Citation Nr: 1034056 Decision Date: 09/10/10 Archive Date: 09/21/10 DOCKET NO. 10-14 013 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Denver, Colorado THE ISSUES 1. Entitlement to an initial rating in excess of 20 percent for glenohumeral and acromioclavicular degenerative joint disease, claimed as left shoulder bursitis. 2. Entitlement to an initial rating in excess of 20 percent for degenerative joint disease of the right ankle and foot. 3. Entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the right hip. 4. Entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the left hip. 5. Entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the right knee. 6. Entitlement to an initial rating in excess of 10 percent prior to April 16, 2009, and in excess of 30 percent thereafter, for degenerative joint disease of the left knee. 7. Entitlement to an initial rating in excess of 10 percent prior to January 16, 2010, and in excess of 20 percent thereafter for spondylosis with degenerative disc disease of the lumbosacral spine. 8. Entitlement to a compensable initial rating for sternum tenderness, costochondritis, and/or Tietze's syndrome. REPRESENTATION Appellant represented by: Virginia A. Girard-Brady, Attorney ATTORNEY FOR THE BOARD Thomas D. Jones, Counsel INTRODUCTION The Veteran served on active duty from March 1951 to January 1955. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2009 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). 38 U.S.C.A. § 7107(a)(2) (West 2002). The issue of entitlement to an increased initial rating for spondylosis with degenerative disc disease of the lumbosacral spine is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The Veteran's glenohumeral and acromioclavicular degenerative joint disease of the left shoulder joint is characterized by an ability to raise his left (minor) arm to approximately shoulder height. 2. The Veteran's degenerative joint disease of the right ankle is characterized by marked limitation of motion. 3. The Veteran's degenerative joint disease of the right hip is characterized by flexion to 90 degrees and abduction to 30 degrees prior to April 16, 2009, and flexion to 60 degrees and abduction to 10 degrees or less thereafter. 4. The Veteran's degenerative joint disease of the left hip is characterized by flexion to 90 degrees and abduction to 30 degrees prior to April 16, 2009, and flexion to 60 degrees and abduction to 10 degrees or less thereafter. 5. The Veteran's degenerative joint disease of the right knee is characterized by flexion to 140 degrees and extension to 0 degrees prior to April 16, 2009, and flexion to 105 degrees and extension to 20 degrees thereafter. 6. The Veteran's degenerative joint disease of the left knee is characterized by flexion to 140 degrees and extension to 0 degrees prior to April 16, 2009, and flexion to 110 degrees and extension to 20 degrees thereafter. 7. The Veteran's sternum tenderness, costochondritis, and/or Tietze's syndrome are characterized by tenderness of the sternum. CONCLUSIONS OF LAW 1. The criteria have not been met for an initial rating in excess of 20 percent for glenohumeral and acromioclavicular degenerative joint disease of the left shoulder, claimed as bursitis. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5200-03 (2009). 2. The criteria have not been met for an initial rating in excess of 20 percent for degenerative joint disease of the right ankle and foot. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271 (2009). 3. The criteria have been met for an initial rating of 20 percent, effective April 16, 2009, for degenerative joint disease of the right hip. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5250-55 (2009). 4. The criteria have been met for an initial rating of 20 percent, effective April 16, 2009, for degenerative joint disease of the left hip. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5250-55 (2009). 5. The criteria have been met for an initial rating of 30 percent, effective April 16, 2009, for degenerative joint disease of the right knee. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5256-63 (2009). 6. The criteria have not been met for an initial rating in excess of 10 percent prior to April 16, 2009, and in excess of 30 percent thereafter, for degenerative joint disease of the left knee. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5256-63 (2009). 7. The criteria have not been met for a compensable initial rating for sternum tenderness, costochondritis, and/or Tietze's syndrome. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.31, Diagnostic Code 5321 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Veterans Claims Assistance Act of 2000 The Veterans Claims Assistance Act of 2000 (VCAA) enhanced VA's duty to notify and assist claimants in substantiating a claim for VA benefits, as codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.326(a) (2009). For the reasons to be discussed below, the Board finds that VA has satisfied its duties to the appellant under the VCAA. A VCAA notice consistent with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) must (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). VCAA notice requirements apply to all five elements of a service connection claim (1) veteran status; (2) existence of disability; (3) connection between service and the disability; (4) degree of disability; and (5) effective date of benefits where a claim is granted. Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006). VA has made all reasonable efforts to assist the Veteran in the development of his claim, has notified him of the information and evidence necessary to substantiate the claims, and has fully disclosed VA's duties to assist him. In October 2003, December 2003, February 2004, and April 2004 letters, the Veteran was notified of the information and evidence needed to substantiate and complete the claims on appeal. Furthermore, as the claims for increased initial ratings for the Veteran's service-connected disabilities are downstream issues from that of service connection, he bears the burden of demonstrating prejudice resulting from defective VCAA notice. See Goodwin v. Peake, 22 Vet. App. 128 (2008) (holding that "where a claim has been substantiated after the enactment of the VCAA, the appellant bears the burden of demonstrating any prejudice from defective VCAA notice with respect to the downstream issues"). The Board notes next that, in the present case, initial notice was issued prior to the April 2004 adverse determination on appeal; thus, no timing issue exists with regard to the notice provided the claimant. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). For an increased-compensation claim, 38 U.S.C.A. § 5103(a) requires, at a minimum, that VA notify the claimant that, to substantiate a claim, the medical or lay evidence must show a worsening or increase in severity of the disability, and the effect that such worsening or increase has on the claimant's employment and daily life. Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008). However, that case was overruled by the U.S. Court of Appeals for the Federal Circuit, and is no longer binding on the Board. Vazquez-Flores v. Shinseki, 580 F.3d 1270 (Fed. Cir. 2009). The Board further finds that VA has complied with the duty to assist by aiding the appellant in obtaining evidence. It appears that all known and available records relevant to the issues on appeal have been obtained and are associated with the Veteran's claims files. The RO has obtained the Veteran's service treatment records, as well as VA and non-VA medical records. He has also been afforded VA medical examinations on several occasions, most recently in January 2010. The Board notes that the VA examination reports contain sufficiently specific clinical findings and informed discussion of the pertinent history and clinical features of the disabilities on appeal and are adequate for purposes of this appeal. The Board is not aware, and the Veteran has not suggested the existence of, any additional pertinent evidence not yet received. Based on the foregoing, the Board finds that the Veteran has not been prejudiced by any failure of VA in its duties to notify and assist him, and that any such violations could be no more than harmless error. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004). In any event, the Veteran has neither alleged nor demonstrated any prejudice with regard to the content or timing of VA's notices or other development. See Shinseki v. Sanders, 129 U.S. 1696 (2009) (reversing prior case law imposing a presumption of prejudice on any notice deficiency, and clarifying that the burden of showing that an error is harmful, or prejudicial, normally falls upon the party attacking the agency's determination). Thus, adjudication of his claims at this time is warranted. II. Increased rating Disability evaluations are based upon the average impairment of earning capacity as contemplated by the schedule for rating disabilities. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2009). In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (West 2002). When, however, the assignment of initial ratings is under consideration, the level of disability in all periods since the effective date of the grant of service connection must be taken into account. Fenderson v. West, 12 Vet. App. 119 (1998). In cases in which a reasonable doubt arises as to the appropriate degree of disability to be assigned, such doubt shall be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2009). 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 required for that rating. 38 C.F.R. § 4.7 (2009). When evaluating musculoskeletal disabilities, the Board must also consider whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45 under any applicable diagnostic code pertaining to limitation of motion. See DeLuca v. Brown, 8 Vet. App. 202 (1995). However, where a musculoskeletal disability is evaluated at the highest rating available based upon limitation of motion, further DeLuca analysis is foreclosed. Johnston v. Brown, 10 Vet. App. 80 (1997). A. Left shoulder The Veteran's left shoulder disability is rated as 20 percent disabling under Diagnostic Code 5201, for limitation of motion of the arm. This Code provides a 20 percent disability rating for limitation of motion of the minor upper extremity to shoulder level, or to a point midway between the side and shoulder level. Limitation of motion to 25 degrees from the side warrants a 30 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5201 (2009). Because the Veteran is right-handed, the criteria for limitation of motion of his minor (left) upper extremity will be used. The Veteran sought private medical treatment in January 2000 for left shoulder pain and tingling in the fingers. Left shoulder bursitis was suspected. A January 2000 private X-ray of the Veteran's left shoulder confirmed degenerative changes of the acromioclavicular joint, without evidence of fracture or dislocation. A VA orthopedic examination of the Veteran's left shoulder was afforded him in April 2009. He reported a history of left shoulder pain following a motor vehicle accident during military service, with chronic pain ever since. He also reported locking and stiffness of the left shoulder, but denied instability or swelling. On objective examination the Veteran had flexion to 135 degrees with pain beginning at 90 degrees. After three repetitive motions, his flexion was reduced to 90 degrees. Extension was to 50 degrees, with pain at 45 degrees, and extension limited to 45 degrees after three repetitive motions. Abduction was to 105 degrees, with pain at 95 degrees, and to 105 degrees after use. External rotation was to 60 degrees with pain at 50 degrees and to 45 degrees with use. Internal rotation was to 75 degrees, with pain at 60 degrees, and to 60 degrees with use. An X-ray of the left shoulder indicated mild glenohumeral spurring and degenerative joint disease. Most recently, the Veteran was afforded a VA examination in January 2010. Left shoulder pain, stiffness, and weakness were reported, without giving way or incoordination. On objective examination, the Veteran's left shoulder displayed tenderness, crepitus, and guarding of movement. Range of motion testing displayed flexion to 120 degrees, abduction to 100 degrees, internal rotation to 55 degrees, and external rotation to 65 degrees. With use, abduction decreased to 90 degrees and internal rotation decreased to 45 degrees. X-rays confirmed severe arthropathy of the left shoulder. After considering the totality of the record, the Board finds the preponderance of the evidence to be against the award of an initial rating in excess of 20 percent for his left shoulder disability. According to the April 2009 and January 2010 VA examination reports, the Veteran has both flexion and abduction of the left shoulder which allows raising of the left arm to approximately shoulder level; thus, because the Veteran's left arm motion exceeds that of 25 degrees from his side, a 30 percent rating under Diagnostic Code 5201 is not warranted. Although the Veteran reports additional impairment due to such factors as pain, pain on use, fatigability, and weakness, no examiner has expressed such impairment in terms of additional limitation of motion which would reduce his left arm mobility to 25 degrees from his side; thus, an increased rating based on these factors is not warranted. See DeLuca, 8 Vet. App. at 202. Next, evaluation of the Veteran's shoulder disability under other criteria for the shoulder joint would not result in an increased rating, as he does not display ankylosis of the shoulder joint or fibrous union of the humerus, as would warrant an increased rating. Finally, insomuch as the Veteran's left shoulder disability has demonstrated an essentially similar degrees of impairment during the pendency of this appeal, a staged rating is not warranted at the present time. See Fenderson, 12 Vet. App. at 119. At no time during the pendency of this appeal did the Veteran's left shoulder disability more closely approximate the criteria for a higher rating. In conclusion, the preponderance of the evidence is against an initial rating in excess of 20 percent for the Veteran's degenerative joint disease of the left shoulder. As a preponderance of the evidence is against the award of an increased rating, the benefit-of-the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 2002); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). B. Right ankle and foot The Veteran's degenerative joint disease of the right ankle and foot is rated as 20 percent disabling under Diagnostic Codes 5010-5271. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27 (2009). Diagnostic Code 5010, for arthritis due to trauma, in turn makes reference to Diagnostic Code 5003, for degenerative arthritis. Degenerative arthritis established by X- ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved, with a minimum rating of 10 percent to be assigned for each major joint affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003 (2009). Diagnostic Code 5271 governs evaluations for limitation of motion of the ankle. It provides a 20 percent rating for limitation of motion of the ankle. This rating represents the maximum schedular rating under this Diagnostic Code. 38 C.F.R. § 4.71a, Diagnostic Code 5271 (2009). Upon receipt of his July 2003 claim, the Veteran was afforded a VA orthopedic examination in October 2003. He reported his involvement in a serious motor vehicle accident during military service in 1954, resulting in multiple orthopedic injuries. Concerning his right ankle, the Veteran reported some pain, morning stiffness, and numbness in the toes, but denied instability or any history of surgery or casting of the foot or ankle. On objective evaluation, the right ankle was without warmth, swelling, or erythema. Crepitus was also absent. Dorsiflexion was to 20 degrees, and plantar flexion was to 40 degrees. Inversion and eversion were within normal limits, and no ligamentous instability was observed. X-rays of the right ankle confirmed overgrowth and probable fusion in the interosseous ligament region, suggestive of an old healed fracture. Mild to moderate osteoarthritis was also present in the right ankle. The Veteran was seen by VA on an outpatient basis in January 2009 for pain of multiple joints, including the right ankle. He described his pain as longstanding, and stated he used ibuprofen for it. Another VA orthopedic examination was afforded the Veteran in April 2009. He again reported chronic right ankle pain since military service. He also experienced locking, stiffness, and swelling. He denied instability, however. On physical examination the Veteran walked with a limp, but did not require an assistance device. No tenderness, instability, or swelling was observed with the right ankle. Ligament stress tests were negative. Dorsiflexion was to 5 degrees, with pain at 3 degrees, and was to 10 degrees after use. Plantar flexion was to 25 degrees, with pain at 20 degrees. X-rays confirmed post- traumatic bony changes of the right ankle, and bony fusion between the fibula and tibia. Most recently, the Veteran was afforded a VA examination in January 2010. He claimed pain, stiffness, giving way, instability, and weakness of the right ankle. On objective examination, his right ankle displayed bony joint enlargement, crepitus, deformity, edema, and abnormal motion. His gait was characterized as unsteady and debilitated, with a very flexed posture. The Veteran, however, was able to walk without the use of assistance devices. Range of motion testing indicated dorsiflexion to 10 degrees and plantar flexion to 35 degrees. Joint ankylosis, however, was not present. The right ankle was without instability or tendon abnormality. Degenerative joint disease of the right ankle was confirmed. After considering the totality of the record, the Board finds the preponderance of the evidence to be against a disability rating in excess of 20 percent for the Veteran's degenerative joint disease of the right ankle. As noted above, the Veteran has already been awarded the maximum schedular rating for limitation of motion of the ankle under Diagnostic Code 5271. Because the Veteran has already been awarded the maximum schedular rating for limitation of motion, additional DeLuca analysis is not required. Additionally, evaluation of the Veteran's disability under other rating criteria for ankle disabilities would not result in a higher initial rating. The range of motion finding noted above reflects no ankylosis, as would warrant a higher rating under Diagnostic Code 5270. The remainder of the schedular criteria for ankle disabilities does not provide a schedular rating in excess of 20 percent. The Board notes that the Veteran and his representative have argued that the schedular criteria are inadequate for evaluation of the disability at issue. Entitlement to an extraschedular rating will be discussed below. Finally, insomuch as the Veteran's right ankle disability has demonstrated an essentially similar degrees of impairment during the pendency of this appeal, a staged rating is not warranted at the present time. See Fenderson, 12 Vet. App. at 119. At no time during the course of this appeal did the Veteran's right ankle disability more closely approximate the criteria for an increased rating. In conclusion, the preponderance of the evidence is against an initial rating in excess of 20 percent for the Veteran's degenerative joint disease of the right ankle and foot. As a preponderance of the evidence is against the award of an increased rating, the benefit-of-the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 2002); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). C. Right hip The Veteran's degenerative joint disease of the right hip is currently rated as 10 percent disabling under Diagnostic Codes 5010-5252. As noted above, Diagnostic Code 5010 refers to traumatic arthritis, and in turn makes reference to Diagnostic Code 5003, for degenerative arthritis. Diagnostic Code 5252 governs limitation of flexion of the thigh. This Code provides a 10 percent rating for flexion limited to 45 degrees, a 20 percent rating for flexion limited to 30 degrees, a 30 percent rating for flexion limited to 20 degrees, and a 40 percent rating for flexion limited to 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5252 (2009). Upon receipt of his July 2003 claim, the Veteran was afforded a VA orthopedic examination in October 2003. He reported his involvement in a serious motor vehicle accident during military service in 1954, resulting in multiple orthopedic injuries. The Veteran reported chronic pain, worsening recently, in his left hip since the accident, but none in his right. He denied any history of hip surgery or cortisone shots. On objective evaluation, the Veteran had hip flexion to 90 degrees, external rotation to 45 degrees, and abduction to 30 degrees, all bilaterally. Pain was reported in both hips, resulting in approximately 15 degrees of additional limitation of flexion, according to the examiner. X-rays of the hips confirmed severe arthropathy on the left and moderate on the right, likely not osteoarthritis. An October 2007 CT scan of the Veteran's torso confirmed significant degenerative changes of the bilateral hip joints. The Veteran was seen by VA on an outpatient basis in January 2009 for pain of multiple joints, including both hips. He described his pain as longstanding, and stated he used ibuprofen for it. Another VA orthopedic examination was afforded the Veteran in April 2009. He reported ongoing pain in both hips, along with locking, stiffness, and swelling; however, he denied instability. Pain was worse on the left than the right. He used medication for his bilateral hip pain. On physical examination the Veteran walked with a limp, but did not require an assistance device. Range of motion testing indicated flexion to 70 degrees on the right, with pain at 70 degrees, and flexion to 65 degrees after use. On the left, flexion was to 75 degrees with pain at 55 degrees, and flexion to 60 degrees after use. Extension was reduced 25 degrees bilaterally, with pain reported at the end of extension. The Veteran could not lie flat in a supine position. Abduction was to 18 degrees on the right, with pain at 12 degrees and abduction to 5 degrees after use. Abduction was to 18 degrees on the left, with pain at 15 degrees and abduction to 5 degrees after use. Adduction was to 6 degrees on the right, with pain at 4 degrees, and adduction to 5 degrees with use. Adduction was to 8 degrees on the left, with pain at 5 degrees and abduction to 8 degrees after use. External rotation was to 15 degrees bilaterally, with pain, and was 20 degrees after use on the right and 10 degrees on the left. On internal rotation, the Veteran lacked 12 degrees from neutral on the right, and 5 degrees from neutral on the left, both with pain. X-rays of the hips were negative for fracture, but confirmed severe degenerative changes bilaterally. Most recently, the Veteran was afforded a VA orthopedic examination of his hips in January 2010. He reported progressive pain and limitation of motion of the hips following his in- service motor vehicle accident. Current symptoms included pain, weakness, deformity, and stiffness of the hips. The Veteran denied, however, instability, giving way, or incoordination of the hip joints. On objective evaluation, the examiner observed deformity, malalignment, abnormal motion, and guarding of motion of the right hip. Deformity, bony joint enlargement, malalignment, crepitus, abnormal motion, and guarding of motion were also present in the left hip. The Veteran's gait was characterized as unsteady and debilitated, with a very flexed posture. Range of motion testing of the right hip indicated flexion to 60 degrees, extension to 30 degrees, and abduction to 10 degrees. On the left, the Veteran had flexion to 60 degrees, extension to 30 degrees, and abduction to 10 degrees. Pain was reported with range of motion of both hips; however, no additional limitation of motion was noted, based on pain, pain on use, incoordination, fatigability, or weakness with repetitive use. X-rays of the hip joints confirmed severe degenerative joint disease, with severe hip flexion contractures, bilaterally. After considering the totality of the record, the Board finds the preponderance of the evidence to be against a disability rating in excess of 10 percent for the Veteran's degenerative joint disease of the right hip prior to April 16, 2009. Considering first the diagnostic criteria for limitation of flexion or abduction of the right hip joint, the Veteran has not displayed limitation of either plane of motion which would support a disability rating in excess of 10 percent during this time period. According to the October 2003 VA examination report, he had flexion to 90 degrees and abduction to 30 degrees. Neither finding supports an initial rating in excess of the 10 percent assigned for this time period. In so deciding, the Board has considered whether separate ratings are warranted for limitation of both flexion and abduction of the hip, pursuant to VAOPGCPREC 9-2004. In the present case, however, the Veteran's flexion of the right hip has not been found to be 45 degrees or less at any time during the pendency of this appeal, as would warrant a compensable rating under Diagnostic Code 5252. Thus, a separate compensable rating under this Code is not warranted. The Board does find, however, that a rating of 20 percent effective April 16, 2009, is warranted under Diagnostic Code 5253, for impairment of the thigh. This Code provides a maximum schedular rating of 20 percent for limitation of abduction to 10 degrees. According to the April 2009 VA examination report, the Veteran had limitation of abduction of the right hip to 5 degrees after use. Such a finding was further confirmed on VA examination in January 2010, when abduction was restricted to 10 degrees. Based on these examination results, an initial rating of 20 percent is warranted for the Veteran's degenerative joint disease of the right hip from the date of that examination. The preponderance of the evidence is against an initial rating in excess of 20 percent for this disability. A 20 percent evaluation is the maximum schedular rating under Diagnostic Code 5253. Furthermore, at no time during the pendency of this appeal has the Veteran demonstrated flexion limited to 45 degrees, as would warrant a separate compensable rating under Diagnostic Code 5252. The Veteran also does not display ankylosis of the right hip, flail joint of the hip, or malunion of the femur as might otherwise provide an initial rating in excess of 20 percent after April 16, 2009, and in excess of 10 percent prior to that date. 38 C.F.R. § 4.71a, Diagnostic Codes 5250-55 (2009). The Veteran reports additional impairment due to such factors as pain, pain on use, fatigability, and weakness, no examiner has expressed such impairment in terms of additional limitation of motion which would further reduce his right hip range of motion; thus, an increased rating based on these factors is not warranted. See DeLuca, 8 Vet. App. at 202. Finally, insomuch as the Veteran's right hip disability has demonstrated an essentially similar degrees of impairment during the pendency of this appeal, a staged rating in excess of that already assigned is not warranted at the present time. See Fenderson, 12 Vet. App. at 119. In conclusion, the evidence of record supports the award of a 20 percent staged disability rating effective April 16, 2009, for degenerative joint disease of the right hip. As a preponderance of the evidence is against the award of an initial rating in excess of 20 percent, the benefit-of-the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 2002); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). D. Left hip The Veteran's degenerative joint disease of the left hip is currently rated as 10 percent disabling under Diagnostic Codes 5010-5252. As noted above, Diagnostic Code 5010 refers to traumatic arthritis, and in turn makes reference to Diagnostic Code 5003, for degenerative arthritis. Diagnostic Code 5252, as noted above, governs limitation of flexion of the thigh. As also noted above, the Veteran has been afforded multiple VA examinations of his hips, and those findings have already been discussed in detail within this decision. After considering the totality of the record, the Board finds the preponderance of the evidence to be against a disability rating in excess of 10 percent for the Veteran's degenerative joint disease of the left hip prior to April 16, 2009. Considering first the diagnostic criteria for limitation of flexion or abduction of the left hip joint, the Veteran has not displayed limitation of either plane which would support a disability rating in excess of 10 percent during this time period. According to the October 2003 VA examination report, he had flexion to 90 degrees and abduction to 30 degrees. Neither finding supports an initial rating in excess of the 10 percent assigned for this time period. In so deciding, the Board has considered whether separate ratings are warranted for limitation of both flexion and abduction of the hip, pursuant to VAOPGCPREC 9-2004. In the present case, however, the Veteran's flexion of the left hip has not been found to be 45 degrees or less at any time during the pendency of this appeal, as would warrant a compensable rating under Diagnostic Code 5252. Thus, a separate compensable rating under this Code is not warranted. The Board does find, however, that an increased initial rating, to 20 percent effective April 16, 2009, is warranted under Diagnostic Code 5253, for impairment of the thigh. This Code provides a maximum schedular rating of 20 percent for limitation of abduction to 10 degrees. According to the April 2009 VA examination report, the Veteran had limitation of abduction of the left hip to 5 degrees after use. Such a finding was further confirmed on VA examination in January 2010, when abduction was restricted to 10 degrees. Based on these examination results, an initial rating of 20 percent is warranted for the Veteran's degenerative joint disease of the left hip from the date of that examination. The preponderance of the evidence is against an initial rating in excess of 20 percent for this disability. A 20 percent evaluation is the maximum schedular rating under Diagnostic Code 5253. Furthermore, at no time during the pendency of this appeal has the Veteran demonstrated flexion limited to 45 degrees, as would warrant a separate compensable rating under Diagnostic Code 5252. The Veteran also does not display ankylosis of the left hip, flail joint of the hip, or malunion of the femur as might otherwise provide an initial rating in excess of 20 percent after April 16, 2009, and in excess of 10 percent prior to that date. 38 C.F.R. § 4.71a, Diagnostic Codes 5250-55 (2009). Although the Veteran reports additional impairment due to such factors as pain, pain on use, fatigability, and weakness, no examiner has expressed such impairment in terms of additional limitation of motion which would further reduce his left hip range of motion; thus, an increased rating based on these factors is not warranted. See DeLuca, 8 Vet. App. at 202. Finally, insomuch as the Veteran's left hip disability has demonstrated an essentially similar degrees of impairment during the pendency of this appeal, a staged rating in excess of that already assigned is not warranted at the present time. See Fenderson, 12 Vet. App. at 119. In conclusion, the evidence of record supports the award of a 20 percent staged disability rating effective April 16, 2009, for degenerative joint disease of the left hip. As a preponderance of the evidence is against the award of an initial rating in excess of 20 percent, the benefit-of-the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 2002); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). E. Right knee The Veteran's degenerative joint disease of the right knee is currently rated as 10 percent disabling under Diagnostic Codes 5010-5252. As noted above, Diagnostic Code 5010 refers to traumatic arthritis, and in turn makes reference to Diagnostic Code 5003, for degenerative arthritis. Limitation of motion of the knee is evaluated under Diagnostic Codes 5260 and 5261. Under Diagnostic Code 5260, a 10 percent rating is assigned for flexion limited to 45 degrees, a 20 percent rating is assigned for flexion limited to 30 degrees, and a 30 percent rating is assigned for flexion limited to 15 degrees. Pursuant to Diagnostic Code 5261, a 10 percent rating will be assigned for extension of the knee limited to 10 degrees, a 20 percent rating is assigned for extension limited to 15 degrees, a 30 percent rating for limitation to 20 degrees, and a 40 percent rating for limitation to 30 degrees. 38 C.F.R. § 4.71a, Diagnostic Codes 5260, 5261 (2009). The Board notes that on September 17, 2004, the VA General Counsel issued General Counsel Opinion (VAOPGCPREC) 9-2004, which held that a Veteran can receive separate ratings under Diagnostic Code 5260 (limitation of flexion), and Diagnostic Code 5261 (limitation of extension) for disability of the same joint. Diagnostic Code 5257, for other impairment of the knee characterized by recurrent subluxation or lateral instability, provides a 10 percent rating for slight knee impairment, a 20 percent rating for moderate impairment, and a 30 percent rating for severe impairment. 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2009). The Board is also cognizant of VAOPGCPREC 23-97, which holds that in certain cases where the Veteran has both limitation of motion and instability of the affected knee joint, a separate compensable rating may be assigned without violating 38 C.F.R. § 4.14, the regulation against pyramiding. Upon receipt of his July 2003 claim, the Veteran was afforded a VA orthopedic examination in October 2003. He reported his involvement in a serious motor vehicle accident during military service in 1954, resulting in multiple orthopedic injuries, including his knees. He reported recurrent bilateral knee pain since the accident, left worse than right, but no history of surgery. His knees occasionally locked, but did not buckle. On physical examination, the Veteran had mild crepitus in the right knee and none in the left. He was able to do deep knee bends. His knees were without warmth, swelling, or effusions. He did not use knee supports. Flexion was to 140 degrees and extension to 0 degrees, both bilaterally. Pain was reported with motion, and resulted in approximately 20 degrees of additional limitation of flexion in each knee, according to the examiner's estimation. Medial and lateral collateral ligaments were stable bilaterally. Lachmann's and McMurray's tests were negative bilaterally. X- rays of the right and left knees confirmed mild degenerative joint disease in both knees. Extensive enthesopathy with extensive spurring were visible on the right, and moderate enthesopathy with chondrocalcinosis were visible on the left. The Veteran was seen by VA on an outpatient basis in January 2009 for pain of multiple joints, including both knees. He described his pain as longstanding, and stated he used ibuprofen for it. Another VA orthopedic examination was afforded the Veteran in April 2009. He reported pain since his knee injury in service, with current complaints of locking, stiffness, swelling, and instability. He also reported a history of surgery on both knees, dates unknown. On physical examination the Veteran walked with a limp, but did not require an assistance device. The knees displayed minimal swelling and mild point tenderness, but some effusion was noted. They were without instability to valgus and varus stresses, and Lachmann's and drawer's tests were all negative. Flexion was to 115 degrees on the right, with pain at 110 degrees, and was reduced to 110 degrees with use. Extension was to 18 degrees with pain at 20 degrees, and was reduced to 20 degrees with use. Flexion was to 110 degrees on the left, with pain at 90 degrees, and remained to 110 degrees with use. Extension was to 10 degrees with pain at 12 degrees, and was reduced to 20 degrees with use. X-rays confirmed severe degenerative changes on the right and moderate to severe degenerative changes on the left. Most recently, the Veteran was afforded a VA orthopedic examination in January 2010. He reported pain, stiffness, and weakness of both knees, without giving way, incoordination, dislocation, subluxation, or instability. His gait was characterized as unsteady and debilitated, with a very flexed posture. However, the Veteran was able to walk without the use of assistance devices. On physical examination, the Veteran's knees displayed crepitus and guarding of movement. No instability or abnormality was noted, however. Range of motion testing reflected flexion to 105 degrees on the right, with extension to 10 degrees. Flexion was to 115 degrees on the left, with extension to 20 degrees. No additional limitation of motion was noted with repetitive motion. X-rays confirmed degenerative changes in both knees. After considering the totality of the record, the Board finds the preponderance of the evidence to be against a disability rating in excess of 10 percent for the Veteran's degenerative joint disease of the right knee prior to April 16, 2009. Considering first the diagnostic criteria for limitation of motion of the knee joint, the Veteran has not displayed limitation of either flexion or extension which would support a disability rating in excess of 10 percent during this time period. According to the October 2003 VA examination report, he had extension to 0 degrees and flexion to 140 degrees. Neither finding supports an initial rating in excess of the 10 percent assigned for this time period, as neither finding supports a compensable rating under Diagnostic Codes 5260 or 5261. As the evidence does not support compensable ratings under either Code for limitation of flexion or extension, the Board need not consider entitlement to separate ratings prior to April 16, 2009, for limitation of both flexion and extension pursuant to VAOPGCPREC 9-2004. On VA examination in April 2009, however, the Veteran displayed extension of the right knee limited to 20 degrees after use. Pursuant to Diagnostic Code 5261, a 30 percent rating is warranted for such limitation of motion. Therefore, affording the Veteran the benefit of the doubt, the Board finds a 30 percent disability rating effective April 16, 2009, the date of the VA examination which demonstrated such impairment, is warranted. See 38 C.F.R. §§ 4.3, 4.7 (2009). The Board also finds the preponderance of the evidence to be against an initial rating in excess of 30 percent after April 16, 2009, as the Veteran did not display either limitation of flexion or extension which would support a higher disability rating. As discussed above, the Veteran has been awarded a 30 percent rating for this time period based on limitation of extension of the right knee. During the same time period, his flexion was to at least 110 degrees, a finding which does not support a compensable rating under Diagnostic Code 5260. Therefore, a separate compensable rating for limitation of flexion, pursuant to VAOPGCPREC 9-2004, is not warranted. While the Veteran reports additional impairment due to such factors as pain, pain on use, fatigability, and weakness, no examiner has expressed such impairment in terms of additional limitation of motion which would further reduce his right knee range of motion; thus, an increased rating based on these factors is not warranted. See DeLuca, 8 Vet. App. at 202. Additionally, a separate rating is not warranted under Diagnostic Code 5257, as the evidence does not suggest instability or subluxation associated with his right knee disorder. Evaluation of the Veteran's knee disability under other diagnostic criteria is also not warranted, as he has not displayed ankylosis of the knee joint, or impairment of the tibia of fibula. Finally, insomuch as the Veteran's right knee disability has demonstrated an essentially similar degrees of impairment during the pendency of this appeal, a staged rating in excess of that already assigned is not warranted at the present time. See Fenderson, 12 Vet. App. at 119. In conclusion, the evidence of record supports the award of a 30 percent staged disability rating effective April 16, 2009, for degenerative joint disease of the right knee. As a preponderance of the evidence is against the award of an initial rating in excess of 30 percent, the benefit-of-the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 2002); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). F. Left knee The Veteran's degenerative joint disease of the left knee is currently rated as 30 percent disabling under Diagnostic Codes 5010-5252. Prior to April 16, 2009, this disability was rated as 10 percent disabling. The general criteria for the evaluation of knee disabilities have already been noted above and need not be repeated here. As also noted above, the Veteran has been afforded multiple VA examinations of his knees, and those findings have already been discussed in detail within this decision. After considering the totality of the record, the Board finds the preponderance of the evidence to be against a disability rating in excess of 10 percent prior to April 16, 2009, and in excess of 30 percent thereafter, for his degenerative joint disease of the left knee. Considering first the diagnostic criteria for limitation of motion of the knee joint, the Veteran has not displayed limitation of either flexion or extension which would support a disability rating in excess of 10 percent prior to April 16, 2009. According to the October 2004, VA examination reports, he had extension to 0 degrees and flexion to 140 degrees. Neither finding supports an initial rating in excess of the 10 percent assigned for this time period as neither finding supports a compensable rating under Diagnostic Codes 5260 or 5261. As the evidence does not support compensable ratings under either Code for limitation of flexion or extension, the Board need not consider entitlement to separate ratings prior to April 16, 2009, for limitation of both flexion and extension, pursuant to VAOPGCPREC 9-2004. On VA examination in April 2009, however, the Veteran displayed extension of the left knee limited to 20 degrees after use. Pursuant to Diagnostic Code 5261, a 30 percent rating has already been assigned by the RO for such limitation of motion. The Board further finds the preponderance of the evidence to be against an initial rating in excess of 30 percent after April 16, 2009, as the Veteran did not display either limitation of flexion or extension which would support a higher disability rating. As discussed above, the Veteran has been awarded a 30 percent rating for this time period based on limitation of extension of the left knee. During the same time period, his flexion was to at least 110 degrees, a finding which does not support a compensable rating under Diagnostic Code 5260. Therefore, a separate compensable rating for limitation of flexion, pursuant to VAOPGCPREC 9-2004, is not warranted. The Veteran reports additional impairment due to such factors as pain, pain on use, fatigability, and weakness, no examiner has expressed such impairment in terms of additional limitation of motion which would further reduce his left knee range of motion; thus, an increased rating based on these factors is not warranted. See DeLuca, 8 Vet. App. at 202. Additionally, a separate rating is not warranted under Diagnostic Code 5257, as the evidence does not suggest instability or subluxation associated with his left knee disorder. Evaluation of the Veteran's knee disability under other diagnostic criteria is also not warranted, as he has not displayed ankylosis of the knee joint, or impairment of the tibia of fibula. Finally, insomuch as the Veteran's left knee disability has demonstrated an essentially similar degrees of impairment during the pendency of this appeal, a staged rating in excess of that already assigned is not warranted at the present time. See Fenderson, 12 Vet. App. at 119. At no time during the pendency of this appeal did the Veteran's left knee disability more closely approximate the criteria for a higher rating. In conclusion, the preponderance of the evidence is against an initial rating in excess of 10 percent prior to April 16, 2009, and in excess of 30 percent thereafter, for degenerative joint disease of the left knee. As a preponderance of the evidence is against the award of an increased initial rating, the benefit-of- the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 2002); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55- 57 (1991). G. Sternum The Veteran's service-connected sternum disability is currently rated as noncompensable under Diagnostic Codes 5399-5321. Diagnostic Code 5321 is used in rating injuries to Muscle Group XXI. The muscles involved in MG XXI include the muscles of respiration, thoracic muscle group. Muscle disability under this provision for the non-dominant group is evaluated as follows: slight (0 percent); moderate (10 percent); moderately severe (20 percent), and severe (30 percent). A VA orthopedic examination was afforded the Veteran in April 2009. He reported a history of pain of the neck, sternum, and ribs following his in-service motor vehicle accident in 1954. On objective examination the Veteran had prominence of the sternum and slight deviation of the thyroid cartridge. Tenderness of the sternum ribs and thyroid cartilage was noted. The sternum was within normal limits on X-ray examination. More recently, the Veteran was afforded VA examination in January 2010. He reported chronic pain and tenderness of the chest and sternum area. He also reported some problems swallowing, requiring water with his food to "flush it down." On physical examination some deviation of the thyroid cartilage was observed. No related physical impairment was noted. After considering the totality of the record, the Board finds the preponderance of the evidence to be against the award of a compensable initial rating for sternum tenderness, costochondritis, and/or Tietze's syndrome. According to the various VA examinations of record, the Veteran has little to no functional impairment related to this disability. His reported symptoms are limited to some tenderness of the upper chest area, and while he has reported some difficulty swallowing, this symptom has not affected his overall health or state of nutrition. As discussed above, Muscle Group XXI involves muscles used in respiration. In the present case, the Veteran is not shown to have any significant respiratory impairment related to this injury. In the absence of any objective impairment related to this disability, a compensable initial rating is not warranted. See 38 C.F.R. § 4.31 (2009). Finally, insomuch as the Veteran's sternum disability has demonstrated an essentially similar degrees of impairment during the pendency of this appeal, a staged rating is not warranted at the present time. See Fenderson, 12 Vet. App. at 119. At no time during the pendency of this appeal did the Veteran's sternum disability more closely approximate the criteria for a higher rating. In conclusion, the preponderance of the evidence is against a compensable initial rating for sternum tenderness, costochondritis, and/or Tietze's syndrome. As a preponderance of the evidence is against the award of an increased initial rating, the benefit-of-the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 2002); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). III. Extraschedular consideration Consideration has also been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the Veteran. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009) (claim for an increased rating includes consideration of whether a total disability rating by reason of individual unemployability is warranted under the provisions of 38 C.F.R. § 4.16). Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2009). To accord justice in an exceptional case where the schedular standards are found to be inadequate, the RO is authorized to refer the case to the Chief Benefits Director or the Director, Compensation and Pension Service for assignment of an extraschedular evaluation commensurate with the average earning capacity impairment. 38 C.F.R. § 3.321(b)(1) (2009). The criterion for such an award is a finding that the case presents an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical application of regular schedular standards. Id. The Court has held that the Board is precluded by regulation from assigning an extraschedular rating under 38 C.F.R. § 3.321(b)(1) in the first instance; however, the Board is not precluded from raising this question, and in fact is obligated to liberally read all documents and oral testimony of record and identify all potential theories of entitlement to a benefit under the law and regulations. Floyd v. Brown, 9 Vet. App. 88 (1996). The Court further held that the Board must address referral under 38 C.F.R. §3.321(b)(1) only where circumstances are presented which the Director of VA's Compensation and Pension Service might consider exceptional or unusual. Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). In Thun v. Peake, 22 Vet. App. 111 (2008), the Court clarified the analytical steps necessary to determine whether referral for extraschedular consideration is warranted. Either the RO or the Board must first determine whether the schedular rating criteria reasonably describe the Veteran's disability level and symptomatology. Id. at 115. If the schedular rating criteria do reasonably describe the Veteran's disability level and symptomatology, the assigned schedular evaluation is adequate, referral for extraschedular consideration is not required, and the analysis stops. If the RO or the Board finds that the schedular evaluation does not contemplate the Veteran's level of disability and symptomatology, then either the RO or the Board must determine whether the Veteran's exceptional disability picture includes other related factors such as marked interference with employment and frequent periods of hospitalization. Id. at 116. If this is the case, then the RO or the Board must refer the matter to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for the third step of the analysis, determining whether justice requires assignment of an extraschedular rating. Id. In this case, the symptoms described by the Veteran fit appropriately with the criteria found in the relevant Diagnostic Codes for the disabilities at issue. The Board observes the Veteran is retired, and has not required recent or extended hospitalization for his service-connected disabilities during the pendency of this appeal. Additionally, no examiner has stated the Veteran's service-connected disabilities, in and of themselves, cause any marked interference with employment. In short, the rating criteria contemplate not only his symptoms but the severity of his disabilities. The Board does not find that the schedular criteria have been inadequate for rating the manifestations of the service-connected disabilities at issue. See 38 U.S.C.A. § 1155 (Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity). For these reasons, referral for extraschedular consideration is not warranted. ORDER Entitlement to an initial rating in excess of 20 percent for glenohumeral and acromioclavicular degenerative joint disease of the left shoulder, claimed as bursitis, is denied. Entitlement to an initial rating in excess of 20 percent for degenerative joint disease of the right ankle and foot is denied. Entitlement to an initial rating of 20 percent but no greater, effective April 16, 2009, for degenerative joint disease of the right hip is granted. Entitlement to an initial rating of 20 percent but no greater, effective April 16, 2009, for degenerative joint disease of the left hip is granted. Entitlement to an initial rating of 30 percent but no greater, effective April 16, 2009, for degenerative joint disease of the right knee is granted. Entitlement to an initial rating in excess of 10 percent prior to April 16, 2009, and in excess of 30 percent thereafter, for degenerative joint disease of the left knee is denied. Entitlement to a compensable initial rating for sternum tenderness, costochondritis, and/or Tietze's syndrome is denied. REMAND The Veteran seeks an increased initial rating for his spondylosis with degenerative disc disease of the lumbosacral spine. Effective September 26, 2003, VA revised the criteria for the evaluation of diseases and injuries of the spine. See 68 Fed. Reg. 51454-58 (August 27, 2003) (codified at 38 C.F.R. § 4.71a, Diagnostic Codes 5235-43). When a law or regulation changes while an appeal is pending, the version most favorable to the claimant applies, absent legislative intent to the contrary. See Dudnick v. Brown, 10 Vet. App. 79 (1997). Revised statutory or regulatory provisions, however, may not be applied to any time period before the effective date of the change. See 38 U.S.C.A. § 7104(c) (West 2002); VAOPGCPREC. 3-2000 (April 10, 2000); Rhodan v. West, 12 Vet. App. 55, 57 (1998). The former rating criteria were listed at 38 C.F.R. § 4.71a, Diagnostic Codes 5285- 95. Because the Veteran's initial service connection claim for his low back disability was filed in July 2003, prior to the regulatory change, both the prior and revised diagnostic criteria apply. Id. Review of the record, however, does not indicate the Veteran was either afforded a copy of the prior rating criteria, or provided adjudication of his claim under such criteria. Because such consideration was not provided by the RO, the agency of original jurisdiction, this issue must be remanded prior to any final adjudication by the Board. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). Expedited handling is requested.) Provide the Veteran and his representative a copy of the diagnostic criteria for spinal disabilities which were in effect prior to September 26, 2003 (38 C.F.R. § 4.71a, Diagnostic Codes 5285-95). After undertaking any additional development deemed appropriate, and giving the appellant full opportunity to supplement the record, adjudicate the Veteran's pending initial rating claim for a low back disability in light of both the prior and revised criteria for spinal disabilities. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a supplemental statement of the case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. The Board offers no opinion at this time regarding the ultimate outcome of this appeal. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). ______________________________________________ JAMES L. MARCH Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs