Citation Nr: 21024014 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 16-38 266 DATE: April 21, 2021 ORDER Service connection for unspecified depressive disorder is granted. An initial rating in excess of 10 percent for irritable bowel syndrome (IBS) is denied. Prior to January 22, 2020, a 10 percent rating, but no higher, for low back strain with lumbar degenerative disc disease is granted, subject to the laws and regulations governing the payment of monetary awards. As of January 22, 2020, a rating in excess of 20 percent for low back strain with lumbar degenerative disc disease is denied. FINDINGS OF FACT 1. Resolving all doubt in the Veteran’s favor, his current acquired psychiatric disorder, diagnosed as unspecified depressive disorder, is related to his military service. 2. For the entire appeal period, the Veteran’s IBS was moderate in nature with frequent episodes of bowel disturbance with abdominal distress, without more severe symptomatology that more nearly approximates severe IBS with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. 3. For the period on appeal prior to January 22, 2020, the Veteran’s low back strain with lumbar degenerative disc disease was manifested by painful, limited motion, but with forward flexion greater than 60 degrees and a combined range of motion of 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, intervertebral disc syndrome (IVDS), or associated objective neurological abnormalities. 4. As of January 22, 2020, the Veteran’s low back strain with lumbar degenerative disc disease was manifested by forward flexion greater than 30 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, ankylosis, IVDS, or associated objective neurological abnormalities. CONCLUSIONS OF LAW 1. The criteria for service connection for unspecified depressive disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for an initial rating in excess of 10 percent for IBS have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.114, Diagnostic Code (DC) 7319. 3. For the appeal period prior to January 22, 2020, the criteria for a 10 percent rating, but no higher, for low back strain with lumbar degenerative disc disease have 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, DC 5237. 4. As of January 22, 2020, a rating in excess of 20 percent for low back strain with lumbar degenerative disc disease 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, DC 5237. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 2004 to September 2006. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued in February 2013 and April 2016 by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Veteran and his fiancé testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In December 2019, the Board remanded the case for additional development and it now returns for further appellate review. In regard to the characterization of the Veteran’s claim for an increased rating for his back disability, the Board notes that the February 2013 rating decision denied a compensable rating for such disability. However, while on appeal, a July 2017 rating decision increased the rating to 10 percent, effective July 15, 2015, and an August 2020 rating decision again increased the rating to 20 percent, effective January 22, 2020. As the Veteran is presumed to be seeking the maximum benefit for a disability, his claim for an increased rating for his back disability remains in appellate status. A.B. v. Brown, 6 Vet. App. 35, 38 (1993). Furthermore, such issue has been characterized to reflect that staged ratings are in effect. Hart v. Mansfield, 21 Vet. App. 505 (2007). Service Connection 1. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depression. The Veteran claims that he has an acquired psychiatric disorder, to include PTSD and depression, that had its onset during service as a result of his fear of hostile military or terrorist activity while stationed in Iraq and discovering that his spouse at the time became pregnant with another man’s baby. In this regard, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996). For PTSD, service connection requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a), which requires a diagnosis that conforms to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a link, established by medical evidence between current symptoms and an in-service stressor, and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f); Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020) (VA requires a diagnosis that conforms to the DSM-5 to compensate for a psychiatric disability). While the Veteran’s service treatment records are negative for any complaints, treatment, or diagnosis referable to an acquired psychiatric disorder, the record reflects that he served in Iraq from January 2005 to October 2005 and, after his return, the use of cocaine and alcohol were documented in July 2006, which the Veteran reports that he used to cope with the onset of psychiatric symptoms, which have continued to the present time. Additionally, as reflected in a February 2011 VA treatment record, following a mental status examination, a VA physician noted a diagnosis of depressive disorder. Here, the VA physician reported that the Veteran served in Iraq and was in a combat area, he started noticing anxiety and depression symptoms in 2007 that were brought on by issues that occurred in the Army, to include learning his spouse was pregnant with another man’s baby and deploying to Iraq. Similarly, additional VA treatment records reflect diagnoses of anxiety disorder and depressive disorder, but do not otherwise relate them to his military service, and, while PTSD was noted by history and a provisional diagnosis of “rule out PTSD’ had been made, no such diagnosis had been rendered based on a clinical evaluation. In fact, such reflect that his PTSD screenings were negative and clinicians indicated that he did not meet the diagnostic criteria for such a diagnosis. Furthermore, VA examinations conducted in November 2015 and January 2020 fail to reflect a diagnosis of PTSD pursuant to the DSM-5. Nonetheless, such reflect a diagnosis of unspecified depressive disorder. In this regard, while the November 2015 VA examiner did not address the etiology of such disorder, the January 2020 VA examiner provided a comprehensive opinion. Specifically, while he found that the Veteran’s unspecified depressive disorder was less likely than not the result of an in-service stressor-related event, he related such disorder to multiple psychosocial factors, including learning, while on deployment, that he was not the biological father of his first spouse’s baby. In this regard, the examiner observed that the Veteran was experiencing personal psychosocial stressors at the time of his in-service cocaine use as he had recently learned that his spouse was pregnant with another man’s baby while he had been deployed to Iraq, a fact which he noted was further documented in the Veteran’s September 2010 claim and October 2010 and February 2011 VA treatment records. Consequently, as the January 2020 VA examiner is a competent medical professional, considered all relevant facts, and offered a rationale for his opinion, and there is no medical opinion to the contrary, the Board resolves all doubt in favor of the Veteran and finds that his current acquired psychiatric disorder, diagnosed as unspecified depressive disorder, is related to his military service. Thus, service connection for such disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Increased Ratings 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, supra. Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. 2. Entitlement to an initial rating in excess of 10 percent for IBS. The Veteran’s IBS has been rated as 10 percent disabling for the entire appeal period stemming from December 30, 2010, the date of service connection was awarded pursuant to DC 7319. 38 C.F.R. § 4.114. Such provides for a 10 percent rating for moderate irritable colon syndrome, with frequent episodes of bowel disturbance with abdominal distress. A 30 percent rating is warranted for severe irritable colon syndrome, with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. Turning to the evidence of record, VA treatment records dated from January 2011 to March 2011 reflect that the Veteran experienced diarrhea for more than two years, usually twice per day after eating lunch and dinner. He denied vomiting and weight loss, and reported only experiencing occasional mild abdominal discomfort. Another VA treatment record from January 2013 noted that the Veteran reported that he was not experiencing diarrhea, constipation, or abdominal pain at that time. August 2015 and October 2015 VA treatment records reflect that the Veteran denied abdominal pain, nausea, vomiting, and diarrhea. At a November 2015 VA examination, the Veteran reported loose stools soon after eating, with no bleeding from the gastrointestinal tract, nausea, or vomiting. On examination, symptoms of diarrhea after meals, frequent episodes of bowel disturbance with abdominal distress (but not more or less consistent abdominal distress), and weight loss attributable to the IBS were noted. No other symptoms were observed, no anemia was present on laboratory testing, and the examiner found that such disability did not impact the Veteran’s ability to work. At his August 2019 Board hearing, the Veteran reported additional symptoms of weight loss; constant abdominal distress, to include diarrhea and cramps, after eating; frequent bathroom use; and blood in his stools. Similarly, in a statement submitted the same month, his fiancé reported that the Veteran experienced diarrhea and abdominal pain. Thus, the Board remanded the case in order to afford him a new VA examination so as to assess the current nature and severity of his IBS. At a January 2020 VA examination, the Veteran reported four to five soft stools a day, abdominal pain, and bowel movements after eating. He denied constipation and treatment; rather, he managed his symptoms by watching his diet. Upon examination, symptoms of diarrhea and frequent episodes of bowel disturbance with abdominal distress (but not more or less consistent abdominal distress). No other symptoms, to include weight loss, were observed and the examiner found that such disability impacted the Veteran’s ability to work insofar as it interrupted his duty day. Based on the foregoing, the Board finds that, for the entire appeal period, the Veteran’s IBS is moderate in nature with frequent episodes of bowel disturbance with abdominal distress. Specifically, his reported symptoms of diarrhea, abdominal pain, and weight loss, as documented in his VA treatment records and examinations reports, are fully contemplated by such rating. Moreover, the Veteran denied nausea, vomiting, and constipation and, while he reported blood in his stools, laboratory testing was negative for anemia. Further, while he reported at his August 2019 that he would describe his abdominal distress as “nearly constant,” such is contradicted by his other statements reflecting symptoms only after eating. Moreover, in consideration of the totality of the Veteran’s symptoms, the November 2015 and January 2020 VA examiners found that such disability resulted in frequent episodes of bowel disturbance with abdominal distress, but not more or less consistent abdominal distress, which is consistent with moderate, rather than severe, IBS. Therefore, an initial rating in excess of 10 percent for the Veteran’s IBS is denied. 3. Entitlement to a compensable rating prior to July 15, 2015, in excess of 10 percent from July 15, 2015 to January 22, 2020, and in excess of 20 percent thereafter for low back strain with lumbar degenerative disc disease. 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 appeal period begins August 23, 2010, the date VA received the Veteran’s claim for an increased rating for his back disability, plus the one-year look-back period. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). Such disability is rated as noncompensably disabling prior to July 15, 2015, 10 percent disabling from July 15, 2015, to January 22, 2020, and 20 percent disabling thereafter pursuant to DC 5237 for lumbosacral strain, which, in turn, is rated under the General Rating Formula for Disease and Injuries of the Spine (General Rating Formula). 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 where there is forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or the 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 where there is 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. 38 C.F.R. § 4.71a. Note (1): 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. IVDS may be evaluated under either the General Rating Formula or under 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 (combined ratings table). 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, VA treatment records reflect the Veteran’s report of pain in his low back throughout the appeal period. He reported experiencing shooting pain three to four times per week when lifting or after certain types of motion. Treatment notes from September 2010 and October 2010 document reports of low back pain, varying in severity but not radiating or producing any bladder or bowel dysfunction. Such was noted to increase with lifting but not bending. Upon examination, no back abnormalities were visible and the spine was non-tender to percussion. The Veteran demonstrated forward flexion to 60 to 70 degrees, and motion was limited by tightness, rather than pain. The examiner noted normal backward and lateral flexion without discomfort. At a follow-up visit in January 2011, the Veteran reported a history of low back pain, but such was noted to be stable. Additional VA treatment records continued to show stable symptomatology, with pain but no fracture, subluxation, significant lumbar spine abnormality, or arthritis. See October 2015 Radiology Report. Accordingly, while the Veteran’s back disability has been assigned a noncompensable rating for the appeal period prior to July 15, 2015, the Board observes that the foregoing evidence reflects that he has painful, limited motion of his back, thus warranting at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton, supra. Consequently, a 10 percent rating for such period is warranted. However, at no point pertinent to the appeal period prior to January 22, 2020, does the evidence show that a rating in excess of 10 percent is warranted. Specifically, as reflected in the foregoing evidence and as will be discussed further herein, the Veteran’s forward flexion is greater than 60 degrees and his combined range of motion of the entire thoracolumbar spine is 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, and there are no muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour, ankylosis, IVDS, or associated objective neurological abnormalities. Specifically, at a November 2015 VA examination, the Veteran reported ongoing back pain, but denied radiating pain, numbness, and tingling. He indicated that he experienced flare-ups at least four times per week, each lasting three to four hours, which resulted in difficult performing his job in construction; occasional difficulty moving in the morning; or participating in physical activities, to include walking, when the pain became severe. Initial range of motion (ROM) testing revealed normal ROM in all planes, with no pain noted on examination. The Veteran was able to participate in repetitive use testing, which also produced no limitation in ROM and no additional functional loss due to pain, fatigue, weakness, lack of endurance, or incoordination. The examination was noted to be conducted following repeated use over time, with no limited functional ability. While the examination was not conducted during a flare-up, such was noted to significantly limit functional ability due to pain. While the examiner was unable to describe in terms of ROM such limitation during a flare-up, the Veteran reported being unable to bend down without pain or otherwise move his back without pain during a flare-up. There was no guarding or muscle spasm of the thoracolumbar spine, and there were no other noted factors contributing to the disability. Muscle strength testing produced normal results, and no muscle atrophy was found. Reflexes were normal, as were results of a sensory examination. No radicular pain or other radicular symptoms were noted, and there was no ankylosis, other neurological abnormalities related to the Veteran’s back disability, or IVDS. Furthermore, no IVDS or any other pertinent physical findings, complications, conditions, signs or symptoms related to the Veteran’s low back disability were found, to include arthritis or a thoracolumbar vertebral fracture with loss of 50 percent or more of height. An associated October 2015 radiology report also noted that there was no fracture, subluxation, or other significant lumbar spine abnormality, as well as no evidence of arthritis or disc abnormalities. VA treatment records dated in October 2016 reflects the Veteran’s report that he had sharp, stabbing pain int the lumbar region of the back that lasted all day. In March 2017, he reported chronic back pain. It was noted the he could bend and reach about 10 inches above the toes, but experienced pain beyond such point. No reflex, motor, or sensory deficits were noted. In May 2018, the Veteran again reported chronic low back pain. Thus, based on the foregoing, the Board finds that the evidence reflects that, prior to January 22, 2020, the Veteran’s back disability resulted in flexion in excess of 60 degrees and a combined ROM in excess of 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. Furthermore, while the Veteran reported muscle spasms and being hunched over at his August 2019 Board hearing, there is no evidence that such result in an abnormal gait or abnormal spinal contour or ankylosis. Consequently, a rating in excess of 10 percent under the General Rating Formula is not warranted. In regard to Note (1), the Board observes that, while the Veteran reported radiating pain at times, such is fully contemplated in the currently assigned 10 percent rating under the General Rating Formula, and there is no evidence of associated objective neurological abnormalities. Moreover, while the Veteran reported physician prescribed bedrest at his August 2019 Board hearing, there is no evidence of IVDS, or such prescribed bedrest, and, thus, a higher rating is likewise not warranted under the IVDS Rating Formula. Nonetheless, in light of the Veteran’s alleged increase in the severity of his back disability at the August 2019 Board hearing, he was afforded another VA examination in January 2020. At such time, the Veteran reported constant low back pain, but denied radiating pain. He described a worsening of such pain with lifting, stooping, or bending. He did not, however, report flare-ups of his back disability. Upon initial ROM testing, the Veteran had flexion to 90 degrees, extension to 25 degrees, right and left lateral flexion to 30 degrees, and right and left lateral rotation to 30 degrees. Pain was noted upon all ROM testing, to include on passive range of motion testing; however, such was not found to cause functional loss. There was no evidence of pain with weight bearing, though there was objective evidence of localized tenderness or pain on palpation of the bilateral lower thoracic, upper lumbar muscle groups. Also, there was no evidence of pain upon non-weight bearing. The Veteran was able to perform repetitive use testing with at least three repetitions, and such did not result in additional loss of function or ROM. The Veteran was examined immediately after repeated use over time, and such was not shown to cause pain, weakness, fatigability or incoordination significantly limiting function ability. There was no guarding noted, but there was muscle spasm resulting in abnormal gait or abnormal spinal contour. Muscle strength was noted to be normal, and there was no muscle atrophy. Hypoactive reflexes were noted in the bilateral knees and ankles; however, sensory examination was normal and there was no evidence of radiculopathy, ankylosis, or other neurologic abnormalities. No IVDS was found. Finally, no other pertinent physical findings, complications, conditions, signs, or symptoms related to the Veteran’s low back disability were found. Thus, based on evidence that the Veteran’s back disability resulted in muscle spasm resulting in abnormal gait or abnormal spinal contour on examination on January 22, 2020, a 20 percent rating under the General Rating Formula was assigned as of such date. However, as the evidence fails to show forward flexion limited to 30 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, or ankylosis, a rating in excess of 20 percent is not warranted under the General Rating Formula. In regard to Note (1), the Board observes that, while the Veteran reported radiating pain, such is fully contemplated in the currently assigned 20 percent rating under the General Rating Formula, and there is no evidence of associated objective neurological abnormalities. Finally, as there is no evidence of IVDS, a rating in excess of 20 percent is likewise not warranted under the IVDS Rating Formula. Other Considerations In reaching the foregoing determinations, the Board acknowledges the Veteran’s belief that IBS and back disability 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, as well as his fiancé, is competent to provide statements regarding his observable symptomatology, they are 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 the Veteran’s and his fiancé’s reports regarding the severity of such conditions. The Board has also considered whether additional staged ratings under Fenderson, supra, and Hart, 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 increased rating claims adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). In reaching the foregoing determinations, the Board has applied the benefit of the doubt doctrine and resolved all doubt in the Veteran’s favor, which has resulted in a partial award of an increased rating for his back disability. However, insofar as the Board has denied higher or separate ratings for his IBS and back disability, the preponderance of the evidence is against such aspects of the Veteran’s claims. Therefore, the benefit of the doubt doctrine is not applicable and such increased rating claims must otherwise 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 M. Breckenridge, 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.