Citation Nr: 18145585 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 14-10 791 DATE: October 29, 2018 ORDER From November 1, 2011, to March 25, 2018, entitlement to an initial rating of 20 percent, but no greater, for degenerative joint disease of the lumbar spine is granted, subject to the laws and regulations governing the payment of monetary benefits. From March 26, 2018, entitlement to a rating in excess of 20 percent for degenerative joint disease of the lumbar spine is denied. From November 1, 2011, to March 25, 2018, entitlement to an initial rating of 20 percent, but no greater, for degenerative joint disease of the left shoulder is granted, subject to the laws and regulations governing the payment of monetary benefits. From November 1, 2011, to March 25, 2018, entitlement to an initial rating of 20 percent, but no greater, for degenerative joint disease of the right shoulder is granted, subject to the laws and regulations governing the payment of monetary benefits. From March 26, 2018, entitlement to a rating in excess of 20 percent for degenerative joint disease of the left shoulder is denied. From March 26, 2018, entitlement to a rating of 30 percent, but no greater, for degenerative joint disease of the right shoulder is granted, subject to the laws and regulations governing the payment of monetary benefits. From November 1, 2011, to March 25, 2018, entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the left elbow is denied. From November 1, 2011, to March 25, 2018, entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the right elbow is denied. From March 26, 2018, entitlement to a rating in excess of 20 percent for degenerative joint disease of the left elbow is denied. From March 26, 2018, entitlement to a rating in excess of 30 percent for degenerative joint disease of the right elbow is denied. From November 1, 2011, to March 25, 2018, entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the left ankle is denied. From November 1, 2011, to March 25, 2018, entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the right ankle is denied. From March 26, 2018, entitlement to a rating of 20 percent, but no greater, for degenerative joint disease of the left ankle is granted, subject to the laws and regulations governing the payment of monetary benefits. From March 26, 2018, entitlement to a rating of 20 percent, but no greater, for degenerative joint disease of the right ankle is granted, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the left hip is denied. Entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the right knee is denied. From March 26, 2018, entitlement to an initial rating of 10 percent, but no greater, for degenerative joint disease of the right knee with limitation of extension is granted, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to a compensable rating for hydrocele is denied. FINDINGS OF FACT 1. From November 1, 2011, to March 25, 2018, the Veteran’s degenerative joint disease of the lumbar spine is characterized by forward flexion between 60 and 75 degrees with minimal functional loss during flare-ups. 2. From March 26, 2018, the Veteran’s degenerative joint disease of the lumbar spine is characterized by forward flexion of 45 degrees with painful motion. 3. From November 1, 2011, to March 25, 2018, the Veteran’s degenerative joint disease of the left shoulder is characterized by noncompensable limitation of motion with painful motion. 4. From November 1, 2011, to March 25, 2018, the Veteran’s degenerative joint disease of the right shoulder is characterized by noncompensable limitation of motion with painful motion. 5. From March 26, 2018, the Veteran’s degenerative joint disease of the left shoulder is characterized by limitation of shoulder motion at shoulder level with painful motion and functional loss after repetitive-use testing. 6. From March 26, 2018, the Veteran’s degenerative joint disease of the right shoulder is characterized by limitation of shoulder motion at shoulder level with painful motion and functional loss after repetitive-use testing. 7. From November 1, 2011, to March 25, 2018, the Veteran’s degenerative joint disease of the left elbow is characterized by noncompensable limitation of motion with painful motion. 8. From November 1, 2011, to March 25, 2018, the Veteran’s degenerative joint disease of the right elbow is characterized by noncompensable limitation of motion with pain. 9. From March 26, 2018, the Veteran’s degenerative joint disease of the left elbow is characterized by limitation of pronation with motion lost beyond the middle of the arc. 10. From March 26, 2018, the Veteran’s degenerative joint disease of the right elbow is characterized by limitation of pronation with motion lost beyond the middle of the arc. 11. From November 1, 2011, to March 25, 2018, the Veteran’s degenerative joint disease of the left ankle is characterized by moderate limitation of motion with painful motion. 12. From November 1, 2011, to March 25, 2018, the Veteran’s degenerative joint disease of the right ankle is characterized by moderate limitation of motion with painful motion. 13. From March 26, 2018, the Veteran’s degenerative joint disease of the left ankle is characterized by marked limitation of motion with painful motion. 14. From March 26, 2018, the Veteran’s degenerative joint disease of the right ankle is characterized by marked limitation of motion with painful motion. 15. The Veteran’s degenerative joint disease of the left hip is characterized by noncompensable limitation of motion with painful motion. 16. The Veteran’s degenerative joint disease of the right knee is characterized by noncompensable limitation of motion with painful motion. 17. From March 26, 2018, the Veteran’s degenerative joint disease of the right knee is characterized by limitation of extension with pain. 18. The Veteran’s hydrocele is not characterized by atrophy of either testicle. CONCLUSIONS OF LAW 1. From November 1, 2011, to March 25, 2018, the criteria for an initial disability rating of 20 percent, but no greater, for degenerative joint disease of the lumbar spine have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5003-5242. 2. From March 26, 2018, the criteria for a disability rating in excess of 20 percent for degenerative joint disease of the lumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5003-5242. 3. From November 1, 2011, to March 25, 2018, the criteria for an initial disability rating of 20 percent, but no greater, for degenerative joint disease of the left shoulder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5201-5003. 4. From November 1, 2011, to March 25, 2018, the criteria for an initial disability rating of 20 percent, but no greater, for degenerative joint disease of the right shoulder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5201-5003. 5. From March 26, 2018, the criteria for a disability rating in excess of 20 percent for degenerative joint disease of the left shoulder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5201-5003. 6. From March 26, 2018, the criteria for a disability rating of 30 percent, but no greater, for degenerative joint disease of the right shoulder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5201-5003. 7. From November 1, 2011, to March 25, 2018, the criteria for an initial disability rating in excess of 10 percent for degenerative joint disease of the left elbow have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5003-5207. 8. From November 1, 2011, to March 25, 2018, the criteria for an initial disability rating in excess of 10 percent for degenerative joint disease of the right elbow have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5003-5207. 9. From March 26, 2018, the criteria for a disability rating in excess of 20 percent for degenerative joint disease of the left elbow have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5003-5207. 10. From March 26, 2018, the criteria for a disability rating in excess of 30 percent for degenerative joint disease of the right elbow have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5003-5207. 11. From November 1, 2011, to March 25, 2018, the criteria for an initial disability rating in excess of 10 percent for degenerative joint disease of the left ankle have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5003-5271. 12. From November 1, 2011, to March 25, 2018, the criteria for an initial disability rating in excess of 10 percent for degenerative joint disease of the right ankle have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5003-5271. 13. From March 26, 2018, the criteria for a disability rating of 20 percent, but no greater, for degenerative joint disease of the left ankle have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5003-5271. 14. From March 26, 2018, the criteria for a disability rating of 20 percent, but no greater, for degenerative joint disease of the right ankle have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5003-5271. 15. The criteria for an initial disability rating in excess of 10 percent for degenerative joint disease of the left hip have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5299-5252. 16. The criteria for an initial disability rating in excess of 10 percent for degenerative joint disease of the right knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5003-5260. 17. From March 26, 2018, the criteria for an initial disability rating of 10 percent, but no greater, for degenerative joint disease of the right knee with limitation of extension have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.71a, Diagnostic Code 5003-5261. 18. The criteria for an initial compensable disability rating for hydrocele have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1–4.14, 4.115b, Diagnostic Code 7523. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1985 to February 1989 and from May 1991 to October 2011. In a March 13, 2017 report of contact, the Veteran stated that he wished to withdraw his request for a hearing. In a letter received March 30, 2017, the Veteran withdrew his request for a hearing. In February 2018, the Board remanded the Veteran’s claims to obtain VA examinations. Also in February 2018, the Board referred claims of entitlement to service connection for acid reflux, hearing loss, sleep apnea, and degenerative arthritis (other than related to the musculoskeletal claims on appeal here). In June 2018, the RO issued a rating decision for these claims. As no notice of disagreement has been filed, the Board will not at this time assume jurisdiction over the claims decided in the June 2018 rating decision. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R. Part 4. The percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to consider all regulations that are potentially applicable through the assertions and issues raised in the record. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings.” Hart v. Mansfield, 21 Vet. App. 505 (2007). When rating musculoskeletal disabilities, VA may, in addition to applying schedular criteria, consider granting a higher rating based on functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination, to include during flare-ups and with repeated use, when those factors are not contemplated in the relevant rating criteria. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45, 4.59. The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the Diagnostic Codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). Such inquiry is not to be limited to muscles or nerves. The limitation of motion determinations are, if feasible, to be expressed in terms of the degree of additional range of motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. DeLuca, 8 Vet. App. at 207. By itself, pain throughout a joint’s range of motion does not constitute functional loss, but if there is additional pain, the examiner must address any additional loss of motion due to the DeLuca factors. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). If a claimant is already receiving the maximum disability rating available based on symptomatology that includes limitation of motion, it is not necessary to consider whether 38 C.F.R. §§ 4.40 and 4.45 are applicable. Spencer v. West, 13 Vet. App. 376, 382 (2000); Johnston v. Brown, 10 Vet. App. 80, 85 (1997). The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011). A VA examination of the joints must, wherever possible, include range of motion testing for pain on active motion, passive motion, weight-bearing, nonweight-bearing, and, if possible, with the range of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158, 169–70 (2016); 38 C.F.R. § 4.59. An examiner must provide an opinion regarding additional range of motion loss due to pain. Sharp v. Shulkin, 29 Vet. App. 26 (2017). 1. From November 1, 2011, to March 25, 2018, entitlement to an initial rating of 20 percent, but no greater, for degenerative joint disease of the lumbar spine In March 2012, the RO granted service connection for degenerative joint disease of the lumbar spine at an initial rating of 10 percent under Diagnostic Code 5003-5242 from November 1, 2011, the day after the Veteran left active service. The Veteran is appealing the rating aspect of that decision. In June 2018, the RO increased the Veteran’s rating to 20 percent from March 26, 2018. Because the claim is an initial claim, the Board will consider evidence of symptomatology from the date of the claim. 38 C.F.R. § 3.400(o). Under the current rating criteria, disabilities of the spine are rated under the General Rating Formula for Diseases and Injuries of the Spine for Diagnostic Codes 5235 to 5243, unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. 38 C.F.R. § 4.71a. Ratings under the General Rating Formula for Diseases and Injuries of the Spine are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. Id. The General Rating Formula for Diseases and Injuries of the Spine provides a 10 percent disability rating for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour, or vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71a. A 20 percent disability rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, the combined range of motion of the thoracolumbar spine not greater than 120 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent disability rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. Id. A 100 percent disability rating is assigned for unfavorable ankylosis of the entire spine. Id. Evaluations for intervertebral disc syndrome are to be performed either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25. 38 C.F.R. § 4.71a, Note 6. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 10 percent disability rating is assigned for incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. 38 C.F.R. § 4.71a. A 20 percent disability rating is assigned for incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. Id. A 40 percent disability rating is assigned for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. Id. A 60 percent disability rating is assigned for incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Id. Under Diagnostic Code 5003, 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 (DC 5200 etc.). 38 C.F.R. § 4.71a. In the absence of limitation of motion, under Diagnostic Code 5003, a 10 percent rating is appropriate with x-ray evidence of involvement of two or more major joints or two or more minor joint groups. 38 C.F.R. § 4.71a. A 20 percent rating is appropriate with x-ray evidence of involvement of two or more major joint groups or two or more minor joint groups, with occasional incapacitating exacerbations. Id. These ratings will not be combined with ratings based on limitation of motion and will not be utilized in rating conditions listed under Diagnostic Codes 5013 to 5024, inclusive. Id. When degenerative arthritis is established by x-ray findings and limitation of motion is noncompensable, a rating of 10 percent is appropriate for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Id. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. The Veteran is entitled to an initial rating of 20 percent from November 1, 2011, to March 25, 2018. In an August 2011 VA examination (received 9/23/11), the Veteran indicates “stiffness, fatigue, spasms, decreased motion and paresthesia.” He “has experienced falls due to the spine condition” and “limitation in walking because of pain.” The examiner indicates no muscle spasm, no tenderness, no guarding, no weakness, and no ankylosis. Forward flexion is to 75 degrees. The Veteran can perform repetitive-use testing with no additional degree of limitation and “is not limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.” But during flare-ups the Veteran experiences slower movement and functional impairment is reflected by pain with bending. Consistent with this, in his February 2013 notice of disagreement, the Veteran describes a single flare-up in which he missed two days of work due to back pain. He also states that he experiences lack of range of motion, pain, flare-ups, and muscle spasms, and has “difficulty doing routine day to day tasks, such as putting on [his] socks or tying [his] shoes.” An April 2013 private medical record (received 8/8/16, page 4 of 36) indicates normal flexion with “persistent achy and sharp back pain that gets worse with range of motion and bending over.” A May 9, 2013 private medical record (received 8/8/16, page 14 of 36) indicates forward flexion of 60 degrees with back pain. In that same record, the Veteran states that during flare-ups “sometimes it hurts so bad he is unable to get out of bed and may not be able to go to work” (page 13). Functional activity is limited by pain, decreased range of motion, and decreased strength (page 15). In a November 2014 private medical record (received 8/8/16, pages 1–3 of 36), the Veteran states that his “[b]ack is tight and goes out randomly,” but indicates no tenderness, no spasms, full range of motion, and states that pain is not elicited by motion. A July 2016 private medical record (received 8/8/16, page 5 of 36) indicates back pain with “[f]ull range of motion.” A July 2016 private radiology note (received 8/8/16, page 31 of 36) states that the Veteran has “chronic back pain” that “flares up.” A February 2017 private medical record (received 3/8/17, page 33 of 36) indicates chronic back pain, tenderness on palpitation, an unspecified decrease in forward flexion, pain elicited by motion, and a recent flare-up, but no muscle spasms (page 35). Prior to March 25, 2018, and giving the Veteran the benefit of the doubt, given the evidence of forward flexion ranging from normal to 60 degrees and the evidence of minimal functional loss due to flare-ups, the Board finds that the evidence more nearly approximates a rating of 20 percent. Of the four measurements of forward flexion in the Veteran’s medical records, only one by itself supports a rating of 20 percent and the other three measurements by themselves support a rating of 10 percent or less. Taken together, given the Veteran’s evidence of forward flexion between normal and 60 degrees with some flare-ups accompanied by some functional loss, the Veteran’s symptoms as a whole more nearly approximate a rating of 20 percent. Because there is no evidence of ankylosis, because the Veteran’s forward flexion never reaches 30 degrees, and because functional loss appears to be overall minimal, the preponderance of the evidence is against a rating of 40 percent or greater. In reaching these conclusions, the Board has considered the Veteran’s lay statements. In statements dated February 2013, February 2014, August 2016, and March 2017, the Veteran states that he experiences lack of range of motion, pain, and muscle spasms. He also has “difficulty doing routine day to day tasks, such as putting on [his] socks or tying [his] shoes.” Because this testimony provides no evidence of flare-ups or functional loss beyond that described above, the Board finds that this testimony does not by itself support a rating in excess of 20 percent. The Veteran is already being compensated for his current symptoms related to functional loss and painful motion, including those reported in his lay statements, and there is no limitation of motion that is not already contemplated by the currently-assigned ratings. 2. From March 26, 2018, entitlement to a rating in excess of 20 percent for degenerative joint disease of the lumbar spine From March 26, 2018, the symptoms are consistent with the current 20 percent rating. A VA back examination of that date (received 4/25/18) indicates forward flexion of 45 degrees with painful motion. The Veteran can perform repetitive-use testing with forward flexion of 35 degrees afterwards. Regarding repeated use over time and flare-ups, the examiner states that “[t]he examination is medically consistent with the Veteran’s statements describing functional loss with repetitive use over time.” Functional loss is reflected by pain and “[d]ifficulty with prolonged standing, walking bending down and heavy lifting.” Additional factors contributing to disability include less movement than normal and weakened movement. Regarding Correia, the March 2018 VA back examination (received 4/25/18) states the following: “The back passive range of motion testing was not performed as it was not medically appropriate [b]ecause passive movement can cause additional back problems.” The evidence is more consistent with a rating of 20 percent. The Veteran’s forward flexion is 45 degrees and only decreases to 35 degrees with repetitive use testing. Both of these values are within the range of forward flexion that corresponds to a rating of 20 percent. His symptoms are therefore contemplated by a rating of 20 percent. The Veteran’s symptoms of pain and difficulty with mobility are also contemplated by a rating of 20 percent, in that it reflects compensation due to muscle guarding (ie pain) and abnormal gait (ie mobility issues like problems walking). Because there is no evidence that forward flexion reaches the level of 30 degrees or less and no evidence of ankylosis, the weight of the evidence is against a rating of 40 percent or greater. Regarding Correia, the March 2018 VA back examination (received 4/25/18) indicates pain on nonweight-bearing. But as the Veteran is already being compensated for his current symptoms related to painful motion, a higher rating under Correia is not warranted. There is no limitation of motion that is not already contemplated by the currently-assigned ratings. The evidence does not support additional staged ratings for any time period on appeal. For no period would the Veteran be entitled to a higher rating under a different Diagnostic Code. 3. From November 1, 2011, to March 25, 2018, entitlement to an initial rating of 20 percent, but no greater, for degenerative joint disease of the left shoulder 4. From November 1, 2011, to March 25, 2018, entitlement to an initial rating of 20 percent, but no greater, for degenerative joint disease of the right shoulder For the right and left shoulder disorders, the same general symptomatology and findings apply for the time period from November 1, 2011, to March 25, 2018. For this reason, the Board will discuss these disorders together. In March 2012, the RO granted service connection for degenerative joint disease of the left and right shoulders with initial ratings of 10 percent under Diagnostic Code 5201-5003 from November 1, 2011, the day after the Veteran left active service. The Veteran is appealing the rating aspect of that decision. In June 2018, the RO increased the Veteran’s ratings to 20 percent from March 26, 2018. Because the claims are initial claims, the Board will consider evidence of symptomatology from the date of the claims. 38 C.F.R. § 3.400(o). Diagnostic Code 5201 provides compensation for limitation of arm motion. 38 C.F.R. § 4.71a. Limitation of motion of the arm at the shoulder level is rated 20 percent for the major shoulder and 20 percent for the minor shoulder. Id. Limitation of motion of the arm midway between the side and shoulder level is rated as 30 percent for the major shoulder and 20 percent for the minor shoulder. Id. Limitation of motion of the arm to 25 degrees from the side is rated as 40 percent for the major shoulder and 30 percent for the minor shoulder. Id. In every case where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. Because the Veteran is right-handed, the minor code provisions apply to the left shoulder and the major code provisions apply to the right shoulder. The Veteran is entitled to an initial rating of 20 percent from November 1, 2011, to March 25, 2018. In an August 2011 VA examination (received 9/23/11), the Veteran indicates “weakness, stiffness, heat, lack of endurance, tenderness and pain.” He states that “he does not experience swelling, redness, giving way, locking, fatigability, deformity, drainage, effusion, subluxation and dislocation.” For the left shoulder, flexion is 120 degrees and abduction is 110 degrees. For the right shoulder, flexion and abduction are 150 degrees. The Veteran can perform repetitive-use testing with no additional degree of limitation and the Veteran “is not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use testing.” In a March 2015 private medical record (received 8/8/16, page 16 of 36), the Veteran describes awakening with right shoulder pain and an unspecified degree of limitation of motion. A different March 2015 private medical record (received 3/8/17, page 26 of 36) indicates painful shoulder motion but does not indicate flare-ups or limitation of motion. A July 2015 private radiology note (received 8/8/16, page 31 of 36) states that the Veteran has “chronic back pain” that “flares up,” but does not indicate flare-ups for either shoulder. The Veteran is not entitled to a compensable rating based on limitation of motion or functional loss. Left shoulder flexion of 120 degrees is above shoulder level. Right shoulder flexion of 150 degrees is also above shoulder level. For neither shoulder is there evidence of functional loss or additional limitation of motion due to flare-ups, repetitive-use-testing, or repeated use over time. For both shoulders the Veteran is entitled to a 20 percent rating based on the existence of painful motion. For painful motion with any form of arthritis, the Veteran is entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The same is true for painful motion in non-arthritis contexts when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). Since there is evidence of painful motion and the minimal compensable rating for a minor and major shoulder joints is 20 percent, the Veteran is entitled to that rating for both shoulders. In reaching these conclusions, the Board has considered the Veteran’s lay statements. In his February 2013 notice of disagreement, the Veteran states that he experiences limitation of motion, popping noises, weakness, and problems sleeping due to pain. The Veteran repeats these arguments in correspondence received in February 2014, August 2016, and March 2017. These statements do not indicate the existence of painful motion, limitation of motion, or functional loss that is not already contemplated by the Veteran’s current rating of 20 percent. 5. From March 26, 2018, entitlement to a in excess of 20 percent for degenerative joint disease of the left shoulder 6. From March 26, 2018, entitlement to a rating of 30 percent, but no greater, for degenerative joint disease of the right shoulder For the right and left shoulder disorders, the same general symptomatology and findings apply for the time period from March 26, 2018. For this reason, the Board will discuss these disorders together. For both shoulders, the March 2018 VA shoulders examination (received 4/25/18) indicates that limitation of flexion is 75 degrees. Functional loss is reflected by the examiner’s finding that for both shoulders, the Veteran cannot perform repetitive-use testing due to pain. Also, flare-ups are accompanied by “pain, weakness, swelling and limitation of use.” Regarding Correia, the March 2018 VA shoulders examination (received 4/25/18) states the following: “There is objective evidence of pain on passive range of motion testing of the right shoulder. There is objective evidence of pain on non-weight bearing testing of the right shoulder. There is objective evidence of pain on passive range of motion testing of the left shoulder. There is objective evidence of pain on non-weight bearing testing of the left shoulder.” Regarding limitation of motion, for both shoulders the degree of limitation more nearly approximates “at shoulder level” (90 degrees) than “midway between side and shoulder level” (45 degrees). Based on limitation of motion alone, the Veteran’s symptoms are more consistent with a 20 percent rating for the left (minor) shoulder and a 20 percent rating for the right (major) shoulder. For the left shoulder, the Veteran is not entitled to a higher rating based on functional loss. While there is evidence of additional functional loss, such evidence does not by itself support a higher rating because the next-highest rating for a minor limb is 20 percent. For this reason, the rating criteria does not in this instance provide for a rating in excess of 20 percent for limitation of arm motion at shoulder level with functional loss during repetitive-use testing and flare-ups. For the right shoulder, the Veteran is entitled to a 30 percent, but not higher, rating based on the existence of functional loss with limitation of arm motion at shoulder level. This is because the next-highest rating for a major limb is 30 percent. Regarding Correia, the March 2018 VA shoulders examination (received 4/25/18) indicates painful motion. As the Veteran is already being compensated for his current symptoms related to painful motion, a higher rating under Correia is not warranted. There is no limitation of motion that is not already contemplated by the currently-assigned ratings. The evidence does not support additional staged ratings for any time period on appeal. There is no evidence of humerus impairment or ankylosis so as to support a higher rating under a different Diagnostic Code. 7. From November 1, 2011, to March 25, 2018, entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the left elbow 8. From November 1, 2011, to March 25, 2018, entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the right elbow For the right and left elbow disorders, the same general symptomatology and findings apply to both disorders for the time period from November 1, 2011, to March 25, 2018. For this reason, the Board will discuss these disorders together. In March 2012, the RO granted service connection for degenerative joint disease of the left elbow at an initial rating of 10 percent under Diagnostic Code 5003-5207 from November 1, 2011, the day after the Veteran left active service. The Veteran is appealing the rating aspect of that decision. In June 2018, the RO increased the Veteran’s ratings to 20 percent from March 26, 2018. Because the claim is an initial claim, the Board will consider evidence of symptomatology from the date of the claim. 38 C.F.R. § 3.400(o). In March 2012, the RO granted service connection for degenerative joint disease of the right elbow at an initial noncompensable rating under Diagnostic Code 5003-5207 from November 1, 2011, the day after the Veteran left active service. The Veteran is appealing the rating aspect of that decision. In June 2018, the RO increased the Veteran’s rating to 10 percent from November 1, 2011, and 30 percent from March 26, 2018. Because the claim is an initial claim, the Board will consider evidence of symptomatology from the date of the claim. 38 C.F.R. § 3.400(o). Diagnostic Code 5206 provides compensation for forearm limitation of flexion. 38 C.F.R. § 4.71a. Where flexion is limited to 110 degrees, a 0 percent rating is provided for the major limb and the minor limb. Id. Where flexion is limited to 100 degrees, a 10 percent rating is provided for the major limb and the minor limb. Id. Where flexion is limited to 90 degrees, a 20 percent rating is provided for the major limb and the minor limb. Id. Where flexion is limited to 70 degrees, a 30 percent rating is provided for the major limb and a 20 percent rating is provided for the minor limb. Id. Where flexion is limited to 55 degrees, a 40 percent rating is provided for the major limb and a 30 percent rating is provided for the minor limb. Id. Where flexion is limited to 45 degrees, a 50 percent rating is provided for the major limb and a 40 percent rating is provided for the minor limb. Id. Diagnostic Code 5207 provides compensation for forearm limitation of extension. 38 C.F.R. § 4.71a. Where extension is limited to 45 degrees, a 10 percent rating is provided for the major limb and the minor limb. Id. Where extension is limited to 60 degrees, a 10 percent rating is provided for the major limb and the minor limb. Id. Where extension is limited to 75 degrees, a 20 percent rating is provided for the major limb and the minor limb. Id. Where extension is limited to 90 degrees, a 30 percent rating is provided for the major limb and a 20 percent rating is provided for the minor limb. Id. Where extension is limited to 100 degrees, a 40 percent rating is provided for the major limb and a 30 percent rating is provided for the minor limb. Id. Where extension is limited to 110 degrees, a 50 percent rating is provided for the major limb and a 40 percent rating is provided for the minor limb. Id. Diagnostic Code 5208 provides a 20 percent rating for both limbs where forearm flexion is limited to 100 degrees and forearm extension is limited to 45 degrees. 38 C.F.R. § 4.71a. Diagnostic Code 5213 provides compensation for impairment of supination and pronation. 38 C.F.R. § 4.71a. For loss of supination and pronation (bone fusion) with loss of bone substance (1 inch (2.5 cm) or more) and marked deformity, a 40 percent rating is provided for a major limb and a 30 percent rating for a minor limb. Id. For loss of supination and pronation (bone fusion) without loss of bone of bone substance or deformity, a 30 percent rating is provided for a major limb and a 20 percent rating for a minor limb. Id. For loss of supination and pronation (bone fusion) with nonunion in upper half, a 20 percent rating is provided for both limbs. Id. For loss of supination and pronation (bone fusion) with malunion (bad alignment), a 10 percent rating is provided for both limbs. Also under Diagnostic Code 5213, for limitation of pronation with motion lost beyond middle of arc, a 30 percent rating is provided for a major limb and a 20 percent rating for a minor limb. 38 C.F.R. § 4.71a. For limitation of pronation with motion lost beyond last quarter of arc (i.e., the hand does not approach full pronation), a 20 percent rating is provided for both limbs. Id. Also under Diagnostic Code 5213, for limitation of supination to 30 degrees or less, a 10 percent rating is provided for both limbs. 38 C.F.R. § 4.71a. Because the Veteran is right-handed, the minor code provisions apply to his left elbow disorder and the major code provisions apply to the right elbow disorder. From November 1, 2011, to March 25, 2018, the Veteran is entitled to an initial rating of 10 percent based on noncompensable limitation of motion with pain. For both elbows, an August 2011 VA examination (received 9/23/11) indicates pain and states that range of motion measurements are within normal limits. The Veteran reports “weakness, stiffness, swelling, heat, giving way, lack of endurance, locking, fatigability, tenderness, pain and [l]ocking.” The Veteran states that “he does not experience redness, deformity, drainage, effusion, subluxation and dislocation.” This evidence supports an initial rating of 10 percent based on the existence of noncompensable limitation of motion with pain. The Veteran is not entitled to a higher rating based on the existence of additional functional loss or limitation of motion so as to support a higher rating. In the August 2011 VA examination (received 9/23/11), the Veteran states that he experiences flare-ups, precipitated by physical activity, up to six time a day with a duration of one hour per flare-up and a pain level of 3 with stiffness. But he “reports that he does not experience any overall functional impairment from this condition.” The Veteran can perform repetitive-use testing with no additional degree of limitation for either elbow. Neither elbow is “additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.” Taken together, there is evidence of slight pain “with stiffness” during flare-ups, but a specific indication of “no functional loss” and a specific finding that the Veteran can also perform repetitive-use testing without functional loss or lost range of motion. Taken togehter, the preponderance of this evidence is against the existence of additional functional loss or limitation of motion so as to support a higher rating. Rather, the existence of stiffness and slight pain during flare-ups are already contemplated by the Veteran’s current initial rating of 10 percent. In reaching these conclusions, the Board has considered the Veteran’s lay statements. In his February 2013 notice of disagreement, the Veteran states that he experiences limitation of motion, pain, weakness, popping, and locking. The Veteran repeats these arguments in correspondence received in February 2014, August 2016, and March 2017. The existence of pain and unspecified limitation of motion are consistent with the Veteran’s current rating of 10 percent. The existence of weakness, popping, and locking does not by itself support a higher rating where, as here, the Veteran is already being compensated for non-compensable limitation of motion with pain and no additional functional loss. 9. From March 26, 2018, entitlement to a rating in excess of 20 percent for degenerative joint disease of the left elbow 10. From March 26, 2018, entitlement to a rating in excess of 30 percent for degenerative joint disease of the right elbow For the right and left elbow disorders, the same general symptomatology and findings apply to both disorders for the time period from March 26, 2018. For this reason, the Board will discuss these disorders together. For both elbows, a March 2018 VA examination (received 4/25/18) indicates forearm supination of 0 to 40 degrees (normal is 85) and forearm pronation of 0 to 40 degrees (normal is 80). Also for both elbows, flexion range of motion is 5 to 100 degrees and extension is from 100 to 5 degrees. The Veteran cannot perform repetitive-use testing due to pain. Functional loss is reflected by pain and weakness. Flare-ups are accompanied by pain, weakness, swelling, limitation of use, difficulty with overhead reaching, and difficulty with heavy lifting. Regarding Correia, the March 2018 VA elbows examinations states: “There is objective evidence of pain on passive range of motion testing of the right elbow. There is objective evidence of pain on non-weight bearing testing of the right elbow. There is objective evidence of pain on passive range of motion testing of the left elbow. There is objective evidence of pain on non-weight bearing testing of the left elbow.” As normal elbow pronation is 80 degrees, limitation of pronation to 40 degrees indicates that elbow pronation is lost beyond the middle of the arc. Under Diagnostic Code, this corresponds to a 30 percent rating for the major (right) elbow and a 20 percent rating for the minor (left) elbow. Because the Veteran is receiving the highest available ratings based on limitation of pronation and there is no bone fusion, he cannot receive a higher rating under this Diagnostic Code 5213 based on functional loss. Regarding Correia, the March 2018 VA elbows examination indicates noncompensable limitation of extension and flexion. As the Veteran is already being compensated for his current symptoms related to painful motion, a higher rating under Correia is not warranted. There is no limitation of motion that is not already contemplated by the currently-assigned ratings. The evidence does not support additional staged ratings for any time period on appeal. For no period would the Veteran be entitled to a higher rating under a different Diagnostic Code. 11. From November 1, 2011, to March 25, 2018, entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the left ankle 12. From November 1, 2011, to March 25, 2018, entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the right ankle For the right and left ankle disorders, the same general symptomatology and findings apply for the time period from November 1, 2011, to March 25, 2018. For this reason, the Board will discuss these disorders together. In March 2012, the RO granted service connection for degenerative joint disease of both ankles with initial noncompensable ratings under Diagnostic Code 5003-5271 from November 1, 2011, the day after the Veteran left active service. The Veteran is appealing the rating aspect of that decision. In June 2018, the RO increased the Veteran’s ratings to 10 percent from November 1, 2011. Because the claim is an initial claim, the Board will consider evidence of symptomatology from the date of the claim. 38 C.F.R. § 3.400(o). Diagnostic Code 5271 provides compensation for ankle limitation of motion. 38 C.F.R. § 4.71. A 10 percent rating is provided for moderate limitation of motion. Id. A 20 percent rating is provided for marked limitation of motion. Id. The words “slight,” “mild,” “moderate” and “severe” as used in the various Diagnostic Codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. An August 2011 VA examination (received 9/23/11) indicates painful motion with normal dorsiflexion and normal plantar flexion for both ankles. The Veteran daily experiences flare-ups, precipitated by physical activity, lasting two hours with a pain level of 4. But “[d]uring flare-ups he experiences neither functional impairment nor any limitation of motion of the joint.” Functional loss is reflected by some difficulty standing and walking. The Veteran can perform repetitive-use testing with no additional degree of limitation and “joint function is not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.” For the right ankle only, the August 2011 VA examination (received 9/23/11) indicates “weakness, stiffness, swelling, giving way, locking, pain and popping and locking.” The Veteran “does not experience heat, redness, lack of endurance, fatigability, deformity, tenderness, drainage, effusion, subluxation and dislocation.” The presence of painful motion with normal flexion, normal dorsiflexion, and some difficulties walking is consistent with a rating of 10 percent. Because there is no evidence of functional loss or limitation of motion after repetitive-use testing and the Veteran denies functional loss during flare-ups, the preponderance of the evidence is against a rating in excess of 20 percent. In reaching these conclusions, the Board has considered the Veteran’s lay statements. In his February 2013 notice of disagreement, the Veteran states that he experiences, pain, popping locking and weakness. Also, his ankles are hard to walk on. The Veteran repeats these arguments in correspondence received in February 2014, August 2016, and March 2017. The presence of pain and difficulties with walking are already accounted for in the Veteran’s rating of 10 percent. By themselves, the Veteran’s lay statements do not support a rating in excess of 10 percent. 13. From March 26, 2018, entitlement to a rating of 20 percent, but no greater, for degenerative joint disease of the left ankle 14. From March 26, 2018, entitlement to a rating of 20 percent, but no greater, for degenerative joint disease of the right ankle For the right and left ankle disorders, the same general symptomatology and findings apply for the time period from March 26, 2018. For this reason, the Board will discuss these disorders together. The March 2018 VA ankles examination (received 4/25/18) indicates that for both ankles dorsiflexion is 0 to 15 degrees (normal is 0 to 20) but decreases to 0 to 10 degrees after repetitive-use testing. Left ankle plantar flexion is 0 to 40 degrees (normal is 0 to 45) but decreases to 0 to 25 degrees after repetitive-use testing. Right ankle plantar flexion is 0 to 35 degrees but decreases to 0 to 20 degrees after repetitive-use testing. For both ankles, functional loss is reflected by pain and “[d]ifficulty with standing or walking.” The examiner specifically states that the findings regarding repetitive-use testing are consistent with those regarding repeated use over time and during flare-ups. There is no ankylosis. Regarding Correia, the March 2018 VA examination (received 4/25/18) states: “There is objective evidence of pain on passive range of motion testing of the right ankle. There is objective evidence of pain on non-weight bearing testing of the right ankle. There is objective evidence of pain on passive range of motion testing of the left ankle. There is objective evidence of pain on non-weight bearing testing of the left ankle.” Taken together, for both ankles, after repetitive-use testing, dorsiflexion decreases to half of normal and plantar flexion decreases to a similar magnitude. There is also pain and difficulty with standing or walking. This evidence supports the existence of marked ankle limitation so as to support a rating of 20 percent. Because there is no evidence of ankylosis, the preponderance of the evidence is against a rating in excess of 20 percent. Regarding Correia, the March 2018 VA examination (received 4/25/18) indicates painful motion for both ankles. As the Veteran is already being compensated for his current symptoms related to painful motion, a higher rating under Correia is not warranted. There is no limitation of motion that is not already contemplated by the currently assigned ratings. The evidence does not support additional staged ratings for any time period on appeal. For no period would the Veteran be entitled to a higher rating under a different Diagnostic Code. 15. Entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the left hip In March 2012, the RO granted service connection for degenerative joint disease of the left hip at an initial noncompensable rating under Diagnostic Code 5299-5252 from November 1, 2011, the day after the Veteran left active service. The Veteran is appealing the rating aspect of that decision. Because the claim is an initial claim, the Board will consider evidence of symptomatology from the date of the claim. 38 C.F.R. § 3.400(o). Diagnostic Code 5251 provides a 10 percent rating where extension of the thigh is limited to 5 degrees. 38 C.F.R. § 4.71a. Diagnostic Code 5252 provides compensation for thigh limitation of flexion. 38 C.F.R. § 4.71a. A 10 percent rating is provided where flexion is limited to 45 degrees. Id. A 20 percent rating is provided where flexion is limited to 30 degrees. Id. A 30 percent rating is provided where flexion is limited to 20 degrees. Id. A 40 percent rating is provided where flexion is limited to 10 degrees. Id. Diagnostic Code 5253 provides compensation for thigh impairment. 38 C.F.R. § 4.71a. A 10 percent rating is also provided where there is limitation of rotation such that the affected leg cannot toe-out more than 15 degrees. Id. A 10 percent rating is also provided where there is limitation of adduction such that the legs cannot be crossed. Id. A 20 percent rating is provided where there is limitation of abduction such that motion is lost beyond 10 degrees. Id. The Veteran is not entitled to more than an initial rating of 10 percent. In an August 2011 VA examination (received 9/23/11), the Veteran states that after strenuous physical activity he experiences left hip pain of a severity of 4 that lasts for about two weeks at a time. There is also weakness and loss of strength. While he cannot run during a flare-up, “[t]he injuries do not affect the functioning of the body” and “[h]e states he can keep up with his normal work requirements.” Range of hip is within normal limits with no ankylosis. There are “no signs of edema, instability, abnormal movement, effusion, weakness, tenderness, redness, heat deformity, malalignment, drainage, subluxation or guarding of movement.” The Veteran is able to perform repetitive use testing with no additional degree of limitation and “is not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use testing.” A May 2013 private medical record (received 8/8/16, page 14 of 36) indicates left hip flexion of 105 degrees. In a November 2014 private medical record (received 8/8/16, pages 1–3 of 36), the Veteran states that he experienced “hip pain with excessive walking a couple of weeks ago.” That record also indicates no instability, no tenderness, and no pain elicited by motion. A July 2015 private radiology note (received 8/8/16, page 31 of 36) states that the Veteran has “chronic back pain” that “flares up” but does not note any flare-ups for the left hip. A May 2018 VA hip examination (received 4/25/18) indicates that flexion is 0 to 100 degrees (normal is 0 to 125 degrees), extension is 0 to 25 degrees (normal is 0 to 30 degrees), abduction is 0 to 40 degrees (normal is 0 to 45 degrees), and adduction is 0 to 20 degrees (normal is 0 to 25 degrees). It is noted that the Veteran is unable perform repetitive-use testing due to pain. Functional loss after repetitive-use testing and after repeated use of time is reflected by pain and weakness. Regarding flare-ups, the Veteran states: “The flare ups of my left hip can be described as pain, weakness, swelling and limitation of use.” Regarding Correia, the March 2018 VA hips examination (received 4/25/18) states: “There is objective evidence of pain on passive range of motion testing of the right hip. There is objective evidence of pain on non-weight bearing testing of the right hip. There is objective evidence of pain on passive range of motion testing of the left hip. There is objective evidence of pain on non-weight bearing testing of the left hip.” Taken together, the evidence indicates noncompensable limitation of motion with pain. This evidence is consistent with a rating of 10 percent. While there is evidence of additional pain during flare-ups, additional pain after repetitive-use testing, and additional pain after repeated use over time, this evidence does not by itself support an additional higher rating where the Veteran is already being compensated for painful motion and there is no evidence of ankylosis. Regarding Correia, the March 2018 hips examination (received 4/25/18) revealed painful motion. As the Veteran is already being compensated for his current symptoms related to painful motion, a higher rating under Correia is not warranted. There is no limitation of motion that is not already contemplated by the currently assigned ratings. In reaching these conclusions, the Board has considered the Veteran’s lay statements. In his February 2013 notice of disagreement, the Veteran states that he experiences pain, numbness, and an unspecified degree of limitation of motion. The Veteran repeats these arguments in correspondence received in February 2014, August 2016, and March 2017. However, as the Veteran is already being compensated for pain and non-compensable limitation of motion without ankylosis, his lay statements do not by themselves support a rating in excess of 10 percent. The evidence does not support additional staged ratings for any time period on appeal. For no period would the Veteran be entitled to a higher rating under a different Diagnostic Code. 16. Entitlement to an initial rating in excess of 10 percent for degenerative joint disease of the right knee In March 2012, the RO granted service connection for degenerative joint disease of the right knee at an initial noncompensable rating under Diagnostic Code 5003-5260 from November 1, 2011, the day after the Veteran left active service. The Veteran is appealing the rating aspect of that decision. Because the claim is an initial claim, the Board will consider evidence of symptomatology from the date of the claim. 38 C.F.R. § 3.400(o). Under Diagnostic Code 5003, 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 (DC 5200 etc.). 38 C.F.R. § 4.71a. In the absence of limitation of motion, under Diagnostic Code 5003, a 10 percent rating is appropriate with x-ray evidence of involvement of two or more major joints or two or more minor joint groups. 38 C.F.R. § 4.71a. A 20 percent rating is appropriate with x-ray evidence of involvement of two or more major joint groups or two or more minor joint groups, with occasional incapacitating exacerbations. Id. These ratings will not be combined with ratings based on limitation of motion and will not be utilized in rating conditions listed under Diagnostic Codes 5013 to 5024, inclusive. Id. When degenerative arthritis is established by x-ray findings and limitation of motion is noncompensable, a rating of 10 percent is appropriate for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Id. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. For a showing of painful motion with any form of arthritis, the Veteran is entitled to at least the minimum compensable rating. 38 C.F.R. § 4.59. The same is true for any painful motion in non-arthritis contexts when raised by the claimant or when reasonably raised by the record. Burton, 25 Vet. App. at 5. Diagnostic Code 5256 governs ankylosis of the knee. 38 C.F.R. § 4.71a. A 30 percent rating is appropriate for ankylosis of a knee at a favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees. Id. A 40 percent rating is appropriate for ankylosis of a knee in flexion between 10 degrees and 20 degrees. Id. A 50 percent rating is appropriate for ankylosis of a knee between 20 degrees and 45 degrees. Id. A 60 percent rating may be assigned for extremely unfavorable ankylosis of a knee in flexion at an angle of 45 degrees or more. Id. Diagnostic Code 5257 governs other impairments of the knee. 38 C.F.R. § 4.71a. A 10 percent rating is appropriate for slight recurrent subluxation or lateral instability of the knee. Id. A 20 percent rating is assigned for moderate recurrent subluxation or lateral instability of the knee. Id. A 30 percent rating is assigned for severe recurrent subluxation or lateral instability of the knee. Id. Under Diagnostic Code 5258, a 20 percent rating is appropriate for cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain, and effusion in to the joint. 38 C.F.R. § 4.71a. Diagnostic Code 5260 governs limitation of flexion of the leg. 38 C.F.R. § 4.71a. A 0 percent rating is appropriate with flexion limited to 60 degrees. 38 C.F.R. § 4.71a. A 10 percent rating is appropriate with flexion limited to 45 degrees. Id. A 20 percent rating is appropriate with flexion limited to 30 degrees. Id. A 30 percent rating is appropriate with flexion limited to 15 degrees. Id. Diagnostic Code 5261 governs limitation of extension of the leg. 38 C.F.R. § 4.71a. A 0 percent rating is warranted for leg extension limited to five degrees. Id. A 10 percent rating is warranted for leg extension limited to 10 degrees. Id. A 20 percent rating is warranted for leg extension limited to 15 degrees. Id. A 30 percent rating is warranted for leg extension limited to 20 degrees. Id. A 40 percent rating is warranted for leg extension limited to 30 degrees. Id. A 50 percent rating is warranted for leg extension limited to 45 degrees. Id. Diagnostic Code 5262 governs impairment of the tibia and fibula. 38 C.F.R. § 4.71a. A 10 percent rating is appropriate for malunion of the tibia and fibula with slight knee or ankle disability. Id. A 20 percent rating is appropriate for malunion of the tibia and fibula with moderate knee or ankle disability. Id. A 30 percent rating is warranted for malunion of the tibia and fibula with marked knee or ankle disability. Id. A 40 percent rating is appropriate for nonunion of the tibia and fibula, with loose motion, requiring a brace. Id. A knee disorder can receive separate ratings based on symptoms related to arthritis, stability, flexion, and extension. Where a Veteran has degenerative joint disease which is evaluated under Diagnostic Code 5003, a separate, compensable evaluation may be assigned under Diagnostic Code 5257 or 5258 if there are concomitant symptoms, such as knee instability or subluxation. See VAOPGCPREC 23-97. When a veteran has a knee disability evaluated under Diagnostic Code 5257, to warrant a separate rating for arthritis based on x-ray findings, the limitation of motion need not be compensable under Diagnostic Code 5260 or Diagnostic Code 5261; rather, such limited motion must at least meet the criteria for a zero-percent rating. See VAOPGCPREC 9-98. Also, a veteran may receive a rating for limitation of flexion only, limitation of extension only, or separate ratings for limitations of both flexion and extension under Diagnostic Code 5260 (leg, limitation of flexion), and Diagnostic Code 5261 (leg, limitation of extension). See VAOPGCPREC 9-2004. Finally, “evaluation of a knee disability under [Diagnostic Codes] 5257 or 5261 or both does not, as a matter of law, preclude separate evaluation of a meniscal disability of the same knee under [Diagnostic Codes] 5258 or 5259, and vice versa.” Lyles v. Shulkin, 29 Vet. App. 107, 109 (2017). An August 2011 VA examination (received 9/23/11) indicates that flexion and extension are within normal limits. The Veteran describes “weakness, stiffness, giving way and tenderness.” He denies “swelling, heat, redness, lack of endurance, locking, fatigability, deformity, drainage, effusion, subluxation, pain and dislocation.” He experiences flare-ups, precipitated by physical activity, as often as twice a week that last for two hours with a pain level of 4, stiffness, and tenderness. “The [Veteran] reports that he does not experience any overall functional impairment from this condition.” The Veteran can perform repetitive-use testing with no additional degree of limitation. His right knee “is not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.” Stability testing is within normal limits. A March 2018 VA knee examination (received 4/25/18) indicates limitation of flexion of 5 to 90 degrees with pain. Joint stability testing is normal, there is no ankylosis, and there is no history of recurrent subluxation, lateral instability, recurrent effusion, or meniscal conditions. The Veteran can perform repetitive-use testing with no functional loss or loss in range of motion. Functional loss is reflected by pain and weakness. Additional factors contributing to disability are less movement than normal, weakened movement due to muscle or nerve injury, some disturbance of locomotion, and interference with standing. Regarding repeated use over time and flare-ups, the examiner specifically indicates that “[t]he examination is medically consistent with the Veteran’s statements describing functional loss with repetitive use over time.” Regarding Correia, the examination states: “There is objective evidence of pain on passive range of motion testing of the right knee. There is objective evidence of pain on non-weight bearing testing of the right knee. There is objective evidence of pain on passive range of motion testing of the left knee. There is objective evidence of pain on non-weight bearing testing of the left knee.” Taken together, the evidence indicates non-compensable limitation of flexion with pain. This evidence supports a 10 percent rating for the right knee. Because there is no ankylosis, no serious functional loss other than pain, and no apparent additional loss in range of motion after repetitive-use testing, after repeated use over time, or during flare-ups, the preponderance of the evidence is against a rating of 20 percent or greater. Regarding Correia, the March 2018 VA knees examinations indicates that there is painful motion. As the Veteran is already being compensated for painful motion, a higher rating under Correia is not warranted. There is no limitation of motion that is not already contemplated by the currently assigned ratings. In reaching these conclusions, the Board has considered the Veteran’s lay statements. In his February 2013 notice of disagreement, the Veteran states that he experiences weakness, limitation of motion, and “pain shooting across the top of the kneecap at times.” The Veteran repeats these arguments in correspondence received in February 2014, August 2016, and March 2017. As the Veteran is already being compensated for noncompensable limitation of motion with pain, these statements do not support a rating in excess of 10 percent. The Veteran is not entitled to a separate rating under Diagnostic Code 5257 due to instability of the knee. In his September 2011 VA examination, the Veteran states that he experiences “giving way” of his knee. But in the same examination, he denies “subluxation” and “dislocation,” and the examiner indicates that joint stability testing is normal. The Veteran does not indicate knee instability during his March 2018 VA examination (received 4/25/18) and the examiner notes there is normal joint stability testing with no history of recurrent subluxation, lateral instability, or recurrent effusion. Consistent with this, while the Veteran’s four lay statements describe pain, weakness, and limitation of motion, none of the statements reference dislocation or instability. Taken together, even though the Veteran mentioned knee instability one time during his September 2011 VA examination, because the preponderance of the evidence is against the existence of knee instability, the Veteran is not entitled to a separate rating under Diagnostic Code 5257. The evidence does not support additional staged ratings for any time period on appeal. For no period would the Veteran be entitled to a higher rating under a different Diagnostic Code. 17. From March 26, 2018, entitlement to an initial rating of 10 percent, but no greater, for degenerative joint disease of the right knee with limitation of extension The March 2018 VA knees examination (received 4/25/18) indicates range of extension from 5 to 90 degrees with pain. This evidence supports a rating of 10 percent under Diagnostic Code 5261. For reasons already described for the right knee, the preponderance of the evidence is against a rating of 20 percent or higher based on the presence of ankylosis or the existence of additional functional loss or loss of range in motion after repetitive-use testing, after repeated use over time, or during flare-ups. The evidence does not support additional staged ratings for any time period on appeal. For no period would the Veteran be entitled to a higher rating under a different Diagnostic Code. 18. Entitlement to a compensable rating for hydrocele In April 2012, the RO granted service connection for hydrocele at an initial noncompensable rating under Diagnostic Code 7523 from November 1, 2011, the day after the Veteran left active service. The Veteran is appealing the rating aspect of that decision. Because the claim is an initial claim, the Board will consider evidence of symptomatology from the date of the claim. 38 C.F.R. § 3.400(o). Diagnostic Code 7523 provides compensation for atrophy of the testis. A 0 percent rating is provided for complete atrophy of one testes. Id. A 20 percent rating is provided for complete atrophy of both testis. Id. The April 2012 and March 2018 VA male reproductive organs examination specifically state that there is no atrophy of either testicle. A May 2012 private medical record (received 8/8/16, page 26 of 36) states that the Veteran “[i]s interested in hydrocele repair as it makes exercise very difficult due to the bulk.” In his February 2013 notice of disagreement, the Veteran states that “[t]hey are still larger than before the operation” and that “[m]aintaining an erection has become a problem.” The Veteran repeats these statements in correspondence received in February 2014, August 2016, and March 2017. There is no evidence of complete atrophy of both testis so as to support a schedular rating under Diagnostic Code 7523. The main difficulty associated with the Veteran’s disorder is difficulty exercising, which is consistent with a non-compensable rating. As the Veteran’s current rating is contemplated by the applicable rating criteria and there is no evidence of hospitalizations or missed work due to hydrocele, the Board will not refer the Veteran’s claim for extraschedular consideration. The evidence does not support additional staged ratings for any time period on appeal. For no period would the Veteran be entitled to a higher rating under a different Diagnostic Code. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Cannon, Associate Counsel