Citation Nr: 21042687 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 15-22 598 DATE: July 13, 2021 ORDER Entitlement to service connection for a disability manifested by light sensitivity is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for a disability manifested by memory loss is denied. Entitlement to a compensable rating for a traumatic brain injury (TBI) is denied. Entitlement to a compensable rating for migraine headaches is denied. Entitlement to a rating in excess of 30 percent for an anxiety disorder is denied. FINDINGS OF FACT 1. The preponderance of the evidence shows that the Veteran was not diagnosed with a disability manifested by light sensitivity unrelated to the already service-connected TBI or migraine headaches or hearing loss in either ear as defined by the Veterans' Administration to include as a residual of his TBI nor an undiagnosed illness, a diagnosable but medically unexplained chronic multisymptom illnesses of unknown etiology, or a diagnosable chronic multisymptom illness with a partially explained etiology at any time during the pendency of the appeal. 2. The preponderance of the evidence shows that a disability manifested by memory loss, diagnosed as attention-deficit/hyperactivity disorder (ADHD), was not present in service or until many years thereafter, it is not related to service or to an incident of service origin, it is not caused or aggravated by a service-connected disability, and it is not an undiagnosed illness, a diagnosable but medically unexplained chronic multisymptom illnesses of unknown etiology, or a diagnosable chronic multisymptom illness with a partially explained etiology. 3. The preponderance of the evidence shows that the TBI is manifested by no more than a facet of "0" in each of the 10 cognitive facets (disturbances in memory, attention, concentration and executive function, judgment, social interaction, orientation, motor activity, visual and spatial orientation, neurobehavioral effects, communication, consciousness, and other subjective symptoms); his TBI does not cause emotional/behavioral dysfunction distinct from his already service-connected anxiety disorder; and his TBI does not cause physical dysfunction distinct from his already service-connected migraine headaches at all times during the pendency of the appeal. 4. The preponderance of the evidence shows that the migraine headaches are not manifested by at least characteristic prostrating attacks occurring, on an average, once every two months over last several months at all times during the pendency of the appeal. 5. The preponderance of the evidence shows that the anxiety disorder is productive of no more than occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks at all times during the pendency of the appeal. CONCLUSIONS OF LAW 1. The criteria for service connection for a disability manifested by light sensitivity, bilateral hearing loss and a disability manifested by memory loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310, 3.317, 3.385. 2. The criteria for a compensable rating for a TBI have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.14, 4.124a, Diagnostic Code 8045. 3. The criteria for a compensable rating for migraine headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.14, 4.124, 4.124a, Diagnostic Code 8100. 4. The criteria for a rating in excess of 30 percent for an anxiety disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.14, 4.130, Diagnostic Codes 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Army from June 2006 to March 2013 which service including service in Iraq from November 2007 to February 2009 and Afghanistan from August 2010 to August 2011. In the Veteran's June 2015 VA Form 9, Appeal to Board of Veterans' Appeals, he specifically limited the issues he was appealing to the denial of his claims of service connection for bilateral hearing loss, a right ankle disability, a disability manifested by light sensitivity, and disability manifested by memory loss as well as the denial of his claims for increased ratings for his TBI, migraine headaches, and an anxiety disorder. Therefore, while the record on appeal shows that in February 2014 the Veteran filed a notice of disagreement to the January 2014 rating decision that also denied his claims of service connection for right hip, back, and left ankle disabilities as well as for bilateral shin splints, tinnitus, a right upper extremity scar, and a right arm skin lesion, the Board of Veterans' Appeal (Board) finds that these issues are not in appellate status because he did not perfect his appeal to them by filing a substantial appeal. See 38C.F.R. §§20.200, 20.302(c) (an appeal requires a notice of disagreement anda timely filed substantive appeal after issuance of a statement of the case). In August 2016, the Veteran and his spouse testified at a personal hearing before the undersigned and a transcript of that hearing is associated with the record. In August 2018, the Board issued a decision that denied service connection for bilateral hearing loss and a disability manifested by light sensitivity and Remanded for additional development claims of service connection for a disability manifested by memory loss and a right ankle disability as well as claims for increased ratings for a TBI, migraine headaches, and an anxiety disorder. As to the claims of service connection for bilateral hearing loss and a disability manifested by light sensitivity, the Veteran appealed the August 2018 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a subsequent October 2019 order, that incorporated the parties of Joint Motion for Partial Remand (JMPR), the Court vacated and remanded the August 2018 Board decision to the extent that it denied service connection for bilateral hearing loss and a disability manifested by light sensitivity. As to the claims of service connection for a right ankle disability and a compensable rating for an anxiety disorder, a subsequent January 2019 rating decision granted service connection for the right ankle disability and a 30 percent rating for the anxiety disorder. Therefore, the Board finds that the claim of service connection for a right ankle disability is no longer in appellate status (see Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997) (holding that the RO's award of service connection for a particular disability constitutes a full award of benefits on the appeal initiated by the veteran's notice of disagreement on such issue)) and the rating claim is recharacterized as it appears above (see Fenderson v. West, 12 Vet. App. 119, 125-26 (1999)). In August 2020, the Board again Remanded the appeal to address the concerns raised in the JMPR. Lastly, the Board finds that a claim for a total rating based on individual unemployability (TDIU) is not raised by the record notwithstanding the Court's holding in Rice v. Shinseki, 22 Vet. App. 447 (2009) because the Veteran does not claim, and the record does not show, that he is unable to obtain and maintain gainful employment solely because of his service-connected disabilities. In fact, the record shows that he is working full-time. The Concerns Raised by the JMPR & Post-Remand Compliance Regarding the JMPR, the Board finds some concerns with the findings contained within the JMPR, particularly reliance on statements made by the Veteran to find fault in prior examinations that appear to fully addressed the disability at issue. Later remands and further examinations only confirm this finding. In any event, as to the claim of service connection for a disability manifested by light sensitivity, the JMPR noted that the Board had not specifically addressed the Veteran's explicit contentions regarding the inadequacy of the January 2014 medical examination. Specifically, and as noted in the JMPR, at the August 2016 hearing the Veteran "testified that he 'talked to several eye doctors, which actually had a test for light sensitivity' and that 'never happened' when he was afforded a VA examination... He also stated that there was 'nothing light sensitive' about the examination." In this regard, the Board finds that, notwithstanding the Veteran's claims to the contrary, the opinion provided by the January 2014 VA examiner that he did not have a disability manifested by light sensitivity because he did not have light sensitivity both competent and credible to adjudicate the claim. The Board has reached this conclusion because the examination was conducted by a medical professional who is an expert on the eyes (i.e., an optometrist). See Black v. Brown, 10 Vet. App. 297, 284 (1997) (in evaluating the probative value of medical statements, the Board looks at factors such as the individual knowledge and skill in analyzing the medical data). The Board also finds the January 2014 VA examiner's opinion adequate to adjudicate the claim of service connection for a disability manifested by light sensitivity because it was provided after specifically considering the Veteran's claims as to how he injured his eyes and the observable problems he was currently experiencing, a review of the record on appeal, and a detailed eye examination, which included slit lamp as well as external and internal eye examinations, which examinations were all normal. See Guerrieri v. Brown, 4 Vet. App. 467, 473 (1993) ("the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.... As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the [Board as] adjudicators..."); Wray v. Brown, 7 Vet. App. 488, 493 (1995) (holding that the adoption of an expert medical opinion may satisfy the Board's statutory requirement of an adequate statement of reasons and bases if the expert fairly considered the material evidence seemingly supporting the veteran's position). While the Veteran may believe some other test should have been performed, the Board finds that the examination was, overall, fully comprehensive. Next, as to the claim of service connection for bilateral hearing loss, the JMPR noted that there were indications in the record that the Veteran's hearing issue might be a symptom of/a residual of his TBI when it cited to the July 2014 physical medical rehabilitation consultation where the appellant reported "[v]ery [s]evere" hearing difficulty and "mild" sensitivity to noise and at the August 2016 hearing where he testified that "the audio nerve somewhere in there something's [sic] not right because there's a pitch that [he] just do[es not] hear" and "[t]here's no pitch for some reason" and he "just do[es not] hear at all." Initially, the Board notes that it is not bound to accept a physician's opinion when it is based exclusively on the recitations of a claimant. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The question in this case is not if the Veteran's "hearing loss" is the result of the TBI, but whether the Veteran has hearing loss (for VA purposes) at all, undercutting the basis of the JMPR. Nonetheless, to address all concerns of the parties of the JMPR, the Board in August 2020 remanded this issue to obtain a VA medical opinion as to this question. Tellingly, the Board finds that the post-Remand development addressed the concern raised by the JMPR that the Veteran's hearing problem may be a residual of his TBI. See 38 U.S.C. § 5103; Barr v. Nicholson, 21 Vet. App. 303 (2007); Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request, is required); Dyment v. West, 13 Vet. App. 141, 146-47 (holding that there was no Stegall violation when the examiner made the ultimate determination required by the Board's remand, because such determination more than substantially complied with the Board's remand order). The Board has reached this conclusion because while this issue was in Remand status the Veteran was provided a VA examination in May 2021 and that examiner once again found that audiological testing did not show hearing loss in either ear as defined by VA. Moreover, the May 2021 VA examiner opined that, and notwithstanding Veteran's reports of hearing problems at the July 2014 physical medical rehabilitation consultation and at his personal hearing, the preponderance of the evidence shows that the appellant's sub-threshold hearing problems are not due to his military service, including the incident in which he sustained the already service-connected TBI, a residual of his TBI, or caused or aggravated by his service-connected TBI. Furthermore, the Board finds the May 2021 VA examiner's opinions both competent and credible to adjudicate the Veteran's claim of service connection for bilateral hearing loss because they were provided after a review of the record on appeal and an examination of the Veteran, they took into account all theories of entitlement, and because they are supported by citation to the service treatment records and the post-service medical records, they took into account the lay claims regarding observable symptomatology, and the opinions are supported by medical reasoning and controlling medical literature. See Guerrieri, supra; Wray, supra; ElAmin v. Shinseki, 26 Vet. App. 136, 140-41 (2013) (holding that, when multiple theories of entitlement are at issue, the Board must ensure that the medical opinions of record directly address all theories reasonably raised by the record). As to the claim of service connection for a disability manifested by memory loss, the Board also finds that the post-Remand development complied with the Remand. See 38 U.S.C. § 5103; Barr, supra; D'Aries, supra; Dyment, supra. The Board has reached this conclusion because in October 2018 the Veteran was afforded VA psychiatric and neuropsychiatric examinations at which time he was diagnosed with ADHD. Moreover, the October 2018 VA psychiatric examiner thereafter opined, to the extent that the appellant has a chronic disability manifested by memory loss, it is the context of his ADHD. Additionally, the October 2018 VA psychiatric examiner thereafter opined that the ADHD was not due to the Veteran's military service including the incident in which he sustained his already service-connected TBI, a residual of his TBI, or caused or aggravated by his service-connected TBI and/or his anxiety disorder. In this regard, the October 2018 VA examiners opinions were supported by a review of the record on appeal and an examination of the Veteran which included neuropsychological testing, including ATTENTION/WORKING MEMORY and Memory testing. Additionally, the Board finds the October 2018 VA examiners opinions both competent and credible to adjudicate the Veteran's claim of service connection for a disability manifested by memory loss. The Board has reached this conclusion because the opinions were provided after a review of the record on appeal and an examination of the Veteran, they took into account all theories of entitlement, and they are supported by citation to the service treatment records and the post-service medical records, they took into account the lay claims regarding observable symptomatology, and the opinions are supported by medical reasoning and controlling medical literature. See Guerrieri, supra; Wray, supra; ElAmin, supra. As to the claims for increased ratings for a TBI, migraine headaches, and an anxiety disorder, the Board finds that the post-Remand development complied with the Remand because it shows that the Veteran was afforded VA examinations in October 2018 and November 2018 which are adequate to rate his disabilities under all potentially applicable rating criteria. Id; also see 38 U.S.C. § 5103; Barr, supra; D'Aries, supra; Dyment, supra. The Board also finds that the post-Remand development complied with the Remand because while the appeal was in remand status all identified and available VA and private treatment records were obtained and associated with the record. See 38 U.S.C. § 5103; Stegall, supra. Therefore, the Board finds that further delay by remanding the appeal to provide the Veteran with another VA examination or to try to obtain additional medical records is not required. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). The Service Connection Claims The Veteran claims that he is entitled to service connection for a disability manifested by light sensitivity, a disability manifested by memory loss, and bilateral hearing loss because, in substance, they are due to his military service including his exposure to toxins in the Persian Gulf. As to his light sensitivity, he also claims that it is due to his already service-connected TBI and/or migraine headaches. As to his bilateral hearing loss, he also claims that it is due to his already service-connected TBI. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptomatology after service is required for service connection if the disability is one that is listed in 38 C.F.R. § 3.309. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, service connection may also be granted on the basis of a post-service initial diagnosis of a disease, where the physician relates the current condition to the period of service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(d). Other specifically enumerated disorders, including sensor neural hearing loss, will be presumed to have been incurred in service if they manifested to a compensable degree within the first year following separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Service connection for impaired hearing is subject to 38 C.F.R. § 3.385, which provides that impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. The requirements for service connection for hearing loss as defined in 38 C.F.R. § 3.385 need not be shown by the results of audiometric testing during a claimant's period of active military service in order for service connection to be granted. 38 C.F.R. § 3.385 does not prevent a claimant from establishing service connection on the basis of post-service evidence of hearing loss related to service when there were no audiometric scores reported at separation from service. Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). The regulation does not necessarily preclude service connection for hearing loss that first met the regulation's requirements after service. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). Thus, a claimant who seeks to establish service connection for a current hearing disability must show, as is required in a claim for service connection for any disability, that a current disability is the result of an injury or disease incurred in service, the determination of which depends on a review of all the evidence of record including that pertinent to service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303 and 3.304; Hensley, 5 Vet. App. at 159-60. The Court in Hensley also held that "audiometric testing measures threshold hearing levels (in decibels (dB)) over a range of frequencies (in Hertz (Hz)); the threshold for normal hearing is from 0 to 20 dB, and higher threshold levels indicate some degree of hearing loss." Hensley, 5 Vet. App. at 157. In this regard, to establish service connection for the claimed disorders, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may also be established on a secondary basis for a disability proximately due to or aggravated by a service-connected disease or injury. See 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). To establish secondary service connection, a Veteran must show: (1) the existence of a present disability; (2) the existence of a service-connected disability; and (3) a causal relationship between the present disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Ward v. Wilkie, 31 Vet. App. 233 (2019). The requirement of a current disability is "satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim." See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Court in Joyner v. McDonald, 766 F.3d 1393, 1395 (Fed. Cir. 2014) held, in part, that the Board needs to always consider 38 U.S.C. § 1117 and 38 C.F.R. § 3.317 in cases like the current appeal in which Veterans have served in the Persian Gulf since August 2, 1990. Therefore, the Board finds that it is also required to consider 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. See 38 C.F.R. § 3.117 (d)(1) and (2) (a "Persian Gulf veteran" is defined as "a veteran who served on active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War. The "Southwest Asia theater of operations" includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations). In this regard, service connection may be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War, or that became manifest to a degree of 10 percent or more not later than December 31, 2021. 38 C.F.R. § 3.317(a)(1). For purposes of 38 C.F.R. § 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi symptom illness; and (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. An "undiagnosed illness" is defined as a condition that by history, physical examination and laboratory tests cannot be attributed to a known clinical diagnosis. In the case of claims based on undiagnosed illness under 38 U.S.C. § 1117; 38 C.F.R. § 3.317, unlike those for "direct service connection," there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez, 19 Vet. App. at 8-9. Further, lay persons are competent to report objective signs of illness. Id. To determine whether the undiagnosed illness is manifested to a degree of 10 percent or more the condition must be rated by analogy to a disease or injury in which the functions affected, anatomical location or symptomatology are similar. See 38 C.F.R. § 3.317(a)(5); see also Stankevich v. Nicholson, 19 Vet. App. 470 (2006). A medically unexplained chronic multisymptom illnesses is one defined by a cluster of signs or symptoms and specifically includes chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders (excluding structural gastrointestinal diseases), as well as any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multisymptom illness. A "medically unexplained chronic multisymptom illness" means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities." Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). Functional gastrointestinal disorders are a group of conditions characterized by chronic or recurrent symptoms that are unexplained by any structural, endoscopic, laboratory, or other objective signs of injury or disease and may be related to any part of the gastrointestinal tract. Specific functional gastrointestinal disorders include, but are not limited to, irritable bowel syndrome, functional dyspepsia, functional vomiting, functional constipation, functional bloating, functional abdominal pain syndrome, and functional dysphagia. These disorders are commonly characterized by symptoms including abdominal pain, substernal burning or pain, nausea, vomiting, altered bowel habits (including diarrhea, constipation), indigestion, bloating, postprandial fullness, and painful or difficult swallowing. Diagnosis of specific functional gastrointestinal disorders is made in accordance with established medical principles, which generally require symptom onset at least 6 months prior to diagnosis and the presence of symptoms sufficient to diagnose the specific disorder at least 3 months prior to diagnosis. 38 C.F.R. § 3.317 (a)(2)(i)(B)(3). In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). i. A disability manifested by light sensitivity and bilateral hearing loss With the above criteria in mind, simply stated, the Veteran does not have these disabilities. The Board notes that service treatment records, including the December 2006 Individual Readiness Record, July 2007 Individual Readiness Record, the July 2007 Pre-Deployment Health Assessment, March 2009 Post-Deployment Health Assessment, March 2009 Individual Readiness Record, May 2009 Post-Deployment Health Re-Assessment, June 2009 examination, March 2010 Post-Deployment Health Assessment, March 2010 Individual Readiness Record, May 2010 Pre-Deployment Health Assessment, and January 2011 Post-Deployment Health Assessment, are negative for complaints, diagnoses, or treatment for a disability manifested by light sensitivity and hearing loss in either ear. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (VA may only consider independent medical evidence to support its findings and is not permitted to base decisions on its own unsubstantiated medical conclusions). In this regard, the Board notes that the Veteran did not provide answers on the March 2009 Post-Deployment Health Assessment, May 2009 Post-Deployment Health Re-Assessment, and January 2011 Post-Deployment Health Assessment when he was asked if he had sensitivity to bright light. Next, Board notes that the Veteran's March 2009, March 2010, and June 2011 audiological examinations were within normal limits even considering the Court's holding in Hensley, supra. Id. Similarly, in August 2007 and March 2009, it was opined that his hearing tests were within normal limits. Likewise, and more importantly, the post-service record including the January 2014 and May 2021 VA examinations are negative for diagnoses of a disability manifested by light sensitivity and/or hearing loss in either ear as defined by VA. In fact, at the January 2014 VA eye examination, which were held for the express purpose of obtaining a diagnosis, the optometrist, after a detailed eye examination which included slit lamp as well as external and internal eye examinations, opined that he did not have a disability manifested by light sensitivity because he did not have light sensitivity. Likewise, at the audiological examinations in January 2014 and May 2021, which were also held for the express purpose of obtaining a diagnosis, audiometric testing showed that the Veteran did not have hearing loss in either ear as defined by VA. Next, and as noted above, the May 2021 VA examiner specifically opined that the Veteran's sub-threshold hearing problems were not due to his military service, including the incident in which he sustained the already service-connected TBI, a residual of his TBI, nor caused or aggravated by his service-connected TBI. Furthermore, the January 2014 VA Gulf War examiner opined, in substance, that the Veteran did not have an undiagnosed illness, a diagnosable but medically unexplained chronic multisymptom illnesses of unknown etiology, or a diagnosable chronic multisymptom illness with a partially explained etiology. Lastly, the Board finds the opinions provided by the above VA examiners to be both competent and credible to adjudicate the Veteran's claims as well as the most probative evidence of record because they were provided after a review of the record on appeal and an examination of the appellant by medical professionals and took into account all theories of entitlement, they are supported by citation to the service treatment records and the post-service medical records, they took into account the competent and credible lay claims regarding observable symptomatology, and the opinions are supported by medical reasoning and controlling medical literature. See Guerrieri, supra; Wray, supra; ElAmin, supra. The Board also notes that these medical opinions are not directly contradicted by any other medical evidence of record. See Colvin, supra. Further, while the Veteran and his wife are competent to report on the symptoms they observe, the Board finds that they are not competent to diagnose a disability manifested by light sensitivity and hearing loss in either ear as defined by VA because diagnosing them requires special medical training that they do not have and therefore they cannot provide the missing diagnoses. See Davidson, supra. Lastly, the Board finds that the facts of this appeal are distinguishable from those in Saunders, supra, because the findings by the January 2014 and May 2021 VA examiners show that none of the claimed disabilities result in functional impairment that affects earning capacity. See Owens, supra. Accordingly, the Board finds that the most probative evidence of record shows that the Veteran did not have a diagnosis of a disability manifested by light sensitivity and hearing loss in either ear as defined by VA nor an undiagnosed illness, a diagnosable but medically unexplained chronic multisymptom illnesses of unknown etiology, or a diagnosable chronic multisymptom illness with a partially explained etiology at any time during the pendency of the appeal. See Owens, supra. Therefore, the Board finds that the claims of service connection for a disability manifested by light sensitivity and bilateral hearing loss are denied under all theories of entitlement including loss as a residual of the Veteran's TBI and/or migraine headaches. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310, 3.317. ii. A disability manifested by memory loss As to a current disability, the October 2018 VA psychiatric and neuropsychiatric examiners diagnosed the Veteran with ADHD and the October 2018 VA psychiatric examiner opined, to the extent that the appellant has a chronic disability manifested by memory loss, it is in the context of his ADHD. Therefore, with granting the veteran the benefit of any doubt in this matter, the Board concludes that he has a currently disability. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Moreover, service treatment records document the Veteran's periodic reports of memory problems. See, e.g., service treatment records dated in April 2012 and July 2012. Additionally, the Board finds that the Veteran and his wife are competent and credible to report on the observable symptoms of this disability. See Davidson, supra. However, at the July 2005 examination as well as in July 2009, November 2009, and September 2011 treatment records, the Veteran specifically denied having a problem with his memory. Likewise, when examined in July 2012 it was opined that his memory was normal. See Colvin, supra. It is important for the Veteran to understand that, at times, such as the above, it is the Veteran himself that provides evidence against his own claims. Similarly, the Board notes that service treatment records, including the December 2006 Individual Readiness Record, July 2007 Individual Readiness Record, the July 2007 Pre-Deployment Health Assessment, March 2009 Post-Deployment Health Assessment, March 2009 Individual Readiness Record, May 2009 Post-Deployment Health Re-Assessment, June 2009 examination, March 2010 Post-Deployment Health Assessment, March 2010 Individual Readiness Record, May 2010 Pre-Deployment Health Assessment, and January 2011 Post-Deployment Health Assessment, are otherwise negative for complaints, diagnoses, or treatment for a disability manifested by memory loss. Id. The Board also notes that Veteran did not provide answers on the March 2009 Post-Deployment Health Assessment, May 2009 Post-Deployment Health Re-Assessment, and January 2011 Post-Deployment Health Assessment when he was asked if he had memory problems or lapses. Therefore, the Board finds that the most probative evidence of record shows that the Veteran did not sustain a disease or injury while on active duty that caused the memory problems, which post-service were attributed to his ADHD, despite the memory problems/symptoms seen on a few occasions while on active duty. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In this regard, the Board finds that the detailed service record, which documents the Veteran's complaints, diagnoses, or treatment for a number of other problems weights against the Veteran and his spouse's claims that the appellant had observable memory problems, which post-service were attributed to his ADHD, while on active duty. See Owens, supra. Overall, the Board must find the service records provide unusually highly probative evidence against this claim because they are very detailed, clearly indicating that the Veteran did not have a memory disability in service and instead suggesting that the Veteran had problems due to his already service connected TBI and/or anxiety disorder. Next, the Board will consider whether the Veteran is entitled to service connection for a disability manifested by memory loss due to continuity of symptomatology under 38 U.S.C. § 1110; 38 C.F.R. § 3.303(b). However, the post-service record does not show that the Veteran had a continued problem with a disability manifested by memory loss in and since service. Id. In fact, as noted above, service treatment records do not even show the Veteran being diagnosed with a disability manifested by memory loss, diagnosed post-service as due to ADHD, despite the reports of memory problems; providing highly probative evidence against the claim. See Colvin, supra. Likewise, and more importantly, the post-service is negative for any complaints, diagnoses, or treatment for memory loss, diagnosed post-service as due to ADHD, until, at the earliest, the October 2018 VA examinations (i.e., over five years after his March 2013 separation from active duty). Given this record, the Board finds that the service medical records and the post-service medical evidence provides highly probative evidence, overall, against this claim which evidence the Board finds more probative than the lay claims that he had observable symptoms of a disability manifested by memory loss on active duty and since that time. See Owens, supra. In this case, the Board finds that the most probative evidence of record shows that the Veteran did not have a continued problem with a disability manifested by memory loss in and since service despite the documented memory problems seen on a few occasions while on active duty. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(b). For the reasons noted above, the Board finds that the post-service medical records provide highly probative evidence against this claim. The service and post-service records in this case provide particularly negative evidence against this claim (both are highly detailed, indicating clearly that the problem began years after service). The Board also finds that the preponderance of the evidence shows that the Veteran's disability manifested by memory loss, diagnosed as ADHD, is not due to his military service, a residual of the TBI, and/or caused or aggravated by the service-connected TBI and/or anxiety disorder. See 38 U.S.C. § 1110, 38 C.F.R. §§ 3.303(d), 3.310; also see Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992) (establishing service connection requires finding a relationship between a current disability and events in service or an injury or disease incurred therein); Allen, supra; Wallin, supra; Ward, supra. In this regard, and as discussed in part above, the October 2018 VA psychiatric examiner opined that the ADHD was not due to the Veteran's military service including the incident in which he sustained the already service-connected TBI, a residual of his TBI, or caused or aggravated by his service-connected TBI and/or his anxiety disorder. In this regard, the October 2018 VA examiners opinions were supported by a review of the record on appeal and an examination of the Veteran which included neuropsychological testing, including ATTENTION/WORKING MEMORY and Memory testing. Additionally, the Board finds the October 2018 VA examiners opinions both competent and credible to adjudicate the Veteran's claim. The Board has reached this conclusion because the opinions were provided after a review of the record on appeal and an examination of the Veteran and they took into account all theories of entitlement as well as because they are supported by citation to the service treatment records and the post-service medical records, they took into account the lay claims regarding observable symptomatology, and the opinions are supported by medical reasoning and controlling medical literature as well as because they are not contradicted by any other medical evidence of record. See Guerrieri, supra; Wray, supra; ElAmin, supra; Colvin, supra. Therefore, the Board finds that the most probative evidence of record shows that the Veteran's disability manifested by memory loss, diagnosed as ADHD, is not due to his military service, a residual of his TBI, nor caused or aggravated by a service connected TBI and/or anxiety disorder. See 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303(d), 3.310; also see Rabideau, supra; Allen, supra; Wallin, supra; Ward, supra. Lastly, given the Veteran's documented service in South West Asia the laws and regulations governing undiagnosed illnesses are applicable to the current claim. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317. However, the January 2014 VA Gulf War examiner opined, in substance, that the Veteran did not have any diagnosed illnesses for which an etiology was not established, no signs and/or symptoms that may represent an undiagnosed illness or diagnosed medically unexplained chronic multisymptom illness, nor additional signs and/or symptoms that may represent an undiagnosed illness or diagnosed medically unexplained chronic multisymptom illness. Additionally, the Board finds the July 2014 medical opinion the most probative evidence of record because it is provided after a review of the record on appeal and an examination of the Veteran as well as because it is supported by citation to evidence found in the record and controlling medical literature as well as because it is supported by medical reasoning and not contradicted by any other medical evidence of record. See Owens, supra, Colvin, supra. Therefore, the Board finds that the record on appeal show that the Veteran's disability manifested by memory loss, diagnosed as ADHD, is not an undiagnosed illness, a diagnosable but medically unexplained chronic multisymptom illnesses of unknown etiology, or a diagnosable chronic multisymptom illness with a partially explained etiology. See 38 U.S.C. §§ 1110, 1117; Owens, supra, Colvin, supra. In addition, the Board finds that neither the Veteran or his wife is competent to provide the missing direct and secondary nexus opinions or diagnosis of an undiagnosed illness because they do not have the required medical expertise to provide answers to these complex medical questions (i.e., what caused his current disability manifested by memory loss diagnosed as ADHD). See Davidson, supra. It is vital for the Veteran to understand that the Board has taken his concerns seriously (it was the bases of the Board's remands), however, there is now overwhelming medical evidence against claims from examiners that the Board cannot ignore. The service and post-service treatment records, as noted above, also have been found by the Board to provide highly probative evidence against this claim, beyond the medical opinions in this case that also provide evidence against this claim. There is no basis to assume that yet another medical opinion in this case will provide a basis to grant this claim, in light of this record. With each remand, the Board has been provide more evidence against the Veteran's claims. Therefore, the Board finds that the claim of service connection for a disability manifested by memory loss, diagnosed as ADHD, is also denied. 38 U.S.C. §§ 1110, 1117; 38 C.F.R. §§ 3.303, 3.310, 3.317. The Rating Claims The Veteran contends that his TBI, migraine headaches, and anxiety disorder are more severely disabling than represented by the ratings assigned at all times during the appeal. Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by a Diagnostic Code. 38 C.F.R. § 4.27. When rating the Veteran's service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Separate higher or lower compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). Regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation 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. The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis and demonstrated symptomatology. Any change in a diagnostic code by VA must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625 (1992). i. TBI The Veteran's TBI is rated as 0 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code 8045. The Veteran has also been assigned a separate 0 percent evaluation for the distinct diagnosis of migraine headaches under 38 C.F.R. § 4.124a, Diagnostic Code 8100 and a separate 30 percent evaluation for the distinct diagnosis of an anxiety disorder under 38 C.F.R. § 4.130, Diagnostic Code 9411 which issues will be evaluated separately by the Board. Diagnostic Code 8045 states that there are three main areas of dysfunction that may result from a TBI and have profound effects on functioning: cognitive (which is common in varying degrees after a traumatic brain injury), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation. 38 C.F.R. § 4.124a. Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions include goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In each individual, symptoms may fluctuate in severity from day to day. VA is to evaluate cognitive impairment under the table titled "Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified." Subjective symptoms may be the only residual of a TBI or may be associated with cognitive impairment or other areas of dysfunction. Subjective symptoms that are residuals of a TBI, whether or not they are part of cognitive impairment, should be evaluated under the subjective symptoms facet in the table titled "Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified." However, VA is to separately evaluate any residual with a distinct diagnosis that may be evaluated under another DC, such as migraine headache or Meniere's disease, even if that diagnosis is based on subjective symptoms, rather than under the "Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified" table. VA is to evaluate emotional/behavioral dysfunction under 38 C.F.R. § 4.130 (Schedule of ratings-mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled "Evaluation of Cognitive Impairment and Other Residuals of Traumatic Brain Injury Not Otherwise Classified." Here, the Veteran is separately service-connected for an acquired psychiatric disorder which have been directly linked to his service, rather than as secondary to his service-connected TBI residuals. Therefore, it will be evaluated separately by the Board. VA is to evaluate physical (including neurological) dysfunction based on the following list, under an appropriate diagnostic code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions. Here, the Veteran is separately service-connected for vertigo, a back disability, left shoulder disorder, hearing loss, left knee disorder, left hand disorder, tinnitus, sinusitis, tinea pedis, erectile dysfunction, and hair loss, which have been directly linked to his service, rather than as secondary to his service-connected TBI residuals. Moreover, the Board also finds that no further discussion of them is required except for those that are in appellate status. As to the issues that are in appellate status, the Board will address those issues below. The preceding list of types of physical dysfunction does not encompass all possible residuals of a TBI. For residuals not listed in 38 C.F.R. § 4.124a, Diagnostic Code 8045, that are reported on an examination, VA is to evaluate under the most appropriate Diagnostic Code. Each condition is to be evaluated separately, as long as the same signs and symptoms are not used to support more than one evaluation and combine under 38 C.F.R. § 4.25 the evaluations for each separately rated condition. The evaluation assigned based on the "Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified" table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations. The table titled "Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified" addresses 10 facets of a TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled "total." These facets are memory, attention, concentration and executive function, judgment, social interaction, orientation, motor activity, visual and spatial orientation, neurobehavioral effects, communication, consciousness, and other subjective symptoms. Not every facet has every level of severity. The consciousness facet, for example, does not provide for an impairment level other than "total," since any level of impaired consciousness would be totally disabling. A 100 percent evaluation is assigned if "total" is the level of evaluation for one or more facets. If no facet is evaluated as "total," the overall percentage evaluation is assigned based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, a 70 percent evaluation is assigned if 3 is the highest level of evaluation for any facet. In this regard, it is important for the Veteran to understand that the evaluation of a TBI is highly multifaceted (as is clearly indicated above). The current version of Diagnostic Code 8045 contains the following notes: Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled "Evaluation of Cognitive Impairment and Other Residuals of a Traumatic Brain Injury Not Otherwise Classified" with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition. Note (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation. Note (3): "Instrumental activities of daily living" refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one's own medications, and using a telephone. These activities are distinguished from "Activities of daily living," which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet. Note (4): The terms "mild," "moderate," and "severe" traumatic brain injury, which may appear in medical records, refer to a classification of a traumatic brain injury made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under Diagnostic Code 8045. Note (5): A veteran whose residuals of a traumatic brain injury are rated under a version of 38 C.F.R. § 4.124a, Diagnostic Code 8045, in effect before October 23, 2008, may request review under Diagnostic Code 8045, irrespective of whether his disability has worsened since the last review. VA will review that Veteran's disability rating to determine whether the Veteran may be entitled to a higher disability rating under Diagnostic Code 8045. A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating awarded as a result of such review, VA will apply 38 C.F.R. § 3.114, if applicable. 38 C.F.R. § 4.124a, Diagnostic Code 8045. With the above criteria in mind, at the January 2014 VA psychiatric and TBI examinations it was opined that the Veteran's cognitive impairment in each of the 10 facets of a TBI were as follows: (i) memory, attention, concentration and executive function=complaints of mild memory loss , but without objective evidence on testing-problems with recent memory after trauma that eventually cleared (0); (ii) judgment=normal (0); (iii) social interaction=social interaction is routinely appropriate (0); (iv) orientation=always oriented to person, time, place, and situation (0); (v) motor activity= normal (0); (vi) visual and spatial orientation=mildly impaired. Occasionally gets lost in unfamiliar surroundings, has difficulty reading maps or following directions. Is able to use assistive devices such as GPS (global positioning system). May get lost in unfamiliar places (0); (vii) subjective symptoms=subjective symptoms that do not interfere with work; instrumental activities of daily living; or work, family or other close relationships. Examples are mild or occasional headaches, and mild anxiety. The Veteran complains of recurrent headaches and dizziness (0). (viii) neurobehavioral affects=one or more neurobehavioral effects that do not interfere with workplace interaction or social interaction-Veteran became sullen and depressive (0); (ix) communication=able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language (0); and (x) consciousness=normal (0). The TBI examiner next noted that the Veteran did not have any other subjective symptoms. It was also opined by the TBI examiner that the Veteran had the following other pertinent physical findings, complications, conditions, signs, and/or symptoms: Speech was fluent, non-dysarthric, with normal repetition, comprehension, and naming; CRANIAL NERVES: Smell was intact to citrus odor. Vision was grossly normal. Visual fields were fully intact to confrontation and extra-ocular movements were full and conjugate without nystagmus or gaze paresis. Pupils were 5 mm bilaterally and reactive to light. Fundoscopic examination revealed sharp disc margins. Saccadic eye movements were normal. Eye closure and oral grimace were symmetrical. Facial sensation to temperature were equal bilaterally. Tongue and palate elevated and protruded, respectively, in the midline, and patient lateralized finger rub accurately. Sternocleiodo-mastoid and trapezius strength were 5/5 bilaterally. MOTOR: There was no observed tremor, fix, or drift. Muscle tone was normal. All muscle groups in the bilateral upper and lower extremities were 5/5 in strength. There was no observed atrophy. REFLEXES: Muscle stretch reflexes in the upper (biceps, triceps, and brachioradialis) were symmetrically 2/4. Muscle stretch reflexes in the lower extremities (patellar and ankle) were symmetric ally 2/4. Hoffman's reflex was absent and plantar responses were flexor. SENSORY: Proprioception was intact in the upper and lower extremities and vibration was present to 15 seconds at the great toes. There was no hypesthesia to light touch, temperature, or noxious stimuli in the upper or lower extremities. COMPLEX MOTOR: There was no dysmetria observed with finger-to-nose testing. GAIT AND STATION: Romberg testing was negative. Gait was normal with both casual and tandem walking. Lastly, the Board finds that the above VA examination shows that the Veteran's highest level of evaluation for any facet is a "0". At the subsequent October 2018 psychiatric and November 2018 VA TBI examinations, it was opined that the Veteran's cognitive impairment in each of the 10 facets of a TBI were as follows: (i) memory, attention, concentration and executive function=complaints of mild memory loss but without objective evidence on testing-short term memory problems; needs to write down things to not forget (0); (ii) judgment=normal (0); (iii) social interaction=social interaction is routinely appropriate (0); (iv) orientation=always oriented to person, time, place, and situation (0); (v) motor activity= normal (0); (vi) visual and spatial orientation=mildly impaired. Occasionally gets lost in unfamiliar surroundings, has difficulty reading maps or following directions. Is able to use assistive devices such as GPS. Gets lost in unfamiliar places (0); (vii) subjective symptoms=subjective symptoms that do not interfere with work; instrumental activities of daily living; or work, family or other close relationships. Examples are mild or occasional headaches and mild anxiety. The Veteran complains of recurrent headaches and dizziness (0). (viii) neurobehavioral affects=one or more neurobehavioral effects that do not interfere with workplace interaction or social interaction. The Veteran is depressive and has lack of motivation (0); (ix) communication=able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language (0); and (x) consciousness=normal (0). The November 2018 TBI examiner next noted that the Veteran did not had any other subjective symptoms. It was next opined by the November 2018 TBI examiner that the Veteran had the following other pertinent physical findings, complications, conditions, signs, and/or symptoms: CN I: Able to identify two distinct smells; CN II: Intact visual fields. Discs flat with normal retinal vasculature; CN III, IV, VI: PERRLA, extraocular movements intact without nystagmus; CN V: intact LT sensation bilaterally over temples, cheek, and jawline. Symmetric massester bulk; CN VII: Symmetric facial expression in puffing out cheeks and raising eyebrows; CN VIII: Can hear finger rub bilaterally; CN IX, X: Clear speech with symmetric palatal elevation; CN XI: Symmetric upper trapezii and SCM strength; and CN XII: Tongue midline without fasiculations or atrophy. Tone normal. DTRs 2+ and symmetric. Toes downgoing. Sensation intact to vibration, light touch and proprioception. Strength 5/5 in bilateral upper and lower extremities without evidence of atrophy. RAM, finger to nose and heel to shin intact without dysmetria. Follows 2 step commands. Crosses midline. Written communication intact. Heel, toe, heel-to-toe walking intact. Romberg negative. Lastly, the Board finds that the above VA examination shows that the Veteran's highest level of evaluation for any facet is a "0." Next, the Board finds that nothing in the treatment records show the Veteran's adverse TBI symptomatology to be worse than what was reported by the above VA examiners. See Colvin, supra. As to the lay statements found in the record from the Veteran and his wife regarding the severity of the appellant's TBI symptoms, the Board finds that they are competent and credible to report on what comes to them via their own senses. See Davidson, supra. However, the Board finds the VA examiners opinions as to the severity of the claimant's TBI symptoms more probative because healthcare professionals have greater medical training. See Black, supra. Simply stated, a medical professional is better qualified to tell us what injury caused what problems. Given the findings by the above VA examiners, the Board finds that the most probative evidence of record are the above VA examinations which shows, at its worse, he had a facet of "0" in the 10 facets of a TBI related to cognitive impairment (i.e., memory, attention, concentration and executive function, judgment, social interaction, orientation, motor activity, visual and spatial orientation, neurobehavioral effects, communication, consciousness, and other subjective symptoms). See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.124a, Diagnostic Code 8045; Gilbert, supra; Owens, supra; Colvin, supra. Moreover, the Board find this facet score most accurately compensates him for the adverse symptomatology caused by his TBI at all times during the pendency of the appeal. Id; Fenderson, supra; Hart, supra. The Board also finds that the most probative evidence of records are the VA examinations which report that the Veteran's TBI residuals neither includes emotional/behavioral dysfunction distinct from his already service-connected anxiety disorder or physical dysfunctions distinct from his already service-connected migraine headaches. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.124a, Diagnostic Code 8045; Owens, supra; Colvin, supra. In this regard, the Board notes that the Veteran cannot be compensated twice for the same problem including the anxiety disorder and migraine headaches even if they were part of his TBI. This finding does not suggest that the Veteran does not have problems related to his service (he clearly has many problems related to service, forming the basis of a 40 percent disability evaluation). However, they are being compensated by other service-connected disabilities that are not at issue before the Board in this part of the decision or not at all. Therefore, because the Veteran's highest facet is a "0," the Board finds that the criteria for at least a compensable rating for a TBI are not met at all times during the pendency of the appeal. 38 C.F.R. § 4.124a, Diagnostic Code 8045; also see Fenderson, supra; Hart, supra. ii. Migraine Headaches The Veteran's migraine headaches are rated as 0 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code 8100. In this regard, Diagnostic Code 8100 provides that migraine headaches with characteristic prostrating attacks averaging less that one in two months over the last several months warrants a 0 percent disability rating; with characteristic prostrating attacks averaging one in two months over the last several months warrants a 10 percent disability rating; with characteristic prostrating attacks occurring on an average once a month over last several months warrants a 30 percent disability rating; and with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability warrants a 50 percent disability rating. With the above criteria in mind, the Board notes that at the January 2014 VA examination the Veteran reported that he hasn't had a migraine since he left service in March 2013. Next, it was noted that his treatment plane included taking gabapentin (300 mg tid). The Veteran thereafter reported that his migraine headache adverse symptomatology consisted of pulsating or throbbing head pain on both sides of the head, nausea, and sensitivity to light which last less than one day. The examiner opined that the Veteran's migraine headaches did not cause characteristic prostrating attacks. At the subsequent October 2018 VA examination, it was noted that the Veteran continued to take gabapentin (300 mg tid) once at night. The Veteran reported that his adverse symptomatology consisted of pulsating or throbbing head pain on both sides of the head, nausea, and sensitivity to light which last less than one day. The examiner opined that the Veteran's migraine headaches did not cause characteristic prostrating attacks. Thereafter, the October 2018 VA examiner opined that, while the Veteran reported that he had migraine headaches once per week since 2012 with pain located in the front and back of head that does not go away, his medical records show that he "is being followed for his migraine headaches at the VA clinic ... The headaches continue to be well controlled with Gabapentin 300mg daily. Review of the claims file showed no clinical evidence that the [V]eteran is suffering from migraine headaches once or twice per month. Review of the claims file showed that the [V]eteran's migraine headaches are very well controlled and he did not suffer from debilitating headaches. Initially, the Board notes that the January 2014 and October 2018 VA examiners both opined that the Veteran's headaches did not cause characteristic prostrating attacks, much less attacks that occurred, on average, once in two months over the last several months. See Colvin, supra. Similarly, while the Veteran's treatment records periodically document his complaints and treatment for headaches, none of these treatment records show that his headaches cause, at least, characteristic prostrating attacks. Id. Next, the Board notes that in writings to VA and at his VA examinations the Veteran and/or his wife reported on observable adverse manifestations of the service-connected migraine headaches. See Davidsons, supra. However, the Board finds that they are not competent to provide an opinion as to whether the migraine headaches cause characteristic prostrating attacks because this is a medical opinion and he does not have the required training. Id. The Board also finds that the opinions provided by the VA examiners as to the severity of his migraine headaches is more probative than the lay claims because a healthcare professional has greater medical expertise. See Black, supra. Given the above, the Board finds that the January 2014 and October 2018 VA examiners opinions as to the severity of the Veteran's migraine headaches the most probative evidence of record because they were provided after a review of the record on appeal and an examination of the Veteran as well as because they are supported by the evidence of record and not contradicted by any other evidence of record. See Owens, supra; Colvin, supra. Accordingly, the Board finds that at all times during the appeal the preponderance of the evidence shows that the Veteran's migraine headaches are not manifested by at least characteristic prostrating attacks. Id. Therefore, the Board finds that the criteria for a compensable rating for migraine headaches have not been met at all times during the appeal. See 38 C.F.R. § 4.124a, Diagnostic Code 8100; Fenderson, supra; Hart, supra. iii. Anxiety Disorder The Veteran's anxiety disorder is rated as 30 percent disabling under 38 C.F.R. § 4.130, Diagnostic Code 9411 (the General Rating Formula for Mental Disorders (General Formula)). The General Formula provides a 30 percent rating is warranted when the evidence shows occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted when the evidence shows occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted when there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depressive disorder affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted when the evidence shows total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. Ratings are assigned according to the manifestation of particular symptoms. However, the use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). When determining the appropriate disability evaluation to assign, however, the Board's "primary consideration" is the Veteran's symptoms. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). Initially, the Board notes that this claim for a higher rating for the anxiety disorder was pending before the agency of original jurisdiction on or after August 4, 2014. Therefore, the Board finds that the AMERICAN PSYCHIATRIC ASSOCIATION: DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 5th Edition (2013) (DSM-5) applies to the current appeal. See 53 Fed. Reg. 14308 (March 19, 2015); 38 C.F.R. §§ 3.384, 4.125, 4.126, 4.127, and 4.130 (2017). Accordingly, the Board's adjudication of this claim cannot include any discussion of the Global Assessment of Functioning (GAF) scores found in the record. See Golden v. Shulkin, 29 Vet. App. 221 (2018). Next, the Board finds that the most probative evidence of record shows that the Veteran's anxiety disorder does not cause at least occupational and social impairment with reduced reliability and productivity despite the January 2014 and/or October 2018 VA examiners opining that it caused problems with anxiety, a depressed mood, chronic sleep impairment, mild memory loss (i.e., such as forgetting names, directions, or recent events), disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Initially, the Board notes that the criteria for an increased, 50 percent, rating lists as examples of the type of adverse symptomatology that equates to at least occupational and social impairment with reduced reliability and productivity impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks), disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. However, the Board does not find the adverse symptomatology reported by the January 2014 and/or October 2018 VA examiners is the type of symptomatology contemplated by the rating criteria for at least a 50 percent rating. The Board has reached this conclusion because the memory loss reported by the or October 2018 VA examiners VA examiners was opined to be mild (i.e., such as forgetting names, directions or recent events) and not for retention of only highly learned material, forgetting to complete tasks. Therefore, the Board finds that the Veteran's degree of memory loss weighs against finding that he meets the criteria for at least a 50 percent rating. See Owens, supra. Similarly, the Board has reached this conclusion because the disturbances of motivation and mood and difficulty in establishing and maintaining effective work and social relationships reported by the October 2018 VA examiners are not the type of symptomatology contemplated by the criteria for at least a 50 percent rating. The Board has reached this conclusion because the examiners also reported that the Veteran was employed full-time as a manager, was just a few credits short from earning his college degree, and remains married too and living with his wife of over seven years. Therefore, the Board finds that the VA examiners' opinion that the Veteran's adverse psychiatric includes disturbances of motivation and mood and difficulty in establishing and maintaining effective work and social relationships is not probative because they are contrary to the occupational and social history also reported at the VA examinations and seen in the record. See Owens, supra. The Board also finds that the most probative evidence of record shows that the Veteran's anxiety disorder does not cause at least occupational and social impairment with reduced reliability and productivity because, while not exclusive symptomatology, the Board finds the symptomatology that the January 2014 and/or October 2018 VA examiners opined that the Veteran did not have included most of the symptoms listed as examples of adverse symptomatology that warrant a 50 percent rating (i.e., flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks more than once a week, difficulty in understanding complex commands, impaired judgment, and impaired abstract thinking). See Owens, supra. The Board also finds the fact that none of these symptoms are documented in his treatment record also weighs against finding that his anxiety disorder meeting the criteria for at least a higher rating. Id. Likewise, the Board finds the fact that the January 2014 and/or October 2018 VA examiners opined that the Veteran dressed appropriately in casual attire, had no deficits in grooming or hygiene, engaged in a pleasant and cooperative manner, he had a normal mood and affect that was reactive and full in range, his content of thought was reality based with no suggestions of psychosis or thought disorder, did not report any active suicidal/homicidal ideation, intent, or planning, his speech was normal, motor activity was normal, affect was pleasant and euthymic, he has no evidence of psychosis, he was fully oriented, his insight and judgment were appropriate, and the results of the neurocognitive battery reflect estimated average pre-morbid and current intellectual ability with fairly equal development in the verbal and visual-spatial domains weighs against finding that his anxiety disorder causes occupational and social impairment with reduced reliability and productivity in most areas weighs against finding that his anxiety disorder meeting the criteria for at least a higher rating. Id. Furthermore, the Board finds the fact that the Veteran told the October 2018 VA examiners that he remains employed full-time as a manager for the last three and a half years and is just a few credits short from earning his college degree, weighs against finding that his anxiety disorder causes at least occupational impairment with reduced reliability and productivity even though he also reported that he had problems following directions from multiple supervisors. See Owens, supra. Lastly, while the Veteran told the October 2018 VA examiners that he has few friends and his marriage was in troubled, the Board finds the fact that he also told the VA examiners that he always had few friends and the problems with his marriage is due to her infertility and financial pressures, and not his anxiety disorder, as well as that they continue to be married and live with one another for over seven years, weighs against finding that his anxiety disorder causes at least social impairment with reduced reliability and productivity. See Owens, supra. The above findings do not suggest that the Veteran does not have some problems because of his anxiety disorder. However, while the Veteran clearly has problems because of his service-connected anxiety disorder, the only question is the degree of the problem. Without taking into consideration his statements and the problems cited above the current 30 percent finding could not be justified based on this medical evidence. Not all the evidence in this record supports the current ratings. Therefore, given the above record, the Board finds that the claim for a higher evaluation for his anxiety disorder is denied at all times during the appeal because the most probative evidence of record shows that the criteria for a higher rating have not been met. See 38 C.F.R. § 4.130; Hart, supra; Fenderson, supra. Conclusion In reaching the above conclusions, the Board considered the doctrine of reasonable doubt. 38 U.S.C. § 5107(b). However, as the preponderance of the evidence is against the claims, the Board finds that the doctrine is not for application. See also, e.g., Ortiz, supra; Gilbert, supra. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.T. Werner, 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.