Citation Nr: 21028278 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 16-19 463 DATE: May 10, 2021 ORDER Entitlement to service connection for a low back disability is denied. Entitlement to service connection for a left shoulder disability is denied. Entitlement to a compensable rating for residuals of a tonsillectomy is denied. Entitlement to a compensable rating for anal fissure is denied. Entitlement to a compensable rating for bilateral calluses is denied. Entitlement to a disability rating in excess of 10 percent for gastroesophageal reflux disease is denied. Entitlement to a compensable rating prior to September 14, 2020, and in excess of 50 percent thereafter for bilateral plantar fasciitis is denied. FINDINGS OF FACT 1. A current low back disability was not incurred in service, did not manifest within a year of service separation, has not been chronic or continuous since service, and is not due to an in-service disease, injury, or other incident of service. 2. A current left shoulder disability was not incurred in service, did not manifest within a year of service separation, has not been chronic or continuous since service, and is not due to an in-service disease, injury, or other incident of service. 3. The Veteran's residuals of a tonsillectomy do not result in any current impairment. 4. The Veteran's anal fissure does not result in any current impairment. 5. The Veteran's bilateral calluses do not result in any current impairment. 6. The Veteran's gastroesophageal reflux disease is characterized by nausea, vomiting, and pyrosis, without persistently recurrent epigastric distress with dysphagia and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. 7. Prior to September 14, 2020, the Veteran's bilateral plantar fasciitis was characterized by subjective reports of pain, without the weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, or pain on manipulation and use of the feet. 8. Effective September 14, 2020, the Veteran's bilateral plantar fascitis is characterized by bilateral foot pain, without functional impairment equivalent to amputation. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a low back disability have not been met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 2. The criteria for entitlement to service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 3. The criteria for entitlement to a compensable rating for residuals of a tonsillectomy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.97, Diagnostic Code (DC) 6516. 4. The criteria for entitlement to a compensable rating for anal fissure have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.114, DC 7334. 5. The criteria for entitlement to a compensable rating for bilateral calluses have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.118, DCs 7800-19. 6. The criteria for entitlement to a disability rating in excess of 10 percent for gastroesophageal reflux disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.114, DC 7346. 7. The criteria for entitlement to a compensable rating prior to September 14, 2020, and in excess of 50 percent thereafter for bilateral plantar fasciitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, DCs 5276-5284. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1995 to April 2001. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). These issues were previously presented to the Board in June 2019, at which time they were remanded for additional development. They have now been returned to the Board. Also subsequent to the June 2019, the Veteran changed her accredited representative. Her current representative is noted above. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. 1. Entitlement to service connection for a low back disability The Veteran seeks service connection for a low back disability. She asserts she injured her low back during active duty service while lifting a patient as a medical technician. Therefore, she asserts, service connection is warranted. Considering first the service treatment records, these indicate that in February 1997, the Veteran sought treatment for a two-day history of a stomachache. Other reported symptoms included nausea, pelvic pain, and intermittent low back pain. Examination of her back indicated full range of motion and no tenderness to palpation. She was diagnosed with gastrointestinal discomfort and given medication. No disease or injury of the low back or lumbosacral spine was diagnosed at that time. Thereafter, the Veteran did not seek treatment for and was not diagnosed with a low back or spinal disability. A service separation examination is not of record. Post service, the Veteran was not diagnosed with a low back disability until 2007. In April 2007, the Veteran sought private treatment for low back pain. She reported onset of her pain approximately four months ago, without any noted precipitating event or injury. Paravertebral muscle spasm and numbness of her left foot were reported. A May 2007 x-ray indicated degenerative joint disease of the lumbosacral spine and a May 2007 MRI of the lumbosacral spine indicated lower lumbar facet degenerative joint disease, most pronounced at the L5-S1 level. She again reported ongoing low back pain in September 2007. A lumbar strain was diagnosed. The Veteran again sought private treatment in June 2011 for low back pain. She reported onset of her current low back pain episode several months ago, without any noted precipitating event or injury. A June 2011 x-ray indicated moderate facet arthropathy. A lumbar strain was diagnosed. In July 2011, she denied any prior history of low back pain. A September 2011 MRI confirmed mild to moderate degenerative disc disease of the lumbosacral spine. Based on this evidence, the Board must conclude that while the Veteran has a current diagnosis of a low back disability, to include a lumbar strain and degenerative disc disease of the lumbosacral spine, such a disability was not incurred in service, did not manifest within a year of service separation, and has not been chronic or continuous since service. While she did report intermittent low back pain on one occasion during service, this appeared to be related to a gastrointestinal disability at that time, as no objective findings of a low back disease or injury were noted by the service examiner, and no diagnosis of a low back disability was rendered. The remainder of the service treatment records are likewise without a diagnosis of a back or spine disability. According to the private medical records, the first current disability was diagnosed in 2007, more than five years after service separation. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology, and weighs heavily against the claim. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000); see, e.g., Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). The Board further notes that the Veteran first filed a VA compensation claim in May 2001, shortly after service separation, but did not report a low back or spinal disability at that time. This evidence also suggests against a finding of a chronic disability or continuity of symptomatology following service. Thus, service connection for a low back disability is not warranted. The preponderance of the evidence is also against a nexus between a current low back or spinal disability and a disease, injury, or other incident of service. A VA medical examination and opinion was afforded the Veteran in September 2020. Her claims file was reviewed in conjunction with the examination. After examination of the Veteran and review of the claims file, the VA examiner determined it was less likely than not that any current low back disability was incurred, the result of, or was aggravated by active duty service. The examiner noted the Veteran had current diagnoses of mild facet arthropathy, a lumbosacral strain, and degenerative arthritis; none of these diagnoses, however, were rendered during service, and the examiner could find no evidence of onset of such disabilities during service. Thus, in the absence of competent evidence to the contrary, the Board must conclude that service connection for a low back disability is not warranted on any basis. The Veteran herself asserts that her current low back disabilities are the result of an injury to the low back while lifting a patient. Service personnel records confirm she served as a medical technician. As such, the Board recognizes the Veteran has received medical training. However, the Veteran has not provided an explanatory rationale supporting her assertions. Additionally, the Board finds that the Veteran's experience as a general medical technician does not demonstrate that she is competent to provide a nexus opinion regarding the etiology of her current lumbosacral spine disability, because the identification and treatment for orthopedic disabilities is medically complex, as it requires knowledge of complicated diagnostic medical testing and pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that she has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). In conclusion, the preponderance of the evidence is against the award of service connection for a low back disability on any basis. As the preponderance of the evidence is against the claim, service connection for a low back disability is not warranted, and the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 2. Entitlement to service connection for a left shoulder disability The Veteran seeks service connection for a left shoulder disability. She asserts she injured her left shoulder during active duty service while lifting a patient as a medical technician. Therefore, she asserts, service connection is warranted. Considering first the service treatment records, these are negative for any diagnosis of or treatment for a disability of the left shoulder. A service separation examination is not of record. Post service, the Veteran reportedly sought private treatment in approximately 2011, although obtained private treatment records do not reflect a current diagnosis of a left shoulder disability. Regardless, this lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology, and weighs heavily against the claim. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000); see, e.g., Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). The Board further notes that the Veteran first filed a VA compensation claim in May 2001, shortly after service separation, but did not report a left shoulder disability at that time. This evidence also suggests against a finding of a chronic disability or continuity of symptomatology following service. Thus, service connection for a left shoulder disability is not warranted. The preponderance of the evidence is also against a nexus between a current left shoulder disability and a disease, injury, or other incident of service. A VA medical examination and opinion was afforded the Veteran in September 2020. Her claims file was reviewed in conjunction with the examination. After examination of the Veteran and review of the claims file, the VA examiner determined it was less likely than not that any current left shoulder disability was incurred, the result of, or was aggravated by active duty service. The examiner noted the Veteran had current subjective complaints of left shoulder pain and limitation of motion; none of these symptoms, however, were noted during service, and the examiner could find no evidence of onset of such disabilities during service. Thus, in the absence of competent evidence to the contrary, the Board must conclude that service connection for a left shoulder disability is not warranted on any basis. The Veteran herself asserts that her current left shoulder disability is the result of an injury to the left shoulder while lifting a patient in service. Service personnel records confirm she served as a medical technician, as noted above. As such, the Board recognizes the Veteran has received medical training. However, the Veteran has not provided an explanatory rationale supporting her assertions. Additionally, the Board finds that the Veteran's experience as a general medical technician does not demonstrate that she is competent to provide a nexus opinion regarding the etiology of her current left shoulder disability, because the identification and treatment for orthopedic disabilities is medically complex, as it requires knowledge of complicated diagnostic medical testing and pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that she has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). In conclusion, the preponderance of the evidence is against the award of service connection for a left shoulder disability on any basis. As the preponderance of the evidence is against the claim, service connection for a left shoulder disability is not warranted, and the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). Increased Rating Disability evaluations are based upon the average impairment of earning capacity as contemplated by the schedule for rating disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). In adjudicating increased rating claims, the level of disability in all periods since the effective date of the grant of service connection must be taken into account, to include the possibility that a staged rating may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). As such, the Board will consider whether staged ratings are appropriate to the pending appeals. In cases in which a reasonable doubt arises as to the appropriate degree of disability to be assigned, such doubt shall be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. 3. Entitlement to a compensable rating for residuals of a tonsillectomy The Veteran seeks a compensable rating for her residuals of a tonsillectomy. She asserts this disability has worsened in severity, and an increased rating is therefore warranted. The Veteran's residuals of a tonsillectomy disability are rated under Diagnostic Code (DC) 6599-6516. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. DC 6516 provides for the evaluation of laryngitis, chronic. Under DC 6516, hoarseness, with inflammation of cords or mucous membrane is rated 10 percent. Hoarseness with thickening of nodules or cords, polyps, submucous infiltration, or pre-malignant changes on biopsy are rated 30 percent, the maximum rating provided under Diagnostic Code 6516. 38 C.F.R. § 4.97, DC 6516. In every instance where the schedule does not provide a zero percent rating for a diagnostic code, a zero percent rating shall be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. An initial VA examination was afforded the Veteran in October 2012. The Veteran's history of an in-service tonsillectomy was noted. She reported two instances of strep throat following her surgery, but no recent symptomatology. On physical examination, the VA examiner found no evidence of chronic sinusitis, rhinitis, laryngitis, or other nasal, sinus, or respiratory impairment. Her residuals of a tonsillectomy were not found to result in any functional impairment. On VA examination in September 2020, her history of an in-service tonsillectomy was noted. She reported recurrent strep throat infections since this operation. She also stated, however, that she has had no further treatment, referrals, surgeries, or hospitalizations resulting from her tonsillectomy. She also used no medications related to this disability, and denied any sinus-related symptoms. On physical evaluation of the Veteran, the VA examiner could identify no impairment or symptomatology related to her tonsillectomy. After thorough review of the evidence of record, the Board concludes that the weight of the probative evidence of record is against a compensable rating for the Veteran's residuals of a tonsillectomy. According to the VA examination reports and other evidence, the Veteran has not exhibited the criteria for a compensable rating at any time during the appeals period. See 38 C.F.R. § 4.30. Also, as no symptomatology or functional impairment has been attributed to her residuals of a tonsillectomy, evaluation of this disability under other diagnostic criteria is not warranted. In the absence of any evidence that the Veteran experienced symptoms attributable to her in-service tonsillectomy at any time during the appeals period, a compensable rating for residuals of a tonsillectomy is not warranted. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 4. Entitlement to a compensable rating for anal fissure The Veteran seeks a compensable rating for anal fissure. She asserts this disability has worsened in severity, and an increased rating is therefore warranted. The Veteran's anal fissure disability is rated under Diagnostic Code (DC) 7399-7334. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. DC 7334 pertains to prolapse of the rectum. Under DC 7334, mild prolapse with constant slight or occasional moderate leakage is provided a 10 percent rating. Moderate prolapse, persistent or frequently recurring, is provided a 30 percent rating. Severe or complete prolapse, persistent, is provided a 50 percent rating. 38 C.F.R. § 4.114, DC 7334. In every instance where the schedule does not provide a zero percent rating for a diagnostic code, a zero percent rating shall be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. On initial VA examination in October 2012, she reported onset of symptoms following sexual assault during service. She denied any current symptoms, however, according to the examination report. No current treatment, medications, history of surgery or hospitalization, or other impairment was reported. Physical examination was within normal limits, according to the examiner. A complete blood count was also negative for anemia or other symptomatology. No current functional impairment was noted. Another VA examination was afforded the Veteran in August 2020. She reported she has continued to have symptoms related to this condition, but stated she has had no further treatment, referrals, or evaluations in the recent past. She further stated she was uncomfortable talking about her symptoms at the present time. Based on the Veteran's reluctance to submit to physical examination, the examiner could find no evidence of current symptomatology. Thus, based on the above, the Board finds a compensable rating for the Veteran's anal fissure is not warranted, as this disability does not result in mild prolapse with constant slight or occasional moderate leakage, as would warrant a 10 percent rating under DC 7334. In the absence of any of the required symptomatology, a compensable rating is not warranted. Additionally, as this disability results in no other identified symptoms or impairment, evaluation under other pertinent diagnostic criteria is also not warranted. In conclusion, the preponderance of the evidence is against the award of a compensable rating for the Veteran's anal fissure. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 5. Entitlement to a compensable rating for bilateral calluses The Veteran seeks a compensable rating for her bilateral calluses of the feet. She asserts this disability has resulted in pain and other impairment of the feet, and an increased rating is therefore warranted. The Veteran's bilateral calluses are rated under DC 7899-7819. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. As noted above, the Veteran has been granted a separate service connection award for the concurrent disability of bilateral plantar fascitis. That disability, and any impairment resulting therefrom, will be discussed below. DC 7819, for benign skin neoplasms, provides for rating as disfigurement of the head, face, or neck under Diagnostic Code 7800, as scars under Diagnostic Codes 7801-7805, or as impairment of function. 38 C.F.R. § 4.118, DC 7819. DC 7800 pertains to burn scarring affecting the head, face, or neck; scarring of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck. As that Code explicitly pertains to scars that are of the head, face, or neck, it is not applicable to this appeal. 38 C.F.R. § 4.118. DCs 7801 to 7805 provide alternative rating approaches for scars. Under DC 7801, a scar at a location other than the head, face, or neck that is superficial, with associated underlying tissue damage, would have to have a scar with an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.) warrants a 10 percent rating. A scar with an area or areas of at least 12 square inches (77 sq. cm.) but less than 72 square inches (465 sq. cm.) warrants a 20 percent rating. A scar with an area or areas of at least 72 square inches (465 sq. cm.) but less than 144 square inches (929 sq. cm.) warrants a 30 percent rating. A scar with an area or areas of 144 square inches (929 sq. cm.) or greater warrants a 40 percent rating. Id. Under DC 7802, a scar at a location other than the head, face, or neck that is superficial, with no underlying tissue damage, would have to have an area exceeding 144 square inches (929 square centimeters) to warrant a compensable, 10 percent rating. 38 C.F.R. § 4.118, DC 7802. A superficial scar is one that is not associated with underlying soft tissue damage. Id., DC 7802, Note (1). DC 7804 rates scars that are unstable or painful. Five or more scars that are unstable or painful receive a 30 percent disability rating; three or four scars that are unstable or painful receive a 20 percent disability rating; one or two scars that are unstable or painful receive a 10 percent disability rating. Id., DC 7804. DC 7805 pertains to other scars and other effects of scars evaluated under DCs 7800, 7801, 7802, or 7804. DC 7805 provides that any disabling effect(s) not considered in a rating provided under DCs 7800 to 7804 should be evaluated under an appropriate diagnostic code. Id., DC 7805. For the purposes of this appeal, the Board will limit its analysis to DC 7802. Because DC 7819 calls for rating under the diagnostic codes for scars, the Board will treat the bilateral calluses at issue as analogues to scars for the purposes of DC 7802. On VA examination in October 2012, she reported continuing problems with bilateral foot pain, especially with closed toe shoes. On physical examination, the examiner made no findings of scars, calluses, or impairment of the skin of either foot. The Veteran did not require any assistance devices to ambulate, and her gait was normal. No functional impairment was noted. Likewise, on a more recent September 2020 VA examination, the Veteran denied any medications or treatments involving her bilateral calluses. On physical examination, the Veteran had small rough callus nodules on the fifth (pinky) toes bilaterally. These were described as red and hard. Her gait was within normal limits, and no other functional impairment was attributed to these calluses. After considering the totality of the record, the Board finds the preponderance of the evidence to be against a compensable rating at any time during the appeals period for the Veteran's bilateral calluses. According to the October 2012 and 2020 VA examinations, these calluses result in no functional impairment of either foot. They are also not disfiguring, painful, deep, or involving an area of at least 39. sq. cm. Thus, under no applicable diagnostic criteria would the Veteran's bilateral calluses warrant a compensable rating. In conclusion, the preponderance of the evidence is against the award of a compensable rating for bilateral calluses. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 6. Entitlement to a disability rating in excess of 10 percent for gastroesophageal reflux disease The Veteran seeks an increased rating for her gastroesophageal reflux disease. She asserts this disability has resulted in pain and other impairment of her gastrointestinal system, and an increased rating is therefore warranted. The Veteran's gastroesophageal reflux disease is rated under DC 7399-7346. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. DC 7346, for hiatal hernia, provides a 10 percent rating for two or more symptoms for a 30 percent rating, but of lesser severity. A 30 percent rating is assigned for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 60 percent rating is assigned for symptoms of pain, vomiting, material weight loss, and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. 38 C.F.R. § 4.114, DC 7346. The Veteran was afforded an initial VA examination of her gastroesophageal reflux disease in September 2012. Her reported symptoms included epigastric burning and cramping. She stated these symptoms were "under control" with medication. She also reported pyrosis and sleep disturbances, but denied material weight loss, hematemesis, melena, dysphagia, reflux, regurgitation, nausea, vomiting, spasm of the esophagus, or substernal or arm or shoulder pain. The examiner determined the Veteran's gastroesophageal reflux disease did not interfere with her employment. On VA examination in September 2020, the Veteran reported intermittent nausea, vomiting, heart burn, and reflux with the consumption of food. She also reported she used medication on a regular basis to address her symptoms. She denied, however, material weight loss, hematemesis, melena, dysphagia, spasm of the esophagus, or substernal or arm or shoulder pain. The examiner concluded the Veteran's gastroesophageal reflux disease did not impair her ability to work. Thus, based on these examination reports, as well as the VA and private treatment records, the Board concludes the preponderance of the evidence is against the award of a disability rating in excess of 10 percent for the Veteran's gastroesophageal reflux disease at any time during the pendency of this appeal. While the Veteran has reported such symptoms as nausea, vomiting, and pyrosis, she has been without persistently recurrent epigastric distress with dysphagia and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. The Veteran's reported symptoms also do not suggest evaluation under other diagnostic criteria for gastrointestinal disabilities would result in a higher disability rating. In conclusion, the preponderance of the evidence is against a disability rating in excess of 10 percent for the Veteran's gastroesophageal reflux disease at any time during the appeals process, and the claim must be denied. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 7. Entitlement to a compensable rating prior to September 14, 2020, and in excess of 50 percent thereafter for bilateral plantar fasciitis The Veteran seeks an increased rating for her bilateral plantar fascitis. She asserts this disability has resulted in pain and other impairment of the feet, and an increased rating is therefore warranted. For the disability at issue, she has been granted a noncompensable initial rating prior to September 14, 2020, and a 50 percent rating effective that date. Because specific diagnostic criteria have not been established for the Veteran's plantar fascitis, this disability is rated by analogy under DC 5276, for acquired flat foot. Plantar fascitis may also be rated under DC 5284, which evaluates other non-specified foot disabilities. Under DC 5276, 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 rating is assigned for severe unilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is warranted for severe bilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A maximum 50 percent rating is warranted for pronounced bilateral 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, Diagnostic Code 5276. DC 5284 provides a 10 percent rating for other foot injuries resulting in moderate disability. Moderately severe disability warrants a 20 percent rating, and severe disability warrants a 30 percent rating. 38 C.F.R. § 4.71a, DC 5284. In every instance where the schedule does not provide a zero percent rating for a diagnostic code, a zero percent rating shall be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. On VA examination in October 2012, the Veteran reported ongoing bilateral foot pain due to her plantar fascitis. She stated she received physical therapy and medication for her feet post-service, but without relief of her symptoms. On physical examination, she was without pes planus, hallux valgus, hallux rigidus, pes cavus, hammer toes, metatarsalgia, Morton's neuroma, bilateral weak foot, or malunion or nonunion of the tarsal/metatarsal bones. X-rays of the feet indicated small plantar heel spurs bilaterally, but were otherwise within normal limits. The Veteran did not require any assistance devices to ambulate, and her gait was within normal limits. The examiner found the Veteran's bilateral plantar fascitis did not impair her ability to work. Considering first the period prior to September 14, 2020, the Board finds the preponderance of the evidence to be against a compensable rating for this period. Neither the October 2012 examination report nor the VA and private outpatient treatment records reflect the weight-bearing line over or medial to the great toe, inward bowing of the tendo achillis, or pain on manipulation and use, as would warrant a compensable rating for this period. She had an essentially normal gait, and required no assistance devices to aid mobility. Overall, the evidence of record suggests no more than mild impairment, and thus a noncompensable initial rating is warranted. As for the rating assigned from September 14, 2020, the Board notes that the Veteran is in receipt of the highest 50 percent schedular rating under DC 5276 for bilateral acquired flat foot and, as such, there is no basis to award a higher rating. In evaluating the ratings assignable prior to and after September 14, 2020, the Board has also considered other Diagnostic Codes pertaining to the foot. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). In Scott v. Wilkie, the Federal Circuit expressly adopted the Court's holding that disabilities specifically listed in the rating schedule may only be rated under Diagnostic Codes which specifically pertain to them. Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333, 336 (2015)). The Federal Circuit also expressly adopted the Court's holding that unlisted conditions may be rated by analogy to Diagnostic Codes that may not describe the unlisted disability but addresses disabilities that may be productive of similar symptoms. Scott, 920 F.3d 1375 (citing Yancy v. McDonald, 27 Vet. App. 484, 493 (2016). Finally, the Federal Circuit concluded that the Board must also consider assigning separate ratings under analogous Diagnostic Codes, when rating an unlisted service-connected foot disability exhibiting distinct manifestations, even when service connection has also been granted for one of the eight conditions listed in the rating schedule. Id. In this case, as noted, plantar fasciitis does not have its own diagnostic code and is also rated under DC 5284, which evaluates other non-specified foot disabilities. Under DC 5284, a severe foot injury warrants a 30 percent rating, whereas a maximum 40 percent rating is assigned where these is actual loss of the foot. The Board finds DC 5284 does not assist the Veteran in obtaining a compensable rating prior to September 14, 2020 because the evidence does not show or suggest that her plantar fasciitis disability has resulted in more than mild impairment of either foot at any point during this period. As for the period after September 14, 2020, the evidence shows the Veteran has maintained the ability to use both feet, and does not have the functional equivalent of loss of either foot, according to the September 2020 examination report. There is no evidence to the contrary. The Board further notes that the Veteran does have other service-connected foot disabilities with distinct manifestations; therefore, DCs 5280 and 5282 are not applicable, as they evaluate hallux valgus and hammertoes. As for the remaining Diagnostic Codes pertaining to the foot, the Board notes that the lay and medical evidence of record does not reflect that the Veteran's bilateral plantar fasciitis disability is manifested by weak foot, claw foot, metatarsalia, or hallux rigidus. Therefore, Diagnostic Codes 5277, 5278, 5279, 5281, and 5283 are not relevant to this case and are not applicable. In conclusion, the Board finds that the preponderance of the evidence is against a compensable rating prior to September 14, 2020 and against a rating in excess of 50 percent thereafter for the service-connected bilateral plantar fasciitis disability. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Thomas D. Jones, 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.