Citation Nr: 1304099 Decision Date: 02/05/13 Archive Date: 02/08/13 DOCKET NO. 05-38 797 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Salt Lake City, Utah THE ISSUE Entitlement to a disability rating in excess of 30 percent for a right shoulder disability. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Tiffany Berry, Associate Counsel INTRODUCTION The Veteran served on active duty from July 1976 to March 1980. This matter comes to the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah, dated in September 2003, September 2004, and May and December 2010. In the September 2003 rating decision, the RO increased the Veteran's disability rating for his service-connected right acromiovclavicular separation, post operative with loss of motion, to 30 percent, effective August 20, 2003. In the September 2004 rating decision, the RO readjudicated the Veteran's increased rating claim, following the submission of new and material medical evidence pursuant to 38 C.F.R. § 3.156(b), and continued his 30 percent disability rating. In the December 2010 rating decision, the RO granted the Veteran a temporary 100 percent convalescent rating based on surgical or other treatment of his service-connected right shoulder, effective August 4, 2009. The December 2010 rating decision continued the assigned 30 percent disability rating effective October 1, 2009. In May 2010, the RO granted a separate 10 percent disability rating for the surgical scar associated with the Veteran's right shoulder, effective from May 14, 2009. In January 2009, February 2011 and April 2012 decisions, the Board remanded the Veteran's appeal to the RO via the Appeals Management Center (AMC), in Washington, D.C., for further development. All requested actions have been completed and the claim is once again before the Board. FINDINGS OF FACT 1. The Veteran is right-handed. 2. The Veteran's right shoulder disability is at most, limited to abduction to 50 degrees, with painful motion; it is not manifested by ankylosis, or a fibrous union or nonunion of the humerus, or loss of the head of the humerus. 3. The Veteran's surgical scar on the right shoulder is not manifest by three or four scars that are unstable or painful. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 30 percent for the right shoulder disability have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. § 4.71a, Diagnostic Code 5299-5201 (2012). 2. The criteria for a rating in excess of 10 percent for a scar on the right shoulder have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. § 4.118, Diagnostic Code 7804 (2012) REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. The Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100 , 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002 & Supp. 2011)) redefined VA's duty to assist a claimant in the development of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2012). The notice requirements of the VCAA require VA to notify a claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, VA will attempt to obtain. 38 C.F.R. § 3.159(b). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between a veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VCAA notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO, to include the AMC). Id.; see also Pelegrini v. Principi, 18 Vet. App. 112 (2004). However, insufficiency in the timing or content of VCAA notice is harmless if the errors are not prejudicial to the claimant. See Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004) (holding that VCAA notice errors are reviewed under a prejudicial error rule). In this case, the Veteran was provided VCAA notice in August 2003, March 2006, January 2009, September 2010, March 2011, and April 2012 letters, advising him of what information and evidence is needed to substantiate his claim for an increased rating, as well as what information and evidence must be submitted by the Veteran and what information and evidence will be obtained by VA. The March 2006 and January 2009s letter advised him of how disability evaluations and effective dates are assigned and the type of evidence that impacts those determinations. The case was last adjudicated in November 2012. The record also reflects that VA has made reasonable efforts to obtain relevant records adequately identified by the Veteran, including service treatment records, VA and private treatment records, VA examination reports and medical opinions, and lay statements. The Board also notes that actions requested in the prior remands have been undertaken. Here, additional VA records were obtained and associated with the paper and electronic claims file, including treatment records dated through April 2012. An additional VA joints examination was conducted in November 2012 that was responsive to the applicable criteria for evaluating shoulder disabilities. Thus, the Board finds that the remand directives have been substantially complied with, and a decision on the merits can proceed. See D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict, compliance with the terms of a Board remand is required pursuant to Stegall v. West, 11 Vet. App. 268 (1998)). VA has considered and complied with the VCAA provisions discussed above. The Veteran was notified and aware of the evidence needed to substantiate his claim, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. The Veteran was an active participant in the claims process by submitting evidence and argument. Thus, the Veteran was provided with a meaningful opportunity to participate in the claims process and has done so. Any error in the sequence of events or content of the notices is not shown to have affected the essential fairness of the adjudication or to cause injury to the Veteran. Therefore, any such error is harmless and does not prohibit consideration of this matter on the merits. See Conway, 353 F.3d at 1374; Dingess, 19 Vet. App. 473; see also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). II. Increased Ratings The Board has reviewed all the evidence in the Veteran's claims file and electronic Virtual VA file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history; reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; assigning the higher rating where there is a question as to which of two evaluations apply and where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and evaluating functional impairment on the basis of lack of usefulness, and the effects of the disabilities upon the person's ordinary activity, 38 C.F.R. § 4.10. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of a Veteran's condition. Schafrath, 1 Vet. App. at 594. However, where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. When evaluating joint disabilities rated on the basis of limitation of motion, VA may consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; Mitchell v. Shinseki, 25 Vet App 32 (2011); see also DeLuca v. Brown, 8 Vet. App. 202 (1995). Functional loss due to pain is rated at the same level as functional loss where motion is impeded. See Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Pursuant to 38 C.F.R. § 4.59, painful motion should be considered limited motion, even though a range of motion may be possible beyond the point when pain sets in. See Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995). Indeed, when 38 C.F.R. § 4.59 is raised by a claimant or reasonably raised by the record, even in non-arthritis contexts, the Board should address its applicability. See Burton v. Shinseki, 25 Vet App 1 (2011). In Burton, the CAVC found the Board had failed to address painful motion and the applicability of 38 C.F.R. § 4.59 to an initial disability rating for residuals of a left shoulder injury with surgical repair. Id. The Veteran's right shoulder disability is currently rated as 30 percent disabling pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5299-5201 (2012). Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. In this case, Diagnostic Code 5299 is used to identify disabilities of the musculoskeletal system that are not specifically listed in the schedule, but are rated by analogy to similar disabilities under the schedule. Diagnostic Code 5201 is used in rating limitation of motion of the arm. In addition, his right shoulder disability is evaluated under the criteria for a major extremity because, as noted in the evidence below, he is right-handed. See 38 C.F.R. § 4.69. For VA purposes, normal range of motion of the shoulder is: forward flexion from 0 to 180 degrees; abduction from 0 to 180 degrees; external rotation from 0 to 90 degrees; and internal rotation from 0 to 90 degrees. 38 C.F.R. § 4.71, Plate I (2012). Pursuant to the rating schedule, limitation of motion of the arm is evaluated as follows: at shoulder level, 20 percent (major or minor extremity); midway between side and shoulder level [abduction], 30 percent (major extremity); and to 25 degrees from side [abduction], 40 percent (major extremity). 38 C.F.R. § 4.71a, Diagnostic Code 5201. Favorable and unfavorable ankylosis of the scapulohumeral articulation of the major extremity is evaluated as 30 percent disabling, or more. 38 C.F.R. § 4.71a, Diagnostic Code 5200. Impairment of the humerus is rated under Diagnostic Code 5202. That provision provides that malunion of the humerus of the major shoulder and arm warrants a rating of 20 percent for moderate deformity and 30 percent for marked deformity. Recurrent dislocation of the humerus at the scapulohumeral joint of the major shoulder or arm warrants a rating of 20 percent with infrequent episodes and guarding of movement only at the shoulder level and all arm movements, and a 30 percent rating with frequent episodes and guarding of all arm movements. For the major shoulder or arm, fibrous union of the humerus warrants a 50 percent rating, nonunion of the humerus (false flail joint) warrants a 60 percent rating, and loss of the head of the humerus (flail shoulder) warrants an 80 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5202. Impairment of the clavicle or scapula is rated under Diagnostic Code 5203. That provision provides that malunion of the clavicle or scapula, or nonunion without loose movement, warrants a 10 percent rating. Nonunion with loose movement or dislocation of the clavicle or scapula warrants a 20 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5203. The Veteran also has a disability rating of 10 percent, effective from May 14, 2009, for a scar on the right shoulder, which was determined to be inextricably intertwined with the increased rating for the right shoulder disability. Specifically, the Board remanded this increased rating claim for the right shoulder in January 2009, and the RO granted a separate disability rating of 10 percent for the scar, in a May 2010 rating decision. The rating criteria for Diagnostic Codes 7800 - 7804 were amended effective October 2008; those revisions are applicable to claims for benefits received by the VA on or after October 23, 2008 and are for application in this claim. See 73 Fed. Reg. 54708 (September 23, 2008). Burn scars, or scars due to other causes, that are not of the head, face, or neck, that are deep and nonlinear are evaluated pursuant to Diagnostic Code 7801. A scar of an area or areas of 144 square inches (929 sq. cm.) or greater warrants an evaluation of 40 percent. A scar of an area or areas of at least 72 square inches (465 sq. cm.) but less than 144 square inches (929 sq. cm.) warrants an evaluation of 30 percent. A scar of an area or areas of at least 12 square inches (77 sq. cm.) but less than 72 square inches (465 sq. cm.) warrants an evaluation of 20 percent. A scar of an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.) warrants an evaluation of 10 percent. 38 C.F.R. § 4.118, Diagnostic Code 7801. A deep scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7801, Note 1. If multiple qualifying scars are present, or if a single qualifying scar affects more than one extremity, or a single qualifying scar affects one or more extremities and either the anterior portion or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, applicable regulation directs assignment of a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity, assignment of a separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assignment of a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. The midaxillary line on each side separates the anterior and posterior portions of the trunk. The separate evaluations are then combined under § 4.25. Qualifying scars are scars that are nonlinear, deep, and are not located on the head, face, or neck. 38 C.F.R. § 4.118, Diagnostic Code 7801, Note 2. Scars that are unstable or painful are evaluated pursuant to Diagnostic Code 7804. Five or more scars that are unstable or painful warrant an evaluation of 30 percent. Three or four scars that are unstable or painful warrant an evaluation of 20 percent. One or two scars that are unstable or painful warrant an evaluation of 10 percent. 38 C.F.R. § 4.118, Diagnostic Code 7804. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118, Diagnostic Code 7804, Note 1. If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. 38 C.F.R. § 4.118, Diagnostic Code 7804, Note 2. Pursuant to Diagnostic Code 7805, other scars, including linear scars, and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, and 7804 are evaluated based upon any disabling effect(s), not considered in a rating provided under diagnostic codes 7800-04, under an appropriate diagnostic code. 38 C.F.R. § 4.118, Diagnostic Code 7805. On VA examination in September 2003, the Veteran reported that he is right handed. He also stated he experiences constant pain in the right shoulder, aggravated by any attempts at lifting, with reduced range of motion of the shoulder. On physical examination, the examiner noted palpable tenderness over the entire superior aspect of the right shoulder. Range of motion was noted to be markedly reduced with pain at 45 degrees of forward flexion, 50 degrees of abduction, and 50 degrees for both internal and external rotation. The shoulder girdle multi-strength was reduced to 3/5, and hand grip strength was 40 on the grip meter for the right hand, compared to 80 for the left hand. The examiner assessed the Veteran as status post Mumford procedure for traumatic acromioclavicular separation of the right shoulder and excision of the distal clavicle with residual constant pain, markedly reduced range of motion and residual 3/5 motor weakness in the right shoulder girdle and weakness in the right hand grip. X-rays, also dated in September 2003, indicated the right shoulder demonstrates stable appearance of the postsurgical changes at the AC joint. There were no significant glenohumeral degenerative changes, fractures, or dislocations. The subacromial space was preserved, and the visualized portions over the hemithorax were unremarkable. Concerning the scar on the right shoulder as a result of the Veteran's previous surgery, the examiner stated it is a healed 6 centimeter by 2 centimeter surgical scar, proximal to the apex of the right shoulder with an obvious depressed deformity over the distal clavicle. No further physical findings were noted. The Veteran underwent an evaluation of his right shoulder in March 2004. The Veteran again reported complaints of pain. The treating physician noted the Veteran has forward elevation to 180 degrees, internal rotation to T12, and external rotation to 90 degrees. Positive Neer's and Hawkins's signs were both noted. An MRI, taking during the March 2004 evaluation report noted a linear tear at the undersurface of the superior labrum, consistent with a focal labral tear. The Veteran was also identified as a Mumford- type clavicular resection patient with irregular margins remaining, indicating probable posttraumatic changes. Additionally, bursal-side fraying of the supraspinatus tendon with associated tendinopathy was noted. In May 2005, the Veteran was scheduled for another VA examination to reassess the severity of his right shoulder disability. The examiner again indicated the Veteran is right handed, and noted his complaints of chronic right shoulder pain, aggravated by lifting and easy fatigue. The Veteran reported flare-ups, with pain rating a 10/10. Upon physical examination, flexion was noted to be 145 degrees, with pain beginning at 80 degrees; extension to 30 degrees, with pain at the extreme; abduction to 180 degrees, with pain beginning at 70 degrees; adduction to 25 degrees, with pain at the extreme; internal rotation to 90 degrees, with no pain; and external rotation to 60 degrees, with pain at the extreme. The examiner also noted positive crepitus in the right shoulder. Additionally, the examiner stated the right shoulder appeared to be lower than the left shoulder, when the Veteran is standing with normal posture. No muscle atrophy was noted, but there was increased pain and fatigue upon repetitive motion. However, the Veteran denied any decreased range of motion, weakness, or incoordination with repetitive motion or during flare-ups. X-rays taken during the March 2005 VA examination also showed evidence of remote acromioclavicular separation and post-surgical changes of distal right clavicle resection. Additionally, coracoclavicular ligamentous dystrophic calcifications were notable. However, the examiner stated that appearance is not significantly changed from the prior examination. Concerning the scar on the right shoulder due to the Veteran's surgery for this disability, the examiner indicated that it measured 5 centimeters by 1 centimeter, and described it as mildly erythematous, flat, stable, and well-healed. There was no sign of keloid formations, induction, inflammation, or edema. Additionally, the scar was found to be non-tender to palpation, but the Veteran did report decreased sensation in the area. The examiner determined the scar was not adherent to underlying tissues. In April 2006, the Veteran received treatment at a VA medical center for right shoulder impingement with mild acromioclavicular joint distal clavicle tenderness. He received a corticosteroid injection. In May 2009, the Veteran's right shoulder was again reexamined. The examiner again indicated the Veteran is right handed, and describes a pain of 4 out of 10 on a constant basis, with flare-ups a 10 out of 10, twice weekly. The Veteran states overhead activity aggravated his pain. The examiner also noted the Veteran's posture is normal, and he does not use assistive devices. Upon physical examination, the Veteran's range of motion was abduction to 90 degrees, with pain at 90 degrees. The Veteran was eventually able to abduct to 145 degrees, but experienced pain. External rotation was to 90 degrees, without pain; but, internal rotation was to 45 degrees, with pain. The examiner also noted tenderness on the superior aspect of the shoulder. There was additional loss of range of motion by about 10 degrees of the right shoulder joint due to pain and impaired endurance as a result of repetitive active or passive range of motion. Ultimately, the examiner confirmed the prior diagnoses of states post Mumford procedure for acromioclavicular separation. The clinical examination was consistent with an impingement syndrome in the right shoulder. Concerning the scar, the examiner noted there is a 1 1/2 inch by 1 inch scar on the top of the right shoulder. It was described as slightly tender, with mild keloid formation, but is not inflamed. An August 2009 private treatment record from Dr. Kimball shows the Veteran underwent a right shoulder arthroscopy procedure. However, no range of motion findings were included in the private treatment record. In June 2011, in connection with a claim of entitlement to a total disability rating based on individual unemployability, since denied, the Veteran's right shoulder was re-evaluated. At that time, the examiner determined the range of motion of the right shoulder, the examiner stated he removed his shirt and the examiner could see flexion was to 160 degrees, but during the examination, flexion was only to 65 degrees. Abduction was to 65 degrees, external rotation to 30 degrees, and internal rotation to 60 degrees. The Veteran reported pain through the range of motion for all ranges. His extremity strength was 5/5, i.e., normal, with normal muscle tone and bulk. The examiner also noted the right shoulder does not reveal any atrophy, posture abnormalities, fixed deformities, or abnormalities in musculature. There is painful motion and tenderness over the acromioclavicular joint, and severe guarding was noted on examination to the point where it rendered the examination invalid. Concerning the scar, the June 2011 examiner described it as a 6 centimeter by 2 centimeter, linear scar that is not painful. The scar is mildly indented and is hyperpigmented compared to the surrounding tissue, but is not adhered to the underlying tissue. The examiner noted a mild amount of underlying tissue loss. The scar does not restrict range of motion of the right shoulder joint. Additionally, there is no instability, ulceration, breakdown, or elevation of the depression. It is noted to be superficial, with no inflammation, edema, or keloid formations. X-rays conducted in July 2011 showed no evidence of acute fractures, but did indicate osseous irregularity of the mid-clavicle with several adjacent corticated osseous fragments, compatible with remote trauma. The examiner determined the Veteran's right shoulder post-surgical and posttraumatic appearance of the clavicle was unchanged. The Veteran was most recently re-evaluated in November 2012, pursuant to the Board's April 2012 remand directives, to determine the current severity of his right shoulder disability. The Veteran's reported symptoms include pain, described as fatigue and burning, which is exacerbated by with overhead movement. He also complained of popping and grinding in the right shoulder, with morning stiffness. The Veteran stated that flare-ups impact the functioning of his right shoulder. Upon objective physical examination, range of motion findings were found to be flexion to 95 degrees, with pain at 50 degrees; and abduction to 85 degrees, with pain at 85 degrees. The Veteran was able to perform repetitive use testing with three repetitions. No additional limitation in the range of motion, functional loss, or impairment as a result of repetitive use testing. Localized tenderness of the right shoulder was noted, but no guarding. Muscle strength was 4/5 for right shoulder abduction and forward flexion. Additionally, ankylosis of the glenohumeral articulation was found on abduction of the right shoulder, limited between 60 and 25 degrees. Hawkins' impingement test, Empty-can test, external rotation infrasuprspinatus strength test, and lift-off subscapularos tests were all positive for the right side. No recurrent dislocation/ subluxation of the glenohumeral joint was noted, or impairment of the clavicle or scapula. Additionally, the Veteran has not had total joint replacement for the right shoulder. The examiner noted that it is difficult to assign a percentage of change concerning the right shoulder disability as the Veteran's remarks regarding the ability remove his shirt without difficulty, and swimming, are incompatible with the range of motion measure during the examination. The examiner indicated the Veteran's range of motion as better in the November 2012 examination than the June 2011 examination. For example, flexion is to 95 degrees in November 2012, but only 65 during the June 2011 examination. Further, abduction is 85 degrees November 2012, but only 65 degrees in June 2011. Consequently, the examiner stated there appears to be an increase in the Veteran's range of motion by about 30 degrees, and no pain to palpation of the AC joint. Concerning the Veteran's scar on the right shoulder, the November 2012 VA examiner determined that it was not painful or unstable, and the total are of all related scars is not greater than 39 square centimeters, or 6 square inches. No further testing concerning the scar was noted. Finally, VA treatment records dated through April 2012 are associated with the Veteran's virtual VA claims file. These VA treatment records note the Veteran's continuous treatment for his right shoulder disability, and complaints of pain. However, there are no additional range of motion findings relevant to this right shoulder. After a review of the evidence of record, the Board finds that a rating in excess of 30 percent for the right shoulder disability is not warranted. Objective medical evidence reflects that the Veteran's right shoulder disability is manifested at worst by abduction to 50 degrees with pain, as stated in the September 2003 VA examination; abduction was documented at 50 degrees (midway between the side and shoulder) or much greater, up to 145, as noted in the May 2009 VA examination, albeit with significant pain. These findings are consistent with the 30 percent rating currently in effect for the Veteran's right shoulder disability. A higher rating is not warranted because the evidence of record does not reflect arm motion limited to 25 degrees from the side, even considering the Veteran's complaints of pain and functional impairment. See Mitchell, Burton, and DeLuca, supra. Nor does the evidence reveal ankylosis, or a fibrous union or nonunion of the humerus, or loss of the head of the humerus. The Board notes the November 2012 VA examiner's notation that the Veteran has ankylosis, with abduction limited between 25 and 60 degrees for the right shoulder. However, the fact that he has motion in his right shoulder is evidence against a finding of ankylosis. See Dorland's Illustrated Medical Dictionary 94 (31st ed.2007) (defining ankylosis as "immobility and consolidation of a joint due to disease, injury, or surgical procedure."). See also Cullen v. Shinseki, 24 Vet. App. 74, 77 (2010). Thus, the criteria for a rating in excess of 30 percent for a right shoulder disability have not been more nearly approximated. Additionally, a rating in excess of 10 percent for the right shoulder scar is not warranted at any point during the appeals period. As an initial matter, the Veteran only has one scar associated with the right shoulder disability. Further, the right shoulder scar has never been described as 12 square inches or greater, or affect the function of the Veteran's right shoulder. Finally, the right shoulder scar has never been described as unstable, at any point during this appeal. Therefore, entitlement to a disability rating higher than 10 percent for the scar, is not warranted. 38 C.F.R. § 4.118, DC 7804. Upon consideration of the record, the Board concludes that the medical findings on examination are of greater probative value than the Veteran's allegations regarding the severity of his right shoulder disability. The Board is mindful of his complaints of pain, difficulty raising his right arm, and continuous treatment. However, the Board finds that the preponderance of the evidence is against the claim for a rating in excess of 30 percent for right shoulder disability based on the objective range of motion findings exhibited in his numerous VA examinations. As a final matter, the Board has also considered whether the Veteran's right shoulder disability and associated scar present an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards such that referral to the appropriate officials for consideration of an extraschedular rating is warranted. See 38 C.F.R. § 3.321(b)(1) (2012); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993) ("[R]ating schedule will apply unless there are 'exceptional or unusual' factors which render application of the schedule impractical."). Here, the rating criteria reasonably describe the Veteran's disability level and symptomatology, and provide for higher ratings for additional or more severe symptomatology than is shown by the evidence. Thus, his disability picture is contemplated by the rating schedule, and the assigned schedular evaluation is, therefore, adequate. See Thun v. Peake, 22 Vet. App. 111, 115 (2008). Consequently, referral for extraschedular consideration is not warranted. For all the foregoing reasons, the Board finds that the most probative and credible evidence does not support the assignment of a rating in excess of 30 percent for a right shoulder disability and 10 percent for the associated scar at any point during the course of the claim. See Hart, 21 Vet. App. 505. Therefore, entitlement to increased ratings is not warranted, and the claims must be denied. In reaching the conclusions above, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim for a higher rating, that doctrine is not applicable. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). ORDER Entitlement to a rating in excess of 30 percent for a right shoulder disability is denied. Entitlement to a rating in excess of 10 percent for a scar of the right shoulder is denied. ____________________________________________ M. G. MAZZUCCHELLI Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs