Citation Nr: 21029490 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 10-11 764 DATE: May 13, 2021 ORDER A rating in excess of 30 percent for bilateral pes planus prior to December 1, 2020, is denied. A rating in excess of 50 percent for bilateral pes planus since December 1, 2020, is denied. A compensable rating for hallux valgus left foot is denied. A compensable rating for hallux valgus right foot is denied. A compensable rating for degenerative joint disease (DJD), right foot is denied. A 10 percent rating, but no more, for a moderate left foot disorder since September 22, 2006, is granted, subject to the payment of monetary benefits A 10 percent rating, but no more, for a moderate right foot disorder since September 22, 2006, is granted, subject to the payment of monetary benefits A 10 percent rating, but no more, for bilateral plantar fasciitis since February 7, 2021, is granted, subject to the payment of monetary benefits. A total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The Veteran had active duty from June 1980 to June 1984; he has been 100 percent disabled since December 2020. 2. The bilateral foot disabilities have been manifested by subjective complaints of pain on use, weightbearing, manipulation, and on palpation, flare-ups, stiffness in and lack of flexibility in the morning, numbness, pes planus, severe-to-pronounced plantar fasciitis, hallux valgus, and X-ray evidence of right foot DJD. 3. The Veteran's service-connected disabilities do not preclude him from securing or maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 30 percent for bilateral pes planus prior to December 1, 2020, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5003, 5276-5284 (2020); 38 C.F.R. § 4.71a DCs 5003, 5003, 5269, 5276-5284 (2021). 2. The criteria for a rating in excess of 50 percent for bilateral pes planus since December 1, 2020, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5003, 5276-5284 (2020); 38 C.F.R. § 4.71a DCs 5003, 5003, 5269, 5276-5284 (2021). 3. The criteria for a compensable rating for hallux valgus left foot have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5280 (2020); 38 C.F.R. § 4.71a DC 5280 (2021). 4. The criteria for a compensable rating for hallux valgus right foot have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5280 (2020); 38 C.F.R. § 4.71a DC 5280 (2021). 5. The criteria for a compensable rating for DJD, right foot have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5003 (2020); 38 C.F.R. § 4.71a DC 5003 (2021). 6. The criteria for a separate 10 percent rating for a moderate left foot disorder since September 22, 2006, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5284 (2020); 38 C.F.R. § 4.71a DC 5284 (2021). 7. The criteria for a separate rating of 10 percent for a moderate right foot injury since September 22, 2006, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5284 (2020); 38 C.F.R. § 4.71a DC 5284 (2021). 8. The criteria for a separate rating of 10 percent for bilateral plantar fasciitis since February 7, 2021, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a DC 5269 (2021). 9. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1110, 1131, 1521, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.16. (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board denied the appeals in May 2014. The Veteran appealed to the Veterans Claims Court. In September 2014, the Court Clerk granted a Joint Motion for Partial Remand (JMPR). The appeals have been remanded four additional time for development. Increased Rating Claims Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. While this appeal was pending, the rating criteria for musculoskeletal disabilities was amended effective February 7, 2021. See 85 Fed. Reg. 230 (Nov. 30, 2020). If the amended criteria are more favorable, the implementation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of the change. If the pre-amended criteria are more favorable, VA can apply the pre-amended criteria for the period prior to and from the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's appeals under the pre-amended criteria prior to February 7, 2021, and both the pre-amended and amended criteria since February 7, 2021. The criteria that is more favorable will be applied. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). To warrant a rating in excess of 30 percent from September 22, 2006, for pes planus under DC 5276, the evidence must show: pronounced flat foot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achilles on manipulation, that is not improved by orthopedic shoes or appliances. Turning to the evidence, a June 2007 VA examiner found 5 degrees of pronation bilaterally, tenderness of the plantar fascial insertion. The Veteran reported using orthotics for one year with some degree of improvements, as well as receiving steroid injections six months previously with some relief. The examiner described the Veteran's symptoms narratively in the physical examination section, and did not state that there was marked inward displacement and severe spasm of the tendo achilles on manipulation within that section of the examination report. A January 2010 VA examiner found mild pronation, right more than left foot. Non tender callosities at the plantar bilateral 5th metatarsal heads, with tenderness to palpation for the plantar metatarsal and plantar central middle to heels, with tenderness over the achilles bilaterally, and mild weight bearing achilles valgus angulation uncorrected with manipulation. The Veteran reported wearing inserts and ankle braces but receiving no pain relief. An August 2012 VA examiner found continued reports of foot pain, described as diffuse and in the dorsal, plantar, heel, and radiating in the lower legs. In addition, pain was accentuated by use and accentuated on manipulation, with no characteristic calluses, and symptoms relived by arch supports, with no extreme tenderness of plantar surface of one or both feet, and no marked deformity of the foot or marked pronation of the foot, and no inward displacement and severe spasm of the achilles tendon on manipulation. Next, a November 2013 VA examination report showed that the Veteran had no tenderness, especially to the plantar surface of his feet or achilles tendon region, with no marked pronation and no achilles spasm with manipulation. In March 2015, a VA examiner found the Veteran did not have extreme tenderness of plantar surfaces bilaterally, did not find marked pronation, but did note inward bowing of the achilles with lateral deviation over the heel for both feet, but no marked inward displacement and severe spasm of the achilles tendon on manipulation of either feet. The examiner noted 'flexible flat foot' bilaterally. Further, the examiner found that arch supports relieved symptoms bilaterally. Next, a November 2015 VA examiner found that the Veteran had characteristic callouses bilaterally, that he used arch supports, built-up shoes, and orthotics for each foot but remained symptomatic. However, the examiner did not find extreme tenderness of plantar surfaces on either foot, instead indicating it to be moderate. Further, the examiner did not find objective evidence of marked deformity of either foot or marked pronation of either foot. Finally, the examiner did not note marked inward displacement and severe spasm of the achilles tendon on manipulation of one or both feet. In December 2020, a VA examiner found his symptoms warranted the increase to 50 degrees, the maximum allowable under the diagnostic code. Additionally, VA and private medical records during the appeal period contain extensive complaints of symptoms and corresponding treatment. June 2006 private medical records show bilateral pronation, swelling and tenderness. August 2006 private medical records showed that he still had bilateral pronation and tenderness, and that his pain returned after wearing orthotics for four hours. August 2009 private medical records similarly recorded that steroid injections in his feet in the past helped but did not last, which the treating medical professional deemed "failed treatment with injections." excessive pronation was associated with pes planus, and a notation of recommendation to refit orthotics was included. September 2009 VA medical records show moderate pronation bilaterally, with pain on palpation of the medial band of plantar fascia bilateral, as well as along the course of the posterior tibial tendon bilaterally, with the right worse than the left. The Veteran explained that his pain had since returned in the years following receiving orthotics and cortisone shots. He was given new inserts to try and improve his symptoms. However, November 2009 VA medical records record that gauntlet ankle braces were ordered because the inserts were unsuccessful. In his hearing testimony before the Board the next week, he claimed that the new braces helped at the beginning, but that pain remained. In October 2011 private medical records, he stated he was given new shoe inserts that were better, but the treating medical professional found that the burning in his feet was probably from pes plana, whereas the arthralgia was due to osteoarthritis or DJD. June 2012 private medical records include X-ray evidence of osteoarthritis of the right first metatarsophalangeal joint, but the reviewing medical professional found his foot pain most likely consistent with plantar fasciitis and most likely bilateral subtalar strains. The Veteran submitted a July 2012 letter from a treating private medical professional that stated his subtalar pronation was so extreme as to cause excessive stress to the knees, causing a chain of 'malicious malalignment syndrome' throughout his lower extremities. A September 2012 letter submitted by a treating private medical professional noted that his subtalar joints were out of line enough to cause significant torque to the ankles and attached a prescription for orthopedic shoes. September 2012 private medical records show he was not tender at the plantar fascia due to prolotherapy injections from a few weeks prior, and that he was continuing to use the ankle foot brace to help provide stability to his ankle and decrease the tenderness in his feet, but that conservative treatment was failing to treat plantar fasciitis pain. However, November 2012 private medical records reveal he stopped wearing the braces for a time because the injections had lowered his pain to 5 out of 10. February 2014 VA medical records show continued treatment for plantar fasciitis that was improved by orthotics. June 2015 private medical records show numbness of the feet, and January 2016 private medical records not he had plantar fasciitis bilaterally and lateral column compensatory pain but was treated with a cortisone injection. April 2017 private treatment notes record his complaints of pain in both heels 5-10/10, with the left more than right, aggravated by standing or walking, worse in the mornings with injections giving him 6 to 9 months of relief last time. June 2017 private medical records include a diagnosis of significant pes planus, with tenderness to palpation along the proximal insertion site of the medial plantar fascia. He was given a new set of inserts and was given another set of prolotherapy injections. A December 2017 VA medical note shows he continued to use his brace daily to ambulate and also at night to stretch his plantar fascia. He described during another March 2018 VA medical appointment that he had continued pain and stiffness in his feet, treated by occasional steroid injections and his brace. This is repeated in VA treatment records for the next two years, although he did receive new orthotics in November 2018. A review of the evidence fails to show the various symptoms and functional impact associated with a 50 percent rating prior to the December 2020 VA examination. Specifically, the evidence did not show severe spasm of the tendo achilles on manipulation. While the efficacy of orthopedic shoes and appliances wavered throughout the appeal period, the level of pronation described in each foot varied significantly, and generally significant tenderness was noted, DC 5257 is associated is inclusive of all those symptoms. Although VA regulations generally provide that symptoms need only more nearly approximate the criteria for a higher rating in order to warrant such a rating, see 38 C.F.R. §§ 4.7, 4.21, 4.71a, those regulations do not apply where, as here, the conjunction "and" is used and the criteria are successive, with the criteria for the lower ratings encompassed within those for higher ratings. Camacho v. Nicholson, 21 Vet. App. 360, 363 (2007)., 21 Vet. App. at 366; Tatum v. Shinseki, 23 Vet. App. 152, 155-56 (2009). As such, the medical evidence does not support a rating in excess of 30 percent prior to December 1, 2020, under DC 5276. A rating in excess of 50 percent is not warranted, as that is the highest schedular rating under DC 5276. Separate ratings under DC 5284 will be discussed below, so rating pes planus under that diagnostic code is not appropriate. Further, to the extent there are symptoms not captured under this diagnostic code, they will be separately considered under DC 5284. As such, the medical evidence does not support a rating in excess of 50 percent under DC 5276. To warrant a compensable rating for degenerative arthritis of the right foot under DC 5003, the evidence must show: degenerative arthritis with X-ray evidence and limitation of motion confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion; or, X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. A review of the evidence fails to show that the Veteran had X-ray involvement of 2 or more major joints or 2 or more minor groups. November 2013 X-rays show that he had mild DJD in the first MTP joint. No X-rays have shown that another joint in the right foot is arthritic, and as such as compensable rating is not warranted. Additionally, he is already compensated for symptomatic limitation of motion under other diagnostic codes, and as such a separate compensable rating would result in pyramiding. Next, to warrant a compensable rating for hallux valgus under DC 5280, the evidence must show: unliteral hallux valgus operated with resection of the metatarsal head; or, severe, if equivalent to amputation of great toe. A review of the evidence, at no point has the Veteran ever had an operation on either foot relating to hallux valgus. Similarly, June 2007, January 2010, August 2012, March 2015, November 2015, and December 2020 VA examiners, as well as both VA and private medical records never equated the severity of his hallux valgus of either foot to amputation of the great toe. As such, the medical evidence does not support a compensable rating for hallux valgus. Next, for a higher or separate rating under DC 5277 for weak foot, DC 5278 for acquired claw foot, DC 5279 for anterior metatarsalgia, DC 5281 for hallux rigidus, DC 5282 for hammer toe, DC 5283 for malunion or nonunion of tarsal or metatarsal bones, or DC 5284 for other foot injury, the evidence must show: bilateral weak foot, a symptomatic condition secondary to many constitutional conditions, characterized by atrophy of the musculature, disturbed circulation and weakness (10% under DC 5277); unilateral acquired claw foot with all toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads (30% under DC 5278); unilateral or bilateral anterior metatarsalgia (10% under DC 5279); severe unilateral hallux rigidus if equivalent to amputation of the great toe (10% under DC 5281); all toes hammer toe, unilateral without claw food (10% under DC 5282); or, moderate malunion or nonunion of the tarsal or metatarsal bones (10% under DC 5283). a moderate foot injury (10% under DC 5284); a moderately severe foot injury (20% under DC 5284); or, severe foot injury (30% under DC 5284). Turning again to the evidence, June 2007, January 2010, August 2012, March 2015, November 2015, and December 2020 VA examiners all failed to find to find diagnoses of bilateral weak foot, claw foot, anterior metatarsalgia, hallux rigidus, hammer toe, or malunion or nonunion of the tarsal or metatarsal bones, or to associate those symptoms with his service-connected disabilities. Further, private and VA medical records similarly fail to show the diagnoses or symptoms that could warrant separate or higher ratings under those diagnostic codes. As such, the medical evidence does not support a separate or higher rating under DCs 5277, 5278, 5279, 5281, 5282, and 5283. As to a higher rating under DC 5276, the Veteran has consistently stated he had stiffness in his feet in the morning, flare-ups 3-4 times per week that caused additional pain and reduced functional utility. He periodically received injections to help manage his foot pain and utilized a host of orthotics and braces with varying levels of success to limit his symptoms. Additionally, he complained at multiple junctures of numbness in his feet. Given these additional symptoms that are not contemplated by DC 5276, and resolving all reasonable doubt in his benefit, a separate 10 percent rating under DC 5284 for both moderate left and right foot disabilities is warranted. A rating of 20 percent for either foot is not warranted, as no medical professional has specifically found that he has a moderately severe foot injury separate and distinct from pes planus, plantar fasciitis, hallux valgus, or degenerative arthritis of the right foot. Such a rating would thus likely be both overstepping the Board's authority and making a medical determination, as well as constitute pyramiding by compensating the Veteran multiple times for the same symptoms. As such, the medical evidence supports separate 10 percent ratings, but no more, under DC 5284 for moderate foot injuries. After the new regulations take effect as of February 7, 2021, there is no schedular rating in excess of 50 percent for DC 5276, and the evidence to warrant a compensable rating for hallux valgus under DC 5280 and other foot injuries DC 5284 remain unchanged. However, a new diagnostic code (DC 5269) was added that specifically compensates to plantar fasciitis. Next, to warrant a separate rating for plantar fasciitis under the amended DC 5269, the evidence must show: unilateral or bilateral plantar fasciitis (10%); no relief from both non-surgical and surgical treatment, unilateral (20%); or, no relief from both non-surgical and surgical treatment, bilateral (30%). Turning to the evidence, the Veteran has been service-connected for both pes planus and plantar fasciitis under DC 5276. As a 10 percent rating under DC 5269 requires only a diagnosed condition related to service, and he has been specifically service-connected for the disability for the duration of the appeal period, a separate rating of 10 percent for bilateral plantar fasciitis is warranted from February 7, 2021. However, a higher rating under DC 5269 is not warranted, as at no point during the appeal period had he sought relief through surgical treatment. The evidence does not support that a medical professional has stated that plantar fasciitis could not be relieved by surgical treatment. Similarly, the record prior to February 7, 2021, showed that using braces, orthotics, and regular steroid injections have had some success in reducing symptoms. As such, the medical evidence does not support a rating in excess of 10 percent. For all ratings below the left and right knee, the combined rating for these disabilities cannot exceed the 40 percent rating available under DC 5165 (leg amputation at a lower level than the knee permitting prosthesis). If these combined ratings exceed the maximum rating allowable under the amputation rule, despite the ratings assigned herein, the maximum combined rating for the service-connected left and right below foot disorders remains 40 percent. The Board has also considered the Veteran's lay statements that his foot disabilities are worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of this disorder according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran's multiple foot disabilities has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which this disability is evaluated. Moreover, as the examiners had the requisite medical expertise to render medical opinions regarding the degree of impairment caused by the disabilities and had sufficient facts and data on which to base their conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran's subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, other than the separate ratings of 10 percent awarded for foot injuries and plantar fasciitis under DCs 5284 and DC 5269, the benefit of the doubt rule is not applicable and the appeals are otherwise denied. TDIU It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated as totally disabled. 38 C.F.R. § 4.16. Substantially gainful employment is that employment that is ordinarily followed by the nondisabled to earn their livelihoods with earnings common to the particular occupation in the community where the veteran resides. Moore v. Derwinski, 1 Vet. App. 356 (1991). Marginal employment will not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). A TDIU may be assigned, if the scheduler rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability it is ratable at 60 percent or more, and that if there are two or more such disabilities at least one is ratable at 40 percent or more and the combined rating is 70 percent or more. 38 C.F.R. § 4.16(a). The central inquiry is whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524 (1993). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). Although the Veteran is awarded a 100 percent rating from December 1, 2020, the issue of entitlement to a TDIU is not rendered moot from that date. In Bradley v. Peake, 22 Vet. App. 280, 294 (2008), the Court found that it might benefit a veteran to retain the TDIU rating, even where a 100 percent schedular rating has also been granted. See also Buie v. Shinseki, 24 Vet. App. 242, 248 (2010). Although no additional disability compensation may be paid when a total schedular disability rating is already in effect, the Court's decision in Bradley recognized that a separate award of TDIU predicated on a single disability may form the basis for an award of special monthly compensation (SMC), which is contrary to the holdings in VAOGCPREC 6-99. Therefore, the Veteran's pursuit of a TDIU in the present case was not rendered moot as of December 1, 2020. The Veteran is currently service connected for the following disabilities: bilateral pes planus at 30 percent from May 15, 2004, and 50 percent from December 1, 2020; 30 percent for left upper extremity radiculopathy from August 7, 2019; 20 percent for DJD lumbar spine from March 11, 2004; right upper extremity radiculopathy at 20 percent from August 7, 2019; 10 percent for the residuals of a right great toe fracture at 10 percent from May 15, 2004; 10 percent for left ankle tendinitis from November 1, 2012; 10 percent for right ankle tendinitis from November 1, 2012; 10 percent for degenerative arthritis of the cervical spine from August 7, 2019; 10 percent for right lower extremity radiculopathy from August 7, 2019; 10 percent for left lower extremity radiculopathy from August 7, 2019; 10 percent for moderate left foot injury from September 22, 2006; 10 percent for moderate right foot injury from September 22, 2006; 10 percent for bilateral plantar fasciitis from February 7, 2021, and noncompensable ratings for hypertension, degenerative arthritis of the right foot, hallus valgus of the left foot, and hallux valgus of the right foot. As of September 22, 2006, he had a combined rating of 60 percent; 70 percent as of November 1, 2012; 90 percent from 8/7/2019; and 100 percent from December 1, 2020. Given that each of his disabilities from September 22, 2006, are musculoskeletal or orthopedic in nature, for the purposes of determining a single disability they are determined to be of one body system, and thus qualify as a single disability rated at 60 percent. As such, he meets the eligibility requirements under 38 C.F.R. § 4.16(a). Turning to the evidence, the Veteran retired from working in law enforcement in a full-time capacity on October 1, 2014. However, August 2019 VA medical records showed he continued to work in a delivery capacity. He has not provided VA with a VA 21-8950 detailing his full work, educational, and salary history. So, while VA medical records and a June 2020 private vocational assessment reflected that he retired October 1, 2014, the extend that he was working is unclear. Additionally, he told a September 2019 VA examiners that his current occupation was "testing chemicals" for the company he has also stated he delivered for. Turning next to the functional impact of his service-connected disabilities, the various disabilities associated with his service-connected feet are reviewed above. The examiner's assessed the functional impact of both foot and his toe disability in these examinations. The June 2007 VA examiner related that pain, including on flare-ups, weakness, fatigue, lack of endurance, and incoordination limited were all limiting. A January 2010 VA examiner found that the same factors caused functional impairment; however, August 2012 VA and March 2015 VA examiners found that his feet did not cause any functional impairment. The December 2020 VA examiner found that the Veteran lost 1-2 weeks of work time in the past 12 months of law enforcement work. The examiner was likely referring to the last year that the Veteran was working full-time, although it is not clear. The examiner continued that the Veteran's bilateral hallux valgus caused episodes of bilateral foot pain that were aggravated by strenuous activity and weightbearing exercises. The examiner related that his impacted the Veteran's ability to prevent crime by explaining and enforcing applicable federal, state, and local laws and ordinances; teaching preventive, protective, and defensive tactics; mediating disputes; patrolling assigned area; responding to notices of disturbances; conducting searches; observing suspicious activities. The examiner did not elaborate on how episodic foot pain would prevent the Veteran from explaining or teaching. Additionally, the last law enforcement position he retired from was working as an Air Marshall, so some of the activities described by the examiner do not seem to correspond to his actual former day to day occupation. A November 2013 VA examiner found that the Veteran's bilateral ankle disabilities did not cause any functional impact. Similarly, an October 2014 VA examiner found that hypertension caused no functional impact. However, a September 2019 VA examiner found that hypertension impacted employment, that he had lost 1 to 2 weeks work time in the past 12 months, and specifically that it required frequent self-monitoring. This required that the Veteran use a blood pressure kit and take frequent breaks to monitor, which disrupted his daily workflow. Also, his high blood pressure caused him to often be dizzy and required frequent breaks preventing the Veteran from being on long inspections. Again, it is unclear if the time missed from work is an estimate or if the Veteran actually missed that much time of full-time work in the prior 12 months. A September 2019 VA examiner found that the Veteran neck disability made him unable to bend, stoop or reach, and that his mobility was slow. Further, the Veteran reported that he lost 2 to 4 weeks of work time in the past 12 months from testing chemicals. Neck pain required him to take frequent breaks to switch positions or stretch his neck out. Neck pain also prevented him from sitting at a desk with a computer for long periods of time without causing severe pain. The Veteran was unable to sit in long testing exams or meetings due to neck pain requiring stretching and shifting positions. A September 2019 VA examiner also found that the service-connected peripheral nerve conditions had caused him to miss 2 to 4 weeks in the last 12 months, for identical reasons as his neck. The Veteran's lower back disability was evaluated by a June 2004 VA examiner prior to the appeal period. At that time, he reported acute flairs of low back pain would cause him to cease what he was doing such as ambulation or standing or excessive sitting. A June 2020 private vocational counselor found that the Veteran was unable to secure and maintain competitive employment in the general national economy due to his service-connected conditions, particularly that he would be unable to reenter employment in law enforcement. The expert referenced that the Veteran had missed 14 days of work due to his bilateral feet disorder in 2010-2011. However, as he retired in 2014, he continued working in law enforcement for several years after that. The vocational counselor also found that the totality of the Veteran's service-connected disabilities meant he could stand for less than 10 minutes and walk less than 3/4 of a mile, was unable to sit for more than 15-20 minutes without becoming stiff, had incoordination in the bilateral upper extremities on an unpredictable basis, the amount of sick days taken due to bilateral foot pain in one year would exceed the amount that would be considered acceptable in competitive employment, his inability to bend more than 10 times, lift less than 40 pounds, radiating pain down the thigh into the calf that impaired his ability to walk after sitting for periods of time, and that he needed multiple braces and orthotics. Although the assessment contained a comprehensive review of his medical records, it failed to include that the Veteran was working in some capacity in the years following his October 1, 2014, retirement from law enforcement, which diminishes its probative value. The June 2020 vocational counselor and the evidence both clearly show that the Veteran's physical impairments would make following and maintaining employment that required moderate levels of manual labor difficult. However, as he has continued to work after his retirement delivering parcels for a company, as well as conducting of chemical testing, the evidence shows that he still retained the capability to work in either a laboratory setting or one that required driving, but little manual labor. The Veteran's disabilities caused functional impact, as shown by their associated ratings, however, given that it appears throughout the appeal period he has continued to work in some capacity, to include in August 2019 when service connection was granted for radicular and cervical disabilities, it cannot be said that he was unable to maintain or follow substantially gainful employment. The analysis does not change as of December 1, 2020 when the Veteran's total combined rating was increased to 100 percent. As the evidence suggest he is both still capable of and actually working at that point, his disabilities, neither any one nor collectively, cause him to be unable to maintain or follow substantially gainful employment. While he may not be able to perform his prior employment in law enforcement, the evidence does not support a finding that he is capable of employment with less physical impact such as computer work, filing, virtual training or teaching, or greeting. The Board has considered the lay statements and testimony of the Veteran regarding his capacity to work throughout the entire period on appeal. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of symptomatology sufficient to satisfy the requirements of 38 C.F.R. § 4.16(a). Such competent evidence concerning the nature and extent of the Veteran's employability has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which his employability is evaluated. Moreover, as the examiners have the requisite medical expertise to render medical opinions regarding the impact of the Veteran's service-connected disabilities on his capacity to work and had sufficient facts and data on which to base the conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran's subjective evidence of unemployability, and the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Brendan A. Evans, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.