Citation Nr: 21032525 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 17-51 624 DATE: May 27, 2021 ORDER An initial disability rating in excess of 10 percent for lumbosacral strain prior to March 2, 2020 is denied. A rating in excess of 40 percent for lumbosacral strain since March 2, 2020 is denied. An initial compensable disability rating for migraine headaches prior to March 2, 2020 is denied. A rating in excess of 50 percent for migraine headaches since March 2, 2020 is denied. An initial disability rating in excess of 20 percent for hepatitis B and D is denied. An initial compensable disability rating for allergic rhinitis is denied. FINDINGS OF FACT 1. Prior to March 2, 2020, the Veteran's lumbar spine disability was not manifested by forward flexion greater than 30 degrees but not greater than 60 degrees, or by a combined range of motion of less than 120 degrees. There was no muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis, and there were no incapacitating episodes of at least 2 but less than 4 weeks duration due to intervertebral disc syndrome. 2. Since March 2, 2020, the lumbar spine disability has not been manifested by unfavorable ankylosis or intervertebral disc syndrome with incapacitating episodes. 3. Prior to March 2, 2020, the headache disability was not manifested by characteristic prostrating attacks averaging one in two months over last several months. 4. Since March 2, 2020, the Veteran has been assigned a 50 percent rating for his headache disability, which is the maximum schedular rating authorized under 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8100. 5. The Veteran's hepatitis B and D is not manifested by weight loss, hepatomegaly, or incapacitating episodes having a duration of at least four weeks or longer. 6. The Veteran's allergic rhinitis is not manifested by a greater than 50 percent obstruction of the nasal passages on both sides, complete obstruction on one side, or nasal polyps. CONCLUSIONS OF LAW 1. Prior to March 2, 2020, the criteria for an initial disability rating in excess of 10 percent for lumbosacral strain were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.27, 4.71a, DC 5237. 2. Since March 2, 2020, the criteria for a rating in excess of 40 percent for lumbosacral strain have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.27, 4.71a, DC 5237. 3. Prior to March 2, 2020, the criteria for an initial compensable disability rating for headaches were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 8100. 4. Since March 2, 2020, the criteria for a disability rating in excess of 50 percent for headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 8100. 5. The criteria for an initial disability rating in excess of 20 percent for hepatitis B and D have not been met. 38 U.S.C. §§ 1155, 5107; §§ 4.1, 4.3, 4.7, 4.114, DC 7345. 6. The criteria for an initial compensable disability rating for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107; §§ 4.1, 4.3, 4.7, 4.97, DC 6522. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 2010 to February 2015 in the United States Army. These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In November 2019, the Veteran testified before the undersigned during a hearing in Washington, DC. A transcript of the hearing is included in the electronic claims file. Higher Ratings Disability evaluations 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. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disability specified is considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. The Board's analysis will focus specifically on what evidence is needed to substantiate the claim, and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000); Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The probative evidence here is limited and largely consists of the VA examination reports discussed below. The Veteran's treatment records were considered, but generally do not contain the specific information sufficient for rating the disabilities under the applicable rating criteria. Additionally, as discussed by the Board in the underlying remand, this appeal originates from claims arising out of the Disability Evaluation System Pilot Program, a joint initiative between the Department of Defense and the Department of Veterans Affairs in which the Veteran's fitness for continued service was evaluated by a Physical Evaluation Board. Although examinations assessing the severity of the disabilities on appeal were conducted in connection with this program, as they were conducted while the Veteran was still serving on active duty, they cannot be used to evaluate the post-service severity of the disabilities. As noted by the Board, the date following the Veteran's discharge from service, February 11, 2015, serves as the effective date for compensation and is the date starting the review period for determining whether he is entitled to higher ratings for his service-connected disabilities. 1. An initial disability rating in excess of 10 percent for lumbosacral strain prior to March 2, 2020 is denied. 2. A rating in excess of 40 percent for lumbosacral strain since March 2, 2020 is denied. Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent evaluation is warranted when the 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. A 40 percent evaluation requires forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Ratings of 50 percent and 100 percent are assigned with evidence of unfavorable ankylosis of the entire thoracolumbar spine, or of the entire spine, respectively. Under the Formula for Intervertebral Disc Syndrome (IVDS) based on Incapacitating Episodes, ratings are assigned based on the quantity and duration of incapacitating episodes over a prior 12-month period. For purposes of evaluation under this formula, an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician. Under this Formula, a 20 percent evaluation is warranted if incapacitating episodes have a total duration of at least two weeks but less than four weeks during the past 12 months, a 40 percent rating is warranted if the total duration is at least four weeks but less than six weeks, and a 60 percent rating is warranted if the total duration is at least six weeks. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, and normal extension, bilateral lateral flexion, and bilateral lateral rotation is zero to 30 degrees. These rating criteria are applied with and 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. Ankylosis is the complete immobility and consolidation of a joint due to disease, injury or surgical procedure. See, e.g., Dinsay v. Brown, 9 Vet. App. 79, 81 (1996), citing Dorland's Illustrated Medical Dictionary at 86 (27th ed. 1988). Note (5) in DCs 5235-5242 further explains that, for VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. When evaluating musculoskeletal disabilities, VA may, in addition to applying schedular criteria, consider granting a higher rating in cases in which the claimant experiences additional functional loss due to pain, weakness, excess fatigability, or incoordination, to include with repeated use or during flare-ups, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). The provisions of 38 C.F.R. §§ 4.40 and 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996). Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are separately rated under an appropriate diagnostic code. 38 C.F.R. § 4.71a, Diagnostic Code, 5242, 5243, at Note (1). Effective February 7, 2021, changes were made to the regulations pertaining to the spine. The revised regulations specify that DC 5242 pertains to degenerative arthritis, degenerative disc disease other than IVDS (also, see either DC 5003 or 5010). DC 5243 pertains to IVDS and provides that the diagnostic code is to be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root; DC 5242 is to be assigned for all other disc diagnoses. DC 5244 was added to the rating schedule and provides ratings for complete traumatic paralysis. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76462 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Codes 5242, 5243, 5244). In the March 2015 rating decision on appeal, the VA Regional Office granted service connection and assigned a 10 percent rating for the Veteran's lumbar spine disability. In February 2020, the Board remanded the claim for further development. In a September 2020 rating decision, the VA regional office granted a higher rating of 40 percent for the lumbar spine disability, effective March 2, 2020. Turning to the evidence, on VA examination in May 2016, the Veteran reported pain with walking and sitting for prolonged periods. He also had pain with bending and climbing up and down stairs. He denied having flare-ups. On examination, flexion was to 75 degrees and the combined range of motion exceeded 120 degrees. While pain was noted on testing, it did not cause functional loss. There was no pain with weight-bearing. The Veteran could perform repetitive use testing with no additional loss of function or range of motion. Pain, weakness, fatigability, and incoordination did not significantly limit functional ability with repeated use over time. The veteran did not have guarding or muscle spasms. A neurological assessment was normal and the examiner found no evidence of radiculopathy or any other neurological abnormalities associated with the lumbar spine disability. The veteran did not have IVDS of the thoracolumbar spine. At the November 2019 hearing, the Veteran testified that his lumbar spine disability had worsened since his last VA examination, and he could no longer sit, stand, or walk for prolonged periods of time. He took Ibuprofen three times a day and required accommodations at his job due to back pain. The pain was constant, radiating, and worsened by physical activity. On VA examination in March 2020, the Veteran reported ongoing back pain at a level of 4/10, and increasing to 6/7-10 at times. The pain was worsened with lifting and bending. He reported moderate to severe flare-ups lasting one to two hours, worsened by lifting, bending, and constipation. On examination, flexion was to 10 degrees, extension was 5 degrees, bilateral lateral flexion was to 10 degrees, and bilateral lateral rotation was to 5 degrees. There was pain throughout the Veteran's range of motion. There was pain with weight-bearing but not in non-weight bearing status. Pain in active and passive motion was the same. The Veteran was not able to perform repetitive-use testing. Pain, weakness, fatigability, and incoordination significantly limited functional ability with repeated use over time and with flare-ups. The Veteran's range of motion was unchanged during flare-ups. The examiner found mild radiculopathy affecting the left lower extremity, but no other neurological abnormalities. The Veteran did not have IVDS. There was no ankylosis of the spine. Prior to March 2, 2020 Considering the pertinent evidence in light of the governing legal authority, the Board finds the preponderance of the evidence is against a rating in excess of 10 percent for the lumbar spine disability prior to March 2, 2020. As noted, a 20 percent evaluation is assigned where forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, 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. On VA examination in May 2016, flexion was to 75 degrees and the combined range of motion was greater than 120 degrees. There was no guarding or muscle spasms. As such, the evidence does not support the assignment of a rating in excess of 10 percent due to limited motion of the spine. The Board also finds insufficient evidence to support a finding that the Veteran's low back pain was so disabling as to actually or effectively limit lumbar spine motion to such an extent as to warrant the assignment of a higher rating during this time period. The Veteran denied having flare-ups and could perform repetitive-use testing with no additional loss of function or range of motion after three repetitions. There was no pain with weight-bearing. Pain, weakness, fatigability, and incoordination did not significantly limit functional ability with repeated use over time. Thus, while the Veteran experienced pain and functional loss, the Board cannot find that it approximated the level of severity as described by a 20 percent rating. The Board finds that pain and functional loss have already been considered in assigning the current rating. As for consideration of a higher rating on the basis of "incapacitating episodes," the May 2016 VA examiner found the Veteran did not have IVDS of the spine. The Veteran's treatment records also do not indicate that he was prescribed bed rest by a physician due to the service-connected lumbar spine disability during the pertinent time period. As such, the criteria for a higher evaluation under Diagnostic Code 5243 have not been met. As for consideration of a separate rating on the basis of neurological manifestations of the disability, the May 2016 VA examiner found no radiculopathy, and the record does not otherwise indicate the presence of any neurological abnormalities related to the service-connected lumbar spine disability during the pertinent time period. For all the foregoing reasons, the Board finds the preponderance of the evidence is against a rating higher than 10 percent for the lumbar spine disability prior to March 2, 2020 or any separate rating based on neurological abnormalities during this time period. In reaching this decision the Board considered the doctrine of reasonable doubt. Since March 2, 2020 Considering the pertinent evidence in light of the governing legal authority, the Board finds the preponderance of the evidence is against a rating in excess of 40 percent for the lumbar spine disability since March 2, 2020. As the March 2020 VA examiner found no ankylosis of the spine and the range of motion measurements do not indicate otherwise, the evidence does not support the assignment of a rating in excess of 40 percent due to limited motion of the spine. The Board also finds insufficient evidence to support a finding that the Veteran's low back pain was so disabling as to actually or effectively limit lumbar spine motion to such an extent as to warrant the assignment of a higher rating. While the Veteran reported flare-ups, the examiner found the Veteran's range of motion was unchanged during flare-ups. During flare-ups, flexion was still to 10 degrees, extension was 5 degrees, bilateral lateral flexion was to 10 degrees, and bilateral lateral rotation to 5 degrees. This disability picture does not approximate one comparable to unfavorable ankylosis of the entire thoracolumbar spine. Thus, while the Veteran clearly experiences pain and functional loss, the Board cannot find that it approximates the level of severity as described by a 50 percent rating. The Board finds that pain and functional loss have already been considered in assigning the current rating. As for consideration of a higher rating on the basis of "incapacitating episodes," the March 2020 VA examiner found the Veteran did not have IVDS of the spine. His treatment records also do not indicate that he was prescribed bed rest by a physician due to the service-connected lumbar spine disability. As such, the criteria for a higher evaluation under Diagnostic Code 5243 have not been met. As for consideration of a separate rating on the basis of neurological manifestations of the disability, the Veteran has been in receipt of a separate disability rating for radiculopathy of the left lower extremity throughout the pertinent appeal period, and the matter of entitlement to a higher rating for this disability is not currently before the Board. The record does not indicate the presence of any other neurological abnormalities related to the service-connected lumbar spine disability since March 2, 2020. For all the foregoing reasons, the Board finds the preponderance of the evidence is against a rating higher than 40 percent for the lumbar spine disability since March 2, 2020, or the assignment of any additional separate rating based on neurological abnormalities during this time period. In reaching this decision the Board considered the doctrine of reasonable doubt. 3. An initial compensable disability rating for migraine headaches prior to March 2, 2020 is denied. 4. A rating in excess of 50 percent for migraine headaches since March 2, 2020 is denied. Migraine headaches are rated pursuant to 38 C.F.R. § 4.124a, DC 8100. Under that code, a maximum rating of 50 percent is assigned with evidence of very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 30 percent rating is assigned with evidence of characteristic prostrating attacks occurring on an average once a month over last several months. A 10 percent rating is assigned with evidence of characteristic prostrating attacks averaging one in 2 months over last several months . A noncompensable rating is assigned for less frequent attacks. In the March 2015 rating decision on appeal, the VA Regional Office granted service connection and assigned a noncompensable rating for the Veteran's migraine headache disability. In February 2020, the Board remanded the claim for further development. In a September 2020 rating decision, the VA regional office granted a higher rating of 50 percent for the migraine headache disability, effective March 2, 2020. For the portion of the appeal period dated prior to March 2, 2020, the evidence is limited and no VA examination was conducted. In March 2015, the Veteran reported having headaches that lasted 30 to 34 minutes two to three times per week. In April 2015, he reported mild headaches. In September 2015, he reported having headaches three to four times per week, lasting up to ten minutes but recurring hourly. His headaches were worsened by noise but unaffected by light, and he had associated nausea. He stated that the headaches impacted vision very rarely, he had no numbness or weakness associated with them, and did not have dysarthria. In October 2015, July 2016, and November 2016, he reported experiencing occasional headaches. At the November 2019 hearing, the Veteran testified that certain kinds of light worsened his headaches, and that he was receiving accommodations at work due to this. He testified that his headaches had begun lasting longer and required him to lay down until they subsided. On VA examination in March 2020, the Veteran was found to have prostrating attacks occurring more frequently than once per month. The attacks were productive of severe economic inadaptability. Prior to March 2, 2020 Considering the pertinent evidence in light of the governing legal authority, the Board finds the preponderance of the evidence is against the assignment of a compensable rating for the Veteran's headache disability prior to March 2, 2020. Neither the rating criteria nor the Court has defined "prostrating" for VA purposes. The medical definition of the term is "extreme exhaustion or powerlessness," Dorland's Illustrated Medical Dictionary 1554 (31st ed. 2007). "Prostration" is also defined as or as "physically or emotionally exhausted," Webster II New College Dictionary 889 (3rd ed. 2001). The record does not support that the Veteran experienced prostrating attacks occurring one in two months over the portion of the appeal period dated prior to March 2, 2020. Reports of the frequency of his headaches during this time period varied from "occasional" to several times per week. There is no indication that the headaches caused powerlessness or extreme exhaustion; to the contrary, he reported in April 2015 that they were "mild." He made no such assertions to treatment providers in March 2015, September 2015, October 2015, July 2016, or November 2016. To the extent he testified at the November 2019 hearing that his headaches required him to lay down, he did not indicate the frequency with which this occurred or the duration of time over which it had been happening. For all the foregoing reasons, the Board finds that the preponderance of the evidence is against a compensable disability rating for the Veteran's headache disability prior to March 2, 2020. In reaching this decision the Board considered the doctrine of reasonable doubt. Since March 2, 2020 Considering the pertinent evidence in light of the governing legal authority, the Board finds that a higher rating for the Veteran's headache disability since March 2, 2020 is not possible under the assigned code, DC 8100, because 50 percent is the maximum rating allowed by this code. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). The Board can point to no other diagnostic code that would provide a basis for the assignment of a rating in excess of 50 percent for the Veteran's headaches. The symptomatology of this disability is specifically contemplated by DC 8100; the record does not implicate other symptoms not addressed by this code. Moreover, while the Veteran has a severe headache disability, the symptoms of such are squarely contemplated the pertinent rating criteria; hence, referral for consideration an "extra-schedular" is not warranted. The Board thus finds that the preponderance of the evidence is against a disability rating higher than 50 percent for the Veteran's headache disability since March 2, 2020. In reaching this decision the Board considered the doctrine of reasonable doubt. 5. An initial disability rating in excess of 20 percent for hepatitis B and D is denied. The Veteran's liver disability is rated under 38 C.F.R. § 4.114, DC 7345. Under that code, a 100 percent rating is assigned with evidence of near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). A 60 percent rating is assigned with evidence of daily fatigue, malaise, and anorexia, with substantial weight loss (or other indication of malnutrition), and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12-month period, but not occurring constantly. A 40 percent rating is assigned with evidence of daily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least four weeks, but less than six weeks, during the past 12-month period. A 20 percent rating is assigned with evidence of daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past 12-month period. In light of the conjunctive "and" in the various rating criteria listed under DC 7345, all criteria must be met to establish entitlement to particular percent rating. See, e.g., Watson v. Dep't of the Navy, 262 F.3d 1292, 1299 (Fed. Cir. 2001) (noting that inclusion of conjunctive "and" clearly indicates that all three criteria in 5 C.F.R. §§ 831.902 and 842.802 must be demonstrated). Moreover, the rating criteria of DC 7354 are successive. Rating criteria are successive where the criteria for a higher rating include those of a lesser rating, such that the higher rating is not warranted if the criteria for the lower rating are not met. See Camacho v. Nicholson, 21 Vet. App. 360, 366-667 (2007) (explaining that where a DC establishes a successive rating criteria, a claimant must meet all of the requirements of a lower rating criteria before he can be eligible for a higher rating criteria). Notes accompanying DC 7345 provide that sequelae, such as cirrhosis or malignancy of the liver, are to be rated under an appropriate diagnostic code, but the rater is not to use the same signs and symptoms as the basis for evaluation under DC 7354 and under a diagnostic code for sequelae. (Note (1)). An "incapacitating episode" is defined as a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician. (Note (2)). In the March 2015 rating decision on appeal, the VA Regional Office granted service connection, and assigned a 20 percent rating for the Veteran's liver disability. In February 2020, the Board remanded the claim for further development. Turning to the evidence, on VA examination in May 2016, the examiner found that the Veteran's liver disability was manifested by intermittent nausea and right upper quadrant pain. He did not have signs or symptoms attributable to cirrhosis. The Veteran did not have weight loss or hepatomegaly, and there were no incapacitating episodes. On VA examination in October 2017, the examiner found that the Veteran's hepatitis disability was manifested by daily fatigue, malaise, anorexia, nausea, vomiting, and arthralgia. He additionally had cirrhosis manifested by weakness, anorexia, abdominal pain, and malaise. The liver disabilities were not manifested by weight loss or hepatomegaly. The Veteran experienced incapacitating episodes lasting at least two weeks but less than four weeks. On VA examination in November 2017, the examiner found that the Veteran's hepatitis disability was manifested by daily fatigue, malaise, anorexia, nausea, vomiting, arthralgia, and right upper quadrant pain. Cirrhosis was manifested by intermittent anorexia, daily abdominal pain, daily malaise. The liver disabilities were not manifested by weight loss or hepatomegaly. The Veteran experienced incapacitating episodes lasting less than one week. The examiner noted that the cirrhosis of the liver constituted a progression of the service-connected hepatitis infections. At the November 2019 hearing, the Veteran testified that he experienced daily fatigue and a loss of appetite due to his liver disability. He also had pain in both the left and right sides and constipation. He reported that he had gained weight due to food not leaving his body on time. On VA examination in March 2020, the examiner found that the Veteran's hepatitis disability was manifested by daily fatigue, malaise, nausea, vomiting, arthralgia, and right upper quadrant pain. Cirrhosis was manifested by weakness, abdominal pain, and malaise. The liver disabilities were not manifested by weight loss or hepatomegaly. The Veteran experienced incapacitating episodes lasting at least two weeks but less than four weeks. Considering the pertinent evidence in light of the governing legal authority, the preponderance of the evidence is against the assignment of a rating higher than 20 percent for the Veteran's liver disability. Significantly, he underwent four VA examinations during the course of the appeal period, and each examiner found that his disability was not manifested by weight loss, hepatomegaly, or incapacitating episodes with a duration longer than two to four weeks. As this symptomatology is required for higher ratings, the preponderance of the evidence is against the claim. The Board can point to no other diagnostic code that would provide a basis for the assignment of a rating in excess of 20 percent for the Veteran's liver disability Many of the diagnostic codes pertaining to the digestive system contain overlapping rating criteria. To the extent there are codes with different criteria, the record does not raise the presence of those disabilities or the symptomatology contemplated by those codes. Moreover, to the extent the Veteran has cirrhosis in addition to his hepatitis infections, the symptomatology of these disabilities is not distinguishable to the extent that separate compensable ratings can be assigned. In reaching this decision, the Board considered the doctrine of reasonable doubt. 6. An initial compensable disability rating for allergic rhinitis is denied. The Veteran's allergic rhinitis is rated under 38 C.F.R. § 4.97, DC 6522. Under that code, a 30 percent rating is assigned for allergic rhinitis with polyps. A 10 percent rating is assigned for allergic rhinitis without polyps, but with greater than a 50 percent obstruction of the nasal passages on both sides, or complete obstruction on one side. In the March 2015 rating decision on appeal, the VA Regional Office granted service connection, and assigned a noncompensable rating for the Veteran's allergic rhinitis. In February 2020, the Board remanded the claim for further development. The evidence sufficient for rating the disability under DC 6522 is limited and consists of the Veteran's hearing testimony and a March 2020 VA examination report. At the November 2019 hearing, the Veteran testified that his rhinitis causes crusting and obstruction in both nasal passages. He testified that lying down causes his nose to become completely blocked. He also testified that blood comes out of his nose when he blows it, and that he has nasal polys that itch. On VA examination in March 2020, the Veteran reported having nasal congestion that he treated with saline spray and Flonase. On examination, the examiner found there was not a greater than 50 percent obstruction of the nasal passages on both sides due to rhinitis. There was also not complete obstruction on either the left side of the nose, or the right. There were no nasal polyps. Considering the pertinent evidence in light of the governing legal authority, the preponderance of the evidence is against the assignment of a compensable disability rating for allergic rhinitis. On VA examination in March 2020, the examiner found the disability was not manifested by the severity of obstruction contemplated by DC 6522, and that the Veteran did not have nasal polyps. To the extent the Veteran testified that he has complete obstruction of the nasal passages and nasal polyps, this is not documented in any of the post-service treatment records, and the Board finds the objective clinical examination performed by the March 2020 VA examiner more probative than the lay statements in this regard. The Board can point to no other diagnostic code that would provide a basis for the assignment of a compensable disability for the Veteran's allergic rhinitis. In reaching this decision, the Board considered the doctrine of reasonable doubt. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith, 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.