Citation Nr: 23014167
Decision Date: 03/09/23	Archive Date: 03/08/23

DOCKET NO. 18-40 265
DATE: March 9, 2023

ORDER

The appeal for entitlement to service connection for bilateral inguinal hernia repair is dismissed.

The appeal for entitlement to an initial rating higher than 10 percent for tinnitus is dismissed.

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for testicular pain is granted.

Entitlement to service connection for otitis media is denied.

Entitlement to service connection for facial skin tag removal is denied.

Entitlement to an initial 20 percent rating, but no higher, for right lower extremity radiculopathy involving the femoral nerve is granted.

Entitlement to an initial rating of 20 percent, but no higher, for right lower extremity radiculopathy involving the sciatic nerve is granted.

Entitlement to a 20 percent rating, but no higher, for left lower extremity radiculopathy involving the femoral nerve is granted.

Entitlement to a 40 percent rating, but no higher, for left lower extremity radiculopathy involving the sciatic nerve is granted.

Entitlement to a compensable rating for left lower extremity radiculopathy involving the external cutaneous nerve is denied.

Entitlement to an initial rating higher than 30 percent for ulcerative colitis is denied.

Entitlement to an initial rating higher than 10 percent for bilateral flat foot is denied.

Entitlement to a compensable initial rating for scars from right flank lipoma removal and left knee surgery is denied.

Entitlement to an initial 20 percent rating, but no higher, for scars from status post left breast mass removal (claimed as left breast lump) and left shoulder surgery is granted.

Entitlement to a compensable initial rating for allergic rhinitis is denied.

Entitlement to an initial rating higher than 10 percent for asthma (claimed as a respiratory condition) is denied.

Entitlement to an initial 10 percent rating, but no higher, for pseudofolliculitis with seborrheic keratosis granted.

Entitlement to a compensable initial rating for hemorrhoids with proctitis is denied.

Entitlement to an initial 10 percent rating, but no higher, for Bell's palsy is granted.

REMANDED

Issue of entitlement to service connection for a left elbow condition is remanded.

Issue of entitlement to service connection for a left wrist or hand condition is remanded.

Issue of entitlement to service connection for a right wrist or hand condition is remanded. 

Issue of entitlement to service connection for traumatic brain injury (TBI) is remanded.

Issue of entitlement to service connection for migraines (claimed as post traumatic headaches) is remanded.

Issue of entitlement to service connection for sinusitis is remanded.

Issue of entitlement to an initial rating higher than 10 percent for right ankle tendonitis is remanded.

Issue of entitlement to an initial rating higher than 10 percent for left ankle tendonitis is remanded.

Issue of entitlement to an initial rating higher than 20 percent for status post left shoulder surgery with shoulder strain is remanded.

Issue of entitlement to an initial rating higher than 10 percent for lumbar spine strain with IVDS (claimed as back condition) is remanded.

Issue of entitlement to an initial rating higher than 10 percent for right knee patellofemoral pain syndrome is remanded.

Issue of entitlement to an initial rating higher than 10 percent for status post left knee surgery is remanded. 

Issue of entitlement to an initial rating higher than 10 percent for cervical spine strain with IVDS is remanded.

Issue of entitlement to an initial rating higher than 20 percent for left upper extremity radiculopathy is remanded.

Issue of entitlement to an initial rating higher than 20 percent for right upper extremity radiculopathy is remanded.

FINDINGS OF FACT

1. During December 2022 hearing, and prior to the promulgation of a decision on the appeal, the Veteran requested that his appeal for entitlement to service connection for bilateral inguinal hernia repair be withdrawn.

2. The withdrawal of the appeal of entitlement to service connection for bilateral inguinal hernia repair was explicit, unambiguous, and done with the full understanding of the consequences of such action.

3. During the December 2022 hearing, and prior to the promulgation of a decision on the appeal, the Veteran, through his authorized representative, requested that the appeal for entitlement to an initial rating higher than 10 percent for tinnitus be withdrawn.

4. The withdrawal of the appeal for entitlement to an initial rating higher than 10 percent for tinnitus was explicit, unambiguous, and done with the full understanding of the consequences of such action. 

5. The evidence is persuasively against finding that the Veteran has a current disability of left or right ear hearing loss.

6. The evidence is in at least relative equipoise as to whether the Veteran has a current disability of testicular pain that was incurred during service.

7. The Veteran does not have a current disability of otitis media.

8. The evidence is persuasively against finding that the Veteran's facial skin tag removal is a current disability.

9. The evidence supports that the Veteran's right lower extremity radiculopathy involving the femoral nerve manifested with symptoms that more closely approximates moderate incomplete paralysis during the entire period on appeal, but the evidence is persuasively against finding severe or complete paralysis of the right femoral nerve.

10. The evidence supports that the Veteran's right lower extremity radiculopathy involving the sciatic nerve manifested with symptoms that more closely approximates moderate incomplete paralysis, but the evidence is persuasively against finding moderately severe, severe, or complete paralysis of the right sciatic nerve.

11. The evidence supports that the Veteran's left lower extremity radiculopathy involving the femoral nerve manifested with symptoms that more closely approximates moderate incomplete paralysis during the entire period on appeal, but the evidence is persuasively against finding severe or complete paralysis of the left femoral nerve.

12. The evidence supports that the Veteran's left lower extremity radiculopathy involving the sciatic nerve manifested with symptoms that more closely approximates moderately severe incomplete paralysis, but the evidence is persuasively against finding severe or complete paralysis of the left sciatic nerve. 

13. The evidence is persuasively against finding that the Veteran's left lower extremity radiculopathy involving the external cutaneous nerve manifested with more than moderate incomplete paralysis.

14.  The evidence is persuasively against finding that the Veteran's ulcerative colitis has manifested with malnutrition, anemia, general debility, or serious complications as liver abscess.

15. The evidence is persuasively against finding that the Veteran's bilateral flat foot manifested with marked deformity, pain on manipulation and use accentuated, swelling on use, or characteristic callosities.

16. The evidence is persuasively against finding that the Veteran's scars from right flank lipoma removal and left knee surgery are 39 square centimeters or more in area, painful, unstable, or result in a functional impact.

17. The evidence is in at least relative equipoise as to whether he has four painful scars from status post left breast mass removal and left shoulder surgery.

18. The evidence is persuasively against finding that the Veteran's allergic rhinitis manifested with greater than 50 percent obstruction of nasal passages on both sides, complete obstruction of one nasal passage, or with polyps.

19. The evidence is persuasively against finding that the Veteran's asthma manifested with FEV-1 less than 71-percent predicted, FEV-1/FVC less than 71 percent, with use of daily inhalational or oral bronchodilator therapy, or with use of inhalational anti-inflammatory medication.

20. The evidence is in at least relative equipoise as to whether the Veteran's pseudofolliculitis with seborrheic keratosis manifest with deep inflamed nodules and pus-filled cysts when he shaves.

21. The evidence is persuasively against finding that the Veteran's hemorrhoids with proctitis manifested with large or thrombotic hemorrhoids, irreducible, with excessive redundant tissue evidencing frequent recurrences; or that it has resulted in anemia or fissures.

22. The evidence supports that the Veteran's Bell's palsy has manifested with moderate incomplete paralysis of the seventh cranial nerve, but the evidence is persuasively against finding that there is severe incomplete paralysis or complete paralysis.

CONCLUSIONS OF LAW

1. The criteria for dismissal of the appeal for entitlement to service connection for bilateral inguinal hernia repair have been met.  38 U.S.C. § 7105; 38 C.F.R. § 19.55.

2. The criteria for dismissal of the appeal for entitlement to an initial rating higher than 10 percent for tinnitus have been met.  38 U.S.C. § 7105; 38 C.F.R. § 19.55.

3. The criteria for entitlement to service connection for bilateral hearing loss have not been met.  38 U.S.C. §§ 1110, 1112, 1113, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309(a), 3.385.

4. The criteria for entitlement to service connection for testicular pain have been met.  38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to service connection for otitis media have not been met.  38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for entitlement to service connection for facial skin tag removal have not been met.  38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for entitlement to an initial 20 percent rating for right lower extremity radiculopathy involving the femoral nerve have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.120, 4.123, 4.124, 4.124a, Diagnostic Code 8526.

8. The criteria for entitlement to an initial 20 percent rating for right lower extremity radiculopathy involving the sciatic nerve have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.120, 4.123, 4.124, 4.124a, Diagnostic Code 8720.

9. The criteria for entitlement to an initial 20 percent rating for left lower extremity radiculopathy involving the femoral nerve have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.120, 4.123, 4.124, 4.124a, Diagnostic Code 8526.

10. The criteria for entitlement to an initial 40 percent rating for left lower extremity radiculopathy involving the sciatic nerve have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.120, 4.123, 4.124, 4.124a, Diagnostic Code 8720.

11. The criteria for entitlement to a compensable initial rating for left lower extremity radiculopathy involving the external cutaneous nerve of the thigh have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.120, 4.123, 4.124, 4.124a, Diagnostic Code 8529.

12. The criteria for entitlement to an initial rating higher than 30 percent for ulcerative colitis have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7323.

13. The criteria for entitlement to an initial rating higher than 10 percent for bilateral flat foot have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.27, 4.71a, Diagnostic Code 5276.

14. The criteria for entitlement to a compensable initial rating for scars from right flank lipoma removal and left knee surgery have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Codes 7800 to 7804 (2016), 4.118 Diagnostic Codes 7800 to 7804 (2022).

15. The criteria for entitlement to an initial 20 percent rating for scars from status post left breast mass removal and left shoulder surgery have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Codes 7800 to 7804 (2016), 4.118 Diagnostic Codes 7800 to 7804 (2022).

16. The criteria for entitlement to a compensable initial rating for allergic rhinitis have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.96, 4.97, Diagnostic Code 6522.

17. The criteria for entitlement to an initial rating higher than 10 percent for asthma (claimed as a respiratory condition) have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.96, 4.97, Diagnostic Code 6602.

18. The criteria for entitlement to an initial 10 percent rating for pseudofolliculitis with seborrheic keratosis have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7828.

19. The criteria for entitlement to a compensable initial rating for hemorrhoids with proctitis have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.113, 4.114, Diagnostic Code 7336.

20. The criteria for entitlement to a 10 percent rating for Bell's palsy been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.123, 4.124, 4.124a, Diagnostic Code 8207.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from February 2004 to June 2016.

This appeal to the Board of Veterans' Appeals (Board) arose from an August 2016 rating decision issued by the Department of Veterans Affairs (VA).  See July 2017 Notice of Disagreement (NOD); June 2018 Statement of the Case (SOC); August 2018 Substantive Appeal (VA Form 9).

During the pendency of the appeal, the agency of original jurisdiction (AOJ) granted an increased rating of 20 percent for the Veteran's right lower extremity radiculopathy involving the femoral nerve, effective April 1, 2021.  September 2021 Rating Decision.  The AOJ also granted an increased rating of 20 percent for right lower extremity radiculopathy involving the sciatic nerve, effective April 1, 2021; an increased rating of 40 percent for left lower extremity radiculopathy involving the sciatic nerve, effective April 1, 2021; and an increased rating of 20 percent for the left lower extremity radiculopathy involving the femoral nerve, effective April 1, 2021.  Id.

The Board notes that the AOJ considered and issued an initial adjudication for all of the relevant evidence.  See June 2018 SOC; September 2021 Rating Decision. 

The Veteran testified before the undersigned Veterans Law Judge in a December 2022 hearing.  See December 20222 Hearing Transcript.

Withdrawal

The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed.  38 U.S.C. § 7105.  An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision.  38 C.F.R. § § 19.55.  Withdrawal may be made by the appellant or by his or her authorized representative.  38 C.F.R. § § 19.55.

1. The appeal for entitlement to service connection for bilateral inguinal hernia repair.

During the December 2022 Board hearing, the Veteran testified that he had asked his prior representative to withdraw his claim for entitlement to service connection for a bilateral inguinal hernia repair.  December 2022 Hearing Transcript.  He testified that the condition preexisted service, he did not know why the claim was still part of his appeal, and it "should be not even in consideration."  Id. 

The hearing transcript shows that the Veteran clearly identified the issue and that he is requesting withdrawal.  The Veteran's testimony indicates that he is aware of the process and criteria required for entitlement to service connection and, thus, understands the consequences of withdrawal.  The Veteran was also represented at the hearing.  See December 2022 Hearing Transcript.

The Board finds that the Veteran explicitly, unambiguously, and with full understanding of the consequences, withdrew his appeal for entitlement to service connection for bilateral inguinal hernia repair.  As the Veteran's appeal have been withdrawn, there remain no allegations of errors of fact or law for appellate consideration. 

Accordingly, the Board does not have jurisdiction to review the appeal and it is dismissed.

2. The appeal for entitlement to an initial rating higher than 10 percent for tinnitus.

During the December 2022 Board hearing, the Veteran's representative withdrew the appeal for entitlement to an initial rating higher than 10 percent for tinnitus.  December 2022 Hearing Transcript.  The representative stated that they wished to withdraw the appeal because the Veteran's tinnitus is already at the schedular maximum.  Id.

The representative clearly identified the issue and that they were requesting withdrawal.  The representative is aware of the rating criteria, tinnitus, and the consequences of withdrawal.  The Veteran was present during the hearing and did not indicate that he had any questions or concerns.  The Board, thus, finds that the Veteran, through his representative, unambiguously, and with full understanding of the consequences, withdrew his appeal for entitlement to an initial rating higher than 10 percent for tinnitus.  As the Veteran's appeal have been withdrawn, there remain no allegations of errors of fact or law for appellate consideration. 

Accordingly, the Board does not have jurisdiction to review the appeal and it is dismissed.

Service Connection

Service connection may be established for a disability resulting from a disease or injury incurred in or aggravated by active service.  38 U.S.C. § 1131; 38 C.F.R. § 3.303.  Service connection is established when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury.  38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d).

Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether evidence is persuasively against the claim, in which case the claim is denied.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990).

1. Entitlement to service connection for bilateral hearing loss.

The Veteran asserts entitlement to service connection for bilateral hearing loss due to exposure to hazardous noise during service, including from weapons fire and military vehicles.  See July 2017 NOD: December 2022 Hearing Transcript..  The Veteran testified that he has trouble determining who is talking while in a group setting and hearing someone with a higher pitch or volume voice when they are more than 15 to 20 feet away.  Id.

In this case, the Board finds that the Veteran does have impaired hearing considered a disability for the purposes of applying the laws administered by VA.

For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent.  38 C.F.R. § 3.385.

During the May 2015 VA examination for hearing loss and tinnitus, the Veteran's audiological findings for his right ear showed, at most, a 15-decibel auditory threshold for the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz.  His left ear showed, at most, a 10-decibel auditory threshold.  Id.  The examination also showed a 96 percent speech discrimination score for the right ear and a 100 percent speech discrimination score for the left ear.  Id.  

A December 2015 Hearing Conservation Data showed that the Veteran's right ear had, at most, a 10-decibel auditory threshold in any of the frequencies at 500, 1000, 2000, 3000, or 4000 Hertz and, his left ear had, at most, 20-decibel auditory threshold in any of those frequencies.

These are the most recent hearing test in the claims file and the Veteran has not asserted that his hearing loss has worsened since separation.  

The Board finds the audiological findings in May 2015 VA examination for hearing loss and tinnitus and the December 2015 Hearing Conservation Data to be probative as the examinations were performed by qualified medical professionals and provide specific and relevant findings needed to evaluate the Veteran's hearing loss.  This evidence is persuasively against finding that the Veteran's current hearing loss is a current disability under the standards established by 38 C.F.R. § 3.385. 

The Board considered the Veteran's testimony about having trouble hearing in groups and with people with high pitch or volume voices.  See December 2022 Hearing Transcript.  The Veteran description of his hearing problems is too non specific to be probative in establishing whether he has impaired hearing as defined by 38 C.F.R. § 3.385.

The Board notes that it does not doubt the Veteran's testimony that he has problems with his hearing, and that the audiological findings may show some hearing loss due to service.  But the evidence does support that the Veteran's hearing loss meets the standards to be considered a disability for the purposes of applying the laws administered by VA.

As the Veteran does not have a current hearing loss disability eligible for service connection, the claim must be denied.  See Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).  

2. Entitlement to service connection for testicular pain.

The Veteran asserts entitlement to testicular pain that had its onset during service.  See December 2022 Hearing Transcript.  The Veteran testified that his testicular pain began around 2013, has mostly resolved, but still occurs with heavy lifting or certain movements.  See id.  

The Board finds that the Veteran has a current disability of testicular pain.  The Veteran's testimony that he has testicular pain that occurs with heavy lifting or certain movements is probative as the Veteran is competent to report the pain he experiences and its onset.  See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).  His testimony is also consistent with his report to service treatment providers that he has flares of testicular pain with strenuous activity.  October 2012 Service treatment record.  The Board finds that the Veteran's complaint of testicular pain that occurs with strenuous activity such as heavy lifting amounts to a disability that causes functionally impairment.  See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018)

The Board recognizes that the May 2015 VA examination for male reproductive systems conditions found no diagnosis for a testicular condition because the examiner found no pathology for his pain to render a diagnosis.  However, the examiner did not consider or discuss whether the Veteran's testicular pain results in a functional impairment.  Id.  The Board, thus, finds the May 2015 VA examination to be less probative as to whether the Veteran has a current testicular pain disability based on functional impairment from pain.

As noted above, service treatment records show that the Veteran sought treatment for testicular pain during service.  See, e.g., October 2012 Service treatment record.  He reported to his service treatment provider that it was a sudden onset was in 2012.  August 2012 Service treatment record.  

Based on the lay and medical evidence, the Board finds that the Veteran has a current disability of testicular pain that was incurred during service.  

Accordingly, entitlement to service connection for testicular pain is warranted. 

3. Entitlement to service connection for otitis media.

The Veteran asserts entitlement to service connection for otitis media.  April 2015 VA Form 21 0819; July 2017 NOD.

After careful and thorough review of the evidence, the Board finds that otitis media is not a current disability.

The existence of a current disability is the cornerstone of a claim for VA disability compensation.  See, e.g., Degmetich v. Brown, 104 F.3d 1328 (1997).  Congress has specifically limited entitlement to service connection for a disease or injury where such instances have resulted in a disability.  38 U.S.C. §§ 1110, 1131. 

Service treatment records show that the Veteran was treated several times for right ear infections, diagnosed as otitis media or otitis externa.  August 2006 Service treatment record; February 2011 Service treatment record; April 2012 Service treatment record.   His treatment provider indicated that that the condition would resolve in 10 days with treatment.  April 2012 Service treatment record.  The medical treatment evidence shows no complaint or treatment for an ear infection since separation.

The Veteran was afforded a May 2015 VA examination for ear condition in which the examiner found no evidence of a recent ear infection.  

The Veteran has not reported having current symptoms or treatment for an ear infection.  See, e.g., July 2017 NOD; December 2022 Hearing Transcript.  

The is, thus, no medical and lay evidence to support a current diagnosis of otitis media.  Nor are there symptoms related to an ear infection that would functionally impair the Veteran.  See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018).

Because the first element of service connection, i.e., a current disability, has not been met, the claim for entitlement to service connection for otitis media must be denied.  See Gilpin, 155 F.3d 1353; Brammer, 3 Vet. App. at 225.     

4. Entitlement to service connection for facial skin tag removal.

The Veteran asserts entitlement to service connection for facial skin tag removal.  April 2015 VA Form 21 0819; July 2017 NOD.  The Veteran testified that he had skin tags the size of a pea excised from over his left eye around 2011 or 2012.  December 2022 Hearing Transcript.

After careful and thorough review of the evidence, the Board finds that the Veteran does not have a current disability from his facial skin tag removal to establish entitlement to service connection.  See, e.g., Degmetich, 104 F.3d 1328; 38 U.S.C. §§ 1110, 1131.

Service treatment records show that the Veteran had a skin tag removed near his eyelid and another removed near his chin.  February 2011 Service treatment record.  The Veteran was released without limitations and told to follow up with his doctor for suture removal.  Id.  Medical treatment records show no complaint about symptoms or a condition related to his skin tag removals.

The Veteran was afforded a May 2015 VA examination for scars that found no evidence of a scar from his facial skin tag removals.  There is also a May 2015 VA examination for skin diseases that showed no evidence of a facial skin condition.  The VA examiner who provided the examination reports is a medical professional qualified to evaluate the Veteran's skin and had the opportunity to examine the Veteran and review his medical history.  The examiner's findings are probative for these reasons and are persuasive in finding that the Veteran does not have current disability from his 2011 facial skin tag removals.

The Board considered the Veteran's testimony about his facial skin tag removals.  His testimony is consistent with the medical evidence showing that he underwent facial skin tag removals during service, but the Veteran did not indicate that he still had a condition or symptoms from his fascial skin tag removals to support a current disability.  See December 2022 Hearing Transcript.

Because the first element of service connection, i.e., a current disability, has not been met, the claim for entitlement to service connection for facial skin tag removal must be denied.  See Gilpin, 155 F.3d 1353; Brammer, 3 Vet. App. at 225.   

Increased Rating

Disability ratings are determined by the application of the VA's Schedule for Rating Disabilities.  Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § Part 4.  Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity.  See 38 C.F.R. § 4.1.

If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating.  38 C.F.R. § 4.7.  Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran.  38 C.F.R. § 4.3.

Evidence to be considered in the appeal of an initial assignment of a disability rating is not limited to that reflecting the then-current severity of the disorder.  Fenderson v. West, 12 Vet. App. 119 (1999).  "Staged ratings," or different percentage evaluations for separate periods based on the facts found, may also be awarded.  Id. at 126-127.

The Board has considered the entire record, but only the evidence pertinent to the rating criteria and current disability will be discussed.  See Gonzales v. West, 218 F. 3d 1378 (Fed. Cir. 2000).

When 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 Veteran.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

5. Entitlement to an initial 20 percent rating, but no higher, for right lower extremity radiculopathy involving the femoral nerve.

The Veteran asserts entitlement to an initial rating higher than 20 percent for right lower extremity radiculopathy involving the femoral nerve.  July 2017 NOD.  He testified to having decreased strength and a consistent dull pain in his lower extremities.  December 2022 Hearing Transcript.  He testified strenuous activity will cause shooting pain down his legs with constant pain that lasts a few hours.  See id.  

The Veteran's right lower extremity radiculopathy involving the femoral nerve is currently evaluated under Diagnostic Code 8526 and rated 10 percent disabling from June 28, 2016, to April 1, 2021, and 20 percent thereafter.  September 2021 Rating Decision.

Under Diagnostic Code 8526, a 20 percent rating is warranted for moderate incomplete paralysis of the anterior crural (femoral) nerve.  38 C.F.R. § 4.124a.  A 30 percent is warranted for severe incomplete paralysis.  Id.  The highest rating of 40 percent is warranted for complete paralysis of the femoral nerve, which is shown by paralysis of the quadriceps extensor muscles.

Disability in this field is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function.  38 C.F.R. § 4.120.  Consideration is especially given to psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc.  Id.  The site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances are also considered.  Id.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to a varied level of the nerve lesion or to partial regeneration.  When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree.  38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves."

The Rating Schedule does not define the words "mild," "moderate," and "severe" as used in the various Diagnostic Codes.  The Board turns to a dictionary to define these terms.  In this regard, mild is generally defined as "not severe." MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 787 (11th ed. 2003). Moderate is defined as "tending toward the mean or average amount."  Id. at 798.  Severe is usually defined as "a great degree" or "serious."  Id. at 1140.

The VA Adjudication Procedure Manual (M21-1) includes definitions of the terms mild, moderate, and severe as used for incomplete paralysis and 38 C.F.R. § 4.124a.  Although not bound by the M21-1 provisions, the Board has considered the definitions as general guidelines for each level of incomplete paralysis of the upper and lower peripheral nerves and incorporates some of the examples of incomplete paralysis into the definitions of mild, moderate, and severe below for use in this appeal.

For the purposes of this appeal, the Board defines mild incomplete paralysis as manifesting with sensory deficits that are lower graded, less persistent, or effecting a small area.  The symptoms may be recurrent, but not continuous.  There may also be very minimal reflex or motor abnormality.  The symptoms should not be severe, and less than the average, meaning that the symptoms will be at least enough to establish a diagnosis, but not cause functional limitations.

Moderate incomplete paralysis may be considered to include sensory-only symptoms that affect a larger area and likely described by claimant, and medically graded, as severe.  It may also include lower graded sensory deficits, but with a combination of reflex or motor changes of also a lower degree, such as muscle weakness and diminished or hyperactive reflexes.

A severe incomplete paralysis should be expected to manifest with motor or reflex impairment at a very high level of limitation or disability in signs or symptoms such as atrophy, weakness, or diminished or hyperactive reflexes.  Some of these symptoms should be medically graded as severe or noted to be a greater degree of symptoms than the average person with this type of condition.  Trophic changes may be seen in severe longstanding neuropathy.  The signs and symptoms should be less than findings for complete paralysis, but there should be some resembling those of complete paralysis.  For the femoral nerve, there should be some evidence of problems using the quadriceps extensor muscles, which extend the leg/knee.  See 38 C.F.R. § 4.124a, 8526; Dorland's Illustrated Medical Dictionary 1192 (33d ed. 2022).

Rather than applying a mechanical formula, VA must evaluate all evidence to ensure that decisions will be equitable and just.  38 C.F.R. § 4.6.  Regulations provide that ratings for peripheral neurological disorders are assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance.  38 C.F.R. § 4.120.  Consideration is also given for loss of reflexes, pain, and muscle atrophy.  See 38 C.F.R. §§ 4.123, 4.124.  

The use of descriptive terminology such as "severe" by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue.  See 38 C.F.R. § 4.2.  Instead, adjudicators must evaluate all of the evidence and render a decision that is "equitable and just."  38 U.S.C. § 7104(a); 38 C.F.R. § 4.6.

After careful and thorough review of the evidence, the Board finds that the Veteran's right lower extremity radiculopathy involving the femoral nerve has manifested with no more than moderate incomplete paralysis.  

The Veteran's report of decreased strength and a consistent dull pain in his lower extremities with a flare up of pain after strenuous activity suggest more than mild incomplete paralysis given the sensory and motor symptoms involved.  See December 2022 Hearing Transcript.  The Board finds the Veteran's report of having pain and problems with movement to be probative, but his lay statements are too general to differentiate between what is considered the average intensity of symptoms felt by those with right lower extremity radiculopathy and those at a more serious, or higher level intensity, for severe incomplete paralysis.

A review of the medical treatment evidence shows that the Veteran has complained of radiating pain to his lower extremities.  See, e.g.,  February 2019 VA treatment evidence; February 2021 Private treatment evidence.  But his treatment providers found normal strength, reflexes, and sensation in his lower extremities.  See, e.g., July 2018 VA treatment evidence; February 2021 Private treatment evidence.  The normal examination findings with complaints of pain would support, at most, mild incomplete paralysis of the right lower extremity femoral nerve. 

There are also several VA examinations that evaluate the Veteran's right lower extremity radiculopathy.  The Veteran was afforded a May 2015 VA examination for back conditions, which include an evaluation of radiculopathy.  The examiner found the Veteran's right lower extremity showed normal strength, reflexes, and sensation.  Id.  The May 2015 examiner found no sign of right lower extremity radiculopathy.  Id.  During a January 2021 VA examination for peripheral nerves conditions, the Veteran was found, again, to have normal strength, reflexes, and sensation in his lower extremities.  But this examiner found the Veteran had mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness.  Id.  The January 2021 VA examiner opined that the Veteran had mild incomplete paralysis of the right lower extremity sciatic nerve, but no radiculopathy due to his femoral nerve.  See January 2021 VA Examination Addendum.  The May 2015 and January 2021 VA examiners' findings would be against finding a current disability of right lower extremity radiculopathy involving the femoral nerve.

A few months later, however, the Veteran was afforded another VA examination for his peripheral nerves.  The examiner found 4/5 right lower extremity strength, normal knee extension, and decreased sensation and reflexes in his ankle.  August 2021 VA Examination for Peripheral Nerves Conditions.  The Veteran's right lower extremity was found to have mild constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness.  Id.  The Veteran was also noted to have an antalgic gait.  Id.  The August 2021 VA examiner opined that the Veteran had moderate incomplete paralysis of the right lower extremity femoral nerve.

The Board finds each of the VA examiners' findings and opinions to be probative as they are medical professionals who had the opportunity to examine the Veteran and provided detailed reports with specific findings relevant to the rating criteria.  But the Board gives more weight to the August 2021 VA examiner's findings because they are more consistent with the Veteran's reported symptoms, including flare-ups after strenuous activity.

Based on the more probative lay and medical evidence, the Board finds that, during the entire period on appeal, the Veteran's right lower extremity radiculopathy involving the femoral nerve has manifested with a constant mild and dull pain and a moderate level of pain that occurs intermittently and with strenuous activity.  The Veteran also experiences a moderate level of paresthesias and/or dysesthesia, moderate numbness, and a 4/5 decrease of strength and hypoactive reflexes that contribute to an antalgic gait.  However, there are no signs of trophic changes or muscle atrophy in his right lower extremity, and the Veteran does not need an assistive device to walk.  The evidence shows his right lower extremity still has active movement against some resistance and at least some reflexes and sensation.  He also has normal strength and reflexes in his knee.

The evidence does not show that the Veteran has been diagnosed with neuritis or neuralgia in his right lower extremity.

The Board finds that the Veteran's symptoms most closely approximate a moderate incomplete paralysis of his right lower extremity femoral nerve, but are persuasively against finding severe incomplete paralysis or complete paralysis of the right femoral nerve.  

The Board has considered all other potentially applicable Diagnostic Codes, but the evidence is persuasively against finding that the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected.  The Board recognizes that the May 2015 VA examination for the back indicates that the Veteran's left lower extremity radiculopathy also involves the superficial peroneal nerve.  But the August 2021 VA examination is more specific for peripheral nerve conditions and found no evidence of superficial peroneal nerve involvement.  August 2021 VA Examination for Peripheral Nerve Conditions.  The Board gives more weight to the August 2021 VA examination as the examiner specifically tested the nerves involved and reported more detailed findings.  A separate or higher rating under a different Diagnostic Code is, thus, not warranted based on the more probative evidence.  

Accordingly, the schedular criteria for a 20 percent rating, but no higher, for right lower extremity radiculopathy involving the femoral nerve has been met since June 28, 2016.

6. Entitlement to an initial rating of 20 percent, but no higher, for right lower extremity radiculopathy involving the sciatic nerve.

The Veteran asserts entitlement to an initial rating higher than 20 percent for right lower extremity radiculopathy involving the sciatic nerve.  July 2017 NOD.  He testified to having decreased strength and a consistent dull pain in his lower extremities.  December 2022 Hearing Transcript.  He testified that strenuous activity will cause shooting pain down his legs with constant pain, lasting a few hours.  See id.

The Veteran's right lower extremity radiculopathy involving the sciatic nerve is currently evaluated under Diagnostic Code 8520 and is rated as 10 percent disabling from June 28, 2016, to April 1, 2021, and 20 percent thereafter.  September 2021 Rating Decision.

Under Diagnostic Code 8520, a 10 percent rating is warranted for mild incomplete paralysis; 20 percent for moderate incomplete paralysis; 40 percent for moderately severe incomplete paralysis; 60 percent for severe incomplete paralysis with marked muscular atrophy; and a 80 percent is warranted for complete paralysis of the sciatic nerve as showed by the foot dangling and dropping with no active movement possible of the muscles below the knee, flexion of the knee weakened or (very rarely) lost.  38 C.F.R. § 4.124a.

Disability in this field is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function.  38 C.F.R. § 4.120.  Consideration is especially given to psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc.  Id.  The site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances are also considered.  Id.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to a varied level of the nerve lesion or to partial regeneration.  When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree.  38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves."

The Rating Schedule does not define the words "mild," "moderate," "moderately severe" and "severe" as used in the various Diagnostic Codes.  The Board turns to a dictionary to define these terms.  In this regard, mild is generally defined as "not severe." MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 787 (11th ed. 2003). Moderate is defined as "tending toward the mean or average amount."  Id. at 798.  Severe is usually defined as "a great degree" or "serious."  Id. at 1140.

The VA Adjudication Procedure Manual (M21-1) includes definitions of the terms mild, moderate, and severe as used for incomplete paralysis and 38 C.F.R. § 4.124a.  Although not bound by the M21-1 provisions, the Board has considered the definitions as general guidelines for each level of incomplete paralysis of the upper and lower peripheral nerves and incorporates some of the examples of incomplete paralysis into the definitions of mild, moderate, and severe below for use in this appeal.

For the purposes of this appeal, the Board defines mild incomplete paralysis as manifesting with sensory deficits that are lower graded, less persistent, or effecting a small area.  The symptoms may be recurrent, but not continuous.  There may also be very minimal reflex or motor abnormality.  The symptoms should not be severe, and less than the average, meaning that the symptoms will be at least enough to establish a diagnosis, but not cause functional limitations.

Moderate incomplete paralysis may be considered to include sensory-only symptoms that affect a larger area and likely described by claimant, and medically graded, as severe.  It may also include lower graded sensory deficits, but with a combination of reflex or motor changes of also a lower degree, such as muscle weakness and diminished or hyperactive reflexes.

Moderately severe incomplete paralysis will be considered to include high level of limitation or disability in motor or reflexes, that may be medically graded at the moderate and severe level.  It is more than just sensory symptoms and will include motor or reflex symptoms.  Atrophy may be present.

A severe incomplete paralysis should be expected to manifest with motor or reflex impairment at a very high level of limitation or disability.  Some of the symptoms should be medically graded as severe or considered to have greater degree of symptoms than the average person with this type of condition.  For the sciatic nerve, there should be marked muscular atrophy.  Trophic changes may be seen in severe longstanding neuropathy.  The signs and symptoms should be less than findings for complete paralysis, but there should be some resembling those of complete paralysis.  In this case, there should be some evidence of problems using his right foot or weakened movement in the knee.  See 38 C.F.R. § 4.124a, 8520.

Rather than applying a mechanical formula, VA must evaluate all evidence to ensure that decisions will be equitable and just.  38 C.F.R. § 4.6.  Regulations provide that ratings for peripheral neurological disorders are assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance.  38 C.F.R. § 4.120.  Consideration is also given for loss of reflexes, pain, and muscle atrophy.  See 38 C.F.R. §§ 4.123, 4.124.  

The use of descriptive terminology such as "severe" by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue.  See 38 C.F.R. § 4.2.  Instead, adjudicators must evaluate all of the evidence and render a decision that is "equitable and just."  38 U.S.C. § 7104(a); 38 C.F.R. § 4.6.

After careful and thorough review of the evidence, the Board finds that the Veteran's right lower extremity radiculopathy involving the sciatic nerve has manifested with no more than moderate incomplete paralysis. 

As discussed above, the Veteran's report of decreased strength and a consistent dull pain in his lower extremities with a flare up of pain after strenuous activity suggest more than mild incomplete paralysis given the sensory and motor symptoms involved.  See December 2022 Hearing Transcript.  The Board finds the Veteran's report of having pain and problems with movement to be probative here as well, but the Veteran's lay statements are too general to differentiate between what is considered the average intensity of symptoms felt by those with right lower extremity radiculopathy and those at a more serious, or higher level intensity, for moderately severe incomplete paralysis.

A review of the medical treatment evidence shows that the Veteran has complained of radiating pain to his lower extremities.  See, e.g.,  February 2019 VA treatment evidence; February 2021 Private treatment evidence.  But his treatment providers have found normal strength, reflexes, and sensation in his lower extremities.  See, e.g., July 2018 VA treatment evidence; February 2021 Private treatment evidence.  The normal examination findings with complaints of pain would support, at most, mild incomplete paralysis of the right lower extremity sciatic nerve. 

There are also several VA examinations that evaluate the Veteran's right lower extremity radiculopathy.  The Veteran was afforded a May 2015 VA examination for back conditions, which included an evaluation of radiculopathy.  The examiner found the Veteran's right lower extremity showed normal strength, reflexes, and sensation.  Id.  The May 2015 examiner found no sign of right lower extremity radiculopathy.  Id.  During a January 2021 VA examination for peripheral nerves conditions, the Veteran was found, again, to have normal strength, reflexes, and sensation in his lower extremities.  But this examiner found the Veteran had mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness.  Id.  The January 2021 VA examiner opined that the Veteran had mild incomplete paralysis of his right lower extremity sciatic nerve.  Id.  The May 2015 and January 2021 VA examiners' findings would support no more than mild incomplete paralysis based the sensory impairments and normal motor and reflex findings.

A few months later, however, the Veteran was afforded another VA examination for his peripheral nerves.  The examiner found 4/5 right lower extremity strength in his ankles, but normal strength in his knees. August 2021 VA Examination for Peripheral Nerves Conditions.  The examiner also found decreased sensation and reflex in his ankle.  Id.  The Veteran's right lower extremity was found to have mild constant pain, moderate intermittent pain, and moderate numbness.  Id.  The Veteran was also noted to have an antalgic gait.  Id.  The August 2021 VA examiner opined that the Veteran had moderate incomplete paralysis of the right lower extremity sciatic nerve.  Id.

The Board finds each of the VA examiners' findings and opinion to be probative as they are medical professionals who had the opportunity to examine the Veteran and provided detailed reports with specific findings relevant to the rating criteria.  But the Board gives more weight to the August 2021 VA examiner's findings because they are more consistent with the Veteran's reported symptoms, including flare ups after strenuous activity.

Based on the more probative lay and medical evidence, the Board finds that the Veteran's right lower extremity radiculopathy involving the sciatic nerve has manifested with a mild, dull, constant pain and a moderate level of pain that occurs intermittently and with strenuous activity during the entire period on appeal.  The Veteran also experiences a moderate level of paresthesias and/or dysesthesia, moderate numbness, and a decrease of 4/5 strength and hypoactive reflexes that contribute to an antalgic gait.  However, the evidence shows his right lower extremity still has active movement against some resistance, normal strength and reflexes in his knee, and at least some reflexes and sensation.  None of the Veteran's symptoms has been medically graded as severe.  There is no sign of trophic changes or muscle atrophy in his right lower extremity, and the Veteran does not need an assistive device to walk.

The evidence does not show that the Veteran has been diagnosed with neuritis or neuralgia in his right lower extremity.

The Board finds that these symptoms most closely approximate a moderate incomplete paralysis of his right lower extremity sciatic nerve, and is persuasively against finding moderately severe or severe incomplete paralysis.  

As discussed above, the Board has considered all other potentially applicable Diagnostic Codes, but the evidence is persuasively against finding that the Veteran has neurological impairment associated with any other peripheral nerves other than those that have already been service connected.  A separate or higher rating under a different Diagnostic Code is not warranted based on the current evidence.  

Accordingly, the schedular criteria for a 20 percent rating, but no higher, for right lower extremity radiculopathy involving the sciatic nerve has been met since June 28, 2016.

7. Entitlement to a 20 percent rating, but no higher, for left lower extremity radiculopathy involving the femoral nerve is granted.

The Veteran asserts entitlement to an initial rating higher than 20 percent for left lower extremity radiculopathy involving the femoral nerve.  July 2017 NOD.  He testified to having decreased strength and a consistent dull pain in his lower extremities.  December 2022 Hearing Transcript.  He testified that strenuous activity will cause shooting pain down his legs with constant pain, lasting a few hours.  See id.  

The Veteran's left lower extremity radiculopathy involving the femoral nerve is currently evaluated under Diagnostic Code 8526 and rated 10 percent disabling from June 28, 2016, to April 1, 2021, and 20 percent thereafter.  September 2021 Rating Decision.

Under Diagnostic Code 8526, a 20 percent rating is warranted for moderate incomplete paralysis of the anterior crural (femoral) nerve.  38 C.F.R. § 4.124a.  A 30 percent is warranted for severe incomplete paralysis.  Id.  The highest rating of 40 percent is warranted for complete paralysis of the femoral nerve, which is shown by paralysis of the quadriceps extensor muscles.  Id.

Disability in this field is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function.  38 C.F.R. § 4.120.  Consideration is especially given to psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc.  Id.  The site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances are also considered.  Id.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to a varied level of the nerve lesion or to partial regeneration.  When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree.  38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves."

The Rating Schedule does not define the words "mild," "moderate," and "severe" as used in the various Diagnostic Codes.  The Board turns to a dictionary to define these terms.  In this regard, mild is generally defined as "not severe." MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 787 (11th ed. 2003). Moderate is defined as "tending toward the mean or average amount."  Id. at 798.  Severe is usually defined as "a great degree" or "serious."  Id. at 1140.

The VA Adjudication Procedure Manual (M21-1) includes definitions of the terms mild, moderate, and severe as used for incomplete paralysis and 38 C.F.R. § 4.124a.  Although not bound by the M21-1 provisions, the Board has considered the definitions as general guidelines for each level of incomplete paralysis of the upper and lower peripheral nerves and incorporates some of the examples of incomplete paralysis into the definitions of mild, moderate, and severe below for use in this appeal.

For the purposes of this appeal, the Board defines mild incomplete paralysis as manifesting with sensory deficits that are lower graded, less persistent, or effecting a small area.  The symptoms may be recurrent, but not continuous.  There may also be very minimal reflex or motor abnormality.  The symptoms should not be severe, and less than the average, meaning that the symptoms will be at least enough to establish a diagnosis, but not cause functional limitations.

Moderate incomplete paralysis may be considered to include sensory-only symptoms that affect a larger area and likely described by claimant, and medically graded, as severe.  It may also include lower graded sensory deficits, but with a combination of reflex or motor changes of also a lower degree, such as muscle weakness and diminished or hyperactive reflexes.

A severe incomplete paralysis should be expected to manifest with motor or reflex impairment at a very high level of limitation or disability in signs or symptoms such as atrophy, weakness, or diminished or hyperactive reflexes.  Some of the symptoms should be medically graded as severe or considered to have greater degree of symptoms than the average person with this type of condition.  Trophic changes may be seen in severe longstanding neuropathy.  The signs and symptoms should be less than findings for complete paralysis, but there should be some resembling those of complete paralysis.  In this case, there should be some evidence of problems using the quadriceps extensor muscles, which extends the leg/knee.  See 38 C.F.R. § 4.124a, 8526; Dorland's Illustrated Medical Dictionary 1192 (33d ed. 2022).

Rather than applying a mechanical formula, VA must evaluate all evidence to ensure that decisions will be equitable and just.  38 C.F.R. § 4.6.  Regulations provide that ratings for peripheral neurological disorders are assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance.  38 C.F.R. § 4.120.  Consideration is also given for loss of reflexes, pain, and muscle atrophy.  See 38 C.F.R. §§ 4.123, 4.124.  

The use of descriptive terminology such as "severe" by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue.  See 38 C.F.R. § 4.2.  Instead, adjudicators must evaluate all of the evidence and render a decision that is "equitable and just."  38 U.S.C. § 7104(a); 38 C.F.R. § 4.6.

After careful and thorough review of the evidence, the Board finds that the Veteran's left lower extremity radiculopathy involving the femoral nerve has manifested with no more than moderate incomplete paralysis.  

The Veteran's report of decreased strength and a consistent dull pain in his lower extremities with a flare up of pain after strenuous activity suggest more than mild incomplete paralysis given the sensory and motor symptoms involved.  See December 2022 Hearing Transcript.  The Board finds the Veteran's report of having pain and problems with movement to be probative, but the Veteran's lay statements are too general to differentiate between what is considered the average intensity of symptoms felt by those with left lower extremity radiculopathy and those at a more serious, or higher level intensity, for severe incomplete paralysis.

A review of the medical treatment evidence shows that the Veteran has complained of radiating pain to his lower extremities.  See, e.g.,  February 2019 VA treatment evidence; February 2021 Private treatment evidence.  But his treatment providers have found normal strength, reflexes, and sensation in his lower extremities.  See, e.g., July 2018 VA treatment evidence; February 2021 Private treatment evidence.  The normal examination findings with complaints of pain would support, at most, mild incomplete paralysis of the left lower extremity femoral nerve. 

There are also several VA examinations that evaluate the Veteran's left lower extremity radiculopathy.  The Veteran was afforded a May 2015 VA examination for back conditions, which includes an evaluation of radiculopathy.  The examiner found the left lower extremity showed normal strength and reflexes, but a decrease in sensation, mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness.  Id.  The May 2015 examiner opined that the Veteran had mild left lower extremity radiculopathy involving the femoral nerve.  Id.  During a January 2021 VA examination for peripheral nerves conditions, the Veteran was found to have normal strength, reflexes, as well as sensation in his lower extremities.  The examiner found the Veteran had mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness.  Id.  The January 2021 VA examiner opined that the Veteran had mild incomplete paralysis of the left lower extremity femoral nerve.  Id.  The May 2015 and January 2021 VA examiners' findings and opinions support no more than a mild incomplete paralysis of the left lower extremity radiculopathy involving the femoral nerve.

A few months later, however, the Veteran was afforded another VA examination for his peripheral nerves.  The examiner found 4/5 left lower extremity strength, but normal knee extension and decreased sensation and reflexes in his ankle.  August 2021 VA Examination for Peripheral Nerves Conditions.  The Veteran's left lower extremity was found to have mild constant pain, severe intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness.  Id.  The Veteran was also noted to have an antalgic gait.  Id.  The August 2021 VA examiner opined that the Veteran had moderate incomplete paralysis of the left lower extremity femoral nerve.

The Board finds each of the VA examiners' findings and opinion to be probative as they are medical professionals who had the opportunity to examine the Veteran and provided detailed reports with specific findings relevant to the rating criteria.  But the Board gives more weight to the August 2021 VA examiner's findings because they are more consistent with the Veteran's reported symptoms, including after strenuous activity, during the entire period on appeal. 

Based on the more probative lay and medical evidence, the Board finds that, during the entire period on appeal, the Veteran's right lower extremity radiculopathy involving the femoral nerve has manifested with a constant mild and dull pain, and a severe level of pain occurring intermittently and with strenuous activity.  The Veteran also experiences a moderate level of paresthesias and/or dysesthesias, moderate numbness, and a decrease of 4/5 strength and hypoactive reflexes that contribute to an antalgic gait.  However, there are no signs of trophic changes or muscle atrophy in his left lower extremity, and the Veteran does not need an assistive device to walk.  He has normal strength and reflexes in his knee.  The evidence shows his left lower extremity still has active movement against some resistance and at least some reflexes and sensation.

The evidence does not show that the Veteran has been diagnosed with neuritis or neuralgia in his right lower extremity.

While the evidence shows he experiences more severe intermittent pain in his left lower extremity than his right, the Board finds that his symptoms still most closely approximate a moderate incomplete paralysis of his left lower extremity femoral nerve, and is persuasively against finding severe incomplete paralysis or complete paralysis.  

The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected.  A separate or higher rating under a different Diagnostic Code is not warranted based on the current evidence.  

Accordingly, the schedular criteria for a 20 percent rating, but no higher, for left lower extremity radiculopathy involving the femoral nerve has been met since June 28, 2016.

8. Entitlement to a 40 percent rating, but no higher, for left lower extremity radiculopathy involving the sciatic nerve is granted.

The Veteran asserts entitlement to an initial rating higher than 40 percent for left lower extremity radiculopathy involving the sciatic nerve.  July 2017 NOD.  He testified to having decreased strength and a consistent dull pain in his lower extremities.  December 2022 Hearing Transcript.  He testified strenuous activity will cause shooting pain down his legs with constant pain that lasts a few hours.  See id.

The Veteran's left lower extremity radiculopathy involving the sciatic nerve is currently evaluated under Diagnostic Code 8520 and is rated as 10 percent disabling from June 28, 2016, to April 1, 2021, and 40 percent thereafter.  September 2021 Rating Decision.

Under Diagnostic Code 8520, a 10 percent rating is warranted for mild incomplete paralysis; 20 percent for moderate incomplete paralysis; 40 percent for moderately severe incomplete paralysis; 60 percent for severe incomplete paralysis with marked muscular atrophy; and a 80 percent is warranted for complete paralysis of the sciatic nerve as showed by the foot dangling and dropping with no active movement possible of the muscles below the knee, flexion of the knee weakened or (very rarely) lost.  38 C.F.R. § 4.124a.

Disability in this field is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function.  38 C.F.R. § 4.120.  Consideration is especially given to psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc.  Id.  The site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances are also considered.  Id.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to a varied level of the nerve lesion or to partial regeneration.  When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree.  38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves."

The Rating Schedule does not define the words "mild," "moderate," "moderately severe" and "severe" as used in the various Diagnostic Codes.  The Board turns to a dictionary to define these terms.  In this regard, mild is generally defined as "not severe." MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 787 (11th ed. 2003). Moderate is defined as "tending toward the mean or average amount."  Id. at 798.  Severe is usually defined as "a great degree" or "serious."  Id. at 1140.

For the purposes of this appeal, the Board defines mild incomplete paralysis as manifesting with sensory deficits that are lower graded, less persistent, or effecting a small area.  The symptoms may be recurrent, but not continuous.  There may also be very minimal reflex or motor abnormality.  The symptoms should not be severe, and less than the average, meaning that the symptoms will be at least enough to establish a diagnosis, but not cause functional limitations.

Moderate incomplete paralysis may be considered to include sensory-only symptoms that affect a larger area and likely described by claimant, and medically graded, as severe.  It may also include lower graded sensory deficits, but with a combination of reflex or motor changes of also a lower degree, such as muscle weakness and diminished or hyperactive reflexes.

Moderately severe incomplete paralysis will be considered to include high level of limitation or disability in motor or reflexes, that may be medically graded at the moderate and severe level.  It is more than just sensory symptoms and will include motor or reflex symptoms.  Atrophy may be present.

A severe incomplete paralysis should be expected to manifest with motor or reflex impairment at a very high level of limitation or disability in signs or symptoms such as atrophy, weakness, or diminished or hyperactive reflexes.  Some of these symptoms should be medically graded as severe or noted to be a greater degree of symptoms than the average person with this type of condition.  Trophic changes may be seen in severe longstanding neuropathy.  The signs and symptoms should be less than findings for complete paralysis, but there should be some resembling those of complete paralysis.  In this case, there should be some evidence of problems using his left foot or weakened movement in the knee.  See 38 C.F.R. § 4.124a, 8520.

Rather than applying a mechanical formula, VA must evaluate all evidence to ensure that decisions will be equitable and just.  38 C.F.R. § 4.6.  Regulations provide that ratings for peripheral neurological disorders are assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance.  38 C.F.R. § 4.120.  Consideration is also given for loss of reflexes, pain, and muscle atrophy.  See 38 C.F.R. §§ 4.123, 4.124.  

The use of descriptive terminology such as "severe" by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue.  See 38 C.F.R. § 4.2.  Instead, adjudicators must evaluate all of the evidence and render a decision that is "equitable and just."  38 U.S.C. § 7104(a); 38 C.F.R. § 4.6.

After careful and thorough review of the evidence, the Board finds that the Veteran's left lower extremity radiculopathy involving the sciatic nerve has manifested with no more than moderately severe incomplete paralysis. 

As discussed above, the Veteran's report of decreased strength and a consistent dull pain in his lower extremities with a flare up of pain after strenuous activity suggest more than mild incomplete paralysis given the sensory and motor symptoms involved.  See December 2022 Hearing Transcript.  The Board finds the Veteran's report of having pain and problems with movement to be probative here as well, but the Veteran's lay statements are too general to differentiate between what is considered moderately severe and severe symptoms, or evidence of marked muscular atrophy.

A review of the medical treatment evidence shows that the Veteran has complained of radiating pain to his lower extremities.  See, e.g.,  February 2019 VA treatment evidence; February 2021 Private treatment evidence.  But his treatment providers have found normal strength, reflexes, and sensation in his lower extremities.  See, e.g., July 2018 VA treatment evidence; February 2021 Private treatment evidence.  The normal examination findings with complaints of pain would support, at most, mild incomplete paralysis of the right lower extremity sciatic nerve. 

There are also several VA examinations that evaluate the Veteran's left lower extremity radiculopathy.  The Veteran was afforded a May 2015 VA examination for back conditions, which included an evaluation of radiculopathy.  The examiner found the left lower extremity showed normal strength and reflexes, but a decrease in sensation, mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness.  Id.  The May 2015 examiner opined that the Veteran had mild left lower extremity radiculopathy involving the sciatic nerve.  Id.  During a January 2021 VA examination for peripheral nerves conditions, the Veteran was found to have normal strength, reflexes, as well as sensation in his lower extremities.  The examiner found the Veteran had mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness.  Id.  The January 2021 VA examiner opined that the Veteran had mild incomplete paralysis of the left lower extremity sciatic nerve.  Id.  The May 2015 and January 2021 VA examiners' findings and opinions support no more than a mild incomplete paralysis of the left lower extremity radiculopathy involving the sciatic nerve.

A few months later, however, the Veteran was afforded another VA examination for his peripheral nerves.  The examiner found 4/5 left lower extremity strength in the ankles, but normal with knee extension.  August 2021 VA Examination for Peripheral Nerves Conditions.  He had decreased sensation, and decreased reflex in his ankle.  Id.  The Veteran's left lower extremity was found to have mild constant pain, severe intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness.  Id.  The Veteran was also noted to have an antalgic gait.  Id.  The August 2021 VA examiner opined that the Veteran had moderate severe incomplete paralysis of the left lower extremity sciatic nerve.

The Board finds each of the VA examiners' findings and opinion to be probative as they are medical professionals who had the opportunity to examine the Veteran and provided detailed reports with specific findings relevant to the rating criteria.  But the Board gives more weight to the August 2021 VA examiner's findings because they are more consistent with the Veteran's reported symptoms, including after strenuous activity. 

Based on the more probative lay and medical evidence, the Board finds that, during the entire period on appeal, the Veteran's left lower extremity radiculopathy involving the sciatic nerve has manifested with a constant mild and dull pain, and a severe level of pain occurring intermittently and with strenuous activity.  The Veteran also experiences a moderate level of paresthesias and/or dysesthesias, moderate numbness, and a decrease of 4/5 strength and hypoactive reflexes that contribute to an antalgic gait.  However, there are no signs of trophic changes or muscle atrophy in his left lower extremity, and the Veteran does not need an assistive device to walk.  The evidence shows his left lower extremity still has active movement against some resistance and at least some reflexes and sensation.

The evidence does not show that the Veteran has been diagnosed with neuritis or neuralgia in his left lower extremity.

His left lower extremity has been graded with severe intermittent pain, suggesting a higher level of incomplete paralysis than his right sciatic nerve.  The 4/5 strength and hypoactive reflexes and sensation in the left ankle, but not his knee, supports a higher level of incomplete paralysis in his left sciatic nerve than the left femoral nerve.  The Board finds that these symptoms most closely approximate a moderately severe incomplete paralysis of his left lower extremity sciatic nerve, but is persuasively against finding severe incomplete paralysis or complete paralysis of the sciatic nerve.  

As discussed above, the Board has considered all other potentially applicable Diagnostic Codes, but the evidence is persuasively against finding that the Veteran has neurological impairment associated with any other peripheral nerves other than those that have already been service connected.  A separate or higher rating under a different Diagnostic Code is not warranted based on the current evidence.  

Accordingly, the schedular criteria for a 40 percent rating, but no higher, for left lower extremity radiculopathy involving the sciatic nerve has been met since June 28, 2016.

9. Entitlement to a compensable rating for left lower extremity radiculopathy involving the external cutaneous nerve is denied.

The Veteran asserts entitlement to a compensable rating for his left lower extremity radiculopathy involving the external cutaneous nerve.  July 2017 NOD.  He testified to having decreased strength and a consistent dull pain in his lower extremities.  December 2022 Hearing Transcript.  He testified strenuous activity will cause shooting pain down his legs with constant pain that lasts a few hours.  See id.

The Veteran's left lower extremity radiculopathy involving the external cutaneous nerve is currently evaluated under Diagnostic Code 8529 and is rated as noncompensable, or zero percent disabling.  September 2021 Rating Decision.

Under Diagnostic Code 8529, a zero percent rating is warranted for mild or moderate incomplete paralysis of the external cutaneous nerve of the thigh.  See 38 C.F.R. § 4.124a.  A 10 percent rating, which is the highest schedular rating under Diagnostic Code 8529, is warranted for severe incomplete paralysis to complete paralysis of the external cutaneous nerve of the thigh.  See id.

Disability in this field is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function.  38 C.F.R. § 4.120.  Consideration is especially given to psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc.  Id.  The site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances are also considered.  Id.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to a varied level of the nerve lesion or to partial regeneration.  When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree.  38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves."

When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree.  38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves."

The Rating Schedule does not define the words "mild," "moderate," and "severe" as used in the various Diagnostic Codes.  The Board turns to a dictionary to define these terms.  In this regard, mild is generally defined as "not severe." MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 787 (11th ed. 2003).  Moderate is defined as "tending toward the mean or average amount."  Id. at 798.  Severe is usually defined as "a great degree" or "serious."  Id. at 1140.

The VA Adjudication Procedure Manual (M21-1) includes definitions of the terms mild, moderate, and severe as used for incomplete paralysis and 38 C.F.R. § 4.124a.  Although not bound by the M21-1 provisions, the Board has considered the definitions as general guidelines for each level of incomplete paralysis of the upper and lower peripheral nerves and incorporates some of the examples of incomplete paralysis into the definitions of mild, moderate, and severe below for use in this appeal.

For the purposes of this appeal, the Board defines mild incomplete paralysis as manifesting with sensory deficits that are lower graded, less persistent, or effecting a small area.  The symptoms may be recurrent, but not continuous.  There may also be very minimal reflex or motor abnormality.  The symptoms should not be severe, and less than the average, meaning that the symptoms will be at least enough to establish a diagnosis, but not cause functional limitations.

Moderate incomplete paralysis may be considered to include sensory-only symptoms that affect a larger area and likely described by claimant, and medically graded, as severe.  It may also include lower graded sensory deficits, but with a combination of reflex or motor changes of also a lower degree, such as muscle weakness and diminished or hyperactive reflexes.

A severe incomplete paralysis should be expected to manifest with motor or reflex impairment at a very high level of limitation or disability in signs or symptoms such as atrophy, weakness, or diminished or hyperactive reflexes.  Some of these symptoms should be medically graded as severe or noted to be a greater degree of symptoms than the average person with this type of condition.  Trophic changes may be seen in severe longstanding neuropathy.  The signs and symptoms should be less than findings for complete paralysis, but there should be some resembling those of complete paralysis.  The external cutaneous nerve of the thigh is a sensory nerve of the thigh.  See Dorland's Illustrated Medical Dictionary 1238 (33d ed. 2022).

Rather than applying a mechanical formula, VA must evaluate all evidence to ensure that decisions will be equitable and just.  38 C.F.R. § 4.6.  Regulations provide that ratings for peripheral neurological disorders are assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance.  38 C.F.R. § 4.120.  Consideration is also given for loss of reflexes, pain, and muscle atrophy.  See 38 C.F.R. §§ 4.123, 4.124.  

The use of descriptive terminology such as "severe" by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue.  See 38 C.F.R. § 4.2.  Instead, adjudicators must evaluate all of the evidence and render a decision that is "equitable and just."  38 U.S.C. § 7104(a); 38 C.F.R. § 4.6.

After careful and thorough review of the evidence, the Board finds that the Veteran's left lower extremity radiculopathy involving the external cutaneous nerve of the thigh has manifested with no more than moderate incomplete paralysis.

As discussed above, the Veteran's report of decreased strength and a consistent dull pain in his lower extremities with a flare up of pain after strenuous activity suggest more than mild incomplete paralysis given the sensory and motor symptoms involved.  See December 2022 Hearing Transcript.  The Board finds the Veteran's report of having pain and problems with movement to be probative here as well, but the Veteran's lay statements are too general to differentiate between what is considered moderate and severe or complete paralysis symptoms.

A review of the medical treatment evidence shows that the Veteran has complained of radiating pain to his lower extremities.  See, e.g.,  February 2019 VA treatment evidence; February 2021 Private treatment evidence.  But his treatment providers have found normal strength, reflexes, and sensation in his lower extremities.  See, e.g., July 2018 VA treatment evidence; February 2021 Private treatment evidence.  The normal examination findings with complaints of pain would support, at most, mild incomplete paralysis of the left lower extremity external cutaneous nerve of the thigh. 

There are also several VA examinations that evaluate the Veteran's left lower extremity radiculopathy.  The Veteran was afforded a May 2015 VA examination for back conditions, which included an evaluation of radiculopathy.  The examiner found the left lower extremity showed normal strength and reflexes, but a decrease in sensation, mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness.  Id.  The May 2015 examiner opined that the Veteran had mild left lower extremity radiculopathy involving the external cutaneous nerve of the thigh.  Id.  During a January 2021 VA examination for peripheral nerves conditions, the Veteran was found to have normal strength, reflexes, as well as sensation in his lower extremities.  The examiner found the Veteran had mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness.  Id.  The January 2021 VA examiner opined that the Veteran had mild incomplete paralysis of the left lower extremity sciatic nerve and did not provide an opinion about the external cutaneous nerve.  Id.  The January 2021 VA examiner's findings are less probative for the external cutaneous nerve for this reason, but the May 2015 and January 2021 VA examiners' findings, and the May 2015 examiner's opinion, would support no more than a mild incomplete paralysis of the left lower extremity radiculopathy involving the external cutaneous nerve.

A few months later, however, the Veteran was afforded another VA examination for his peripheral nerves.  The Veteran's left lower extremity was found to have mild constant pain, severe intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness.  August 2021 VA Examination for Peripheral Nerves Conditions.  Id.  A sensory exam found a decrease sensation in his upper anterior thigh and thigh/knee.  Id.  The August 2021 VA examiner opined that the Veteran had moderate severe incomplete paralysis of the left lower extremity external cutaneous nerve of the thigh.  Id.

The Board finds each of the VA examiners' findings to be probative as they are medical professionals who had the opportunity to examine the Veteran and provided detailed reports with specific findings relevant to the rating criteria.  But the Board gives more weight to the August 2021 VA examiner's findings and opinion because they specifically address symptoms of his external cutaneous nerve of the thigh. 

Based on the more probative lay and medical evidence, the Board finds that, during the entire period on appeal, the Veteran's left lower extremity radiculopathy involving the external cutaneous nerve of the thigh has manifested with a constant mild and dull pain, and a severe level of pain occurring intermittently and with strenuous activity.  The Veteran also experiences a moderate level of paresthesias and/or dysesthesias, moderate numbness, and a decrease sensation in his thigh.  However, there is sign of trophic changes and the Veteran still has some sensation in his thigh.

The evidence does not show that the Veteran has been diagnosed with neuritis or neuralgia in his left lower extremity.

The Board finds that these symptoms most closely approximate a moderate incomplete paralysis of his left lower extremity external cutaneous nerve of the thigh, and is persuasively against finding severe incomplete paralysis or complete paralysis.  

As discussed above, the Board has considered all other potentially applicable Diagnostic Codes, but the evidence is persuasively against finding that the Veteran has neurological impairment associated with any other peripheral nerves other than those that have already been service connected.  A separate or higher rating under a different Diagnostic Code is not warranted based on the current evidence.  

Accordingly, a compensable rating for left lower extremity radiculopathy involving the external cutaneous nerve of the thigh is not warranted.

10. Entitlement to an initial rating higher than 30 percent for ulcerative colitis.

The Veteran asserts entitlement to an initial rating higher than 30 percent for his ulcerative colitis.  July 2017 NOD.  The Veteran testified that he uses steroids to control his colitis.  December 2022 Hearing Transcript.  He watches his diet and needs to be aware of where bathrooms are located when he leaves his home and may need to leave work meetings due to his symptoms.  Id.   

The Veterans ulcerative colitis is currently evaluated under Diagnostic Code 7323 and rated as 30 percent disabling.  August 2016 Rating Decision.

Under Diagnostic Code 7323, 10 percent rating is warranted for moderate ulcerative colitis with infrequent exacerbations.  A 30 percent rating is warranted for moderately severe ulcerative colitis with frequent exacerbations.  38 C.F.R. § 4.114.  The next higher rating of 60 percent is warranted for severe ulcerative colitis, with numerous attacks a year and malnutrition, and health only fair during remissions.  Id.  A 100 percent rating is warranted for pronounced ulcerative colitis that results in marked malnutrition, anemia, and general debility, or with serious complications as liver abscess.  Id.

The Rating Schedule does not define the words "mild," "moderate," and "severe" as used in the various Diagnostic Codes.  Here, however, the Board finds that severe ulcerative colitis should manifest with at least numerous attacks a year and malnutrition.  See 38 C.F.R. § 4.114, Diagnostic Code 7323.  Likewise, pronounced ulcerative colitis should have marked malnutrition, anemia, and genera debility, or with serious complications.  Id.  Moderately severe ulcerative colitis would, thus, present with symptoms that do not result in malnutrition; and there should be no evidence of resulting anemia, general debility, or serious complications as liver abscess.     

Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue.  Rather than applying a mechanical formula, VA must evaluate all the evidence in arriving at a decision regarding a request for an increased disability rating.  38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6.

After careful and thorough review of the evidence, the Board finds that the Veteran's ulcerative colitis has manifested with symptoms that warrant no more than a 30 percent rating.

An October 2014 colonoscopy referred to the Veteran's colitis as "mild."  October 2014 Service treatment record.  His treatment provider A R, M.D., noted that the Veteran sought treatment for an acute flare-up of his colitis in 2015, which presented as abdominal pain, alternating constipation and diarrhea, and mucus and blood in his stools.  August 2015 Service treatment record.  Dr. A R found no evidence of fever, nausea, or vomiting, and there was no mention of a malnutrition problem.  Id.  Medical treatment evidence shows that the Veteran's ulcerative colitis continued to present as abdominal pain, blood/mucus in stools, and constipation or diarrhea.  See, e.g. October 2015 Service treatment record; November 2015 Service treatment record.  A 2018 exercise and nutrition screen recommended that the Veteran exercise more and eat a healthy diet; there was no mention of malnutrition.  June 2018 VA treatment evidence.  The medical treatment evidence is against finding that the Veteran's ulcerative colitis has manifested with symptoms of malnutrition, anemia, or other symptoms that would warrant a rating higher than 30 percent.

During a May 2015 VA examination for his colitis, the examiner found that the Veteran had frequent episodes of abdominal distress, bloody stools, and bloating.  May 2015 VA Examination for Intestinal Conditions.  The examiner found that the Veteran had 7 or more episodes of exacerbation and/or attacks of the intestinal condition in the past 12 months.  Id.  But the examiner found no evidence of malnutrition or weight loss, and, instead, noted that the Veteran had a 35-pound weight gain.  Id.  The VA examiner is a medical professional qualified to evaluate his ulcerative colitis, who had the opportunity to examine the Veteran and provided a detailed report relevant to the rating criteria.  The Board find the May 2015 VA examiner's findings to be probative and persuasive against finding that the Veteran's ulcerative colitis has manifested with symptoms such as malnutrition, anemia, or only fair health during remissions to warrant a rating higher than 30 percent.

The Board also considered the Veteran's December 2022 hearing testimony about his ulcerative colitis symptoms.  His testimony suggests that he needs to use steroids and diet to control his ulcerative colitis symptoms, and that those symptoms still cause urgent bathroom needs.  However, this does not suggest his ulcerative colitis has also resulted in malnutrition, anemia, or other symptoms to warrant a rating higher than 30 percent.

Based on the lay and medical evidence, the Board finds that the evidence supports that the Veteran's ulcerative colitis has manifested with frequent abdominal pain, diarrhea or constipation, stools with blood and/or mucus, the need for steroids and diet for control.  But the evidence is persuasive against finding that his ulcerative colitis has manifested with symptoms such as malnutrition, only fair health during remissions, anemia, general debility, or with serious complication such as liver abscess.  The Board finds that the Veteran's ulcerative colitis symptoms more closely approximate the criteria for a 30 percent rating.

Accordingly, entitlement to an initial rating higher than 30 percent for ulcerative colitis is not warranted.

11. Entitlement to an initial rating higher than 10 percent for bilateral flat foot.

The Veteran asserts entitlement to an initial rating higher than 10 percent for bilateral flat feet.  August 2016 Rating Decision.  The Veteran testified that he cannot be on his feet for very long or walk for more than one to two hours due to his ankles and feet.  December 2022 Hearing Transcript.  

His bilateral flat feet, or pes planus, is currently evaluated under Diagnostic Code 5276 and rated as 10 percent disabling.  August 2016 Rating Decision.

Under Diagnostic Code 5276, a zero percent rating is assigned for pes planus that is mild, with symptoms relieved by built up shoe or arch.  38 C.F.R. § 4.71a.  A 10 percent rating is assigned for either bilateral or unilateral pes planus where symptoms are moderate, with weight bearing line over or medial to the great toe, inward bowing of the tendo-Achillis, pain on manipulation and use of the feet.  Id.  A 20 percent rating is warranted for unilateral severe pes planus as shown by objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities; with a 30 percent rating for bilateral involvement.  Id.  For pes planus that is pronounced, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo-Achillis on manipulation, not improved by orthopedic shoes or appliances, a 30 percent rating is assigned for unilateral pes planus, while a 50 percent rating is assigned for bilateral pes planus.  Id. 

After careful and through consideration of the evidence, the Board finds that the Veteran's bilateral pes planus more closely approximates the criteria for a 10 percent rating.

The May 2015 VA examination for foot conditions found the Veteran had tenderness on the plantar surfaces of his feet and a decrease in his longitudinal arch height.  But there was no pain on manipulation, characteristic calluses, or marked deformity, or marked pronation.  Id.  The VA examiner is a medical professional qualified to evaluate the Veteran's feet and provided a detailed report with relevant findings to the rating criteria.  The Board finds the May 2015 VA examiner's findings to be highly probative and that it is persuasively against finding that the Veteran's bilateral pes planus warrants more than a 10 percent rating.

In addition, a more recent podiatry treatment also noted that the Veteran's had mild foot pain to the touch, but with normal skin texture, sensation, and strength.  July 2018 VA treatment evidence.  There is no mention of marked deformity or marked pronation of either foot.  See id.  The Board finds the treatment note to be consistent with the May 2015 VA examiner's findings.

The Board considered the Veteran's testimony that he has problems being on his feet or walking for prolonged times.  While the Veteran is competent to report his pain and problems being on his feet, he is not competent to state whether his symptoms warrant a specific rating under the schedule for rating disabilities.  See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed Cir. 2006); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).  His report of pain is considered and found probative.  But his lay statements do not provide the specific findings such as marked deformity, characteristic callosities, marked inward displacement, or severe spasm of the tendo-Achillis on manipulation which would support a rating higher than 10 percent for his flat feet.

Based on the more probative lay and medical evidence, the Board finds that the Veteran's bilateral flat feet has manifested with pain on manipulation and use, and a decreased in his longitudinal arch.  But the evidence is against finding that there is of swelling, characteristic callosities, or marked deformity.  The Board finds the Veteran's bilateral flat feet manifested with symptoms that more closely approximates a 10 percent rating.

Accordingly, entitlement to a rating higher than 10 percent for bilateral flat feet is not warranted. 

12. Entitlement to a compensable initial rating for scars from right flank lipoma removal and left knee surgery.

The Veteran appealed for entitlement to compensable initial ratings for scars from his right flank lipoma removal and left knee surgery.  See July 2017 NOD.

As an initial matter, the Board notes that the criteria for rating skin disabilities, including scars, were amended, effective August 13, 2018.  See 83 Fed. Reg. 32,592 (July 13, 2018).  When a law or regulation changes during the pendency of an appeal, the version most favorable to the Veteran applies, absent congressional intent to the contrary.  See VAOPGCPREC 3-2000, 65 Fed. Reg. 33,422 (May 23, 2000); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003).  The amended rating criteria, if favorable to the claim, can be applied only for periods from the effective date of the regulatory change; however, the old regulations will be considered for the periods both before and after the change was made.  See 38 U.S.C. § 5110(g); 38 C.F.R. § 3.114; VAOPGCPREC 3-2000, 65 Fed. Reg. 33,422 (May 23, 2000); Kuzma, 341 F.3d 1327.  In this case, the changes to the rating criteria for skin disabilities do not affect how the Veteran's scars from his right flank lipoma removal and left knee surgery are evaluated.  For consistency in adjudication through the entire period on appeal, though, the Board will apply the current rating criteria in effect.

His scars from right flank lipoma removal and left knee surgery are currently rated under Diagnostic Code 7805 and rated as noncompensable, or zero percent disabling.  August 2016 Rating Decision.  

The Board notes that Diagnostic Code 7805 applies to any disabling effect(s) not considered in a rating provided under the diagnostic codes from 7800 to 7804.  38 C.F.R. § 4.118.  But the Board has also considered whether the Veteran's right flank lipoma removal and left knee surgery is entitled to a compensable rating under 7800 to 7804 for scars.  

However, after careful and thorough consideration of the evidence, the Board finds that the Veteran's scars from right flank lipoma removal and left knee surgery are noncompensable.

The Veteran was afforded a May 2015 VA examination for scars.  The examiner found the Veteran's right flank scar to be a superficial, non-linear, scar that measured 3 centimeters by 0.5 centimeters, which would be a total area of 1.5 square centimeters in area.  See id.  The Veteran had three linear scars on his left knee that each measured 0.5 centimeters.  Id.  Neither of the scars were noted as painful or unstable.  See id.  The Board finds the VA examiner's finding to be probative as they are provided by a medical professional qualified to evaluate the Veteran's scars and give a detailed assessment of his scars' characteristics. 

In addition, the Board notes that the Veteran has reported having pain with his scars from his left breast mass removal and left shoulder surgery, but has not report pain with his scars from right flank lipoma removal or left knee surgery.  See May 2015 VA Examination for Breast Conditions and Disorders; December 2022 Hearing Transcript.  

The Board finds that the Veteran's right flank and left knee scars are less than 39 square centimeters in area and neither painful nor unstable.

Diagnostic Code 7800 does not apply in this case as the Veteran's right flank and left knee scars are not of his head, face or neck.  38 C.F.R. § 4.118.

Diagnostic Code 7801 can provide a compensable, 10 percent, rating if the Veteran's scars are at least 39 square centimeters.  38 C.F.R. § 4.118.  As discussed above, the Veteran's scars are much less than 39 square centimeters is area.  A compensable rating is not warranted under Diagnostic Code 7801.

Likewise, Diagnostic Code 7802 can provide a compensable rating if the Veteran's scars are at least 929 square centimeters, but his scars are much less than that in total area.  See 38 C.F.R. § 4.118; May 2015 VA Examination for Scars.  A compensable rating is not warranted under Diagnostic Code 7802.

Diagnostic Code 7804 provides a compensable rating for a scar that is unstable or painful.  An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar.  38 C.F.R. § 4.118, Diagnostic Code 7804, Note (1).  There is no lay evidence that his right flank and left knee scars are painful or unstable.  The May 2015 VA examiner specifically found that they are not painful or unstable.  May 2015 VA Examination for Scars.  A compensable rating is, thus, not warranted under Diagnostic Code 7804.  

Finally, the Board considered whether there is evidence of any disabling effects not considered in the ratings provided under diagnostic codes 7800 to 7804 to warrant a compensable rating under Diagnostic Code 7805.  See 38 C.F.R. § 4.118.  As discussed above, the Veteran has not reported any symptoms related to his right flank and left knee scars and the May 2015 VA examiner found no functional impact from his scars.  A compensable rating under 7805 is also not warranted.

The Board finds that the lay and medical evidence is, thus, persuasively against finding that a compensable rating is warranted for the Veteran's scars from right flank lipoma removal and left knee surgery.  

13. Entitlement to an initial 20 percent rating, but no higher, for scars from status post left breast mass removal (claimed as left breast lump) and left shoulder surgery.

The Veteran asserts entitlement to a compensable rating for scars from his status post left breast mass removal and left shoulder surgery.  July 2017 NOD.

The Veteran's scars from status post left breast removal and left shoulder surgery are currently evaluated under Diagnostic Code 7805 and rated as noncompensable, or zero percent disabling.  August 2016 Rating Decision.

As discussed above, the criteria for rating skin disabilities, including scars, were amended, effective August 13, 2018.  See 83 Fed. Reg. 32,592 (July 13, 2018).  But the changes to the rating criteria for skin disabilities do not affect how the Veteran's scar from his status post left breast mass removal is evaluated and, for consistency in adjudication through the entire period on appeal, the Board will apply the current rating criteria in effect.

After careful and thorough review of the evidence, the Board finds that his scars from status post left breast mass removal and left shoulder surgery are more appropriately rated under Diagnostic Code 7804 for scars that are unstable or painful.  

Under Diagnostic Code 7804, a 10 percent rating is warranted for one or two scars that are unstable or painful.  38 C.F.R. § 4.118.  A 20 percent rating is warranted for three or four scars that are unstable or painful, and a 30 percent rating is warranted for five or more scars that are unstable or painful.  Id.  An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (1).   

The Veteran was afforded a May 2015 VA examination for scars in which the examiner found three scars on his left shoulder.  Each scar was considered linear and 1.5 centimeters in length.  Id.  His scar on his left breast was found to be superficial and nonlinear, and measured 3.5 centimeters by 0.5 centimeters.  Id.  The scars were found to be neither painful nor unstable.  Id.  The VA examiner is a medical professional qualified to evaluate the Veteran's scars, who had the opportunity to examine the Veteran.  The Board finds the examiner's findings to be probative for these reasons.

But the Board also considered the Veteran's testimony about having painful scars from his left shoulder surgery and left breast mass removal.  See December 2022 Hearing Transcript.  During his May 2015 VA examination for breast conditions and disorders, the Veteran also reported having a painful scar from his left breast surgery.  A Veteran is competent to report having pain from his scars.  See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).  The Board finds his statements to be probative and that they raise a reasonable doubt as to whether he has painful scars from his left shoulder surgery and left breast mass removal.

In resolving any reasonable doubt in favor of the Veteran, the Board finds that the evidence supports that the Veteran has three painful scars from his left shoulder surgery and one from his left breast mass removal.   Accordingly, entitlement to a 20 percent rating under Diagnostic Code 7804 for four painful scars is warranted.

The Board also considered whether a separate rating is warranted under Diagnostic Codes 7800, 7801, 7082, and 7085.

Diagnostic Code 7800 does not apply because his scars are not of the head, face, or neck.  See 38 C.F.R. § 4.118.

Diagnostic Codes 7801 and 7802 do not provide a compensable rating because the area of his left breast mass removal scar and left shoulder surgery scars are much less than 39 square centimeters in total area.  See 38 C.F.R. § 4.118; May 2015 VA Examination for Scars.

Finally, there is no lay or medical evidence of any other disabling effect from his scar from left breast mass removal or left shoulder surgery that are not considered under Diagnostic Codes 7800 to 7804 to warrant a compensable rating under Diagnostic Code 7805.  See 38 C.F.R. § 4.118.

Accordingly, the Board finds that the Veteran's scars from status post breast mass removal and left shoulder surgery warrant a 20 percent rating, but no higher, under Diagnostic Code 7804 for four painful scars.

14. Entitlement to a compensable initial rating for allergic rhinitis.

The Veteran asserts entitlement to a compensable rating for allergic rhinitis.  July 2017 NOD.  The Veteran testified that he coughs and has nasal congestion more now than he had prior to service.  See December 2022 Hearing Transcript. 

The Veteran's allergic rhinitis is currently evaluated under Diagnostic Code 6522 and rated as noncompensable, or zero percent disabling.  August 2016 Rating Decision.

Under Diagnostic Code 6522, a 10 percent rating is warranted for allergic or vasomotor rhinitis that manifests without polyps, but with greater than 50 percent obstruction of nasal passage on both sides or compete obstruction on one side.  38 C.F.R. § 4.97.  A 30 percent rating is warranted if it manifests with polyps.  Id.  

The Veteran was afforded a May 2015 VA examination for his allergic rhinitis in which the examiner found the Veteran needed continuous medication to control his symptoms, but that there was not 50 percent or more obstruction of the nasal passage on both sides, complete obstruction on one side, nor evidence of nasal polyps.  May 2015 VA Examination for Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx and Pharynx.  The VA examiner is a medical professional qualified to evaluate the Veteran's allergic rhinitis, who had the opportunity to examine the Veteran, and provided a detailed report with findings relevant to the rating criteria.  The Board finds the VA examiner's findings to be highly probative for these reasons.

The Board considered the Veteran's testimony about his nasal conditions.  While the Veteran is competent to report symptoms such as having nasal congestion, he is not competent to state whether his symptoms warrant a specific rating under the schedule for rating disabilities.  See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed Cir. 2006); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).  For example, while the Board does not doubt that the Veteran has nasal congestion, his statements do not address whether there is more than 50 percent nasal obstruction or if there are nasal polyps as described in the rating criteria for Diagnostic Code 6522.  His statements are not probative for this reason.

The Board, thus, finds that the Veteran allergic rhinitis has manifested with nasal congestion, but that the evidence is persuasively against finding that he has had more than 50 percent obstruction of the nasal passage on both sides, complete obstruction on one side, or that there are nasal polyps.

Accordingly, a compensable rating for allergic rhinitis is not warranted.   

15. Entitlement to an initial rating higher than 10 percent for asthma (claimed as a respiratory condition).

The Veteran asserts entitlement to an initial rating higher than 10 percent for asthma.  July 2017 NOD.  The Veteran testified to having nasal congestion and more coughing than he has had prior to service.  December 2022 Hearing Transcript.

The Veteran's asthma is currently evaluated under Diagnostic Code 6602 and rated as 10 percent disabling.  August 2016 Rating Decision.

Under Diagnostic Code 6602, a 10 percent rating is warranted for asthma that manifests with FEV 1 of 71 to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; intermittent inhalational or oral bronchodilator therapy.  38 C.F.R. § 4.97.  The next higher rating of 30 percent is warranted for FEV-1 of 56 to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; daily inhalational or oral bronchodilator therapy, or; inhalational anti inflammatory medication.  Id.

Pulmonary function tests (PFT's) are required to evaluate asthma except when: (i) the results of a maximum exercise capacity test are of record and are 20 ml/kg/min or less; (ii) pulmonary hypertension (documented by an echocardiogram or cardiac catheterization), cor pulmonale, or right ventricular hypertrophy has been diagnosed; (iii) there have been one or more episodes of acute respiratory failure; or (iv) when outpatient oxygen therapy is required.  38 C.F.R. § 4.96(d)(1).

When PFT's are not consistent with clinical findings, the evaluation will be based on PFT's unless the examiner states why they are not a valid indication of respiratory functional impairment in a particular case.  38 C.F.R. § 4.96(d)(3).

Post-bronchodilator studies are required when PFT's are done for disability evaluation purposes except when the results of pre-bronchodilator pulmonary function tests are normal or when the examiner determines that post-bronchodilator studies should not be done and states why.  38 C.F.R. § 4.96(d)(4).  When evaluating based on PFT's, post-bronchodilator results are used in applying the evaluation criteria in the rating schedule unless the post-bronchodilator results were poorer than the pre-bronchodilator results; in which case the pre bronchodilator values are used for rating purposes.  38 C.F.R. § 4.96(d)(5).

When there is a disparity between the results of different PFT's (FEV-1 (Forced Expiratory Volume in one second), FVC (Forced Vital Capacity), etc.), so that the level of evaluation would differ depending on which test result is used, the test result that the examiner states most accurately reflects the level of disability will be used.  38 C.F.R. § 4.96(d)(6).

If the FEV-1 and the FVC are both greater than 100 percent, a compensable evaluation will not be assigned based on a decreased FEV-1/FVC ratio.  38 C.F.R. § 4.96(d)(7).

After careful and thorough review of the evidence, the Board finds that the Veteran's asthma most closely approximates the criteria for a 10 percent rating.

The Veteran was afforded a May 2015 VA examination for respiratory conditions in which the examiner found the Veteran used intermittent inhalational bronchodilator therapy for his asthma.  His PFT results showed an FEV-1 of 82-percent predicted and a FEV-1/FVC of 88 percent.  Id.  The VA examiner is a medical professional qualified evaluate the Veteran's asthma and provided detailed findings relevant to the rating criteria.  The VA examiner's findings are probative for these reasons and are persuasive against finding a rating higher than 10 percent is warranted for the Veteran's asthma.

The Board considered the Veteran's testimony about his having a cough and nasal congestion.  While the Veteran is competent to report symptoms such symptoms, he is not competent to state whether his symptoms warrant a specific rating under the schedule for rating disabilities.  See Buchanan 451 F.3d at 1337; Jandreau, 492 F.3d at 1376-77.  While the Board does not doubt that the Veteran has a cough and nasal congestion, his statements do not address if he needs more than intermittent use of inhalational or oral bronchodilator therapy, nor provide the PFT results necessary under the rating criteria.  His statements are not probative for these reasons.

Based on the probative evidence of record, the Board finds that the Veteran's asthma has manifested with the need for intermittent use of inhalational or oral bronchodilator therapy, but the evidence is persuasively against finding that he has an FEV-1 70-percent predicted or less, or; FEV-1/FVC of 70 percent or less, or; uses daily inhalational or oral bronchodilator therapy, or; uses inhalational anti inflammatory medication for his asthma. 

Accordingly, entitlement to a rating higher than 10 percent for asthma is not warranted. 

16. Entitlement to an initial 10 percent rating, but no higher, for pseudofolliculitis with seborrheic keratosis is granted. 

The Veteran asserts entitlement to a compensable rating for pseudofolliculitis with seborrheic keratosis.  July 2017 NOD.  The Veteran testified that he develops ingrown hairs that are filled with puss when he shaves under his neck and chin due ot his pseudofolliculitis.  December 2022 Hearing Transcript.

The Board notes that the criteria for rating skin disabilities were amended, effective August 13, 2018.  See 83 Fed. Reg. 32,592 (July 13, 2018).  But the amendments made no relevant changes to the criteria under Diagnostic Code 7828 nor change how the Veteran's pseudofolliculitis with seborrheic keratosis would be evaluated.  See id.  For consistency in adjudication through the entire period on appeal, the Board will apply the current rating criteria in effect.  

The Veteran's pseudofolliculitis with seborrheic keratosis is currently evaluated under Diagnostic Code 7828 and rated as noncompensable, or zero percent disabling.  August 2016 Rating Decision.

Under Diagnostic Code 7828, superficial acne (comedones, papules, pustules, superficial cysts) of any extent are noncompensable.  38 C.F.R. § 4.118.  A 10 percent rating is warranted for deep ance (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck, or for deep ance other than on the face and neck.  Id.  A 30 percent rating is warranted for deep acne (deep inflamed nodules and pus-filled cysts) affecting 40 percent or more of the face and neck.  Id. 

After careful and thorough review of the evidence, the Board finds that the Veteran's pseudofolliculitis with seborrheic keratosis more closely approximates the criteria for a 10 percent rating.

The Board considered the Veteran's testimony that he keeps a beard because his pseudofolliculitis causes red bumps filled with puss on his neck if he shaves.  December 2022 Hearing Transcript.  The Veteran did not testify to any symptoms from his seborrheic keratosis.  See id.  The Board finds the Veteran's testimony to be probative as he is competent to observed and report these skin symptoms.  See Buchanan 451 F.3d at 1337; Jandreau, 492 F.3d at 1376-77.

A May 2010 service treatment record noted that the Veteran had a small follicular like papule with some mild tenderness on his neck.  It was not infected at the time.  Id.  The Veteran was also noted to have a small cyst that was diagnosed as seborrheic keratosis, which was treated.  Id.

The Veteran was afforded a May 2015 VA examination for skin conditions in which the examiner found the Veteran was diagnosed with pseudofolliculitis on his neck and seborrheic keratosis on his shoulders and arms.  The examiner found that his pseudofolliculitis affected less than 5 percent of his neck and the seborrheic keratosis is less than 5 percent of his total body area.  Id.  The examiner found no evidence of an acne condition during the examination and did not opine on the severity of the Veteran's pseudofolliculitis when he has ingrown hairs.  The Board finds the VA examiner's opinion about the area that would be affected by his pseudofolliculitis and seborrheic keratosis to be probative because he is a medical professional qualified to evaluate the Veteran's skin conditions.  But the examiner did not discuss the severity of the Veteran's pseudofolliculitis symptoms after he shaves.

Based on the lay and medical evidence, and resolving any reasonable doubt in favor of the Veteran, the Board finds that the Veteran's pseudofolliculitis manifests after shaving with deep inflamed nodules that are filled with puss and affects less than 5 percent of his neck.  The evidence is, however, against finding that his pseudofolliculitis with seborrheic keratosis manifests with symptoms that affect 40 percent or more of his neck or face.

The Board also considered if his pseudofolliculitis manifests with disfigurement or scars that may be rated under Diagnostic Codes 7800 to 7805.  The medical evidence does not indicate that there are disfigurements or scars on head, face, or neck, or other parts of his body resulting from his pseudofolliculitis with seborrheic keratosis.  See May 2015 VA Examination for Skin Conditions.  The Veteran's testified that he avoids shaving if possible and that the ingrown hairs are unsightly if they develop, but he did not indicate that they were scars or skin issues other than the puss-filled bumps considered under Diagnostic Code 7828.

Accordingly, the Board finds that a 10 percent rating, but no higher, is warranted for the Veteran's pseudofolliculitis with seborrheic keratosis.

17. Entitlement to a compensable initial rating for hemorrhoids with proctitis is denied.

The Veteran asserts entitlement to a compensable rating for his hemorrhoids with proctitis.  July 2017 NOD.  He testified having flare-ups of his hemorrhoids a few times a year, with symptoms of pain and bleeding.  December 2022 Hearing Transcript.  He would, at times, need to keep an extra pair of underwear with him due to the amount of bleeding.  Id.

His hemorrhoids with proctitis are currently evaluated under Diagnostic Code 7336 and rated as noncompensable, or zero percent disabling.  August 2016 Rating Decision.  

Under Diagnostic Code 7336, mild or moderate hemorrhoids are rated as zero percent disabling.  38 C.F.R. § 4.114.  A 10 percent rating is warranted for large or thrombotic hemorrhoids, irreducible, with excessive redundant tissue, evidencing frequent recurrences.  Id.  A 20 percent rating is warranted for hemorrhoids with persistent bleeding and with secondary anemia, or with fissures.  Id.

The rating schedule does not define the terms "mild" or "moderate" as used in Diagnostic Code 7336.  See 38 C.F.R. § pt. 4.  But the Board finds that mild or moderate hemorrhoids present with less symptoms than what would warrant a compensable rating.  In other words, mild or moderate hemorrhoids would not be large, thrombotic, or irreducible.  There would also not be excessive redundant tissues evidencing frequent recurrences.

After careful and thorough review of the evidence, the Board finds that the Veteran's hemorrhoids with proctitis most closely approximates a zero percent rating.  

The Board considered the Veteran's testimony about having flare-ups a few times as year with bleeding and pain.  While the Board does not doubt that the Veteran's hemorrhoids cause bleeding and pain, he is not competent to state whether his symptoms warrant a specific rating under the schedule for rating disabilities.  See Buchanan, 451 F.3d at 1337; Jandreau, 492 F.3d at 1376-77.  For example, a compensable rating for hemorrhoids would require evidence such as the hemorrhoid's size, whether it is reducible, if there is excessive redundant tissue, and whether the bleeding causes anemia.  See 38 C.F.R. § 4.114, Diagnostic Code 7336.  His report of pain and bleeding have some, but limited, probative value in evaluating his hemorrhoids under the rating criteria.

An October 2014 service treatment record shows that the Veteran was treated for hemorrhoids.  His treatment providers performed a coloscopy that showed a hemorrhoid and a skin tag, but no evidence of fissure or other abnormal findings.  While this evidence shows that there is no evidence of fissures, it does not describe the size or severity of the Veteran's hemorrhoid nor indicate whether the skin tag is considered excessive redundant tissues evidencing frequent recurrences of hemorrhoids. 

The Veteran was also afforded a May 2015 VA examination for Rectum and Anus Conditions.  The VA examiner examined the Veteran and found no evidence of external hemorrhoids, anal fissures, or other abnormalities.  Id.  This includes no evidence of large, thrombotic, or irreducible hemorrhoid, nor excessive redundant tissue.  See id.  The examiner opined that the Veteran had mild to moderate hemorrhoids that present with constant rectal swelling, bleeding, pain, and itching.  Id.  The Board finds the May 2015 VA examiner's examination findings and opinion to be probative because they are from a medical professional qualified to assess hemorrhoids, who had the opportunity to examine the Veteran.

There is no evidence that the Veteran has experience anemia due to his hemorrhoids.    

Based on the lay and medical evidence, the Board finds that the Veteran's has hemorrhoids that occur a few times a year with pain and bleeding, but that they are not large, thrombotic, or irreducible, and that there is not excessive redundant tissue evidencing frequent recurrences.  There is also no fissures or evidence of bleeding causing anemia.  The Board finds that the Veteran's hemorrhoid symptoms more closely approximate the criteria for a zero percent rating.

Accordingly, entitlement to a compensable rating for hemorrhoids with proctitis is not warranted.  

18. Entitlement to an initial 10 percent rating, but no higher, for Bell's palsy is granted.

The Veteran asserts entitlement to a compensable initial rating for Bell's palsy.  July 2017 NOD.  

The Veteran's Bell's palsy is currently evaluated under Diagnostic Code 8207 and rated as noncompensable, or zero percent disabling.  August 2016 Rating Decision.

Under Diagnostic Code 8207, a 10 percent rating is warranted for moderate incomplete paralysis of the seventh (facial) cranial nerve.  38 C.F.R. § 4.124a.  A 20 percent rating is warranted for severe incomplete paralysis and a 30 percent rating is warranted for complete paralysis of the seventh cranial nerve.  Id.  

Disability in this field is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function.  38 C.F.R. § 4.120.  Consideration is especially given to psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc.  Id.  The site and character of the injury, the relative impairment in motor function, trophic changes, or sensory disturbances are also considered.  Id.

The ratings for the cranial nerves are for unilateral involvement; bilateral conditions are combined as a disability without the bilateral factor.  See 38 C.F.R. § 4.124a, Diseases of the Cranial Nerves.  

The Rating Schedule does not define the words "mild," "moderate," and "severe" as used in the various Diagnostic Codes.  The Board turns to a dictionary to define these terms.  In this regard, mild is generally defined as "not severe." MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 787 (11th ed. 2003).  Moderate is defined as "tending toward the mean or average amount."  Id. at 798.  Severe is usually defined as "a great degree" or "serious."  Id. at 1140.

The VA Adjudication Procedure Manual (M21-1) includes definitions of the terms mild, moderate, and severe as used for incomplete paralysis and 38 C.F.R. § 4.124a.  There Board is not bound by the M21-1 provisions and, moreover, those provisions are for the peripheral nerves while the Veteran's Bell's palsy involves a cranial nerve.  See May 2015 VA Examination for Cranial Nerves Conditions.  Still, the Board considered the definitions as general guidelines for the purposes of this appeal and incorporates some of the examples of incomplete paralysis into the definitions of mild, moderate, and severe below.

For the purposes of this appeal, the Board defines mild incomplete paralysis as manifesting with sensory deficits that are lower graded, less persistent, or effecting a small area.  The symptoms are recurrent, but not continuous.  It is not severe and less than the average, meaning that the symptoms will be at least enough to establish a diagnosis, but not cause functional limitations.

Moderate incomplete paralysis will be considered to include sensory-only symptoms that affect a larger area and likely described by claimants, and medically graded, as severe.  It may also include lower level sensory deficits with a combinations of reflex (if appropriate for the nerve) or motor changes of a lower degree such as muscle weakness and diminished or hyperactive reflexes.

A severe incomplete paralysis should be expected to manifest with motor or reflex impairment (if appropriate for the nerve) at a very high level of limitation or disability in signs or symptoms such as atrophy, weakness, or diminished or hyperactive reflexes.  Some of the symptoms should be medically graded as severe or considered to have greater degree of symptoms than the average person with this type of condition.  Trophic changes may be seen in severe longstanding neuropathy.  The signs and symptoms should be less than findings for complete paralysis, but there should be some resembling those of complete paralysis.

Rather than applying a mechanical formula, VA must evaluate all evidence to ensure that decisions will be equitable and just.  38 C.F.R. § 4.6.  Regulations provide that ratings for peripheral neurological disorders are assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance.  38 C.F.R. § 4.120.  Consideration is also given for loss of reflexes, pain, and muscle atrophy.  See 38 C.F.R. §§ 4.123, 4.124.  

The use of descriptive terminology such as "severe" by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue.  See 38 C.F.R. § 4.2.  Instead, adjudicators must evaluate all of the evidence and render a decision that is "equitable and just."  38 U.S.C. § 7104(a); 38 C.F.R. § 4.6.

After careful and thorough consideration of the evidence, the Board finds that the Veteran's Bell's palsy has manifested with moderate incomplete paralysis of the seventh cranial nerve.

Medical treatment evidence shows that the Veteran was treated in 2006 for a complaint that "his face just stopped working..."  August 2006 Service treatment record.  His treatment provider noted mild ptosis and right face droop.  Id.  Testing showed loss of innervation in his upper and lower face on the right side, and the Veteran was diagnosed with Bell's palsy.  Id.  The Veteran also reported having right ear pain, but the treatment note indicates it existed prior to and separately from his facial paralysis.  See id.

The Veteran was afforded a May 2015 VA examination for cranial nerves diseases.  The examiner found mild muscle strength loss in the right cranial nerve VII that affects the muscles of facial expression, but no evidence of pain, paresthesias and/or dysesthesias, or numbness attributable to his Bell's palsy.  Id.  The examiner opined that the Veteran had moderate incomplete paralysis of the cranial nerve VII.  Id.  

There is no evidence of neuritis or neuralgia associated with his Bell's palsy.

The Veteran has not reported or testified to any other symptoms than those reported to his 2006 treatment provider and the May 2015 VA examiner.

The medical treatment evidence and the May 2015 VA examiner's findings are probative as it is provided by medical professionals qualified to evaluate the Veteran's cranial nerves and function.  The evidence shows that the Veteran's Bell's palsy results in facial muscle weakness significant enough to cause a noticeable droop.  However, there is no evidence of pain, numbness, or more than mild muscle strength loss.  May 2015 VA Examination for Cranial Nerves Diseases.  There is also no evidence of muscle atrophy or trophic changes.  Id.  The Veteran also indicated that he is still able to smile, just that "his smile wasn't the same."   August 2006 Service treatment record.

The Board finds the loss of motor function to more closely approximate moderate incomplete paralysis of the seventh cranial nerve.

The Board has considered all other potentially applicable Diagnostic Codes, but the evidence is persuasively against finding that the Veteran has neurological impairment associated with any other cranial nerve.  A separate or higher rating under a different Diagnostic Code is not warranted based on the current evidence.

Accordingly, entitlement to a 10 percent rating, but no higher, is warranted for the Veteran's Bell's palsy. 

REASONS FOR REMAND

1. Issue of entitlement to service connection for a left elbow condition is remanded.

2. Issue of entitlement to service connection for a left hand or wrist condition is remanded.

The Board cannot make a fully informed decision on the issue of entitlement to service connection for a left elbow, hand, or wrist condition because further development through a VA examiner is needed.

The May 2015 VA examiner noted that the Veteran's left elbow, hand, and wrist conditions were due to a motor vehicle accident that was not considered in the line of duty and thus not incurred in or caused by service.  See May 2015 VA Examination for Wrist Conditions; May 2015 VA Examination for Elbow and Forearm Conditions.

However, the Veteran testified that he had hand, wrist, and elbow problems separate from those caused by his 2013 motor vehicle accident.  December 2022 Hearing Transcript.  He testified that he believes his conditions were due to carry his gear and using heavy weapons, including recoil from 50-caliber weapons.  Id.  A December 2012 Post-Deployment Health Assessment indicates that the Veteran did report combat specialty as an aerial gunner and having exposure to excessive vibration.

The Board finds that an opinion from a VA examiner is needed as to whether the Veteran has current left elbow, hand, or wrist disabilities that are due to service, to include carrying gear and using heavy weapons.      

3. Issue of entitlement to service connection for a right wrist or hand condition is remanded.

The Board cannot make fully informed decision on the issue of entitlement to service connection for a right wrist or hand condition because clarification is needed from a VA examiner.

The May 2015 VA examiner found no diagnosis to establish a current disability for the Veteran's reported right hand pain and weakness.  May 2015 VA Examination for Wrist Conditions.  However, the service treatment records shows that the Veteran has reported a sudden onset of right wrist pain that radiated up into forearm, albeit it x-ray evidence at the time was unremarkable.  August 2012 Service treatment record.  It is unclear how the May 2015 VA examiner considered the Veteran's report of a current right wrist condition and if his opinion that the Veteran is limited to "no heavy lifting" is due to his left wrist, right wrist, or both.  See May 2015 VA Examination for Wrist Conditions.  

An opinion from the VA examiner is needed.

4. Issue of entitlement to service connection for TBI is remanded.

5. Issue of entitlement to service connection for migraines (claimed as post traumatic headaches) is remanded.

The Board cannot make a fully informed decision on the issue of entitlement to service connection for TBI and migraines because further development is needed.

The Veteran testified to being in a convoy on four occasions in 2007 where he was near an explosion and one occasion in which he was blown back in his gunner turret.  December 2022 Hearing Transcript.  He also reported being near two rocket attacks.  Id.

The Board notes that during his evaluation for TBI, the Veteran also reported that he was exposed to more than 3 blasts, the first occurring in 2007 and the second in 2008.  May 2015 VA Examination Initial Evaluation of Residuals of TBI.  Three of the blasts were reported as severe enough to knock him down or cause injury.  But the examiner did not consider his reported exposures to blasts because it was not documented in the medical evidence.  See id.

The Board finds that an attempt to verify the circumstances and severity of the Veteran's reported exposures to the explosions and an addendum opinion from a VA examiner is needed.

6. Issue of entitlement to service connection for sinusitis is remanded.

The Board cannot make a fully informed decision on the issue of entitlement to service connection for sinusitis because further development through a VA examiner is needed.

The May 2015 VA examiner found no diagnosis for sinusitis, only allergic rhinitis, because current imaging evidence showed normal sinuses.  See May 2015 VA Examination for Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx.  The examiner found the Veteran did not have chronic sinusitis, but indicated that he had seven or more non-incapacitating episodes of sinusitis in the last 12 months.  Id.  The medical treatment evidence notes sinusitis as an active problem for most of 2015.  See, e.g., December 2015 Service treatment record.  The Board finds that it is unclear why the Veteran's is not considered to have chronic sinusitis.

An opinion from a VA examiner is needed as to whether the Veteran has a current disability of sinusitis.  

7. Issue of entitlement to an initial rating higher than 10 percent for right ankle tendonitis is remanded.

8. Issue of entitlement to an initial rating higher than 10 percent for left ankle tendonitis is remanded.

The Board cannot make a fully informed decision on the issue of entitlement to initial ratings higher than 10 percent for right and left ankle tendonitis because further development is needed.

The May 2015 VA examiantion for ankle conditions does not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016).  The examinations do not contain passive range of motion measurements or pain on weight-bearing testing.

The Veteran should be afforded another opportunity for a VA examination for his right ankle.

9. Issue of entitlement to an initial rating higher than 20 percent for status post left shoulder surgery with shoulder strain is remanded.

The Board cannot make a fully informed decision on the issue of entitlement to an initial rating higher than 20 percent for status post left shoulder surgery because further development is needed.

The May 2015 VA examiantion for shoulder and arm conditions does not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016).  The examinations do not contain passive range of motion measurements or pain on weight-bearing testing.

The Veteran should be afforded another opportunity for a VA examination for his left shoulder.

10. Issue of entitlement to an initial rating higher than 10 percent for lumbar spine strain with IVDS (claimed as back condition) is remanded.

The Board cannot make a fully informed decision on the issue of entitlement to an initial rating higher than 10 percent for lumbar spine strain with IVDS because further development is needed.

The May 2015 VA examination for back conditions does not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016).  The examinations do not contain passive range of motion measurements or pain on weight-bearing testing.

The Veteran should be afforded another opportunity for a VA examination for his lumbar spine.

11. Issue of entitlement to an initial rating higher than 10 percent for right knee patellofemoral pain syndrome is remanded.

12. Issue of entitlement to an initial rating higher than 10 percent for status post left knee surgery is remanded.

The Board cannot make a fully informed decision on the issue of entitlement to initial ratings higher than 10 percent for right knee patellofemoral pain syndrome and status post left knee surgery because further development is needed.

The May 2015 VA examination for knee and lower leg conditions does not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016).  The examinations do not contain passive range of motion measurements or pain on weight-bearing testing.

In addition, the May 2015 VA examiner found the Veteran reported flare-ups with his left knee, but not his right knee.  May 2015 VA Examination for Knee and Lower Leg Conditions.  The examination report indicates that the Veteran reported flare-ups resulting in "limited running and exercise" and to functional loss that "limited running, weakness, and bending of the knees."  Id.  It is unclear what the VA examiner's finding that the Veteran only has flare-ups in his left knee is based on.  

The Veteran should be afforded another VA examination for his knees.

13. Issue of entitlement to an initial rating higher than 10 percent for cervical spine strain with IVDS is remanded.

The Board cannot make a fully informed decision on the issue of entitlement to an initial rating higher than 10 percent for cervical spine because further development is needed.

The May 2015 VA examination for neck conditions does not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016).  The examinations do not contain passive range of motion measurements or pain on weight-bearing testing.

The Veteran should be afforded another opportunity for a VA examination for his cervical spine.

14. Issue of entitlement to an initial rating higher than 20 percent for left upper extremity radiculopathy is remanded.

15. Issue of entitlement to an initial rating higher than 20 percent for right upper extremity radiculopathy is remanded.

The Board cannot make a fully informed decision on the issue of entitlement to initial ratings higher than 20 percent for the Veteran's left and right upper extremity radiculopathy because further development through a VA examination is needed.

A May 2015 VA examination for neck conditions in which the examiner found the Veteran had bilateral intermittent pain his upper extremities.  The examiner also found his left upper extremity to have decreased sensation, and mild paresthesias/dysesthesias, and mild numbness.  Id.  The May 2015 examiner opined that the Veteran had mild radiculopathy in his bilateral upper extremities.  Id.

However, during the August 2021 VA examination for peripheral nerves conditions, the examiner found no evidence of no evidence of any upper extremity radiculopathy symptoms.  This includes findings of normal sensation and no pain.  Id.

The Board finds that the Veteran should be afforded another VA examination to clarify the severity of his upper extremity radiculopathy symptoms during the entire period on appeal.

The matters are REMANDED for the following action:

1. Ask the Veteran to identify the provider(s) of any evaluations and/or treatment received for his upper extremity radiculopathy, ankles, shoulders, back, neck, knees, and left shoulder.  The Veteran should be asked to provide authorizations for VA to obtain records of any such private treatment.  Conduct all appropriate development for any records identified.

2. Attempt to develop the Veteran's reported exposure to IED and rocket explosions.  If the regional office (RO) finds it is necessary, they may ask for Veteran for further details and submit a request to the Joint Services Records Research Center.  All steps taken to develop the evidence must be documented in the claims and, if corroboration is not possible, then this should be documented in the claims file as well.

3. After the above development is completed, schedule the Veteran for VA examination(s) to determine the nature and cause of his TBI and migraines.  The examiner should answer the following:

(a) Did the Veteran's TBI and/or migraines begin in (or is otherwise related to) the Veteran's military service?  

The medical professional should consider and discuss the Veteran's November 2013 motor vehicle accident (MVA) during service, which is not considered in the line of duty.  If the examiner finds that his current TBI or migraines are due only to his MVA injuries, the examiner should discuss this and give rationale as to why.  The Board notes that a TBI or migraine condition resulting only from injuries from his MVA may not be considered for service connection under a theory of aggravation.

The examiner should consider and discuss the Veteran's lay testimony and assertions regarding any pertinent complaints and symptoms.  For the purposes of obtaining a medical opinion only, take the Veteran's statements about his exposure to explosions in 2007 and 2008 from IEDs and rockets as true.  The Board notes that a TBI or migraine condition found to exist prior to his November 2013 MVA may be considered for service connection and a medical nexus opinion to any current TBI or migraine condition should be provided. 

A detailed explanation (rationale) is requested.

4. Obtain addendum opinions to determine the nature and cause of the Veteran's left elbow, hand, and wrist conditions.  If the medical professional determines that it is necessary, schedule the Veteran for another VA examination.  The medical professional should respond to the following:

(a) Identify all of the Veteran's current left elbow, hand, and wrist conditions.  

(b) The medical professional should consider and discuss the Veteran's November 2013 motor vehicle accident (MVA) during service, which is not considered in the line of duty.  The conditions only resulting from the injuries from the MVA are, thus, not to be considered for an opinion about medical nexus.  The conditions resulting only from injuries from his MVA may also not be considered for an opinion about aggravation by service.  

In other words, the medical professional should identify the current left elbow, hand, and wrist conditions that, in the medical professional's opinion, is separate from those due only to injuries from his November 2013 MVA.  This includes any current left elbow, hand, or wrist condition that the medical professional finds existed prior to the November 2013 MVA (even if the condition was later worsened by the MVA).

(b) For each identified current condition that is found separate from his November 2013 MVA injuries, did it begin in (or is it otherwise related to) the Veteran's service?  The medical professional should consider and discuss the Veteran's lay testimony and assertions regarding any pertinent complaints and symptoms.  This includes the Veteran's December 2022 hearing testimony that he believes he had left elbow, hand, and wrist conditions prior to the November 2013 MVA due to carrying gear and using heavy weapons, including recoil from 50 caliber weapons.

If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted.  Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible?

A detailed explanation (rationale) is requested.

5. Obtain an addendum opinion from an appropriate medical professional to determine the nature and cause of any current right hand condition.  If the medical professional determines that it is necessary, schedule the Veteran for another VA examination.  The medical professional should respond to the following:

(a) Identify any current right hand condition.  If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion below.

(b) For each identified current right hand condition, did it begin in (or is it otherwise related to) the Veteran's service?

A detailed explanation (rationale) is requested.

6. Obtain an addendum opinion to determine the nature and cause of any current sinusitis condition.  If the medical professional determines that it is necessary, schedule the Veteran for a VA examination.  The medical professional should respond to the following:

(a) Does the Veteran have, or did he have, a disability of sinusitis during the period on appeal?  The medical professional should consider and discuss the May 2015 VA examination for sinusitis, rhinitis, and other conditions of the nose, throat, larynx, and pharynx that indicates the Veteran had seven non-incapacitating episodes of sinusitis in the past 12 months and 2015 VA treatment records noting sinusitis as an active problem.  Does this evidence support a current sinusitis disability?

(b) If sinusitis is found as a current disability, did it begin in (or is it otherwise related to) the Veteran's service?  

A detailed explanation (rationale) is requested.

7. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected right and left ankle tendonitis.  The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.  

8. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected status post left shoulder surgery with shoulder strain.  The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.  

9. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected lumbar spine strain with IVDS.  

10. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected right knee patellofemoral pain syndrome and status post left knee surgery.  

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11. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected cervical spine strain with IVDS.    

12. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left and right upper extremity radiculopathy.

 

R. FEINBERG

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Lin, M

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.