Citation Nr: 22006335 Decision Date: 02/03/22 Archive Date: 02/03/22 DOCKET NO. 14-40 655 DATE: February 3, 2022 ORDER Entitlement to an initial rating in excess of 20 percent for bilateral exophthalmos and dry eye syndrome associated with status post Grave's disease with hypothyroidism, hereinafter a "bilateral eye disorder," is denied. Entitlement to a rating of 30 percent, but not higher, prior to June 15, 2021 for status post Grave's disease with hypothyroidism, hereinafter "Grave's disease," is granted. Entitlement to a rating in excess of 30 percent for Grave's disease is denied. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran has been in receipt of a 20 percent rating for his bilateral eye disorder, which is the maximum schedular rating for that disability. 2. Throughout the period on appeal, the Veteran's Grave's disease was manifested by fatigability, constipation, and mental sluggishness; and without muscular weakness, mental disturbance, and weight gain to warrant a higher rating under the prior criteria; and without myxedema and mental disturbance for a period of six months after an examiner has determined the condition had stabilized to warrant a higher rating under the revised criteria. CONCLUSIONS OF LAW 1. There is no legal basis for the assignment of a schedular rating in excess of 20 percent for a bilateral eye disorder. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.754.78, 4.79, Diagnostic Code 6025. 2. The criteria for a 30 percent rating, but not higher, prior to June 15, 2021 for Grave's disease have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.754.78, 4.119, Diagnostic Code 7903 (2016). 3. The criteria for a rating in excess of 30 percent at any time during the period on appeal for Grave's disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.754.78, 4.119, Diagnostic Code 7903 (2016, 2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from August 1981 to August 2001. These matters come to the Board of Veterans' Appeals (Board) on appeal from a July 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) San Diego, California. Jurisdiction of this appeal is currently with the RO in Atlanta, Georgia. This case was most recently before the Board in May 2021, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. The case has now been returned to the Board for appellate action. In addition, in an August 2021 rating decision, the AOJ granted an increased rating for the Veteran's Grave's disease, and assigned a 30 percent disability rating effective June 15, 2021. However, as this does not represent a full grant of the benefits sought on appeal, the claim remains before the Board, and the Board has reframed the issue to reflect the rating increase. Increased Rating Disability ratings are determined by application of the criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 50910 (2007). The veteran's entire history is considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A review of the recorded history of a disability is necessary to make an accurate rating. 38 C.F.R. §§ 4.2, 4.41. The regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue. Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The assignment of a particular diagnostic code is 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. In reviewing the claim for a higher rating, the Board must consider which diagnostic code or codes are most appropriate for application in the veteran's case and provide an explanation for the conclusion. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran's service-connected disability. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. When an evaluation of a disability is based upon limitation of motion, the Board must also consider, in conjunction with the otherwise applicable diagnostic code, any additional functional loss the veteran may have sustained by virtue of other factors as described in 38 C.F.R. §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Such factors include more or less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, and deformity or atrophy from disuse. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the veteran. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claims. When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Bilateral Eye Disorder The Veteran seeks a higher initial rating for his service-connected bilateral eye disorder. Specific argument in support of this appeal has not been provided. The Veteran's bilateral eye disorder is currently rated as 20 percent disabling under Diagnostic Code 6099-6025 for disorders of the lacrimal apparatus (epiphora, dacryocystitis, etc.). 38 C.F.R. § 4.79. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. Under Diagnostic Code 6025, a 20 percent rating is warranted for bilateral involvement and a 10 percent rating is warranted for unilateral involvement. During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. There was no amendment to Diagnostic Code 6025. The Veteran was granted entitlement to service connection for a bilateral eye disorder in a July 2014 rating decision and assigned a 20 percent rating, effective March 31, 2014 under Diagnostic Code 6025. 38 C.F.R. § 4.79. As noted above, Diagnostic Code 6025 provides a maximum disability rating of 20 percent for bilateral involvement. 38 C.F.R. § 4.79, Diagnostic Code 6025; see also Smith v. Nicholson, 451 F.3d 1344, 1350 (Fed. Cir. 2006). As there is no adequate legal basis upon which to award a rating in excess of 20 percent for the bilateral eye disorder, the Veteran's claim for a higher schedular rating must be denied. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). 2. Grave's Disease The Veteran seeks higher ratings for his Grave's disease. Specifically, the Veteran asserts that his "hypothyroid" disorder had not become a "hyperthyroid" disorder. See Correspondence, December 31, 2020. Additionally, the Veteran's representative argued that the November 2019 VA examination report was inadequate to adequately address the current severity of the Veteran's Grave's disease because the VA examiner did not afford a physical examination, and rather noted that nothing in the claims filed warranted a change in the previous opinion without adequately addressing relevant treatment records. See Appellate Brief, October 19, 2020. Moreover, the Veteran's representative argues that the Veteran's symptoms of fatigability, mental sluggishness or disturbance, muscular weakness, and weight gain, warrant a 60 percent rating. See Appellate Brief, October 26, 2018; see also VA Form 646 Statement of Accredited Representative in Appealed Case, February 5, 2015. The Veteran's Grave's disease is currently rated as 10 percent disabling prior to June 15, 2021, and 30 percent disabling thereafter under Diagnostic Code 7903. 38 C.F.R. § 4.119. He filed his increased rating claim on March 3, 2014. Diagnostic Code 7903 was amended on December 10, 2017. The Veteran's current 10 percent evaluation is based on the previous criteria. Under those criteria, a 10 percent evaluation was warranted for fatigability, or; continuous medication required for control. A 30 percent evaluation was warranted for fatigability, constipation, and mental sluggishness. A 60 percent evaluation was warranted for muscular weakness, mental disturbance, and weight gain. A 100 percent evaluation was warranted for cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 beats per minute), and sleepiness. 38 C.F.R. § 4.119, Diagnostic Code 7903 (2016). Under the current version of Diagnostic Code 7903, a 30 percent rating is assigned for hypothyroidism without myxedema. Note (2) appending the 30 percent criteria states that this evaluation shall continue for six months after initial diagnosis. Thereafter, rate residuals of disease or medical treatment under the most appropriate diagnostic code(s) under the appropriate body system (e.g., eye, digestive, mental disorders). Note (3) states that if eye involvement, such as exophthalmos, corneal ulcer, blurred vision, or diplopia, is also present due to thyroid disease, also separately evaluate under the appropriate diagnostic code(s) in §4.79, Schedule of Ratings Eye (such as diplopia (Diagnostic Code 6090) or impairment of central visual acuity (Diagnostic Codes 6061-6066)). As discussed above, the Veteran has been assigned a 20 percent rating for his bilateral eye disorder for the entire period on appeal. A 100 percent rating is assigned for hypothyroidism manifesting as myxedema (cold intolerance, muscular weakness, cardiovascular involvement (including, but not limited to hypotension, bradycardia, and pericardial effusion), and mental disturbance (including, but not limited to dementia, slowing of thought and depression)) for a period of six months after an examiner has determined the condition is stabilized. Note (1) appending the 100 percent criteria states that this evaluation shall continue for six months beyond the date that an examining physician has determined crisis stabilization. Thereafter, the residual effects of hypothyroidism shall be rated under the appropriate diagnostic code(s) within the appropriate body system(s) (e.g., eye, digestive, and mental disorders). 38 C.F.R. § 4.119, Diagnostic Code 7903. Turning to the evidence, of record is a March 2014 letter by Dr. S.A. that indicates the Veteran had hypothyroid treatment resulting in weight gain, memory lapses, irritability, and fatigue. The Veteran was afforded a VA examination in June 2014. At that time, the Veteran reported he had Synthroid doses increased; felt tired, irritable, and forgetful; experienced weight gain; and stated his eyes bulged to an extent, but less than when he was acutely ill with Grave's disease. His weight was 185 pounds, earlier in June he weighed 189 pounds. The VA examiner noted that the Veteran's thyroid tests were within the normal range, and that the Veteran had a diagnosis of sleep apnea; he was noncompliant with his prescribed CPAP machine, which was likely the cause of his symptoms. The Veteran had radioactive iodine treatment for a thyroid condition in the 1980s, and had not had any other type of treatment for a thyroid or parathyroid condition. Residual endocrine dysfunction following such treatment included hypothyroid endocrine dysfunction. There were no current findings, signs, or symptoms attributable to a hyperthyroid condition. The examiner noted that fatigability and maybe irritability were current findings, signs, or symptoms attributable to a hypothyroid condition. He did not have findings, signs, or symptoms attributable to conditions related to hyper parathyroid, hypoparathyroid, or pressure on adjacent organs. Upon physical examination in June 2014, the Veteran had slight exophthalmos of the bilateral eyes that were symmetric; normal neck; normal pulse; hypoactive bilateral triceps and brachioradialis reflexes; and did not have scars. He was not shown to have any areas of the skin of the neck that were hypo- or hyperpigmented, abnormal texture, or missing underlying soft tissue, nor indurated and inflexible related to a thyroid or parathyroid disease and/or treatment. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. The examiner noted the Veteran's Grave's disease did not impact his ability to work. Of record is an October 2014 VA treatment record that indicates the Veteran had normal muscle strength and tone; no depression; and pulses were normal bilaterally. VA treatment record, October 20, 2014. Of record is a November 2014 lay statement submitted by the Veteran's wife. In her statement, she indicated that the Veteran's symptoms included feeling tired all of the time; weakness; always being sleepy; irritability; excessive sweating; slow thought processes, inability to absorb messages; forgetfulness; memory loss; excessive bowel movements between 4 or 5 times a day; weight gain; and decreased libido. Of record is a November 2014 thyroid and parathyroid conditions disability benefits questionnaire (DBQ) completed by Dr. S.A. At this time, the Veteran was shown to require continuous medication for control of his condition; had radioactive iodine treatment in 1984; did not require surgery; and residuals included hypothyroid endocrine dysfunction. Findings, signs, or symptoms attributable to a hyperthyroid condition included palpitations; increased pulse pressure or blood pressure; emotional instability; fatigability; eye involvement; muscular weakness; and frequent bowel movements. Findings, signs, or symptoms attributable to a hypothyroid condition included fatigability; constipation; mental sluggishness; muscular weakness; weight gain of 55 pounds; sleepiness; and cold intolerance. He did not have findings, signs, or symptoms attributable to conditions related to hyper parathyroid, hypoparathyroid, or pressure on adjacent organs. Upon physical examination in November 2014, Dr. S.A. noted the Veteran had exophalmus. He did not have scars. He was not shown to have any areas of the skin of the neck that were hypo- or hyperpigmented, abnormal texture, or missing underlying soft tissue, nor indurated and inflexible related to a thyroid or parathyroid disease and/or treatment. Other pertinent physical findings included hypothyroidism. Dr. S.A. noted the Veteran's Grave's disease impacted his ability to work due to tiredness and being easily fatigued. Of record is a December 2014 VA treatment record that indicates the Veteran had significant weight gain and low energy that was attributable to his Grave's disease. Of record is a December 2014 VA treatment record that indicates the Veteran's excessive daytime somnolence was partially due to his obstructive sleep apnea, and that such symptom had improved since his compliance with the CPAP machine. VA treatment record, December 9, 2014. Of record is January 2015 VA treatment record that indicates the Veteran's symptoms of snoring and fatigue were more likely symptoms of his obstructive sleep apnea rather than his Grave's disease. The Veteran was afforded a VA examination in August 2015. At that time, the examiner noted the Veteran's current diagnosis of hypothyroidism was a progression of his service-connected disability. The examiner noted there were no current findings, signs or symptoms attributable to conditions related to hyperthyroid, hypothyroid, hyper parathyroid, hypoparathyroid, nor pressure on the adjacent organs. Upon physical examination in August 2015, the Veteran was shown to have mild exophthalmos bilaterally; and hypoactive deep tendon reflexes in the bilateral knees and ankles. He did not have scars. He was not shown to have any areas of the skin of the neck that were hypo- or hyperpigmented, abnormal texture, or missing underlying soft tissue, nor indurated and inflexible related to a thyroid or parathyroid disease and/or treatment. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. The examiner noted the Veteran's Grave's disease did not impact his ability to work. In a November 2015 VA Form 21-4138 Statement in Support of Claim, the Veteran reported symptoms of his Grave's disease included being easily fatigued; weakness with activity; sleepiness most of the time; forgetfulness; difficulty focusing; slight weight gain, sometimes stable weight; and feet becoming easily cold in cold weather. VA Form 21-4138 Statement in Support of Claim, November 9, 2015. In a November 2015 VA Form 21-4138 Statement in Support of Claim, the Veteran's wife reported that the Veteran's had increasingly exhibited forgetfulness, slow mental processing, and always being sleepy. VA Form 21-4138 Statement in Support of Claim, November 9, 2015. Of record is a February 2017 VA treatment record that indicates the Veteran's severe obstructive sleep apnea was under excellent control when compliant with his CPAP; his excessive daytime somnolence was due to the poor CPAP compliance and his obstructive sleep apnea. Of record is a September 2017 VA treatment record that indicates the Veteran's obesity was due to dietary indiscretion and a sedentary lifestyle; his hypothyroidism was not well controlled due to noncompliance with medication. Of record is are June 2019 and July 2019 VA treatment records that indicate the Veteran denied chills, fatigue, constitutional symptoms, weakness, depression, and memory loss. At an August 2019 VA knee examination, the VA examiner noted the Veteran did not have a reduction in muscle strength nor muscle atrophy in either knee. The Veteran was afforded a VA examination in November 2019. At that time, the Veteran reported he took Synthroid daily; his weight was 190 pounds, and was considered obese; had sleep apnea and used his CPAP about five hours every night; and he reported he woke up feeling refreshed but would feel "sluggish" later in the day. The Veteran reported feeling sluggish, forgetful, irritable, low libido, weakness, diarrhea about four to five times a day, and bulging eyes. The examiner noted there were no current findings, signs or symptoms attributable to conditions related to hyperthyroid, hypothyroid, hyper parathyroid, hypoparathyroid, nor pressure on the adjacent organs. Upon physical examination in November 2019, the Veteran was shown to have mild exophthalmos bilaterally; and hypoactive deep tendon reflexes in the bilateral knees and ankles. He did not have scars. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. The examiner noted the Veteran's Grave's disease did not impact his ability to work. The examiner remarked that the Veteran retired early due to foot problems; the current severity of the thyroid condition was treated and stable, with minimal effects on his daily living; his symptoms of fatigue could be distinguished from his obstructive sleep apnea, and noted that his normal thyroid levels indicate his fatigue should be attributed to his obstructive sleep apnea alone; and that his weight gain results in increased medication for his thyroid condition but that it is not related to his thyroid condition due to the Veteran's lifestyle choices and habits. In short, the November 2019 VA examiner opined that the Veteran's euthyroid was due to the supplementation and his symptoms should not be attributed to his thyroid condition. Of record is a July 2020 VA addendum opinion as to the November 2019 VA examination report. In the July 2020 VA addendum opinion, the examiner noted that, as of March 2020, the Veteran's thyroid levels were low showing overtreatment; his Synthroid was then lowered. No subsequent testing or notes were available for review. Therefore, the VA examiner opined that she did not see anything in the new documents to alter her previous opinion; the Veteran had a diagnosis of postprocedural hypothyroidism that was treated, stable, and had minimal effects on his daily living. Of record is a September 2020 lay statement submitted by the Veteran. At this time, the Veteran reported symptoms of physical exhaustion; extreme fatigue, even with sufficient sleep; muscle weakness or lack of feeling in his legs and arms; memory lapses or loss and mental slowness; delayed thought processing; getting lost; needing physical therapy weekly; having to write things down to remember things; low libido; dry and itchy skin, and requiring lotion; bulging eyes and tearing; hypertension; swelling on the left side of his neck; difficulty swallowing; and uncontrolled weight gain. Correspondence, September 10, 2020. Of record is a September 2020 lay statement submitted by the Veteran's wife. At this time, she reported symptoms of worsening fatigue, mental slowness, and muscle weakness. She indicated the Veteran required regular massages on his legs and thighs; diagnosis of muscle loss and weakness; physical therapy once a week; difficulty swallowing; and swelling on the neck. She reported she did not believe his Grave's disease was treated nor stable, and that his medication required adjustment every four to six months. Of record is a January 2021 VA opinion. At that time, the VA examiner opined it was not possible to say whether or not myxedema would manifest now, without the ameliorating effects of thyroid medication. The most recent hormone testing showed normal hormone levels that indicate myxedema is not expected. However, there was an elevated testing result in 2009, so it is not known what his levels would be currently without his medication. The VA examiner opined that could not be known without pure speculation what symptoms, to include myxedema, would manifest without his medications. Therefore, it is less likely than not there had been weight gain due to his hypothyroidism. In this regard, the VA examiner noted that during the past 11 years, the Veteran's hormone levels had fluctuated but his weight had remained relatively stable and did not demonstrate significant weight gain. Additionally, at those times, one of his hormone levels remained normal or near normal, and would therefore not expect to cause significant weight gain. Therefore, his weight gain was less likely than not due to his thyroid condition. Additionally, the VA examiner considered the lay statements submitted by the Veteran and his spouse, and found that the hormone levels during this time remained normal, and therefore did not result in the symptoms reported in the lay statements submitted. The Veteran was afforded a VA examination in June 2021. At that time, the Veteran reported current symptoms of eye tearing; proptosis; no tachycardia; fatigue; nervousness; cold intolerance; skin sometimes weak; weight gain; tremor; memory problems; larger and swollen neck; difficulty swallowing on occasion; decreased libido; and slow thinking. Thyroid findings and symptoms included eye involvement, non-toxi thyroid enlargement; and myxedema. Upon physical examination in June 2021, the Veteran was shown to have proptosis and exophylitic; and enlarged thyroid gland with a left neck nodule, cystic like. The Veteran had disfigurement to the neck due to enlargement of the thyroid gland. Reflex examination was normal. The Veteran did not have any scars. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. Laboratory testing was all normal. The examiner noted the Veteran's Grave's disease impacted his ability work due to slowing of thinking, difficulty with swallowing on occasion, feeling pressure on his throat and neck when lying on his back, but could still eat and swallow. The June 2021 VA examiner opined the Veteran's hypothyroidism had not become hyperthyroidism and the condition was just a continuation of his service-connected Grave's disease with hypothyroidism. His medication was well regulated by his doctor, and that his hormone levels were within normal limits. In support of this conclusion, the VA examiner noted the doctor could do no better with the regulation of the hormone levels based on the regulation of his medications; and that although the Veteran may experience symptoms of either hypo- or hyperthyroidism, the doctor's management of the medication resulted in normal hormone levels. The June 2021 VA examiner also provided a full description of the disability and reported all signs and symptoms, and their functional impacts as necessary to rate his Grave's disorder. Such symptoms included intolerance, skin sometimes weak, weight gain, tremor, memory problems, large neck and swollen, sometimes difficulty swallowing, decreased libido, and slow thinking. However, the examiner opined these symptoms did not seem to impact his ability to work. The examiner noted that all of the Veteran's contentions and treatment records in the associated claims file were considered. Additionally, the VA examiner noted the Veteran's hormones were all within normal limits so that he was not proceeding to hyperthyroidism. The Board notes that a review of the record shows that the Veteran has received treatment for his service-connected Grave's disease from VA Medical Centers and private treatment providers. However, there is no indication from the record that the Veteran's symptoms are worse than those reported in the various records discussed above. Based on the foregoing, and resolving all doubt in favor of the Veteran, the Board finds that a rating of 30 percent, but not higher, prior to June 15, 2021 is warranted. In this regard, the medical evidence indicates that the Veteran experienced fatigability, constipation, and mental sluggishness due to his Grave's disease. Although, on occasion, it was unclear whether his fatigability and mental sluggishness was to be attributable to his obstructive sleep apnea or his Grave's disease, the Veteran was consistently shown to experience and report fatigability and slow mental processing. Notably, at his June 2014 VA examination, the Veteran was shown to have fatigability that was attributable to his thyroid condition, and perhaps irritability. Additionally, in a November 2014 lay statement submitted by the Veteran's wife, and a November 2014 private DBQ submitted by Dr. S.A., the Veteran was shown to have fatigability, muscular weakness, constipation, frequent bowel movements, and mental sluggishness attributable to his thyroid condition. Furthermore, in November 2015 lay statements, the Veteran and his wife again reported symptoms of being forgetful, easily fatigue, weakness, difficulty focusing, sleepiness, and slow mental processing. Although VA treatment records seem to indicate that the Veteran's symptoms of fatigue and weight gain were more likely due to obstructive sleep apnea and lifestyle choices, those treatment records did not provide rationale for the conclusions reached and are therefore afforded little, if any, probative weight. In contrast, the June 2014 VA examination report and November 2014 private DBQ completed by Dr. S.A. included a physical examination and interview with the Veteran when determining that fatigability and other symptoms were attributable to his thyroid condition. Therefore, resolving all doubt in favor of the Veteran, the Board finds that the Veteran's symptoms of Grave's disease included fatigability, constipation, and mental sluggishness to warrant a 30 percent rating under the previous diagnostic criteria. 38 C.F.R. § 4.119, Diagnostic Code 7903 (2016). Based on the foregoing, the Board finds that a rating in excess of 30 percent is not warranted at any time during the period on appeal for the Veteran's Grave's disease. In this regard, the medical evidence does not demonstrate that the Veteran had muscular weakness, weight gain, and mental disturbance to warrant a higher 60 percent rating under the former criteria. Id. In this regard, the Veteran was shown to have muscular weakness and weight gain, however, he did not report symptoms of mental disturbance at any time. Notably, his extensive VA treatment records are silent for reports of mental disturbances, and he consistently denied symptoms of depression. Rather, the VA examination reports and November 2014 private DBQ reports show that the Veteran experienced muscular weakness, weight gain, and mental sluggishness. Those symptoms more closely approximate the rating criteria for a 30 percent rating, and do not rise to warrant a higher 60 percent rating. Id. Additionally, the medical evidence does not demonstrate that the Veteran had myxedema and mental disturbance for a period of six months after an examiner has determined that the condition had stabilized so as to warrant a higher 100 percent rating under the revised criteria. 38 C.F.R. § 4.119, Diagnostic Code 7903 (2021). In this regard, a January 2021 VA medical opinion indicates that the Veteran did not have myxedema. Specifically, the VA examiner noted that the Veteran's thyroid condition was treated with medication and that his hormone levels were generally stable and within normal limits for the past 11 years; therefore, significant weight gain would not be expected as a result of his thyroid condition. Moreover, as noted above, the Veteran has not been shown to have mental disturbance at any time during the period on appeal. Significantly, the January 2021 VA opinion indicates the Veteran's condition has been stable for at least 11 years. The June 2021 VA examination report shows the Veteran reported symptoms of eye tearing; proptosis; no tachycardia; fatigue; nervousness; cold intolerance; skin sometimes weak; weight gain; tremor; memory problems; larger and swollen neck; difficulty swallowing on occasion; decreased libido; and slow thinking. However, there is no evidence of myxedema, and his hormone levels were within normal limits. Specific to an evaluation under Note (2) or Note (3), there is no evidence of digestive, or mental symptoms or manifestations related to hypothyroidism. His eye symptoms are separately evaluated as discussed supra. Therefore, the Board finds that there is no evidence of myxedema as is necessary for a 100 percent evaluation under the revised criteria. 38 C.F.R. § 4.119, Diagnostic Code 7903 (2021). While the Board recognizes that the Veteran is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, supra. Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability considering the rating criteria to be more persuasive than the Veteran's reports regarding the severity of his condition. Despite the foregoing, the Board acknowledges the Veteran's assertions and the reports of his wife that his various symptoms and functional impairments warrant a higher rating due to physical therapy, numbness in his legs and extremities, cold interlace, forgetfulness, mental sluggishness, weight gain, sleepiness, and fatigue. However, even after considering such contentions as to the effects of the disability on his daily life, the Board finds that the criteria for a higher rating are not met. The Rating Schedule contemplates such impairment under the ordinary conditions of daily life. 38 C.F.R. § 4.10; see also Martinak v. Nicholson, supra. This argument is therefore without merit. The Board has also considered the arguments of the Veteran's representative, namely, that the November 2019 VA examiner did not afford a physical examination, and rather noted that nothing in the claims filed warranted a change in the previous opinion without adequately addressing relevant treatment records; and that the Veteran's symptoms of fatigability, mental sluggishness or disturbance, muscular weakness, and weight gain, warrant a 60 percent rating. The Board notes that the Veteran's most recent VA examination afforded in June 2021 afforded the Veteran a physical examination and performed an interview of the Veteran, and adequately addressed the claims file and relevant treatment records; and that the prior June 2014 and August 2015 VA examination reports were rendered following a physical examination and interview of the Veteran, as well as the November 2015 private DBQ submitted. Additionally, the Board notes that the Veteran's representative is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, supra. These arguments are therefore without merit. The Board has considered whether a staged rating under Fenderson v. West, supra is appropriate; however, the Board finds that his symptomatology was been stable throughout the appeal period. Therefore, assigning a staged rating is not warranted. The Veteran nor his representative have not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, supra. (Continued on the next page) Accordingly, the Board finds evidence persuasively favors the assignment of a 30 percent rating, but not higher, prior to June 15, 2021, for the Veteran's Grave's disease and to that extent, the appeal is granted. However, the evidence is against the claim for a rating in excess of 30 percent at any time during the period on appeal for Grave's disease, and to that extent, the appeal is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. J. Smith Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mariah N. Sim, 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.