Citation Nr: 0518304 Decision Date: 07/05/05 Archive Date: 07/14/05 DOCKET NO. 02-16 063 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to an increased evaluation for calcific peritendonitis of the left (minor) shoulder, currently assigned a 20 percent disability evaluation. 2. Entitlement to an increased evaluation for lumbar strain, currently assigned a 20 percent disability evaluation. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Jessica J. Wills, Associate Counsel INTRODUCTION This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a January 2002 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio, which denied the benefits sought on appeal. The veteran, who had active service from August 1977 to October 1981, appealed that decision to BVA, and the case was referred to the Board for appellate review. The Board remanded the case for further development in April 2004, and that development was completed by the Appeals Management Center. The case has since been returned to the Board for appellate review. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. The veteran's calcific peritendonitis of the left shoulder is not productive of limitation of the minor arm to 25 degrees from his side. 3. The veteran's lumbosacral strain has not been shown to be severe with listing of the whole spine to opposite side, positive Goldwaithe's sign, marked limitation of forward bending in standing position, loss of lateral motion with osteoarthritic changes, or narrowing or irregularity of joint space, or some of the above with abnormal mobility on forced motion. 4. The veteran's lumbar strain is not productive of forward flexion of the thoracolumbar spine 30 degrees or less or of favorable ankylosis of the entire thoracolumbar spine. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 20 percent for calcific peritendonitis of the left shoulder have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.40-4.45, 4.71a, Diagnostic Codes 5024-5201 (2004). 2. The criteria for an evaluation in excess of 20 percent for a lumbar strain have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.40-4.45, 4.71a, Diagnostic Codes 5235- 5243, 5295 (2001-2004). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As a preliminary matter, the Board is required to address the Veterans Claims Assistance Act of 2000 (VCAA) that became law in November 2000. The VCAA provides, among other things, that the VA will make reasonable efforts to notify a claimant of the relevant evidence necessary to substantiate a claim for benefits under laws administered by the VA. The VCAA also requires the VA to assist a claimant in obtaining that evidence. 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2004). First, the VA has a duty under the VCAA to notify a claimant and any representative of the information and evidence needed to substantiate a claim. Collectively, the January 2002 rating decision, as well as the September 2002 Statement of the Case and the March 2005 Supplemental Statement of the Case issued in connection with the appellant's appeal have notified him of the evidence considered, the pertinent laws and regulations, including the schedular criteria, and the reason his claims were denied. In addition, a letter was sent to the veteran in April 2004 that specifically informed him of the substance of the VCAA. Consistent with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) April 2004 letter essentially satisfied the notice requirements by: (1) Informing the appellant about the information and evidence not of record that is necessary to substantiate the claim; (2) informing the appellant about the information and evidence the VA will seek to provide; (3) informing the appellant about the information and evidence the claimant was expected to provide; and (4) informing the appellant to provide any evidence in the appellant's possession that pertains to the claim, or something to the effect that the claimant should "give us everything you got pertaining to your claim." This "fourth element" of the notice requirement comes from the language of 38 C.F.R. § 3.159(b)(1). The Board acknowledges that the April 2004 letter was provided to the appellant after the initial unfavorable decision in this case. However, in another case regarding the timing of the VCAA notice, the United States Court of Appeals for Veterans Claims (Court) has held that in such situations, the appellant has a right to a VCAA content- complying notice and proper subsequent VA process. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). That notice was provided to the appellant in April 2004, and the RO subsequently reviewed the appellant's claim and continued the denial of the benefit sought on appeal. All the VCAA requires is that the duty to notify be satisfied and that a claimant is given an opportunity to submit information and evidence in support of their claim. Once this has been accomplished, all due process concerns have been satisfied. See Bernard v. Brown, 4 Vet. App. 384 (1993); Sutton v. Brown, 9 Vet. App. 553 (1996); see also 38 C.F.R. § 20.1102 (harmless error). Under these circumstances, the Board finds that the notification requirements of the VCAA have been satisfied. Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Second, the VA has a duty to assist a claimant in obtaining evidence necessary to substantiate a claim. In this regard, the veteran's service medical records have been obtained and associated with the claims file, as were his VA medical records and private medical records. The veteran was also afforded VA examinations in July 2001 and May 2004. The veteran and his representative have not made the Board aware of any additional, relevant evidence that needs to be obtained prior to appellate review. The Board finds that VA has done everything reasonably possible to assist the appellant. In the circumstances of this case, additional efforts to assist the appellant in accordance with the VCAA would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the appellant are to be avoided). VA has satisfied its duties to inform and assist the appellant at every stage of this case. Given the extensive development undertaken by the RO, the Board finds that the record is ready for appellate review. The Board therefore finds that disposition of the appellant's claims is appropriate. Background and Evidence A rating decision dated in March 1982 granted service connection for calcific peritendonitis of the left shoulder and for a lumbar strain and assigned both disabilities separate 10 percent disability evaluations effective from October 25, 1981. That determination was based on a review of the veteran's service medical records as well as on the findings of a VA examination performed in October 1981. The veteran disagreed with the assigned evaluations, but an April 1982 Statement of the Case continued the evaluations. A subsequent rating decision dated in December 1983 also confirmed the 10 percent disability evaluations, as did a February 1984 Statement of the Case. The veteran later filed a claim in May 2001 for an increased evaluation for both his left shoulder and back disabilities, and the January 2002 rating decision currently on appeal increased both evaluations to 20 percent effective from May 30, 2001. During the pendency of the appeal, the veteran's separate 20 percent disability evaluations have remained in effect until the present time. VA medical records dated from May 2001 to February 2002 document the veteran's treatment for various disorders, including his left shoulder and back disabilities. In June 2001, the veteran complained of sharp back pain, which he rated as a seven on a scale of one to ten. He indicated that position changes caused him pain and that changing positions also decreased the pain. Associated symptoms included sleep disruption, and he took Naproxen to treat his pain. The veteran was later seen in July 2001 at which time an x-ray of his left shoulder was obtained. The x-ray was negative for a fracture or dislocation, and there were minimal arthritic changes in both shoulders at the glenoid labrum. The veteran later sought treatment in December 2001 during which he reported having chronic back pain, which interfered with his ability to sleep well. A physical examination revealed a normal gait, and he was able to walk on his heels, toes, and in tandem. He did complain of pain with light palpation along the entire spine, and he had reduced flexion and extension of the lumbosacral spine. He had good range of motion of the cervical spine, and his strength was 5/5 of all major muscles of the upper and lower extremities, including the extensor hallucis longus. There was no dermatomal sensory loss in the legs. The veteran was diagnosed with cervical spondylosis with mild residuals of C6 radiculopathy as well as musculoskeletal low back pain without objective evidence of radiculopathy. His dosage of medication was increased, and he was given a transcutaneous electrical nerve stimulation (TENS) unit as a non-medication modality for pain reduction. The veteran returned for follow-up appointments in January and February 2002 at which time it was noted that his TENS treatment had decreased his back pain. He was discharged from physical therapy in February 2002. VA medical records dated from June 2001 to May 2004 document the veteran's treatment for various disorders, including his lumbar strain. In June 2001, the veteran was seen with complaints of chronic low back pain. It was noted that he also had cervical radiculopathy and a history of degenerative joint disease of multiple joints. A physical examination did not reveal any tenderness along his spine, and he was diagnosed with cervical spine radiculopathy and with low back pain. He was later seen in August 2003 at which time a physical examination did not find any tenderness along his spine. VA medical records dated from June 2001 to March 2005 document the veteran's treatment for various disorders, including his back and left shoulder pain. An x-ray of the veteran's lumbosacral spine was obtained in June 2001, which revealed minimal changes of spondylosis. In August 2001, the veteran complained of sharp back pain that he rated as a seven on a scale of one to ten. He indicated that position changes increased his pain and that changing positions decreased it. He also noted that the pain disrupted his sleep. The veteran was later seen in June 2002 for a follow- up appointment for his cervical radiculopathy and low back pain. It was noted that he had been using a TENS unit, which had worked well for him, and he was also taking nortriptyline. He continued to have difficulty sleeping and had a low exercise tolerance due to pain and stiffness in his spine. The veteran indicated that his pain was unchanged for the most part and that he did not have any new symptoms. A physical examination revealed an antalgic gait, but he stood well on his heels and toes. The treating physician listed his impression as stable, chronic neck and back pain. The veteran returned for a follow-up appointment in December 2002 during which he reported no new symptoms. He indicated that he did not work, but that he was able to drive. He walked short distances before resting due to pain and stiffness, and he occasionally used a cane for longer distances. The veteran managed his pain with a TENS unit and several medications. He denied having any gait dysfunction, and it was noted that his condition was stable and not progressing. Following a physical examination, he was diagnosed with chronic pain syndrome involving the neck and back that was stable. In April 2003, the veteran complained that his low back pain was radiating down his left leg to his calf and down his right buttock. He also reported taking Naproxen and muscle relaxers, but indicated that he continued to have pain. He subsequently attended a class on managing chronic pain in May 2003. The veteran was later seen in February 2004 during which he continued to complain of chronic low back pain that he described as sharp and throbbing. He took several prescribed medications and stated that he was able to function at an acceptable level when he took all of his medication. In March 2004, the veteran also reported having aching and stabbing pain in both his left shoulder and lower back. He continued to take several medications, and he indicated that he used a TENS unit three times a week for four hours with good relief. The veteran returned for a pain assessment in October 2004 at which time he reported having back pain that he rated as a level four. The veteran was afforded a VA examination in July 2001 at which time it was noted that he was right-handed. He reported having increased pain in his left shoulder, which was constant, and he rated the pain as a six out of a scale of one to ten. He noted that the pain increased with the use of his left shoulder and indicated that he had weakness and stiffness secondary to his pain. He also had swelling, and his shoulder occasionally felt warm. The veteran stated that he was very limited in the length of time he could use his left shoulder for activities, such as driving or housework, as he experienced increased pain during such activities and developed a crunching or sandpaper feeling inside the joint. He took methocarbamol and Naproxen for his muscle pain and spasm, and he also used an air jet spa to apply heat to his shoulder. He reported occasionally using a sling for support, but he never had any surgeries and did not have any injections since 1981. The veteran also denied having any other injuries to his left shoulder. A physical examination found the veteran to have both forward flexion and abduction from zero to 100 degrees actively and zero to 140 degrees passively, but he expressed pain from approximately 120 to 140 degrees in both forward flexion and abduction. On internal rotation, he could reach to L2 with his left hand while his shoulder was abducted to 90 degrees and trying to rotate to 85 degrees. On external rotation with the elbow tucked to the side of the body, he could externally rotate to 45 degrees. With his shoulder abducted to 90 degrees, he could externally rotate to 90 degrees. The veteran was noted to have pain at the endpoints of the rotation movements. He was diagnosed with mild arthritis with impingement syndrome of the left shoulder as well as with limited range of motion in his left shoulder secondary to his pain caused by chronic capsulitis. With respect to his lumbar spine, the veteran told the July 2001 VA examiner that he had constant pain, which he rated as a four or five on a scale of one to ten, but he also noted that such pain increased to a nine on a daily basis. He stated that there was weakness and stiffness associated with the pain as well as easy fatigability and lack of endurance. He experienced flare-ups daily, which lasted until he was able to relax. When the veteran experienced such a flare-up, he had to stop walking, sit down, and use treatments, such as heat and the spa. Precipitating factors included bending, lifting, and housework, and he noted that rest and the spa were alleviating factors. He indicated that he had to go to bed or use his air jet spa to relieve his pain and spasms, and he also took Naproxen and methocarbamol for his back pain. He had not had any surgery on his back, and he denied using crutches or a brace. The veteran also claimed that he had to stop working secondary to his shoulder and back pain, but further stated that he was not working at the time of his examination due to his right shoulder pain and cervical radiculopathy. A physical examination of the veteran's lumbar spine revealed that he was able to stand fully erect, and his musculature was symmetrical. He had some difficulty with tiptoe walking, but on his third attempt, the veteran was able to walk five steps with each foot. He was also able to perform heel walking with his toes off of the floor. The veteran had standing lumbar lordosis at 30 degrees, and forward bending changed the lordosis to an eight-degree kyphosis with him only able to reach to the level of his knees. Back bending also increased his lordosis to 48 degrees. The veteran was able to bend to the right and left 10 degrees, and his rotation was limited to approximately 20 degrees in each direction. He stated his low back pain limited his activity. In this regard, he related that he had to sit on the floor to load the dishwasher rather than bend over. He also noted that the pain radiated into his buttocks. He expressed his pain and moved slowly with grunting and grimacing. On straight leg raise, the veteran was able to do straight leg raise bilaterally to 90 degrees and expressed pain from 70 to 90 degrees. His deep tendon reflexes were 1+ bilaterally at the knee and ankle, and his Babinski reflex was normal. He also had equal sensation in the feet and ankle bilaterally. The veteran was diagnosed as having back pain with x-ray findings of spondylosis at multiple levels. In his September 2002 VA Form 9, the veteran indicated that his left shoulder pain increased with use and that reaching overhead was very painful. He related that he was enrolled in a pain management program and took Nortriptyline as well as Naproxen and Methocarbamol. He also used a TENS unit to control his back pain and spasms. The veteran claimed that he could no longer run, throw things, bend, or lift and that he could not sit in one place for very long without having to make postural changes. He also indicated that he had to take breaks when walking because his pain radiated into his legs and he sometimes lost feeling. Private medical records dated in August 2003 indicate that the veteran underwent a functional capacity evaluation with a diagnosis of cervico-brachial neuralgia. In May 2004, the veteran submitted a statement in which he claimed that his left shoulder and back pain had limited his daily living. He stated that his left shoulder had worsened to the point that he experienced pain any time he moved his arm. He could no longer reach overhead or lift weights, and he continued to experience pain in his left arm when resting after activity. The veteran also claimed that his back pain had increased and bothered him whenever he sat, walked, or stood. The pain woke him up several times each night, and he could only walk short distances. He could occasionally bend over, but he had a limited range of motion, and he could only sit for a short period of time before having to change positions to stand or lie down. The veteran further indicated that he tool several medications and used hot and cold compresses as well as a TENS unit to treat his left shoulder and back pain. He had also undergone physical therapy for both of his disabilities. The veteran was afforded a VA examination in May 2004 at which time it was noted that he was right-hand dominant. He indicated that both his back and left shoulder had worsened. He stated that he had constant left shoulder pain while at rest and noted that the motion and strength had worsened. The veteran related that he experienced a flare-up of his left shoulder pain on a daily basis. Repetitive movements with his left shoulder caused him the most discomfort and pain, especially if movements were attempted over his shoulder level. He denied having any surgery on his left shoulder, and he indicated that his shoulder had improved with heat and rest. He had not had any physical therapy for his shoulder for many years, nor had he had any recent cortisone injections for his shoulder. With respect to the veteran's back, he claimed that his pain had increased in frequency and severity. He experienced a flare-up of his low back pain several times per week, which was usually precipitated by mild activities, such as bending, stooping, attempting to lift, or even occasionally walking. He indicated that his low back pain radiated into his buttocks on both sides, but he did not have any significant numbness in either of his legs. The veteran was able to walk approximately 500 yards before he needed to stop, and he used a cane for ambulation because of his low back. He also used a TENS unit for symptomatic relief as well as spa soaks. He had been prescribed several medications for both of his disabilities, but he denied using an orthosis for his low back. The veteran also claimed that he was unable to do certain activities, such as playing with his children, because of his left shoulder and back pain, but he further stated that he was able to perform his activities of daily living for the most part, although he had difficulty with certain maneuvers. A physical examination of the veteran's left shoulder found point tenderness over the left acromioclavicular (AC) joint as well some tenderness over the sub-bursal area. He had a negative speed test and Yergason test, but he had a positive cross-body adduction test. He had both active forward flexion and active abduction to 90 degrees, and he could passively flex and abduct to 140 degrees. The veteran experienced discomfort between 90 and 140 degrees in both forward flexion and abduction. He had external rotation to 50 degrees, and his external rotation strength was 5/5. On forward flexing of the veteran's shoulder multiple times, his scapula was noted to have some dyskinesis with forward elevation, and he had prominence of his inferomedial border of his scapula. When stabilization of his scapula was attempted, he had some mild resolution of the pain. The veteran was neurovascularly intact in his left upper extremity. He was assessed as having left rotator cuff tendonitis with AC joint arthrosis and dyskinesis with impingement. A physical examination of the veteran's back found that he ambulated with a cane and had a forward bending stooping type of gait, which was slightly slow, but he did not have any antalgia in his gait. He was able to actively flex forward 80 degrees, and he had passive flexion to 90 degrees with pain. He normally stood at 30 degrees of forward flexion, and he could actively extend to zero degrees. He could not passively extend much further due to his severe pain. The veteran could side bend to both the right and left to 10 degrees, and he could rotate to the right and left to 20 degrees. He was also able to do some toe walking as well as heel walking for at least five or six steps. The veteran had some tenderness in his low back on his paraspinal musculature as well as some mild spasm in the low back. He had a seated straight leg raise on both sides. His quadriceps muscle strength was 5/5, and there was no atrophy. Nor was there any sensory changes on either side. He attempted to do some repetitive bending motions in forward flexion, but he tired after approximately seven or eight times of repetitive bending and forward flexion. An x-ray of his lumbosacral spine was obtained, which revealed some degenerative changes in the form of spurs at the vertebral bodies. The veteran was diagnosed with lumbar degenerative arthritis. The May 2004 VA examiner commented that the veteran had symptomatically worsened since his last VA examination and noted that he did have function limitations with regards to his left shoulder and back. He indicated that the veteran may be able to perform activities and a desk job, but doubted that he would be able to tolerate a physically active job. The examiner also noted that his ranges of motion had essentially remained the same since the last time he was seen, but noted that he did appear to have weakness and fatigability with repetitive movements. He further stated that the veteran did not have any specific neurologic symptoms in his lower extremities or his left upper extremity, which would prohibit him from ambulating. The examiner commented that most of his limitation was related to his pain and opined that this was for the most part a moderate disability. The May 2004 VA examiner submitted an addendum to his examination report in May 2005. In this addendum, he stated that the veteran had functional loss of motion, which was related primarily to pain. He did not have any significant weakness, fatigability, or incoordination with use. The examiner noted that his loss of function secondary to pain was visible in his behavior. In this regard, the veteran grimaced with passive motion beyond forward flexion and abduction of 90 degrees, which was indicative of impingement. His low back discomfort also limited his motion and any repetitive bending exercises. Fatigability and endurance could not be adequately evaluated because pain prohibited repetitive use. The examiner stated that any perceived fatigability or lack of endurance he reported was more likely than not related to pain, as the veteran was unable to perform repetitious activity secondary to pain. Apparent weakness and fatigability was assessed by asking the veteran to perform activities to which he responded that he could not continue because he was in pain and tired. The veteran did not have any lower extremity weakness or sensory loss indicative of radiculopathy. A straight leg raise caused low back and buttocks pain, but there was no pain that radiated down the leg, particularly past the knee, which was more diagnostic of true radicular pain. Deep tendon reflexes were also elicited in his lower extremities, which were symmetric and 2+. Law and Analysis The veteran contends that he is entitled to an increased evaluation for his calcific peritendonitis of the left shoulder and for his lumbar strain. More specifically, he claims that the current evaluations for his disorders do not accurately reflect the severity of the symptomatology associated with those disabilities. 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. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions and civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 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. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran. 38 C.F.R. § 4.3. While the veteran's entire history is reviewed when making a disability determination, 38 C.F.R. § 4.1, where service connection has already been established, and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Ratings shall be based as far as practicable, upon the average impairment of earning capacity with the additional provision that the Secretary of Veterans Affairs shall from time to time readjust the Schedule of Ratings in accordance with experience. In exceptional cases where the schedular evaluations are found to be inadequate, an extraschedular evaluation may be assigned commensurate with the average earning capacity impairment due exclusively to the service- connected disability or disabilities. The governing norm in these exceptional cases is a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59. I. Calcific Peritendonitis of the Left Shoulder The veteran's calcific peritendonitis of the left shoulder is currently assigned a 20 percent disability evaluation under 38 C.F.R. § 4.71a, Diagnostic Code 5024-5201, as analogous to tenosynovitis. Rating by analogy is appropriate where an unlisted condition is encountered, and a closely related condition which approximates the anatomical localization, symptomatology and functional impairment is available. 38 C.F.R. § 4.20. In the selection of code numbers assigned to disabilities, injuries will generally be represented by the number assigned to the residual condition on the basis of which the rating is determined. With diseases, preference is to be given to the number assigned to the disease itself; if the rating is determined on the basis of residual conditions, the number appropriate to the residual condition will be added, preceded by a hyphen. 38 C.F.R. § 4.27 (2004). The hyphenated diagnostic code in this case indicates that tenosynovitis under Diagnostic Code 5024 is the service-connected disorder and that the limitation of motion of the arm under Diagnostic Code 5201 is a residual condition. Tenosynovitis under Diagnostic Code 5024 is to be rated on limitation of motion of affected parts as degenerative arthritis. 38 C.F.R. § 4.71a, Diagnostic Code 5024 (2004). Diagnostic Code 5003 provides that degenerative arthritis established by x-ray findings will be evaluated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. 38 C.F.R. § 4.71a, Diagnostic Code 5003 (2004). Under Diagnostic Code 5201, a 20 percent disability evaluation is for assignment when the motion of the arm of the minor or major extremity is limited to shoulder level. A 20 percent disability evaluation is also contemplated when the minor arm is limited to midway between side and shoulder level. A 30 percent disability evaluation is warranted when the motion of the arm of the major extremity is limited to shoulder level or midway between side and shoulder level or when the motion of the arm of the minor extremity is limited to 25 degrees from the side. Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. The veteran is right-handed and as such, minor, as opposed to major, hand disability ratings are applicable. 38 C.F.R. § 4.69. When the evidence of record is considered under the laws and regulations as set forth above, the Board is of the opinion that the veteran is not entitled to an increased evaluation for his calcific peritendonitis of the left shoulder. The medical evidence of record does not show his left arm to be limited to 25 degrees from the side. In this regard, the July 2001 VA examination found the veteran to have both forward flexion and abduction from zero to 100 degrees actively and zero to 140 degrees passively, and the May 2004 VA examiner indicated that he had both active forward flexion and active abduction to 90 degrees and that he could passively flex and abduct to 140 degrees. As such, the medical evidence of record does not show the veteran to have met the criteria for a 30 percent disability evaluation. Therefore, the Board finds that an increased evaluation for the veteran's left shoulder disability is not warranted. The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. However, an increased evaluation for the veteran's left shoulder disability is not warranted on the basis of functional loss due to pain or weakness in this case, as the veteran's symptoms are supported by pathology consistent with the assigned 20 percent rating, and no higher. In this regard, the Board observes that the veteran has complained of left shoulder pain on numerous occasions and that the May 2004 VA examiner stated that his functional loss of motion was primarily related to his pain. However, the effect of the pain in the veteran's left shoulder is contemplated in the currently assigned 20 percent disability evaluation under Diagnostic Code 5024-5201. Indeed, the January 2002 rating decision specifically contemplated this pain and its effect on the veteran's limitation of motion in its grant of the 20 percent disability evaluation under Diagnostic Code 5024- 5201. The veteran's complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant an increased evaluation. In fact, the May 2004 VA examiner stated that the veteran did not have any significant weakness, fatigability, or incoordination with use and found that any perceived fatigability or lack of endurance was more likely related to pain. Therefore, the Board finds that the preponderance of the evidence is against an increased evaluation for the veteran's calcific peritendonitis of the left shoulder. II. Lumbar Strain The veteran's lumbar strain is currently assigned a 20 percent disability evaluation under 38 C.F.R. § 4.71a, Diagnostic Code 5295. The Board notes that during the pendency of this appeal, VA issued new schedular criteria for rating intervertebral disc syndrome under 38 C.F.R. § 4.71a, Diagnostic Code 5293, which became effective September 23, 2002. However, as there is no evidence of intervertebral disc disease or radiculopathy related to the veteran's service-connected lumbar sprain, such amendment is not relevant to the instant appeal. However, VA subsequently amended the rating schedule again for evaluating disabilities of the spine, contained in 38 C.F.R. § 4.71a, which became effective on September 23, 2003. The new criteria for evaluating service-connected spine disabilities are codified at newly designated 38 C.F.R. § 4.71a, Diagnostic Codes 5235 through 5243. However, the Board notes that consideration under the revised schedular criteria should not be undertaken before such criteria became effective. The effective date rule contained in 38 U.S.C.A. § 5110(g) prevents the application of a later, liberalizing law to a claim prior to the effective date of the liberalizing law. That is, for any date prior to September 23, 2002 and September 23, 2003, neither the RO nor the Board could apply the revised rating schedule. Under the versions of Diagnostic Code 5295 applicable both prior to and after September 23, 2002, a 20 percent disability evaluation is contemplated for a lumbosacral strain with muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral, in standing position. A 40 percent disability evaluation is warranted for a severe lumbosacral strain with listing of the whole spine to opposite side, positive Goldwaite's sign, marked limitation of forward bending in standing position, loss of lateral motion with osteoarthritic changes, or narrowing or irregularity of joint space, or some of the above with abnormal mobility on forced motion. Further, prior to September 23, 2003, Diagnostic Code 5292 provided for ratings based on limitation of motion of the lumbar spine. When such limitation of motion is moderate, a 20 percent rating is warranted. When limitation of motion is severe, a 40 percent rating is warranted. The maximum rating under Code 5292 is 40 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5292 (2002). Additional new regulations that became effective on September 23, 2003 revised the schedular criteria for the rating of spine disabilities. See 38 C.F.R. § 4.71a, Diagnostic Code 5235-5243 (2003). The revised criteria provide that a lumbosacral strain will be evaluated under the General Rating Formula for Disease and Injuries of the Spine. Under the general formula, a 20 percent disability evaluation is contemplated when there is forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 6 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent evaluation is for assignment when there is forward flexion of the cervical spine 15 degrees or less; or favorable ankylosis of the entire cervical spine. A 40 percent evaluation is warranted when there is unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The normal combined range of motion range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 230 degrees. The normal ranges of motions for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (3) (2004). See also 38 C.F.R. § 4.71a, Plate V (2004). Unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5), as added by 68 Fed. Reg. 51, 454 (Aug. 27, 2003). When the evidence in this case is considered under the old schedular criteria of Diagnostic Code 5295 applicable both prior to and after September 23, 2002, the Board finds that the evidence of record does not establish entitlement to an increased evaluation for the veteran's lumbar strain. The medical evidence of record does not show the veteran to have listing of the whole spine to opposite side, a positive Goldwaite's sign, marked limitation of forward bending in standing position, loss of lateral motion with osteoarthritic changes, or narrowing or irregularity of joint space, or some of the above with abnormal mobility on forced motion. The July 2001 VA examination found the veteran able to stand fully erect and to tiptoe and heel walk for a few steps. He could also bend to the right and left 10 degrees and rotate to approximately 20 degrees in each direction, and he performed straight leg raises bilaterally to 90 degrees. Although the May 2004 VA examiner indicated that the veteran ambulated with a cane and had a forward bending, stooping type of gait, which was slightly slow, the examiner noted that he did not have any antalgia in his gait. The veteran actively flexed forward 80 degrees, and he normally stood at 30 degrees of forward flexion and could actively extend to zero degrees. The veteran was also able side bend to both the right and left to 10 degrees and rotate to the right and left to 20 degrees. He could do some toe walking and heel walking for at least five or six steps, and he had a seated straight leg raise on both sides. In addition, the May 2004 VA examiner opined that the veteran had a moderate disability for the most part. As such, the veteran has not been shown to have a severe lumbosacral strain. In fact, the 20 percent rating currently assigned under Diagnostic Code 5295 contemplates lumbosacral strain manifested by muscle spasm on extreme forward bending, and unilateral loss of lateral spine motion in the standing position. These criteria clearly contemplate the currently demonstrated functional limitation which the examiners have found to be due to pain in the lumbar spine. Therefore, the Board finds that the veteran has not met the criteria for an increased evaluation for his lumbosacral strain under Diagnostic Code 5295. The Board finds further that the limitation of motion on repeat examination does with consideration of the limitations caused by pain comport with moderate limitation of motion under the provisions of former Diagnostic Code 5292. When the evidence of record is considered under the revised rating schedule that became effective on September 23, 2003, the Board also finds that an increased evaluation is not warranted for the veteran's lumbar strain. The May 2004 VA examiner indicated that the veteran was able to actively flex forward 80 degrees and that he normally stood at 30 degrees of forward flexion and could actively extend to zero degrees. The examiner also noted that the veteran could bend to both the right and left sides to 10 degrees and that he could rotate to the right and left to 20 degrees. As such, the veteran has not been shown to have forward flexion of the thoracolumbar spine 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. Therefore, the Board finds that the veteran is not entitled to an increased evaluation for his lumbar strain under the revised rating criteria. The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. However, an increased evaluation for the veteran's back disability is not warranted on the basis of functional loss due to pain or weakness in this case, as the veteran's symptoms are supported by pathology consistent with the assigned 20 percent rating, and no higher. In this regard, the Board observes that the veteran has complained of pain on numerous occasions and that the May 2004 VA examiner commented that his low back discomfort limited his motion and any repetitive bending exercises. However, the effect of the pain in the veteran's back is contemplated in the currently assigned 20 percent disability evaluation under Diagnostic Code 5295. Indeed, the January 2002 rating decision specifically contemplated this pain and its effect on the veteran's functioning in its grant of the 20 percent disability evaluation under Diagnostic Code 5295. The veteran's complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant an increased evaluation. In fact, the May 2004 VA examiner stated that the veteran did not have any significant weakness, fatigability, or incoordination with use and essentially concluded that the veteran's functional limitation was due to pain. Therefore, the Board finds that the preponderance of the evidence is against an increased evaluation for the veteran's lumbar strain. III. Conclusion In reaching this decision, the potential application of various provisions of Title 38 Code of Federal Regulations have been considered, whether or not they were raised by the veteran, as required by the holding of the United States Court of Appeals for Veteran's Claims in Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In particular, the Board has considered the provisions of 38 C.F.R. § 3.321(b)(1). In this case, however, there has been no showing that the veteran's service-connected left shoulder disability and lumbar strain have caused marked interference with employment beyond that contemplated by the schedule for rating disabilities, necessitated frequent periods of hospitalization, or otherwise renders impractical the application of the regular schedular standards utilized to evaluate the severity of his disabilities. The Board acknowledges that the veteran told the July 2001 VA examiner that that he had to stop working secondary to his shoulder and back pain; however, he also told the examiner that he was not working at the time of his examination due to his right shoulder pain and cervical radiculopathy. In addition, despite his doubt as to whether the veteran could perform a physically active job, the May 2004 VA examiner indicated that the veteran may be able to perform activities and a desk job. As such, the current medical evidence of record does not suggest that the regular schedular standards are inadequate at the present time. To the extent that the veteran asserts that his service-connected disabilities prevent him from retaining and maintaining gainful employment, the Board notes further, that the veteran's apparent claim for a total disability rating based on individual unemployability was referred to the RO for adjudication in the Board's April 2004 remand. In conclusion, the Board finds that the requirements for an extraschedular evaluation for the veteran's service-connected calcific peritendonitis of the left shoulder and lumbar strain under the provisions of 38 C.F.R. § 3.321(b)(1) have not been met. Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218 (1995). ORDER An evaluation in excess of 20 percent for calcific peritendonitis of the left shoulder is denied. An evaluation in excess of 20 percent for lumbar strain is denied. ____________________________________________ S. L. Kennedy Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs