Citation Nr: 21025904 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 09-16 065 DATE: April 29, 2021 ORDER Entitlement to a disability rating of 20 percent (increased from 10 percent), but no higher, for degenerative disc disease and joint disease of the thoracolumbar spine, for the period prior to July 29, 2009, is granted. Entitlement to a disability rating in excess of 20 percent for degenerative disc disease and joint disease of the thoracolumbar spine, for the period from July 29, 2009, to November 2, 2015, is denied. Entitlement to a disability rating of 20 percent (increased from 10 percent), but no higher, for degenerative disc disease and joint disease of the thoracolumbar spine, for the period from November 2, 2015, to January 31, 2018, is granted. Entitlement to increased disability ratings for degenerative disc disease and joint disease of the thoracolumbar spine for the periods from January 31, 2018, onward (rated 20 percent disabling from January 31, 2018, to September 15, 2020, and rated 40 percent disabling from September 15, 2020, onward), is denied. Entitlement to a compensable disability rating for rhinitis is denied. Entitlement to service connection for headaches, as secondary to rhinitis, is granted. FINDINGS OF FACT 1. For the period prior to July 29, 2009, the Veteran’s degenerative disc disease and joint disease of the thoracolumbar spine was manifested by functional impairment approximating limitation of the combined range of motion of the thoracolumbar spine to not greater than 120 degrees; it was not manifested by limitation of forward flexion of the thoracolumbar spine to 30 degrees or less, nor by ankylosis, nor by incapacitating intervertebral disc syndrome (IVDS) episodes having a total duration of at least 4 weeks during a 12 month period. 2. For the period from July 29, 2009, to November 2, 2015, the Veteran’s degenerative disc disease and joint disease of the thoracolumbar spine was not manifested by limitation of forward flexion of the thoracolumbar spine to 30 degrees or less, nor by ankylosis, nor by incapacitating IVDS episodes having a total duration of at least 4 weeks during a 12 month period. 3. For the period from November 2, 2015, to January 31, 2018, the Veteran’s degenerative disc disease and joint disease of the thoracolumbar spine was manifested by functional impairment approximating limitation of the combined range of motion of the thoracolumbar spine to not greater than 120 degrees; it was not manifested by limitation of forward flexion of the thoracolumbar spine to 30 degrees or less, nor by ankylosis, nor by incapacitating IVDS episodes having a total duration of at least 4 weeks during a 12 month period. 4. For the period from January 31, 2018, to September 15, 2020, the Veteran’s degenerative disc disease and joint disease of the thoracolumbar spine was not manifested by limitation of forward flexion of the thoracolumbar spine to 30 degrees or less, nor by ankylosis, nor by incapacitating IVDS episodes having a total duration of at least 4 weeks during a 12 month period. 5. For the period from September 15, 2020, onward, the Veteran’s degenerative disc disease and joint disease of the thoracolumbar spine has not been manifested by unfavorable ankylosis of the entire thoracolumbar spine or the functional equivalent of ankylosis, nor incapacitating IVDS episodes having a total duration of at least 6 weeks during a 12 month period. 6. Throughout the period on appeal, the Veteran’s rhinitis has not been manifested by an obstruction that was greater than 50 percent of the nasal passage on both sides, nor a complete obstruction in either nasal passage, nor polyps. 7. Resolving reasonable doubt in the Veteran’s favor, the evidence shows that the Veteran suffers from functional impairment from headaches that are proximately due to or the result of his service-connected rhinitis. CONCLUSIONS OF LAW 1. Throughout the period prior to July 29, 2009, the criteria for a 20 percent rating, but no higher, for degenerative disc disease and joint disease of the thoracolumbar spine have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 2. Throughout the period from July 29, 2009, to November 2, 2015, the criteria for a rating in excess of 20 percent for degenerative disc disease of the thoracolumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 3. Throughout the period from November 2, 2015, to January 31, 2018, the criteria for a 20 percent rating, but no higher, for degenerative disc disease and joint disease of the thoracolumbar spine have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 4. Throughout the period from January 31, 2018, to September 15, 2020, the criteria for a rating in excess of 20 percent for degenerative disc disease of the thoracolumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 5. Throughout the period from September 15, 2020, onward, the criteria for a rating in excess of 40 percent for degenerative disc disease of the thoracolumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 6. The criteria for an initial compensable rating for rhinitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.97, Code 6522. 7. The criteria for entitlement to service connection for headaches are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from September 1985 to May 2005, and on active duty for training from May to September 1984. The issues concerning rating assignments for degenerative disc disease and joint disease of the thoracolumbar spine come before the Board of Veterans’ Appeals (Board) on remand from the United States Court of Appeals for Veterans Claims (Court). These matters originally came to the Board on appeal from an October 2006 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA) which granted service connection for lumbar spine degenerative disc and joint disease and assigned an initial disability rating of 10 percent. In December 2014, the Veteran testified at a videoconference hearing before the undersigned; a transcript of that hearing is of record. In November 2016, the Board issued a decision that (in pertinent part) denied entitlement to a rating in excess of 10 percent for lumbar spine degenerative disc and joint disease. The Veteran appealed this determination to the United States Court of Appeals for Veterans Claims (Court). In June 2017, the Office of General Counsel for the Department of Veterans Affairs and the Veteran’s representative before the Court (hereinafter “the parties”) filed a Joint Motion for Partial Remand (Joint Motion) that was granted by the Court in a June 2017 Order. The portion of the November 2016 Board decision concerning the rating assignment for lumbar spine disability was vacated, and the case was returned to the Board for further consideration in accordance with the terms of the Joint Motion. In November 2017 and in April 2020, the Board remanded the lumbar spine rating issue to the Agency of Original Jurisdiction (AOJ) for additional development to comply with the terms of the Joint Motion. The case has now returned to the Board for further appellate review. During the processing of the April 2020 remand, the AOJ issued a rating decision in October 2020 that granted increases of the Veteran’s thoracolumbar spine disability rating (previously 10 percent) in stages: (1) a 20 percent rating from July 29, 2009, to November 2, 2015; (2) a 20 percent rating from January 31, 2018, to September 15, 2020; and (3) a 40 percent rating from September 15, 2020, onward. The Veteran maintains the appeal for further and additional increased ratings throughout the rating periods on appeal. The Board’s November 2016 decision additionally denied entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy prior to November 2, 2015, and in excess of 20 percent thereafter. However, the June 2017 Joint Motion clearly explains: “Appellant abandons his appeal of the Board’s denial of an initial rating higher than 10% for right lower extremity radiculopathy prior to November 2, 2015, and higher than 20% thereafter.” Accordingly, that determination of the November 2016 Board decision has not been disturbed, and that issue is not to be revisited by the Board at this time. The issue of entitlement to a compensable rating for rhinitis and the associated issue of entitlement to service connection for headaches as secondary to rhinitis come before the Board on appeal from a rating decision dated November 2015. In June 2005, the Veteran submitted a claim for service connection for what was later identified as sinusitis/ rhinitis. In a March 2007 rating decision, the RO, in pertinent part, denied service connection for chronic sinusitis. In June 2015, the Board remanded the claim to afford the Veteran new VA examinations and etiology opinions for sinusitis and headaches. In a November 2015 rating decision, the RO granted service connection for rhinitis effective June 1, 2005, and assigned a noncompensable rating. This appeal ensued. The rhinitis rating issue was previously before the Board in March 2019, when the Board remanded the issue for additional development. While the rhinitis rating issue had not yet returned to the Board by the time of the Board’s April 2020 remand of the spine rating issue, the rhinitis rating issue has now returned to the Board for further appellate review. The Board shall therefore consider the rhinitis rating issue in this decision. At the time of the March 2019 remand, the Board noted that the record reflected that the Veteran had raised the issue of entitlement to service connection for headaches secondary to his service-connected rhinitis, and the Board referred the matter to the AOJ for appropriate development. Explicit AOJ adjudication of the headaches issue has not been completed. However, the Court recently held in Bailey v. Wilkie, 33 Vet. App. 188 (2021), that in addition to considering entitlement to increased benefits, VA must consider entitlement to any additional benefits due to complications from the disability, and it is not necessary that the Veteran file a formal claim for service connection for such additional disability. In this case, the Veteran’s appeal for greater compensation for his service-connected rhinitis has raised the question of potential entitlement to service connection for headaches as secondary to the rhinitis. Accordingly, the Board has considered the issue of entitlement to service connection for headaches as part of the appeal for increased compensation for rhinitis. Increased Rating Disability ratings are based on average impairment in earning capacity resulting from a particular disability and are determined by comparing symptoms shown with criteria in VA’s Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two ratings apply, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. An exception to this rule occurs when the rating criteria are successive. In such a case, all the requirements of the lower levels must be met before a higher level is awarded, so 38 C.F.R. §§ 4.7 and 4.21 do not apply. Johnson v. Wilkie, 30 Vet. App. 245 (2018). 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. It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant; however, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. With a claim for an increased initial rating, separate staged ratings may be assigned based on facts found. Fenderson v. West, 12 Vet. App. 119 (1999). In a claim for increase in a previously established rating, the present level of disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the evidence contains factual findings that demonstrate distinct time periods when the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, staged ratings are to be considered. See Hart v. Mansfield, 21 Vet. App. 505 (2007). When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Veteran’s statements describing symptoms and conditions are competent evidence to the extent that one can describe one’s own experiences. However, these statements must be viewed in conjunction with the medical evidence and the pertinent rating criteria. Lay evidence is not competent evidence concerning complex medical questions requiring specialized training or expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans’ Court.). It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. The Board notes that it has reviewed all of the evidence in the Veteran’s record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (VA must review the entire record but does not have to discuss each piece of evidence.) Hence, the Board will summarize the relevant evidence, as appropriate, and the Board’s analysis will focus specifically on what the evidence shows, or does not show, as to the claim. In McGrath v. Gober, 14 Vet. App. 28 (2000), the Court held that when evidence is created is irrelevant compared to when the Veteran was actually experiencing the symptoms. Thus, the Board will consider whether the evidence of record suggests that the severity of pertinent symptoms increased sometime prior to the date of the examination reports noting pertinent findings. The Board has also considered the history of the Veteran’s disabilities prior to the rating period on appeal to see if it supports a higher rating during the rating period on appeal. Further references to the Veteran’s pertinent disabilities are presented in additional evidence of record beyond the most detailed pertinent evidence discussed by the Board in this decision. The additional evidence of record does not present findings concerning the Veteran’s pertinent disabilities that significantly expand upon, revise, or contradict the findings in the most detailed evidence discussed by the Board in this decision. 1. Entitlement to a disability rating of 20 percent (increased from 10 percent), but no higher, for degenerative disc disease and joint disease of the thoracolumbar spine, for the period prior to July 29, 2009, is granted. 2. Entitlement to a disability rating in excess of 20 percent for degenerative disc disease and joint disease of the thoracolumbar spine, for the period from July 29, 2009, to November 2, 2015, is denied. 3. Entitlement to a disability rating of 20 percent (increased from 10 percent), but no higher, for degenerative disc disease and joint disease of the thoracolumbar spine, for the period from November 2, 2015, to January 31, 2018, is granted. 4. Entitlement to increased disability ratings for degenerative disc disease and joint disease of the thoracolumbar spine for the periods from January 31, 2018, onward (rated 20 percent disabling from January 31, 2018, to September 15, 2020, and rated 40 percent disabling from September 15, 2020, onward), is denied. The Veteran contends that he is entitled to higher ratings for his service-connected lumbar spine degenerative disc and joint disease. He contends that the severity of the disability has been greater than the assigned ratings reflect. The beginning of the rating period for consideration in this case is defined by the effective date of the grant of service connection for the disability: June 1, 2005. During the pendency of the instant appeal, VA promulgated new regulations governing ratings for musculoskeletal system and muscle disabilities, effective February 7, 2021. See 85 Fed. Reg. 76,453 (Nov. 30, 2020). When a law or regulation changes during the pendency of a Veteran’s appeal, the version most favorable to the Veteran applies, absent congressional intent to the contrary. The amended rating criteria, if favorable to the claim, can be applied only for periods from the effective date of the regulatory change; however, the old regulations will be considered for the periods both before and after the change was made. See 38 U.S.C. § 5110(g); 38 C.F.R. § 3.114; VAOPGCPREC 3-2000, 65 Fed. Reg. 33,422 (2000); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Thus, the Veteran is entitled to application of the criteria that are most favorable to his claim, except that an award based on the amended regulations may not be made effective before the effective date of the change. The provisions pertinent to the Board’s decision in this case are not substantially changed by the new regulations effective February 7, 2021. Disabilities of the spine are rated under the General Rating Formula for Diseases and Injuries of the Spine for Diagnostic Codes 5235 to 5243, unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. Ratings under the General Rating Formula for Diseases and Injuries of the Spine 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. The Veteran’s degenerative joint disease of the lumbar spine is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5242. Under the General Rating Formula for Diseases and Injuries of the Spine: A 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Note (1) to the rating formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (2) (See also Plate V.) specifies that for VA compensation purposes, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 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 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) specifies that 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) specifies that the rating analysis must round each range of motion measurement to the nearest five degrees. Note (5) specifies that for VA compensation purposes, unfavorable ankylosis is a condition in which 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. IVDS (preoperatively or postoperatively) may be evaluated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined. See 38 C.F.R. § 4.25 (combined ratings table). The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes provides that incapacitating episodes having a total duration of at least 1 week but less than 2 weeks during the past 12 months warrant a 10 percent rating. Incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months warrant a 20 percent rating. Incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months warrant a 40 percent rating. Incapacitating episodes having a total duration of at least 6 weeks during the past 12 months warrant a 60 percent rating. For purposes of rating under Code 5243, 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. 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note 1. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 directly is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). The Court has held that diagnostic codes predicated on limitation of motion do not prohibit consideration of a higher rating based on functional loss due to pain on use or due to flare-ups under 38 C.F.R. §§ 4.40, 4.45, and 4.59. See Johnson v. Brown, 9 Vet. App. 7 (1996); DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). The Court clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Pain, in and of itself, that does not result in additional functional loss does not warrant a higher rating; the Court held that pain alone does not constitute functional loss but is just one factor to be considered when evaluating functional impairment. Id. VA regulations require that a finding of dysfunction due to pain must be supported by, among other things, adequate pathology. 38 C.F.R. § 4.40 (functional loss due to pain is to be rated at the same level as the functional loss when flexion is impeded); see Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997) (citing 38 C.F.R. § 4.40). It is the intention of the VA rating schedule to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. The 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. 38 C.F.R. § 4.59. Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 creates a requirement that certain range of motion testing be conducted whenever possible in cases of joint disabilities. The final sentence provides that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint.” The Court found that, to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of § 4.59. Correia, 28 Vet. App. at 169-170. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The Court explained that case law and VA guidelines do not require direct observation of functional impairment after repetitive use or during a flare-up as a prerequisite to offering a DeLuca opinion. DeLuca v. Brown, 8 Vet. App. 202 (1995). Indeed, it is not expected that such observation will usually occur; therefore, VA examiners should offer opinions based on estimates derived from information procured from all relevant sources, including the lay statements of Veterans. VA examiners have a duty to elicit information from the Veteran when attempting to describe functional loss associated with pain during unobserved exacerbations. If a non-speculative opinion still cannot be offered, the VA examiner must explain the basis for this conclusion. It must be apparent that the inability to provide an opinion without resorting to speculation reflects the limitation of knowledge in the medical community at large and not a limitation (whether based on lack of expertise, insufficient information, or unprocured testing) of the individual examiner. First, the Board finds that this case presents an evidentiary record supporting, with resolution of reasonable doubt in the Veteran’s favor, a grant of an increased 20 percent rating for the thoracolumbar spine disability for the period from November 2, 2015, to January 31, 2018. This period of approximately two years is currently assigned a 10 percent rating, preceded by a 6-year period for which the Veteran has already established that the disability met the criteria for a 20 percent rating. The Veteran has also already established that the disability met the criteria for a 20 percent rating from January 31, 2018, onward (with a further higher rating from a later date). The AOJ has assigned a 10 percent rating from November 2, 2015, to January 31, 2018, based upon the findings of a November 2015 VA examination report (and an additional retrospective assessment interpreting the November 2015 findings, provided in an October 2020 VA medical opinion). The Board also notes, as discussed in more detail below, that this Board decision’s determination regarding the earliest portion of the rating period on appeal results in a finding that the criteria for a 20 percent rating were met continuously from the effective date of the grant of service connection: June 1, 2005. Thus, the Board’s findings (discussed below) result in the Veteran establishing that the back disability was 20 percent disabling for more than 10 years preceding the November 2015 VA examination report. The detailed findings in the November 2015 VA examination report primarily reflect the status of the Veteran’s back on a particular day. While VA has subsequently obtained an October 2020 medical opinion to interpret the data and estimate the additional degree of impairment that the Veteran would have experienced during unobserved exacerbations, the October 2020 effort to provide such retrospective estimations for November 2015 is essentially limited to making standardized adjustments to the ranges of motion recorded on the day of the November 2015 VA examination. Considering that the Veteran’s back disability is already established to have met the criteria for a 20 percent rating for more than 6 years prior to November 2015 (indeed, more than 10 years in light of the Board’s further findings, below), and it is already established to have met the criteria for 20 percent rating upon the first VA rating examination following November 2015, the Board is not persuaded that the evidence establishes a substantial sustained improvement in his back function for the November 2015 through January 2018 period. The Board finds it reasonable to view the November 2015 VA examination report as more of an outlier than a demonstration that the back disability had meaningfully improved. Resolving reasonable doubt in the Veteran’s favor, the Board finds that an increased 20 percent rating is warranted for the period from November 2, 2015, to January 31, 2018. To this extent, the appeal is granted. This grant results in the Veteran now having established entitlement to a 20 percent rating for the thoracolumbar spine disability for a continuous period from July 29, 2009, to September 15, 2020. Prior to this period, a 10 percent rating is in effect. Following this period, a 40 percent rating is in effect. The Board now turns to the question of whether any increased rating is warranted prior to July 29, 2009. The Board finds that the evidence reasonably supports a further grant of an increased 20 percent rating for the earliest stage of the rating period on appeal prior to July 29, 2009. For the earliest rating period, from June 1, 2005, to July 29, 2009, the Veteran is currently in receipt of a 10 percent rating. The criteria for an increased rating require impairment such that forward flexion of the thoracolumbar spine is not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or, muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Ankylosis also qualifies for higher ratings. A June 2006 VA examination report shows that clinical inspection of the Veteran’s spine revealed forward flexion to “75 degrees active, passive and fatigued with pain starting at 75 degrees.” Extension was to “30 degrees active, passive and fatigued with pain starting at 25 degrees.” Left lateral flexion was to “20 degrees active, passive and fatigued with pain starting at 20 degrees.” Right lateral flexion was to “25 degrees active, passive and fatigued without pain.” Left rotation was to “25 degrees active, passive and fatigued without pain.” Right rotation was to “25 degrees active, passive and fatigued without pain.” The combined range of motion was 200 degrees, and the report indicates that the Veteran’s combined pain-free extents of ranges of motion well-exceeded 120 degrees. The June 2006 VA examiner noted tenderness to palpation and spasm, but “[n]ormal spinal curvatures are maintained, posture and gait are normal.” The VA examiner also noted that there was no change in the range of motion (“none”) following repetitive use. The June 2006 VA examiner recorded that the Veteran described that he would at times “have spasms and at times has to lie down. Riding in car too long or sitting in wrong position causes increased pain and muscle spasms. He walks bent over for a couple of days; can’t straighten up. Has to be careful about how he moves and is unable to do any heavy lifting or be on his feet for long periods…. [He] had so much back pain from being on his feet all day and had to quit [his job managing a coffee shop].” The report presents no indication that the Veteran’s degenerative disc disease manifested in incapacitating episodes requiring any significant duration of bed rest prescribed by a physician and treatment by a physician. A March 2008 VA examination report shows that clinical inspection of the Veteran’s spine revealed forward flexion to 90 degrees, extension to 30 degrees, left lateral flexion to 30 degrees, left lateral rotation 30 degrees, right lateral flexion to 30 degrees, and right lateral rotation to 30 degrees. At that time, the examiner noted that there was no evidence of objective evidence of pain on active range of motion. Gait and spinal curvatures were normal. The examiner noted objective evidence of pain following repetitive motion, but there was no additional limitation after three repetitions of range of motion testing. The VA examiner recorded the Veteran’s report of symptoms of stiffness, weakness, spasms, and “Severe” pain of the lower back. The Veteran described “Severe” flare-ups occurring “[e]very 2 to 3 weeks” with duration of “1 to 2 days.” The report presents no indication that the Veteran’s degenerative disc disease manifested in incapacitating episodes requiring any significant duration of bed rest prescribed by a physician and treatment by a physician; the VA examiner stated that “No,” there were -not- “incapacitating episodes of spine disease.” The March 2008 VA examination report was reviewed by the author of an October 2020 VA medical opinion, and the October 2020 VA medical opinion indicates: “It is estimated that the veteran may lose an additional 5 degrees of range of motion in all directions of the lumbar spine after repetitive use over time,” and “It is estimated that the veteran may lose an additional 10 degrees of range of motion of the thoracolumbar spine in all directions during a flare up.” By applying the October 2020 VA medical opinion’s estimations to the March 2008 clinical data, the ranges of motion during flare-ups are estimated to be forward flexion to 80 degrees, extension to 20 degrees, left lateral flexion to 20 degrees, left lateral rotation 20 degrees, right lateral flexion to 20 degrees, and right lateral rotation to 20 degrees. The estimated combined range of motion during flare-ups was then 180 degrees. A July 2009 VA examination report shows that clinical inspection of the Veteran’s spine revealed forward flexion to 70 degrees, extension to 20 degrees, left lateral flexion to 25 degrees, left lateral rotation to 25 degrees, right lateral flexion to 10 degrees, and right lateral rotation to 20 degrees. The VA examiner noted “Yes,” there was “objective evidence of pain on active ROM,” but “No,” there was -not- “additional limitation after three repetitions of range of motion.” The combined range of motion was 170 degrees. The July 2009 VA examiner noted that the Veteran reported exacerbations of pain and that “[h]e has to avoid certain movements. Riding in car or plane for long causes stiffness and pain. At work he has to get up and move around often.” The VA examiner noted that the Veteran reported that the disability had become “[p]rogressively worse” over time. The Veteran’s pain experience was “[c]onstant,” featuring a “[d]ull ache and occasionally sharp pain.” The severity of the pain was “[m]oderate.” The Veteran described flare-ups as “[s]evere,” with a frequency of “[e]very 2 to 3 weeks” and duration of “1 to 2 days.” During flare-ups, the Veteran “[h]as to stop moving for a few minutes, has to avoid strenuous activity.” The Veteran’s gait was “antalgic, favors right,” and his spinal curvatures were normal except for “lumbar flattening.” While the VA examiner noted muscle spasms, the examiner determined that “No,” it was -not- the case that “muscle spasm, localized tenderness or guarding [was] severe enough to be responsible for abnormal gait or abnormal spinal contour.” The VA examiner noted that the disability caused “[p]roblems with lifting and carrying, pain,” with “Moderate” effect upon daily chores, and a “Mild” effect upon some of the Veteran’s other daily activities. The report presents no indication that the Veteran’s degenerative disc disease manifested in incapacitating episodes requiring any significant duration of bed rest prescribed by a physician and treatment by a physician; the VA examiner stated that “No,” there were -not- “incapacitating episodes of spine disease.” The July 2009 VA examination report was reviewed by the author of an October 2020 VA medical opinion, and the October 2020 VA medical opinion indicates: “It is estimated that the veteran may lose an additional 5 degrees of range of motion in all directions of the lumbar spine after repetitive use over time,” and “It is estimated that the veteran may lose an additional 10 degrees of range of motion of the thoracolumbar spine in all directions during a flare up.” On the basis of applying the October 2020 VA medical opinion’s estimations to the July 2009 clinical data, the AOJ assigned a 20 percent rating effective from the date of the July 2009 VA examination. The Board has considered the Veteran’s description of flare-ups in June 2006, including that he sometimes had to “walk[] bent over for a couple of days; can’t straighten up.” The inability to fully straighten-up during flare-ups appears to be most reasonably understood as a limitation of extension of the spine. The Board notes that the standard estimated additional limitation presented by the October 2020 VA medical opinion in this case is 10 degrees lost in each plane of thoracolumbar motion. The June 2006 VA examination report’s clinical findings show 200 degrees of combined range of motion between the six pertinent planes, and applying the estimated 10 degrees of additional functional loss for each plane results in 140 degrees of remaining combined range of motion. This does not meet the criteria for a rating in excess of 10 percent, and the combined range of motion will not meet the criteria for an increased rating unless a further loss of 20 degrees of range of motion is supported by the evidence. In this context, the Board has carefully considered the Veteran’s specific description that he sometimes had to “walk[] bent over for a couple of days; can’t straighten up.” The Board finds that it is reasonable to understand this description as depicting a limitation of thoracolumbar ranges of motion during a flare-up. If the Board interprets the Veteran’s described impairment as approximating further limitation of extension the Veteran’s combined range of motion becomes 120 degrees; that result would meet the criteria for a 20 percent rating. The Board finds that this is a reasonable interpretation of the available information pertinent to the Veteran’s impairment as of June 2006. Resolving reasonable doubt in the Veteran’s favor, the Board finds that the criteria for a 20 percent rating were met from the time of the June 2006 VA examination report. The June 2006 VA examination report is the earliest detailed VA examination report during the rating period, and the Board finds no persuasive contrary evidence of record. The Board acknowledges that the March 2008 VA examination report does not provide findings as supportive of an award of a 20 percent rating. In light of the fact that the Board finds that back disability is reasonably shown to have met the criteria for a 20 percent rating prior to March 2008, and it is already established to have met the criteria for a 20 percent rating 16 months after March 2008, the Board is not persuaded that the Veteran’s back disability was substantially less severe in March 2008. The Board finds it reasonable to view the March 2008 as more of an outlier than a demonstration that the back disability had meaningfully improved. Thus, the Board finds that this level of impairment is reasonably shown from the beginning of the rating period in June 2005. Accordingly, the Board finds that an increased 20 percent rating is warranted throughout the rating period prior to July 29, 2009. To this extent, the appeal is granted. This grant results in the Veteran now having established entitlement to a 20 percent rating for the thoracolumbar spine disability for a continuous period from June 1, 2005 (the effective date of the grant of service connection), to September 15, 2020. Following this period, a 40 percent rating is in effect. The Board now turns to the question of whether any rating in excess of 20 percent is warranted during the rating period prior to September 15, 2020. The Board finds that the preponderance of the evidence is against entitlement to any additional increase of ratings for the Veteran’s thoracolumbar spine disability during the rating period prior to September 15, 2020. In the absence of incapacitating episodes of IVDS, the criteria for a rating in excess of 20 percent require limitation of forward flexion of the thoracolumbar spine to 30 degrees or less; or, at least favorable ankylosis or functional equivalent of ankylosis of the entire thoracolumbar spine. See Chavis v. McDonough, No. 18-2928, U.S. Vet. App. (Apr. 16, 2021). The medical evidence of record presents no showing that the Veteran’s degenerative disc disease has manifested in incapacitating episodes requiring any significant duration of bed rest prescribed by a physician and treatment by a physician; multiple pertinent VA examination reports specifically state that the Veteran’s disability does not feature any such incapacitating episodes (including the March 2008, July 2009, November 2015, January 2018, and September 2020 VA examination reports discussed above and below). The Board notes that neither the evidence of record nor the Veteran’s contentions have ever suggested that the Veteran’s spine has been ankylosed at any time during this period; the medical evidence of record repeatedly indicates that the Veteran’s spine was not ankylosed, with no contrary indications of record. Furthermore, the medical evidence discussed by the Board in this decision repeatedly and consistently demonstrates that the Veteran has had functional movement of the thoracolumbar spine at all times, even after accounting for functional loss during unobserved exacerbations. Therefore, there was no functional equivalent of ankylosis during the appeal period. Accordingly, the Board’s analysis focuses upon the question of whether the Veteran’s disability manifested in limitation of forward flexion of the thoracolumbar spine to 30 degrees or less. The June 2006 VA examination report, discussed in more detail above, shows clinical measurement of forward flexion to 75 degrees. Even considering the Veteran’s descriptions of unobserved exacerbations and functional impairment, and considering the October 2020 VA medical opinion’s suggestion of a 10 degree further impairment during flare-ups, the Board finds no basis for concluding that the described impairment was comparable to limitation of flexion to 30 degrees or less at that time. The March 2008 VA examination report, discussed in more detail above, shows clinical measurement of forward flexion to 90 degrees. Even considering the Veteran’s descriptions of flare-ups and functional impairment, and considering the October 2020 VA medical opinion’s suggestion of a 10 degree further impairment during flare-ups (resulting in 80 degrees of remaining flexion), the Board finds no basis for concluding that the described impairment was comparable to limitation of flexion to 30 degrees or less that that time. The July 2009 VA examination report, discussed in more detail above, shows clinical measurement of forward flexion to 70 degrees. The October 2020 VA medical opinion’s retrospective estimate provides that during flare-ups, the Veteran’s forward flexion was limited to 60 degrees. Even considering the Veteran’s descriptions of unobserved exacerbations and functional impairment, the Board finds no basis for concluding the impairment was comparable to limitation of flexion to 30 degrees or less at that time. The July 2009 VA examination report indicates that the Veteran perceived that his pathology had become “[p]rogressively worse” over time, which does not suggest that he experienced any greater level of impairment during the earliest portions of the rating period compared to the impairment shown in the detailed VA examination findings in the July 2009 report. A November 2015 VA examination report shows clinical measurement of forward flexion to 90 degrees. The Veteran described that flare-ups “occur 1-2x/week with exacerbation of radicular symptoms with staying in one position too long.” Functional impairment was described as: “He has to get up and stretch approximately every hour to avoid flares.” Pain was noted during range of motion testing, “but does not result in/cause functional loss.” There was evidence of pain with weight bearing, and objective evidence of the Veteran being “mildly tender to palpation right paraspinal muscle are into right buttock.” The Veteran’s muscle spasm and localized tenderness were “[n]ot resulting in abnormal gait or abnormal spinal contour.” The VA examiner noted that the Veteran’s back disability caused “[i]nterference with sitting” and “standing,” and the Veteran reported “during flares, pain with excess sitting or standing, relieved with stretching.” The VA examiner found that “No,” the Veteran did -not- have “Intervertebral disc syndrome” of the thoracolumbar spine (and thus no incapacitating episodes attributable to such). The VA examiner noted that the Veteran occasionally used a “tens unit as needed.” The VA examiner stated that the Veteran “is able to work however he gets up frequently to stretch.” The October 2020 VA medical opinion’s retrospective estimate provides that during flare-ups, the Veteran’s forward flexion was limited to 80 degrees. Even considering the Veteran’s descriptions of unobserved exacerbations and functional impairment, the Board finds no basis for concluding the impairment was comparable to limitation of flexion to 30 degrees or less at that time. A January 2018 VA examination report shows clinical measurement of forward flexion to 70 degrees. The Veteran described low back “pain to level 10 with dull ache and sometimes twinges. He also has spasming to the right hip.” The Veteran reported flare-ups “2-3 times per week” of “Moderate to severe” intensity for “2-3 days” duration. The Veteran described functional loss in terms of being “[u]nable to sit or stand for prolonged periods, especially without frequent position changes and breaks to stretch out. Prolonged weight bearing is difficult.” The Veteran’s muscle spasm and guarding were “not resulting in abnormal gait or abnormal spinal contour.” The VA examiner found that “No,” the Veteran did -not- have “any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months.” The VA examiner characterized functional impact as involving “0-1 week work time lost in last 12 months,” and “[l]imited prolonged weight bearing, standing, and ambulation. Tolerates sedentary activities well with frequent breaks for stretch or walking around.” There was no evidence of pain when the spine was in a “non-weight bearing position at rest,” and the VA examiner explained that passive range of motion testing was “not feasible to do in a safe and reasonable manner.” The VA examiner remarked that the Veteran presented “with normal gait. He is able to bend at the waist, cross legs to tie shoes. Able to pick up objects from the floor without obvious difficulty.” The October 2020 VA medical opinion’s retrospective estimate provides that during flare-ups, the Veteran’s forward flexion was limited to 60 degrees. An October 2019 VA medical opinion declines to present estimations of functional impairment, and does not otherwise present information pertinent to meeting the criteria for an increased rating in this case. A September 2020 VA examination report presents findings that have served as the basis of the assignment of a 40 percent rating effective from the date of the examination. The Board notes that the report shows that the VA examiner found that “No,” the Veteran has -not- “had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months.” The report otherwise shows that the Veteran’s forward flexion was functionally limited to 20 degrees during flare-ups, and this has served as the basis for the award of a 40 percent rating effective from the date of the examination. The September 2020 VA examination report does not identify an earlier date of occurrence of this increased impairment nor otherwise present a basis for finding limitation of flexion to 30 degrees or less from any ascertainable date prior to the examination. The October 2020 addendum to the September 2020 VA examination report presents retrospective functional impairment estimations based upon review of prior VA examination reports; the Board has incorporated and cited the October 2020 addendum’s estimations in its discussion of the prior VA examination reports, above. None of the retrospective estimations indicate limitation of flexion to 30 degrees or less from any ascertainable date prior to the September 2020 VA examination. The Board notes that the October 2020 addendum presents estimates of limitation during unobserved exacerbations associated with repeated use over time and also with flare-ups. In every instance, the October 2020 addendum estimates a greater degree of limitation/impairment for flare-ups than for repeated use over time; the Board has accordingly focused upon the flare-up impairment estimates in this decision because those estimates are the most favorable to the Veteran’s claim on appeal. The Board finds that the evidence does not show limitation of thoracolumbar spinal flexion to 30 degrees or less at any time during the period prior to September 15, 2020. The evidence does not show ankylosis, nor functional impairment comparable to ankylosis; the Veteran has been repeatedly and consistently medically assessed to retain functional movement in his thoracolumbar spine, including in estimations of functional limitation during unobserved exacerbations. The evidence does not show incapacitating IVDS episodes having a total duration of at least 4 weeks during any 12 month period. The Board finds that the evidence of record does not show that the criteria for a rating in excess of 20 percent were met during the period prior to September 15, 2020. Accordingly, no rating in excess of 20 percent is warranted prior to September 15, 2020, and the appeal must be denied to this extent. Finally, the Board now turns to consideration of whether any rating in excess of 40 percent is warranted for the period from September 15, 2020, to the present. The applicable rating criteria for a rating in excess of 40 percent require unfavorable ankylosis of the entire thoracolumbar spine, or functional equivalent of ankylosis, or incapacitating episodes having a total duration of at least 6 weeks during a 12-month period. Regarding ankylosis, the evidence of record shows that the Veteran’s spine has not been actually or functionally ankylosed: the September 2020 VA examination report is uncontradicted in its medical finding that “No,” the Veteran does -not- have “ankylosis of the spine.” Furthermore, the evidence does not indicate that the Veteran’s functional impairments are comparable to ankylosis of the spine, even during exacerbations of impairment and accounting for pain: the September 2020 VA examination report shows that even during flare-ups and following repeated use over time, the Veteran retained functional movement of the thoracolumbar spine in every plane / aspect. Regarding incapacitating episodes, the evidence of record shows no indication that the Veteran has experienced incapacitating episodes having a total duration of at least 6 weeks during a 12-month period during (or proximate to) the rating period from September 15, 2020, onward: the September 2020 VA examination report shows that “No,” the Veteran has -not- “had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months.” For all of the indications discussed in this paragraph, the Board finds no contrary evidence of record. The Board finds that the evidence of record does not show that the criteria for a rating in excess of 40 percent have been met during the period from September 15, 2020, to the present. Accordingly, no rating in excess of 40 percent is warranted for the period from September 15, 2020, to the present, and the appeal must be denied to this extent. In summary, the Board has found that the evidence reasonably supports an award of an increased 20 percent rating for the period prior to July 29, 2009, and an award of an increased 20 percent rating for the period from November 2, 2015, to January 31, 2018. Beyond these grants, the Board finds that the preponderance of the evidence is against the award of a rating in excess of 20 percent prior to September 15, 2020, and against the award of a rating in excess of 40 percent from September 15, 2020, to the present. To the extent that the Board finds that the preponderance of the evidence weighs against further / additional increased ratings, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. The Veteran and his representative have not raised any other issues in connection with the back disability rating issue on appeal, nor have any other associated issues been reasonably raised by the record in connection with this matter. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 5. Entitlement to a compensable disability rating for rhinitis is denied. A November 2015 rating decision granted service connection for rhinitis, and assigned a noncompensable / zero-percent initial rating effective from June 1, 2005, the day following the Veteran’s separation from service. The Veteran’s rhinitis was rated under 38 C.F.R. § 4.97, Diagnostic Code 6522. Under Code 6522, a 10 percent evaluation is assigned for allergic or vasomotor rhinitis without polyps, but with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side. A maximum 30 percent evaluation is assigned for allergic or vasomotor rhinitis with polyps. 38 C.F.R. § 4.97, Diagnostic Code 6522. After a review of the evidence of record, the Board finds that a compensable rating is not warranted at any time during the period on appeal. A November 2015 VA examination report notes that the Veteran was diagnosed with vasomotor rhinitis; however, there was no obstruction greater than 50 percent of the nasal passage on both sides or complete obstruction on either side, permanent hypertrophy of the nasal turbinates, nasal polyps, or granulomatous conditions. In fact, the only symptom was a “mild amount of blood in left nare.” The examiner also concluded that there was no functional impact on the Veteran’s ability to work. A January 2018 VA examination report confirms the diagnosis of rhinitis; however, there was again no obstruction greater than 50 percent of the nasal passage on both sides or complete obstruction on either side, permanent hypertrophy of the nasal turbinates, nasal polyps, or granulomatous conditions. The examiner also concluded that there was no functional impact on the Veteran’s ability to work. A May 2020 VA examination report again confirms the diagnosis of rhinitis; however, there was again no obstruction greater than 50 percent of the nasal passage on both sides or complete obstruction on either side, permanent hypertrophy of the nasal turbinates, nasal polyps, or granulomatous conditions. The examiner also concluded that there was no functional impact on the Veteran’s ability to work. These findings are consistent with the VA and private treatment records available for review, which do not reflect any obstructions or polyps in the nasal passage that would warrant a higher rating. After careful review, the Board finds that the most probative evidence does not reach the level of equipoise regarding the question of a compensable rating for rhinitis. There is no evidence of record showing the presence of polyps or the degree of nasal obstruction which is required for a compensable rating for this disability. It is also not shown that there were any disabling effects not considered in a rating under any other Diagnostic Code. The Board has considered the Veteran’s competent lay statements. Layno, 6 Vet. App. at 469. The Veteran reported to the January 2018 VA examiner that his symptoms featured: “Year round congestion, crustiness of nose, nose bleeds, headaches and drainage causing him to gag and sometimes vomit due to the mucus.” The May 2020 VA examiner reviewed the Veteran’s documented reports of “nasal drainage,” “raspy deep voice,” “on and off cough from post nasal drip,” at times, with “no rhinitis complaints” also reported on at least one occasion. Amongst the reported symptoms, the Board notes that the Veteran’s headaches have been recognized in the medical evidence as a symptomatic impairment associated with the rhinitis, and the Board has addressed this impairment in a separate section of this decision (below) granting entitlement to service connection for the headaches. The other reported symptoms were considered by the January 2018 VA and May 2020 VA examiners (who documented them in the examination reports), and both considered the Veteran’s reported symptoms when concluding that “No,” the Veteran’s symptoms do -not- “impact his … ability to work.” Apart from the headaches (addressed separately below), the Board finds that the evidence does not otherwise indicate functional impairment from the Veteran’s rhinitis symptoms raising further questions of compensable manifestations of disability in this case. Whether or not there is underlying pathology constituting increased disability, or whether there is a symptom related to a disability, is a medical question beyond the capability of the Veteran’s own lay observation. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In evaluating this claim, the Board finds that the most probative evidence regarding the severity of the Veteran’s rhinitis is the medical evidence of record, which is silent as to findings (or complaints) of nasal polyps or obstruction of the nasal passages; the medical evidence otherwise indicates no functional impairment from the Veteran’s rhinitis symptoms (apart from the headaches, addressed separately in this decision). This medical evidence, featuring multiple VA rating examination reports, has considered the Veteran’s reported symptoms and provides clinical evaluation of the disability and any related functional impairment. In summary, the Board finds that a compensable rating for rhinitis is not warranted at any time during the appeal period. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, his appeal as to this matter must be denied. 38 U.S.C. § 5107. The Veteran and his representative have not raised any other issues in connection with the rhinitis rating issue on appeal, nor have any other associated issues been reasonably raised by the record in connection with this matter (apart from the matters addressed in this decision, such as the grant of service connection for associated headaches in the section below). See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 6. Entitlement to service connection for headaches, as secondary to rhinitis, is granted. The Court recently held in Bailey v. Wilkie, 33 Vet. App. 188 (2021), that in addition to considering entitlement to increased benefits, VA must consider entitlement to any additional benefits due to complications from the disability, and it is not necessary that the Veteran file a formal claim for service connection for such additional disability. In this case, the Veteran’s appeal for greater compensation for his service-connected rhinitis has raised the question of potential entitlement to service connection for headaches as secondary to the rhinitis. Under 38 C.F.R. § 3.310, service connection may be granted, on a secondary basis, for disability that is proximately due to or the result of a service-connected disease or injury, or for the degree of disability resulting from aggravation of a nonservice-connected disability, by a service-connected disability. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Service connection is limited to those cases where disease or injury has resulted in a disability. In the absence of proof of a present disability for which service connection is sought, there is no valid claim of service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992). The requirement of having a current disability is met when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). A disability under 38 U.S.C. § 1110 refers to functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d 1356 (2018). However, subjective complaints of pain in the absence of objective evidence of functional impairment are not sufficient to show a current disability for VA purposes. Id. at 1367-68. A November 2015 VA medical opinion includes the assertion that the Veteran’s “current symptoms of his headaches and mild nasal dryness …. are related to the chronic rhinitis for which he is currently treated ….” A May 2017 VA medical opinion states that “the headaches are symptoms related to rhinitis,” although then further states that the headaches “do not warrant a separate clinical diagnosis of a headache condition.” The May 2017 VA examiner noted that the Veteran “reports headaches 2-3 times a week, worsened by change in weather at times.” A January 2018 VA examiner noted that the Veteran reported “[l]ight headaches on most days but there are some days where he has called out from work. He has missed church to sleep in to get rid of the headaches.” With consideration to the nature of headaches and the functional impairment associated with headache experiences, the Board finds that the medical evidence recording that the Veteran’s headaches interfere at times with his work and his personal activities is sufficient in this case to show that the headaches cause some degree of functional impairment beyond merely reports of pain. The Board is satisfied that a functional impairment meeting the criteria for consideration of service connection has been met with regard to the Veteran’s headaches in this case, despite the absence of a medical diagnosis distinct from his rhinitis symptomatology. The medical evidence discussed above clearly establishes that the Veteran’s headaches are due to or the result of his service-connected rhinitis. Accordingly, the Board finds that service connection for headaches as secondary to rhinitis is warranted in this case. To this extent, the Veteran’s appeal is granted.   The AOJ shall now process the Board’s grant of service connection for the Veteran’s headaches and issue a determination regarding the disability rating and effective date in the first instance. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Barone, 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.