Citation Nr: 21041156 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 11-29 802 DATE: July 8, 2021 ORDER From September 13, 2007 to February 1, 2021, entitlement to a rating in excess of 20 percent for lumbar spine degenerative disc disease (DDD) is denied. From February 1, 2021, entitlement to a rating in excess of 40 percent for lumbar spine degenerative disc disease (DDD) is denied. Entitlement to separate rating for painful bowel function as a neurological manifestation of lumbar spine DDD is denied. FINDINGS OF FACT 1. From September 13, 2007 to February 1, 2021, the Veteran's lumbar spine DDD is manifested by, at worst, forward flexion ending at 50 degrees; it was not manifested by ankylosis; IVDS was not manifested by episodes of acute signs and symptoms that required bed rest prescribed by a physician and treatment by a physician in the previous 12 months. 2. From February 1, 2021, the Veteran's lumbar spine DDD is manifested by, at worst, forward flexion ended at 20 degrees; it was not manifested by ankylosis; IVDS was not manifested by episodes of acute signs and symptoms that required bed rest prescribed by a physician and treatment by a physician in the previous 12 months. 3. The preponderance of evidence weighs against finding that the Veteran has a bowel disability that is related to his lumbar spine DDD. CONCLUSIONS OF LAW 1. From September 13, 2007 to February 1, 2021, the criteria for a rating in excess of 20 percent for lumbar spine DDD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243. 2. From February 1, 2021, the criteria for a rating in excess of 40 percent for lumbar spine DDD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243. 3. The criteria for a separate rating for painful bowel function as a neurological manifestation of lumbar spine DDD have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102 , 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from June 1983 to October 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from October 2009 and August 2011 rating decisions by a Department of Veterans Affairs (VA) Regional Office. In a September 2018 decision, the Board noted that the Veteran had reported painful bowel movements. Accordingly, the Board remanded the lumbar spine claim for a VA examination to determine if such manifestations are the result of neurological abnormalities secondary to the service-connected DDD. In December 2019, pursuant to a June 2019 Joint Motion for Partial Remand (JMPR), the Board remanded the Veteran's claim for an increased rating for his low back DDD and he was scheduled for a VA examination. In January 2021, the Board found that the Veteran provided good cause for not attending his VA examination. As such, the Board remanded his claim for an increased rating for his low back DDD, as well as the inextricably intertwined claim for a separate rating for painful bowel function, to schedule him for another examination. In a February 2021 rating decision by the RO, the Veteran's lumbar spine degenerative disc disease was granted an increased evaluation of 40 percent, effective from February 1, 2021. A February 2021 supplemental statement of the case (SSOC) addressed both the lumbar spine issue and the separate rating for a neurological impairment and the appeal was returned to appellate status. Therefore, both issues are properly before the Board. Increased Rating A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on the facts found, a practice known as 'staged ratings.' Fenderson v. West, 12 Vet. App. 119, 12627 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). VA must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, which requires the VA to regard as "seriously disabled" any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) did not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including during flare-ups. The Board notes that the guidance provided by DeLuca must be followed in adjudicating claims where a rating under the diagnostic codes governing limitation of motion should be considered. However, pain that does not result in additional functional loss does not warrant a higher rating. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011) (holding that pain alone does not constitute function loss but is just one fact to be considered when evaluating functional impairment). Entitlement to higher ratings for a lumbosacral spine disability. The Veteran contends that his degenerative disc disease (DDD) of lumbosacral spine (back disability) is more severe than currently rated. He contends that a rating in excess of 20 percent is warranted prior to February 1, 2021 and in excess of 40 percent thereafter, due to worsening symptoms. The Veteran's back disability is rated 20 percent disabling from September 13, 2007 to February 1, 2021, and 40 percent disabling thereafter. The VA received the Veteran's request to reopen a previous claim in July 2009. The Veteran timely perfected the appeal of an October 2009 rating decision that increased his back disability rating from 0 to 20 percent disabling. See August 2010 notice of disagreement. He stated that his symptoms are more consistent with an evaluation of 40 percent due to incapacitating episodes of intervertebral disc syndrome having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; or forward flexion of the thoracolumbar spine of 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. The Veteran's back disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5243. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation 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 claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Under both the former and amended criteria for DCs 5235-42, the General Rating Formula for Diseases and Injuries of the Spine provides a 20 percent rating for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 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. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5235 through 5242. For VA purposes, unfavorable ankylosis is a condition in which 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 (0 degrees) always represents favorable ankylosis. See General Rating Formula for Diseases and Injuries of the Spine, Note 5. Note (1) to the General Rating Formula provides that associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be rated separately under an appropriate diagnostic code. The former criteria, DCs 5235-42 also instructs to evaluate degenerative arthritis of the spine under Diagnostic Code 5003 if limitation of motion is noncompensable. Under the amended criteria, DCs 5235-42, also instructs to evaluate degenerative arthritis, DDD other than intervertebral disc syndrome (IVDS) under either Diagnostic Code 5003 (Degenerative arthritis, other than post-traumatic) if limitation of motion is noncompensable, or under Diagnostic Code 5010 (Post-traumatic arthritis), which instructs to rate as limitation of motion, dislocation, or other specified instability under the affected joint, and where two or more joints are affected, each rating shall be combined in accordance with 38 C.F.R. § 4.25. A rating under Diagnostic Code 5003 cannot be combined with a rating based on limitation of motion of the same joint. Here, the Veteran is currently in receipt of a compensable rating under Diagnostic Code 5243 for limitation of motion for his lumbar spine. The revised Diagnostic Code 5010 distinguishes between joint conditions arising from traumatic causes and joint disease resulting from systemic processes. Traumatic arthritis will be rated as limitation of motion for the affected joint, dislocation or other specified instability under the affected joint. Diagnostic Code 5243 contemplates intervertebral disc syndrome (preoperatively or postoperatively). Back disabilities are rated under either the Formula for Rating IVDS based on Incapacitating Episodes or the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. § 4.71a. Under the old DC 5243, intervertebral disc syndrome (IVDS) is rated either on the total duration of incapacitating episodes over the past 12 months or by combining separate evaluations of the chronic orthopedic and neurologic manifestations, whichever method results in the higher rating. See Bierman v. Brown, 6 Vet. App. 125 (1994). However, assigning separate ratings for combination may not be permitted to result in pyramiding under 38 C.F.R. § 4.14 - which prohibits "[t]he evaluation of the same disability under various diagnoses". See Brady v. Brown, 4 Vet. App. 203, 206 (1993). See, too, Esteban v. Brown, 6 Vet. App. 259, 262 (1994) (the critical element is if symptoms of one condition are duplicative of or overlapping of another). Thus, a rating for IVDS may not be assigned while at the same time assigning separate ratings for the orthopedic and the neurologic components of IVDS. As to incapacitating episodes, if there are incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months, a 20 percent rating is warranted. If there are incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months, a 40 percent rating is warranted. If there are incapacitating episodes having a total duration of at least six weeks during the past 12 months, a maximum 60 percent rating is warranted. The IVDS rating criteria do not provide for an evaluation in excess of 60 percent on the basis of the total duration of incapacitating episodes. The Board notes that revised criteria defines the clinical manifestations that are required for a diagnosis IVDS, but does not alter the rating of this disability. 1. Entitlement to a rating in excess of 20 percent for lumbar spine DDD, prior to February 1, 2021. Prior to February 1, 2021, the Veteran's back disability is rated 20 percent disabling. A July 2009 treatment record showed that flare-ups of the back condition was improving with chiropractic treatment. He had pain in the right lower back with internal rotation of left hip, and constant dull low back pain and stiffness. He had difficulty standing, sitting, getting up, bending, lifting. An August 2010 private treatment record showed low back pain and a possibility of disc herniation. The impression was degeneration and left paramedian extrusion to the left of midline at L5-S1 severely compressing the left traversing nerve root. He had back pain that radiated to his buttock and sometimes to the foot. He reported that he "threw his back out" and had "can hardly move." An October 2015 VA examination showed a diagnosis of lumbar DDD intervertebral disc syndrome. The Veteran endorsed daily pain across the low back with stiffness. Pain radiated down the legs to the feet and the examiner stated that lifting may provoke pain. He takes prescribed medication for pain. There was no history of back surgery. The Veteran did not report flare-ups. He had functional loss or functional impairment. Initial range of motion (ROM) was abnormal or outside of normal range. Forward flexion ended at 50 degrees; extension ended at 10 degrees; right and left lateral flexion ended at 30 degrees; right and left lateral rotation ended at 30 degrees. ROM itself did not contribute to a functional loss. Pain was noted on examination but did not result in/cause functional loss. There was pain on extension. There was no evidence of pain on weight bearing or objective evidence of localized tenderness or pain. The Veteran was able to perform repetitive use testing with at least three repetitions. There was no additional loss of function or ROM after three repetitions. Pain, weakness, fatiguability and incoordination did not significantly limit functional ability with repeated use over a period of time. The Veteran had guarding or muscle spasm of the thoracolumbar spine. The Veteran had less movement than normal due to symptoms such as adhesions. There was disturbance of locomotion and interference with standing. He did not have muscle atrophy or ankylosis. The Veteran had intervertebral disc syndrome (IVDS) of the thoracolumbar spine. He did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. Based on the evidence of record, the Board finds that prior to February 1, 2021, a rating in excess of 20 percent for the back disability is not warranted. The evidence showed, at worst, forward flexion ending at 50 degrees, which is consistent with a 20 percent rating. At no time prior to February 1, 2021, did the evidence show flexion ending at 30 degrees or less, as required for a higher rating. For this period, a higher rating would otherwise require evidence of ankylosis. The medical and lay evidence does not reflect evidence of this disability or disability tantamount to ankylosis. Johnston v. Brown, 10 Vet. App. 80, 84-85 (1997). Further, there is no evidence of incapacitating episodes resulting from intervertebral disc syndrome, and thus a higher rating under the IVDS formula is not proper. Therefore, a rating in excess of 20 percent prior to February 1, 2021 is not warranted. The Board has considered the lay statements in the record regarding the Veteran's spine disability; however, they do not support a basis for assignment of a higher rating. The Veteran is competent to report his observations, including reports of pain and decreased mobility. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, his statements are consistent with the rating assigned. The Veteran is already in receipt of a compensable rating for limitation of motion, and his lay reports in that regard are fully contemplated by the current rating assigned. See 38 C.F.R. § 4.59. The occurrence of pain and increased difficulty while performing physical activities are not additional symptoms, but rather the practical effect of the symptoms of pain and limited range of motion that have been clinically observed and measured in the evidence of record. The Veteran has contended that his spine disability is manifested by symptoms which amount to a higher rating. However, the medical evidence revealed no such symptoms prior to February 1, 2021. Although the Veteran reported increased pain, pain alone is not sufficient to warrant a higher rating; as pain, in itself, does not constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 40-41 (2011). Pain must affect some aspect of "the normal working movements of the body" such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. Id. at 43; see 38 C.F.R. § 4.40. The Board considered the DeLuca factors, and the Veteran's contentions of pain and limitations on daily activities such as bending and lifting. However, October 2015 VA examination found no further limitation of motion on repetitive use testing and, thus, there is no suggestion that pain is akin to ankylosis. See 38 C.F.R. §§ 4.40, 4.45, 4.59; Deluca v. Brown, 8 Vet. App. 202 (1995). To the extent that the Veteran and his representative have indicated symptomatology greater than that found on examination, the clinical findings of a trained medical professional are found to be of greater probative weight than their general lay assertions. See, e.g., Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, as the preponderance of evidence is against the claim, a rating in excess of 20 percent for the Veteran's spine disability prior to February 1, 2021 is not warranted. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to a rating in excess of 40 percent for lumbar spine DDD, from February 1, 2021. A February 2021 rating decision by the RO granted an increased rating of 40 percent for the Veteran's back disability, effective from February 1, 2021. However, as the maximum benefit has not been achieved, the claim for increased evaluation remains in appellate status until review by the Board. A February 2021 VA examination showed the diagnosis of degenerative disc disease. He noted pain that is constant at 5/10. He reported that pain is worse the longer he is on his feet; he reported that pulling patients can worsen his pain, noting he feels pain halfway into his shift while working in the ICU. During the examination, the Veteran reported flare-ups of the thoracolumbar spine. He stated that he gets flare ups about twice a month, which lasts 2-3 days and is alleviated with ice or heat and ibuprofen; flares can be precipitated by a wrong move; he can get things done and function during a flare up as long as he doesn't bend, i.e.; he squats down to pick up something instead to avoid bending; he also uses a tens unit during a flare up. The Veteran reported functional loss or functional impairment, stating that lifting and bending is limited. Initial ROM was abnormal. Active ROM showed forward flexion ending at 50 degrees; extension ending at 10 degrees; right and left lateral flexion ending at 30 degrees; right and left lateral rotation ending at 30 degrees. Extension exhibited pain. The Veteran could not passively move the spine without eliciting some active motion and weightbearing. There was evidence of pain on active motion and on rest/non-movement. There was no objective evidence of crepitus. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue; specifically, the Veteran had mild paralumbar discomfort. There was no additional loss of function or ROM after performing three repetitions. Following repeated use over time and during flare ups, pain, fatiguability, weakness, and lack of endurance caused function loss. Estimated ROM both following repeated use over time and during flare ups were as follows: forward flexion ended at 20 degrees; extension ended at 10 degrees; right and left lateral flexion ended at 30 degrees; right and left lateral rotation ended at 30 degrees. The Veteran had localized tenderness not resulting in abnormal gait or abnormal spinal contour, related to the paralumbar discomfort. He did not have muscle spasm or guarding. He did not have muscle atrophy. The Veteran had moderate bilateral lower extremity radiculopathy caused by degenerative disc disease, which has been separately rated as 20 percent disabling from October 16, 2015, and consistent with the symptoms below. He had deep tendon reflex exam was hypoactive bilaterally. Sensory exam was normal, except for in the feet and toes, which showed decreased sensation. Straight leg test was negative. He had bilateral radicular pain that was constant and moderate. He also has paresthesias and/or dysesthesias and numbness that was moderate bilaterally. There was involvement of L4/L5/S1/S2/S3 nerve roots (sciatic nerve). There was no ankylosis of the spine or other neurological abnormalities related to the thoracolumbar spine condition. The examination confirmed IVDS of the thoracolumbar spine. However, he had not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the previous 12 months. After a careful review of the record, the Board finds that from February 1, 2021, a rating in excess of 40 percent for the Veteran's back disability is not warranted. The evidence of record shows that the Veteran's back disability was manifested by, at worst, forward flexion ended at 20 degrees, which is consistent with a 40 percent rating. For this period, a higher rating would require evidence of ankylosis. The medical and lay evidence does not reflect evidence of this disability or disability tantamount to ankylosis. Johnston v. Brown, 10 Vet. App. 80, 84-85 (1997). Accordingly, a rating in excess of 40 percent is denied for this period of time. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Further, there is no evidence of incapacitating episodes resulting from intervertebral disc syndrome, and thus a higher rating under the IVDS formula is also not proper. Therefore, a rating in excess of 40 percent, from February 1, 2021, is not warranted. The Veteran has contended that his spine disability is manifested by symptoms which amount to a higher rating. The February 2021 examination indeed showed symptoms, including but not limited to pain and fatiguability, that caused functional loss and affected. The Board has considered the DeLuca factors, and the Veteran's contentions of pain and limitations on daily activities such as bending and lifting. Additionally, the February 2021 VA examination found limitation of motion was further decreased upon repetitive use testing and during flare ups. However, there is no suggestion that such pain or limitation is akin to ankylosis. See 38 C.F.R. §§ 4.40, 4.45, 4.59; Deluca v. Brown, 8 Vet. App. 202 (1995). The Veteran's current assigned rating of 40 percent is consistent with his limited forward flexion, as shown by objective evidence and with consideration of his lay statements. To the extent that the Veteran and his representative have indicated symptomatology greater than that found on examination, the clinical findings of a trained medical professional are found to be of greater probative weight than their general lay assertions. See, e.g., Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, from February 1, 2021, the preponderance of evidence is against a rating in excess of 40 percent for the Veteran's spine disability, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Associated Neurological Abnormality Note (1) of the General Rating Formula for Diseases and Injuries of the Spine indicates that any associated objective neurological abnormality should be evaluated separately under an appropriate diagnostic code. 3. Entitlement to separate rating for painful bowel function as a possible neurological manifestation of lumbar spine DDD. The Veteran contends that he has painful bowel function as a possible manifestation of his lumbar spine DDD. See January 2019 VA examination. In a July 2009 private treatment record, the Veteran denied loss of bladder or bowel control. March 2010 private treatment notes were negative for bowel changes. April 2015 CT scan of the abdomen/pelvis showed mild to moderate fluid within the colon that may represent enteritis. October 2015 VA back examination showed that the Veteran did not have other neurologic abnormalities or findings related to a thoracolumbar spine (back) condition (such as bowel or bladder problems/pathologic reflexes). January 2016 VA intestinal examination did not show a diagnosis of an intestinal condition. The Veteran reported that he has never actually been diagnosed with irritable bowel syndrome (IBS). He reported bouts of diarrhea or constipation. He stated that, in general, he just tries to eat more fiber and stay hydrated. April 2016 colonoscopy screening noted possible hyperplastic polyp and tubulovillous adenoma. December 2018 VA treatment note showed no complaints of dysphagia, constipation, diarrhea, melena, hematochezia, reflux, or abdominal pain. January 2019 VA intestinal examination showed a 2001 diagnosis of diverticulosis. The Veteran described symptoms as 10 percent diarrhea and 90 percent constipation. He reported that symptoms occur when he eats certain foods. He did not have weight loss, abdominal pain, nausea or vomiting. The examiner opined that the Veteran's bowel dysfunction is less likely than not proximately due to or the result of DDD low back. The examiner reasoned that the diverticulosis is most likely related to diet and/or genetics and his diarrhea and constipation is most likely related to dies and/or lack of water and fiber in diet. Upon a February 2021 VA intestinal examination, the examiner determined that the Veteran did not have an intestinal condition. The examiner noted that the Veteran did have constipation attributable to non-surgical, non-infectious intestinal condition(s). The Veteran reported that he has had constipation for the last 1.5 years, noting a bowel movement every 4 to 5 days. He denied any associated pain or blood. He occasionally takes over the counter medication but no other treatment has been initiated. He stated that he is not drinking enough water daily and also believes he needs more fiber. The examiner opined that that the Veteran's claimed bowel impairment is less likely as not proximately due to or the result of degenerative disc disease because the record does not show evidence to support the claimed condition as the result of degenerative disc disease. In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) (service connection may not be granted unless a current disability exists). Although the Veteran's has reported symptoms of constipation and diarrhea and the record reveals a 2001 diagnosis formally finding such, the Veteran has not submitted current medical evidence nor does the record show that he has a current bowel disability. In this regard, the Board finds based on the clarifying opinion of the February 2021 VA examiner, there is no indication of a bowel disability during the appellate period. Even if the record supported a previous finding of a disability, both the January 2019 VA examiner and the February 2021 examiner opined that the Veteran's constipation is less likely than not proximately due to or the result of his degenerative disc disease. Instead, the medical professionals explained that, based on the Veteran's report and the record, his diverticulosis/constipation is most likely related to diet and/or genetics and his diarrhea and constipation is most likely related to diet and/or lack of water and fiber in diet. To the extent that the Veteran and his representative have indicated a relationship between his bowel symptoms and hid DDD, the clinical findings of a trained medical professional are found to be of greater probative weight than their general lay assertions. See, e.g., Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, the Board finds that the preponderance of the evidence is against the claim, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); Gilbert, 1 Vet. App. at 55. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Wilson, 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.