Citation Nr: 21041587 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 14-16 782 DATE: July 9, 2021 ORDER Entitlement to service connection for sinus disorder, manifested by chronic sinusitis, is granted. Entitlement to service connection for an allergic disorder, manifested by allergic rhinitis, is granted. Entitlement to service connection for a gynecologic disorder is denied. Entitlement to service connection for a bilateral knee disorder is denied. Prior to November 30, 2011, entitlement to a disability rating of 20 percent, but not higher, for the service-connected lumbar spine disability, is granted. From November 30, 2011, to October 28, 2019, entitlement to a disability rating higher than 20 percent for the service-connected lumbar spine disability is denied. Since October 28, 2019, entitlement to a disability rating higher than 40 percent for the service-connected lumbar spine disability, is denied. FINDINGS OF FACT 1. A sinus disorder, manifested by chronic sinusitis, was incurred in service. 2. An allergic disorder, manifested by allergic rhinitis, was incurred in service. 3. A gynecologic disorder is not related to service. 4. A bilateral knee disorder is not related to service. 5. Prior to November 30, 2011, and from November 30, 2011, to October 28, 2019, the service-connected lumbar spine disability was manifested by painful motion with forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees. 6. Since October 28, 2019, the service-connected lumbar spine disability is manifested by painful motion with forward flexion of the thoracolumbar spine limited to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for an allergic disorder, manifested by allergic rhinitis. are met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 2. The criteria for entitlement to service connection for a sinus disorder, manifested by chronic sinusitis, are met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 3. The criteria for entitlement to service connection for a gynecologic disorder are not met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 4. The criteria for entitlement to service connection for a bilateral knee disorder are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310, 3.317. 5. Prior to November 30, 2011, the criteria for a disability rating of 20 percent for the service-connected lumbar spine disability were met; the criteria for a rating higher than 20 percent were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 6. From November 30, 2011, to October 28, 2019, the criteria for a disability rating higher than 20 percent for the service-connected lumbar spine disability were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 7. Since October 28, 2019, the criteria for a disability rating higher than 40 percent for the service-connected lumbar spine disability are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a veteran (the Veteran) who had active duty service from April 2002 to July 2009. This appeal comes before the Board of Veterans' Appeals (Board) from a September 2010 rating decision of the RO in Atlanta, Georgia. In April 2017, the Veteran presented testimony at a Board hearing, chaired via videoconference by the undersigned Veterans Law Judge, and accepted such hearing in lieu of an in-person hearing before a Member of the Board. See 38 C.F.R. § 20.700(e). At the Board hearing, the Veteran was informed of the basis for the RO's denial of her claims and she was informed of the information and evidence necessary to substantiate each claim. 38 C.F.R. § 3.103. A transcript of the hearing is associated with the claims file. The Board has considered whether a claim of entitlement to a total disability rating based on individual unemployability due to service connected disabilities (TDIU) is a component of the rating claims on appeal in accordance with Rice v. Shinseki, 22 Vet. App. 447 (2009). However, the claims on appeal were specifically addressed at the Board hearing, and in written correspondence from the Veteran and from the Veteran's representative. Such a claim has not been reasonably raised. In an October 2018, the Board remanded these issues for additional evidentiary development. The appeal has since been returned to the Board for further appellate action. The Board also dismissed several other issues that were withdrawn. The Board's decision with respect to those matters is final. See 38 C.F.R. § 20.1100. Increased RatingsLaw and Regulations Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. See also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Nevertheless, where a veteran is appealing the rating for an already established service-connected condition, his present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, when an appeal is based on the assignment of an initial rating for a disability, following an initial award of service connection for this disability, the rule articulated in Francisco does not apply. Fenderson v. West, 12 Vet. App. 119 (1999). The rating must be based on the overall recorded history of a disability, giving equal weight to past and present medical reports. Id. Staged ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Disability of the musculoskeletal system is primarily the inability, due to damage or infection of parts of the musculoskeletal system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. The functional loss may be due to absence of part, or all, of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca, supra; see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016). Generally, lay evidence is competent with regard to identification of a disease with unique and readily identifiable features which are capable of lay observation. A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as sustaining a fall leading to a broken leg. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir 2007). Lay persons may also provide competent evidence regarding a contemporaneous medical diagnosis or a description of symptoms in service which supports a later diagnosis by a medical professional. However, a lay person is not competent to provide evidence as to more complex medical questions, i.e., those which are not capable of lay observation. Lay statements are not competent evidence regarding diagnosis or etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); Jandreau, at 1377, n. 4 ('sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer'); 38 C.F.R. § 3.159(a)(2). After the evidence has been assembled, it is the Board's responsibility to evaluate the entire record. 38 U.S.C. § 7104(a). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A VA claimant need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), Gilbert at 54. Entitlement to an increased disability rating for the service-connected lumbar spine disability, currently a rating of 0 percent prior to November 30, 2011, 20 percent from November 30, 2011, to October 28, 2019, and 40 percent since October 28, 2019. The current appeal arises from a claim of entitlement to service connection for a lumbar spine disorder that was received at the RO on February 17, 2010. In a September 2010 rating decision, the RO granted service connection for "degenerative disc disease of the lumbar spine" and assigned an initial rating of 0 percent, under Diagnostic Code 5242, effective July 11, 2009, the day after service separation. In an April 2014 decision, the RO increased the disability rating for the lumbar spine disability to 20 percent, effective November 30, 2011, corresponding to the date of a VA examination. Effective February 7, 2021, degenerative arthritis, and degenerative disc disease other than intervertebral disc syndrome are to be rated under Diagnostic Code 5242. A rating under Diagnostic Code 5243 for intervertebral disc syndrome is only to be assigned when there is disc herniation with compression of the adjacent nerve root. See 85 Fed. Reg. 76464 (Nov. 30, 2020). These changes do not affect the ratings assigned, but simply affect the diagnostic code to be assigned. All disabilities of the spine are rated under the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Disabilities of the spine are rated under the General Rating Formula for Diseases and Injuries of the Spine (for Diagnostic Codes 5235 to 5243, unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes). Ratings under the General Rating Formula for Diseases and Injuries of the Spine are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. A rating of 100 percent requires unfavorable ankylosis of the entire spine. A rating of 50 percent requires unfavorable ankylosis of the entire thoracolumbar spine. A rating of 40 percent requires forward flexion of the thoracolumbar spine limited to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A rating of 20 percent requires 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 rating of 10 percent is assigned with forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. 38 C.F.R. § 4.71a, General Formula, note (2) (See also Plate V). 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. 38 C.F.R. § 4.71a, General Formula, Note (5). On the Notice of Disagreement, the Veteran reported that she had severe pain on motion of her back (Record 08/24/2011). At the Board hearing, the Veteran testified that no instruments were used to measure range of motion during the 2010 examination (Record 04/24/2017 at 4). The report of an April 2010 VA Spine Examination reveals the Veteran's complaint of constant aching pain with radiation to both lower extremities. No incapacitating episodes were reported. No flares were reported. The Veteran reported that she could walk more than 14 mile, but less than 1 mile. On examination, the Veteran's posture, gait, and head position were normal with symmetry in appearance. There were no abnormal spinal curvatures. There was no objective evidence of spasm, atrophy, guarding, pain, tenderness, or weakness. Testing of lower extremity strength was normal. There was no muscle atrophy. Muscle tone was normal. Testing of sensation and reflexes in the lower extremities was normal. Range of motion testing revealed forward flexion from 0 to 90 degrees; extension from 0 to 30 degrees; and lateral flexion and rotation from 0 to 30 degrees, bilaterally. There was no additional limitation of motion after 3 repetitions. Passive and active range of motion were equal. No pain, fatigue, weakness, or incoordination were noted on motion. X-rays revealed moderate to severe degenerative changes. The effect of the disability on chores, shopping, exercise, sports, recreation, and traveling was mild. There was no effect on feeding, bathing, dressing, toileting, and grooming (Record 04/14/2010 at 20). A June 15, 2011, clinical note reveals that the Veteran complained of an 8-year history of back pain. She reported that her pain was constant on a daily basis. She reported having epidural injections and taking pain medication. An MRI showed significant degeneration of the discs. Examination revealed low back pain (Record 12/02/2011 at 3). The Veteran underwent multi-level discectomy and fusion on June 27, 2011 (Record 12/02/2011 at 9). The report of a November 2011 VA Spine Examination reveals the Veteran's complaint of constant low back pain with flares 3 or 4 days per week, which lasts for hours or all day. At these times she is unable to continue with activities and lays down. Range of motion testing reveals forward flexion to 40 degrees with objective evidence of pain at 35 degrees; extension was to 30 degrees with objective evidence of pain at 5 degrees; right lateral flexion was to 30 degree with objective evidence of pain at 25 degrees; left lateral flexion was measured to 20 degrees with objective evidence of painful motion at 5 degrees; and, lateral rotation was measured to 20 degrees, bilaterally. Objective evidence of painful motion was noted at 15 degrees on right rotation, and 5 degrees on left rotation. After 3 repetitions, measured motion was unchanged. Functional loss consisted of less movement than normal and pain on movement. Lower extremity muscle strength was normal and there was no atrophy. Reflexes were hypoactive. Sensation was decreased in the left lower leg/ankle, and in the foot/toes. Sensation was otherwise normal, bilaterally. Straight-leg raise testing was negative. Radiculopathy in the left lower extremity was assessed as moderate numbness and paresthesias. There was no radiculopathy in the right lower extremity. There were no other neurological abnormalities. The examiner noted the total duration of incapacitating episodes was least than 1 week over the prior 12 months. The examiner diagnosed degenerative disc disease and lumbar disc herniation with radiculopathy (Record 11/30/2011). A March 14, 2012, clinical note reveals the Veteran's complaint that she was in unbearable pain 7 "times" a week due to her low back. Examination revealed full range of motion of the thoracolumbar spine with no muscle spasms (Record 08/26/2019 at 499). A VA Examination of the low back in October 30, 2019, reveals the Veteran's complaint of symptom flares such that "it's hard to stand up, it's hard to walk, the pain is constant." Functional was described as "I can't run, jump, play sports, prolonged standing, sitting or walking long distances." Forward flexion of the thoracolumbar spine was measured to 60 degrees. Extension was measured to 10 degrees. Lateral flexion was measured to 15 degrees, bilaterally. Rotation was measured to 20 degrees, bilaterally. The combined range of motion as calculated by the Board is / degrees. Pain was noted with all motion. This pain caused functional loss. There was pain with weight-bearing. After 3 repetitions, there was no additional limitation of motion. After repeated use over a period of time, the examiner stated: "There is no further ROM loss anticipated during these scenarios, only increased symptoms of pain and thus no ROM estimate is warranted." With flares, forward flexion of the thoracolumbar spine was estimated to be 30 degrees. Extension was estimated to 3 degrees. Lateral flexion was estimated to 5 degrees, bilaterally. Rotation was estimated to 10 degrees, bilaterally. The combined range of motion as calculated by the Board is / degrees. Muscle spasms resulted in abnormal gait or abnormal spine contour. Symptoms included disturbance of locomotion, interference with sitting, and interference with standing. Muscle strength in the lower extremities was reduced, but there was no muscle atrophy. Reflexes were reduced, but sensation was normal. Lower extremity radiculopathy was present to a moderate degree. There were no other neurological abnormalities. The Veteran wore a brace regularly. The functional impact was no heavy lifting, prolonged sitting, standing, or extended ambulation, and no high impact exercises or activities. The examiner diagnosed degenerative disc disease with bilateral lower extremity radiculopathy (Record 10/30/2019). After a review of all of the evidence, the Board finds that the criteria for a disability rating of 20 percent were met during the period prior to November 30, 2011. However, for that period, and for the period from November 30, 2011, to October 28, 2019, the criteria for a rating higher than 20 percent were not met; and, for the period since October 28, 2019, the criteria for a rating higher than 40 percent are not met. The Veteran has provided competent and credible evidence that motion of her low back was painful for the entire period on appeal. She report constant daily back pain in June 2011 and underwent surgery that same month. This is probative and persuasive evidence that motion of the Veteran's spine has been painful for the entire period. Therefore, consistent with 38 C.F.R. § 4.59, the Board finds that a rating of at least 10 percent is warranted prior to November 30, 2011. Moreover, the evidence indicates that a still higher rating of 20 percent is warranted. The November 2011 VA examination substantiates entitlement to a rating of 20 percent based on limitation of motion. The Veteran has indicated that the VA examiner in April 2010 did not use instruments to measure range of motion. Under VA regulations, the use of a goniometer in the measurement of limitation of motion is "indispensable" in examinations conducted within the Department of Veterans Affairs. 38 C.F.R. § 4.46. The Veteran may not be competent to identify a goniometer, but she is competent to report that no instrument of any kind was used. In light of proximity in time of the November 2011 to the April 2010 examination, the Board finds the results of the November 2011 examination to be of greater probative weight than the prior examination in which a goniometer was not used. However, the Board finds that a rating higher than 20 percent is not warranted at any time prior to October 28, 2019, the evidence did not substantiate forward flexion of the thoracolumbar spine limited to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. As demonstrated on the November 2011 VA examination, motion of the thoracolumbar spine clearly exceeded those extents. The Board also finds that, since October 28, 2019, the evidence does not substantiate unfavorable ankylosis of the entire thoracolumbar spine. The Veteran still retains flexion and extension beyond the neutral position (0 degrees), and she does not have any of the conditions associated with unfavorable ankylosis. In light of these findings of fact, the Board concludes that a disability rating of 20 percent is warranted for the period prior to November 30, 2011; however, no higher ratings are warranted for the subsequent periods on appeal. In denying higher ratings, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim to those extents, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 371 (2017) (the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Increased RatingsLaw and Regulations VA law provides that, for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during a period of war, or other than a period of war, the United States will pay to any veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation, except if the disability is a result of the veteran's own willful misconduct or abuse of alcohol or drugs. 38 U.S.C. §§ 1110, 1131 (West 2014). Entitlement to service connection on a direct basis requires (1) evidence of current nonservice-connected disability; (2) evidence of in-service incurrence or aggravation of disease or injury; and (3) evidence of a nexus between the in-service disease or injury and the current nonservice-connected disability. 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Saunders v. Wilkie, 886 F.3d 1356 (2018). Service connection on a secondary basis requires (1) evidence of a current nonservice-connected disability; (2) evidence of a service-connected disability; and (3) evidence establishing that the service-connected disability caused or aggravated the current nonservice-connected disability. 38 C.F.R. § 3.310. For specific enumerated diseases designated as "chronic" there is a presumption that such chronic disease was incurred in or aggravated by service even though there is no evidence of such chronic disease during the period of service. In order for the presumption to attach, the disease must have become manifest to a degree of 10 percent or more within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Presumptive service connection for the specified chronic diseases may alternatively be established by way of continuity of symptomatology under 38 C.F.R. § 3.303(b). However, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a) Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Entitlement to service connection for a sinus disorder. Entitlement to service connection for an allergic disorder. Entitlement to service connection for a gynecologic disorder. Entitlement to service connection for a bilateral knee disorder. Service treatment records reveal a July 3, 2002, complaint of menstrual cramps (Record 04/02/2015 at 116). A November 7, 2002, gynecology examination reveals normal findings (Record 04/02/2015 at 136). A January 6, 2003, clinical note reveals complaint of sinus drainage. The examiner assessed an upper-respiratory infection (Record 04/02/2015 at 132). An October 22, 2003, gynecology examination reveals complaint of tearfulness and pelvic pain. The diagnosis was PMS (premenstrual syndrome) (Record 04/02/2015 at 105). A March 4, 2004, clinical note reveals complaints of sinus pressure and discharge. The examiner assessed sinusitis (Record 04/02/2015 at 103). A March 22, 2004, clinical note reveals complaint of itchy, watery eyes, sneezing, and blood in mucous when blowing her nose for 4 days. The assessment was allergic rhinitis (Record 04/02/2015 at 102). A July 22, 2005, clinical note reveals the Veteran's complaint of passing clots (in menses) (Record 04/02/2015 at 8). A June 26, 2006, clinical note reveals complaint of vaginal irritation. The diagnosis was vaginitis candida albicans (Record 04/02/2015 at 44). An August 9, 2006, clinical note reveals primary complaint of having fallen down some steps. There were no head symptoms, no ENT symptoms, and no pulmonary symptoms. With the exception of pain to the coccyx, there were no other orthopedic injuries (Record 04/02/2015 at 36). A list of "chronic" illnesses from a non-VA provider includes allergic rhinitis with a date of onset or diagnosis as September 15, 2006, and chronic maxillary sinusitis with a date of onset or diagnosis as November 1, 2006 (Record 08/26/2019 at 815). A November 1, 2006, X-rays shows normal sinuses. The Veteran had complained of sinus congestion for the prior month. The diagnosis was chronic maxillary sinusitis (Record 08/26/2019 at 199). A pelvic examination on November 5, 2008, was normal (Record 04/02/2015 at 55). A January 22, 2008, clinical note reveals a diagnosis of an upper-respiratory infection (Record 04/02/2015 at 68). A February 24, 2009, CT scan shows acute sinusitis (Record 08/26/2019 at 197). An April 20, 2009, Clinical Note reveals that ENT examination and musculoskeletal examination was normal (Record 04/02/2015 at 76). A May 5, 2009, Clinical Note reveals that examination of the nose and sinuses was normal (Record 04/02/2015 at 63). A June 17, 2009, Clinical Note reveals that on musculoskeletal examination, the Veteran's knees were normal (Record 04/02/2015 at 58). X-rays of the bilateral knees in June 2009 were normal (Record 08/26/2019 at 195). A June 17, 2009, examination at service separation reveals complaint of bilateral knee pain. Examination of the head and lungs was normal. The knees were normal in appearance. There was no tenderness to palpation. range of motion was normal. There was no pain with motion. There was no muscle weakness (Record 08/26/2019 at 559). The report of an April 2010 VA Gynecology Examination reveals the Veteran's history of irregular menses prior to her pregnancy. The examiner assessed premenstrual "Disphofic" disorder-resolved-not active (Record 04/14/2010 at 33). The report of an April 2010 VA Nose and Sinus Examination reveals the Veteran's history of allergies and sinus infections in service. At the time of the examination, no rhinitis or sinusitis symptoms were present. The examiner concluded that there was no objective evidence of allergic rhinitis or sinusitis from the examination (Record 04/14/2010 at 17). The report of an April 2010 VA Joints Examination reveals the Veteran's history of knee pain in service. She denied any specific trauma. X-rays were reported as normal. The examiner assessed a normal bilateral knee examination (Record 04/14/2010 at 13). An October 2, 2017, clinical note reveals the Veteran's sinuses were not tender to palpation or percussion (Record 11/06/2019 at 13). Knee X-rays in June 2014 showed degenerative changes, right more than left (Record 08/26/2019 at 194). After a review of all of the evidence, the Board finds that the criteria for entitlement to service connection for chronic sinusitis and allergic rhinitis are met. However, the criteria for entitlement to service connection for a bilateral knee disorder or a gynecological disorder are not met. The clinical records from the Veteran's non-VA service department provider shows diagnoses of chronic sinusitis and allergic rhinitis while the Veteran was still in service. Accordingly, with resolution of all reasonable doubt in favor of the claims, the Board finds that service connection for these conditions is warranted. As this represents the full benefit sought on appeal, there is no prejudice resulting from any deficiency in the duties to notify or assist. The Veteran has not clearly described the nature of the gynecological disorder she is claiming. On the claim form, she listed PMS. On the April 2010 examination, she described irregular menses prior to her pregnancy. On the Notice of Disagreement, she described inflamed hemorrhoids as the disorder. The Board finds the April 2010 opinion to be persuasive regarding the lack of chronic disability involving the irregular menses and the diagnosed condition of premenstrual "disphofic" (presumed to be either dysphoric or dysphonic) disorder (resolved-not active). Regarding PMS, this would not appear to be a chronic disability for which service connection can be granted. Regarding hemorrhoids, there is no associated injury or disease in service. Accordingly, giving the broadest interpretation to her claim, the Board finds that service connection for any reasonably raised gynecologic claim is not warranted. With respect to the bilateral knee disability, there is no injury or disease in service. The Veteran states that her knees were painful in service; however, the June 17, 2009, service separation examination indicates that the Veteran's knees were normal. Thus, her complaint of knee pain was investigated by a competent medical professional and found to be not indicative of a disorder. Examination was also normal after service in April 2010. She did not report knee symptoms in relation to the August 2006 fall. This is persuasive evidence that there was no injury or disease in service, and there was no knee disability at the time of service separation. The Board has considered the Veteran's lay statements regarding the etiology of her knee symptoms. While the Veteran is competent to describe joint pain, she is not competent to determine the medical cause or origin of the pain. Service connection is in effect for bilateral lower extremity radiculopathy, which is manifested by lower extremity pain. She has not provided evidence that would distinguish her lower extremity pain due to radiculopathy from a distinct knee disorder. In sum, the Board finds that the claimed gynecological disorder and bilateral knee disorders are not related to service. In light of these findings of fact, the Board concludes that service connection for the claimed disorders is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against each claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Cramp 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.