Citation Nr: 21024389 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 16-24 606 DATE: April 22, 2021 ORDER Entitlement to service connection for diabetes mellitus, type II is denied. Entitlement to service connection for an acquired psychiatric disorder, to include anxiety and depression is denied. Entitlement to service connection for an eye disorder, including retinitis and cataracts, is denied. Entitlement to service connection for shortness of breath is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for a kidney disorder, to include as secondary to diabetes mellitus, is denied. Entitlement to service connection for a heart disorder, to include as secondary to diabetes mellitus, is denied. Entitlement to service connection for neuropathy of the right upper extremity, to include as secondary to diabetes mellitus, is denied. Entitlement to service connection for neuropathy of the left upper extremity, to include as secondary to diabetes mellitus, is denied. Entitlement to service connection for neuropathy, right lower extremity, to include as secondary to diabetes mellitus, is denied. Entitlement to service connection for neuropathy of the left lower extremity, to include as secondary to diabetes mellitus, is denied. Entitlement to an increased rating for a lumbosacral strain, rated as 10 percent disabling prior to March 6, 2020 and 20 percent thereafter, is denied. Entitlement to an initial rating in excess of 10 percent for right leg radiculopathy is denied. FINDINGS OF FACT 1. Diabetes mellitus did not manifest during the Veteran's active service or to a compensable degree within one year after active service, and the current diabetes mellitus is not related to active service. 2. The Veteran's acquired psychiatric disorder, including other specified depressive disorder, and other specified disruptive, impulsive-control and conduct disorder, did not have its onset during active service and was not caused by active service. 3. The Veteran’s current eye disorder, including cataracts, did not have its onset during active service and is not otherwise related to an in-service injury or disease. 4. The Veteran has not had a disability manifested by shortness of breath at any time from contemporaneous to when he filed his claim to the present. 5. The Veteran's hypertension did not begin in active service, did not manifest within one year of separation from active service, and is not otherwise related to active service. 6. The Veteran's heart disease is not secondary to service-connected disability and did not otherwise related to an in-service injury or disease. 7. The Veteran's kidney disease is not secondary to service-connected disability and is not otherwise related to an in-service injury or disease. 8. The Veteran’s neuropathy of the right and left upper extremities are not otherwise related to an in-service injury or disease and are not attributable to a service-connected disability. 9. The Veteran’s neuropathy of the right and left lower extremities are not otherwise related to an in-service injury or disease and are not attributable to a service-connected disability. 10. For the appeal period prior to March 6, 2020, the Veteran’s lumbosacral strain was not manifested by forward flexion greater than 60 degrees and the combined range of motion of the thoracolumbar spine greater than 120 degrees even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, swelling, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, ankylosis, intervertebral disc syndrome, left lower extremity nerve impairment, bowel or bladder impairment. 11. For the appeal period beginning on March 6, 2020, the Veteran’s lumbosacral strain did not manifest as forward flexion of the thoracolumbar spine greater than 30 degrees even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, swelling, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without ankylosis, intervertebral disc syndrome, left lower extremity nerve impairment, bowel or bladder impairment. 12. Throughout the period on appeal, the Veteran's right lower extremity radiculopathy of the sciatic nerve without lost or diminished reflexes, muscle atrophy, sensory disturbances, and constant pain. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus type II have not been met. 38 U.S.C. §§ 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for an acquired psychiatric disorder, to include anxiety and depression have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for an eye disorder, including cataracts, have not all been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.9. 4. The criteria for service connection for shortness of breath have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 5. The criteria for service connection for hypertension have not all been met. 38 U.S.C. §§ 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for service connection for a kidney disorder, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 7. The criteria for service connection for a heart disorder, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for neuropathy of the right upper extremity, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for neuropathy of the left upper extremity, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for service connection for neuropathy of the right lower extremity, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 11. The criteria for service connection for neuropathy of the left lower extremity, to include as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 12. The criteria for an increased rating for lumbosacral strain, rated as 10 percent disabling prior to March 6, 2020 and 20 percent thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.21, 4.40, 4.45, 4.71a, Diagnostic Code 5237. 13. The criteria for an initial rating in excess of 10 percent for right leg radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.123, 4.124A, Diagnostic Code 8620. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1983 to March 1986. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision, which increased the rating for history of a back injury from zero percent to 10 percent, effective May 6, 2014; that rating action granted service connection for right leg radiculopathy and assigned a 10 percent rating effective May 6, 2014. That rating action also denied the claims of service connection for high blood pressure, service connection for a kidney condition, service connection for a heart condition, service connection for diabetes mellitus, service connection for anxiety, service connection for depression, service connection for a vision disorder, service connection for shortness of breath, and service connection for neuropathy of the upper and lower extremities. The Veteran perfected a timely appeal to that decision. In December 2018, the Board remanded the case to the RO for further evidentiary development. By a rating action in August 2020, the RO recharacterized the back disorder as lumbosacral strain and increased the rating from 10 percent to 20 percent, effective March 6, 2020. A supplemental statement of the case (SSOC) was issued in August 2020. A claimant is presumed to be seeking the highest rating available under law. AB v. Brown, 6 Vet. App. 35, 38 (1993). Consequently, the matter of an increased rating for the Veteran's lumbosacral strain remains in appellate status. An August 2020 rating decision granted the Veteran's claim for service connection for migraines and assigned an initial rating. As this decision represents a full grant of the benefits sought with respect to this claim for service connection, such issue is no longer before the Board for consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). "To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"- the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For a showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. If the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection will be presumed for certain chronic diseases, including diabetes mellitus and cardiovascular-renal disease, if they were manifest to a compensable degree within the year after active service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). The Veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In such cases, the Board is within its province to weigh that testimony and to decide as to whether the evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr v. Nicholson, 21. Vet. App. 303 (2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id. see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 1. Entitlement to service connection for diabetes mellitus, type II The Veteran is seeking service connection for diabetes mellitus, type II, which he claims developed as a result of military service. Significantly, the Veteran's service treatment records are completely silent with respect to any complaints, treatment or diagnosis related to diabetes mellitus. In fact, laboratory studies performed in May 1985 noted that urinalysis was normal. Additionally, while the Veteran reported being treated for symptoms of diabetes in service and being diagnosed with diabetes in 2011, the earliest documentation of a diagnosis of diabetes was in September 2015, more than 29 years following the Veteran's discharge from service. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Therefore, as the Veteran did not manifest diabetes mellitus within one year of his service discharge in March 1986, he is not entitled to presumptive service connection for this disorder. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Moreover, while the Veteran's VA medical records reflect that he is currently diagnosed with diabetes mellitus, type II, the records do not reflect that any medical professional has ever indicated that his diagnosed condition may have been related to active duty service. Indeed, the only evidence in support of his claim is the Veteran's own statements that his diabetes developed as a result of his military service. The Board acknowledges the Veteran's belief that his diabetes mellitus is related to his military service. The Board notes that the Veteran is competent to testify as to a condition within his knowledge and personal observation. See Barr v. Nicholson, 21 Vet. App. 303, 308-10 (2007). However, it is clear, based on a detailed review of the statements overall, that the Veteran has no actual specialized knowledge of medicine and that he is merely speculating as to whether his diabetes mellitus was incurred in service. In this regard, he is not competent to diagnose this condition or symptoms, as such diagnosis involve complex questions the answers to which require specialized medical knowledge and specific testing. As such, the Veteran's statements to this effect are lacking in probative value. The Board notes that the Veteran has not been afforded a VA examination addressing his claimed diabetes mellitus, type II. However, the Board finds that such an examination is not required. In this regard, in determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a Veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the Veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court of Appeals for Veterans Claims (Court) has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The service treatment records are otherwise negative for complaints, treatments or diagnoses related to diabetes mellitus, type II. Further, the evidence does not indicate that his current diabetes mellitus, type II may be related to his military service. See McLendon, supra. In this regard, while the Veteran himself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010). Therefore, the Board finds that a VA examination and/or opinion is not necessary to decide this claim. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 2. Entitlement to service connection for an acquired psychiatric disorder, to include anxiety and depression The Veteran maintains that he suffers from an acquired psychiatric disorder as a result of the injuries he suffered during his period of active duty. In the alternative, he maintains that he suffers from depression as a result of pain from his disabilities. Significantly, VA treatment reports dated from September 2015 through September 2019 reflect diagnoses of depression, unspecified and anxiety. Moreover, following a recent VA examination in March 2020, the Veteran was diagnosed with other specified depressive disorder, and other specified disruptive, impulsive-control and conduct disorder. As such, the first requirement for establishing a claim of service connection is met. Concerning the second requirement of an in-service incurrence of a disease, there is no evidence of treatment for any acquired psychiatric disability during service. The service treatment records are completely silent with respect to any complaints or treatment related to a psychiatric disorder, including anxiety and unspecified depression. The earliest evidence of any diagnosis of an acquired psychiatric disorder is contained in VA treatment records dated beginning in January 2019, approximately 33 years following Veteran's separation from service. The Court has determined that a significant lapse in time between service and post-service medical treatment may be considered as part of the analysis of a service connection claim. See generally Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Moreover, while the medical evidence of record reflects diagnoses of adjustment disorder, depression and anxiety disorder, the competent medical evidence of record has not related the Veteran's currently diagnosed psychiatric disorder to his military service. Significantly, Following an examination in March 2020, the VA examiner opined that the claimed psychiatric disorder, currently diagnosed as depressive disorder and other specified disruptive, impulsive-control and conduct disorder, is less likely than not incurred in or caused by the claimed inservice injury, event, or illness. The examiner noted that the Veteran stated that he did not seek mental health treatment during service nor was diagnosed with a depressive condition while in-service. The examiner further noted that the Veteran’s available medical records don't show evidence of depression during his time in service. The examiner observed that a medical note, dated September 24, 2014, shows a negative screening for depression. Therefore, the examiner concluded that the currently diagnosed conditions other specified depressive disorder and other specified disruptive, impulsive-control, and conduct disorder are co-occurring conditions cannot be attributed to his time in service. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There is no contrary opinion of record. The Board acknowledges the Veteran's contentions that the claimed acquired psychiatric disorder is related to his military service. While the Veteran himself might believe that his depressive disorder is the result of active service and is competent to report observable symptoms, he is not competent to opine as to the specific etiology of a condition as complex as a mental disorder; the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, supra; see also Kahana v. Shinseki, supra. Consequently, the Board gives more probative weight to the March 2020 medical opinion. In summary, although the evidence shows that the Veteran has a current diagnosis of a psychiatric disorder, namely depressive disorder, and other specified disruptive, impulsive-control and conduct disorder, there is no competent and credible evidence of a psychiatric disorder during the Veteran's period of service, no credible evidence that the claimed in-service events occurred during service, and no competent evidence suggesting that any current psychiatric disorder is related to the Veteran's period of military service. For these reasons, the Board must deny the appeal as to entitlement to service connection for an acquired psychiatric disorder, to include depressive disorder, and other specified disruptive, impulsive-control and conduct disorder. There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 3. Entitlement to service connection for an eye disorder, including cataracts The Veteran is seeking service connection for an eye disorder, including cataracts, claimed as service. Although the Veteran had diagnoses of refractive error and incipient cataracts, there is no evidence of an in-service injury, illness, or event. Service treatment records do not show a diagnosis or treatment for an eye disorder. Post-service VA treatment records include a December 2015 ophthalmology clinic note in which the Veteran complained of having difficulty reading smaller print with over the counter glasses. The pertinent diagnoses were incipient cataracts and refractive error. The Court has determined that a significant lapse in time between service and post-service medical treatment may be considered as part of the analysis of a service connection claim. See generally Maxson v. Gober, supra. The Board notes that service connection for refractive error is not warranted as congenital or developmental defects and refractive errors of the eyes are not diseases or injuries within the meaning of applicable legislation and, thus, are not disabilities for which service connection may be granted. 38 C.F.R. §§ 3.303(c), 4.9; Beno v. Principi, 3 Vet. App. 439 (1992). The Board has considered the lay statements that the Veteran has presented in this claim. The Board notes that the Veteran is competent to testify as to a condition within his knowledge and personal observation. See Barr v. Nicholson, 21 Vet. App. 303, 308-10 (2007). However, while lay persons are competent to provide opinions on some medical issues, the diagnosis and etiology of an eye disorder, including incipient cataracts, is complex and falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, supra; Jandreau v. Nicholson, supra. Therefore, the Veteran is not considered competent (meaning medically qualified) to address the etiology of his claimed eye disorder. The only evidence in support of his claim is the Veteran's own statements that his eye disorder developed as a result of his military service. The Board acknowledges the Veteran's belief that his eye disorder is related to his military service. The Board notes that the Veteran is competent to testify as to a condition within his knowledge and personal observation. See Barr v. Nicholson, supra. However, it is clear, based on a detailed review of the statements overall, that the Veteran has no actual specialized knowledge of medicine and that he is merely speculating as to whether his eye disorder was incurred in service. In this regard, he is not competent to diagnose this condition or symptoms, as such diagnosis involve complex questions the answers to which require specialized medical knowledge and specific testing. As such, the Veteran's statements to this effect are lacking in probative value. The Board notes that the Veteran has not been afforded a VA examination addressing his claimed eye disorder. However, the Board finds that such an examination is not required. In this regard, in determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a Veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the Veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. McLendon v. Nicholson, supra. The service treatment records are otherwise negative for complaints, treatments or diagnoses related to an eye disorder. Further, the evidence does not indicate that his current eye disorder may be related to his military service. See McLendon, supra. In this regard, while the Veteran himself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, supra. The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, supra. Therefore, the Board finds that a VA examination and/or opinion is not necessary to decide this claim. In sum, the preponderance of the evidence is against finding that the Veteran’s eye disorders, including incipient and cataracts, were related to service. For these reasons, there is no doubt to be resolved; service connection is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 4. Entitlement to service connection for shortness of breath The Veteran essentially contends that he developed a disability manifested by shortness of breath during his period of active duty. Specific argument in support of this appeal has not been submitted. The Board concludes that the Veteran does not have a current disability manifested by shortness of breath and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). Service treatment records reflect complaints of shortness of breath and an assessment of an upper respiratory infection in October 1983. Post-service treatment records are negative for complaints, treatments or diagnoses related to shortness of breath. With regard to the claimed shortness of breath there is not sufficient evidence to show that the Veteran has had a disability manifested as shortness of breath during the appeal period. See McClain v. Nicholson, 21 Vet. App. 319 (2007). The Board acknowledges the Court’s holding in Saunders but does not find a basis for determining that there is functional impairment related to a diagnosis of bilateral hand cramps. See Saunders v. Wilkie, 886 F.3d. 1356 (2018). In addition, the Veteran has not alleged manifestations of similar severity, frequency and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. Wait v. Wilkie, 33 Vet. App. 8 (2020). The Board notes that the Veteran has not been afforded a VA examination addressing his claimed shortness of breath. However, the Board finds that such an examination is not required. In this regard, in determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a Veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the Veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. McLendon v. Nicholson, supra. The service treatment records are otherwise negative for complaints, treatments or diagnoses related to a disability manifested by shortness of breath. Further, the evidence does not indicate that his claimed disability manifested by shortness of breath may be related to his military service. See McLendon v. Nicholson, supra. In this regard, while the Veteran himself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, supra. The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, supra. Therefore, the Board finds that a VA examination and/or opinion is not necessary to decide this claim. The Board has considered the Veteran's assertions that he has a chronic disability manifested by shortness of breath that is related to an episode of shortness of breath during his time in service. Although the Veteran is competent to report such symptoms as shortness of breath, the evidence does not establish that the Veteran has expertise in diagnosing a medical condition. He is thus considered a non-expert, or a layperson. Whether the diagnosis of a layperson is competent evidence depends on the facts of the case. See Jandreau v. Nicholson, supra. Here, whether the Veteran has a disability manifested by shortness of breath due to disease or injury is a complex question. Consequently, the Board gives more probative weight to the competent medical evidence of record and concludes that the Veteran does not have a disability manifested by shortness of breath. The Board finds that, in light of the fact that the evidence fails to establish that the Veteran has, at any point during the pendency of his claim or contemporaneous to when he filed his claim, been treated for or diagnosed with a disability manifested by shortness of breath, the claim of service connection for a disability manifested by shortness of breath must be denied. Brammer v. Derwinski, 3 Vet. App. 223, 225; see also Clemons v. Shinseki, 23 Vet. App. 1 (2009) (stating that it is the responsibility of VA to consider alternate current conditions within the scope of the claim). Service connection is only warranted where there is disability due to disease incurred in or disease contracted in active service. Here, the preponderance of evidence is against a finding that the Veteran has shortness of breath due to disease or injury. In finding that service connection for a chronic disability manifested shortness of breath is not warranted, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 5. Entitlement to service connection for hypertension The Veteran essentially contends that he is entitled to service connection for hypertension. Specific argument in support of this appeal has not been presented. Service treatment records are negative for complaints, treatments or diagnoses related to hypertension. Post-service treatment records show the treatment and diagnosis of hypertension. The Board has first considered whether service connection is warranted for hypertension on a presumptive basis. The record does not show blood pressure readings consistent with hypertension, as defined by regulation, during his active duty service or within one year of his separation from active duty service in March 1986. In fact, the Veteran underwent a September 1987 VA examination in conjunction with another claim. This was during the presumptive period. At that time, his blood pressure was 110/70, which is not hypertension as defined by 38 C.F.R. § 4.104, Diagnostic Code 7101, Note 1. VA treatment records show the Veteran was not diagnosed with hypertension until September 2015, decades after his separation from service and decades outside of the applicable presumptive period. As such, service connection on a presumptive basis is not warranted. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Moreover, while the Veteran's VA medical records reflect that he is currently diagnosed with hypertension, the records do not reflect that any medical professional has ever indicated that his diagnosed condition may have been related to active duty service. The Board notes that the Veteran has not been afforded a VA examination addressing his claimed hypertension. However, the Board finds that such an examination is not required. In this regard, in determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a Veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the Veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. McLendon v. Nicholson, supra. The service treatment records are otherwise negative for complaints, treatments or diagnoses related to hypertension. Further, the evidence does not indicate that his current hypertension may be related to his military service. See McLendon, supra. In this regard, while the Veteran himself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, supra. The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, supra. Therefore, the Board finds that a VA examination and/or opinion is not necessary to decide this claim. The Board has considered the Veteran's assertions that he has hypertension that is related to an episode of shortness of breath during his time in service. Although the Veteran is competent to report some symptoms, the evidence does not establish that the Veteran has expertise in diagnosing a medical condition. He is thus considered a non-expert, or a layperson. Whether the diagnosis of a layperson is competent evidence depends on the facts of the case. See Jandreau v. Nicholson, supra. Here, whether the Veteran has a disability manifested by shortness of breath due to disease or injury is a complex question. Consequently, the Board gives more probative weight to the competent medical evidence of record and concludes that the Veteran does not have hypertension. For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran's claim of entitlement to service connection for hypertension and his appeal must be denied. There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 6. Entitlement to service connection for a kidney disorder 7. Entitlement to service connection for a heart disorder 8. Entitlement to service connection for neuropathy of the right upper extremity 9. Entitlement to service connection for neuropathy of the left upper extremity 10. Entitlement to service connection for neuropathy of the right lower extremity 11. Entitlement to service connection for neuropathy of the left lower extremity The Veteran maintains that he has a heart disorder, a kidney disorder and neuropathy of the upper and lower extremities that developed as a result of military service. Specific argument in support of these appeals has not been submitted. In this regard, the Board notes that the Veteran’s service treatment records are completely silent as to any complaints of or treatment for a heart disorder, a kidney disorder or neuropathy of the upper and lower extremities. The evidentiary record does not contain any medical evidence showing the Veteran manifested any heart disorder, kidney disease, or neuropathy of the extremities for many years following service discharge. In fact, post-service treatment records do not show any treatment for neuropathy, heart disorder, or kidney disorder until October 2015 and December 2015 respectively, more than 29 years after the Veteran’s discharge from active service, well outside of the period for presumptive service connection. The gap of time of between the service and the first medical evidence of diagnoses of diabetic neuropathy, sinus tachycardia and chronic kidney disease is in itself, significant and it weighs against the Veteran’s claims. See Maxson v. Gober, supra. Further, to the extent that the Veteran claims that he is entitled to service connection for a kidney disorder, a heart condition, and neuropathy of the upper and lower extremities as secondary to diabetes mellitus, the assertion of a secondary relationship fails. The Veteran’s diabetes mellitus is not service connected, consequently, any claimed kidney disorder, heart disorder, and neuropathy of the upper and lower extremities cannot be secondarily service connected to the diabetes mellitus for compensation purposes. See 38 C.F.R. § 3.310(a); Allen v. Principi, supra. That is to say, the elimination of one relationship to service, as the supposed precipitant, necessarily also eliminates all associated residual conditions. See Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998). As the Veteran is not service connected for diabetes mellitus, service connection of a kidney disorder, a heart disorder, and peripheral neuropathy of the upper and lower extremities, as secondary to diabetes mellitus, must be denied as a matter of law. The Board notes that the Veteran has not been afforded a VA examination addressing his claimed heart disorder, a kidney disorder and neuropathy of the upper and lower extremities. However, the Board finds that such an examination is not required. In this regard, in determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a Veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the Veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). With respect to the third factor above, the Court has stated that this element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and the veteran's service. McLendon v. Nicholson, supra. The service treatment records are otherwise negative for complaints, treatments or diagnoses related to heart disorder, a kidney disorder and/or neuropathy of the upper and lower extremities. Further, the evidence does not indicate that his claimed heart disorder, a kidney disorder and/or neuropathy of the upper and lower extremities may be related to his military service. See McLendon, supra. In this regard, while the Veteran himself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, supra. The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, supra. Therefore, the Board finds that a VA examination and/or opinion is not necessary to decide these claims. The Board acknowledges the Veteran’s contentions that his kidney disorder, heart disorder, and peripheral neuropathy of the upper and lower extremities are related to his period of service. However, the Veteran’s opinion that his disabilities are related to service is not probative. See Routen v. Brown, 10 Vet. App. 183, 186 (1997) (“a layperson is generally not capable of opining on matters requiring medical knowledge”); see also Jandreau v. Nicholson, supra. The Board finds that the etiology of a kidney disorder, a heart disorder, and peripheral neuropathy of the upper and lower extremities, manifested years after his period of service, is far too complex a medical question to lend itself to the opinion of a layperson. In sum, the preponderance of the evidence weighs against a finding that any current kidney disorder, heart disorder, and peripheral neuropathy of the upper and lower extremities heart disease is related to the Veteran’s period of service. As the preponderance of the evidence is against the claims, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disabilities resulting from all types of diseases and injuries encountered because of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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 appellant working or seeking work. 38 C.F.R. § 4.2. Where entitlement to compensation has been established and 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). 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. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. 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. For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The court has instructed that in applying these regulations VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. Mitchell v. Shinseki, 25 Vet. App. 32 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board notes that effective February 7, 2021, the criteria for schedule of ratings for the musculoskeletal system was revised. See 86 Fed. Reg. 8142 (Feb. 4, 2021) (codified at 38 C.F.R. pt. 4). In the instant case, the claims file is absent any medical evidence submitted or associated with the claims file subsequent to the revised rating effective date of February 7, 2021. Therefore, the February 2021 musculoskeletal criteria do not apply to the Veteran’s claim on appeal; and the appropriate criteria is discussed below. The Board also notes that the February 7, 2021 musculoskeletal amendments presented no changes to the rating criteria for Diagnostic Code 5237. In other words, Diagnostic Code 5237 is the same both prior to and after February 7, 2021. Compare 38 C.F.R. § 4.71a (December 29, 2020) with 38 C.F.R. § 4.71a (February 7, 2021). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). In Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court held that a claim for a total disability rating due to individual unemployability (TDIU) is part of a rating claim when such claim is expressly raised by the Veteran or reasonably raised by the record. In this case, the record does not reflect, and the Veteran does not allege, that he is unemployable due to a lumbosacral strain or right lower extremity radiculopathy. The Veteran reported that he was working in an April 2020 VA treatment note and throughout the treatment records. Therefore, the Board finds that a TDIU is not raised by the Veteran or reasonably raised by the record in connection with his increased rating claims decided herein and, consequently, no further consideration of such is necessary at this time. 12. Entitlement to an increased rating for a lumbosacral strain, rated as 10 percent disabling prior to March 6, 2020 and 20 percent thereafter. The Veteran maintains that his lumbosacral strain is more severe than reflected by the currently assigned rating. Specific argument in support of the appeal has not been presented. The Veteran's low back disorder is currently evaluated pursuant to the General Rating Formula for Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a, Diagnostic Code 5237. The General Formula provides that an evaluation of 10 percent rating is warranted for: 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 an abnormal gait or abnormal spinal contour, or, vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71a. A 20 percent rating is warranted for: Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; a 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 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. Id. Ankylosis is defined, for VA compensation purposes, as a condition in which all or part of the spine is fixed in flexion or extension. Id. at Note (5). The General Formula directs raters that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately, under an appropriate diagnostic code. Id. at Note (1). For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is 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 for the cervical spine is 340 degrees, and the normal combined range of motion for the thoracolumbar spine is 240 degrees. Id. at Note (2). Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes a 60 percent evaluation is assigned where there are incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. A 40 percent rating is assigned where there are incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. Id. A 20 percent rating is assigned where there are incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months. Id. Note (1) states that for purposes of evaluations of intervertebral disc syndrome (IVDS), an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Id. A rating decision, dated in October 1987, granted service connection for history of back injury lumbosacral sprain, and assigned a zero percent rating, effective March 28, 1986. The Veteran’s claim for an increased rating was received in May 2014. In conjunction with his claim, the Veteran was afforded a VA examination in September 2014. At that time, he reported soreness and stiffness, for which he takes pain medication. He has not been hospitalized for treatment of the back in the back year. He indicated that he was not currently under any type of medical restrictions or limitations regarding the use or motion of his back. He indicated that he has had intermittent episodes over several years where his back feels locked up, and he reported intermittent episodes of back pain radiating down his right leg since about a year and a half ago. Range of motion testing showed forward flexion to 80 degrees, with no objective evidence of painful motion. Extension was to 15 degrees, with no objective evidence of painful motion. Right and left lateral flexion to 25 degrees, and right and left lateral rotation to 25 degrees. The examiner stated that the Veteran was able to perform repetitive use testing with three repetitions. The examiner stated that the Veteran experienced less movement than normal and pain on movement. The Veteran did not have any muscle spasms or guarding of the thoracolumbar spine. Muscle strength was normal. No muscle atrophy was noted. The examiner indicted that the Veteran had mild radiculopathy in the right lower extremity. No ankylosis was noted. In addition, the examiner indicated no evidence of IVDS. The Veteran was afforded a recent VA examination in March 2020, at which time he reported that his symptoms have worsened over the years. The Veteran reported increased pain and periodic flare-ups; he noted that the flareups occur almost daily and worse in the evening. The flareups are precipitated by standing for long periods of time and heavy lifting, and they are alleviated by rest and Tylenol. The Veteran reported difficulty with heavy lifting and limited range of motion. Range of motion testing showed forward flexion to 60 degrees, extension to 20 degrees, right and left lateral flexion to 20 degrees, and right and left lateral rotation to 20 degrees. The examiner indicated that pain was noted on the examination and caused functional loss. The examiner stated that the Veteran was able to perform repetitive use testing with 3 repetitions. After repetitive use testing, range of motion testing revealed forward flexion to 55 degrees, extension to 15 degrees, right and left lateral flexion to 15 degrees, and right and left lateral rotation to 15 degrees. The examiner noted that functional loss was caused by pain and lack of endurance. The examiner indicated that the examination is medically consistent with the Veteran's statement describing functional loss with repetitive use over time. The examiner also noted that pain and lack of endurance causes functional loss during flare-ups; range of motion testing revealed forward flexion to 45 degrees, extension to 10 degrees, right and left lateral flexion to 10 degrees, and right and left lateral rotation to 10 degrees. No muscle spasms or guarding was noted. The examiner noted that the Veteran had less movement than normal due to ankylosis, limitation or blocking, adhesions, etc. Muscle strength was normal at 5/5. No muscle atrophy was noted. Deep tendon reflexes were 2+. Sensation was normal. The examiner stated that straight leg raising was negative; he did not have radicular pain or any other signs or symptoms due to radiculopathy. There was no ankylosis of the spine. The Veteran did not have IVDS of the thoracolumbar spine. The Veteran was not currently using assistive devices. The March 2020 VA examiner noted that the Veteran’s back disorder would impact his ability to work due to back pain, stiffness, limited range of motion, and difficulty with prolonged walking and bending over to pick up heavy items. The examiner found objective evidence of pain on passive range of motion testing; he also noted objective evidence of pain in non-weight bearing. The examiner noted that the functional impact of condition on employment is there is back pain, stiffness, limited range of motion, and difficulty with prolong walking and bending over to pick up heavy items more than 20 pounds; he stated that the condition had no impact on sedentary activities. VA treatment records have also been associated with the Veteran’s claims file. In summary, these records reflect the Veteran complained of back pain for which he had ongoing treatment. For the appeal period prior to March 6, 2020, the Board finds that a rating in excess of 10 percent for the Veteran’s lumbosacral strain is not warranted. In this regard, the record fails to show that forward flexion of the thoracolumbar spine is limited to 30 degrees but not greater than 60 degrees or a combined range of motion of the thoracolumbar spine that is not 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. A September 2014 VA examination found forward flexion to be 80 degrees with pain and that there was no additional loss of function on range of motion testing. Here, the VA treatment records and VA examinations do not reveal additional functional impairment, including additional limitation of motion, on account of pain, weakness, etc, that is not already contemplated by the assigned 10 percent rating. 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca v. Brown, supra. Thus, a higher rating is not warranted for the Veteran's lumbosacral strain in consideration of painful motion and other factors such as weakness, fatigability, lack of endurance, and incoordination. Moreover, there was no ankylosis or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. Therefore, a rating in excess of 10 percent is not warranted for the appeal period prior to March 6, 2020. For the appeal period beginning on March 6, 2020, the Board finds that a rating in excess of 20 percent for the Veteran’s lumbosacral strain is not warranted. In this regard, the record fails to show that forward flexion of the thoracolumbar spine is limited to 30 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. A March 2020 VA examination found forward flexion to be 45 degrees, at worst, with flare-ups. Here, the VA treatment records and VA examinations do not reveal additional functional impairment, including additional limitation of motion, on account of pain, weakness, etc, that is not already contemplated by the assigned 20 percent rating. 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca v. Brown, supra. Thus, a higher rating is not warranted for the Veteran's lumbosacral strain even in consideration of painful motion and other factors such as weakness, fatigability, lack of endurance, and incoordination. Moreover, there was no ankylosis. Therefore, a rating in excess of 20 percent is not warranted for the period beginning on March 6, 2020. Furthermore, as the evidence fails to show that the Veteran has intervertebral disc syndrome with incapacitating episodes resulting in bed rest ordered by a physician at any point pertinent to the appeals period, a higher or separate rating is not warranted under the intervertebral disc syndrome Rating Formula. In addition to considering the orthopedic manifestations of a back disability, VA regulations also require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. However, the Veteran has not alleged, and the evidence does not show, that he has bladder impairment, bowel impairment or left lower extremity nerve impairment as a result of his service-connected lumbosacral strain Moreover, the Veteran is already in receipt of separate ratings for right lower extremity radiculopathy Therefore, the Board finds that, at no time during the appeal period, has the Veteran's service-connected lumbosacral strain resulted in neurological impairment of the bowel or bladder warranting an additional separate rating. Finally, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court’s holdings in Correia and Sharp. See Correia v. McDonald, supra, and Sharp v. Shulkin, supra. In this case, the September 2014 VA examination was conducted prior to Correia and Sharp and provides only partial information as described above. Pain was noted on examination in the September 2014 and March 2020 VA examination reports. The effect of pain on range of motion is described above. Regarding repeated use over time, the Board notes that the September 2014 VA examiner conducted repetitive-use testing. The March 2020 VA examiner also conducted repetitive-use testing and additional limitation of motion is detailed above. Regarding flare-ups, the Board acknowledges that the January 2014 VA examiner did not provide an opinion regarding additional functional impairment during flare-ups and that the Veteran reported intermittent flare-ups. However, the Board finds that all information required for rating purposes was provided. The January 2014 VA examiner indicated that the impact of the Veteran’s flare-ups could not be reported in range of motion as the examiner was not present to measure range of motion during such flare-ups. A March 2020 VA examiner noted the Veteran’s reports that he experienced occasional flare-ups that were precipitated by standing for long periods of time and heavy lifting and provided range of motion measurements during flare-ups. The March 2020 VA examination reflected measurements for active and passive range of motion as well as range of motion testing in weight-bearing and nonweight-bearing. As the Veteran’s spine does not have an opposing joint, it is not possible to measure range of motion in the undamaged joint. The Veteran reported flare-ups and the March 2020 VA examiner estimated the range of motion during such flare-ups. Therefore, the examinations of records are adequate for rating purposes. In reaching its conclusions, the Board acknowledges the Veteran's sincere belief that his lumbosacral strain is more severe than as reflected by the currently assigned disability ratings. The Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his 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). Ultimately, 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 in light of the rating criteria to be more persuasive than his reports regarding the severity of his lumbosacral strain. The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran's service-connected lumbosacral strain; however, the Board finds that his symptomatology has been stable throughout the period on appeal. Therefore, assigning a staged rating for such disability is not warranted. Furthermore, the Veteran has not raised any other issues, nor has any other issues been reasonably raised by the record, with regard to the increased rating claim adjudicated herein. See 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. However, insofar as the Board has denied higher or separate ratings, the preponderance of the evidence is against such aspects of the claim. Therefore, the benefit of the doubt doctrine is not applicable and the increased rating claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 13. Entitlement to an initial rating in excess of 10 percent for right leg radiculopathy The Veteran essentially contends that his right lower leg radiculopathy is more severe than reflected by the rating currently assigned; therefore, a higher rating is warranted. The Veteran's radiculopathy of the right lower extremity is currently rated under Diagnostic Code 8620 which provides ratings for paralysis of the sciatic nerve. Under Diagnostic Code 8620, mild incomplete paralysis of the sciatic nerve warrants a 10 percent disability rating. Moderate incomplete paralysis warrants a 20 percent disability rating, moderately severe incomplete paralysis warrants a 40 percent rating, and severe incomplete paralysis with marked muscle atrophy warrants a 60 percent disability rating. See 38 C.F.R. § 4.124A, Diagnostic Code 8620. Complete paralysis of the sciatic nerve is when the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost and warrants an 80 percent rating. Id. The term "incomplete paralysis" with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured 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 there is bilateral involvement, the VA adjudicator is to combine the ratings for the peripheral nerves, with application of the bilateral factor. 38 C.F.R. § 4.124a. When the involvement is only sensory, the rating should be for the mild, or at most, the moderate degree. 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 words such as "slight," "moderate," and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Use of terminology such as "severe" by VA examiners and others, although evidence to be considered by the Board, is not dispositive of an issue. 38 C.F.R. §§ 4.2, 4.6. During the September 2014 VA examination of the lumbar spine, the Veteran reported intermittent episodes of back pain radiating down his right leg since about a year and a half ago. Muscle strength testing was normal in all joints, and no muscle atrophy was noted. Deep tendon reflexes were 1+ in the knees and ankles. Sensory examination was normal. Straight leg raising was negative. It was noted that the Veteran had mild intermittent pain in the right lower extremity. The examiner stated that the Veteran had mild radiculopathy of the L4/L5/S1/S2/S3 nerve roots (sciatic nerve). The Veteran reported typical tightness in the right SI region at maximal range of motion. The Veteran did not use any assistive devices. On the occasion of a more recent VA examination in March 2020, muscle strength testing was normal in all joints, and no muscle atrophy was noted. Deep tendon reflexes were 2+ in the knees and ankles. Sensory examination was normal. Straight leg raising was negative. The examiner indicated that the Veteran did not have any radicular pain or any other signs or symptoms due to radiculopathy. He also has not used an assistive device for locomotion. Considering the pertinent evidence in light of the above, the Board finds that the medical evidence reflects that the Veteran's radiculopathy in the right lower extremity has caused disability comparable to no more than mild incomplete paralysis of the sciatic nerve, manifested by complaints of pain and tightness, but with no loss of muscle mass, strength, or function attributed to this service-connected disability. As noted, where, as here, the involvement is wholly sensory; the rating should be for the mild, or, at most, the moderate degree. The record was negative for, and the Veteran ash not alleged, lost or diminished reflexes, muscle atrophy, sensory disturbances, and constant pain. Here, only sensory impairment was noted on the neurological evaluation, and the record does not otherwise provide a basis for more than a 10 percent rating. In reaching its conclusions, the Board acknowledges the Veteran's belief that his right lower extremity radiculopathy is more severe than as reflected by the currently assigned rating. The Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his 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. Ultimately, 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 in light of the rating criteria to be more persuasive than his reports regarding the severity of his right lower extremity radiculopathy. The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran's service connected left lower extremity radiculopathy; however, the Board finds that his symptomatology has otherwise been stable throughout the period on appeal. Therefore, assigning staged ratings for such disability is not warranted. Further, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the initial rating claims adjudicated herein. See Doucette v. Shulkin, supra. Despite the complaints and findings noted above, the overall disability picture is not found to be comparable to moderate incomplete paralysis of the sciatic nerve. Accordingly, there is no basis for a rating in excess of 10 percent for radiculopathy of the right lower extremity. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Suzie S. Gaston, 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.