Citation Nr: 22017763 Decision Date: 03/26/22 Archive Date: 03/26/22 DOCKET NO. 11-22 176 DATE: March 26, 2022 ORDER Entitlement to an initial rating in excess of 10 percent for bilateral blepharoconjunctivitis is denied. Entitlement to service connection for a left-sided chest disability is denied. Entitlement to service connection for a left arm disability, other than a left shoulder disability, is denied. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran's bilateral blepharoconjunctivitis manifests as active pathology with symptoms; with visual acuity of at worst 20/40 bilaterally; without a documented visual field defect; and incapacitating episodes of at worst, at least one but less than three episodes in the past 12 months. 2. At no time during, or prior to, the pendency of the claim did the Veteran have a current a left-sided chest disability with functional impairment of earning capacity due to a left-sided chest disability. 3. At no time during, or prior to, the pendency of the claim did the Veteran have a left arm impairment, other than a left shoulder disability, with functional impairment of earning capacity due to a left arm disability. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for bilateral blepharoconjunctivitis have not been met. 38 U.S.C. § 1155, 5107; 3.102, 4.14.14, 4.123, 4.75-4.79, Diagnostic Code 6018. 2. The criteria for service connection for a left-sided chest disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for a left arm disability, other than a left shoulder disability, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from March 1978 to October 2002. These matters come to the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a video conference hearing before the undersigned Veterans Law Judge (VLJ) of the Board in May 2013. This case was previously before the Board in July 2014, May 2018, May 2020 and in April 2021, when it was remanded for further development. In addition, in a December 2021 rating decision, the AOJ granted an increased rating for the Veteran's bilateral blepharoconjunctivitis and assigned a 10 percent disability rating effective October 23, 2008. However, as this does not represent a full grant of the benefits sought on appeal, the claim remains before the Board, and the Board has reframed the issue to reflect the rating increase. Increased Rating Bilateral Blepharoconjunctivitis The Veteran seeks a higher initial rating for his service-connected bilateral blepharoconjunctivitis because his symptoms are more severe than contemplated by the current rating assigned. Specifically, the Veteran testified at his Board hearing that he experienced decreased visual acuity, development of cataracts, and chronic episodes of conjunctivitis. See Board hearing transcript, May 30, 2013. Additionally, the Veteran testified that the Veteran's bilateral conjunctivitis manifested with flare-ups occurring three or four times; required the use of eye drops; and continued episodes of blepharoconjunctivitis. Id. In addition, in a May 2013 lay statement submitted by the Veteran's wife, she reported the Veteran's bilateral blepharoconjunctivitis manifested with red eyes, requiring him to stay in bed for two days, and use cold compresses to treat symptoms; with recurrent flare-ups many times since the onset. See Lay statement, May 9, 2013. The Veteran's bilateral blepharoconjunctivitis is rated as 10 percent disabling under 38 C.F.R. § 4.79, Diagnostic Code 6018, for chronic conjunctivitis (non-trachomatous). During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. Both the former and revised criteria distinguish active and inactive disease processes. Under the former criteria, an active disease process (with objective findings, such as red, thick conjunctivae, mucous secretion, etc.) is assigned a 10 percent rating. Under the revised criteria, an active disease process is rated pursuant to the General Rating Formula for Diseases of the Eye, with a minimum rating of 10 percent. For an inactive disease process, both the former and revised criteria instruct to evaluate based on residuals, such as visual impairment and disfigurement (DC 7800). With regard to visual impairment, the May 2018 amendments made no substantive changes to how visual acuity is rated. With regard to visual field and muscle function examinations, the use of a Goldmann chart is no longer required. There are otherwise no substantive changes to how those types of visual impairment are rated. The General Rating Formula for Diagnostic Codes 6000 through 6009 instructs to evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where incapacitating episodes have a total duration of at least 1 week, but less than 2 weeks, during the past 12 months, a 10 percent rating is warranted. Where incapacitating episodes have a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months, a 20 percent rating is warranted. Where incapacitating episodes have a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months, a 40 percent rating is warranted. Where incapacitating episodes have a total duration of at least 6 weeks during the past 12 months, a 60 percent rating is warranted. A Note following the General Rating Formula indicates that, for VA purposes, an incapacitating episode is a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider. The General Rating Formal for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where there are documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months, a 10 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months, a 20 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition during the past 12 months, a 40 percent rating is warranted. Where there are documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months, a 60 percent rating is warranted. Note (1) indicates that, for the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note (2) indicates that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. Note (3) indicates that, for the purposes of evaluating visual impairment due to a particular condition, refer to 38 C.F.R. § 4.75-4.78 and to § 4.79, Diagnostic Codes 6061-6091. The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75(a). Examinations of visual impairment must be conducted by a licensed optometrist or ophthalmologist, and the examiner must identify the disease, injury, or other pathologic process for any visual impairment found. Id. § 4.75(b). Examinations of visual field or muscle function will be conducted only when medically indicated. Id. Evaluation of visual acuity is based on corrected distance vision with central fixation. 38 C.F.R. § 4.76(b)(1). The measurements for each eye are applied to the table for Impairment of Central Visual Acuity. Generally, the table is divided into steps corresponding to different levels of visual acuity for one eye, and each step is further divided into subsections of visual acuity for the other eye, with corresponding ratings. The rater will first locate the step that matches the visual acuity of the poorer eye. Within that step, the rater will then locate the subsection that matches the visual acuity of the better eye, which will produce the corresponding rating. Where a reported visual acuity is between two sequentially listed visual acuities, the visual acuity which permits the higher evaluation will be used. 38 C.F.R. § 4.76(c). When the lens required to correct distance vision in the poorer eye differs by more than three diopters from the lens required to correct distance vision in the better eye (and the difference is not due to congenital or developmental refractive error), and either the poorer eye or both eyes are service connected, the visual acuity of the poorer eye will be evaluated using either its uncorrected or corrected visual acuity, whichever results in better combined visual acuity. 38 C.F.R. § 4.76(b)(1). Provided that the claimant customarily wears contact lenses, evaluate the visual acuity of any individual affected by a corneal disorder that results in severe irregular astigmatism that can be improved more by contact lenses than by eye glasses, as corrected by contact lenses. 38 C.F.R. § 4.76(b)(2). In any case where an examiner reports that there is a difference equal to two or more scheduled steps between near and distance corrected vision, with the near vision being worse, the examination report must include at least two recordings of near and distance corrected vision and an explanation of the reason for the difference. In these cases, evaluation will be based on corrected distance vision adjusted to one step poorer than measured. 38 C.F.R. § 4.76(b)(3). The table of Impairment of Central Visual Acuity encompasses Diagnostic Codes 6061-66. Under Diagnostic Code 6061, a 100 percent rating is warranted for anatomical loss of both eyes. Under Diagnostic Code 6062, a 100 percent rating is warranted for no more than light perception in both eyes. Diagnostic Code 6063 provides ratings where there is anatomical loss of one eye (the poorer eye). A 40 percent rating is warranted where visual acuity of the other eye is 20/40. A 50 percent rating is warranted where visual acuity of the other eye is 20/50. A 60 percent rating is warranted where visual acuity of the other eye is 20/100 or 20/70. A 70 percent rating is warranted where visual acuity of the other eye is 20/200. An 80 percent rating is warranted where visual acuity of the other eye is 15/200. A 90 percent rating is warranted where visual acuity of the other eye is 10/200. A 100 percent rating is warranted where visual acuity of the other eye is 5/200. Diagnostic Code 6064 provides ratings where there is no more than light perception in one eye (the poorer eye). A 30 percent rating is warranted where visual acuity in the other eye is 20/40. A 40 percent rating is warranted where visual acuity in the other eye is 20/50. A 50 percent rating is warranted where visual acuity in the other eye is 20/70. A 60 percent rating is warranted where visual acuity in the other eye is 20/100. A 70 percent rating is warranted where visual acuity in the other eye is 20/200. An 80 percent rating is warranted where visual acuity in the other eye is 15/200. A 90 percent rating is warranted where visual acuity in the other eye is 10/200. A 100 percent rating is warranted where visual acuity in the other eye is 5/200. Diagnostic Code 6065 provides ratings where vision in one eye (the poorer eye) is 5/200. A 30 percent rating is warranted where vision in the other eye is 20/40. A 40 percent rating is warranted where vision in the other eye is 20/50. A 50 percent rating is warranted where vision in the other eye is20/70. A 60 percent rating is warranted where vision in the other eye is 20/100. A 70 percent rating is warranted where vision in the other eye is 20/200. An 80 percent rating is warranted where vision in the other eye is 15/200. A 90 percent rating is warranted where vision in the other eye is 10/200. A 100 percent rating is warranted where vision in the other eye is also 5/200. Diagnostic Code 6066 provides ratings where vision in one eye (the poorer eye) is 10/200 or better. Where the visual acuity in both eyes is 20/40, a 0 percent rating is warranted. Where the visual acuity in one eye (the poorer eye) is 20/50, the following ratings apply. A 10 percent rating is warranted where vision in the other eye is either 20/50 or 20/40. Where the visual acuity in one eye (the poorer eye) is 20/70, the following ratings apply. A 30 percent rating is warranted where vision in the other eye is also 20/70. A 20 percent rating is warranted where vision in the other eye is 20/50. A 10 percent rating is warranted where vision in the other eye is 20/40. Where the visual acuity in one eye (the poorer eye) is 20/100, the following ratings apply. A 50 percent rating is warranted where vision in the other eye is also 20/100. A 30 percent rating is warranted where vision in the other eye is 20/70. A 20 percent rating is warranted where vision in the other eye is 20/50. A 10 percent rating is warranted where vision in the other eye is 20/40. Where visual acuity in one eye (the poorer eye) is 20/200, the following ratings apply. A 70 percent rating is warranted where vision in the other eye is also 20/200. A 60 percent rating is warranted where vision in the other eye is 20/100. A 40 percent rating is warranted where vision in the other eye is 20/70. A 30 percent rating is warranted where vision in the other eye is 20/50. A 20 percent rating is warranted where vision in the other eye is 20/40. Where visual acuity in one eye (the poorer eye) is 15/200, the following ratings apply. An 80 percent rating is warranted where vision in the other eye is also 15/200. A 70 percent rating is warranted where vision in the other eye is 20/200. A 60 percent rating is warranted where vision in the other eye is 20/100. A 40 percent rating is warranted where vision in the other eye is 20/70. A 30 percent rating is warranted where vision in the other eye is 20/50. A 20 percent rating is warranted where vision in the other eye is 20/40. Where visual acuity in one eye (the poorer eye) is 10/200, the following ratings apply. A 90 percent rating is warranted where vision in the other eye is also 10/200. An 80 percent rating is warranted where vision in the other eye is 15/200. A 70 percent rating is warranted where vision in the other eye is 20/200. A 60 percent rating is warranted where vision in the other eye is 20/100. A 50 percent rating is warranted where vision in the other eye is 20/70. A 40 percent rating is warranted where vision in the other eye is 20/50. A 30 percent rating is warranted where vision in the other eye is 20/40. Turning to the evidence, the Veteran was afforded a VA examination in October 2009. At that time, the Veteran complained that his eyes teared and would be red after coming out of the shower. Upon physical examination, visual acuity testing showed corrected distance visual acuity of 20/20 bilaterally. The Veteran did not have a history of diplopia. There was no indication to perform visual field testing on the Veteran at that time; accordingly, a Goldmann chart was not associated with the claims file. The VA examiner noted the Veteran had both temporal and nasally in both eyes pinguecula, and his eyes were otherwise negative and quiet. The bilateral pinguecula were unrelated to his viral conjunctivitis of the bilateral eyes. The Veteran was afforded a VA examination in November 2016. At that time, the examiner diagnosed bilateral blepharoconjunctivitis, right conjunctivitis, and bilateral dry eyes. The Veteran reported current symptoms of redness and irritation on awakening; using a cold wash cloth; increased pain with showering and swimming; and the use of drops and ointments, with pain that would decrease to a 1 out of 10 pain intensity from a 9 out of 10 pain intensity. Upon physical examination, corrected distance visual acuity was 20/40 or better bilaterally. The Veteran did not have a difference equal to two or more lines on the Snellen test type chart or its equivalent between distance and near corrected vision, with the near vision being worse. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. The Veteran did not have diplopia. The VA examiner noted the Veteran had a visual field defect and performed Humphrey Full Field 120 visual field testing only; Goldmann testing was not performed and accordingly, a Goldmann chart was not associated with the claims file. The Veteran did not have contraction nor loss of a visual field. His conjunctivitis was non trachomatous and inactive bilaterally; he had bilateral pinguecula. There was no scarring or disfigurement attributable to an eye condition found. The Veteran did not have any incapacitating episodes attributable to any eye condition in the last 12 months. The VA examiner noted the Veteran's eye diagnoses rendered did not impact his ability to work. The Veteran was afforded a VA examination in January 2021. At that time, the VA examiner diagnosed blepharitis and dry eye bilaterally, and age related cataracts bilaterally. Current symptoms reported included redness and dryness; he had no symptoms related to his aging lens changes. Upon physical examination, corrected distance visual acuity was 20/20 or better bilaterally. The Veteran did not have a difference equal to two or more lines on the Snellen test type chart or its equivalent between distance and near corrected vision, with the near vision being worse. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. The Veteran did not have a corneal irregularity that results in severe irregular astigmatism. The Veteran did not have diplopia. The Veteran did not have a documented visual field defect; Goldmann charts were associated with the claims file. The VA examiner noted there was no decrease in visual acuity or other visual impairment attributable to an external eye condition, namely, bilateral pinguecula. There was no scarring or disfigurement attributable to an eye condition found. The Veteran was shown to have at least one but less than three incapacitating episodes in the past 12 months that was attributable to his dry eye. Specifically, the Veteran reported he typically lost two days a year of work due to his dry eye; he required cool compresses and artificial tears in both eyes during his incapacitating episodes. The VA examiner noted that his bilateral blepharoconjunctivitis impacted his ability to work as a medical administrator due to zero to one week of work time lost in the last 12 months due to symptoms of dry eye interfering with computer work and requiring him to stay home. Finally, the Veteran was afforded a VA examination in November 2021. At that time, the VA examiner diagnosed bilateral blepharoconjunctivitis, dry eye, and pinguecula. Historical symptoms included frequent but not daily use of eye drops; warm and cool compresses a few times a week; pain wit showering and swimming; and having to use drops and ointments. The Veteran denied any current symptoms and/or treatment; there was no impact on his ability to work and perform occupational or ordinary activities. Upon physical examination, corrected distance visual acuity was 20/20 or better bilaterally. The Veteran did not have a difference equal to two or more lines on the Snellen test type chart or its equivalent between distance and near corrected vision, with the near vision being worse. The Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. The Veteran did not have corneal irregularity that resulted in severe irregular astigmatism. The Veteran did not have diplopia. The Veteran did not have diplopia. The Veteran did not have a documented visual field defect. There was no decrease in visual acuity or visual impairment associated with any diagnosed eye disorder. The Veteran did not have any incapacitating episodes attributable to any eye condition in the past 12 months. The Veteran's bilateral blepharoconjunctivitis impaired his ability to work due to the frequent use of artificial tears needed; dry eyes that required him to stay home and use cool compresses on the eyes; inflammation was severe from blepharoconjunctivitis, with pain that was severe and work was missed. The VA examiner remarked the Veteran's dry eye, pinguecula were due to his bilateral blepharoconjunctivitis; the conditions remained unchanged. His cataracts were consistent with aging of the eyes. His presbyopia was more likely than not due to congenital or development error refraction, and required the use of reading glasses. His visual field was consistent with no peripheral defects bilaterally, and showed a mild decrease in range of superior visual field of the left eye more likely than not due to fatigue of the upper lid during testing. There was no constriction of a visual field. Further review of the record shows that the Veteran receives treatment at VA medical centers and from private treatment providers for various disabilities, to include his eyes and bilateral blepharoconjunctivitis. However, there is no indication from the treatment notes of record that the Veteran has reported symptoms of his bilateral blepharoconjunctivitis that are worse than those noted in the various VA examination reports and treatment records of record. Based on the foregoing, the Board finds that an initial rating in excess of 10 percent is not warranted for service-connected bilateral blepharoconjunctivitis. A higher rating under the former diagnostic criteria would require incapacitating episodes of a total duration of at least two weeks but less than four weeks during the past 12 months; and under the revised diagnostic criteria would require at least three but less than five treatment visits for an eye condition during the past 12 months. In addition, a higher rating based on decreased visual acuity would require visual acuity of 20/50 in one eye and 20/70 in the other eye; or 20/50 in one eye and 20/100 in the other eye; or 20/200 in one eye and 20/40 in the other eye; and or 15/200 in one eye and 20/40 in the other eye. In this case, his visual acuity was consistently demonstrated as 20/40 or better bilaterally; without a visual field defect or contraction of a visual field; and without diplopia or astigmatism to warrant a higher rating. Additionally, the Veteran was shown to have at worst, at least one but less than three incapacitating episodes due to his bilateral blepharoconjunctivitis at his January 2021 VA examination. The Veteran did not demonstrate incapacitating episodes at any other time during the period on appeal. However, the Board notes the Veteran and his spouse have consistently reported having at least one but less than three incapacitating episodes due to his bilateral blepharoconjunctivitis symptoms from at least May 2013 to the present. See e.g. Lay statement, May 9, 2013. The Veteran has not been shown to have impairment of muscle function. These symptoms warrant a 10 percent rating. See 38 C.F.R. § 4.79, Diagnostic Code 6018. This is the current rating assigned for this disability. In sum, the Board finds the Veteran's bilateral blepharoconjunctivitis manifests with dry eye syndrome and as active pathology with symptoms of dry and irritated eyes and pain, but he does not have disfigurement or any other non-visual impairments; with at worst, at least one but less than three incapacitating episodes in the past 12 months. This disability is rated under Diagnostic Code 6018, which provides a minimum 10 percent rating for active conjunctivitis. As the Veteran has current symptoms of dry eyes, the requirements for the minimum rating are met. He does not have disfigurement or any other compensable non-visual impairments that would allow for a higher initial rating under any other Diagnostic Code. See 38 C.F.R. § 4.79. Moreover, to the extent that the Veteran alleges that he is entitled to a higher rating due to pain and/or interference with work due to having to miss work and use cold compresses as treatment, the Board notes that such symptoms are contemplated under the current rating assigned. The Veteran's belief that he is entitled to a higher initial rating for his bilateral blepharoconjunctivitis is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination reports and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran's general belief that he is entitled to a higher initial rating. For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether a higher rating is warranted. Rather, the evidence persuasively weighs against an increased rating The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). SERVICE CONNECTION LEFT CHEST AND LEFT ARM The Veteran seeks entitlement to service connection for a left-sided chest disability and left arm disability, other than a left shoulder disability. Specifically, the Veteran asserts that his left-sided chest disability and left arm disability are due to a ski accident that occurred during service; the physical rigors of his service, to include training for the Marine Corps Marathon; and as secondary to his service-connected low back disability. See e.g. Board hearing transcript, May 30, 2013. Initially, the Board notes that entitlement to service connection for intervertebral disc syndrome (IVDS), claimed as lower back pain, was granted in a September 2014 rating decision, effective October 23, 2008. In addition, entitlement to service connection for left shoulder arthritis was granted in a May 2020 rating decision, effective October 23, 2008. 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 requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1131; 38 C.F.R. §§ 3.307, 3.309. A disability that is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310 (a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. 38 C.F.R. § 3.310(b). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that "pain in the absence of a presently-diagnosed condition can cause functional impairment," which may qualify as a "disability" for VA compensation purposes. Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018). The Federal Circuit in Saunders, however, cautioned against the notion that "a veteran could demonstrate service connection simply by asserting subjective pain" because, to establish that a disability is present, the veteran "will need to show that... pain reaches the level of a functional impairment of earning capacity." Id. at 1367-68. "Functional impairment," the Federal Circuit noted, is defined as the inability of the body or a constituent part of it "'to function under the ordinary conditions of daily life including employment.'" Id. at 1363 (quoting 38 C.F.R. § 4.10). Turning to the evidence, service treatment records are unremarkable for complaints of, treatment for, or diagnoses of any condition related to a left-sided chest disability. A January 1978 report of medical history indicates the Veteran complained of swollen or painful joints upon entry into service. Post-service treatment records are also unremarkable for complaints of, treatment for, or diagnoses of any condition related to a left-sided chest disorder. A private treatment record from January 2019 indicates the Veteran complained of pain in the arms, with relief from medication, and was presumed to have peripheral neuropathy pain. See Private treatment record, January 8, 2019. The Veteran was afforded VA examinations for his claimed left-sided chest disability and left arm disability in November 2016. At that time, Veteran was diagnosed with left chest wall strain and a diagnosis as to the left arm was not rendered. With regard to his left-sided chest disability, the Veteran reported pain in his left arm and chest wall that had their onset after stopping medication in 2005; had previously treated with pain medication; and that he currently did not experience any symptoms after being prescribed a different medication. The VA examiner noted that the Veteran's claimed left-sided chest disability did not impact his ability to work; there were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. With regard to his left arm disability, the Veteran reported symptoms of pain that was well controlled with over-the-counter pain medication. He denied flare-ups and did not report any functional loss or functional impairment of his left arm. The November 2016 VA examiner opined that, since the Veteran's chest pain was related to his stoppage of Motrin and resolved when prescribed a new medication, did not have any pain noted on the examination, the etiology of pain could not be ascertained; the pain was muscular in origin per history; and the aggravation factor was most likely caused by the stoppage of Motrin than any trauma, and or organic cause. The November 2016 VA examiner opined that there was no objective evidence of a left arm condition and did not render an opinion as to etiology or nature of his claimed disability. The Veteran was afforded VA examinations for his left-sided chest disability and left arm disability in September 2019. With regard to his left-sided chest disability, the VA examiner found the Veteran did not have or ever had been diagnosed with a muscle injury; there were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown; and any left-sided chest disability did not impact his ability to work. In this regard, the VA examiner noted that there was insufficient evidence for a chronic medical diagnosis of a chest injury, and the Veteran stated he had no symptoms since he started Cymbalta. With regard to his left arm disability, the VA examiner found the Veteran did not have a diagnosis associated with his claim for a left arm disability. The Veteran did not report having any functional loss or functional impairment of his left arm, that all of his pain had resolved, and that there were no residuals. The VA examiner noted the Veteran's left shoulder disability would have a mild impact on his ability to work only on heavy physical labor. Of record is an August 2019 VA treatment record that indicates the Veteran denied chest pain, shortness of breath, chest squeezing, chest pressure, dyspnea on exertion, and dyspnea at rest. The Veteran was afforded a VA examination for muscle injuries in November 2020. At that time, the VA examiner determined the Veteran did not have a currently diagnosed muscle injury. In this regard, the VA examiner noted there was no objective evidence of a left chest disorder. The Veteran reported he experienced left-sided chest pain following a skiing accident in 2001, and that his pain had resolved with the use of Cymbalta. The Veteran reported his symptoms were resolved, and that he did not have any pain or other symptoms reported at that time. The VA examiner noted the Veteran's claimed left-sided chest disability did not impact his ability to work; there were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. The Veteran was afforded a VA examination for shoulder and arm conditions in November 2020. At that time, the VA examiner determined the Veteran had only a diagnosis of left shoulder degenerative arthritis. The Veteran reported pain that was managed and resolved with the use of Cymbalta. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. The VA examiner noted only the Veteran's left shoulder degenerative arthritis impacted his ability to work. The November 2020 VA examiner opined that there was no current left-chest condition nor left arm disorder, and therefore, a relationship to service could not be made. In this regard, the VA examiner noted there was no evidence of aggravation, i.e. no evidence of a permanent increase in severity that was beyond natural progression for any of the conditions claimed. Additionally, the VA examiner noted that there was no medical proof or evidence for a connection between the claimed conditions and service, and any current conditions were at least as likely as not due to aging, occupational and recreational history, and wear and tear on the body caused by aging. Moreover, the VA examiner noted that the conditions were less likely than not aggravated because the conditions were stable on Cymbalta, without any objective evidence of pain or discomfort; and without evidence of chronicity of medical treatment that showed there was aggravation of the claimed left-sided chest disability and left arm disability. The Veteran was afforded a VA examination for muscle injuries in July 2021. At that time, the VA examiner found there was no currently diagnosed muscle injury. The Veteran reported his condition had stayed the same; he continued to treat with Cymbalta and Motrin. Upon physical examination, there were no signs and/or symptoms attributable to any muscle injury. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms shown. The VA examiner noted the Veteran's claimed left-sided chest disability did not impact his ability to work. The VA examiner opined that the claimed left-sided chest disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness; was less likely than not proximately due to or the result of the Veteran's service-connected condition; and a baseline level of severity could not be determined based upon medical evidence; because there was no diagnosis to render an opinion, and there was no medical records showing severity of his left-sided chest pain. The Veteran was afforded a VA examination for his left arm disability in July 2021, with a VA opinion rendered in October 2021. With regard to a left arm disability, the July 2021 VA examiner opined that it was less likely than not that his left arm disability was proximately due to or the result of the Veteran's service-connected condition. In this regard, the VA examiner noted there was no left arm diagnosis other than his left shoulder degenerative arthritis; service connection was already in effect for left shoulder degenerative arthritis; and that the positive objective findings are attributable to his diagnosed left shoulder degenerative arthritis. The VA examiner continued that there were no other objective findings assignable to other left arm pathology. Finally, the Veteran was afforded a VA examination for his claimed left-sided chest disability in January 2022. A that time, the VA examiner opined the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness because the condition had resolved and there was no diagnosis associated with a left-sided chest disability. The VA examiner found there was no muscle disability nor radiculopathy issue. In the instant case, the probative evidence of record fails to demonstrate left-sided chest impairment and/or a left arm impairment, other than a left shoulder disability with functional impairment of earning capacity related to the claimed left-sided chest disability and/or left arm disability at any time during the appeal period, and there is no probative evidence of any reported functional impairment of earning capacity related to such disorders prior to the Veteran's claims. In this case, there is no credible persuasive evidence that the Veteran suffered from separately diagnosed left-sided chest and/or left arm impairment that were productive of functional impairment. To that end, the record contains no evidence or allegation that the Veteran experienced functional impairment associated with such claimed disorders. Notably, the Veteran has not asserted that he experiences functional impairment nor functional limitations associated with his left-sided chest disability and/or left arm disability. Rather, the Veteran has consistently reported that his pain and other symptoms have resolved since starting Cymbalta. Additionally, the VA examiners noted the Veteran denied flare-ups or functional loss of his left arm, other symptoms related to either of the claimed conditions, and such conditions did not impact his ability to work. In addition, the record does not reflect, and the Veteran did not allege, that he suffered from impairment of earning capacity due to his left-sided chest impairment and/or left arm impairment, other than that of his already service-connected left shoulder degenerative arthritis, that is of similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. Wait v. Wilkie, 33 Vet. App. 8 (2020). For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection is warranted. Rather, the evidence persuasively weighs against service connection for left-sided chest impairment and/or left arm impairment The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). Steven D. Reiss Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mariah N. Sim, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.