Citation Nr: 18147198 Decision Date: 11/05/18 Archive Date: 11/02/18 DOCKET NO. 16-43 391 DATE: November 5, 2018 ORDER Entitlement to a rating greater than 10 percent for a left ankle disability is denied. FINDING OF FACT The Veteran’s left ankle disability manifested with complaints of pain and weakness but no marked amount of limitation of motion. CONCLUSION OF LAW The criteria for entitlement to a rating greater than 10 percent for a left ankle disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from February 1976 to March 1979 and from December 2009 to December 2010. Entitlement to a rating greater than 10 percent for a left ankle disability. Increased ratings Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2017). If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. 38 C.F.R. § 4.40 (2017). Weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity, or atrophy of disuse are relevant factors in regard to joint disability. 38 C.F.R. § 4.45 (2017). Therefore, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. Limitation of motion of the ankle may be rated under Diagnostic Code 5271. Under Diagnostic Code 5271, a 10 percent evaluation is assigned for moderate limitation of the ankle, and a maximum 20 percent evaluation is assigned for marked limitation of motion. 38 C.F.R. § 4.71a. Normal ankle dorsiflexion is from 0 to 20 degrees, and normal ankle plantar flexion is from 0 degrees to 45 degrees. 38 C.F.R. § 4.71a, Plate II. Merits The Veteran contends a higher rating is warranted for his left ankle disability. Presently, the Veteran’s left ankle is rated at 10 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5271. After reviewing the lay and medical evidence of record, the Board finds that the preponderance of the evidence warrants a 10 percent rating, but no higher, as the Veteran’s left ankle disability was manifested by pain and weakness with full range of motion. In addition, there were no further limitations due to pain, fatigue, incoordination, weakness, or lack of endurance. In support thereof, the Board notes the Veteran’s VA examination in August 2015 for his left ankle disability where the Veteran reported he continues to have pain and weakness. The examiner diagnosed the Veteran with left achilles tendonitis. Range of motion was found to be normal reflecting 20 degrees dorsiflexion and 45 degrees plantar flexion. The examiner found no pain during the exam, including no pain with weightbearing, and no pain or tenderness on palpation of the joint. There was also no evidence of crepitus. The Veteran was able to perform repetitive use testing with no loss of function or decrease in range of motion, and pain, weakness, fatigability, or incoordination did not limit the Veteran’s functional ability after repeated use over time. Muscle strength testing was found to be normal, and there was no evidence of muscle atrophy, ankylosis, or joint instability. Further, diagnostic testing found no evidence of degenerative or traumatic arthritis. The Board notes that aside from the Veteran’s above -referenced VA examination, there is no other medical evidence of record pertaining to the Veteran’s left ankle except for a March 2015 medical treatment record, and his February 2016 peripheral nerves exam where the Veteran reported having chronic ankle pain. However, neither of these records show evidence that the Veteran’s left ankle exhibited pain or any other functional loss causing a marked limitation of motion. The Board has also considered the Veteran’s lay statements. Specifically, the Board recognizes the Veteran’s Notice of Disagreement (NOD) where he reported that he is living day-to-day on 80 percent medication. Additionally, in his substantive appeal (VA Form 9), the Veteran reported experiencing pain daily for years. However, the Board finds the evidence does not substantiate the Veteran’s claim for an increased rating for the reasons that follow. The Board notes that in addition to his report of ankle pain in his substantive appeal, the Veteran also reported having pain in his neck, back, elbows, feet, severe headaches, and pain in his fingers, hands, and toes due to pinched nerves. Medical treatment records show that the Veteran has complained of the same and has received medications for his reported pain. Notably, the Veteran has sought service connection for his back, neck, right foot, and pinched nerves, and the Veteran is service-connected for tension headaches. Additionally, medical records show that the Veteran was prescribed naproxen and cyclobenzaprine for back pain and nitroglycerine for chest pain. Further, although the Veteran was given a refill of hydrocodone in his March 2015 visit referenced above, this was given to assist with the reported pain in his chest and ankle as the Veteran’s chief complaint during that visit was chest pain. Moreover, the evidence shows the Veteran was initially prescribed hydrocodone in September 2013 after reporting that his right foot was ran over by a truck, as opposed to being prescribed such for his ankle; and, pharmacy notes show that the Veteran’s hydrocodone is to be taken when in severe pain. It was also noted in his 2016 peripheral nerves exam, that the Veteran has been prescribed hydrocodone for “pain all over.” Given the above, the Board finds an increased rating is not warranted. The evidence shows that the Veteran’s left ankle manifested with pain and weakness but no limitation of motion. The Veteran’s prescribed pain medication is due to pain in multiple areas of his body as opposed to a worsening of his left ankle disability. Additionally, there is no evidence that pain, weakness, fatigability, or incoordination has caused limitation in motion. Although the examiner noted that functional loss could not be determined during a flare-up, and that swelling and disturbance of locomotion contribute to the Veteran’s left ankle disability, the Board notes the Veteran exhibited normal range of motion during his examination; therefore, it is more likely than not that any additional functional loss he may have had would not have caused a marked limitation in the Veteran’s functional ability to the extent that a higher rating would be warranted. Moreover, there is no other objective medical evidence of record showing that the Veteran’s functional ability was limited. Further, the evidence shows that the Veteran does not use an assistive device as a normal mode of locomotion, x-rays of the Veteran’s left ankle were normal, and his 2016 peripheral nerves examination confirmed that muscle strength testing of his left ankle was normal. The Board has also considered whether higher evaluations are available under other provisions of the code. However, the Veteran’s left ankle has not shown any other factors that would warrant evaluation of the disability under other provisions of the rating schedule. Specifically, the Veteran is not shown to have ankylosis of the ankle to warrant an evaluation under Diagnostic Code 5270. See 38 C.F.R. § 4.71a. In addition, there is no evidence of ankylosis of the subastragalar or tarsal joint, malunion of the os calcis or astragalus, or astragalectomy to warrant ratings under Diagnostic Codes 5270-5274. Id. Consequently, the Board finds a higher rating is not warranted as the Veteran exhibited pain only with an isolated report of weakness. The Veteran’s range of motion of his left ankle was normal and no additional functional loss was exhibited due to pain, fatigue, weakness, or incoordination. Any functional loss the Veteran may have had has already been contemplated in his assigned 10 percent rating. (Continued on the next page)   As all potentially applicable diagnostic codes have been considered, the Board finds the preponderance of the evidence is against a rating greater than 10 percent for the Veteran’s service-connected left ankle disability. As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. For these reasons, the claim for a rating greater than 10 percent is denied. GAYLE E. STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Laffitte, Associate Counsel