Citation Nr: 22016576 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 17-21 615 DATE: March 22, 2022 ORDER Entitlement to service connection for an acquired psychiatric disorder (depression), as secondary to service-connected disabilities, is granted. Entitlement to a 30 percent rating, but no higher, for degenerative arthritis of the cervical spine with history of strain (neck disability), from August 1, 2013 to July 19, 2019, is granted. Entitlement to a rating in excess of 30 percent disabling for a neck disability is denied. FINDINGS OF FACT 1. Resolving all doubt in the Veteran's favor, the most persuasive evidence of record shows that the Veteran's depression was aggravated by her service-connected disabilities, to include her headache, neck, back and radiculopathy disabilities. 2. From August 1, 2013 to July 19, 2019, resolving all doubt in the Veteran's favor, the most adverse symptomatology of her neck disability was shown by forward flexion of the cervical spine to 15 degrees or less. 3. During the pendency of the appeal, the evidence does not show unfavorable ankylosis of the entire cervical spine even when considering her complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups; nor is it manifested by incapacitating episodes that required bed rest prescribed by a physician and treatment by a physician having a total duration of at least 4 weeks during a 12-month period. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for depression as secondary to service-connected disabilities have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 2. From August 1, 2013 to July 19, 2019, the criteria for a rating in excess of 20 percent for a neck disability, have been met. 38 U.S.C. §§ 1155, 5100, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.326, 3.655, 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.27, 4.71a, Diagnostic Codes 5235 to 5243. 3. The criteria for a rating in excess of 30 percent for a neck disability have not been met at any time during the appeal. 38 U.S.C. §§ 1155, 5100, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.326, 3.655, 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.27, 4.71a, Diagnostic Codes 5235 to 5243. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1980 to August 1991. This matter is before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) that increased the Veteran's service-connected neck disability rating to 20 percent effective August 1, 2013 and denied entitlement to service-connection for depression. In the April 2017 substantive appeal, the Veteran requested the opportunity to testify at a hearing held before a Veterans Law Judge. This hearing was scheduled in September 2017, but the Veteran did not appear. The Veteran has not requested that the hearing be rescheduled. Therefore, the request for a Board hearing is deemed withdrawn. 38 C.F.R. § 20.704(d). In February 2019, the Board remanded the Veteran's claim for further development. It has now returned to the Board for further appellate review. During the pendency of the appeal, in December 2020, the regional office (RO) issued a rating decision granting an award for the Veteran's neck disability with an evaluation of 30 percent, effective July 19, 2019. Since the Veteran is presumed to be seeking the maximum benefit allowed by law and regulation, the additional assignment of benefits in the December 2020 rating decision is not considered to have resolved the Veteran's claim at that time. AB v. Brown, 6 Vet. App. 35 (1993). The Board has re-characterized the issue of entitlement to service connection for unspecified depressive disorder to more broadly encompass entitlement to service connection for an acquired psychiatric disorder, to include major depressive disorder, bipolar disorder, type II, obsessive compulsive disorder, and generalized anxiety disorder, pursuant to Clemons v. Shinseki, 23 Vet. App. 1 (2009). It is also valuable to note that the Veteran has already been found to be 100 percent disabled by VA and was granted entitlement to a total disability rating based on individual unemployability (TDIU), effective May 4, 2020. In this case, the Board is only dealing with the limited outstanding issues that it must address under the law. Post-Remand Development Initially, in adjudicating below whether the Veteran meets the criteria for a higher evaluation for her neck disability the Board has not overlooked the Court's holdings in Sharp v. Shulkin, 29 Vet. App. 26 (2017) and Correia v. McDonald, 28 Vet. App. 158 (2016). Tellingly, the Board finds that the record is adequate to address the concerns raised by the Court, where applicable, in both cases, as well as the concerns raised by the Board in the February 2019 Remand. Specifically, the Board finds that the August 2014, March 2017, and April 2021 VA examinations, as well as the June 2016 and July 2019 private Disability Benefits Questionnaires (DBQ), provide VA with medical opinion evidence adequate to rate the Veteran's neck disability when considering her complaints of pain with and without weight bearing and resistance in passive and active range of motion (see Correia, supra) as well as during flare-ups (see Sharp, supra) because, when taken together, the examiners specifically addressed each of these concerns, where such information is applicable to the Veteran's neck disability claim. Therefore, the Board finds that further delay by remanding these issues to provide the Veteran with a new VA examination is not required. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). Accordingly, the Board finds that the post-Remand development complied with the earlier Board remand. See Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008); see also Correia, supra; Sharp, supra. Service Connection The Veteran contends she developed her depression secondary to her service-connected cervical spine, lumbar spine, radiculopathy and headache conditions. Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) a current disability, (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury, and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To establish service connection on a secondary basis, the evidence must show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)(b) (2016); Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). 1. Entitlement to service connection for an acquired psychiatric disorder The July 2014 VA Mental Health Disability Benefits Questionnaire (DBQ) examiner diagnosed the Veteran with Major Depressive Disorder (MDD). The Veteran's private treating psychiatrist since 2014 diagnosed the Veteran with major depressive disorder, bipolar disorder, type II, obsessive compulsive disorder, and generalized anxiety disorder. See November 2020 Private Opinion Letter of Dr. M.C. As such, the first element of a claim for service-connection, a current disability, has been met. Thus, the question before the Board here is whether the Veteran's depression was either proximately caused by, or aggravated by her service-connected disabilities. In this regard, the Veteran currently is service connected for the following disabilities: Degenerative arthritis, cervical spine, with history of strain, rated as 30 percent disabling from July 19, 2019; Bilateral upper extremity radiculopathy associated with degenerative arthritis, cervical spine, rated as 40 percent disabling on the right side and 30 percent disabling on the left side, from August 1, 2013. Bilateral lower extremity radiculopathy associated with degenerative arthritis, cervical spine, rated as 20 percent disabling bilaterally, from August 1, 2013. Chronic lumbar strain, rated as 40 disabling from July 19, 2019; Chronic tension headaches associated with degenerative arthritis, cervical spine, rated as noncompensable from December 5, 2011. After a detailed review of the record, the Board finds there is competent and sufficient evidence to establish a nexus between her current depression and her service-connected disabilities. The Board has reached this conclusion because the November 2020 VA examiner and the Veteran's private psychiatrist, Dr. M.C., each opined there is evidence that her mental health symptoms have been complicated by her chronic pain. As such, it is as least as likely as not that her depression has been aggravated by her headache, neck, back and radiculopathy disabilities. Here, when taking the Veteran's complaints of chronic pain and the circumstances of her multi-faceted disability picture, as well as the competent, credible and probative opinions of medical examiners in this case, the Board finds headache, neck, back and radiculopathy disabilities aggravate her depression. As such, a finding of service connection for an acquired psychiatric condition is warranted as a secondary service-connected disability to her headache, neck, back and radiculopathy disabilities. The Board finds no reason to discount the probative value of the Veteran's statements, or those of her examiners, that her depression is aggravated by chronic pain caused by her service-connected disabilities until the present day. While the medical opinions are flawed, the Board has decided not to prolong this appeal by remanding for another medical opinion addressing the etiology of the Veteran's depression. The Board must weigh the evidence of record as a whole and finds the evidence is at least in approximate balance. Therefore, the benefit of the doubt doctrine applies and the Board will grant the claim. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). The Increased Rating Claim The Veteran contends that her cervical spine disability is more severe than represented by the rating assigned at all times during the appeal. Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. An increase in the evaluation assigned for a disability is warranted when the average impairment in earning capacity resulting from such diseases and injuries in civil occupations has increased and the disability picture meets the criteria required for a higher rating. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.7. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. When rating the Veteran's service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Separate higher or lower compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis and demonstrated symptomatology. Importantly, the evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided. 38 C.F.R. § 4.14. Separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other condition. Id. 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 (2016); DeLuca v. Brown, 8 Vet. App. 202 (1995). The United States Court of Appeals for Veterans Claims (Court) has clarified that 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); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. 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. Therefore, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. See Burton v. Shinseki, 25 Vet. App. 1 (2011). Moreover, in Jones v. Shinseki, 26 Vet. App. 56, 61-63 (2012) the Court held that the Board may not deny entitlement to an increased rating on the basis of relief provided by medication when those effects are specifically contemplated by the rating criteria. The Court in Southall-Norman v. McDonald, 28 Vet. App. 346, 352 (2016) held that the provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to the evaluation of musculoskeletal disabilities under Diagnostic Codes predicated on range of motion measurements. Lastly, in Chavis v. McDonough, 34 Vet. App. 1 (2021), the Court held that ankylosis of the spine may be shown based on symptoms of fixation of the joint equivalent to ankylosis. The Board notes that except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995). 2. Entitlement to a rating in excess of 20 percent from August 1, 2013 to July 19, 2019 for a neck disability 3. Entitlement to a rating in excess of 30 percent disabling for a neck disability The Veteran's neck disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5242 for degenerative arthritis of the cervical spine with history of strain, as 10 percent disabling prior to August 1, 2013, as 20 percent disabling prior to July 19, 2019, and 30 percent disabling thereafter. The Board notes that while the RO has rated the Veteran's neck disability as 20 percent disabling prior to July 19, 2019, and 30 percent thereafter, the Board's adjudication can consider the totality of her adverse neck symptomatology since the time she filed the rating claim when assigning the current rating for the neck. See November 2013 VA 21-4138 Statement In Support of Claim (requesting increased rating for neck disability). At the outset, the Board notes effective February 7, 2021, the Schedule for Rating Disabilities, Musculoskeletal System and Muscle Injuries, has been amended. See 85 Fed. Reg. 76453 (Nov. 30, 2020). Specifically, Diagnostic Code 5242 (degenerative arthritis) has been amended to include degenerative arthritis; degenerative disc disease other than intervertebral disc syndrome. The Board notes that these changes do not alter the way the Veteran's neck disability is rated by VA under the relevant diagnostic criteria in this claim, especially for the time periods on appeal (i.e., prior to February 7, 2021). Here, the Board finds that a remand to provide the Veteran with notice of the change in the rating criteria is not required. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). In this claim, a disability rating under Diagnostic Code 5242 is rated under the General Rating Formula for Disease and Injuries of the Spine. See 38 C.F.R. § 4.71a. The General Rating Formula for Disease and Injuries of the Spine provides that with or without such symptoms as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, a 20 percent rating is warranted if forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees, or, the combined range of motion of the cervical spine not greater than 170 degrees, or guarding severe enough to result in an abnormal gait, or abnormal spinal contour such as scoliosis, reversed lordosis or abnormal kyphosis. A 30 percent rating is warranted if forward flexion of the cervical spine being 15 degrees or less, or, favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted if there is unfavorable ankylosis of the entire cervical spine. A 50 percent rating is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine; and 100 percent rating if there is unfavorable ankylosis of the entire spine. Note (2) to the General Rating Formula for Diseases and Injuries of the Spine provides that normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. See also 38 C.F.R. § 4.71a, Plate V. Intervertebral Disc Syndrome (IVDS) may be evaluated either under the General Rating Formula or under the Formula for Rating IVDS Based on Incapacitating Episodes, depending on which method results in the higher evaluation when all disabilities are combined. Under the Formula for Rating IVDS Based on Incapacitating Episodes, Diagnostic Code 5243 provides a 20 percent rating for incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past twelve months; a 40 rating for incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past twelve months; and a 60 percent rating for incapacitating episodes having a total duration of at least six weeks during the past twelve months. 38 C.F.R. § 4.71a. Note (1) to Diagnostic Code 5243 provides that an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Importantly, the Veteran does not have acute signs and symptoms due to her intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician at any time on appeal. Therefore, the regulations under 38 C.F.R. § 4.71a Diagnostic Code 5243 for IVDS will not be considered further in this decision. With the above criteria in mind, and with giving the Veteran the benefit of doubt in the matter, the Board nonetheless finds that when considering 38 C.F.R. §§ 4.40, 4.45, 4.59 and the Court's holding in Correia, Sharp, Mitchell, Burton, Southall-Norman, and DeLuca, as well as when considering the appellant's competent reports of her observable adverse symptomatology (see Davidson, supra), she meets the criteria for at least a 30 percent rating at all times during the appeal under the General Rating Formula for Disease and Injuries of the Spine. The Board has reached this conclusion because the ranges of motion of the Veteran's neck taking into account the above criteria were as follows at her VA examinations: at the November 2011 VA examination forward flexion of the cervical spine was 40 degrees and the combined range of motion of the cervical spine was 190 degrees; at the July 2014 VA examination forward flexion of the cervical spine was 40 degrees and the combined range of motion of the cervical spine was 160 degrees; No range of motion measurements were provided on the June 2016 private DBQ; at the March 2017 VA examination forward flexion of the cervical spine was 25 degrees and the combined range of motion of the cervical spine was 190 degrees; at the July 2019 private DBQ forward flexion of the cervical spine was 12 degrees and the combined range of motion of the cervical spine was 72 degrees; at the April 2021 VA examination forward flexion of the cervical spine was 30 degrees and the combined range of motion of the cervical spine was 180 degrees. Importantly, the Court has held that, "it is the information in a medical opinion, and not the date the medical opinion was provided that is relevant when assigning an effective date." Tatum v. Shinseki, 24 Vet. App. 139, 145 (2010) (discussing assignment of an effective date for a reduction in disability rating under Diagnostic Code 7528); see also Young v. McDonald, 766 F.3d 1348, 1352-53 (Fed. Cir. 2014) (holding that a medical opinion can diagnose the presence of the condition and identify an earlier onset date based on preexisting symptoms). Accordingly, since the record shows that forward flexion of the cervical spine was 15 degrees or less at the July 2019 private DBQ examination, even though it was higher at her other VA and private examinations (see Tatum, supra), the Board finds she meets the criteria for at least a 30 percent rating at all times during the appeal. See 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.71a; Fenderson, supra; Hart, supra; see also 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert, supra. Moreover, the Board notes that while treatment records also periodically document the Veteran's complaints and treatment related to her neck disability, nothing in these records show her adverse symptomatology to be worse than what was reported at the above VA examinations and private DBQ's. It is important for the Veteran to understand that while the Board is granting entitlement to an increased rating from 20 percent to 30 percent disabling, from August 1, 2013 to July 19, 2019, in this decision, the Board also finds an evaluation in excess of 30 percent is not warranted by the evidence of record for any time on appeal. Tellingly, the Board highlights the fact that a higher evaluation (i.e., of 40 percent) is not warranted for diseases and injuries of the cervical spine unless the evidence shows unfavorable ankylosis of the entire cervical spine. Ankylosis is a condition of, or term used for the sign/symptom of, abnormal stiffness, immobility, or abnormal bending of a joint. It is a stiffness or immobility in a joint caused by bones fusing as a result of disease or injury or by intentional fusion through surgery. Unfavorable ankyloses is fixation of a joint in flexion or extension that results in significant functional impairment. The evidence of record, to include the Veteran's private medical records, VA treatment records, private Disability Benefits Questionnaires (DBQs), as well as DBQs completed by VA, are all silent for evidence showing unfavorable ankylosis (i.e., fixation of a joint in flexion or extension) of the entire cervical spine to warrant a higher evaluation of 40 percent disabling. Tellingly, after examining the Veteran and reviewing the record, the August 2014, March 2017, and April 2021 VA examiners all opined that the Veteran did not have ankylosis, and specifically did not mark the Veteran as having "unfavorable ankylosis" and these medical opinions are not contradicted by any other medical evidence of record. Cf. July 2019 Private DBQ (private examiner marked the Veteran as having "favorable ankylosis" but expressly did not mark "unfavorable ankylosis"); see also Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (VA may only consider independent medical evidence to support its findings and is not permitted to base decisions on its own unsubstantiated medical conclusions). Therefore, the Board finds that even when considering the Veteran's complaints of pain for her cervical neck disability, as per 38 C.F.R. §§ 4.40, 4.45, 4.59 and the Court's holdings in Correia, Sharp, Mitchell, Burton, Southall-Norman, and DeLuca, as well as when considering the appellant's competent reports of her observable adverse symptomatology (see Davidson, supra), she does not meet the criteria for at least the next higher, 40 percent, rating at any time on appeal because unfavorable ankylosis of the cervical spine was not shown at any time during the appeal. The Board also finds that the Veteran is not competent to provide a finding of unfavorable ankylosis because it is medical in nature and she does not have the required expertise. See Colvin, supra; Davidson, supra. Therefore, the Board finds that she meets the criteria for a 30 percent rating, but not higher, at all times on appeal, including from August 1, 2013 to July 19, 2019. However, the Board also finds that the criteria for a rating in excess of 30 percent for the Veteran's neck disability is not met at any time during the appeal under 38 C.F.R. § 4.71a, Diagnostic Code 5242, for the reasons outline above. See Fenderson, supra; Hart, supra; Davidson, supra; Colvin, supra. Nothing above suggests that the Veteran is not having problems with this disability. The only question is the degree of the problem based on the evidence and the law. It is important for the Veteran to understand that the medical findings provide highly probative evidence against the claim that the Board cannot, unfortunately, ignore. In addition, the Board has not overlooked the claims from the Veteran regarding her adverse symptomatology. See Davidson, supra. However, the Board finds the VA examiner's opinions as to the Veteran's adverse symptomatology more probative than the lay claims from the appellant to the contrary even though her symptomatology is observable by a lay person because the examiner has medical training. See Black v. Brown, 10 Vet. App. 297, 284 (1997) (in evaluating the probative value of medical statements, the Board looks at factors such as the individual knowledge and skill in analyzing the medical data). (Continued on the next page) Finally, neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin,28 Vet. App. 366, 69-70 (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 above conclusions the Board has considered the applicability of the benefit of the doubt doctrine. However, to the extent already outlined above, there is not an approximate balance of positive and negative evidence regarding the claim for an increased rating in excess of 30 percent disabling for the Veteran's neck disability and that doctrine is not applicable in such case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher M. Davidson 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.