Citation Nr: 22012001 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 19-30 239 DATE: March 2, 2022 ORDER Entitlement to a 10 percent disability rating based on multiple, noncompensable, service-connected disabilities is dismissed. Entitlement to an increased initial 10 percent disability rating for the Veteran's back condition with prior lumbar laminectomy (low back disability) prior to July 18, 2019 is granted. Entitlement to an increased initial 10 percent disability rating for degenerative joint disease, claimed as left wrist sprain (left wrist disability) prior to July 18, 2019 is granted. Entitlement to an increased initial 10 percent disability rating for degenerative joint disease, claimed as right wrist sprain (right wrist disability) prior to July 18, 2019 is granted. Entitlement to an increased initial 50 percent disability rating for headaches is granted. Entitlement to an initial compensable disability rating for hypertension is denied. Service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD), depression and anxiety, also claimed as anxiety secondary to (PTSD) is granted. Service connection for hypercholesterolemia is denied. REMANDED Entitlement to a disability rating in excess of 10 percent for the low back disability for the period from July 18, 2019 is remanded. Entitlement to a disability rating in excess of 10 precent for left wrist disability for the period from July 18, 2019 is remanded. Entitlement to a disability rating in excess of 10 percent for the right wrist disability for the period from July 18, 2019 is remanded. Service connection for a left leg condition is remanded. FINDINGS OF FACT 1. On the record at the September 2021 hearing, prior to the promulgation of this decision on appeal, the Veteran withdrew his appeal as to the claim for entitlement to a 10 percent evaluation based on multiple, noncompensable, service-connected disabilities. 2. Prior to July 18, 2019, the Veteran's low back disability was manifested by arthritis and painful motion, but forward flexion was not limited to greater than 60 degrees but not greater than 85 degrees. 3. The Veteran's left wrist disability is manifested by pain and limitation of motion prior to July 18, 2019, ankylosis of the left wrist is not shown. 4. The Veteran's right wrist disability is manifested by pain and limitation of motion prior to July 18, 2019, ankylosis of the right wrist is not shown. 5. The Veteran's headaches are manifested by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 6. The evidence of record demonstrates that the Veteran does not have diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more. Additionally, while the Veteran does require continuous medication for control of his hypertension, he does not have a history of diastolic pressure predominantly 100 or more. 7. The Veteran has a current diagnosis of PTSD related to in-service stressors. 8. Hypercholesterolemia is a laboratory finding and neither a disease nor disability as contemplated by the Veteran's Administration (VA). CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal for entitlement to a 10 percent disability rating based on multiple, noncompensable, service-connected disabilities are met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for entitlement to an initial 10 percent rating for the Veteran's low back disability, prior to July 18, 2019, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, Diagnostic Code 5242. 3. The criteria for entitlement to an initial 10 percent disability rating for the Veteran's left wrist disability, prior to July 18, 2019, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, Diagnostic Code 5215. 4. The criteria for entitlement to an initial 10 percent disability rating for the Veteran's right wrist disability, prior to July 18, 2019, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, Diagnostic Code 5215. 5. The criteria for an initial 50 percent disability rating for headaches are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.124a, Diagnostic Code 8100. 6. The criteria for an initial compensable disability rating for hypertension are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.104, Diagnostic Code 7101. 7. The criteria for service connection for PTSD are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 8. The criteria for service connection for hypercholesterolemia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1984 to August 1984, November 1990 to August 1991, December 2004 to January 2006 and June 2007 to September 2012. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in September 2021. A transcript of the hearing is of record. The Board notes that the Veteran has an appeal pending at the Board for increased initial disability ratings for bilateral lower extremity radiculopathy as part of a separate Appeals Modernization Act (AMA) appeal, and these claims will not be considered as part of this legacy appeal. Withdrawal A substantive appeal may be withdrawn in writing or on the record at a hearing by the Veteran or his authorized representative, at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. In Acree v. O'Rourke, the Federal Circuit Court of Appeals held that an effective claim withdrawal must be (1) explicit, (2) unambiguous, and (3) done with a full understanding of the consequences of such action on the part of the veteran. 891 F.3d 1009 (Fed. Cir. 2018). On the record at the September 2021 Board hearing, prior to the promulgation of this decision on the appeal, the Veteran and his representative stated that the Veteran wished to withdraw the issue of entitlement to a 10 percent evaluation based on multiple, noncompensable service-connected disabilities. The Board finds that this communication reflects an explicit and unambiguous withdrawal of the veteran's claim and demonstrates a full understanding of the effect of such withdrawal. Accordingly, there are no specific errors of fact or law for appellate consideration with respect to this issue and it is dismissed. 38 U.S.C. § 7105(d); 38 C.F.R. § 19.55. Increased Ratings Generally, disability ratings are determined by applying the rating criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule) and represent the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations 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. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA compensation, as well as the whole recorded history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; see generally Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question of which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating is assigned. Id. Additionally, while it is not expected that all cases will show all the findings specified, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where the appellant has expressed dissatisfaction with the assignment of a rating, separate, or "staged," ratings can be assigned for separate periods of time based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. See id. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The Court has held that the provisions of 38 C.F.R. § 4.59 are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011). The intent of the rating schedule is to recognize painful motion with joint and periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or maligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The Board notes that during the pendency of this appeal, the schedule for rating musculoskeletal disabilities was amended, effective February 7, 2012. See 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5257). Where, as here, a diagnostic code is amended while a claim is pending, VA is required to consider both versions of the code and apply the version most favorable to the Veteran. Low Back Disability The criteria for rating all disabilities of the spine are set forth in 38 C.F.R. § 4.71a, which provides that spine disabilities are to be evaluated under the General Rating Formula for Diseases and Injuries of the Spine (General Spinal Formula) or under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula), whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. Prior to the regulatory change, Diagnostic Code 5242 was assigned for degenerative arthritis of the spine (see also Diagnostic Code 5003) and Diagnostic Code 5243 for IVDS. As of February 7, 2021, under the amended criteria, Diagnostic Code 5242 is assigned for degenerative arthritis and degenerative disc disease (DDD) other than IVDS (see also either Diagnostic Code 5003 or 5010). It also amends Diagnostic Code 5243 for IVDS allowing the Diagnostic Code to be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root; otherwise, Diagnostic Code 5242 must be used for all other disc diagnoses. Although the amended criteria for 5242 and 5243 separated DDD from IVDS, the rating formula under each Diagnostic Code was unchanged. The General Spinal Formula provides a 10 percent disability rating for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71a, General Spinal Formula. A 20 percent rating requires evidence of forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, or a combined range of motion of the thoracolumbar spine not greater than 120 degrees; a 40 percent rating requires evidence of forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. See id. For an increase to 50 percent, the evidence must show unfavorable ankylosis of the entire thoracolumbar spine. See id. A 100 percent evaluation is assigned for unfavorable ankylosis of the entire spine. See id. These criteria are to be applied irrespective of whether there are symptoms such as pain (whether or not it radiates), stiffness, or aching in the affected area of the spine, Id., and they "are meant to encompass and take into account the presence of pain, stiffness, or aching, which are generally present when there is a disability of the spine." 68 Fed. Reg. 51,455 (August 27, 2003) (Supplementary Information). For VA compensation purposes, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees. See id., at Note (2). Note 5 to the General Spinal Formula defines unfavorable ankylosis as "a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dislocation; or neurologic symptoms due to nerve root stretching." Under the IVDS Formula, ratings are based on evidence of incapacitating episodes, defined as periods of acute signs and symptoms that require bed rest prescribed by a physician and treatment by a physician. The maximum rating under this formula is 60 percent. As demonstrated below, the evidence of record does not demonstrate IVDS and, as such, the ratings are inapplicable. The Board recognizes that, in some circumstances, it must consider functional impairment in addition to limitation of motion due to factors such as pain, weakness, premature or excess fatigability, and incoordination when deciding an appropriate rating. See 38 C.F.R. §§ 4.40, 4.45, 4.59; De Luca v Brown, 8 Vet. App. 202, 204-7 (1995). The Veteran has an initial noncompensable disability rating for his low back disability prior to July 18, 2019. As relevant here, the Veteran was afforded VA examinations for his low back disability in November 2016 and May 2017. The November 2016 examiner noted diagnoses of degenerative arthritis of the spine and lumbosacral strain. The Veteran reported experiencing back pain since 1991 with limited range of motion. Forward flexion was measured to 85 degrees with extension measured to 25 degrees. Pain was noted on both movements. The examiner reported that the Veteran was able to perform repetitive use testing without any additional loss of function or range of motion. The examiner also noted that the Veteran had guarding or muscle spasm that did not result in abnormal gait or spinal contour. The Veteran was not noted to have ankylosis or IVDS. The Veteran reported to the May 2017 VA examiner that his back had gotten worse, resulting in difficulty standing for prolonged periods of time, daily pain and an inability to bend down repeatedly. The Veteran also reported flareups of increased pain. The examiner reported normal range of motion with no pain and the ability to perform repetitive use testing without additional loss of function or range of motion. The examiner also reported no loss of range of motion with repeated use over time or flareups. The examiner noted that pain significantly limited functional ability with flareups. The examiner reported that the Veteran did not have localized tenderness, guarding or muscle spasm of the thoracolumbar spine. The examiner also noted no ankylosis or IVDS. The Veteran testified that he experienced low back pain, including flareups. The Veteran's complaints of low back pain during the period prior to July 18, 2019 are reflected in the VA treatment records. Based on the evidence, the Board concludes that prior to Jul 18, 2019, the Veteran is entitled to a compensable initial rating of 10 percent for his low back disability. Specifically, at the time of the November 2016 VA examination, the examiner noted a diagnosis of degenerative arthritis and reported that the Veteran experienced pain on motion. The Board notes that the minimum compensable evaluation for a joint disability is warranted for painful motion under 38 C.F.R. § 4.59. Although the May 2017 examiner reported that the Veteran did not experience pain on motion, this conclusion is belied by the Veteran's reported symptoms as reflected in his lay statements to the examiners, his testimony at the Board hearing and his reports to VA treatment providers during the appeal period. The evidence of painful motion warrants a determination that the Veteran is entitled to an initial 10 percent rating for his low back disability. 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Code 5242. A disability rating in excess of 10 percent is not warranted for the period prior to July 18, 2019 as the evidence of record does not show forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees or unfavorable ankylosis of the thoracolumbar spine or the entire spine. Bilateral Wrist Disabilities The Veteran has initial noncompensable disability ratings for his bilateral wrist disabilities prior to July 18, 2019, pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5215. Diagnostic Code 5215 provides for the assignment of a 10 percent disability rating with dorsiflexion less than 15 degrees or palmar flexion limited in line with forearm. The Board observes that the 10 percent rating is the maximum rating provided under Diagnostic Code 5215. The Board notes that Diagnostic Code 5214 (wrist, ankylosis of), which is the only other diagnostic code which specifically references the wrist, is not appropriate for application in this case because, as is discussed below, there is no evidence of ankylosis in the record. Ankylosis is "immobility and consolidation of a joint due to disease, injury, surgical procedure." See Lewis v. Derwinski, 3 Vet. App. 259 (1992) (citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)). The Board also notes that the February 7, 2021 musculoskeletal amendments presented no changes to the rating criteria for Diagnostic Codes 5214 and 5215. The Veteran was provided VA examinations for his wrists in November 2016 and May 2017. The November 2016 examiner noted diagnoses of bilateral wrist sprain and degenerative arthritis. The Veteran reported that he did not have the strength to open jars, his range of motion was limited, and he could not do pushups because of pain. The Veteran did not report any flareups. The examiner reported that the Veteran had full range of motion with no pain and was able to perform repetitive use testing without additional loss of function or range of motion. The Veteran was noted to have full muscle strength and no ankylosis. The Veteran reported to the May 2017 VA examiner that he experienced dull pain and weakness with flareups of increased pain. The examiner reported that the Veteran had normal range of motion bilaterally with no pain on examination. The examiner also reported that the Veteran was able to perform repetitive use testing without additional loss of function or range of motion and that the Veteran did not experience loss of range of motion with flareups. The examiner did note that the Veteran had reduced range of motion of the right wrist with repeated use over time with palmar flexion reduced to 75 degrees. The examiner reported that the Veteran had full muscle strength, no atrophy and no ankylosis. The Veteran testified at the Board hearing that his wrists have always been painful. Based on the foregoing, the Board finds that the Veteran is entitled to initial 10 percent disability ratings for his bilateral wrist disabilities based on painful motion that resulted in loss of function. 38 C.F.R. §§ 4.40, 4.45. The Veteran credibly testified that his wrists have always been painful and reported to the VA examiners that he experienced pain and loss of function, including pain with exercise, limited strength and difficulty opening jars. Accordingly, an initial rating of 10 percent is warranted for the bilateral wrist disabilities for the period prior to July 18, 2019. 38 C.F.R. § 4.71a, Diagnostic Code 5215. The Board also concludes that there is no basis for a rating in excess of 10 percent during the period prior to July 18, 2019 as there is no evidence that the Veteran's wrist disabilities were manifested by ankylosis. 38 C.F.R. § 4.71a, Diagnostic Code 5214. Headaches The Veteran has a noncompensable initial rating for his headaches, pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100. Under that codes, a noncompensable rating is warranted for migraines with less frequent attacks. A 10 percent rating is warranted for migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the highest schedular rating under DC 8100. The rating criteria of DC 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). This renders 38 C.F.R. §§ 4.7 and 4.21 inapplicable. Johnson, 30 Vet. App. at 252. The phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under DC 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as "extreme exhaustion or powerlessness." Thus, the phrase "characteristic prostrating attacks" is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness. The rating criteria for a 50 percent rating contains several undefined phrases. The descriptive phrase "very frequent" connotes a frequency at least greater than once a month, as is required by the rating criteria corresponding to a lesser 30 percent rating. Johnson, 30 Vet. App. at 253. The phrase "completely prostrating" generally means that the migraines attack must render the veteran entirely powerless. Id. The completely prostrating attacks must also be "prolonged," which is defined as "to lengthen in time: extend duration: draw out: continue, protract." Id. (internal citation omitted). Lastly, the 50 percent rating criteria requires that the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and, with regard to severe economic inadaptability, nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004). In rating headache disabilities, ameliorative effects of medication may not be considered. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). The Veteran was afforded VA examinations for his headaches in December 2016, February 2017 and May 2017. The examiners noted that the Veteran's treatment plan included medication. The Veteran reported that he had headache pain, nausea and sensitivity to light and sound. The December 2016 and February 2017 examiners concluded that the Veteran did not have characteristic attacks of pain or very prostrating and prolonged attacks of pain productive of severe economic inadaptability. Both examiners noted that the Veteran lost at least 1 week per year of work due to sensitivity to noise and light during migraines. The May 2017 VA examiner noted that the Veteran had characteristic prostrating attacks once in 2 months, and did not have very prostrating or prolonged attacks productive of severe economic inadaptability. A March 2013 private treatment note documented the Veteran's complaint that he had headaches for several years that were associated with nausea and sensitivity to light and sound that lasted for hours or days and were frequent for several weeks. The Veteran and his wife submitted lay statements describing the Veteran's debilitating migraine headaches 1 to 2 times per month that lasted for days and required him to lay down in the dark with no stimuli. The Veteran's stated that he is unable to function during his headaches and that he experienced these migraines since 2010. The Veteran testified at the Board hearing that he experienced 2 to 3 headaches per month that required him to avoid external stimuli and that his headaches would be worse if not for his medication. The Veteran testified that the headaches lasted 4 to 10 hours, sometimes days, and affected his job. Construing the evidence in the light most favorable to the Veteran, and providing him the benefit of the doubt, the Board finds that the evidence is in relative equipoise as to whether his headaches manifested with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. The Veteran has consistently reported that he experiences multiple headaches per month that last for days, render him unable to function and affect his ability to perform his job. The Veteran's wife corroborated his account regarding the Veteran's migraines and their effect on him. The VA examiners, although describing the attacks as less frequent, did note that they included nausea and light and sound sensitivity. The examiners also noted that the Veteran's headaches affected his ability to work. The record also reflects that the Veteran takes medication for his headaches and the Veteran testified that his headaches would be worse without the medication. Given the competent and credible evidence that the Veteran experiences multiple migraine headaches per month that can last for days, are ameliorated by medication and have affected his employment, the Board finds that a 50 percent rating for the Veteran's migraines is warranted. 38 C.F.R. § 4.124a, Diagnostic Code 8100. Hypertension The Veteran was assigned an initial noncompensable disability rating for his hypertension, pursuant to 38 C.F.R. § 4.104, Diagnostic Code 7101. Under that code, a compensable rating is assignable when either of 3 criteria are satisfied: (1) when diastolic pressure is predominantly 100 or more; (2) systolic pressure is predominantly 160 or more; or (3) an individual has a history of diastolic pressure of predominantly 100 or more and requires continuous medication for control. 38 Id. A 20 percent rating is assigned for diastolic pressure 110 or more or; systolic pressure predominantly 200 or more. Id. A 40 percent rating is assigned for diastolic pressure predominantly 120 or more and a 60 percent rating is assigned for diastolic pressure predominantly 130 or more. Id. In McCarroll v. McDonald, the Court of Appeals for Veterans Claims (Court) interpreted Diagnostic Code 7101 and clarified its application in the increased rating context. 28 Vet. App. 267, 272 (2016). The Court first stated that the criteria for compensable ratings under Diagnostic Code 7101 "contemplate two factual alternatives[:]" (1) a veteran whose blood pressure is currently controlled by medication, but who has a history of diastolic pressure predominantly 100 or more, is entitled to the minimum compensable rating of 10 percent; or (2) if the blood pressure is not controlled by medication, the actual blood pressure level determines the disability rating from 20 to 60 percent. Id. The Court then specified that a finding of "predominantly 100 or more" may not be substantiated by merely one diastolic pressure reading of 100. Id. at 274. Here, the record reflects that the Veteran's hypertension is controlled by continuous medication. This is confirmed by the reports of the December 2016 and May 2017 VA examinations and is reflected in the VA and private treatment records. As the Veteran's hypertension is controlled by continuous medication, a compensable rating of 10 percent is only available if the evidence of record demonstrates a history of diastolic pressure predominantly 100 or more. See McCarroll, 28 Vet. App. at 272; Wilson v. McDonough, 2021 WL 5997922, * 8 (Vet. App. Dec. 20, 2021). In reviewing the evidence of record, the Board finds only one reference to a blood pressure reading where diastolic pression was 100 or more. The Veteran reported in January 2016 that his blood pressure was 170/102. VA treatment records otherwise reflect blood pressure readings of 127/81 in February 2016, 117/79 in April 2016, 122/74 in May 2016, 127/82 in November 2016, 128/78 in December 2018, 131/76 in July 2019 and 128/70 in January 2020. Readings at the December 2016 VA examination were recorded as 134/79, 139/84 and 136/82. Readings for the May 2017 VA examination were recorded as 131/80, 137/95 and 128/79. The Veteran testified that he did not think he met the threshold after he started taking blood pressure medicine. As the evidence of record only includes one reported reading where diastolic pressure was 100 or greater, and the Veteran' s hypertension is controlled through the use of continuous medication, the Board finds that entitlement to an initial compensable rating is not warranted. See 38 C.F.R. § 4.104, Diagnostic Code 7101. Thus, the Veteran's claim is denied. Service Connection Generally, service connection will be granted if the evidence demonstrates that a current disability resulted from a disease or injury incurred in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection requires evidence of a current disability, an in-service incurrence, disease or injury and a causal relationship between the current disability and the in-service incurrence, disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall 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). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Acquired Psychiatric Condition Service connection for PTSD requires medical evidence establishing a diagnosis of the disorder, credible supporting evidence that the claimed in-service stressor(s) occurred and medical evidence establishing a link between current symptomology and the in-service stressor. 38 C.F.R. § 3.304(f). Here, the record reflects that the Veteran has a current diagnosis of PTSD, satisfying the first element of service connection. Specifically, the Veteran submitted a November 2019 letter from his treating VA physician documenting a PTSD diagnosis and an August 2021 opinion from a private psychologist that also noted the Veteran's PTSD diagnosis based on the DSM-V. A PTSD diagnosis by a mental health professional must be presumed to have been made in accordance with the applicable DSM criteria as to both the adequacy of symptomatology and the sufficiency of the stressor absent compelling evidence to the contrary. Cohen v. Brown, 10 Vet. App. 128, 140 (1997); see also Rizzo v. Shinseki, 580 F.3d 1288, 1291 (Fed. Cir. 2009) (holding that, in the absence of evidence to the contrary, medical professionals are presumed to be competent to render the diagnoses they render). The Board acknowledges that the November 2016 VA examiner concluded that the Veteran did not meet the criteria for a PTSD diagnosis. However, given the conflicting diagnoses, the evidence is at least in equipoise on the issue. The Veteran is entitled to have reasonable doubt decided in his favor and, accordingly, the Board finds that the Veteran has a current PTSD diagnosis made in accordance with the DSM-V. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Cohen, supra. The Board notes that the existence of a credible in-service stressor has been conceded. Specifically, the RO confirmed in the August 2019 Statement of the Case (SOC) that the Veteran served in Southwest Asia in an area involving hostile military or terrorist activity and that the Veteran's report of being exposed to indirect fire met the criteria for a PTSD stressor. The Veteran's military personnel records confirm the Veteran's deployments and he has submitted lay statements and testimony describing his stressful experiences on his deployments. The record also includes competent evidence of a link between the Veteran's in-service stressors and the current PTSD diagnosis. The Veteran's treating VA physician noted that the Veteran's PTSD stemmed from his multiple deployments and the stressful events he experienced during them. The private psychologist also described the Veteran's PTSD as "combat-related." The Board finds these opinions entitled to probative weight as they are based on the relevant records, and treatment of the Veteran. There are no contradictory opinions as the November 2016 VA examiner did not offer a nexus opinion. After thorough review of the evidence of record, the Board concludes that the weight of the evidence is in favor of a finding that the Veteran's current PTSD is related to service. Accordingly, entitlement to service connection for PTSD is granted. Hypercholesterolemia The Veteran is seeking service connection for high cholesterol. The Veteran's VA treatment records show that he had ongoing abnormal laboratory findings of hypercholesterolemia. Initially, the Board notes that high cholesterol is a laboratory finding, and not a disability subject to service connection. VA's stated policy is that hyperlipidemia is a general term for elevated concentrations of any or all of the lipids in the plasma, including hypertriglyceridemia, hypercholesterolemia, etc., and is a laboratory finding and not a disability in and of itself for which VA compensation benefits are payable. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) (Diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are actually laboratory results and are not, in and of themselves, disabilities. They are, therefore, not appropriate entities for the rating schedule). While high cholesterol may reflect a possible underlying disability, there is no showing of a current medically diagnosed disability manifested by high cholesterol. Statements by the Veteran to the effect that he has high cholesterol, or a condition manifested by high cholesterol, does not constitute competent evidence of a current disability productive of impairment in earning capacity. In the absence of proof of a present disability there can be no valid claim of service connection on a direct basis pursuant to 38 C.F.R. § 3.303. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also McClain v. Nicholson, 21 Vet. App. 319 (2007) (holding that a "current disability" exists if the diagnosed disability is present at the time of the claim or during the pendency of that claim). There being no competent medical evidence of a diagnosed chronic disability resulting from high cholesterol, the claim is denied. As the preponderance of the evidence weighs against the claim (that is to say, the weight of the evidence is neither in approximate balance nor nearly equal), the benefit-of-the-doubt rule is inapplicable. See Lynch v. McDonough, 2021 U.S. App. LEXIS 37307 (Dec. 17, 2021); see also 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND Low Back Disability and Bilateral Wrists The Veteran's testimony at the September 2021 Board hearing reflect a worsening of the severity of his bilateral wrist and low back disabilities, including the bilateral lower extremity radiculopathy. Accordingly, the claims of entitlement to increased disability ratings for these disabilities for the periods after July 18, 2019 are remanded to determine the current nature and severity of these disabilities. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Left Leg Condition The Veteran contends that he has a left leg condition, separate from his left lower extremity radiculopathy, caused by an incident in service. Specifically, the Veteran testified that while participating in a sporting activity while on active duty he felt a pop in his left leg, tore his calf muscle and has been in constant pain ever since. A December 2016 VA examiner noted that the Veteran had chronic tendonitis of the crural fascia and a tear of the anterior crural fascia. The examiner noted the lack of objective medical evidence documenting treatment during service and concluded that a nexus was not established. The Board finds the VA examiner's opinion inadequate as it fails to consider the Veteran's lay statements regarding the injury and provides no rationale for the conclusory assertion that a nexus was not established. Accordingly, remand for an addendum opinion is warranted. See Barr, supra (when VA undertakes to provide a VA examination or obtain a VA opinion it must ensure that the examination or opinion is adequate.) The matters are REMANDED for the following action: 1. Obtain pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Following the development in item 1, schedule the Veteran for VA examinations with appropriate clinicians to evaluate the Veteran's low back and bilateral wrist disabilities. The examiners must be provided with and review the entire claims file, including this remand. All appropriate tests and studies should be conducted. The examiner should provide full descriptions of the Veteran's low back and bilateral wrist disabilities and report all signs and symptoms necessary for evaluating the disabilities under the rating criteria. The examiners must also provide a rationale for any opinions, citing to specific evidence in the record. 3. Following the development in item 1, obtain an addendum opinion regarding the Veteran's left leg condition form a qualified clinician. The clinician must review the claims file, including this remand. Following review of the record, the examiner should offer an opinion as to the following: Is the Veteran's left leg condition at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) related to service, including the Veteran's reports that he injured his leg in service and has felt pain ever since. The clinician is advised that a medical opinion that relies upon silence in the service treatment records is inadequate. All findings and conclusions should be supported with a complete rationale based on consideration of the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason so should be explained, indicating whether the inability to provide an opinion is based on the limits of medical knowledge in general or of the examiner. If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts required), the RO should develop the claim to the extent necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the RO should obtain an opinion from a medical professional who has the knowledge and training need to render such an opinion. S.C. KREMBS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Snyder, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.