Citation Nr: 21027558 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 16-35 632 DATE: May 6, 2021 ORDER Entitlement to a rating in excess of 10 percent for left knee patellofemoral syndrome with degenerative arthritis is denied. Entitlement to a uniform 10 percent rating for the entire period on appeal for slight left knee instability is granted. Entitlement to a separate compensable rating for limitation of left knee extension or flexion is denied. Entitlement to a rating in excess of 30 percent for bilateral pes planus is denied. Entitlement to a compensable rating for bilateral hearing loss is denied. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran's left knee patellofemoral syndrome with degenerative arthritis has manifested as painful and reduced motion, but he has not exhibited ankylosis, removal or dislocation of the meniscus, impairment of the tibia or fibula, or genu recurvatum. 2. Resolving reasonable doubt in the Veteran's favor, he has exhibited slight, but not moderate, instability of the left knee throughout the period on appeal. 3. Throughout the period on appeal, the Veteran's left knee patellofemoral syndrome with degenerative arthritis has generally manifested as, at worst, flexion limited to 90 degrees and extension limited to 5 degrees, and he is already compensated for functional impairment caused by painful and reduced motion. 4. Throughout the period on appeal, the Veteran's bilateral pes planus has manifested as accentuated pain on manipulation and use, but he has not exhibited marked pronation, extreme tenderness of the plantar surfaces of the feet or marked inward displacement and severe spasm of the tendo achillis on manipulation. 5. According to audiometric testing, the Veteran's hearing impairment is no worse than Level I in the right ear and Level II in the left ear. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 10 percent for left knee patellofemoral syndrome with degenerative arthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5003, 5256-5263. 2. The criteria for entitlement to a uniform rating of 10 percent for slight instability of the left knee have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5257. 3. The criteria for entitlement to a separate compensable rating for limitation of flexion or extension of the left knee due to patellofemoral syndrome with degenerative arthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DCs 5260-5261. 4. For the period on appeal, the criteria for a rating in excess of 30 percent have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.3, 4.71a, DC 5276. 5. The criteria for entitlement to a compensable rating for service-connected bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.85, 4.86, DC 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Marine Corps from May 1980 to May 2000. These matters came before the Board of Veterans' Appeals (Board) on appeal from June and July 2016 rating decisions issued by a Regional Office (hereinafter agency of original jurisdiction or AOJ) of the Department of Veterans Affairs (VA). In November 2018, the Board advanced this case on the docket pursuant to 38 U.S.C. § 7107(b)(3). 38 C.F.R. § 20.900(c). These claims were previously remanded by the Board in November 2018 for consideration of new evidence by the AOJ in the first instance and have now been returned to the Board for appellate review. Since the initial rating decisions on appeal, the AOJ has granted the Veteran increases in disability ratings for bilateral pes planus as well as the left knee. However, as less than the maximum benefit has been awarded, the issues remain in controversy. See AB v. Brown, 6 Vet. App. 35 (1993). Increased Ratings Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify various disabilities and the criteria for specific ratings. Relevant regulations do not require that all cases show all findings specified by the Schedule; however, findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. §§ 4.7, 4.21. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran. 38 C.F.R. § 4.3. In establishing an appropriate initial assignment of a disability rating, the proper scope of evidence includes all medical evidence submitted in support of the veteran's claim. Fenderson v. West, 12 Vet. App. 119 (1999). In cases where an assigned disability rating has been challenged or appealed, it is possible for a veteran to receive a staged rating. A staged rating is an award of separate percentage evaluations for separate periods, based on the facts found during the appeal period. Id. at 126-28; see also Hart v. Mansfield, 21 Vet. App. 505 (2007). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. This regulation also requires that, whenever possible, the joints involved are 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. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, 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). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45 but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). In Sharp v. Shulkin, the United States Court of Appeals for Veterans Claims (Court) decision addressed what constitutes an adequate explanation for an examiner's inability to estimate motion loss in terms of degrees during periods of flare-ups. 29 Vet. App. 26 (2017). The Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. Id. 1. Entitlement to a rating in excess of 10 percent for left knee patella femoral syndrome with degenerative arthritis 2. Entitlement to a compensable rating from June 27, 2016 to May 24, 2017 and in excess of 10 percent before and after for left knee instability 3. Entitlement to a compensable rating for left knee limitation of extension The Veteran's left knee is currently rated as 10 percent disabling for the entire period on appeal for patellofemoral syndrome with degenerative arthritis, noncompensable (0 percent) for the entire period on appeal for limitation of extension related to the same, and as 10 percent disabling from February 7, 2014, noncompensable from June 27, 2016 to May 24, 2017 and 10 percent from May 25, 2017 onward for instability and recurrent subluxation related to the same. Included within 38 C.F.R. § 4.71a are multiple DCs that evaluate impairment resulting from service-connected knee disorders, including DC 5256 (ankylosis), DC 5257 (other impairment, including recurrent subluxation or lateral instability), DC 5258 (dislocated semilunar cartilage), DC 5259 (symptomatic removal of semilunar cartilage), DC 5260 (limitation of flexion), DC 5261 (limitation of extension), DC 5262 (impairment of the tibia and fibula), and DC 5263 (genu recurvatum). The Board notes at the outset that the evidence does not indicate, and the Veteran does not allege: ankylosis, impairment of the tibia or fibula or genu recurvatum. Under DC 5260, a noncompensable rating is assigned when flexion of the leg is limited to 60 degrees; a 10 percent rating is assigned when flexion is limited to 45 degrees; a 20 percent rating is assigned when flexion is limited to 30 degrees; and a 30 percent rating is assigned when flexion is limited to 15 degrees. 38 C.F.R. § 4.71a. Under DC 5261, a noncompensable rating is assigned when extension of the leg is limited to 5 degrees; a 10 percent rating is assigned when extension is limited to 10 degrees; a 20 percent rating is assigned when extension is limited to 15 degrees; a 30 percent rating is assigned when extension is limited to 20 degrees; a 40 percent rating is warranted for extension limited to 30 degrees; and a 50 percent rating is assigned when extension is limited to 45 degrees. Id. The normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II. Under DC 5257, which evaluates recurrent subluxation or lateral instability of a knee, and assigns a 10 percent disabling for a slight impairment, 20 percent disabling for a moderate impairment, and 30 percent disabling for a severe impairment. The terms "slight," "moderate," "moderately severe," 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. The use of terminology such as "slight" or "moderate" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. Diagnostic Code 5257 was revised, effective February 7, 2021. Part 4 - Schedule for Rating Disabilities, § 4.71a Schedule of ratings musculoskeletal system, 85 Fed. Reg. 230, 76463 (November 30, 2020). Effective February 7, 2021, Diagnostic Code 5257, concerning recurrent subluxation or instability, provides a 30 percent rating for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. A 30 percent award is also warranted for sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation. A 20 percent rating applies where the evidence shows unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 10 percent rating is for application for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. Regarding patellar instability: A 30 percent rating applies for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. A 20 percent rating applies for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A 10 percent rating applies for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. Note (1): For patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note (2): A surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). Under DC 5258, a maximum 20 percent rating is warranted for semilunar cartilage, dislocated, with frequent episodes of "locking", pain, and effusion into the joint. Lastly, under DC 5259, a maximum 10 percent rating is warranted for removal of semilunar cartilage that is symptomatic. Separate ratings under DCs 5260 and 5261 may be assigned for disability of the same knee joint. See VAOPGCPREC 9-2004. Additionally, for a knee disability already rated under DCs 5260 and/or 5261, a claimant would have additional disability justifying a separate rating if there is instability and/or subluxation of the knee joint under DC 5257. See generally VAOPGCPREC 23-97. Furthermore, the rating criteria do not preclude separate ratings for meniscal injury under DCs 5258 and 5259 where there are separate ratings for limitation of motion under DCs 5260 and/or 5261, or instability under DCs 5257. Lyles v. Shulkin, 29 Vet. App. 107 (2017). The Veteran was afforded a VA knee examination in October 2012, during which the examiner diagnosed right knee patellofemoral syndrome but did not provide a left knee diagnosis. The Veteran did not report any flareups and his range of motion was 125 degrees flexion and 0 degrees extension both before and after repetitive use. His stability testing was normal, and he did not report the use of an ambulatory aid, but x-ray imaging revealed bilateral arthritis of the knees. The examiner opined that the Veteran's left knee disability did not impact his ability to work. The Veteran was afforded an additional VA examination in November 2012, during which he reported a history of constant pain with occasional swelling and popping as well as a "feeling of giving out" since around the year 2000. He stated he was told he had a Baker's Cyst and had received injections for his knees but denied any surgeries. His range of motion was 110 degrees flexion with painful motion at full flexion and 0 degrees extension with no objective evidence of painful motion and no change after repetitive use. The examiner noted pain on palpation, full muscle strength and normal stability testing with no evidence of recurrent patellar subluxation, dislocation or meniscal conditions. The Veteran reported regular use of a cane, and the examiner noted his knee disability interfered with sitting, standing and weight bearing. The Veteran was afforded an additional VA examination in February 2014, during which he exhibited flexion to 120 degrees with painful motion at 135 as well as extension to five degrees with painful motion at the same. The examiner noted less movement, weakened movement, and swelling in the left knee with pain on palpation, three of five muscle strength on flexion and extension, and minor instability with evidence of slight patellar subluxation. A meniscal condition was noted for the right knee only, with no surgeries or assistive devices, and imaging revealed bilateral arthritis. The Veteran was afforded an additional VA examination in June 2016, during which he reported symptoms of left knee popping after sitting and "giving way" after prolonged sitting with pain and tenderness along the joint line of the knee. The examiner noted flexion to 130 degrees and extension to 0 degrees with pain on flexion and with weight bearing, no pain on palpation and the presence of crepitus. The Veteran reported increased pain upon repetitive use but the same range of motion. Muscle strength was full and stability testing was normal, with no meniscal condition or ambulatory assistive devices noted. The examiner opined that pain caused a functional loss while standing, walking, lifting or sitting for an extended period of time. February 2017 VA treatment records note the Veteran reported worsening bilateral knee pain over the past several months. The Veteran submitted private treatment records containing a May 2017 private examination, during which he reported constant left knee pain in varying degrees intensified by sitting, standing and using stairs, as well as clicking, popping and "giving out" unpredictably, causing him to stumble but not fall. The private physician recorded "flexion performed with pain to 45 degrees, extension is adequate," as well as "orthopedic examination reveals lateral instability which answers the giving out." The Veteran was afforded an additional VA knee examination in July 2017, during which he exhibited flexion to 120 and extension to 0 degrees, with no pain on weight bearing but pain to the patella upon palpation with crepitus. There was no additional functional loss on repetitive use testing, and examiner was unable to say without speculation whether functional ability was severely limited by pain, weakness, fatigability, or incoordination after repeated use or during flareups. Muscle strength was full and joint stability was normal, with no history of recurrent subluxation, lateral instability, meniscal condition or recurrent effusion noted. The Veteran reported wearing a knee brace on the right side only, and the examiner did not assess the functional impact of his left knee disability. March 2018 VA treatment records indicate the Veteran exhibited tenderness on active motion of the left knee. He was afforded an additional VA examination in February 2016, where he was diagnosed with osteoarthritis, recurrent subluxation with instability and patellofemoral pain syndrome of the left knee. The Veteran reported swelling, locking and popping, with weekly flareups causing difficulty with stairs, treated with tramadol, ice packs, drainage, and a pillow between his legs. The examiner noted abnormal range of motion of flexion to 95 and extension to 0 degrees with pain on flexion, weight bearing and active motion causing a functional loss while running. No crepitus or tenderness on palpation were observed, but decreased flexion of 90 degrees with increased pain were recorded upon repetitive use and during flareups, causing difficulty standing for extended periods. No atrophy or ankylosis were noted, but recurrent subluxation and/or persistent instability were recorded, although the examiner observed no history or surgery and stated no prescription for an ambulatory aid was warranted. Finally, no meniscal condition was noted, but mild arthritis of the knees was revealed by July 2018 imaging. The Veteran underwent an additional VA examination in April 2021, wherein his diagnoses of left knee patellofemoral syndrome and degenerative arthritis were confirmed. The Veteran reported joint stiffness with limited range of motion, aggravated by sitting, standing or walking for an extended period of time, alleviated by ice packs. The examiner noted the issuance of an occasionally used bilateral hinged knee brace but indicated no reported functional loss after repetitive use, recurrent subluxation or instability, frequent effusion, muscle atrophy or ankylosis. Abnormal range of motion was recorded as 90 degrees flexion and 0 degrees extension, with pain on flexion and weight bearing as well as active and passive motion, although without additional functional loss. The examination took place after repeated use over time although not during a flareup. The Veteran reported no increase in symptoms during flares and the examiner described additional factors contributing to the disability as "less movement than normal, joint stiffness, weakened movement." The examiner indicated the Veteran had been diagnosed with a meniscus condition, noting "residual pain," but also stated there was no history of surgery, meniscectomy, arthroscopic ligament repair, or residual symptoms from the same. Throughout the period on appeal, the range of motion of the Veteran's left knee has generally been limited to, at worst, 90 degrees flexion and 5 degrees extension, neither of which his high enough to warrant a compensable rating under DC 5260 or 5261, which require flexion and extension limited to 45 degrees and 10 degrees, respectfully. Although the private DC noted "flexion to 45 degrees with pain," this measurement is not consistent with the rest of the Veteran's medical history. Regardless, there is objective evidence that the Veteran's left knee disability has caused painful and reduced range of motion, warranting a 10 percent rating, the minimum compensable rating for the joint and the same rating provided for flexion limited to 45 degrees. See 38 C.F.R. § 4.59. As noted above, the evidence does not indicate, and the Veteran does not allege, ankylosis, impairment of the tibia or fibula or genu recurvatum. The Veteran's treatment records as well as VA and private examinations indicate waxing and waning recurrent lateral instability or recurrent subluxation. This instability, noted during February 2014, May 2017 and February 2021 VA and private examinations, is described by the Veteran as a "giving way" sensation. While the June 2016 VA examination noted normal joint stability testing, the Veteran reported current symptoms of popping and giving way after prolonged sitting. As such, and affording the Veteran the benefit of the doubt, the Board finds that the Veteran has manifested symptoms of recurrent subluxation or lateral instability throughout the entire period on appeal. The Board also finds that the level of instability exhibited by the Veteran has been, at most, slight per DC 5257 (pre-February 7, 2021). While he has described a feeling of "giving way," there is no evidence this instability has resulted in a fall, and he was not prescribed a knee brace he reported wearing "occasionally" until April 2021. Finally, stability testing throughout the period on appeal was largely normal and characterized clinically, at worst, as "minor," with imaging revealing no or, at most, slight patellar subluxation. In consideration of the new criteria, a higher rating is not warranted as the objective medical evidence and subjective complaints do not reflect unrepaired or failed repair of complete ligament tear causing persistent instability, nor has he been prescribed an assistive device or bracing for ambulation. He has not undergone surgery for his instability and has not been prescribed a brace, cane or walker. With regard to DC 5258 and 5259, dealing with the meniscus (semi-lunar cartilage), the Board observes that there is no evidence of complaints of or treatment for a left knee meniscal disorder in the Veteran's treatment records. While the April 2021 VA examiner noted the Veteran had been diagnosed with a meniscus condition and experienced "residual pain," the same examiner noted the Veteran had not undergone surgery for removal of semi-lunar cartilage or experienced a dislocated meniscus. As such, the Board assigns little probative value to the examiner's report of a meniscal condition diagnosis, and finds more persuasive the numerous other VA and private examinations, one less than two months earlier, that indicate the Veteran has never experienced dislocation or removal of the left meniscus. Therefore, a separate rating under DC 5258 or 5259 is not warranted. In sum, the Board finds that a rating in excess of the current 10 percent for painful motion of the left knee due to arthritis and patellofemoral pain syndrome is not warranted, and that a uniform rating of 10 percent, but no higher, for slight lateral instability is merited for the entire period on appeal. Separate ratings under other diagnostic codes pertaining to the knee are not appropriate in the absence of probative evidence indicating ankylosis, meniscal issues, impairment of the tibia or fibula, or genu recurvatum. 4. Entitlement to a rating in excess of 30 percent for bilateral pes planus The Veteran was initially granted service connection for bilateral pes planus with a disability rating of 10 percent. However, a July 2016 AOJ rating decision granted an increased rating 30 percent for the entire period on appeal. Throughout the appeal period, the Veteran's bilateral pes planus has been rated pursuant to 38 C.F.R. § 4.71a, DC 5276 for flat feet. Under this DC a noncompensable rating is warranted for mild acquired flatfoot; symptoms relieved by built-up shoe or arch support. A 10 percent rating is warranted for moderate acquired flat foot; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral. A 20 percent unilateral or 30 percent bilateral rating is assigned for severe acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. Finally, a maximum 30 percent unilateral or 50 percent bilateral rating is warranted for pronounced acquired flatfoot; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, DC 5276. The Veteran was afforded a VA foot examination in October 2012, which diagnosed bilateral pes planus and noted pain on the use of both feet, accented on manipulation, with no indication of swelling on use, tenderness of the plantar surfaces or characteristic callosities. The examiner noted decreased bilateral arches on weight bearing but no evidence of deformity, pronation, inward bowing of the achilles tendon, inward displacement or severe spasm of the tendo achillies. The Veteran exhibited a smooth and steady gait without any evidence of a limp and was able to walk on his toe tips and heels without any evidence of pain. March 2015 private treatment records indicate the Veteran reported pain in his right heel as well as tenderness along the medial of the plantar fascial ligament and was diagnosed with right foot plantar fasciitis. November 2015 private treatment records reveal the Veteran complained he could not wear shoes comfortably due to think toenails and reported a plantar fasciitis flareup in the past two weeks which had improved. He demonstrated bilateral tenderness to the plantar fascial ligament and was prescribed diabetic-style shoe orthotics to relieve heel pain. According to January 2016 private treatment records, the Veteran complained of worsening foot pain and was diagnosed with bilateral plantar fasciitis as well as bilateral pes planus. His plantar fascia was observed to be tender on manipulation bilaterally, with no additional pain upon manipulation of the hind or forefoot, and he exhibited a normal heel to toe gait. August 2016 private treatment records indicate the Veteran was prescribed custom orthotics. February 2017 VA treatment records indicate the Veteran complained of worsening pain in his right foot. The Veteran underwent a private DC examination in May 2017. The examiner noted the Veteran was service connected for bilateral pes planus and concurred with the Veteran's current 30 percent rating. March 2018 VA treatment records indicate the Veteran exhibited bilateral tenderness of the feet upon manipulation. July 2019 private treatment records note the Veteran complained of increasing left heel pain for the past month, and x-rays revealed bilateral plantar calcaneal exostosis, although it was noted to be asymptomatic on the right. The examiner noted the pain was localized around the plantar medial calcaneal tubercle where the plantar fascia attaches and observed no bruising, swelling or erythema of the left heel. Deep tendon reflexes were intact, muscle strength was full, and the rest of the foot exhibited good pain-free range of motion. The private clinician gave the Veteran a heel injection as well as a prescription for orthotic inserts to take pressure off his heel. After reviewing evidence of the severity of the Veteran's bilateral pes planus, the Board finds that his symptoms, at worst, warrant the current 30 percent rating, to include accentuated pain on manipulation and use. These symptoms have resulted in functional impairment, including a 2012 VA examiner's note that the Veteran would not be able to maintain employment that involved standing for more than an hour at a time. A higher rating of 50 percent is not warranted, as there is no lay or medical evidence of marked pronation, extreme tenderness of the plantar surfaces of the feet or marked inward displacement and severe spasm of the tendo achillis on manipulation. In his January 2014 Form 9 appeal, the Veteran asserted entitlement to a separate rating for painful motion. However, a separate rating for plantar fasciitis or painful motion under another DC would result in prohibited pyramiding, as the predominant symptomatology, pain on manipulation and use accentuated, of the Veteran's pes planus overlaps with that of his plantar fasciitis. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994) (separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not "duplicative of or overlapping with the symptomatology" of the other condition). Similarly, other DCs pertaining to the foot are not applicable as the Federal Circuit has expressly adopted the Court's holding that disabilities specifically listed in the ratings schedule may only be rated under DCs which specifically pertain to them. See Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019). Here, the Veteran's disability of bilateral pes planus is specifically listed under the Rating Schedule and therefore cannot be rated under a different DC. Additionally, the record does not indicate that the Veteran has any other service-connected foot disabilities that would warrant a separate rating under a different DC. The Board observes that the Veteran manifests mild spurring of the left metatarsal head with mild degenerative joint disease. However, review of the record, to include March 2011 and October 2012 VA examinations, indicates these symptoms are due to hallux rigidus, which is not attributed to his pes planus. As such, a separate disability rating for these symptoms is not warranted. The Veteran is competent to describe the pain and limitations caused by his service-connected pes planus. The Board finds these descriptions credible and notes they were relied upon in assignment of his current 30 percent rating. The Board also concludes that the severity of his bilateral pes planus disability is adequately contemplated by the 30 percent rating criteria. Accordingly, a rating in excess of the current 30 percent during the period on appeal is not warranted. 5. Entitlement to a compensable rating for bilateral hearing loss Ratings for hearing impairment are derived by the mechanical application of the Rating Schedule to the numeric designations assigned after audiometry evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345 (1992). DC 6100 of 38 C.F.R. § 4.85, provides a table (Table VI) to determine a Roman numeral designation (I through XI) for hearing impairment, based on puretone thresholds and controlled speech discrimination (Maryland CNC) testing. Table VII is used to determine the rating assigned by combining the Roman numeral designations for hearing impairment of each ear. The "puretone threshold average" as used in Table VI, is the sum of the puretone thresholds at 1000, 2000, 3000, and 4000 Hertz, divided by four. This average is used in all cases to determine the Roman numeral designation for hearing impairment from Table VI or VIA. An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b). The Veteran currently has a noncompensable rating for bilateral hearing loss for the entire period on appeal, and he asserts entitlement to a 30 percent rating. The Veteran was afforded a VA audiological examination in May 2016. The examining audiologist recorded puretone thresholds, in decibels, as follows: HERTZ 1000 2000 3000 4000 AVERAGE RIGHT 30 40 35 35 35 LEFT 45 40 35 40 40 Speech audiometry revealed speech discrimination (Maryland CNC) testing of 100 percent and 88 percent in the right and left ear, respectively. The Veteran was diagnosed with bilateral sensorineural hearing loss. These readings are indicative of a Level I severity hearing loss in the right ear and Level II severity in the left ear, warranting a noncompensable rating. 38 C.F.R. § 4.85, DC 6100, Table VI-VII. The Veteran does not manifest an exceptional pattern of hearing loss, and given his audiometric results, Table VIA would not provide a higher rating. 38 C.F.R. § 4.86. The Veteran underwent a private medical examination in May 2017, performed by a Doctor of Chiropractic (DC). The DC performed a test in which "normal day to day noise (air conditioner, computer, and soft background music) is introduced to test functional hearing under normal day to day conditions," as well as whispered and spoken words from a distance of five feet. The DC indicated that testing revealed the Veteran manifested "bilateral hearing loss under normal conditions of 30 percent of the left ear and 30 percent of the right ear," and recommended the Veteran undergo a puretone audiogram. The Board awards these testing results little probative value, as they do not include an audiometry evaluation. The Board observes that the Veteran's last audiological examination was several years ago. However, there is no evidence the Veteran has complained of worsening hearing loss since his request for a 30 percent rating in a notice of disagreement, received less than two months after his VA examination. This request for a 30 percent rating was also reflected in the private DC examination results. The passage of time alone, without an allegation of worsening, does not warrant a new examination, barring a material change in the condition or problems or inconsistencies in the prior examination. Palczewski v. Nicholson, 21 Vet. App. 174 (2007). As there is no allegation of worsening or indication of problems with the VA examination of record, the Board finds a new examination is not warranted. The Board has considered the Veteran's description of loss of hearing acuity, which is credible and probative, as well as the determination of the private DC. However, with regards to assigning the proper disability rating, the Board is bound by the explicit criteria stated in the Rating Schedule. The Veteran's description of decreased hearing acuity and the DC's impression of "30 percent hearing loss" bilaterally have been measured according to puretone averages and speech discrimination by an audiologist and is contemplated by the schedular criteria. Doucette v. Shulkin, 28 Vet. App. 366 (2017). As noted above, the ratings for hearing impairment are derived by the mechanical application of the Rating Schedule to the numeric designations assigned after audiometry evaluations are rendered. Lendenmann, 3 Vet. App. at 345. Therefore, there is no reasonable doubt to resolve in the Veteran's favor, and his claim for a compensable rating for bilateral hearing loss must be denied. M.W. KREINDLER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. C. Schumacher, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.