Citation Nr: 21028881 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 13-21 866 DATE: May 12, 2021 ORDER Entitlement to an initial compensable rating for lumbar strain prior to February 1, 2011, and in excess of 10 percent, thereafter, is denied. Entitlement to an initial rating in excess of 10 percent for spondylosis and strain of the cervical spine is denied. Entitlement to an initial compensable rating for migraine headaches prior to July 7, 2016, and in excess of 30 percent, thereafter, is denied. Entitlement to an initial rating in excess of 10 percent for gastroesophageal reflux disease (GERD), gastritis, and residuals of cholecystectomy (gallbladder removal) is denied. FINDINGS OF FACT 1. Prior to February 1, 2011, the Veteran's lumbar spine disorder was productive of pain only; after which it was productive of painful motion. 2. Throughout the period of appeal, the Veteran's cervical spine disorder has been manifested by painful motion. 3. Prior to July 16, 2016, the Veteran's migraine headaches were manifested by frequent moderate headaches, but no prostrating attacks. Thereafter, the Veteran's migraine headaches were manifested by prostrating attacks occurring monthly, but no frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 4. Throughout the period of appeal, the Veteran's gastrointestinal disorder has been manifested by symptoms of nausea and diarrhea. CONCLUSIONS OF LAW 1. The criteria for an increased initial compensable evaluation prior to February 1, 2011 and in excess of 10 percent thereafter have not been met for the Veteran's service-connected lumbar spine disorder. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.7, 4.71a, Diagnostic Code (DC) 5237 (2019). 2. The criteria for an increased initial evaluation in excess of 10 percent have not been met for the Veteran's service-connected cervical spine disorder. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.7, 4.71a, DC 5242 (2019). 3. The criteria for an increased initial compensable evaluation prior to July 16, 2016 and in excess of 30 percent thereafter have not been met for the Veteran's service-connected migraine headaches. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.7, 4.124a, DC 8100 (2019). 4. The criteria for an increased initial evaluation in excess of 10 percent have not been met for the Veteran's service-connected gastrointestinal disorder. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.7, 4.114, DC 7318-7346 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from November 1986 to June 2010. These matters come to the Board of Veterans' Appeals (Board) on appeal from November 2010 and February 2011 rating decisions issued by the VA Regional Office (RO) in Winston-Salem, North Carolina. In February 2014, the Veteran and his spouse testified before the undersigned Veterans Law Judge at a Board hearing held in Washington, D.C. A transcript of that hearing has been associated with the record. These matters were previously before the Board in May 2016, December 2017, and November 2020, at which time they were remanded for further development. That development having been completed; this case is once again before the Board. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. § Part 4 (2019). The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § § 4.1 (2019). Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119, 126-127 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007); Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § § 4.7. 1. Lumbar Spine The Veteran's service-connected lumbar spine is rated as noncompensable prior to February 1, 2011 and 10 percent thereafter. 38 C.F.R. § 4.71a, DC 5237. A 10 percent rating is warranted when forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine is greater than 120 degrees but not greater than 235 degrees; or muscle spasm, guarding or localized tenderness not resulting in abnormal gait or abnormal spinal contour or vertebral body fracture with loss of 50 percent or more of height. Id. A 20 percent rating is assigned when forward flexion of the thoracolumbar spine is greater than 30 degrees, but not greater than 60 degrees, or the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is warranted if the medical evidence shows forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine. Id. A 100 percent rating is warranted if there is unfavorable ankylosis of the entire spine. Id. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portrays the anatomical damage and the functional loss with respect to all of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other 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. 38 C.F.R. § 4.40 (2019). Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45 (2019). Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59 (2018); Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). The Veteran contends that his service-connected lumbar spine disability is worse than currently reflected by his 0 percent and 10 percent evaluations respectively. A review of the Veteran's service treatment records shows that the Veteran was first treated for low back pain in October 1987 and again in December 1997, June 2006, and March 2009 where low back strain was diagnosed. No functional impairments were noted due to the pain. The Veteran's June 2006 imaging revealed normal results. The Veteran was provided with a VA examination in August 2010. At the examination, the Veteran was diagnosed with lumbar strain. A history of pain, fatigue, and stiffness were noted. X-rays were normal. No range of motion testing or other objective findings were provided. The Veteran was provided with an additional VA examination in January 2011. The Veteran was diagnosed with lumbar strain. He complained of sharp intermittent low back pain with no radiation. Range of motion testing revealed forward flexion of 90 degrees, extension of 30 degrees, bilateral lateral flexion of 55 degrees each, and bilateral lateral rotation of 90 degrees each, all without pain. There was no additional pain or loss of motion on repetition. X-ray was normal. No flare-ups were noted. There were no findings of arthritis or radiculopathy. There were no findings of ankylosis or incapacitating episodes. No functional impacts were noted. The Veteran was provided with an additional VA examination in February 2011. At the examination, the Veteran was diagnosed with lumbar strain. The Veteran complained of symptoms of pain, fatigue, stiffness, leg weakness, and spasms. In this regard, spasms, guarding, and pain with motion were all objectively confirmed. Range of motion testing revealed forward flexion of 90 degrees, extension of 28 degrees, bilateral lateral flexion of 22 degrees each, and bilateral lateral rotation of 25 degrees each, with pain on motion. There was no additional pain or loss of motion on repetition. No flare-ups were noted. There were no findings of arthritis or radiculopathy. There were no findings of ankylosis or incapacitating episodes. No functional impacts were noted. A review of the Veteran's outpatient treatment records shows that he has been treated for lumbar strain. Records have only shown that the Veteran has been treated for pain and there have been no diagnostic findings of arthritis, limitation of motion, or ankylosis. Also, there have been no findings of incapacitating episodes. In a December 2012 record, however, the Veteran did complain of pain radiating into his right leg. In an additional record that same month in December 2012, the Veteran reported radiation of pain with numbness and tingling into the left leg. Such findings were also reported in an August 2015 treatment record as well. However, no diagnostic testing was apparently accomplished, and no confirmation of any radiculopathy was established. The Veteran was provided with an additional VA examination in August 2016. At the examination, the Veteran was diagnosed with lumbosacral strain. Range of motion testing revealed forward flexion of 75 degrees and extension, bilateral lateral flexion, and bilateral lateral rotation of 20 degrees each, with pain on motion. There was no additional pain or loss of motion on repetition. No flare-ups were noted. There were no findings of arthritis or radiculopathy. There were no findings of ankylosis or incapacitating episodes. No functional impacts were noted. The Veteran was provided with an additional VA examination in January 2019. At the examination, the Veteran was diagnosed with lumbosacral strain. Range of motion testing both active and passive revealed forward flexion of 90 degrees and extension, bilateral lateral flexion, and bilateral lateral rotation of 30 degrees each, with pain on motion. There was no additional pain or loss of motion on repetition. Flare-ups were noted, preventing twisting motions, but there was no overall loss of motion due to this. There were no findings of arthritis. Although the Veteran complained of pain, numbness, and tingling into his right leg, no finding of radiculopathy was confirmed. There were no findings of ankylosis or incapacitating episodes. Functional impacts included limping when in pain. After review of the evidence of record, the Board finds that the Veteran's lumbar spine disorder does not warrant a compensable evaluation for the period prior to February 1, 2011. The evidence of record shows that the Veteran's lumbar spine disability was manifested by pain, but not on motion, in addition to essentially normal ranges of motion. In order to warrant a higher evaluation, the Veteran would need to show evidence of loss of motion, ankylosis, or incapacitating episodes. The probative medical evidence of record has not shown symptoms close to those contemplated by the rating schedule for a higher evaluation at any time during the appeal period. The Board also finds that a rating in excess of 10 percent is not warranted after February 1, 2011. The evidence of record shows that the Veteran's lumbar spine disorder was manifested by a limitation of motion that was noncompensable for VA rating purposes, but with objective evidence of pain on motion. In order to warrant a higher evaluation, the Veteran would need to show evidence of worsened limitation of motion, ankylosis, or incapacitating episodes. The probative medical evidence of record has not shown such symptoms. In conclusion, the evidence of record does not warrant a rating in excess of 0 percent prior to February 1, 2011 or in excess of 10 percent thereafter for the Veteran's service connected lumbar spine disorder. 2. Cervical Spine The Veteran's service-connected cervical spine is rated as 10 percent throughout the period of appeal. 38 C.F.R. § 4.71a, DC 5242. A 10 percent rating is warranted when forward flexion of the cervical spine is greater than 30 degrees, but not greater than 40 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. Id. A 20 percent rating is assigned when forward flexion of the cervical spine is greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 30 percent rating is warranted if the medical evidence shows forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. Id. A 40 percent rating is warranted if there is unfavorable ankylosis of the entire cervical spine. Id. A 100 percent rating is warranted if there is unfavorable ankylosis of the entire spine. Id. The Board also notes that VA published a final rule amending its regulations on musculoskeletal disabilities, effective February 7, 2021. The amendment, in pertinent part, changed the rating criteria for DCs 5003 (degenerative arthritis) and 5010 (posttraumatic arthritis), which were also noted as being referred by DC 5242 (otherwise no other change to that DC). See 85 Fed. Reg. 76453 (November 30, 2020). The amendments changed DC 5003 and 5010 by characterizing different types of arthritis, with degenerative being evaluated under 5003 and traumatic being evaluated under 5010. However, the actual rating criteria for these DCs remained unchanged. Therefore, there is no effect on the instant case. The Veteran contends that his service-connected cervical spine disability is worse than currently reflected by his 10 percent evaluation. A review of the Veteran's service treatment records shows that the Veteran was first treated for neck spasm in March 1992 and neck sprain in October 1999. Pain was noted in each instance. The Veteran was provided with a VA examination in August 2010. At the examination, the Veteran was diagnosed with spondylosis confirmed by x-ray. A history of pain, fatigue, and stiffness were noted. No range of motion testing or other objective findings were provided. The Veteran was provided with an additional VA examination in January 2011. The Veteran was diagnosed with spondylosis. He complained of sharp intermittent low back pain with no radiation. Range of motion testing revealed forward flexion of 55 degrees, extension of 60 degrees, bilateral lateral flexion of 55 degrees each, and bilateral lateral rotation of 70 degrees each, all without pain. There was no additional pain or loss of motion on repetition. No flare-ups were noted. There were no findings of radiculopathy. There were no findings of ankylosis or incapacitating episodes. No functional impacts were noted. The Veteran was provided with an additional VA examination in February 2011. At the examination, the Veteran was diagnosed with spondylosis. The Veteran complained of symptoms of guarding, pain with motion, and tenderness, which were all objectively confirmed. Range of motion testing revealed forward flexion of 40 degrees, extension of 42 degrees, left lateral flexion of 24 degrees, right lateral flexion of 18 degrees, left lateral rotation of 28 degrees, and right lateral rotation of 20 degrees, with pain on motion. There was no additional pain or loss of motion on repetition. No flare-ups were noted. There were no findings of radiculopathy. There were no findings of ankylosis or incapacitating episodes. No functional impacts were noted. A review of the Veteran's outpatient treatment records shows that he has been treated for spondylosis during the appeal period. Records have only shown that the Veteran has been treated for pain and there have been no diagnostic findings of limitation of motion or ankylosis. Also, there have been no findings of incapacitating episodes. The Veteran was provided with an additional VA examination in August 2016. At the examination, the Veteran was diagnosed with cervical strain. Range of motion testing revealed forward flexion of 35 degrees, extension of 40 degrees, bilateral lateral flexion of 30 degrees, and bilateral lateral rotation of 70 degrees each, with pain on motion. There was no additional pain or loss of motion on repetition. No flare-ups were noted. There were no findings of radiculopathy. There were no findings of ankylosis or incapacitating episodes. No functional impacts were noted. The Veteran was provided with an additional VA examination in January 2019. At the examination, the Veteran was diagnosed with cervical strain and spondylosis. Range of motion testing both active and passive revealed forward flexion, extension, and bilateral lateral flexion, of 45 degrees each and bilateral lateral rotation of 80 degrees each, with pain on motion. There was no additional pain or loss of motion on repetition. Flare-ups were noted, resulting in pain and tightness, but there was no overall loss of motion due to them. There were no findings of radiculopathy. There were no findings of ankylosis or incapacitating episodes. Functional impacts were not noted. After review of the evidence of record, the Board finds that the Veteran's cervical spine disorder does not warrant evaluation greater than 10 percent throughout the period of appeal. The evidence of record shows that the Veteran's cervical spine disability was manifested by painful motion with spondylosis, a form of arthritis, and range of motion limited to, at worst, 35 degrees of flexion and combined range of motion of 172 degrees. In order to warrant a higher evaluation, the Veteran would need to show evidence of worsened loss of motion, ankylosis, or incapacitating episodes. The probative medical evidence of record has not shown symptoms close to those contemplated by the rating schedule for a higher evaluation at any time during the appeal period. In conclusion, the evidence of record does not warrant a rating in excess of 10 percent for the Veteran's service connected cervical spine disorder. 3. Migraine Headaches The Veteran's service-connected migraine headaches are rated as noncompensable prior to July 7, 2016 and 30 percent thereafter. 38 C.F.R. § 4.124a, DC 8100. Under this code, a 0 percent evaluation is warranted for a condition with less frequent attacks. Id. A 10 percent evaluation is warranted for migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. Id. A 30 percent evaluation is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over last several months. Id. A 50 percent evaluation is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Id. The rating criteria do not define "prostrating," nor has the Court. See Fenderson v. West, 12 Vet. App. 119 (1999) (quoting Diagnostic Code 8100 verbatim but does not specifically address the matter of what is a prostrating attack.). According to WEBSTER'S NEW WORLD DICTIONARY OF AMERICAN ENGLISH, THIRD COLLEGE EDITION (1986), p. 1080, "prostration" is defined as "utter physical exhaustion or helplessness." A very similar definition is found in DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1367 (28th Ed. 1994), in which "prostration" is defined as "extreme exhaustion or powerlessness." "Productive of economic inadaptability" can be read as having either the meaning of "producing" or "capable of producing," and nowhere in Diagnostic Code 8100 is "inadaptability" defined, nor can a definition be found elsewhere in title 38 of the Code of Federal Regulations. But, nothing in Diagnostic Code 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004). The Veteran contends that his service-connected migraine headaches are worse than currently reflected by his 0 percent and 30 percent evaluations respectively. A review of the Veteran's service treatment records show that the Veteran was treated in September 2005 for tension headaches, which were accompanied by pain and nausea. The Veteran was also treated in August 2009 and prescribed medication for pain. There was no indication of any symptoms of prostration described. The Veteran was provided with a VA examination in August 2010. At the examination the Veteran was diagnosed with migraine headaches. The Veteran described a history of headaches beginning in 1997 which he treated with over the counter pain medication. He described headaches about 4 to 5 times per week that are severe stabbing type pain to the frontal and bilateral temporal and last up to 3 to 8 hours. He also described nausea and flickers of light on occasions during the headaches. He experienced noise and light sensitivity. These attacks were not found to be of a prostrating nature. A review of the Veteran's post-service outpatient treatment records reveals that the Veteran has been followed for complaints of frequent headaches and treated with pain medication. In January 2015, the Veteran was seen for complaints of headaches 2 to 3 times per week, as well as occasions of passing out on 2 occasions in the past 2 and a half years, nausea, eyes fluttery, vomiting, dizziness, and light sensitivity. Taking the passing out instances as prostrating attacks, this would only represent a frequency of about 1 per year. The Veteran was provided with an additional VA examination in July 2016. The Veteran was diagnosed with migraine headaches. The Veteran described experiencing headaches 4 to 5 times per week. He also complained of nausea, sensitivity to light and sound, and visual changes. The Veteran reported symptoms that were consistent with experiencing a prostrating attack once a month. Based on the above, the Board finds that a rating in excess of 0 percent prior to July 7, 2016 and in excess of 30 percent thereafter for the Veteran's migraine headache disability is not warranted. Prior to July 2016, records and VA examinations appeared to reflect migraines of a moderate severity occurring regularly and prostrating attacks occurring, at most, once per year. This showing only warrants a noncompensable evaluation. In order to warrant higher evaluations, the evidence would need to show prostrating attacks occurring at least once per two month periods or greater. As the evidence does not show even close to this finding, a higher evaluation is not warranted. From July 7, 2016, records that address the frequency of prostrating attacks do not show them to be in excess of, on average, once per month. This finding only warrants a 30 percent evaluation. In order to warrant higher evaluations, the evidence would need to show prostrating attacks occurring more frequently with evidence of the situation creating economic inadaptability. As the evidence does not show even close to this finding, a higher evaluation is not warranted. 4. Gastrointestinal Disorder The Veteran's service-connected gastrointestinal disorder is rated as 10 percent. 38 C.F.R. § 4.114, DC 7318-7346. The Veteran's condition is noted to involve gall bladder removal surgery and is partly rated under DC 7318. Under this code, a 10 percent evaluation is warranted for the presence of mild symptoms. Id. A 30 percent evaluation is warranted for severe symptoms. Id. The Veteran's condition also involves GERD and gastritis, both of which are rated analogously under DC 7346 for hiatal hernia. Under this code, a 10 percent evaluation is warranted for a condition with two or more of the symptoms for the 30 percent evaluation of less severity. Id. A 30 percent evaluation is warranted for a condition with persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. Id. A 60 percent evaluation is warranted 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. Id. Notably, however, ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such evaluation. 38 C.F.R. § 4.114. The Veteran contends that his service-connected gastrointestinal disorder is worse than currently reflected by his 10 percent evaluation. A review of the Veteran's service treatment records show that the Veteran was treated in April 1993 for gastritis. In January 2003, the Veteran was treated for complaints of reflux and abdominal pain. An esophagogastroduodenoscopy (EGD) administered at that time revealed chronic gastritis. In May 2003 the Veteran had laparoscopic Nissan fundoplication for refractory GERD. He was prescribed medication. He was treated for continued reflux and abdominal pain. In June 2006, the Veteran was treated for gall bladder inflammation without evidence of gall stones. The gall bladder was removed. Thereafter, he was treated for continued abdominal pain and diarrhea. The Veteran was provided with a VA examination in August 2010. He was diagnosed with GERD and status post cholecystectomy. The Veteran continued to show symptoms including nausea, vomiting, diarrhea, constipation, indigestion, and heartburn. He also continued to have a cramping and aching type pain to the lower mid abdomen that is always associated with diarrhea. He had occasional constipation. However, the physical examination revealed normal findings. There was no evidence of anemia. A review of the Veteran's post-service outpatient treatment records reveals that he has been followed for his gastrointestinal complaints. In October 2010, the Veteran was seen for complaints of abdominal pain, diarrhea, and nausea. The Veteran was also seen that same month by his private provider, who diagnosed him with post-infectious irritable bowel syndrome. The Veteran was found to have severe abdominal pain which was treated with medication. The Veteran was provided with an additional VA examination in July 2016. The Veteran continued to be diagnosed with GERD. There was no discussion of any residuals of the gall bladder removal surgery. It was noted that the Veteran had symptoms of mild epigastric burning and upset stomach about three times per week. Other symptoms included persistently recurrent epigastric distress, reflux, regurgitation, nausea, and sleep disturbance. There were no functional impacts reported. The Veteran was provided with an additional VA examination in January 2019. The Veteran continued to be diagnosed with GERD, gastritis, and post status gall bladder removal. It was noted that the Veteran was asymptomatic and did not have any attributable symptoms. It was noted that the Veteran's symptoms had resolved. There were no functional impacts reported. The Veteran was seen again in December 2019 and reported symptoms of heartburn and abdominal pain. Based on the above, the Board finds that a rating in excess of 10 percent is not warranted. Treatment records and VA examinations appeared to reflect symptoms comprised of intermittent complaints of diarrhea, sleep disturbance and abdominal pain; as well as some reflux, and regurgitation. However, in order to warrant a higher evaluation, the Veteran's condition would need to show more severe symptoms, to include persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health or worse. As the medical evidence of record has not shown symptoms approximating those contemplated for higher evaluations, the Veteran's claim for an increased evaluation in excess of 10 percent is denied. M. E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dodd, Ryan 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.