Citation Nr: 21028492 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 13-01 308 DATE: May 11, 2021 ORDER Entitlement to an initial rating in excess of 20 percent for left knee patellofemoral syndrome, to include consideration of an extraschedular rating, is denied. Entitlement to a separate rating of 10 percent for left knee instability is granted. Entitlement to an initial rating in excess of 20 percent for lumbosacral spine degenerative disc and joint disease, to include consideration of an extraschedular rating, prior to June 6, 2017 is denied. Entitlement to an extraschedular rating of 50 percent, but no higher, for a lumbosacral spine degenerative disc and joint disease, from June 6, 2017 to July 3, 2019 is granted. Entitlement to a rating in excess of 50 percent for lumbosacral spine degenerative disc and joint disease beginning July 3, 2019 is denied. Entitlement to an initial compensable rating for gastroesophageal reflux disease (GERD) with irritable bowel syndrome (IBS) prior to March 18, 2013 is denied. Entitlement to a rating of 30 percent, but no higher, for GERD with IBS beginning March 18, 2013 is granted. Entitlement to initial rating of 10 percent, but no higher, for right hand carpal tunnel syndrome prior to March 18, 2013 is granted. Entitlement to a rating in excess of 10 percent for right hand carpal tunnel syndrome beginning March 18, 2013 is denied. Entitlement to initial rating of 20 percent, but no higher, for left hand carpal tunnel syndrome is granted. Entitlement to an initial rating of 10 percent, but no higher, for left lower extremity radiculopathy and tarsal tunnel syndrome prior to March 18, 2013 is granted. Entitlement to a rating in excess of 10 percent for left lower extremity radiculopathy and tarsal tunnel syndrome beginning March 18, 2013 is denied. Entitlement to an initial rating of 10 percent, but no higher, for right tarsal tunnel syndrome is granted. FINDINGS OF FACT 1. For the entire period on appeal, the Veteran's left knee patellofemoral syndrome has been manifested by frequent episodes of joint locking, pain and effusion, as well as painful motion; flexion limited to, at worst, 110 degrees; and zero degrees extension even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups; without ankylosis, impairment of the tibia and fibula, or genu recurvatum. 2. For the entire period on appeal, the Veteran's left knee patellofemoral syndrome manifested as mild instability. 3. For the appeal period prior to June 6, 2017, the Veteran's lumbosacral spine degenerative disc and joint disease was not manifested by forward flexion of 30 degrees or less, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups; without ankylosis, incapacitating episodes due to intervertebral disc syndrome or associated objective neurological abnormalities such as bowel or bladder impairments. 4. Affording the Veteran the benefit of the doubt, beginning June 6, 2017, the Veteran's lumbosacral spine degenerative disc and joint disease was productive of unfavorable ankylosis of the entire thoracolumbar spine without unfavorable ankylosis of the entire spine. 5. For the appeal period prior to March 18, 2013, the Veteran's GERD with IBS was manifested by reflux and pyrosis without evidence of dysphagia, recurrent epigastric distress, sleep disturbances, regurgitation, substernal pain, vomiting, nausea, substernal arm, shoulder pain or a considerable impairment of health. 6. For the appeal period beginning March 18, 2013, the Veteran's GERD with IBS is manifested by infrequent episodes of epigastric distress, dysphagia, pyrosis, reflux, regurgitation, substernal pain, sleep disturbances without an indication that it resulted in severe impairment of health. 7. Throughout the appeal period, the Veteran's right carpal tunnel syndrome has been productive of a disability picture consistent with mild incomplete paralysis of the median and ulnar nerves without diminished or loss of reflexes or muscle atrophy. 8. Throughout the appeal period, the Veteran's left carpal tunnel syndrome has been productive of a disability picture consistent with moderate incomplete paralysis of the median and ulnar nerves without diminished or a loss of reflexes or muscle atrophy. 9. Throughout the appeal period, the Veteran's right tarsal tunnel syndrome has been productive of a disability picture consistent with mild incomplete paralysis of the tibial nerve without a loss of reflexes, muscle atrophy and constant pain. 10. Throughout the appeal period, the Veteran's left lower extremity radiculopathy and tarsal tunnel syndrome has been productive of a disability picture consistent with mild incomplete paralysis of the tibial nerve; there is no showing of moderate incomplete paralysis. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 20 percent for a left knee patellofemoral syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.14.14, 4.71a, Diagnostic Code 5258. 2. The criteria for a separate rating of 10 percent for left knee instability have been met for the entire period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.71a, Diagnostic Code 5257. 3. The criteria for an initial rating in excess of 20 percent for a lumbosacral spine degenerative disc and joint disease prior to June 6, 2017 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5242-5243. 4. The criteria for an extraschedular rating of 50 percent, but no higher, for a lumbosacral spine degenerative disc and joint disease from June 6, 2017 to July 3, 2019 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5242-5243. 5. The criteria for a rating in excess of 50 percent for a lumbosacral spine degenerative disc and joint disease beginning July 3, 2019 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5242-5243. 6. The criteria for an initial compensable rating for GERD with IBS prior to March 18, 2013 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.114, Diagnostic Codes 7319-7346. 7. The criteria for a rating of 30 percent, but no higher, for GERD with IBS beginning March 18, 2013 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.114, Diagnostic Codes 7319-7346. 8. The criteria for an initial rating of 10 percent, but no higher, for right carpal tunnel syndrome prior to March 18, 2013 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.123, 4.124a, Diagnostic Code 8515. 9. The criteria for a rating of 10 percent for right carpal tunnel syndrome beginning March 18, 2013 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.123, 4.124a, Diagnostic Code 8515. 10. The criteria for an initial rating of 20 percent, but no higher, for left carpal tunnel syndrome have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.123, 4.124a, Diagnostic Code 8515. 11. The criteria for an initial rating of 10 percent, but no higher, for left lower extremity radiculopathy and tarsal tunnel syndrome prior to March 18, 2013 have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8520. 12. The criteria for a rating in excess of 10 percent for left lower extremity radiculopathy and tarsal tunnel syndrome beginning March 18, 2013 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4,123, 4.124a, Diagnostic Code 8520. 13. The criteria for an initial rating of 10 percent, but no higher, for right tarsal tunnel syndrome have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.123, 4.124a, Diagnostic Code 8520. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active naval military service from February 1980 to October 1982, January 1990 to May 1990, November 1994 to May 1995, October 1996 to March 1997, November 1997 to May 1998, May 1998 to September 1998, October 1998 to February 2000, April 2000 to September 2000, October 2000 to April 2001, April 2001 to September 2001, October 2001 to May 2002, October 2002 to October 2003, November 2003 to December 2004, April 2005 to September 2008, October 2008 to April 2009, April 2009 to January 2010, and March 2011 to June 2012. This case comes before the Board of Veterans' Appeals (Board) on appeal from a July 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. This case was previously before the Board in February 2017 and October 2018, at which times the issues currently on appeal was remanded for additional development. Specifically, the claims were remanded to afford the Veteran a VA examination to determine the current nature and severity of her left knee disorder, lumbar spine, carpal tunnel syndrome, GERD and tarsal syndrome as well as obtain updated treatment records. Such examinations were conducted in July 2019, January 2021 and March 2021. A July 2019 letter requested that the Veteran complete an appropriate authorization form to allow VA to obtain private treatment records. The Board therefore concludes that there has been substantial compliance with its previous remands. The case has now been returned to the Board for further appellate action. In a March 2021 rating decision, the Veteran was granted entitlement to service connection for left lower extremity radiculopathy (femoral nerve) and left lower extremity radiculopathy associated with tarsal tunnel syndrome representing full grants of the matters previously on appeal. Accordingly, those matters are no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). In the March 2021 rating decision, the Veteran was also assigned an increased rating for her service-connected lumbosacral spine degenerative disc and joint disease from 20 percent to 50 percent, effective July 3, 2019. As the Veteran is presumed to seek the maximum available benefits, this issue remains on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). In Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court of Appeals for Veterans Claims (Court) held that a claim for a total disability rating due to individual unemployability (TDIU) is part of a rating claim when such claim is expressly raised by the Veteran or reasonably raised by the record. In this case, the Veteran's reported that she was retired in a July 2019 VA treatment note. The record does not reflect, and the Veteran does not allege, that she is not able to obtain and maintain employment due to her service connected disabilities decided herein. Therefore, the Board finds that a TDIU is not raised by the Veteran or reasonably raised by the record in connection with her increased rating claims decided herein and, consequently, no further consideration of such is necessary at this time. Increased Rating Claims Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. Separate evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). VA's determination of the present level of a disability may result in a conclusion that the disability has undergone varying and distinct levels of severity throughout the entire time period the increased-rating claim has been pending. Hart v. Nicholson, 21 Vet. App. 505, 509 (2007). 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 (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself 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 [or 4.73] criteria.").] The Board notes that effective February 7, 2021, the criteria for schedule of ratings for the musculoskeletal system was revised. See 86 Fed. Reg. 8142 (Feb. 4, 2021) (codified at 38 C.F.R. pt. 4). In the instant case, the applicable rating period occurred before the implementation of these revised diagnostic criteria with regard to all evidence submitted after February 7, 2021. Therefore, the February 2021 musculoskeletal criteria apply to aspects of the Veteran's claims on appeal; and the appropriate criteria is discussed below. VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. VA thus must consider the claim for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Left Knee The Veteran generally asserts that she should have a higher rating for her left knee patellofemoral syndrome as it is worse than contemplated by the currently assigned rating. Specific argument in support of this appeal has not been presented. This appeal stems from a claim dated in April 2009. During the period on appeal, the Veteran's left knee patellofemoral syndrome is rated 20 percent under 38 C.F.R. § 4.71a, Diagnostic Code 5258. Separate ratings can be assigned for knee disabilities when none of the symptomatology overlaps and the separate rating is based on additional disabling symptomatology; this includes separate ratings based on limitation of flexion (Diagnostic Code 5260), limitation of extension (Diagnostic Code 5261), lateral instability or recurrent subluxation (Diagnostic Code 5257), and meniscal conditions (Diagnostic Codes 5258, 5259). See VAOPGCPREC 23-97, 62 Fed. Reg. 63,603 (1997); VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998); VAOPGCPREC 9-2004; 69 Fed. Reg. 59,988 (2004); Lyles v. Shulkin, 29 Vet. App. 107 (2017). The normal range of motion of the knee is from zero degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71, Plate II. Limitation of flexion warrants 10, 20, and 30 percent ratings when limitation is to 45 degrees, 30 degrees, and 15 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Limitation of extension warrants 10, 20, 30, 40, and 50 percent ratings when limitation is to 10 degrees, 15 degrees, 20 degrees, 30 degrees, and 45 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5261. A 10 percent rating can also be assigned for the knee joint if there is painful motion without compensable limitation of motion. 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Code 5003; see also Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that the applicability of 38 C.F.R. § 4.59 is not limited to arthritis claims). Recurrent subluxation and lateral instability of the knee warrants a 10, 20, or 30 percent rating if slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Ratings can be assigned when the knee disability affects the meniscus, with a 20 percent rating for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint and a 10 percent rating for removal of semilunar cartilage (e.g., meniscectomy) and current residual symptoms. 38 C.F.R. § 4.71a, Diagnostic Codes 5258, 5259. Ratings can also be assigned for impairment of the tibia or fibula, genu recurvatum, or ankylosis of the knee. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5262, 5263. Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). Ankylosis is also defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary 93 (30th ed. 2003). In this case the evidence does not reflect, and the Veteran does not allege, that she has tibia or fibula impairment, genu recurvatum, or ankylosis of either knee. As such, those diagnostic codes are not for application. In April 2010, the Veteran was afforded a VA examination with regard to her left knee. The examiner indicated that the Veteran was diagnosed with left knee patellofemoral syndrome in 1998. At that time, the Veteran reported that she experienced left knee pain, weakness, stiffness, swelling, heat, redness, giving way, lack of endurance, locking, deformity, drainage, effusion, subluxation and dislocation. The Veteran denied flare-ups but reported difficulty with standing and walking. She indicated that she used an ACE wrap and Motrin to alleviate symptoms. The Veteran indicated that she had not required any left knee surgeries. On range of motion testing, the Veteran demonstrated left knee flexion to 125 degrees, with pain at 120 degrees, and zero degrees of extension. There was no evidence that the Veteran experienced additional functional loss following repetitive-use. The medial/lateral collateral ligaments stability test, and the anterior/posterior cruciate ligaments stability test were within normal limits. The examiner noted that the medial and lateral meniscus test of the left knee was abnormal with a slight degree of severity. At a March 2013 VA examination, the Veteran reported that she experienced left knee flare-ups of pain and that she regularly attended physical therapy. On range of motion testing, the Veteran demonstrated left knee flexion to 140 degrees and zero degrees of extension. There was no evidence of painful motion on flexion or extension. The examiner reported that range of motion did not contribute to functional loss. On examination, there was no evidence of pain on passive range of motion or crepitus. There was evidence of localized mild to moderate localized tenderness and/or pain on palpation of the joint line. There was no evidence that the Veteran experienced additional functional loss following repetitive-use or during flare-ups. The examiner reported that the Veteran's left knee flare-ups did not result in additional loss of range of motion but that recovery following a flare-up required approximately 2 days of resting. Muscle strength testing was normal. The medial/lateral collateral ligaments stability test, anterior/posterior cruciate ligaments stability test, and the medial/lateral meniscus stability test were all within normal limits. The examiner reported that the Veteran did not have ankylosis, and there was no objective evidence of subluxation or lateral instability. The examiner reported that the Veteran experienced a meniscus tear that was productive of frequent episodes of joint locking, pain and effusion. The Veteran reported that she did not use any devices for assistance with ambulation. The examiner reported that the Veteran's left knee disability did not impact her ability to work. At a July 2019 VA examination, the Veteran indicated that she attended physical therapy twice per week, and that she experienced increased pain following running and squatting. The Veteran reported that flare-ups were alleviated with ice and Naproxen. The Veteran reported functional loss resulting from loss of strength and numbness. On range of motion testing, the Veteran demonstrated left knee flexion to 140 degrees and zero degrees of extension. There was no evidence of painful motion on flexion or extension. The examiner reported that range of motion did not contribute to functional loss. On examination, there was no evidence of pain on passive range of motion or crepitus. There was evidence of localized mild to moderate localized tenderness and/or pain on palpation of the joint line. There was no evidence that the Veteran experienced additional functional loss following repetitive-use or during flare-ups. Muscle strength testing was normal. The medial/lateral collateral ligaments stability test, anterior/posterior cruciate ligaments stability test, and the medial/lateral meniscus stability test were all within normal limits. The examiner reported that the Veteran did not have ankylosis, and there was no objective evidence of subluxation or lateral instability, a semilunar cartilage condition, or recurrent patellar dislocation. The Veteran reported occasional use of a brace for assistance with ambulation. With regard to functional impairment, the examiner reported that the Veteran's left knee disability impacted her ability to work in that she was unable to walk for prolonged periods of time without experiencing pain. At a February 2021 VA examination, the Veteran indicated that she experienced left knee pain and swelling. The Veteran reported infrequent flare-ups caused by over-exertion, that occurred approximately twice per month, lasting approximately one day in duration and alleviated with rest. The Veteran denied a history of effusion, lateral instability or recurrent subluxation. On range of motion testing, the Veteran demonstrated left knee flexion to 110 degrees and zero degrees of extension. There was no evidence of painful motion on flexion or extension. There was no evidence that the Veteran experienced additional functional loss following repetitive-use or during flare-ups. The examiner reported that range of motion did not contribute to functional loss. On examination, there was no evidence of pain on passive range of motion or crepitus. There was evidence of localized mild to moderate localized tenderness and/or pain on palpation of the joint line. There was no evidence that the Veteran experienced additional functional loss following repetitive-use or during flare-ups. The examiner reported that the Veteran's left knee flare-ups did not result in additional loss of range of motion but that recovery following a flare-up required approximately two days of resting. Muscle strength testing was normal. The medial/lateral collateral ligaments stability test, anterior/posterior cruciate ligaments stability test, and the medial/lateral meniscus stability test were all within normal limits. The examiner reported that the Veteran did not have ankylosis, and there was no objective evidence of subluxation or lateral instability, or a semilunar cartilage condition or recurrent patellar dislocation. The Veteran reported occasional use of a brace to assist with ambulation. The examiner reported that the Veteran's left knee disability did not impact her ability to work. As noted above, the Veteran has left knee meniscal tear and currently has a 20 percent rating under Diagnostic Code 5258 for the condition. This is the highest schedular rating available under this diagnostic code. Therefore, the Board will consider whether higher or separate ratings are available under other potential diagnostic codes. The Board further observes that left knee range of motion testing was performed during VA examinations in April 2010, March 2013, July 2019 and February 2021 and the Veteran was shown to have, at worst, 110 degrees of flexion and zero degrees of extension. The reports do not suggest that the specific findings on examination and throughout the period on appeal, in terms of range of motion, meet the criteria for a higher or separate rating, to include during a flare-up, after repetitive use, due to pain, or with weight bearing, nor does any other evidence of record to include the Veteran's statements. In this regard, the April 2010, March 2013, July 2019 and February 2021 examiners reported that the Veteran did not experience additional functional loss following repetitive use or during flare-ups. However, such range of motion findings, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination or as a result of repetitive motion and/or flare-ups, do not meet the requirements for a compensable rating under Diagnostic Code 5260 or 5261. Furthermore, the Board notes that assigning separate ratings based on limitation of motion, in addition to the currently assigned 20 percent rating under Diagnostic Code 5258, is tantamount to pyramiding. In this regard, the Court held that rating a knee disability under Diagnostic Codes 5257 or 5260/5261 or both, does not, as a matter of law, preclude the assignment of a separate rating for a meniscal disability of the same knee under Diagnostic Code 5258 or 5259, or vice versa. Lyles v. Shulkin, 29 Vet. App. 107 (2017). However, the Board finds that Diagnostic Code 5258 and Diagnostic Code 5260/5261 both rate based on limitation of motion and knee pain, as a cause of limitation of motion. In the case of Diagnostic Code 5258, limitation of motion is reflected by the symptoms or findings of pain, locking, and effusion into the joint. In the case of Diagnostic Code 5260/5261, such limitation of motion is encompassed by the limitation of flexion or extension, as applicable, including limitation of motion due to pain. Both Diagnostic Codes overlap in "locking" as a form of limitation of motion that is usually accompanied by pain. Thus, both rate based on knee pain and limitation of motion due to pain. Thus, to assign separate ratings under Diagnostic Code 5258 and Diagnostic Code 5260/5261 would compensate the Veteran twice for the same symptomatology, which would result in impermissible pyramiding. 38 C.F.R. § 4.14; Esteban, supra.. The Board has also considered whether the assignment of a separate rating under Diagnostic Codes 5257 and 5258 violates the rule against pyramiding. Diagnostic Code 5258 contemplates dislocation, effusion, and locking of the knee while Diagnostic Code 5257 pertains to knee instability and subluxation. The evaluation of the same disability or the same manifestations under various diagnoses is prohibited. 38 C.F.R. § 4.14; Lyles v. Shulkin, supra. Moreover, the Board notes that that every symptom contemplated by Diagnostic Code 5258 (dislocated semilunar cartilage, episodes of locking, and effusion in the joint) is distinct and separate from the criteria for a rating under Diagnostic Codes 5257, which contemplate instability of the knee. Separate ratings under Diagnostic Code 5257 and 5258 are therefore permissible in this instance and do not amount to impermissible pyramiding. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994); VAOPGCPREC 9-2004. It is noted that on February 7, 2021, during the course of this appeal, revisions to the Schedule for Rating Disabilities that addresses the musculoskeletal system went into effect. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5257). Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021, and the criteria that is more favorable to the Veteran will be applied. Regarding the changes to the Rating Schedule criteria that were made effective February 7, 2021, the Board has considered these changes and finds that the new criteria regarding evaluations of knee disabilities are not as advantageous to the Veteran in this case. Specifically, the significant changes related to knee disabilities were to add Diagnostic Code 5002 for active arthritic process, which the Veteran does not have; change the total replacement and resurfacing criteria under Diagnostic Code 5055, again, which the Veteran does not have in this case; and, finally, to add the requirement of assistive devices to the criteria for Diagnostic Code 5257, which is not present in the pre-February 7, 2021 rating criteria. Prior to February 7, 2021, Diagnostic Code 5257 evaluated recurrent subluxation or lateral instability of the knee. It provided a 10 percent rating for slight recurrent subluxation or lateral instability. A 20 percent rating was warranted for moderate recurrent subluxation or lateral instability. Severe recurrent subluxation or lateral instability warranted a 30 percent rating. The Court recently held that nothing in Diagnostic Code 5257, under the pre-amendment rating criteria, provided that objective medical evidence is required or is to be favored over lay evidence in determining whether to assign a rating for lateral instability of the knee. English v. Wilkie, 30 Vet. App. 347, 349 (2018). As of February 7, 2021, under the amended criteria, Diagnostic Code 5257 evaluates knee, other impairment of, which may be rated under separate criteria for recurrent subluxation or instability or, alternatively, patellar instability. Under the amended criteria for rating patellar instability, a 10 percent rating is warranted 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. 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 warrants a 20 percent rating. A maximum 30 percent rating is warranted 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. Diagnostic Code 5257, Note (1), as amended, defines the patellofemoral complex as consisting of the quadriceps tendon, the patella, and the patellar tendon. Note (2) instructs that 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). Resolving reasonable doubt in the Veteran's favor, the Board will award a separate 10 percent rating for slight left knee instability for the entire period on appeal, under the pre-February 7, 2021 rating criteria for Diagnostic Code 5257. In this regard, the April 2010 VA examination report shows complaints of left knee giving way, and the examiner noted that the medial and lateral meniscus test of the left knee was abnormal with a slight degree of severity. The Board finds that a next-higher 20 percent rating is not warranted. To that end, there are specific objective tests that are designed to reveal instability and laxity of the joints. These tests were administered by a medical professional during March 2013, July 2019 and February 2021 VA examinations, and the testing revealed no instability or laxity. Given the objective testing performed are generally recognized in the medical community as diagnostic for instability and subluxation, the results are afforded high probative value. If subluxation or lateral instability were present to a moderate degree, as required for a 20 percent rating, the Board would expect that this would have been identified again after the April 2010 examination, during the multiple tests that were performed or by the Veteran herself during examination. See 38 C.F.R. §§ 4.31, 4.71a, Diagnostic Code 5257. Instead, following the April 2010 VA examination, examiner stated that there was no evidence of left knee recurrent subluxation and lateral instability and that joint testing revealed no instability. Therefore, the most probative evidence is against a separate rating in excess of 10 percent for the left knee under Diagnostic Code 5257. 38 C.F.R. § 4.71a. The Board also finds that the weight of the evidence is against a separate rating in excess of 10 percent for the left knee under the criteria for Diagnostic Code 5257 from February 7, 2021. There is no evidence that the Veteran's left knee patellofemoral syndrome, a diagnosed condition of the patellofemoral complex, has resulted in a history of surgical repair of the patellofemoral complex resulting in recurrent instability. As noted, joint stability testing during the March 2013, July 2019 and February 2021 VA examinations were normal. Finally, as previously discussed, there is no evidence of a sprain, incomplete ligament tear, or complete ligament tear resulting in persistent instability that requires a medically-prescribed (italics added for emphasis) assistive device. Accordingly, a disability rating in excess of 10 percent is not warranted for left knee instability under the criteria for Diagnostic Code 5257 from February 7, 2021. The Board has considered the applicability of other potential diagnostic codes. As the evidence of record fails to demonstrate ankylosis, impairment of the tibia or fibula, or genu recurvatum, the Veteran is not entitled to a higher or separate rating under 5256, 5262, or 5263, respectively, for her left knee disability. The Board acknowledges the Veteran's statement that her left knee disability is more severe than evaluated. The Veteran is competent to report her symptoms and has presented credible statements in this regard. Layno v. Brown, 6 Vet. App. 465 (1994). The Board finds, however, that neither the Veteran's statements nor medical evidence demonstrates that the criteria for ratings in excess of 20 percent have been met. The Board also acknowledges that the Veteran's VA treatment records note complaints of and treatment for her left knee disability. However, these records do not address the specific rating criteria necessary to determine severity. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. The Board has considered whether a staged rating under Hart, supra, are warranted, however, the Board finds that her symptomatology has been stable throughout the period on appeal. Therefore, assigning staged ratings is not warranted. Furthermore, neither the Veteran nor her representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claim adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (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). The Board also notes that the RO referred the Veteran's claim for extraschedular consideration by the Director of Compensation and Pension Service in accordance with 38 C.F.R. § 3.321(b) in light of the Veteran's contentions that extraschedular consideration was warranted. In March 2021, the Director of Compensation Service issued an Advisory Opinion on the matter. The Director ultimately found that the evidentiary record failed to show an exceptional disability pattern for the service-connected left knee disability that rendered application of the regular rating criteria as impractical. See Thun v. Peake, 22 Vet. App. 111 (2008). In making this determination, the Director noted that there was no evidence that the Veteran experienced joint instability or subluxation, as well as atrophy or ankylosis. The Director also reported that there is no indication that the Veteran has or that the Veteran had ever needed surgery due to the left knee condition. The Director determined that none of the available evidence supports the Veteran's contention that her left knee condition warrants an extra schedular evaluation. As this issue has been considered by the Director in the first instance, the Board now has jurisdiction to consider the issue. Based on thorough consideration of the evidence, the Board finds that the Veteran's disability picture is not so exceptional or unusual as to render impractical the application of the regular schedular criteria. In so finding, the Board acknowledges that the symptoms of the Veteran's left knee disability included constant pain and limitation of motion which impacted her ability to work as she had difficulty bending and squatting, as well as prolonged walking. The Board also acknowledges that flare-ups required the Veteran to occasionally attend physical therapy sessions. However, all of these factors, including economic inadaptability, are considered in the assignment of the 20 percent rating under Diagnostic Code 5258 and separate 10 percent rating under Diagnostic Code 5257. In the instant case, the Board has carefully compared the level of severity and symptomatology of the Veteran's service-connected left knee disability on appeal with the established criteria found in the rating schedule. The Board finds that the Veteran's symptomatology is fully addressed by the rating criteria under which such disability is rated. Therefore, the Board finds that the rating criteria reasonably describe the Veteran's disability level and symptomatology of her service-connected left knee disability. As such, the Board finds that the rating schedule is adequate to evaluate the Veteran's disability picture. In this regard, there is nothing exceptional or unusual about the Veteran's disability because the rating criteria reasonably describe her disability level and symptomatology. Thun, 22 Vet. App. at 115. Accordingly, the Board need not proceed to consider the second factor, whether there are attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization. In light of the opinion of the Director, Compensation and Pension Service, and the analysis herein, the Board finds that 38 C.F.R. § 3.321 is inapplicable and thus an extraschedular is not warranted. As noted above, a separate 10 percent rating, but no higher, is warranted for left knee instability. The preponderance of the evidence is against a rating in excess of 20 percent for her left knee patellofemoral syndrome and the claim must, accordingly, be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. Lumbosacral Spine Degenerative Disc and Joint Disease The Veteran generally asserts that she should have higher ratings for her lumbosacral spine degenerative disc and joint disease as it is worse than contemplated by the currently assigned rating. Specific argument in support of this appeal has not been presented. This appeal stems from a claim dated in April 2009. During the periods on appeal, the Veteran's lumbar spine degenerative disc disease is rated 20 percent prior to July 3, 2019, and 50 percent thereafter under 38 C.F.R. § 4.71a, Diagnostic Codes 5242-5243. Regulations specify that disabilities of the spine should be evaluated under the General Rating Formula for Diseases and Injuries of the Spine (Spinal Formula). 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. When intervertebral disc syndrome (IVDS) is present, it is to be evaluated under the Spinal Formula unless it is more favorable to rate under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula). Ratings under the Spinal Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. As relevant to the thoracolumbar spine, the General Rating Formula provides for a 10 percent rating when forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees, when the combined range of motion of the thoracolumbar spine is greater than 120 degrees but not greater than 235 degrees, or when muscle spasm, guarding or localized tenderness is not severe enough to result in an abnormal gait or abnormal spinal contour. A 20 percent rating when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, when the combined range of motion of the thoracolumbar spine is not greater than 120 degrees, or when 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. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine to 30 degrees or less, or with favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine and a 100 percent rating is assigned with unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is to 90 degrees and the normal combined range of motion is 240 degrees. Id., Note (2). Associated objective neurologic abnormalities should be rated separately under an appropriate diagnostic code. Id., Note (1). Disability of the musculoskeletal system is primarily the inability, due to damage or infection of parts of the musculoskeletal system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. The functional loss may be due to absence of part, or all, of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant 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. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Alternatively, the IVDS Formula provides for rating based on the total duration of incapacitating episodes. 38 C.F.R. § 4.71a, IVDS Formula. Incapacitating episodes are defined as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id., Note (1). Although the record shows that the Veteran experienced IVDS, there is no evidence that the Veteran experiences incapacitating episodes and the Veteran does not contend otherwise. In April 2010, the Veteran was afforded a VA examination. At that time, the examiner noted that the Veteran was diagnosed with lumbar spine degenerative disc disease in 2008. The examiner reported that the Veteran could walk without limitation and that she did not experience falls. The Veteran reported that she experienced lower back stiffness and fatigue, and that she did not experience spasms, decreased motion, paresthesia, numbness, weakness, bowel problems or bladder problems. The Veteran also reported that she experienced constant lower back pain of moderate severity. She indicated that pain was exacerbated by physical activity and alleviated with rest, and that she was able to function without use of pain medication. The Veteran indicated that during flare-ups, she experienced limitation of motion. The Veteran reported that she had not had any back surgeries or been hospitalized for any back condition. The Veteran also indicated that she had not experienced any incapacitating episodes. On range of motion testing, the Veteran demonstrated forward flexion to 65 degrees, with pain at 60 degrees; extension to 30 degrees, with pain at 25 degrees; right and left lateral flexion to 30, with pain at 25 degrees; and right and left lateral rotation to 30 degrees, with pain at 25 degrees. There was no additional functional loss following repetitive-use testing or during flare-ups. The examiner noted that the Veteran did not have an abnormal gait. At a March 2013 VA examination, the Veteran reported that her last flare-up occurred in April 2012 and required hospitalization and physical therapy. On range of motion testing, the Veteran demonstrated forward flexion to 90 degrees; extension to 30 degrees; right and left lateral flexion to 30; and right and left lateral rotation to 30 degrees, with pain noted on forward flexion and extension. There was no additional functional loss following repetitive-use testing or during flare-ups. On examination, there was evidence of localized tenderness and pain to palpation. The examiner reported that the Veteran experienced muscle spasm and guarding that did not result in abnormal gait or spinal contour. Muscle strength testing was normal and there was no evidence of atrophy. Reflex and sensory examinations were normal. There was no evidence of radiculopathy or other neurological impairments. There was no evidence of IVDS, and the Veteran reported that she did not use any devices for assistance with ambulation. The examiner reported that the Veteran's lower back disability did not impact her ability to work. In an August 2016 correspondence, the Veteran's representative reported that the Veteran's lower back and pelvis occasionally locked up as a result of performing daily activities, which required approximately 8 to 12 weeks of physical therapy. At a July 2019 VA examination, the Veteran reported that she regularly attended physical therapy to alleviate extreme back pain and left leg nerve pain. The examiner reported that the Veteran's lower back disability made it difficult to move, sleep and stand. The Veteran indicated that she experienced severe flare-ups of lower back pain that were precipitated by things such as making the bed or moving in the wrong direction. On range of motion testing, the Veteran demonstrated forward flexion to 70 degrees; extension to 20 degrees; right and left lateral flexion to 30; and right and left lateral rotation to 30 degrees, with pain noted on forward flexion and extension. The examiner noted that range of motion contributed to functional loss. On examination, there was no evidence of localized tenderness and pain to palpation. There was no evidence of pain with weight-bearing and non-weight bearing, or passive range of motion. The examiner reported that fatigue, weakness and lack of endurance caused functional loss following repetitive-use. the examiners found that pain, weakness, fatigability, and incoordination significantly limited the Veteran's functional abilities with repeated use over time and during flare-ups. There was no additional loss of range of motion following repetitive-use testing and during flare-ups. The examiner indicated that the Veteran experienced muscle spasm and guarding that did not result in abnormal gait or abnormal spinal contour. The examiner reported that the Veteran experienced less movement than normal due to ankylosis, limitation or blocking, adhesions, etc. Muscle strength testing was normal and there was no evidence of atrophy. The examiner noted that the Veteran experienced unfavorable ankylosis of the entire thoracolumbar spine. The Veteran had decreased sensation in her left thigh/knee, lower leg/ankle, and foot/toes, and normal reflex and sensation on her right and left side. The examiner reported that the Veteran experienced left lower extremity radiculopathy involved with the L2/L3/L4 and L4/L5/S1/S2/S3 nerve roots. The examiner noted that the Veteran experienced mild left lower extremity constant pain and intermittent pain, as well as moderate left lower extremity paresthesia and/or dysesthesias, and numbness. No neurological abnormalities were noted. The examiner noted that the Veteran experienced IVDS without any episodes requiring bed rest. The Veteran denied use of any devices for assistance with ambulation. The examiner reported that the Veteran's lower back disability impacted her ability to work in that she was unable bend or squat without flare-ups. At a January 2021 VA examination, the Veteran reported that she experienced intermittent back pain that was managed with exercise and medication. The Veteran indicated that she was unable to run and that she experienced a loss of range of motion. The Veteran reported that flare-ups consisted of moderate to severe pain, which are alleviated by physical therapy and prescription pain medication. On range of motion testing, the Veteran demonstrated forward flexion to 80 degrees; extension to 20 degrees; right and left lateral flexion to 20; and right and left lateral rotation to 20 degrees. The examiner noted that range of motion did not contribute to functional loss. The Veteran reported pain at all end points during range of motion testing. There was no additional functional loss following repetitive-use testing. There was evidence that pain resulted in functional loss following repeated use over time and during flare-ups. On range of motion testing following repeated use over time and during flare-ups, the Veteran demonstrated forward flexion to 75 degrees; extension to 15 degrees; right and left lateral flexion to 15; and right and left lateral rotation to 15 degrees. On examination, there was no evidence of localized tenderness and pain to palpation. There was no evidence of pain with weight-bearing and non-weight bearing, or passive range of motion. There was no evidence of muscle spasm or guarding. Muscle strength testing was normal and there was no evidence of atrophy or ankylosis. The Veteran had decreased sensation in her left upper anterior thigh, thigh/knee, lower leg/ankle, and foot/toes, and normal reflex and sensation on her right side. The examiner reported that the Veteran experienced left lower extremity radiculopathy involved with the L2/L3/L4 nerve roots. The examiner noted that the Veteran experienced mild left lower extremity intermittent pain, paresthesia and/or dysesthesias, and numbness. The examiner reported that the overall severity of the Veteran's left lower radiculopathy was mild. No neurological abnormalities were noted. There was no evidence of IVDS, and the Veteran denied use of any devices for assistance with ambulation. The examiner reported that the Veteran's lower back disability impacted her ability to work in that she was unable to walk more than a few blocks without experiencing flare-ups of pain. A review of the record shows that the Veteran receives treatment at the VA Medical Center for various disabilities. However, there is no indication from the record that her lumbar spine disability symptoms are manifestly different than those reported at above-mentioned examinations After a careful review of the record, the Board finds that a rating of 50 percent, but no higher, is warranted beginning June 6, 2017, the date that a VA back examination was scheduled but notification of such appears to have been sent to an incorrect address. The Board affords the Veteran the benefit of the doubt that symptomology associated with a 50 percent rating, unfavorable ankylosis of the entire thoracolumbar spine, was present at that time. However, the Board finds that an initial rating in excess of 20 percent prior to June 6, 2017 is not warranted. In this regard, there is no indication from the record that the Veteran had ankylosis of the thoracolumbar spine and the Veteran has not alleged such ankylosis prior to June 6, 2017. Therefore, a higher rating is not warranted. 38 C.F.R. § 4.71a, Diagnostic Codes 5242-5243. The Board acknowledges that the symptoms reported at the July 2019 VA examination meet the criteria for a higher rating. However, this is the earliest date from which it is factually ascertainable that the Veteran's lumbar spine was productive of unfavorable ankylosis of the entire thoracolumbar spine. Prior to the date of that examination, the record does not contain evidence that the Veteran's lumbar spine was productive of such symptomatology, and as noted above, the Board has afforded the Veteran of the doubt that such symptomatology would have been present if the examination had been conducted on June 6, 2017. For the appeal period prior to June 6, 2017, a rating in excess of 20 percent is not warranted for lumbosacral spine degenerative disc and joint disease. In this regard, the record fails to show that forward flexion of the thoracolumbar spine is limited to 30 degrees or less, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. An April 2010 VA examination found forward flexion to be to 65 degrees while a March 2013 VA examination found forward flexion to be to 90 degrees. Here, the VA treatment records and VA examinations do not reveal additional functional impairment, including additional limitation of motion, on account of pain, weakness, etc, that is not already contemplated by the assigned 20 percent rating. 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca v. Brown, supra. Thus, a higher rating is not warranted for the Veteran's lumbosacral strain even in consideration of painful motion and other factors such as weakness, fatigability, lack of endurance, and incoordination. Moreover, there was no ankylosis. Therefore, a rating in excess of 20 percent is not warranted. Next, for the period beginning June 6, 2017, the Board finds that a rating in excess of 50 percent is not warranted. In this regard, there is no evidence or allegation that the Veteran experienced unfavorable ankylosis of the entire spine or incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a. In considering the rating criteria, the Board has considered functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. 38 C.F.R. §§ 4. 40, 4.45, 4.59; DeLuca, 8 Vet. App. 202, 206-7. However, an increased rating for the Veteran's service-connected lumbosacral spine degenerative disc and joint disease is not warranted on the basis of functional loss due to pain but rather based on the presence of ankylosis. The Veteran's symptoms are contemplated by the assigned ratings and any increased limitation of function was acknowledged by the examiners when reporting the Veteran's range of motion measurements and other functional impairment. As the Veteran has been shown to have intervertebral disc syndrome, the Board has considered a higher rating based on incapacitating episodes. However, there is no indication from the record that the Veteran has experienced incapacitating episodes requiring medically prescribed bed rest. As such, the Veteran is appropriately rated based on pain, limitation of motion, and limitation of function. 38 C.F.R. § 4.71a. Neurologic abnormalities or findings related to the thoracolumbar spine condition such as bowel or bladder problems were not found on objective examination in April 2010, March 2013, July 2019 and February 2021. Therefore, absent evidence of objective neurologic abnormalities of bladder or bowel incontinence associated with the lumbar spine disorder, the Board finds that separate ratings for such conditions are not warranted. Additionally, the Veteran record shows that the Veteran experiences left lower extremity radiculopathy, and bilateral lower extremity tarsal tunnel syndrome; however, she is already service-connected and separately rated for those disabilities which are addressed below. In reaching its conclusions, the Board acknowledges the Veteran's belief that her lumbar spine disability is more severe than as reflected by the currently assigned disability rating. The Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding her symptomatology, she is not competent to provide an opinion regarding the severity of her symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged her reported symptoms, and described the manifestations of such disability in light of the rating criteria to be more persuasive than her reports regarding the severity of her lumbar spine disability. The Board also notes that the RO referred the Veteran's claim for extraschedular consideration by the Director of Compensation Service in accordance with 38 C.F.R. § 3.321(b) in light of the Veteran's report's that extraschedular consideration was warranted. In March 2021, the Director of Compensation and Pension Service issued an Advisory Opinion on the matter. The Director ultimately found that the evidentiary record failed to show an exceptional disability pattern for the service-connected lower back disability that rendered application of the regular rating criteria as impractical. See Thun v. Peake, supra. In making this determination, the Director noted that there was no evidence that the Veteran ever needed surgery or experienced incapacitating episodes due to the lower back disability. The Director determined that none of the available evidence supports the Veteran's contention that her lower back condition warrants an extra schedular evaluation. As this issue has been considered by the Director in the first instance, the Board now has jurisdiction to consider the issue. Based on thorough consideration of the evidence, the Board finds that the Veteran's disability picture is not so exceptional or unusual as to render impractical the application of the regular schedular criteria. In so finding, the Board acknowledges that the symptoms of the Veteran's lumbosacral spine degenerative disc and joint disease include pain, which is worsened with activity such as prolonged standing, walking, or sitting, with limitation of motion of the lumbar spine The Board also acknowledges that flare-ups required the Veteran to occasionally attend physical therapy sessions. However, all of these factors, including economic inadaptability, are considered in the assignment of the 20 percent and 50 percent ratings under Diagnostic Codes 5242-5243. In the instant case, the Board has carefully compared the level of severity and symptomatology of the Veteran's service-connected lumbosacral spine degenerative disc and joint disease on appeal with the established criteria found in the rating schedule. The Board finds that the Veteran's symptomatology is fully addressed by the rating criteria under which such disability is rated. Therefore, the Board finds that the rating criteria reasonably describe the Veteran's disability level and symptomatology of her service-connected lumbosacral spine degenerative disc and joint disease. As such, the Board finds that the rating schedule is adequate to evaluate the Veteran's disability picture. In this regard, there is nothing exceptional or unusual about the Veteran's disability because the rating criteria reasonably describe her disability level and symptomatology. Thun, 22 Vet. App. at 115. Accordingly, the Board need not proceed to consider the second factor, whether there are attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization. In light of the opinion of the Director, Compensation and Pension Service, and the analysis herein, the Board finds that 38 C.F.R. § 3.321 is inapplicable and thus an extraschedular is not warranted. Consideration has also been given to assigning additional staged ratings. However, at no time during the period in question has the disability warranted higher schedular ratings than those assigned. Hart v. Mansfield, supra. Furthermore, neither the Veteran nor her representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claim adjudicated herein. See Doucette v. Shulkin, supra. In sum, the Board finds that the evidence supports the award of a 50 percent rating, but no higher, beginning June 6, 2017. The Board finds that the evidence does not support a rating in excess of 20 percent prior to June 6, 2017. In denying higher ratings, the Board finds that the preponderance of the evidence is against such aspect of the Veteran's claims. Therefore, in denying increased ratings, the benefit of the doubt doctrine is not applicable, and the claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102; Gilbert v. Derwinski, supra. GERD/IBS The Veteran asserts that she should have higher ratings for her GERD with IBS disability because her disability is worse than contemplated by the currently assigned ratings. Specific argument in support of this appeal has not been presented. During the periods on appeal, the Veteran's GERD with IBS is rated noncompensable prior to March 18, 2013 and 10 percent thereafter under 38 C.F.R. § 4.71a, Diagnostic Codes 7319-7346. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.2. There is no specific diagnostic code for GERD. It is therefore rated under the diagnostic code for a hiatal hernia, based on similarity of symptoms. In this regard, 38 C.F.R. § 4.20 allows for analogous ratings of an "unlisted condition" under a closely related disease or injury in which not only the functions affected but the anatomical localization and symptoms are closely analogous. However, it further provides that "[c]onjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin." Under 38 C.F.R. § 4.114, Diagnostic Code 7346, a 10 percent rating is warranted if the Veteran experiences two or more of the symptoms for the 30 percent rating of less severity. A 30 percent rating is warranted for persistently recurrent epigastric distress with dysphagia (difficulty swallowing), pyrosis (heartburn), and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 60 percent rating is warranted for symptoms of pain, vomiting, material weight loss and hematemesis (vomiting of blood) or melena (black, tarry feces associated with gastrointestinal hemorrhage) with moderate anemia (a decreased number of red blood cells); or other symptom combinations productive of severe impairment of health. Under Diagnostic code 7319, which evaluates irritable colon syndrome (spastic colitis, mucous colitis, etc.) a noncompensable rating is assigned for mid disturbances of bowel function with occasional episodes of abdominal distress. A 10 percent rating is assigned for moderate frequent episodes of bowel disturbance with abdominal distress. A 30 percent rating is assigned for severe diarrhea, or alternating diarrhea and constipation with more or less constant abdominal distress. 38 C.F.R. § 4.114, Diagnostic Code 7319. Additional potentially applicable diagnostic codes include 7305 and 7307. Under Diagnostic Code 7305, which evaluates duodenal ulcers, a mild duodenal ulcer with recurring symptoms once or twice yearly is assigned a 10 percent rating. A 20 percent rating is assigned for a duodenal ulcer that is moderation with recurring episodes of severe symptoms two or three times a year averaging 10 days in duration, or with continuous moderate manifestations. A 40 percent rating is assigned for a moderately severe duodenal ulcer which is less than severe but with impairment of health manifested by anemia and weight loss, or with recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. A 60 percent rating is assigned for a severe duodenal ulcer with pain only partially relieved by standard ulcer therapy, periodic vomiting, recurrent hematemesis or melena, with manifestations of anemia and weight loss productive of a definite impairment of health. 38 C.F.R. § 4.114, Diagnostic Code 7305. Under Diagnostic Code 7307, which evaluates hypertrophic gastritis (identified by gastroscope), a 10 percent rating is assigned for chronic hypertrophic gastritis with small nodular lesions, and symptoms. A 30 percent rating is assigned for chronic hypertrophic gastritis with multiple small eroded or ulcerated areas, and symptoms. A 60 percent rating is assigned for chronic hypertrophic gastritis with severe hemorrhages, or large ulcerated or eroded areas. 38 C.F.R. § 4.114, Diagnostic Code 7307. In April 2010, the Veteran was afforded a VA examination. At that time, the examiner noted that the Veteran was diagnosed with acid reflux and chronic constipation in 2005. The examiner reported that the Veteran's acid reflux and chronic constipation did not result in weight loss of affect the body as a whole. The Veteran reported that she experienced intermittent heart burn that typically lasted about 1 hour in duration and occurred almost daily. The Veteran denied experiencing dysphagia, epigastric pain, diarrhea, scapular pain, arm pain, hematemesis, passing of black stools, reflux or regurgitation of stomach contents, nausea and vomiting. The examiner reported that the Veteran did not experience functional impairment related to her acid reflux or chronic constipation. At a March 2013 VA examination, the examiner diagnosed the Veteran with GERD. The examiner reported that continuous medication was needed to treat her GERD. The examiner indicated that the Veteran's GERD was productive of reflux, regurgitation, and substantial arm pain. The examiner reported that the Veteran's GERD did not impact her ability to work. At a separate March 2013 VA examination, the examiner diagnosed IBS. At that time, the Veteran reported that she experienced occasional constipation that did not require continuous medication. The examiner reported that the Veteran's IBS was productive of alternating diarrhea and constipation. The examiner indicated that the Veteran did not experience episodes of bowel disturbance with abdominal distress. There was no evidence of weight loss or malnutrition. The examiner reported that the Veteran's IBS did not result in functional impairment. At a July 2019 VA examination with regard to the Veteran's GERD, the Veteran reported that she used medication, diet and exercise to alleviate GERD symptoms. The examiner reported that the Veteran's GERD required the use of continuous medication. The examiner indicated that the Veteran's GERD was productive of infrequent episodes of epigastric distress, dysphagia, pyrosis, reflux, regurgitation, substernal pain, sleep disturbances that occurred 4 or more times per year. There was no evidence that the Veteran experienced material weight loss, nausea, vomiting, hematemesis, or anemia related to her GERD. The examiner noted that the Veteran's GERD also was productive of asymptomatic esophageal stricture. The examiner reported that the Veteran's GERD did not impact her ability to work. At a July 2019 VA examination with regard to the Veteran's IBS, the Veteran indicated that she experienced only occasional symptoms related to IBS. The examiner reported that the Veteran did not require medication for treatment of her IBS, and that she did not experience diarrhea, constipation, abdominal distension, anemia, nausea or vomiting. No other pertinent findings were noted. A review of the record shows that the Veteran receives treatment for various disabilities. However, there is no indication from the record that her GERD with IBS disability is worse than noted at the VA examinations of record. The Board finds that the preponderance of the evidence indicates that a compensable rating is not warranted at any time prior to March 18, 2013. In this regard, the evidence of record does not show two or more of the symptoms for a 30 percent rating of less severity. To that end, for the period on appeal prior to March 18, 2013, the Veteran's GERD was productive of pyrosis and reflux. Conversely, the evidence does not reflect that the Veteran's GERD was productive of persistently recurring epigastric distress, regurgitation, arm or shoulder pain, dysphagia, vomiting, melena, or material weight loss. Moreover, the April 2010 VA examiner reported that the Veteran's GERD did not impact her ability to work. Thus, while the Veteran has complained of varied symptoms, objectively she has not been shown to be of such severity as to result in a compensable rating prior to March 18, 2013. The Board acknowledges that the symptoms reported at the March 2013 VA examination meet the criteria for a higher rating. However, the date of the VA examination is the earliest date from which it is factually ascertainable that the Veteran experienced GERD productive of reflux, regurgitation, and substantial arm pain. Prior to the date of that examination, the record does not contain evidence that the Veteran's GERD was productive of such symptomatology. Therefore, a higher rating is not warranted prior to March 18, 2013. See 38 C.F.R. § 4.114, Diagnostic Code 7346. Next, the Board finds that a rating of 30 percent, but no higher, beginning March 18, 2013 is warranted. In this regard, the evidence shows that continuous medication was required to treat the Veteran's GERD and that she experienced infrequent episodes of epigastric distress, dysphagia, pyrosis, reflux, regurgitation, substernal pain, and sleep disturbances. However, at no point during the pendency of the appeal has the Veteran's GERD with IBS warranted a rating in excess of 30 percent. To that end, material weight loss has not been noted, and the evidence does not reflect her disability has been productive of considerable impairment of health. Indeed, the March 2013 and July 2019 VA examiners reported that the Veteran's gastrointestinal disability did not impact her ability to work. Therefore, a rating of 30 percent, but no higher, is warranted under Diagnostic Code 7346 beginning March 18, 2013. As far as additional potentially applicable ratings, the Board finds that the Veteran is not entitled to a separate or higher rating pursuant to Diagnostic Code 7307, as there is no evidence that she experienced chronic hypertrophic gastritis with severe hemorrhages, or large ulcerated or eroded areas. 38 C.F.R. § 4.114, Diagnostic Code 7307. Similarly, a higher rating is not warranted under Diagnostic Code 7305, which evaluates duodenal ulcers. There is no evidence that the Veteran experienced moderately severe duodenal ulcer with recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year, or severe duodenal periodic vomiting, recurrent hematemesis or melena, with manifestations of anemia and weight loss productive of a definite impairment of health. Further, the Board finds that higher or separate ratings are not warranted under Diagnostic Code 7309. To that end, there is no evidence that the Veteran's IBS was productive of moderate frequent episodes of bowel disturbance with abdominal distress, or severe diarrhea, or alternating diarrhea and constipation with more or less constant abdominal distress. The Board acknowledges the Veteran's statements that her GERD with IBS disability is more severe than evaluated. The Veteran is competent to report her symptoms and has presented credible statements in this regard. Layno v. Brown, 6 Vet. App. 465 (1994). The Board finds, however, that neither the Veteran's statements nor medical evidence demonstrates that the criteria for higher ratings than those assigned have been met. The Board also acknowledges that the Veteran's VA treatment records note complaints of and treatment for her GERD with IBS. However, these records do not address the specific rating criteria necessary to determine severity. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. Consideration has also been given to assigning additional staged ratings. However, at no time during the period in question has the disability warranted higher schedular ratings than those assigned. Hart v. Mansfield, supra. Further, neither the Veteran or appellant, or her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, supra. In sum, the Board finds that the evidence does not support a compensable rating prior to March 18, 2013. Beginning March 18, 2013, the evidence supports the award of a 30 percent rating, but no higher, for the Veteran's GERD with IBS disability. In denying higher ratings, the Board finds that the preponderance of the evidence is against such aspect of the Veteran's claim. Therefore, in denying increased ratings, the benefit of the doubt doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102; Gilbert v. Derwinski, supra. Carpal Tunnel Syndrome and Tarsal Tunnel The Veteran asserts that she is entitled to higher ratings for her right and left carpal tunnel syndrome as well as her right and left tarsal tunnel as her symptoms are worse than those contemplated by the currently assigned ratings. Specific argument in support of this appeal has not been presented. This appeal stems from a claim dated in April 2009. During the periods on appeal, the Veteran's right and left upper extremity carpal tunnel syndrome are separately rated as noncompensable prior to March 18, 2013, and 10 percent thereafter under 38 C.F.R. § 4.71a, Diagnostic Codes 8515. The Veteran's right lower tarsal tunnel syndrome is rated noncompensable under Diagnostic Codes 8525-8520, and her left lower extremity radiculopathy and tarsal tunnel syndrome with radiculopathy is rated noncompensable prior to March 18, 2013, and 10 percent thereafter under Diagnostic Codes 8599-8520. Disease of the peripheral nerves of the upper extremities are rated under 38 C.F.R. § 4.124a, Diagnostic Codes 8510 to 8719. The Veteran's right side is her dominant side, and thus is considered the "major" extremity. The Veteran's left side is her "minor" side. Throughout the appeal period, the Veteran's right and left upper extremity carpal tunnel syndrome has been rated under Diagnostic Code 8515 which contemplates paralysis of the median nerve. Pursuant to Diagnostic Code 8515, incomplete paralysis of the median nerve affecting the major extremity that is mild, moderate, and severe warrants ratings of 10, 30, and 50 percent, respectively. Incomplete paralysis of the median nerve affecting the minor extremity that is mild, moderate, and severe warrants ratings of 10, 20, and 40 percent, respectively. Compete paralysis of the median nerve of the major extremity warrants a 70 percent rating and of the minor extremity warrants a 60 percent rating, with the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances. 38 C.F.R. § 4.124a, Diagnostic Code 8515. Under the applicable diagnostic criteria, mild incomplete paralysis is assigned a 10 percent rating. A 20 percent rating is assigned for moderate incomplete paralysis. Moderately severe incomplete paralysis is assigned a rating for 40 percent. Severe incomplete paralysis is assigned a rating of 60 percent and must include a showing of marked muscular atrophy. Finally, an 80 percent rating is assigned for complete paralysis, which is described as the foot dangles and drops, no active movement possible of the muscles below the knee, flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a, Diagnostic Code 8520 (sciatic nerve). The Board notes that the term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id. Words such as "mild," "moderate," "severe," and "marked" are not defined in the VA Schedule for Rating Disabilities and the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. When the involvement is only sensory, the rating should be for the mild, or at most, the moderate degree. In rating peripheral nerve disability, neuritis-characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate incomplete paralysis, or with sciatic nerve involvement, for moderately severe incomplete paralysis. 38 C.F.R. § 4.123. In April 2010, the Veteran was afforded a VA examination. At that time, the Veteran reported that her right and left carpal tunnel syndrome began approximately four years prior. The Veteran indicated that she experienced constant right and left hand tingling without weakness. The examiner reported that the Veteran did not experience functional impairment associated with her right and left hand carpal tunnel syndrome disabilities. At an April 2010 VA examination, the Veteran reported that she began experience right and left lower extremity tarsal tunnel syndrome in 2006. The Veteran reported that her tarsal tunnel syndrome was productive of pain, swelling and stiffness following prolonged walking, but that it was not productive of weakness or fatigue. The Veteran reported that she experienced flare-ups of pain following prolonged walking that were alleviated with rest. The examiner reported that the Veteran did not experience functional impairment associated with her right and left hand tarsal tunnel syndrome disabilities. At a March 2013 VA examination, the Veteran reported that her right and left hand carpal tunnel syndrome and right and lower extremity tarsal tunnel syndrome began when she was in her mid-30's and the conditions had remained the same since that time. The examiner reported that the Veteran's carpal tunnel syndrome was productive of mild right and left upper extremity numbness, and her tarsal tunnel syndrome was productive of moderate right and left lower extremity constant pain. Muscle strength testing was normal and there was no evidence of atrophy. Reflex and sensory examination was normal of the bilateral upper and lower extremities. There was no evidence of trophic changes and the Veteran had normal gait. The examiner reported that the Veteran's disabilities were productive of mild right median nerve (forearm) incomplete paralysis, moderate left median (forearm) nerve incomplete paralysis, and mild left internal popliteal (tibial) nerve incomplete paralysis. The examiner reported that the Veteran's bilateral carpal tunnel syndrome and bilateral tarsal tunnel syndrome did not impact her ability to work. At a July 2019 VA examination, the examiner noted that the Veteran had underwent surgery in 2008 for right hand carpal tunnel release and in 2015 for left hand carpal tunnel release. The Veteran indicated that she experienced occasional soreness, weakness and tingling in her right and left hands. The examiner indicated that the Veteran is right hand dominate. The examiner reported that the Veteran did not experience constant pain, intermittent pain, paresthesia and/or dysesthesias, or numbness or the right or left upper or lower extremities. Muscle strength testing was normal and there was no evidence of atrophy. The examiner reported that the Veteran experienced hypoactive right and left triceps and brachioradiales, and normal bilateral knee and ankle reflexes. The Veteran experienced decreased sensation of the left upper anterior thigh, thigh/knee, lower leg/ankle, and foot/toes. Right side sensation was normal. There was no evidence of trophic changes or abnormal gait. The examiner reported that the Veteran's disabilities were productive of mild right median (forearm) and ulnar (arm) nerve incomplete paralysis and mild left median and ulnar nerve incomplete paralysis. All other testing related to nerves of the upper and lower extremities were normal. The examiner reported that the Veteran's bilateral carpal tunnel syndrome and bilateral tarsal tunnel syndrome did not impact her ability to work. A review of the record shows that the Veteran receives treatment at the VA Medical Center for various disabilities. However, there is no indication from the record that her bilateral upper extremity carpal tunnel syndrome and bilateral lower extremity tarsal tunnel syndrome symptoms are manifestly different than those reported at above-mentioned VA examinations. With regard to her left carpal tunnel syndrome, the Board finds that the Veteran is entitled to a 20 percent rating throughout the entire period on appeal. In this regard, the March 2013 examiner reported that the Veteran's left median nerve was productive of moderate incomplete paralysis. Even though this degree of severity is not shown at the July 2019 VA examination, the Board will afford the Veteran the benefit of the doubt that impairment associated with her left upper extremity carpal tunnel syndrome continues to be productive of moderate impairment. Next, the Board finds that a rating in excess of 20 percent is not warranted. In this regard, the March 2013 and July 2019 VA examination reports indicate that the Veteran did not experience left hand pain, or paresthesia and/or dysesthesia. Moreover, muscle strength testing was continually normal and there is no evidence of atrophy. The Veteran did not allege, and the record did not shown, a loss of reflexes or muscle atrophy. Turning to the Veteran's right carpal tunnel syndrome, the Board finds that the Veteran is entitled to a rating of 10 percent, but no higher, throughout the entire period on appeal. In this regard, the Board finds that the Veteran's right carpal tunnel syndrome disability picture most nearly approximates that of mild impairment under Diagnostic Code 8515. To that end, March 2013 examiner reported that the Veteran's symptoms were similar to those reported at the April 2010 VA examination, which contained less detail than subsequent examination reports. The March 2013 and July 2019 VA examination reports indicate that the Veteran did not experience right hand pain, or paresthesia and/or dysesthesia. The VA examination reports also indicates that the Veteran's strength and light touch/monofilament of the right upper right extremity were normal on objective examination. Moreover, the March 2013 and July 2019 VA examiners reported that the Veteran's right median and ulnar nerves were productive of no worse than mild incomplete paralysis. The Veteran has not alleged, and the record does not show, loss of reflexes, muscle atrophy and constant pain. Therefore, a rating in excess of 10 percent is not warranted. Based on the foregoing evidence, the Board finds that initial ratings of 10 percent are warranted throughout the entire period on appeal for the Veteran's right and left tarsal tunnel syndrome, respectively. In this regard, the record shows that the Veteran's right and left tarsal tunnel syndrome has been productive of pain and swelling throughout the period on appeal. To that end, the March 2013 and July 2019 VA examination reports indicate that the Veteran did not experience right or left lower extremity numbness, or paresthesia and/or dysesthesia. The VA examination reports also indicates that the Veteran's strength and light touch/monofilament of the lower extremities were normal on objective examination. Moreover, the March 2013 VA examiner found no evidence of right lower extremity incomplete paralysis, and reported that the Veteran's left internal popliteal (tibial) nerve was productive of only mild incomplete paralysis. Further, the April 2010, March 2013 and July 2019 VA examiners reported that the Veteran's right and left tarsal tunnel syndrome did not impact the Veteran's ability to work. Additionally, the July 2019 VA examiner noted no evidence of lower extremity incomplete paralysis to any degree. The Veteran has not alleged, and the record does not show, diminished or loss of reflexes or muscle atrophy. Therefore, a rating in excess of 10 percent is not warranted. The Board has reviewed other Diagnostic Codes pertaining to upper extremity neurological disabilities under 38 C.F.R. § 4.124a. As the evidence is clear that the rated disabilities stem from median and ulnar nerve impairments Diagnostic Codes 8515 and 8516 are the appropriate provision under which to rate the Veteran's disabilities. Consideration has been given to assigning staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). (Continued on the next page) In sum, the Board finds that the evidence supports the awards of an initial 20 percent rating, but no higher, for the Veteran's left upper extremity carpal tunnel syndrome throughout the entire period on appeal, and an initial rating of 10 percent, but no higher, for right upper extremity carpal tunnel syndrome. In addition, the Board finds that the evidence supports the awards of initial 10 percent ratings, but no higher, for the Veteran's right tarsal tunnel syndrome throughout the entire period on appeal, and to an initial rating of 10 percent, but no higher, for the Veteran's left lower extremity radiculopathy and tarsal tunnel syndrome prior to March 18, 2013. In denying higher ratings, the Board finds that the preponderance of the evidence is against such aspect of the Veteran's claims. Therefore, in denying increased ratings, the benefit of the doubt doctrine is not applicable, and the claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher O'Donnell, 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.