Citation Nr: 25005299 Decision Date: 04/18/25 Archive Date: 04/18/25 DOCKET NO. 01-01 647 DATE: April 18, 2025 ORDER Entitlement to service connection for degenerative changes in the neck is denied. Entitlement to service connection for right upper extremity radiculopathy is denied. Entitlement to a compensable initial disability rating prior to August 2, 2012 for bilateral pes cavus is denied. Entitlement to a 30 percent disability rating for bilateral pes cavus from August 2, 2012 to June 7, 2024 is granted. Entitlement to a disability rating higher than 30 percent for bilateral pes cavus from June 7, 2024 is denied. Entitlement to a compensable initial disability rating prior to March 30, 2021 for bilateral pes planus is denied. Entitlement to a disability rating higher than 30 percent for bilateral pes planus from March 30, 2021 is denied. Entitlement to an initial compensable disability rating for bilateral hammer toes is denied. Entitlement to an initial compensable disability rating for bilateral hallux valgus is denied. REMANDED The claim of entitlement to service connection for an eye disorder is remanded. FINDINGS OF FACT 1. The evidence demonstrates that the Veteran did not incur a cervical spine disorder during service or develop one as the result of service-connected disability. 2. The evidence demonstrates that the Veteran did not incur right upper extremity radiculopathy during service or develop it as the result of service-connected disability. 3. Prior to August 2012, the evidence demonstrated that pes cavus did not cause dorsiflexion of the great toe in either foot. 4. Between August 2012 and June 2024, the evidence indicates bilateral pes cavus causing all bilateral toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads. 5. Since June 2024, the evidence demonstrates that the Veteran's bilateral pes cavus has not involved bilateral marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, and marked varus deformity. 6. Prior to March 2021, the evidence demonstrates that pes planus did not cause moderate symptoms involving weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, and pain on manipulation and use of the feet. 7. From March 2021, the evidence demonstrates that pes planus has not caused pronounced bilateral symptoms such as marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation. 8. Since April 1998, the evidence has not indicated hallux valgus involving a resection of the metatarsal head, or severe symptoms equivalent to amputation of the great toe. 9. Since April 1998, the evidence has not indicated that all toes are hammertoes on either foot. CONCLUSIONS OF LAW 1. The criteria for service connection for degenerative changes in the cervical spine are not met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for right upper extremity radiculopathy are not met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 3. The criteria for an initial compensable disability rating for pes cavus prior to August 2, 2012, are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. 4. The criteria for a 30 percent disability rating for pes cavus between August 2, 2012 and June 7, 2024 are met. 38 U.S.C. §§ 1155, 5107 (b); 38 C.F.R. §§ 4.3, 4.71a. 5. The criteria for a disability rating higher than 30 for pes cavus after June 7, 2024, are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. 6. The criteria for a compensable rating for pes planus prior to March 30, 2021, are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. 7. The criteria for a disability rating higher than 30 percent for pes planus from March 30, 2021, are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. 8. The criteria for a compensable rating for hallux valgus are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. 9. The criteria for a compensable rating for hammertoes are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had multiple periods of active service between September 1980 and June 1991. This case came to the Board of Veterans' Appeals (Board) on appeal of rating decisions by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). This case has been subject to multiple actions by the Board and by the U.S. Court of Appeals for Veterans Claims (Court). Most recently, in December 2023, the Board remanded the claims for additional development. The case is again before the Board for appellate review. Service Connection Since December 2005, the Veteran has asserted that he incurred neck and upper extremity radicular disorders as the result of rigors involved in service, particularly from the effect of carrying heavy backpacks while jumping from motor vehicles. He also asserts that a neck disorder is due to service-connected disability such as lower extremity and lower back problems. Law and regulations Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during active service. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Certain chronic disorders such as degenerative arthritis and neurological disorders are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307 (a), 3.309(a). Service connection also may be established on a secondary basis for a disability which is caused by service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence showing (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by service-connected disability. 38 C.F.R. § 3.310 (a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. To deny a claim, the evidence must clearly weigh against the claim. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Evidence and analysis The evidence in this matter consists of lay assertions, service treatment records (STRs), service personnel records (SPRs), private and VA treatment records, and multiple VA compensation examination reports dated between April 2016 and June 2024. This evidence shows that the Veteran has degenerative changes in his cervical spine and associated right upper extremity radiculopathy. These diagnoses are noted most recently in the June 2024 VA reports. The evidence also indicates that he may have experienced stresses to his neck area during service. As detailed in the Board's May 2012 decision to grant entitlement to service connection for lower spine and associated radicular symptoms, the Veteran served in Saudi Arabia during Operation Desert Shield/Storm and repeatedly jumped off trucks while carrying backpacks. Based on lay evidence, the Board found evidence of in-service spinal injuries. He reports that similar activities affected his neck area. The evidence demonstrates, however, that his current neck/cervical spine disorders are not related to service, or to service-connected disability. See Lynch, supra. The STRs and SPRs are negative for neck complaints, treatment, or diagnoses. The Veteran claimed in 2005 that he was then experiencing neck pain but the earliest medical evidence of record of a neck disorder is dated in the late 2010s, nearly three decades after service. Indeed, the record contains thousands of medical records noting treatment for the Veteran's many health problems, some of which are service connected, and none of this evidence prior to the late 2010s notes complaints, treatment, or diagnosis of a neck area problem. See Horn v. Shinseki, 25 Vet. App. 231, 239 (2012). Further, several VA reports also counter the Veteran's assertions that he injured his neck during service and has experienced chronic symptoms since then. Examiners who reviewed this claim indicated that neck disability related neither to service nor to service-connected disabilities, such as lower back, knee, or foot disorders. Rather, multiple examiners have attributed the Veteran's cervical spine and radicular problems to a motor vehicle accident (MVA) he experienced in 2018 in which he fractured his neck. The MVA and the Veteran's injuries from it are detailed in VA treatment records dated beginning in January 2018. The reports indicate that the neck and upper extremity symptoms are directly attributable to the accident and are not worsened by disability in the lower back, left knee, and feet. The reports are probative because they are based on a review of the claims file and on examinations of the Veteran, and specifically cite to evidence in the claims file in support of their opinions. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the value of a physician's statement is dependent, in part, upon the extent to which it reflects clinical data or other rationale to support the opinion). Further, the VA reports are more probative than the Veteran's assertions regarding chronicity of symptoms since service. Laypersons are competent to report observable symptoms such as pain and limited motion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, laypersons are not competent to determine matters such as diagnosis and etiology, particularly concerning an internal pathology such as one in this case. The question of whether the Veteran incurred a neck or spinal disorder during service is a complex medical issue. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). For this reason, the probative VA opinions outweigh the lay theories offered by the Veteran. Indeed, the VA opinions are more credible with regard to the issues before the Board. See Smith v. Derwinski, 1 Vet. App. 235 (1991) (credibility is determined by the fact finder). In sum, the evidence demonstrates that at discharge from service, and for years after service, the Veteran did not have the characteristic manifestations sufficient to identify a chronic neck disorder. See 38 C.F.R. §§ 3.303, 3.307, 3.309. Further, the evidence demonstrates that service-connected disability neither caused nor worsens neck and radicular problems. See 38 C.F.R. § 3.310. As such, the benefit-of-the-doubt doctrine does not apply, and the claims must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Claims for higher ratings for foot disabilities On April 6, 1998, the Veteran claimed entitlement to service connection for multiple foot and ankle disorders. Effective April 6, 1998, the RO had assigned a total disability rating based on individual unemployability (TDIU) based on a combined rating for service-connected disability of 90 percent. See 38 C.F.R. §§ 4.16, 4.25. Since February 2002, the RO has rated service-connected disability 100 percent disabling. In appealed rating decisions dating since May 2000, the RO has service connected and rated several bilateral foot disabilities - pes cavus, pes planus, degenerative joint disease, hallux valgus, and hammertoes. Pursuant to the Board's most recent remand, which responded to the Court's June 2023 remand, the various disorders are now rated separately under separate diagnostic codes. See Copeland v. McDonald, 27 Vet. App. 333 (2015) (holding that it is not appropriate to rate by analogy a disability that is listed in the rating schedule); see also, 38 C.F.R. § 4.27. Degenerative joint disease has been rated 10 percent disabling in each foot since April 1998, pes cavus, 20 and 30 percent disabling since 2012, pes planus, 30 percent disabling since 2021, and hammertoes and hallux valgus, noncompensable throughout the appeal period (since 1998). The June 2023 joint motion for partial remand (JMPR) notes that the Veteran did not appeal to the Court the Board's November 2022 decision regarding bilateral degenerative joint disease in the feet. The question before the Board is whether higher ratings for the other foot disabilities have been warranted at any time since April 1998. Since April 1998, the Veteran has been rated 30 percent disabled for residuals of left ankle fracture. This issue is not on appeal before the Board. Law and regulations Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes (DCs). 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. §§ 4.3, 4.7. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. "Staged" ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). The rule against pyramiding provides that evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is prohibited. See C.F.R. § 4.14. Separately rating duplicative or overlapping symptomatology of distinct disorders is not appropriate. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Evidence and analysis The evidence relevant to these claims consists of lay assertions from the Veteran, private and VA treatment records, and multiple VA compensation examination reports dated between June 2003 and June 2024. The foot disabilities are addressed separately below. Bilateral degenerative joint disease: The Veteran did not appeal to the Court the Board's November 2022 decision regarding this aspect of service-connected bilateral foot disability. See 38 U.S.C. §§ 511, 7266; 38 C.F.R. § 20.1100. The Board will not revisit the question of whether ratings higher than 10 percent are warranted for degenerative joint disease of the feet. See 38 C.F.R. §§ 4.71a, DC 5003-5284. The principal of res judicata precludes relitigating this issue. See Cook v. Principi, 318 F.3d 1334, 1336 (Fed. Cir. 2002). This aspect of the disability is nevertheless addressed here because its symptoms are difficult to differentiate from symptoms associated with the other service-connected disorders whose ratings have been appealed and are subject to this decision, and are addressed below. Degenerative joint disease is rated under DC 5003-5284 of 38 C.F.R. § 4.71a. Hyphenated DCs are used when a rating under one DC requires use of an additional DC to identify the basis for the evaluation assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. Under DC 5003, a 10 percent rating is warranted for degenerative arthritis when a noncompensable rating is warranted under the appropriate DC. Under DC 5284, which rates foot injuries, a 10 percent rating is warranted for moderate symptoms, a 20 percent rating for moderately severe symptoms, a 30 percent rating for severe symptoms, and a 40 percent rating for loss of use of the foot. See 38 C.F.R. § 4.71a. Bilateral hallux valgus and bilateral hammertoes: Hallux valgus is rated under DC 5280 of 38 C.F.R. § 4.71a. Under this DC, sole 10 percent ratings are warranted for hallux valgus operated on with a resection of the metatarsal head, or for severe symptoms equivalent to amputation of the great toe. Hammertoes are rated under DC 5282 of 38 C.F.R. § 4.71a. Under this DC, a sole 10 percent rating is warranted when all unilateral toes are hammertoes and there is no pes cavus. The evidence demonstrates that compensable ratings have been unwarranted since April 1998 for each of these disabilities. The evidence indicates that the Veteran has been diagnosed with these disorders, but none of the voluminous evidence of record indicates resection of a metatarsal head, symptoms equivalent to amputation of the great toe, or that all toes on either foot are hammertoes. See 38 C.F.R. § 4.71a, DCs DC 5280, 5282. Indeed, the June 2024 VA report which addressed these disorders in response to the Board's most recent remand found hammertoes on each foot from the second to the fourth toe, and mild to moderate hallux valgus symptoms without surgery for the disorder. Bilateral pes planus: Pes planus is rated under DC 5276 of 38 C.F.R. § 4.71a. Under this DC, a 10 percent rating is warranted for moderate symptoms involving weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet. A 30 percent rating is warranted for severe bilateral symptoms such as objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities. A 50 percent rating is warranted for pronounced bilateral symptoms such as 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 noncompensable rating is warranted under this DC for evidence showing mild disability with symptoms relieved by built-up shoe or arch support. Pes planus is not separately rated prior to March 30, 2021. From then, the disorder has been rated 30 percent disabling. The initial question is whether, prior to March 30, 2021, this particular foot disorder caused moderate symptoms involving weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet. See 38 C.F.R. § 4.71a, DC 5276. The evidence supports the RO's finding that a noncompensable rating was warranted for pes planus prior to March 30, 2021. The evidence demonstrates that the Veteran was not diagnosed with this disability prior to October 2016, and that from then until March 2021, the symptoms were mild. Since June 1998, the Veteran has complained of chronic soreness and tenderness in his feet with constant swelling. An August 1997 private medical record detailing a sore on his left ankle notes that the Veteran tended to walk on the sides of his feet and had stiffness in the bones of his feet and diminished motion in the forefoot. In a March 2002 statement, a private physician reported that the Veteran had chronic bilateral foot pain, reported swelling and weakness, and required the use of a walking cane. This report focused mainly on radicular and neuropathic symptoms, rather than on the structure of the feet. In a report dated in June 2003, a VA examiner noted the Veteran's continuing complaints of chronic pain with burning and weakness in addition. On examination, the examiner found "a mild arch" and minimal reduction in range of motion. The x-ray evidence showed mild degenerative changes in the right metatarsophalangeal joint and left intertarsal and metatarsophalangeal joints. The examiner found the disability primarily due to burning symptoms from long-standing lumbar radiculopathy. The examiner also noted the constant walking on the lateral border of his feet rather than on the plantar surface. The examiner did not diagnose the Veteran with pes planus. The Veteran did not undergo VA examination of his feet again until April 2016. Nevertheless, the claims file contains voluminous private and VA treatment records addressing multiple nonservice-connected and service-connected disorders, such as the feet (August 2001 and July 2006 private records). The records note the Veteran's continuing complaints of foot pain and that standing and walking caused such symptoms as swelling and achiness. None of these treatment records notes a diagnosis of pes planus. The April 2016 VA report notes diagnoses of bilateral pes cavus and foot degenerative arthritis. The examiner stated that the Veteran reported pain in the outside edge of his foot intermittently with use and proportional to the duration of weight-bearing. Examination of the left foot revealed pain, callosities on the plantar surfaces, and less movement than normal. The report also indicates that the Veteran used a cane regularly for ambulation for multiple musculoskeletal disorders. The report does not note the diagnosis of pes planus. The next VA examination report is dated in March 2021. Again, private and VA treatment records dated between the two examination reports note complaints of chronic pain and the use of a shoe insert. Further, VA podiatry treatment records dated beginning in October 2016 began noting the diagnosis of pes planus with evidence of bilateral decreased medial longitudinal arch. But this alone does not indicate that the criteria for a 10 percent rating were approximated prior to March 2021. See 38 C.F.R. § 4.71a, DC 5276. Nonetheless, based on findings in the March 2021 report, the RO assigned a 30 percent rating. The next question is whether the examination findings or subsequent evidence dated from March 2021 approximate the criteria for a 50 percent rating - i.e., pronounced bilateral symptoms such as 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. 38 C.F.R. § 4.71a, DC 5276. "Pronounced" is defined as a degree greater than "severe" under DC 5276. Prokarym v. McDonald, 27 Vet. App. 307, 311(2015). "Extreme" means existing in very high degree. "Severe" means "of a great degree" or "serious." "Marked" is defined as "clearly defined and evident, noticeable." See www.merriam-webster.com/dictionary; see also Johnson v. Wilkie, 30 Vet. App. 245, 255 (2018). Based on the evidence detailed below, the criteria for a 50 percent rating have not been approximated since March 2021. The March 2021 VA report notes a diagnosis of bilateral pes planus. The examiner found a "flexible pes planus" where the arch was fallen when standing but returns when the foot is lifted off the ground, with more prominent symptoms on the left. The report's findings detail complaints of pain and indicate more severe symptoms related to pes cavus (discussed below) with an inability to put the right foot flat on the floor/ground. The examiner noted symptoms of pes planus of bilateral foot pain, accentuated on use, but no pain on manipulation. There was no indication of swelling on use, but there were characteristic calluses bilaterally. The Veteran used bilateral arch supports but remained symptomatic. The examiner found no extreme tenderness, but there was decreased longitudinal arch height of both feet. There was no objective evidence of marked deformity of either foot or marked pronation of either foot. The weight-bearing line was not over or medial to the great toe and there was no inward bowing of the Achilles' tendon, or hindfoot valgus, with lateral deviation of the heel of one or both feet. There was no marked inward displacement or severe spasm of the Achilles' tendon on manipulation. The examiner stated that the primary foot complaints in recent years were related to the calluses which were of "moderate" severity. A July 2022 VA examiner noted bilateral foot pain and regular use of arch supports, but mainly addressed pes cavus. The June 2024 VA examiner noted complaints of chronic sharp aches, soreness, tenderness, and swelling after extended standing or walking. The examiner noted pain on use in both feet and decreased longitudinal arch height in both feet on weight-bearing, and found that arch supports did not completely relieve symptoms. But the examiner found no pain on manipulation, no extreme tenderness, no marked deformity or marked pronation, no weight-bearing line over or medial to the great toe, no inward bowing of the achilles tendon, no marked inward displacement and severe spasm of the Achilles' tendons on manipulation of the feet, and noted no swelling on use related to pes planus. Contrary to earlier reports, moreover, the examiner found that the calluses on the feet were not due to pes planus. Further, a review of the private and VA treatment records dated since March 2021 is negative for evidence approximating the 50 percent criteria discussed under DC 5276. Based on the foregoing, the 30 percent rating effective from March 30, 2021 should not be increased to 50 percent. None of the evidence dated since then indicates pronounced bilateral symptoms such as marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation. 38 C.F.R. § 4.71a, DC 5276. Bilateral pes cavus: Pes cavus is rated under DC 5278 of 38 C.F.R. § 4.71a. Under this DC, a 10 percent rating is warranted for bilateral symptoms such as great toe dorsiflexed, some limitation of dorsiflexion at ankle, definite tenderness under metatarsal heads. A 30 percent rating is warranted for all bilateral toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads. And a 50 percent rating is warranted for bilateral marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, and marked varus deformity. The criteria under DC 5278 are conjunctive. See Melson v. Derwinski, 1 Vet. App. 334 (1991). To review, pes cavus has been rated 0 percent disabling between April 1998 and August 2012, 20 percent disabling until June 2024, and 30 percent disabling since then. As detailed below, the Board finds a compensable rating unwarranted prior to August 2012, but that the 30 percent rating effective in June 2024 should instead be effective in August 2012. Prior to August 2012, the evidence did not indicate bilateral great toe dorsiflexion. And while the evidence indicated limitation of dorsiflexion at the left ankle, and definite tenderness under metatarsal heads, these symptoms were already compensated for in other ratings. 38 C.F.R. § 4.71a, DC 5278. Specifically, since April 1998, left ankle disability has been rated 30 percent disabling while degenerative arthritis in the forefoot has been rated 10 percent disabling in each foot. The evidence shows that prior to August 2012 the Veteran experienced symptoms that had already been compensated under other DCs. See Esteban, supra. As the Board noted while addressing pes planus, the Veteran has complained of foot pain and swelling since June 1998. An August 1997 private medical record detailing a sore on his left ankle notes that the Veteran tended to walk on the sides of his feet and had stiffness in the bones of his feet and diminished motion in the forefoot. In a March 2002 statement, a private physician reported that the Veteran had chronic bilateral foot pain, reported swelling and weakness, and required the use of a walking cane. This report focused mainly on radicular and neuropathic symptoms, rather than on the structure of the feet. The June 2003 VA report addresses the specific disorder of pes cavus. The examiner noted "a mild arch" which he did not consider to be evidence of pes cavus. This examiner attributed the Veteran's symptoms not to pes cavus or even pes planus, but to radicular symptoms into the feet from lower back disability and to mild degenerative changes in the right metatarsophalangeal joint and left intertarsal and metatarsophalangeal joints. Nevertheless, the examiner noted that the constant walking on the lateral border of his feet aggravated the local plantar nerves which already are functioning abnormally due to the long-standing radiculopathy. The Veteran did not undergo VA examination of his feet again until April 2016. Nevertheless, the claims file contains voluminous private and VA treatment records addressing multiple nonservice-connected and service-connected disorders, such as the feet. The records note the Veteran's continuing complaints of foot pain and that standing and walking caused such symptoms as swelling and achiness. However, none of these treatment records dated prior to August 2012 notes the essential criterion for a 10 percent rating under DC 5278 - great toe dorsiflexion. 38 C.F.R. § 4.71a, DC 5278. As such, a compensable rating was unwarranted prior to August 2012. From then, the RO found appropriate a 20 percent rating based on evidence indicating unilateral dorsiflexion of all toes, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads. The Board finds a 30 percent rating warranted from this date because the evidence indicates that the symptoms were found bilaterally. See 38 C.F.R. § 4.71a, DC 5278. So, the remaining question with pes cavus is whether the maximum 50 percent rating has been warranted from August 2012. Under DC 5278, a 50 percent rating is warranted for bilateral marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, and marked varus deformity. As noted earlier, the Veteran has foot calluses. And the July 2022 and June 2024 VA reports indicate definite tenderness under the metatarsal heads, shortened plantar fascia, and some limitation of dorsiflexion at ankle. The June 2024 report also indicates all toes in dorsiflexion. But none of the evidence dated after August 2012 indicates the other criteria for a 50 percent rating. The VA reports dated in April 2016, March 2021, July 2022, and June 2024 are each negative for marked contraction of plantar fascia, dropped forefoot, varus deformity, and hammertoes for each toe on the foot. Further, a review of the private and VA treatment records dated since August 2012 is negative for evidence approximating the criteria for a 50 percent rating under DC 5278. In sum, the evidence demonstrates that the criteria for higher ratings are not approximated here, with the exception of the increase in rating from 20 to 30 percent for pes cavus from August 2012. The reasonable doubt doctrine does not apply to any claim beyond that granted here. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7. In evaluating each of these claims, the Board has considered the Veteran's lay assertions regarding the degree of his disabilities. The Veteran is competent to describe observable symptomatology such as pain and limited motion. See Jandreau, supra. However, he is not competent to determine issues such as the degree of his disability. Questions surrounding the nature and severity of his various service-connected disabilities are medical matters. See Woehlaert, supra. On these more complex questions, the medical evidence is more credible than the lay evidence. See Smith, supra. REASONS FOR REMAND The Veteran claims entitlement to service connection for an eye disorder. Multiple VA examination reports address his claim that he incurred an eye disability during service as the result of an accident, and that he developed a disorder as the result of service-connected disability. A remand for an addendum opinion is warranted because none of the opinions addresses whether the Veteran has an eye disorder secondary to diabetes mellitus type 2 (diabetes), which the RO recently found service connected. See 38 C.F.R. § 3.310. The matter is REMANDED for the following action: 1. Include in the claims file any outstanding VA treatment records. 2. Then return the case to the VA examiner who wrote the January 2025 report, or to a suitable substitute, for issuance of an addendum medical opinion addressing the eyes. After reviewing the claims file, the examiner should address the following questions: (a). Is it approximately at least as likely as not (i.e., probability of approximately 50 percent or more) that any eye or vision disorder is due to or caused by diabetes? (b). If the answer to (a) is negative, is it approximately at least as likely as not that any eye or vision disorder has been aggravated by diabetes? Please explain in detail any opinion provided and the supporting rationale. In rendering the requested report, the examiner should note that laypersons are competent to attest to matters of which they have first-hand knowledge, including observable symptomatology. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. The evidentiary standard "at least as likely as not" is defined as the "likelihood is at least approximately balanced or nearly equal, if not higher." Conversely, "less likely than not" is defined as the "likelihood is less than approximately balanced or nearly equal." If the examiner cannot provide an opinion without resorting to mere speculation, he or she hall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher McEntee 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.