Citation Nr: 22013774 Decision Date: 03/10/22 Archive Date: 03/10/22 DOCKET NO. 14-31 353 DATE: March 10, 2022 ORDER Service connection for a left foot disorder, separate and distinct from service-connected left hallux valgus, is denied. An initial rating in excess of 10 percent for left hallux valgus, to include on an extra-schedular basis, is denied. A separate rating of 10 percent, but no higher, for arthritis associated with left hallux valgus is granted, subject to the laws and regulations governing the payment of monetary awards. FINDINGS OF FACT 1. A left foot disorder, separate and distinct from service-connected left hallux valgus, is not shown to be causally or etiologically related to any disease, injury, or incident during service and is not caused or aggravated by service-connected left hallux valgus. 2. For the entire appeal period, the Veteran's left hallux valgus has been assigned the maximum schedular rating for such disability. 3. For the entire appeal period, the Veteran's left hallux rigidus and arthritis have been determined to be progressions of his left hallux valgus, the latter of which is manifested by painful motion resulting in functional impairment. CONCLUSIONS OF LAW 1. The criteria for service connection for a left foot disorder, separate and distinct from service-connected left hallux valgus, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for an initial rating in excess of 10 percent for left hallux valgus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5280. 3. The criteria for a separate rating of 10 percent, but no higher, for arthritis associated with left hallux valgus have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5003. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1965 to February 1966. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in May 2014 by a Department of Veterans Affairs (VA) Regional Office. In July 2015, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In July 2018, June 2020, November 2020, and May 2021, the Board remanded the case for additional development and it now returns for further appellate review. 1. Entitlement to service connection for a left foot disorder, separate and distinct from service-connected left hallux valgus, to include as secondary to service-connected left hallux valgus. The Veteran asserts he has a left foot disorder, separate and distinct from his service-connected left hallux valgus, related to service. Alternatively, he contends his service-connected left hallux valgus has caused and/or aggravated a separate left foot disorder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). The Veteran's October 1965 enlistment examination, in relevant part, notes a history of marked hallux valgus of the left foot and large bunion over phalangeal-metatarsal joint, as well as pes planus. In December 1965, he complained of left foot pain and was noted to have had an injury of fracture/dislocation of the 2nd toe growth area at the age of 3. A January 1966 consultation report indicates the Veteran's bunion had been painful since entering service and had been aggravated by walking, running, and wearing military service. Since the initial injury, he had experienced an underdeveloped 2nd toe, with resulting hallux valgus and large metatarsal bunion. He was deemed unfit for military service and separated from service in February 1966 for a condition that pre-existed his entrance to service. His June 1966 separation examination reflects a finding of hallux valgus of left foot secondary to old trauma and deformity of left foot. X-ray examination in April 2014 revealed degenerative arthritis in the left foot. In an April 2019 opinion, a VA physician noted such was diagnosed when the Veteran was 68 years old, "hardly an unusual age to have degenerative arthritis diagnosed for other reasons." He reported additional current diagnoses of left foot hallux valgus and left foot 2nd toe deformity and shortening. With respect to direct service connection, the VA physician opined it is less likely than not that the other left foot disorders are caused by the Veteran's military service. He clarified that the hallux valgus and shortening of the 2nd toe were caused by the pre-service fracture/ dislocation of the 2nd toe, but found it was impossible to say whether the later development of degenerative arthritis was caused by the two pre-existing conditions. In particular, the VA physician found the degenerative arthritis was caused either by normal degenerative aging processes or in process by the pre-existing deformity. A July 2020 VA examination reflects diagnoses of hallux valgus, a left foot injury involving the second toe, and left foot traumatic arthritis. The VA clinician found the left hallux valgus was the progression of the left foot injury. Similarly, she determined that the left first metatarsophalangeal (MTP) joint degeneration was a progression of the childhood injury that caused the hallux valgus. Further, the VA clinician opined the right mild degenerative arthritis was a new and separate condition secondary to the use of the foot over 74 years of life. In an addendum opinion, the VA clinician again reported that the left hallux valgus and shortened second toe were due to an injury that occurred at three years of age. In addition, she found that there was no trauma that occurred in service; rather, the severe left first MTP joint arthritis and traumatic arthritis were progressions of the non-service-connected injury at age three. Although the Veteran stepped on a rock in January 1966, which increased pain of the existing condition, such did not create a new condition of the left foot. The Veteran underwent additional VA examination in November 2021 with the aforementioned VA clinician, who provided current diagnoses of hallux valgus, hallux rigidus, posttraumatic arthritis, and post left foot bunionectomy and exostosis of the 2nd toe. In an associated opinion, she specifically found the arthritis of the left foot was the progression of the left hallux valgus and the surgery was due to the trauma of the left foot prior to service and an indication of the progression of the left hallux valgus. In addition, the hallux rigidus was a progression of the left hallux valgus. In sum, the VA clinician determined there was no disorder separate and distinct from the Veteran's service-connected left hallux valgus. The left foot injury and hallux valgus were the cause of the need for surgery and the causes of the traumatic arthritis and hallux rigidus, which were not separate and distinct from the service-connected left hallux valgus. Furthermore, the VA clinician explained that as such conditions were caused by the hallux valgus, the service-connected disability could not have aggravated them. Upon review, the Board affords great probative weight to the VA clinician's opinions provided in July 2020 and November 2021 in the collective. In this regard, such considered all of the pertinent evidence of record, to include the Veteran's statements and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Here, the VA clinician clearly found there was no current left foot disorder separate and distinct from the Veteran's service-connected left hallux valgus. Notably, there is no medical opinion to the contrary. In this respect, the Board finds the medical articles submitted by the Veteran are not accompanied by any corresponding clinical evidence specific to the Veteran and do not suggest a generic relationship between a separate and distinct left foot disorder and his in-service training, or left hallux valgus, with a degree of certainty such that, under the facts of this specific case, reflects plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion. Consequently, such articles are not probative to the instant matter and, therefore, are insufficient to establish service connection. Wallin v. West, 11 Vet. App. 509 (1998); Sacks v. West, 11 Vet. App. 314 (1998); Libertine v. Brown, 9 Vet. App. 521 (1996). The Board has also considered the Veteran's assertions as to the nature and etiology of his current left foot disorders; however, as a lay person, he does not have the requisite training and experience necessary to address such complex medical matters. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of such disorders, to include the impact physical training and hallux valgus have on them, involve a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. Specifically, such requires knowledge of the musculoskeletal system and the impact repetitive motion, trauma, and an altered gait have on the foot. Therefore, such matters may not be competently addressed by lay statements. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Veteran's opinions as to the etiology of his left foot disorders are not competent evidence and, consequently, are afforded no probative weight. In conclusion, a left foot disorder, separate and distinct from service-connected left hallux valgus, is not shown to be causally or etiologically related to any disease, injury, or incident during service and is not caused or aggravated by service-connected left hallux valgus. Consequently, service connection for such disorder is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claim for service connection, such doctrine is inapplicable and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to an initial rating in excess of 10 percent for left hallux valgus, to include on an extra-schedular basis. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); 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. 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. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). For the entire appeal period stemming from August 7, 2012, the date of service connection, the Veteran is in receipt of a 10 percent rating for his left hallux valgus, which is the maximum rating under Diagnostic Code 5280. In this regard, as noted in the May 2014 rating decision, such disability pre-existed his military service and was aggravated therein; however, as the pre-service disability level was noncompensable, no deduction in the rating was warranted. Diagnostic Code 5280 provides a maximum 10 percent rating for operated unilateral hallux valgus with resection of metatarsal head and severe unilateral hallux valgus equivalent to amputation of the great toe. Thus, as the Veteran is in receipt of the maximum schedular rating for his left hallux valgus under Diagnostic 5280, the Board has considered whether a higher or separate rating is warranted under any other potentially applicable diagnostic code. In this regard, the November 2021 VA examiner determined the Veteran's diagnoses of hallux rigidus and arthritis were both progressions of his service-connected left hallux valgus. However, hallux rigidus, which is evaluated under Diagnostic Code 5281, is rated as severe hallux valgus under Diagnostic Code 5280. Thus, assigning a separate rating for hallux rigidus would be tantamount to pyramiding and is prohibited by law. 38 C.F.R. § 4.14; Esteban, supra. Diagnostic Code 5003 provides that degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. The Board notes that there are no diagnostic codes specific to range of motion of the toes. In this regard, Diagnostic Code 5003 provides that when limitation of motion due to arthritis is noncompensable under the appropriate diagnostic code, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. In the absence of limitation of motion, Diagnostic Code 5003 provides for a 10 percent rating with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. A 20 percent rating under Diagnostic Code 5003 requires involvement of two or more major joints or two or more minor joint groups with occasional incapacitating exacerbations. In application of Diagnostic Code 5003, "painful motion of a major joint... caused by degenerative arthritis, where the arthritis is established by X-ray, is deemed to be limited motion and entitled to a minimum 10-percent rating, per joint, combined under Diagnostic Code 5003, even though there is no actual limitation of motion." See Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991). In the instant case, at the July 2015 Board hearing, the Veteran reported continuous foot pain, an inability to bend his toes, and the need for a cane to walk. On VA examination in July 2020, he reported a decreased ability to stand and walk, and the VA examiner found his left hallux valgus resulted in pain with passive and active movement and with weight bearing, which was a disturbance to locomotion and produced decreased ability for extended standing and decreased endurance with walking. At the VA examination in November 2021, the Veteran reported a difficult time walking more than half a block and symptoms of pain moving up the ankle, leg, and shin. The Veteran's left hallux valgus required the use of a brace, shoe inserts, and a specially-made shoe and caused disturbance in locomotion, interference with standing, and lack of endurance in all weight-bearing activities. The VA examiner determined the Veteran's foot condition chronically compromised weight-bearing as he was unable to bear weight for more than 20 minutes at a time. Thus, based on the foregoing, the Board finds that a separate rating of 10 percent, but no higher, for arthritis associated with left hallux valgus is warranted. In this regard, painful motion of a joint due to arthritis equates to limited motion under Diagnostic Code 5003 and is entitled to at least a compensable rating. See Lichtenfels, 1 Vet. App. at 488; 38 C.F.R. § 4.45(f); 38 C.F.R. § 4.59; Burton, supra; Southall-Normal, supra. Furthermore, the aforementioned symptomatology and resulting functional impairment are not fully contemplated in the currently assigned 10 percent rating under Diagnostic Code 5280, which only contemplates operated unilateral hallux valgus with resection of metatarsal head and/or severe unilateral hallux valgus equivalent to amputation of the great toe. See 38 C.F.R. § 4.14; Esteban, supra. However, a 20 percent rating is not warranted under Diagnostic Code 5003 for X-ray findings of arthritis as the Veteran's left hallux valgus does not involve multiple joints with occasional incapacitating exacerbations. Additionally, other diagnostic codes for foot disabilities are not applicable because the evidence of record not demonstrate the presence of such foot disabilities as associated with the Veteran's left hallux valgus. See 38 C.F.R. § 4.71a , Diagnostic Code 5276 (acquired flatfoot), Diagnostic Code 5277 (weak foot), Diagnostic Code 5278 (claw foot), Diagnostic Code 5279 (anterior metatarsalgia), Diagnostic Code 5282 (hammer toe), Diagnostic Code 5283 (malunion or nonunion of the tarsal and metatarsal bones). Additionally, while the Veteran reports experiencing neurological impairment associated with his left hallux valgus, he is not competent, as a lay person, to relate such symptomatology to a specific diagnosis and the medical evidence does not demonstrate that such service-connected disability results in neurological impairment. Furthermore, as pertinent to Diagnostic Code 5284, which pertains to other foot injuries, the Court held that when a condition is specifically listed in the rating schedule, it may not be rated by analogy. Copeland v. McDonald, 27 Vet. App. 333, 338 (2015); see also Suttmann v. Brown, 5 Vet. App. 127, 134 (1993) (providing that "[a]n analogous rating... may be assigned only where the service-connected condition is 'unlisted.'"). In Copeland, the Court explicitly rejected the appellant's argument that to rate his disability under Diagnostic Code 5284 for "foot injuries, other," would not be rating by analogy. Rather, the Court held that to do so would ignore the plain meaning of the term "other," and would make the remaining foot-related Diagnostic Codes redundant. Given that the Veteran's left foot disability, diagnosed as hallus valgus, hallux rigidus, and arthritis, are specifically listed in the rating schedule under Diagnostic Codes 5280, 5281, and 5003, respectively, Diagnostic Code 5284 is inapplicable and a higher or separate rating is not warranted under such criteria. The Board also notes that the Veteran's representative has alleged that an extra-schedular rating for the Veteran's left hallux valgus is warranted. In this regard, an extra-schedular rating is warranted if the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that application of the regular schedular standards would be impracticable. 38 C.F.R. § 3.321(b)(1). In Thun v. Peake, 22 Vet. App. 111, 115-16 (2008), the Court stated that the determination of whether a claimant is entitled to an extra-schedular rating under 38 C.F.R. § 3.321 is a three-step inquiry. First, it must be determined whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. In this regard, the Court indicated that there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. Under the approach prescribed by VA, if the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. Second, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as "marked interference with employment" and "frequent periods of hospitalization." Third, when an analysis of the first two steps reveals that the rating schedule is inadequate to evaluate a claimant's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran's disability picture requires the assignment of an extra-schedular rating. Id. However, the Court has held that VA's duty to maximize benefits requires it to first exhaust all schedular alternatives for rating a disability that are expressly raised or are reasonably raised by the record including, but not limited to, secondary service connection, analogous ratings, the requirement to assign a higher schedular rating if a veteran's disability more nearly approximates the higher rating, the requirement that VA resolve doubt in favor of claimants, ratings based on individual unemployability, special monthly compensation, and the ability to rate a single disability under multiple diagnostic codes without pyramiding, before the extra-schedular analysis is triggered. Morgan v. Wilkie, 31 Vet. App. 162 (2019). Additionally, the Court has provided six non-exhaustive or mandatory guiding principles to aid in conducting an analysis under Thun's first step: First, the sole focus of Thun's first step is on the ability of the rating schedule to evaluate the veteran's symptomatology; extra-schedular consideration is not applicable to claims that may be properly evaluated with conventional schedular rating tools. See Morgan supra. Second, Thun's first step deals exclusively with whether the veteran's symptomsinterchangeably referred to by the Court as "functional impairments"are exceptional, whereas Thun's second step considers the functional effects of those symptoms. See Yancy v. McDonald, 27 Vet. App. 484, 494 (2016). Third, where a symptom or impairment is not compensable under the rating schedule, as is the case for psychiatric conditions without a valid DSM-5 diagnosis, see Martinez-Bodon v. Wilkie, 32 Vet. App. 393, 404 (2020), it also does not warrant extra-schedular consideration as this would amount to a backdoor means to obtaining compensation for a condition the rating schedule intends to exclude. Fourth, extra-schedular consideration is not warranted for symptoms or effects that lack a nexus to service or to a service-connected disability. Fifth, the Board is only required to discuss the theories of entitlement raised by the veteran or reasonably raised by the record. Sixth, in reviewing the Board's analysis of referral for extra-schedular consideration, the Court will be mindful of the rule against prejudicial error. Long v. Wilkie, 33 Vet. App. 167 (2020) (en banc). The Board has carefully compared the level of severity and symptomatology of the Veteran's service-connected left hallux valgus with the established criteria found in the rating schedule. In the instant case, the Board finds that such disability is fully addressed by the rating criteria under which it is rated. Specifically, the Veteran is in receipt of two separate 10 percent rating for hallux valgus and arthritis, which fully contemplates all symptomatology and functional impairment resulting from such symptomatology, as articulated previously. Therefore, the record does not reflect additional symptomatology or resulting functional impairment that is not contemplated by the rating criteria. Thus, the Board finds that the rating criteria reasonably describe the Veteran's disability level and symptomatology for his service-connected disability and referral for consideration of an extra-schedular rating is not warranted. 38 C.F.R.§ 3.321(b)(1). The Board has considered whether staged ratings under Fenderson, supra, are appropriate for the Veteran's service-connected left hallux valgus; however, the Board finds that his symptomatology had been stable throughout the appeal period. Therefore, assigning staged ratings is not warranted. Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the initial rating claim adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). In reaching the foregoing determinations, the Board has applied the benefit of the doubt doctrine and resolved all doubt in the Veteran's favor, which has resulted in the award of a separate rating for arthritis associated with his left hallux valgus. However, insofar as the Board has denied higher or separate ratings, the weight of the probative evidence is against such aspects of the Veteran's claim. Therefore, the benefit of the doubt doctrine is not applicable in such regard and his initial rating claim must otherwise be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. M. Celli, 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.