124/84, 139/90, 132/88, 134/90, 132/91, 142/94, 147/105 (August 2010), and 130/90. Private treatment records dated in February 2011 and May 2014 reveal blood pressure readings of 144/86 and 121/82. VA treatment records dated from December 2010 to April 2020 reflect blood pressure readings of 125/85, 112/62, 124/81, 122/70, 131/86, 118/83, 120/84, 133/83, 125/83, 111/68, 129/79, 127/88, 116/72, 129/93, 158/100 (December 2010), 140/95, 142/71, 126/85, 130/79, 131/66, 130/90, 141/100 (December 2011), 133/91, 144/96, 120/76, 130/80, 123/81, 116/80, 122/80, 127/84, 120/78, 127/86, 124/81, 119/83, 131/84, 124/86, 123/87, 138/88, 126/89, 124/82, 128/92, 123/84, 120/83, 119/78, 120/77, 124/88, 129/86, 131/93, 124/90, 125/91, 132/78, 128/86, 126/84, 120/76, 144/96, and 119/82. The Veteran underwent a general VA general examination in July 2010. At such time, he reported that his hypertension had existed for ten years, and his current treatment consisted of taking daily Lisinopril with no side effects. The Veteran indicated that he did not experience any overall functional impairment from his hypertension. His current blood pressure readings were 122/98, 124/96, and 124/98. At an April 2016 VA examination, the Veteran reported that his hypertension began in approximately 2006, and he was placed on an antihypertensive treatment with medication while in service. The Veteran noted that he observed a low sodium diet and exercised daily, blood pressure readings had been stable, and he had no problems or complications associated with his hypertension. His treatment plan included taking continuous medication, to include Lisinopril, Felodipine, and Chlorthalidone. The examiner reported that the Veteran did not have a history of diastolic blood pressure of predominantly 100 or more. The Veteran’s current blood pressure readings were 111/70, 112/69, and 108/72. The examiner indicated that the Veteran’s hypertension was stable and well-controlled on oral medications, and he had no functional limitations. At a September 2020 VA examination, the Veteran reported that his hypertension began in 2006, and was currently controlled with antihypertensive medications. Specifically, such required continuous medication for control (Felodipine, Lisinopril, and Chlorthalidone); however, he did not have a history of diastolic blood pressure of predominantly 100 or more. The Veteran’s current blood pressure readings were 140/80, 157/81, and 124/81. Based on the foregoing, the Board finds that an initial compensable rating for the Veteran’s hypertension is not warranted as the evidence shows that, while he requires continuous medication for control, he does not have diastolic pressure predominantly 100 or more, or a history thereof, or systolic pressure predominantly 160 or more. In this regard, while he had a notation of diastolic blood pressure of 100 or more in June 2006, December 2008, August 2010, December 2010, and December 2011, such is not indicative of diagnostic blood pressure readings predominately over 100. Rather, the evidence shows that the vast majority of such readings have reflected that his diastolic blood pressure was under 100. Furthermore, at no time is it shown that he had systolic blood pressure over 160. The Board also acknowledges that the Veteran takes medications for his hypertension, which assists in controlling such disability. However, the use of medications is explicitly contemplated in DC 7107. In this regard, the Court has held that the Board did not err in failing to discount the ameliorative effects of blood pressure medication as the plain language of DC 7101 contemplates the effects of medications. McCarroll v. McDonald, 28 Vet. App. 267, 272-73 (2016). Consequently, an initial compensable rating for hypertension is not warranted. 4. Entitlement to an initial compensable rating for residual surgical scars of the right foot. Since October 1, 2010, the date of service connection, the Veteran’s residual surgical scars of the right foot are rated as noncompensably disabling pursuant to DC 7804. 38 C.F.R. § 4.118. Scars are rated under 38 C.F.R. § 4.118, DCs 7800 through 7805. DC 7800 pertains to burn scars of the head, face, or neck; scars of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck. However, as the scars at issue affect the Veteran’s right foot, DC 7800 is inapplicable and will not be further considered. DC 7801 pertains to burn scars or scars due to other causes, not of the head, face, or neck, that are, prior to August 13, 2018, deep and nonlinear and, after such date, associated with underlying soft tissue damage. Under this DC, a 10 percent rating is assigned when the scar(s) cover an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.). Higher ratings are available for greater areas affected. DC 7802 pertains to burn scars or scars due to other causes not of the head, face, or neck that are, prior to August 13, 2018, superficial and nonlinear and, after such date, not associated with underlying soft tissue damage. Under this DC, a single 10 percent rating is assigned when the scar(s) cover an area or areas of 144 square inches (929 sq. cm) or greater. DC 7804 provides that one or two scars that are unstable or painful warrant a 10 percent evaluation. Three or four scars that are unstable or painful warrant a 20 percent rating, while five or more scars that are unstable or painful warrant a 30 percent evaluation. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) states that if one or more scars are both unstable and painful, the rater is to add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under DC 7804, when applicable. Note (3). DC 7805 provides that other scars (including linear scars) and other effects of scars evaluated under DCs 7800, 7801, 7802, and 7804 that require the evaluation of any disabling effect(s) not considered in a rating provided under DCs 7800-7804 should be rated under an appropriate DC. During the pendency of the appeal, VA amended the criteria for rating the skin, to include scars. See Schedule for Rating Disabilities: Skin, 83 Fed. Reg. 32,592 (July 13, 2018). As pertinent to the instant appeal, such amendment changed DC 7801 by removing the term “deep and nonlinear” and replacing it with “associated with underlying soft tissue damage,” and changed DC 7802 by removing the term “superficial and nonlinear” and replacing it with “not associated with underlying soft tissue damage.” Such also amended the accompanying notes to read: Note (1): For the purposes of DCs 7801 and 7802, the six (6) zones of the body are defined as each extremity, anterior trunk, and posterior trunk. The midaxillary line divides the anterior trunk from the posterior trunk. Note (2): A separate evaluation may be assigned for each affected zone of the body under this diagnostic code if there are multiple scars, or a single scar, affecting multiple zones of the body. Combine the separate evaluations under § 4.25. Alternatively, if a higher evaluation would result from adding the areas affected from multiple zones of the body, a single evaluation may also be assigned under this DC. With regard to the effective date of the new criteria, VA indicated in the Supplementary Information to the Final Rule that its “intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied.” The Veteran’s claim in this case was pending prior to the August 13, 2018, effective date of the new criteria and, therefore, the Board will consider both the old and new criteria. In order to afford the Veteran all possible avenues of entitlement to a higher rating, the Board has considered all applicable DCs, to include both the old and new criteria, as well as his specific reports of his symptoms and the medical evidence. The July 2010 VA general examination report indicates the Veteran has two scars on his right foot. The scars of the right foot include: (1) on the medial aspect of the first digit, which measured 4.5 centimeters (cm) by 0.1 cm; and (2) on the dorsal surface of the second digit, measuring 2.5 cm by 0.1 cm. The examiner indicated that such scars were linear and not painful on examination; there was no skin breakdown; such scars were superficial with no underlying tissue damage; inflammation and edema were absent; there was no keloid formation; such scars were not disfiguring; such scars did not limit the Veteran’s motion; and there was no limitation of function due to the scars. An April 2016 VA foot examination report noted four right foot scars, which were asymptomatic with no subjective complaints or pain, linear/vertical and located on the dorsal surface, and well-healed. The first scar was located above the right big toe and measured 4 cm by 0.1 cm; second scar was on the right second toe, which measured 2 cm by 0.1 cm; third scar was on the right third toe, measuring 1.5 cm by 0.1 cm; and fourth scar was located in between the right second and third toes, which measured 2.25 cm by 0.1 cm. An August 2019 VA foot examination report noted five right foot scars. Here, the examiner indicated that none of the Veteran’s right foot scars were painful or unstable, had a total area equal to or greater than 39 square centimeters, or were located on the head, face, or neck. The first scar was located on the right first toe and measured 6 cm by 0.1 cm; second scar was on the right second toe, which measured 2.5 cm by 0.1 cm; third scar was on the right third toe, measuring 3 cm by 0.1 cm; fourth scar was located on the right fourth toe, which measured 1 cm by 0.1 cm; and fifth scar was also located on the right fourth toe, measuring 1 cm by 0.1 cm. A September 2020 VA scars examination report reveals that the Veteran had five right foot scars located on the right great toe (6 cm by 0.5 cm), right second toe (2.5 cm by 0.5 cm), right third toe (3 cm by 0.5 cm), and right fourth toe (2 – both measuring 1 cm by 0.5 cm). The examiner indicated that none of the scars were painful or unstable, were tender to palpation, or had underlying soft tissue damage. The total area of the Veteran’s right foot scars equaled 6.749 square centimeters. The examiner reported that the Veteran’s scars did not impact his ability to work. Based on the foregoing, the Board finds that an initial compensable rating for the Veteran’s residual surgical scars of the right foot is not warranted. Specifically, as pertinent to DC 7801, the Board finds that the evidence does not show that his scars of the right foot are deep and nonlinear, or associated with underlying soft tissue damage, and do not affect an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.). In regard to DC 7802, the Board finds that the Veteran’s scars of the right foot, while superficial and not associated with underlying soft tissue damage, are linear and do not affect an area or areas of 144 square inches (929 sq. cm) or greater. As pertinent to DC 7804, the Board notes that all VA examinations have found that the Veteran’s scars of the right foot are not painful or unstable. Finally, as relevant to DC 7805, the evidence does not show, nor does the Veteran contend, that his scars of the right foot result in any disabling effects. Rather, VA examinations reflect that such scars do not result in limitation of function. Consequently, a higher or separate rating is not warranted under any other potentially applicable DC pursuant to DC 7805. Other Considerations In making its determination in the instant case, the Board acknowledges the Veteran’s belief that his back disability with associated radiculopathy of the LLE as of April 21, 2016, prior to September 30, 2020, hypertension, and right foot scars are more severe than as reflected by the currently assigned ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that he 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). 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 disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of such conditions. The Board has also considered whether additional staged ratings under Fenderson, supra, are appropriate for the Veteran’s service-connected disabilities; however, the Board finds that his symptomatology has been stable throughout the periods on appeal. Therefore, assigning additional staged ratings for such disabilities is not warranted. Further, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the claims adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Based on the foregoing, the Board finds that higher initial ratings for the Veteran’s back disability with associated radiculopathy of the LLE as of April 21, 2016, prior to September 30, 2020, hypertension, and right foot scars are not warranted. As the preponderance of the evidence is against such claims, the benefit of the doubt doctrine is not applicable and such claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Koria B. Stanton, 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.