Citation Nr: 21042513 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 11-04 174 DATE: July 13, 2021 ORDER Entitlement to an increased rating in excess of 10 percent for a back disability, prior to May 30, 2018, is denied. Entitlement to an increased rating in excess of 20 percent for a back disability, from May 30, 2018, is denied. Entitlement to an increased rating in excess of 10 percent for radiculopathy of the left lower extremity (sciatic), prior to July 13, 2020, is denied. Entitlement to an increased rating in excess of 20 percent for radiculopathy of the left lower extremity (sciatic), from July 13, 2020 is granted. Entitlement to an increased rating in excess of 10 percent for radiculopathy of the right lower extremity (sciatic), prior to July 13, 2020, is denied. Entitlement to an increased rating in excess of 20 percent for radiculopathy of the right lower extremity (sciatic), from July 13, 2020, is granted. Entitlement to a separate rating of 20 percent for radiculopathy of the left lower extremity (femoral), effective July 13, 2020, is granted. Entitlement to a separate rating of 20 percent for radiculopathy of the right lower extremity (femoral), effective July 13, 2020, is granted. Entitlement to a compensable rating for right great toe hallux valgus is denied. REMANDED Entitlement to service connection for a urinary frequency is remanded. Entitlement to service connection for a disability manifested by groin pain, claimed as secondary to the service-connected lumbar spasm is remanded. Entitlement to service connection for plantar fasciitis is remanded. Entitlement to an increased rating in excess of 30 percent for sinusitis is remanded. Entitlement to an increased rating in excess of 10 percent for gastroesophageal reflux disease (GERD) and cirrhosis of the liver is remanded. Entitlement to a total disability rating based on individual unemployability by reason of service-connected disability (TDIU) is remanded. FINDINGS OF FACT 1. Prior to May 30, 2018, the preponderance of evidence is against a finding that the Veteran's back disability manifested with a range of motion limited to less than 60 degrees of flexion, a combined range of motion of less than 120 degrees, or evidence of ankylosis, abnormal gait, or spinal contour. 2. From May 30, 2018, the preponderance of evidence is against the finding that a back disability manifested with a range of motion limited to 30 degrees or less of flexion or ankylosis. 3. Prior to July 13, 2020, radiculopathy of the left and right lower extremities was manifested by symptoms of mild incomplete paralysis of the sciatic nerve. 4. From July 13, 2020, radiculopathy of the left and right lower extremities was manifested by symptoms of moderate incomplete paralysis of the sciatic and femoral nerves. 5. The Veteran's hallux valgus of the right great toe does not require an operation with resection of the metatarsal head, nor is it so severe that it requires the equivalent of an amputation of the great toe. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 10 percent for a back disability, prior to May 30, 2018, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.105(e), 4.1, 4.2, 4.3, 4.21, 4.71(a), General Rating Formula for Diseases and Injuries of the Spine. 2. The criteria for entitlement to a rating in excess of 20 percent for a back disability, from May 30, 2018, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.105(e), 4.1, 4.2, 4.3, 4.21, 4.71(a), General Rating Formula for Diseases and Injuries of the Spine. 3. The criteria for a rating in excess of 10 percent for radiculopathy of the left lower extremity (sciatic), prior to July 13, 2020, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8520. 4. The criteria for a rating in excess of 10 percent for radiculopathy of the right lower extremity (sciatic), prior to July 13, 2020, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8520. 5. The criteria for an increase rating of 20 percent, but not higher, for radiculopathy of the left lower extremity (sciatic), from July 13, 2020, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8520. 6. The criteria for an increase rating of 20 percent, but not higher, for radiculopathy of the right lower extremity (sciatic), from July 13, 2020, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8520. 7. The criteria for a separate rating of 20 percent, but not higher, for radiculopathy of the left lower extremity (femoral), from July 13, 2020, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8526. 8. The criteria for a separate rating of 20 percent, but not higher, for radiculopathy of the right lower extremity (femoral), from July 13, 2020, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code 8526. 9. The criteria for a compensable rating for hallux valgus right great toe, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5280. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from May 1985 to May 2005. These matters come before the Board of Veterans' Appeals (Board) on appeal of January 2009, July 2010, and October 2015 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. With specific regards to the Veteran's claim for service connection for urinary frequency and plantar fasciitis, the Board has recharacterized these claims to reflect the underlying substantive claims. Here, while the RO and previous Board remand had characterized these claims as requiring new and material evidence, the Board finds that a close review of the procedural history of these claims show that such claims has been continuously appealed since their initial denial, and as such does not require reopening. These claims were initial denied in a September 2009 RO rating decision. In December of 2009, the Veteran submitted additional testimony directly contesting this denial. While the Veteran lay statements noted a 'reconsideration' of the RO's initial denial, the Board interprets this contest to be a timely Notice of Disagreement (NOD). The Board notes that during this period, VA law did not required NOD's to be submitted on mandated VA Forms, and informal submission could be construed as NODs to a previous denial. Here, as such contest to the September 2009 rating decision was submitted within a year of that decision, such qualifies as a timely NOD, and as such, the proceeding claim, to include the subsequent July 2012 Statement of the Case (SOC) and September 2012 substantive appeal (VA Form 9), were all a part of the Veteran's original claim for service connection, and not a claim to reopen. Consequently, the Veteran's substantive claims are now before the Board for appellate review. Increased Rating VA's percentage ratings are based on the average impairment of earning capacity as a result of service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. All reasonable doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If two disability evaluations are potentially applicable, 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. Although VA recently amended several of the diagnostic codes or rating criteria for disabilities on appeal, effective February 7, 2021, a close review of these new criteria do not yield a higher rating for the applicable claims herein, and a such will not be discussed further. A separate or higher rating may be assigned based on non-overlapping conditions and symptoms, if the compensable criteria under applicable diagnostic codes are met, including with consideration of additional functional loss after repetitive use or flareups for musculoskeletal conditions based on range of motion. See 38 C.F.R. §§ 4.14, 4.40, 4.45, 4.59, 4.71a; Amberman v. Shinseki, 570 F.3d 1377 (Fed. Cir. 2009); Thompson v. McDonald, 815 F.3d 781 (Fed. Cir. 2016). Pain itself does not constitute functional loss, and painful motion must result in functional loss to constitute limited motion for a rating under diagnostic codes based on limitation of motion. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). The most relevant information in determining the appropriate initial disability rating pertains to the severity of the disability since the effective date of service connection. Fenderson v. West, 12 Vet. App. 119 (1999). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). In either situation, a staged rating may be awarded if there are decreases or increases in symptomatology that meet the criteria for a different rating for a distinct period during the appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). This decision focuses on the evidence pertinent to the rating criteria and disability severity during the relevant period on appeal for each issue, but the Board has considered the entire record to have a full picture of the disability. See 38 C.F.R. §§ 4.1, 4.2, 4.41; Gonzales v. West, 218 F. 3d 1378 (Fed. Cir. 2000). 1. Entitlement to an increased rating in excess of 10 percent for a back disability, prior to May 30, 2018 The Veteran claims that his service-connected back disability is more severe than contemplated by the 10 percent rating assigned prior to May 30, 2018. A review of the competent medical evidence of record, to include VA medical records and a VA examination, shows evidence of, essentially, normal range of motion, with no evidence ankylosis, abnormal gait, or spinal contour. Therefore, the Board finds that a higher rating for the Veteran's back disability is not warranted under the General Rating Formula for Diseases and Injuries of the Spine, and the claim for increased prior to May 30, 2018, must be denied. The rating criteria use a General Rating Formula for Diseases and Injuries of the Spine for Diagnostic Codes 5235 to 5243 unless 5243 is rated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. The General Rating Formula provides a schedule of ratings for spine disabilities 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. Unfavorable ankylosis of the entire spine warrants a 100 percent rating. Unfavorable ankylosis of the entire thoracolumbar spine warrants a 50 percent rating. Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine warrants a 40 percent rating. Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine warrants a 30 percent rating. Forward flexion of the thoracolumbar spine greater than 20 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis warrants a 20 percent rating. Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or the combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, the combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding or localized tenderness not resulting in abnormal gait or abnormal spinal contour, or, vertebral body fracture with loss of 50 percent or more of the height warrants a 10 percent rating. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. The rater is instructed to rate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). For VA compensation purposes, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 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. §§ 4.71, 4.71a, Plate V, General Rating Formula for Diseases and Injuries of the Spine, Note (2). Each range of motion measurement is rounded to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (4). In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion. Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (3). 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 (0 degrees) always represents favorable ankylosis. Each range of motion measurement is rounded to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). Disability of the thoracolumbar and cervical spine segments is separately rated, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. Each range of motion measurement is rounded to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (6). Where there is a question as to which of two ratings is to be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When rating disabilities using Diagnostic Codes which provide a rating on the basis of loss of range of motion, VA must consider, to the extent practicable, the degree of additional loss of function due to pain, weakened movement, excess fatigability, or incoordination. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45. As noted above, under the General Rating Formula, the next higher rating of 20 percent rating is warranted if 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. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. During this period, the Veteran was provided with VA examinations assessing the nature and severity of his back disability in July 2005, October 2008, and June 2016. During his initial examination in July 2005 the Veteran was diagnosed with degenerative disc disease of the lumbar spine. The Veteran was noted to report consistent back pain, with reports of decreased motion, especially upon prolonged use; to this end, the Veteran reported that he was very limited in walking and standing, typically being able to walk about 100 yards and/or standing for 30 minutes before increased pain. The Veteran noted flare-ups, to include at least on episodes within the last year that required him to say in bed. On examination, the Veteran's range of motion was recorded as essentially normal, with 90 degrees of forward flexion, and a combined range of motion limited 240 degrees. The examiner noted no spasms, abnormal gait, or ankylosis. The examiner noted pain on movement, with no decreased in range after repetitive motion testing. Finally, the examiner noted no effects of incoordination, fatigue, weakness, or lack of endurance on spine function. In his October 2008 VA examination for the back, the examiner found that recent X-rays did not note any disc disease and the Veteran was in fact diagnosed with back spasms. The examiner noted the Veteran's reports of daily moderate pain, to include radiating pain down both legs; other symptoms described included stiffness and spasms. The Veteran also reported weekly flare-ups as a result of consistent walking due to his job as a mail carrier for the United States Postal Service; the Veteran claims that these flare-ups cause additional limitation of motion of 65 percent of normal. To this end, however, the Veteran noted that he could walk around one to three miles a day. Upon examination tests for muscle strength, sensory, and reflex examinations all returned normal, to include no evidence of ankylosis, abnormal gait, or lordosis. Range of motion testing reveals normal range of motion, on both active and passive motions, with no objective signs of pain. Functionally, the examiner noted that such disability would have significant effect on the Veteran's employment with increased absenteeism. The Veteran was afforded another VA back examination in June 2016, during the relevant period. During the examination the Veteran was diagnosed with degenerative arthritis of the spine and IVDS. The Veteran identified flare-ups, to include increased pain due to prolonged use to include walking and standing. Upon range of motion testing the Veteran's flexion was noted to be limited to 70 degrees, and extension, lateral flexions, and lateral rotations all to be limited to 20 degrees; with a combined range of motion of 170 degrees. Pain was not noted on weight bearing, with localized tenderness noted on palpation. Repeat range of motion tests revealed no additional loss of range of motion, and the examiner noted any loss of range of motion during flare-ups could not be predicted without speculation. Further examination noted no muscle spasms or guarding, normal muscle strength, reflex, and sensory exams. Ankylosis was not found, and no incapacitating episodes were noted due to the Veteran's IVDS. For the relevant period prior to May 30, 2018, other than that VA examination of record, there is no medical evidence that has shown a worsening condition commensurate to the criteria for a rating in excess of 10 percent, to include in records for VA and private treatment. The Board notes that the Veteran's claims file contains contemporaneous VA and private medical records for the back disability throughout the period. However, those medical records do not show any quantitative increase in severity of the back disability with regards to the objective criteria set out in the rating schedule. Furthermore, those records do not show additional diagnoses of any conditions or symptoms which would warrant a rating higher than those noted in the VA examination. Specifically, the evidence does not show that the Veteran had ankylosis, forward flexion of 60 degrees or less, or had muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. The Board notes that while the VA examinations of record all noted that the Veteran had back pain, which limited his mobility and activities, the objective measurements of the Veteran's range of motion during the examination do not provide the degree or severity of the limitation such that any higher rating could be assigned. Likewise, with regards to the VA treatment records, while evidence of pain is prevalent, there is no indication that the Veteran's condition fulfills the objective criteria requisite for the next higher rating. As an example, the VA medical records show treatment for the back disability throughout the pertinent period, to include conducting X-ray diagnostics. However, the Board notes that those records only detail various treatments for pain, but do not provide any analysis or testing to identify the degree in which the range of motion was affected, or the degree of functional impairment the Veteran had as a result of pain. Therefore, the Board finds that the most persuasive evidence is the range of motion measured at the VA examination noted herein. In making this determination, the Board is cognizant of the Veteran's complaints of increased pain after prolonged use, to especially include during flare-ups. However, a closer review of the objective evidence do not show that flare-ups or repeated use over time additionally limited function in a quantifiable way, or that they are of such length or duration that a higher or staged rating would not violate the rule regarding stabilization of ratings. As noted above, pain alone is not sufficient to constitute limitation of motion without resulting additional functional loss, and painful motion alone does not constitute limited motion for the purposes of rating under the codes pertaining to limitation of motion for a particular disability, as opposed to assigning a minimum rating under DC 5003 or section 4.59. Therefore, the Veteran's reports of exacerbation after repeated use or during flare-ups are not quantifiable and not of sufficient duration to warrant a change in evaluation without violating the spirit of Mitchell, 38 C.F.R. § 4.1, and the rule regarding stabilization of ratings. As the evidence reflects significant forward flexion and combined range of motion despite increased pain or other contributing factors, these factors did not result in a greater degree of functional loss or limitation than noted above for a back disability. Further, the Board points out that throughout the claims period, and in every examination, the VA examiner tested the Veteran's range of motion on repeat use basis, and in each instance, the examiner reported no additional loss of range of motion were noted. The Board does acknowledge that the Veteran had noted during this October 2008 examination that he experienced a 65 percent loss of range of motion due to flare-ups. The Board, however, finds that such estimation to be not highly probative in establishing the objective criteria for a higher rating. First, the Board finds that the Veteran is not competent to provide such an exacting number of loss of range of motion. Exact measure of range of motion requires not only medical expertise and training, but also specific equipment used by the medical profession during examinations to determine such objective results. The Board finds that the Veteran has presented no evidence that he possessed either the medical training or the equipment requisite to make a competent assessment of such exacting number regarding his loss of range of motion. Second, the 65 percent loss of range of motion is not explained by the Veteran in how he arrived at such number. It is also unclear whether flare-ups result in a 65 percent decrease in range of motion, or that the range of motion remaining is 65 percent of his normal range of motion. The Board finds that in light of the surrounding evidence of ostensibly normal finding for range of motion on examinations, and upon repeat testing, the probative value of this assertion of such a dramatic loss of range of motion during flare-ups is minimal. The Board also notes that during this same examination, the Veteran was noted that he was still employed as a mail carrier, and that he walked one to three miles daily. As such, the Board does not find that this single unsubstantiated report of loss of range of motion during flare-ups is insufficient to meet the criteria for the next higher rating. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). Therefore, those records do not support a claim for an increased rating in excess of 10 percent. Consequently, with no competent evidence of a condition worse than that reported during the VA examinations, during the relevant period, the Board finds that a rating in excess of 10 percent is not warranted. The Board finds that the preponderance of the evidence is against the assignment of any higher rating prior to October 5, 2012, and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to an increased rating in excess of 20 percent for a back disability, from May 30, 2018 The Veteran claims that his service-connected back disability is more severe than contemplated by a 20 percent rating assigned for this relevant claim period from May 30, 2018. A review of the competent medical evidence of record, to include VA medical records and VA examinations, shows no evidence of a decreased range of motion with forward flexion limited to less than 30 degrees, or evidence of ankylosis. Therefore, the Board finds that a higher rating for the Veteran's back disability is not warranted under the General Rating Formula for Diseases and Injuries of the Spine, and the claim for increased rating, must be denied. As noted above, under the General Rating Formula, a higher rating of 40 percent is warranted if forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. During the claim period, the Veteran was provided several VA examinations assessing the nature and severity of the back disability in May 2018 and July 2020. In the initial May 2018 VA examination, the Veteran was diagnosed with degenerative disk disease and IVDS of the lumbar spine. The Veteran was noted to report back pain and stiffness, with reports of decreased motion and flare-ups, to especially include after prolonged use to include walking and standing. On examination, range of motion was recorded as 60 degrees of forward flexion with evidence of pain, and repeat motion testing revealed no additional decreased in range. The examiner did not note any findings of ankylosis, or evidence of incapacitating episodes due to IVDS. At a July 2020 VA examination of the back disability, the Veteran was noted to report pain in the back, with reports of flare-ups and limited range of motion. On examination, range of motion was recorded to be limited to forward flexion of 60 degrees, with evidence of pain. Repeat testing reveals further decrease in range of motion to include limitation of flexion decreased to 50 degrees. The examination report noted no diagnosis of ankylosis, or incapacitating episodes due to IVDS. The Veteran was diagnosed with degenerative disc disease of the spine. The Board finds that based on the competent and probative medical evidence that a higher rating in excess of 20 percent is not warranted. The next higher rating of 40 percent requires forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. Similar to the examinations of record, there is no medical evidence that has shown a worsening condition commensurate to the criteria for a rating in excess of 20 percent, to include in records of VA treatment. The Board notes that the claims file contains contemporaneous VA medical records for the back disability throughout the claim period. However, review of those records does not show quantitative increase in severity of the back disability with regards to the objective criteria set out in the rating schedule requisite for the next higher rating. Specifically, the medical records do not demonstrate objective testing demonstrating limitation of flexion of 30 degrees or less. Therefore, the Board finds that the preponderance of evidence remains against the finding that the Veteran's back disability was of a sufficient severity as to warrant a higher rating, based on range of motion. Furthermore, those records do not show additional diagnoses of any conditions or symptoms which would warrant a rating higher than those noted in the VA examinations. Specifically, the evidence does not show that the Veteran has any form of ankylosis that would warrant a higher rating. While the Board acknowledges that in most VA examination and medical records, the Veteran's ability to bend and lift things were limited due to the functional loss from his back disability, to this end, the Veteran's condition has never been so severe as to preclude movement of his spine akin to a finding of ankylosis. In fact, as the physical testing during VA examinations throughout the claims period show, the Veteran still has ample movement remaining despite his back disability. Therefore, the Board finds that the most persuasive evidence is the range of motion measured at the VA examinations of record. Consequently, with no competent evidence of a condition worse than that reported during the VA examinations during the relevant period, the Board finds that a rating in excess of 20 percent is not warranted, even considering functional loss due to flare-ups. The Board has considered, along with the schedular criteria, functional loss due to pain, fatigability, incoordination, pain on movement, and weakness. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board finds that the claims file does not contain sufficient evidence to support any additional increase in disability rating based on any functional loss due to flare-ups of pain. While the Veteran has reported experiencing pain and flare-ups, medical records and examinations show that pain did not result in functional loss. Specifically, during his VA examinations, the VA examiners noted that even upon repeat testing the Veteran's range of motion was only limited to 50 degrees of flexion, which is still in excess of the requisite criteria of 30 degrees of flexion, for the next higher rating. Therefore, the Board finds that no further increase in the Veteran's current back rating is warranted due to any additional factors causing limitation of function. Furthermore, the Board has considered the Veteran's consistent reports of pain, in conjunction with the examinations of record, in finding that the current disability ratings were warranted, despite a greater range of motion at the subsequent examination. The Board, in making the determination of the Veteran's ratings has not ignored the Veteran's statements concerning the symptomology of his back disability, with specific regard to pain and limitation of function. The Board finds that the Veteran is a lay person and is competent to report discernable symptoms, such as pain and fatigue. Layno v. Brown, 6 Vet. App. 465 (1994). Whether lay evidence is considered competent and sufficient in a particular case is an issue of fact and lay evidence can be competent and sufficient to establish a diagnosis when (1) a layperson is competent to identify the medical condition (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), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Here, an opinion concerning the relationship between the Veteran's symptoms and a specific level of impairment of his back disability is of a medically complex nature. The diagnosis and analysis require expert medical training and the use of diagnostics which the Veteran has not demonstrated he possesses. Therefore, the Board finds that the Veteran is not competent provide an opinion as to whether the back disability warrants a rating in excess of the disability rating he currently receives for those respective periods. The Board finds that objective evidence provided by the VA examiners of record to be more persuasive than the Veteran's contention that a higher rating is warranted. Finally, the Board notes that a higher rating under Diagnostic Code 5243 for IVDS is also not warranted, as the preponderance of the evidence is against the finding that the Veteran's IVDS caused him to be prescribed bed rest. The Board notes that while VA examinations have noted IVDS, the examiners have consistently noted no incapacitating episodes in the reports. Likewise, a review of the contemporaneous medical records also does not demonstrate any evidence that a physician prescribed bed rest as to constitute an incapacitating episode under the relevant Diagnostic Code being necessary during the claimed period. Finally, a close review of the Veteran's own statements and reports regarding flare-ups and pain, does not render any self-described episodes of incapacitating episodes either. The Formula for Rating intervertebral disc syndrome Based on Incapacitating Episodes provides that an incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that required bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note (1). Therefore, as there is no evidence of a prescription of bed rest that constitutes as an incapacitating episode, the Veteran's back does not warrant a higher rating under this Diagnostic Code. Accordingly, the Board finds that, for this time period from May 30, 2018, the criteria for an increased rating in excess of 20 percent for a back disability have not been met. The Board finds the current disability rating adequately contemplate the Veteran's disability picture for this period, and a higher rating is not warranted by the evidence of record, and the claim must be denied. The preponderance of the evidence is against the claim for a higher rating and the claim must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to an increased rating in excess of 10 percent for radiculopathy of the left lower extremity (sciatic), prior to July 13, 2020 4. Entitlement to an increased rating in excess of 10 percent for radiculopathy of the right lower extremity (sciatic), prior to July 13, 2020 The Veteran claims that radiculopathy of the bilateral lower extremity (sciatic) is more severe than the 10 percent rating assigned prior to July 13, 2020. The Board notes that the evidence, to include VA examinations and VA medical records, show that the Veteran's bilateral sciatic radiculopathy increased in severity on July 13, 2020. Therefore, as there is no evidence of an increase in the severity of the radiculopathy prior to that date, the Board finds for the staged period prior to July 13, 2020, a rating in excess of 10 percent is not warranted. Radiculopathy of the bilateral lower extremity (sciatic) is rated under Diagnostic Code 8520 which provides that mild incomplete paralysis is rated 10 percent disabling. A 20 percent rating is assigned for moderate incomplete paralysis. A 40 percent rating is assigned for moderately severe incomplete paralysis. A 60 percent rating is assigned for severe incomplete paralysis, with marked muscular atrophy. An 80 percent rating is assigned for complete paralysis. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The term incomplete paralysis with peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement. When there is bilateral involvement, the VA adjudicator is to combine the ratings for the peripheral nerves, with application of the bilateral factor. 38 C.F.R. § 4.124a. The Veteran attended several VA examinations during the relevant time period prior to July 13, 2020, in July 2005, October 2008, June 2016, May 2018, and November 2019; these, examinations included VA examinations for his back, that also spoke to his neuropathy/radiculopathy. The Board will address these in turn. In an initial examination for the Veteran's disability, in July 2005, the VA examiner noted that the Veteran complained about bilateral pain radiating from his low back down his bilateral thighs. While the generalized examination report did not note an actual diagnosis of radiculopathy, the examiner explicitly noted 'radicular pain' in the Veteran's diagnosis of the back. In an October 2008 VA examination, the Veteran was specifically afforded a peripheral nerve disorders examination to assess the nature and severity of his service-connected sciatic disability of the lower extremities. Upon examination, however, the examiner noted normal muscle tone, normal sensory examination, and normal reflexes. The examiner's comment at the end of the report did note the Veteran's radiating pain, noting such as radiculopathy, however, provided no actual diagnoses; to this end, the examiner's notes found that there was "insufficient evidence" to warrant a diagnosis for peripheral neuropathy and/or radiculopathy. During the same examination session, the Veteran's back/spine disability was also evaluated, however, no mention or evaluation of the Veteran's claimed radiculopathy was noted as part of that report. In a June 2016 VA examination, the Veteran was afforded a back examination, in which radiculopathy was diagnosed and evaluated. Here, the examiner noted that the Veteran's suffered from incomplete paralysis of the bilateral sciatic nerve, with complaints of moderate content pain, severe intermittent pain, severe paresthesias/ dysesthesias, and moderate numbness. Reflex, sensory, and muscle strength examinations all returned normal. The examiner ultimately found that such radiculopathy was only considered mild in nature. In a May 2018 VA examination, the Veteran was again afforded a back examination, which included an evaluation of the Veteran's radiculopathy. Like the pervious examination, the examiner noted that the Veteran suffered from incomplete paralysis of the bilateral sciatic nerve, with complaints of moderate content pain, intermittent pain, and moderate numbness, with no complaints of paresthesias/dysesthesias. Reflex, sensory, and muscle strength examinations all returned normal. The examiner ultimately found that such radiculopathy was only considered mild in nature. Finally, in November 2019, the Veteran was afforded a neurological examination. During the examination, the Veteran again was noted to report pain shooting down his legs/thighs from his posterior down his leg. The examiner noted reports of mild to moderate pain, mild paresthesias/dysesthesias, and mild numbness. Upon examination the examiner noted normal result of strength, slightly diminished sensory on the thighs, and slight hypoactivity in the ankles (+1). The examination noted no evidence of atrophy or trophic changes related to the Veteran's lower extremity condition. The examiner again found that the Veteran's radiculopathy of the bilateral lower extremity only affected the sciatic nerve, with incomplete paralysis that was only considered mild. Other than these VA examinations, the contemporaneous VA medical records, and lay statements, shows that the Veteran's radiculopathy of the sciatic nerve was considered mild. The Board notes that a close review of the other VA medical records in the claims file shows no other evidence, that could constitute sufficient to warrant a higher rating, or demonstrate that the Veteran's condition was moderate. While the Veteran complained of pain, the symptoms were wholly sensory and did not include additional symptomatology that would raise to the level of mild/moderate, especially in light of the VA examinations, where considering all factors of the Veteran's symptoms, related to his sciatic disability, the medical professional consistently noted that such condition was mild. Therefore, a higher rating than the 10 percent for the left leg radiculopathy was not warranted prior to July 13, 2020, and the claim for increased rating for that period must be denied. 5. Entitlement to an increased rating in excess of 20 percent for radiculopathy of the left lower extremity (sciatic), from July 13, 2020 6. Entitlement to an increased rating in excess of 20 percent for radiculopathy of the right lower extremity (sciatic), from July 13, 2020 7. Entitlement to a separate rating of 20 percent for radiculopathy of the left lower extremity (femoral), effective July 13, 2020 8. Entitlement to a separate rating of 20 percent for radiculopathy of the right lower extremity (femoral), effective July 13, 2020 The Boards notes that dichotomously, in a July 13, 2020 VA back examination found that the Veteran's radiculopathy was not only more severe, as to be considered moderate, with regards to the Veteran's bilateral sciatic nerve, but that the Veteran's radiculopathy also included incomplete paralysis of the femoral nerve. As such, the Board finds that an increased rating to a 20 percent rating for a sciatic nerve, and separate ratings for radiculopathy of the femoral nerve, are both warranted, for the period from July 13, 2020. Here, in a July 13, 2020, VA examination for the Veteran back disability, the VA examiner noted that the Veteran radiculopathy manifested with moderate pain, numbness and paresthesias/dysesthesias. Examinations revealed normal muscle strength with no atrophy, right side hypoactivity (+1), and normal sensory examinations. However, the examiner found that such radiculopathy showed incomplete paralysis of both the sciatic and femoral nerves, and that both conditions were considered moderate. With regards to the sciatic nerve, as noted above, a higher 20 percent rating is warranted when such condition is characterized as moderate. Here, as the July 13, 2020, is the first instance in which a medical professional has noted that such bilateral condition is considered moderate, the Board finds that such is appropriate for the grant of the next higher rating of 20 percent for both right and left radiculopathy of the sciatic nerve. A higher 30 percent rating is not warranted, as there is no evidence that the condition is considered moderately-severe. Likewise, regarding the July 13, 2020 VA examination, this was the first instance in which a medical professional has noted that such radiculopathy has affected the Veteran's femoral nerve. As such, a separate rating regarding both the left and right femoral nerve is also granted as part and parcel to the Veteran's claim for increased rating. Under the Diagnostic Code for the femoral nerve, moderate incomplete paralysis warrants a 20 percent rating. 38 C.F.R. § 4.124a, Diagnostic Code 8526. A higher rating is not warranted unless the paralysis is considered severe. Therefore, for the period from July 13, 2020, the date of the examination, the Board finds that the evidence demonstrates a more severe disability regarding the radiculopathy of the sciatic nerve, and also an additional disability regarding the femoral nerve. As such, a higher 20 percent rating, but not higher, for the Veteran's radiculopathy of the bilateral lower extremity (sciatic) is granted. Along with such grant, a separate rating of 20 percent is also granted for radiculopathy of the bilateral lower extremity (femoral), also effective July 13, 2020. 9. Entitlement to a compensable rating for right great toe hallux valgus The Veteran contended that his currently service-connected right great toe hallux valgus, is more severe than contemplated by this current noncompensable rating. The Board finds that the relevant medical evidence of record does not demonstrate that the Veteran's right great toe disability is of the severity that meet the criteria for a higher rating, to include requiring resection of the metatarsal head or amputation. As such, the Board finds that a higher rating is not warranted, and the Veteran's claim must be denied. The Veteran Currently has a noncompensable rating under Diagnostic Code 5280. Under Diagnostic Code 5280, a maximum 10 percent rating may be assigned for each foot for hallux valgus if the disability is operated with resection of the metatarsal head or is of a severity analogous to amputation of the great toe. 38 C.F.R. § 4.71a, Diagnostic Code 5280. During the pendency of the claims period, the Veteran was afforded VA examinations in October 2005, May 2018, and July 2020. During his initial examination, the examiner noted that the Veteran reports pain in his foot due to this condition, to especially include after prolonged walking and standing. While the Veteran reported pain and mild discomfort, the examiner noted that the Veteran noted no flare-ups and that such condition did not affect his occupation as a mail carrier or his daily activities. Upon physical testing the examiner diagnosed the Veteran with a hallux valgus deformity, but noted that the right toe was otherwise unremarkable, with no objective evidence of abnormal weightbearing, and no evidence of pain, weakness, edema, instability, or tenderness. Overall, the examiner noted the condition to be mild. In September 2015, the Veteran underwent fusion surgery for his right great toe to relieve pain. A close review of the treating physicians operative notes for the procedure noted that such surgery was not wholly necessary, and that his right side hallux valgus was not "too horrible" but the symptom justified the fusion, especially in light of the operation already done for the contralateral side. The Veteran underwent another VA examination in May 2018. During the examination the Veteran was again diagnosed with hallux valgus, with reports of constant and moderate aching pain, which required the wearing of arch supports. The Veteran reported flare-ups with prolonged use, such as walking; to this end, the examiner also noted swelling and lack of endurance. Ultimately, the examiner noted that the Veteran's right toe condition only constituted as mild/moderate symptoms. In a July 2020 VA examination, the Veteran's right great toe disability was ostensibly evaluated to be in the same condition as prior examination. The Veteran was noted to again complaint of pain in his great toe, to include after prolonged walking/standing. The examiner, here, again noted that the Veteran's symptoms with regards to this condition was only considered mild/moderate. The VA report also noted no resection of the metatarsal head. The Board notes that a close review of the contemporaneous VA and private treatment records also reveals no additional evidence that the Veteran's condition was any more severe than that noted by the VA examiners. While the VA treatment record not complaints of pain, such were noted to be resolved with oral pain killers or ointment to reduce symptoms of pain. No record shows a condition so severe as to require operative intervention so to resection of the metatarsal head, and/or a condition so severe as to be equally served amputated. Based on review of the record, a compensable rating for the Veteran's hallux valgus is not warranted. The Board finds that VA examinations to adequately reflect the Veteran's disability picture, and is of high probative value, as such was done with a comprehensive review of the evidence and medical history, examination of the Veteran, and with consideration of the Veteran's reported symptoms. Therefore, as such examinations do not reflect that the Veteran required surgery of the metatarsal head or severe hallux valgus that is equivalent to amputation of the great toe, the Board must find that the preponderance of evidence remains against the Veteran's claim for a compensable rating, and that the Veteran's claim must be denied. The Board has also considered the provisions of 38 C.F.R. §§ 4.40 and 4.45. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of DeLuca only apply when a diagnostic code is predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7, 9 (1996); see also Sharp v. Shulkin, 29 Vet. App. 26 (2017) (generally requiring estimated motion loss in degrees during periods of flare-ups). As Diagnostic Code 5280 is not based on limitation of motion, the Deluca factors do not apply and the report of flare-ups during the VA examinations cannot serve as the basis for a higher rating. As already stated above, Diagnostic Code 5280 only provides for a compensable rating when there is resection of the metatarsal head or a severity equivalent to amputation of the great toe. The Board has also considered 38 C.F.R. § 4.59, which states, in relevant part, that it is the intention of the rating schedule to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. This regulation cannot provide an independent basis for a compensable rating. See Sowers v. McDonald, 27 Vet. App. 472, 481 - 82 (2016) (citing Petitti v. McDonald, 27 Vet. App. 415, 424 (2015)). Rather, it must be read in conjunction with, and subject to, the applicable diagnostic code. Id. at 479. Here, the only diagnostic code applicable is Diagnostic Code 5280. See Copeland v. McDonald, 27 Vet. App. 333, 336 (2015). Thus, 38 C.F.R. § 4.59 cannot be used to circumvent these specific criteria for a compensable rating for hallux valgus (or bunions). See Sowers, 27 Vet. App. at 481-82 (noting that 38 C.F.R. § 4.59 employs conditional language that must be read in conjunction with the appropriate diagnostic code to be understood and cannot be used to circumvent the statutory and regulatory framework of the rating schedule). The Board notes that the Veteran is competent to report observations about the severity of her symptomatology. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board finds these lay statements to be credible and consistent with the rating assigned even though that is a noncompensable rating. To the extent he argues his symptomatology is more severe, the Veteran's statements must be weighed against the other evidence of the record. Here, the specific examination findings of a trained health care professional during the two examinations and lack of documented surgical treatment are of greater probative weight than the more general lay assertions that a higher rating is warranted. In sum, the preponderance of the evidence is against a compensable rating for right foot hallux valgus; the benefit-of-the doubt doctrine is inapplicable, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a urinary frequency, claimed as secondary to the service-connected lumbar spasm 2. Entitlement to service connection for a disability manifested by groin pain, claimed as secondary to the service-connected lumbar spasm is remanded. 3. Entitlement to service connection for plantar fasciitis is remanded. The Veteran contends that his urinary frequency, groin pain, and plantar fasciitis, are caused by service, and in the alternative is caused or aggravated by his service-connected disabilities. To this end, the Veteran has never been afforded a medical examination to determine whether these claims disabilities are related to his service-connected disabilities, or any aspect of his service. VA's duty to assist includes providing an examination when the record indicates a claim may have merit but there is insufficient evidence to decide the matter. 38 U.S.C. § 5103A; McLendon v. Nicholson, 20 Vet. App. 79 (2006). With regards to the Veteran's claim for urinary frequency, the Board notes that the Veteran was recently service-connected for a psychiatric disability, to include depression. The Board finds that during the course of the claims period, VA treatment records have noted a potential connection between the medication taken for depression and urinary frequency and urgency. As such, the Board finds that such evidence is sufficient to trigger the VA's duty to afford the Veteran a VA examination to assess the nature and etiology of this claimed disability. Likewise, with regards to the Veteran's claim for groin pain, as secondary to the Veteran's back disability. Here, the Board notes that the Veteran is competent to speak to experiencing groin pain and has further alleged that such condition is due to his or aggravated by his back disability. The Board finds that such claim passes the low bar under McLendon and triggers the VA's duty to afford the Veteran a VA examination to assess the etiology of the Veteran's claimed disability. Finally, with regards to the Veteran's plantar fasciitis, the Veteran has submitted ample evidence, to include letters from his treating physicians that he currently or had been diagnosed with during the pendency of the claims period, with plantar fasciitis. As the Veteran is currently service connected for various disabilities affecting the Veteran's foot and lower extremities, the Board finds that a VA examination is required for the VA to fulfill its duty to the Veteran. 4. Entitlement to an increased rating in excess of 30 percent for sinusitis is remanded. The Veteran last underwent a sinus examination in January 2014. The Board recognizes that, generally, the mere passage of time is not a sufficient basis for a new examination. Palczewski v. Nicholson, 21 Vet. App. 174 (2007). However, when available evidence is too old for an adequate evaluation of the current condition, VA's duty to assist includes providing a more current examination. Weggenmann v. Brown, 5 Vet. App. 281 (1993). The Board finds that not only is the last examination remote, but the examination appears to no longer indicate the current level of disability due to sinusitis. Consequently, after all outstanding medical records are associated with the claims file, a more contemporaneous examination is needed to rate the claim for increased ratings for sinusitis. Allday v. Brown, 7 Vet. App. 517 (1995); Caffrey v. Brown, 6 Vet. App. 377 (1994); Snuffer v. Gober, 10 Vet. App. 400 (1997). 5. Entitlement to an increased rating in excess of 10 percent for gastroesophageal reflux disease (GERD) and cirrhosis of the liver 6. Entitlement to a total disability rating based on individual unemployability by reason of service-connected disability (TDIU) is remanded. As the Veteran's entitlement to a TDIU is inextricably intertwined with the increased rating claims on appeal, the Board finds that the claim for a TDIU must be remanded as well. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (issues are inextricably intertwined when a decision on one issue would have a significant impact on another issue). Likewise, with regards to the Veteran's claim for an increased relating to his cirrhosis of the liver, the Board finds that as the Veteran's claim for urinary frequency is being remanded, development on that claim might result in evidence regarding the current nature of the Veteran's liver disability. As such, the Board finds that such claims are also inextricably intertwined, and in the spirit of affording the Veteran every possible benefit of the doubt, this claim will also be remanded. The matters are REMANDED for the following action: 1. Obtain all VA treatment medical records not already of record. 2. Schedule the Veteran for a VA examination with a qualified medical examiner. The examiner must review the claims file and should note that review in the report. The examiner should provide an opinion regarding the nature and etiology of the Veteran's claims urinary frequency. Any additional tests that the examiner deems necessary should be performed. The rationale for all opinions expressed should be provided. Specifically, the examiner should provide the following opinions: (a) Is it at least as likely as not (50 percent probability or greater) that any urinary disability diagnosed during the pendency of the appeal is related to service or any event, disease, or injury during service? (b) Is it at least as likely as not (50 percent probability or greater) that any urinary disability diagnosed during the pendency of the appeal is due to or the result of any service-connected disability to explicitly include medication for depression? (c) Is it at least as likely as not (50 percent probability or greater) that any urinary disability diagnosed during the pendency of the appeal has been aggravated (permanently increased in severity beyond the natural progress of the disorder) by any service-connected disability, to explicitly include any medication for depression? 3. Schedule the Veteran for a VA examination with a qualified medical examiner. The examiner must review the claims file and should note that review in the report. The examiner should provide an opinion regarding the nature and etiology of a groin disability. Any additional tests that the examiner deems necessary should be performed. The rationale for all opinions expressed should be provided. Specifically, the examiner should provide the following opinions: (a) Is it at least as likely as not (50 percent probability or greater) that any groin disability diagnosed during the pendency of the appeal is related to service or any event, disease, or injury during service? (b) Is it at least as likely as not (50 percent probability or greater) that any groin disability diagnosed during the pendency of the appeal is due to or the result of any service-connected disability? (c) Is it at least as likely as not (50 percent probability or greater) that any groin disability diagnosed during the pendency of the appeal has been aggravated (permanently increased in severity beyond the natural progress of the disorder) by any service-connected disability? (d) Is it at least as likely as not (50 percent probability or greater) that groin arthritis manifested within one year following separation from service. 4. Schedule the Veteran for a VA examination with a qualified medical examiner. The examiner must review the claims file and should note that review in the report. The examiner should provide an opinion regarding the nature and etiology of his plantar fasciitis. Any additional tests that the examiner deems necessary should be performed. The rationale for all opinions expressed should be provided. Specifically, the examiner should provide the following opinions: (a) Is it at least as likely as not (50 percent probability or greater) that any plantar fasciitis diagnosed during the pendency of the appeal is related to service or any event, disease, or injury during service? (b) Is it at least as likely as not (50 percent probability or greater) that any plantar fasciitis diagnosed during the pendency of the appeal is due to or the result of any service-connected disability? (c) Is it at least as likely as not (50 percent probability or greater) that any plantar fasciitis diagnosed during the pendency of the appeal has been aggravated (permanently increased in severity beyond the natural progress of the disorder) by any service-connected disability? (d) Is it at least as likely as not (50 percent probability or greater) that plantar fasciitis manifested within one year following separation from service? 5. Then, schedule the Veteran for a VA examination by an examiner with sufficient expertise to determine the current level of severity of all impairment resulting from his service-connected sinus problems. The claims file must be made available to, and reviewed by, the examiner. All indicated tests and studies must be performed. The examiner must provide all information required for rating purposes. B.J. Komins Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Ziheng Zhu, 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.