Citation Nr: 23037862 Decision Date: 07/08/23 Archive Date: 07/08/23 DOCKET NO. 18-49 032 DATE: July 8, 2023 ORDER Entitlement to service connection for an acquired psychiatric disorder is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to a disability rating in excess of 30 percent for bilateral pes planus is denied. Entitlement to a separate disability rating for hallux valgus, associated with bilateral pes planus, is granted. Entitlement to a separate disability rating for metatarsalgia, associated with bilateral pes planus, is granted. REMANDED Entitlement to an initial disability rating for hallux valgus, associated with bilateral pes planus, is remanded. Entitlement to an initial disability rating for metatarsalgia, associated with bilateral pes planus, is remanded. FINDINGS OF FACT 1. The evidence of record does not show that the Veteran is currently diagnosed with an acquired psychiatric disorder. 2. The evidence of record does not show that the Veteran's currently diagnosed bilateral hearing loss is related to service. 3. The evidence of record does not show that the Veteran's bilateral pes planus manifested with extreme tenderness of plantar surfaces of the feet and marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 4. The persuasive evidence of record shows that the Veteran's bilateral pes planus manifests with bilateral hallux valgus. 5. The evidence is in approximate balance as to whether the Veteran's bilateral pes planus manifests with metatarsalgia. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for a disability rating in excess of 30 percent for bilateral pes planus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5276 (2020), Diagnostic Code 5279 (2021). 4. The criteria for entitlement to a separate disability rating for hallux valgus, associated with bilateral pes planus, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, § 4.172, Diagnostic Code 5280; DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011). 5. The criteria for entitlement to a separate disability rating metatarsalgia, associated with bilateral pes planus, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, § 4.172, Diagnostic Code 5279; DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Navy from September 1980 to September 1984. These matters come before the Board of Veterans' Appeals (Board) on appeal from January and June 2017 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2022, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing has been associated with the claims file. In May 2022, the Board remanded these claims for further development, to include for the RO to obtain new VA examinations and opinions. The Board is satisfied that the directives of the May 2022 Board remand have been satisfactorily complied with. Stegall v. West, 11 Vet. App. 268 (1998). The Board notes that beginning July 30, 2015, the RO awarded the maximum schedular disability rating of 100 percent for service-connected coronary artery disease; and beginning February 21, 2017, the RO awarded the maximum schedular disability rating of 100 percent for service-connected lung disease with sleep apnea. The RO also awarded special monthly compensation (SMC) based a single disability rated at 100 percent with additional service-connected disabilities independently rated at 60 percent or more beginning July 30, 2015. Therefore, the claim for TDIU during the appeal period is moot. See Bradley v. Peake, 22 Vet. App. 280 (2008); Buie v. Shinseki, 24 Vet. App. 242 (2010). Service Connection A veteran is entitled to VA disability compensation if there is a current disability resulting from a personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. § 1131. Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). The Board has thoroughly reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the evidence submitted. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 1. Entitlement to service connection for an acquired psychiatric disorder is denied. During his January 2022 Board hearing, the Veteran testified that he believed he had developed symptoms of depression and anxiety as a result of his service-connected disabilities. Specifically, he believed that the limitations caused by his feet disabilities resulted in his development of a psychiatric disability, although he had not sought treatment for/been diagnosed with a psychiatric disability at the time of the examination. Following a review of the record and applicable legal criteria, the Board finds that entitlement to service connection is not warranted as the first element of service connection, that of a current diagnosis, has not been met. In October 2022, the Veteran was provided a VA examination. The Veteran denied experiencing mental health symptoms, hospitalizations, and suicide attempts. He reported that he was not seeking service connection for an acquired psychiatric disorder, rather his counsel had initiated the claim. Following a review of the record and based on the Veteran's statements, the examiner found that the Veteran is not currently diagnosed with a mental health condition. The October 2022 VA opinion is persuasive. The Board finds no adequate basis to reject the findings, based on a lack of credibility or probative value. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997); Evans v. West, 12 Vet. App. 22, 26 (1998). Rather, a review of the record also reflects no diagnosis of a mental health condition. Moreover, the Veteran testified that he does not receive treatment for a mental health condition. Based on the foregoing, the Board finds that a current acquired psychiatric disorder has not been shown and that the first element of service connection has not been met. In reaching this determination, the Board acknowledges the Veteran's contentions, to include his statements in his January 2022 Board hearing. The Board also notes that lay evidence is competent to report on matters that are capable of ordinary observation. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, the ability to diagnose mental health symptoms and relate them to service requires complex medical knowledge that the Veteran has not been shown to possess. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). As such, the Board finds the statements of medical personnel as to whether the Veteran is currently diagnosed with a mental health disability, which incorporate the Veteran's lay statements and examinations of the Veteran, to be the most competent evidence of record. Moreover, VA's duty to assist is a two-way-street; if the Veteran wishes to receive benefits, he cannot passively wait or fail to provide, necessary evidence needed to evaluate his claim, when he may or should have provided essential information. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). As noted above, service connection on any basis may only be granted for a current disability. As there is no current diagnosis of an acquired psychiatric disorder, service connection is not warranted, and there is no doubt to be otherwise resolved. The appeal is denied. 2. Entitlement to service connection bilateral hearing loss is denied. The Veteran contends that his current bilateral hearing loss is related to inservice exposure to engineering/boiler room noise. Following a review of the record and applicable legal criteria, the Board finds that entitlement to service connection is not warranted. Here, the record shows that the Veteran is currently diagnosed with bilateral hearing loss. In addition, VA has conceded in-service noise exposure. As such, the first and second elements of service connection have been met and the salient question is whether the Veteran's bilateral hearing loss is related to service. Turning to the evidence of record, in September 2022, a VA examiner opined that it is less likely than not that the Veteran's hearing loss (sensorineural portions) was caused by noise exposure on active duty. In significant part, he explained that there are no complaints of hearing loss in service or separation. While noise exposure on active duty is conceded and noise is a known cause of hearing loss, the objective evidence is against a nexus. He explained that the evidence of record does not support immediate onset and medical literature does not support onset of noise-induced hearing loss after a prolonged delay. The September 2022 VA examiner also opined that it is less likely than not that the Veteran's otosclerosis had its origin in service. The examiner explained that the Veteran's hearing was well within normal limits during service. Per the NIH "Many people with otosclerosis first notice that they are unable to hear low-pitched sounds or can't hear a whisper. Here, there is no hearing loss or hearing difficulty noted in service or at separation. Furthermore, the Veteran had surgery for his otosclerosis 20+ years after service, suggesting the onset was well outside of service. Thus, a nexus was not established for otosclerosis. Following a March 2023 VA examination, a VA examiner further opined that the Veteran's hearing loss is less likely than not (likelihood is less than approximately balanced or nearly equal) caused by toxic exposure to cleaning chemicals and asbestos. The examiner considered the Veteran's total potential toxic exposure during service and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. He concluded that there is no medical or scientific evidence available that provides any indication of a relationship between the development of the Veteran's conditions and the TERA. He explained that cleaning chemicals are shown to affect the respiratory system when inhaled, but no evidence can be found linking these chemicals to hearing loss. Asbestos exposure can cause cancer to the lungs, kidneys, throat, and gastrointestinal tract, as well as cause lung scarring and pleural effusions but there is no evidence linking asbestos to the claimed condition of hearing loss. The Board finds these VA opinions to be persuasive. The Board finds no adequate basis to reject the findings, based on a lack of credibility or probative value. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997); Evans v. West, 12 Vet. App. 22, 26 (1998). There are also no opinions of record to the contrary. As such, the Board finds that the evidence of record does not show that the Veteran's hearing loss is related to service. In reaching this determination, the Board has considered the Veteran's statements, to include his statements during his January 2022 Board hearing, that he was exposed to loud noises during service and currently wears hearing aids. The Board finds these statements consistent, competent, and credible. Layno v. Brown, 6 Vet. App. 465, 469 (1994). While the Veteran is competent to report symptoms, as this requires only personal knowledge as it comes to him through his senses, he is not competent to offer an opinion as to the etiology of his bilateral hearing loss due to the medical complexity of the matters involved. Such competent evidence concerning the nature and extent of the Veteran's claimed disorders has been provided by the medical personnel who examined him during the current appeal, and who rendered pertinent opinions in conjunction with the evaluations. Therefore, the Board attaches greater probative weight to the clinical findings than to the Veteran's lay statements regarding etiology. Furthermore, the Veteran does not contend, nor does the medical evidence show, that he had bilateral hearing loss during service. Therefore, presumptive service connection based on a "chronic disease or injury shown in service" is not warranted. The Veteran has also not asserted, nor does the medical evidence show, that he has experienced bilateral hearing loss since service, thus presumptive service connected based on continuity of symptomatology since service is also not warranted. The Board acknowledges that the record contains additional VA medical opinions (which do not support the Veteran's claim); however, the Board finds that these opinions are inadequate, as such, these opinions will not be addressed further. In sum, after a careful review of the record, the evidence weighs persuasively against a finding of a nexus between the Veteran's hearing loss and service. As such, service connection is not warranted and there is no doubt to be resolved. The appeal is denied. 3. Entitlement to a disability rating in excess of 30 percent for bilateral pes planus is denied. Entitlement to a separate disability rating for hallux valgus, associated with bilateral pes planus, is granted. Applicable Law Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (rating schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be "staged." Hart v. Mansfield, 21 Vet. App. 505 (2007) (staged ratings are appropriate when the factual findings show distinct period where the service-connected disability exhibits symptoms that would warrant different ratings.); see also Fenderson v. West, 12 Vet. App. 119, 126 (2001). When assessing the severity of a musculoskeletal disability that is rated on the basis of limitation of motion, VA must consider the extent to which a veteran may have additional functional impairment beyond the limitation of motion objectively demonstrated, such as when the symptoms are most prevalent due to the extent of the pain and painful motion, weakness, premature or excess fatigability, and incoordination. See 38 C.F.R. §§ 4.40, 4.45, 4.59 (2017); DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). The rating schedule is intended to recognize actually painful, unstable, or malaligned joints due to healed injury as entitled to at least the minimum compensable rating for the joint. See 38 C.F.R. § 4.59. Application of 38 C.F.R. § 4.59 is not limited to cases of painful motion in which there is a finding of arthritis. See Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). Case law and VA guidelines anticipate that VA examiners will use information procured from relevant sources, including lay statements, to estimate additional functional loss during flare-ups of musculoskeletal disability. See DeLuca v. Brown, 8 Vet. App. 202 (1995); Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the diagnosis and demonstrated symptomatology. Any change in a diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Furthermore, the selection of diagnostic codes or applicable rating criteria is not protected and may be appropriately revised if the action does not result in the reduction of compensation. See 38 C.F.R. §§ 3.951, 3.957. The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). In Butts v. Brown, 5 Vet. App. 532 (1993), the Court held that the selection of the proper diagnostic code is not a question of law subject to the de novo standard of review. Accordingly, the Butts Court held that, as VA and the Board possess specialized expertise in determining the application of a particular diagnostic code to a particular condition, their determination is due greater deference. Indeed, the Court has also held that, although the reason for a change in diagnostic codes must be explained, the VA and the Board may change the diagnostic codes under which a disability or disabilities are evaluated. V. Derwinski, 2 Vet. App. 625 (1992). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Board has thoroughly reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the evidence submitted. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Here the Veteran is currently assigned a 30 percent disability rating for bilateral pes planus under Diagnostic Code 5276. Under Diagnostic Code 5276, mild disability with symptoms relieved by built-up shoe or arch support will result in a noncompensable rating. A 10 percent rating requires evidence of moderate disability 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. A 30 percent rating requires severe disability with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities, if it is bilateral. A 50 percent rating requires pronounced disability with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achilles on manipulation, that is not improved by orthopedic shoes or appliances, if it is bilateral. Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "mild," "moderate," "moderately severe," and "severe." Spellers v. Wilkie, 30 Vet. App. 211, 219-20 (2018) (Where diagnostic code did not define "mild," "moderate," "moderately severe," or "severe," or generally associate those terms with specific symptoms). Rather than applying a mechanical formula, the Board must instead evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. The Board notes that mild is generally defined as "not severe." Merriam-Webster's Collegiate Dictionary, 787 (11th ed. 2003). Moderate is generally defined as "tending toward the mean or average amount." Id. at 798. Severe is generally defined as "of a great degree." Id. at 1140. While some of the symptoms listed in the rating criteria of Diagnostic Code 5276 are conjunctive, e.g., "pain on manipulation and use accentuated," the rating criteria themselves are not. In other words, a claimant does not need to demonstrate all of the symptoms under a particular rating to be assigned that evaluation. See Tatum v. Shinseki, 23 Vet. App. 152, 156 (2009) (discussing how some Diagnostic Codes, such as Diagnostic Code 7903 for hypothyroidism, are not conjunctive); Dyess v. Derwinski, 1 Vet. App. 448 (1991). Where a disability manifests in some criteria from a lower rating and some criteria for a higher rating, the Board should address 38 C.F.R. §§ 4.7 and 4.21 and explain which rating the disability more nearly approximates. During the pendency of the instant appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. The criteria under Diagnostic Code 5276 were not amended. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (codified at 38 C.F.R. § 4.71a, DCs 5235-5243). However, the February 7, 2021, revision added Diagnostic Code 5269 for plantar fasciitis. Compare 38 C.F.R. § 4.71a (Feb. 2021) with 38 C.F.R. § 4.71a (Jun. 2004). Under Diagnostic Code 5269, a 10 percent rating is warranted for unilateral or bilateral plantar fasciitis. A 20 percent rating is warranted for unilateral plantar fasciitis with no relief from non-surgical and surgical treatment. A 30 percent rating is warranted for bilateral plantar fasciitis with no relief from non-surgical and surgical treatment. Prior to the revision, plantar fasciitis was generally rated by analogy under Diagnostic Code 5276 for pes planus. If a law or regulation changes during the course of a claim or an appeal, the version more favorable will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g); see also Kuzma v. Principi, 341 F.3d 1327 Fed. Cir. 2003). If the revised version is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. Id. Therefore, the Board will consider the Veteran's claim under the criteria prior to February 7, 2021 and both the previous rating criteria and new rating criteria from February 7, 2021. The criteria that is more favorable will be applied. Factual Background VA treatment records from June 2015 show a painful depressed medial longitudinal arch with excessive foot pronation. The Veteran walked with an abducted gait and heel was everted during stance. His first "MTPJ" left was slightly hypertrophied and limited in motion. There was no pain, but his feet were numb. He had diminished hair growth and diminished pulses on the left. He also had absent monofilament/light touch sensation on both feet. He was assessed with pes planus, peripheral neuropathy, onychomycosis, and hallux rigidus. In November 2015, the Veteran was afforded a VA examination. He reported a long history of right flat foot deformity, numbness at the tips of toes, and pain with long periods of standing. He also reported being treated by a podiatrist with shoe inserts and burning pain. On examination, the Veteran was noted to have main on use and accentuated on use of right foot. There was no indication of pain on manipulation. The was evidence of swelling and calluses on the right foot. Orthotics were shown to relieve symptoms in the right foot. No tenderness on the plantar surfaces was shown, but there was bilateral decreased longitudinal arch height on weight-bearing and marked deformity and pronation. There was bilateral inward bowing, but no marked inward displacement or severe spasm of the achilles tendon. Pain, weakness, and fatigability were not noted to cause functional loss and no assistive devices were reported. In a subsequent January 2017 VA examination, the Veteran reported swelling in his right food which affects his ability to stand or ambulate during flareups. On examination, the Veteran was noted have bilateral pain on use and accentuated with use of the feet. There was no pain on manipulation. There was swelling in the right foot and no characteristic calluses. Bilateral arch supports did not relieve symptoms. There was no extreme tenderness of plantar surfaces although the Veteran did have decreased longitudinal arch height with weight-bearing. There was no marked deformity or marked pronation, weight-bearing line did not fall over medial to the great toe, and there was no inward bowing or displacement and severe spasm of the achilles tendon. There was evidence of metatarsalgia in the left foot, i.e., locking and pain. There was also evidence of mild or moderate bilateral hallux rigidus. Pain was also noted to cause functional loss, swelling, instability, disturbance of motion, and interference with standing. No assistive devices were noted. July 2018 VA treatment records indicate that the Veteran received contract shoes for his congenital pes planus for support and protection while ambulating. In his January 2022 Board hearing the Veteran testified that he experiences stiffness, pain, and swelling. Specifically, he had pain and numbness in his achilles/heel, and he uses shoe inserts. He reported cramps in his legs. In October 2022, the Veteran was afforded a VA examination and reported pain, swelling, tightness, fatigue, weakness, lack of endurance, incoordination, abnormal gait, falls, and limited mobility. He was noted to have pain on use of feet and manipulation of feet that was accentuated on use, swelling, and calluses. He was noted use arch supports but remained symptomatic. No tenderness on the plantar surfaces was shown, but there was bilateral decreased longitudinal arch height on weight-bearing and marked deformity. There was no marked pronation, bilateral inward bowing, or marked inward displacement or severe spasm of the achilles tendon. No metatarsalgia was noted, however, mild or moderate hallux valgus condition was noted. he was noted to have minimal sensory sensation in the right foot and to use a walker. Analysis Following a review of the record and applicable legal criteria, the Board finds that a higher rating for bilateral pes planus under Diagnostic Code 5176 is not warranted. However, separate disability ratings for metatarsalgia and hallus valgus are warranted. As a preliminary matter, the Board notes that the maximum rating under the new Diagnostic Code 5269 is 30 percent. As it is not more favorable than the Veteran's current rating the Board will not evaluate the Veteran's condition under this Diagnostic Code. Next, after careful review, the Board finds that, under Diagnostic Code 5276, the Veteran is not entitled to rating in excess of 30 percent. As illustrated above, the evidence shows that the Veteran's service-connected bilateral pes planus is more nearly approximated by the 30 percent rating criteria. Specifically, the Veteran's disability is manifested by severe objective evidence of pain of the feet, which is accentuated on use, swelling on use, and marked bilateral deformity. The Board also finds that the severity of the Veteran's disability does not rise to a level that meets the criteria for the assignment of a 50 percent disability rating. Although the Veteran experienced marked pronation, the evidence does not show that the Veteran's pes planus is manifested by bilateral pronounced flatfoot with extreme tenderness of plantar surfaces, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. The Board acknowledges the Veteran has consistently indicated and submitted statements that he has experienced constant foot pain and worsening of foot pain throughout the entire appeal period. The Board notes that the Veteran is competent to give evidence about what he experiences; for example, he is competent to discuss current pain, swelling, and other experienced symptoms. See Layno v. Brown, 6 Vet. App. 465 (1994). Such consistent competent statements are credible and afforded probative weight. In this case, however, the Board finds that the objective medical findings by skilled professionals are more persuasive, which, as indicated above, do not support a disability rating greater than 30 percent under Diagnostic Code 5276. Moreover, regarding the Veteran's reports of numbness in his toes, the Veteran has already been awarded service connection for peripheral neuropathy of the right first and second toes associated with bilateral pes planus. The Board nots that pyramiding of disabilities is to be avoided under 38 C.F.R. § 4.14. As such, the Board will not address these symptoms further herein. The Board has considered all the applicable Diagnostic Codes to determine whether a higher disability rating is warranted under a separate Diagnostic Code. The Board notes that the evidence of record shows that the Veteran is currently diagnosed with unilateral metatarsalgia which manifests with "locking." See January 2017 VA Examination. Accordingly, as part and parcel of the claim for increased rating for bilateral pes planus, the Board finds that a separate rating is warranted for metatarsalgia. As noted below, this issue is to be remanded to the AOJ for assignment of a rating in the first instance. In addition, the evidence of record shows that the Veteran is currently diagnosed with bilateral hallux valgus. A VA examination has further asserted that this disability is a progression of the Veteran's bilateral pes planus. See October 2022 VA Examination. Accordingly, as part and parcel of the claim for increased rating for bilateral pes planus, the Board finds that a separate rating is warranted for bilateral hallux valgus. As noted below, this issue is to be remanded to the AOJ for assignment of a rating in the first instance. In sum, after a careful review of the record, separate disability ratings for metatarsalgia and hallux valgus are warranted. However, the evidence weighs persuasively against finding that a higher rating for bilateral pes planus is warranted. There is no doubt to be resolved and the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017). REASONS FOR REMAND 1. Entitlement to a separate disability rating for bilateral hallux valgus is remanded. 2. Entitlement to a separate disability rating for metatarsalgia is remanded. The Board has herein granted entitlement for separate ratings for hallux valgus and metatarsalgia. However, the Board cannot assign a disability rating for such period in the first instance. Consequently, adjudication of an initial increased rating claim for such period would be premature and the issue must be deferred pending assignment of a disability rating. The matters are REMANDED for the following action: Assign disability evaluations in the first instance for the claims granted herein. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Kaufer, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.