Citation Nr: 18153760 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 07-05 332 DATE: November 28, 2018 ORDER An initial rating in excess of 20 percent for left shoulder arthritis is denied. An initial rating of 20 percent, but no higher, for lumbar spine arthritis is granted, subject to the laws and regulations governing the payment of monetary awards. FINDINGS OF FACT 1. The Veteran is right hand dominant. 2. For the entire appeal period, the Veteran’s left shoulder arthritis is manifested by loss of range of motion (ROM) of the arm, but not to 25 degrees from his side, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis of the scapulohumeral articulation, impairment of the humerus, or impairment of the clavicle or scapula. 3. For the entire appeal period, the Veteran’s lumbar spine arthritis is manifested by forward flexion to less than 60 degrees, without forward flexion to less than 30 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, incapacitating episodes due to intervertebral disc syndrome (IVDS), or associated objective neurological abnormalities. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 20 percent for left shoulder arthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5003-5201. 2. The criteria for an initial rating of 20 percent, but no higher, for lumbar spine arthritis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5010-5242. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1970 to November 1982. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2008 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for left shoulder arthritis and lumbar spine arthritis and assigned initial ratings of 10 percent from September 27, 2005, to March 21, 2008, and 20 percent thereafter for each disability. Further, the Board had also previously assumed jurisdiction over a claim of entitlement to a total disability rating based on individual unemployability (TDIU) pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran testified at Board hearings before the three undersigned Veterans Law Judges in November 2008, June 2011, and December 2016. Transcripts from such hearings are of record. In February 2013, September 2013, February 2016, and June 2017, the Board remanded the case for additional development. While on remand, in a March 2018 rating decision, the Agency of Original Jurisdiction (AOJ) granted an initial rating of 20 percent for the Veteran’s left shoulder arthritis for the entire appeal period. However, as the Veteran is presumed to seek the maximum available benefit for a disability, and a higher rating for his left shoulder disability remains available, such claim remains viable on appeal. AB v. Brown, 6 Vet. App. 35, 38 (1993). The March 2018 rating decision also granted a TDIU effective May 31, 2014, the day after the Veteran stopped working. Consequently, such award constitutes a full grant of the benefit sought on appeal with regard to such issue, and it is no longer before the Board. The remaining claims now return for further appellate review. Initial Rating Claims The Veteran contends he is entitled to higher initial ratings for his service-connected arthritis of the left shoulder and lumbar spine as such disabilities are more severe than as reflected by the currently assigned ratings. Specifically, he claims that such disabilities result in great pain and cause greater difficulty in lifting things, bending, crouching, walking, and doing chores and housework. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). 1. Entitlement to an initial rating in excess of 20 percent for left shoulder arthritis. The Veteran’s left shoulder arthritis is rated pursuant to DC 5003-5201. DC 5003 provides that arthritis established by x-ray findings will be rated on the basis of limitation of motion of the specific joint involved. When, however, the limitation of motion of the specific joint involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, x-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations warrants a 20 percent evaluation. X-ray evidence of involvement of two or more major joints or two or more minor joints warrants a 10 percent evaluation. 38 C.F.R. § 4.71a. Under DC 5201, limitation of arm motion that is limited to shoulder level warrants a 20 percent rating in the major and minor extremity. Such limitation that is limited midway between the side and shoulder level warrants a 20 percent rating in the minor extremity and a 30 percent rating in the major extremity. Such limitation to 25 degrees from the side warrants a 30 percent rating in the minor extremity and a 40 percent rating in the major extremity. 38 C.F.R. § 4.71a. Normal range of motion in the shoulder is from zero to 180 degrees of forward elevation (flexion) and zero to 180 degrees of shoulder abduction. See 38 C.F.R. § 4.71a, Plate I. As an initial matter, the Board notes that the Veteran challenged the adequacy of his VA examinations conducted to date at his December 2016 Board hearing. Specifically, he argued that his shoulder function was tested by him standing and pulling an examiner while she sat in a chair. However, the Veteran did not indicate which examination this test was conducted during, nor has he shown any evidence that such a test was not proper. In this regard, a VA examiner is presumed to have properly discharged his or her duties as a health professional (presumption of regularity) in a review of the record, in interviewing the veteran, and supporting his or her opinion with medical analysis applied to the significant facts of the case. See Rizzo v. Shinseki, 580 F.3d 1288 (Fed. Cir. 2009) (applying the presumption of regularity to VA medical examiners in the discharge of their regular duties). The presumption of regularity is rebuttable by clear evidence to the contrary. Miley v. Principi, 366 F.3d 1343, 1347 (Fed. Cir. 2004). Although the conduct of the examination may not be what the Veteran expected, the Board presumes the VA examiner carried out his or her duties in a regular manner. See Rizzo, supra. Thus, the Board finds his argument without merit. Furthermore, neither the Veteran nor his representative have otherwise argued that the VA examinations conducted during the course of the appeal, to include most recently in September 2017, are inadequate. After a careful review of the record, the Board finds that an initial rating in excess of 20 percent for the Veteran’s left shoulder disability is not warranted pursuant to DC 5201 as the evidence does not show limitation of the left arm, the minor extremity, to 25 degrees from the side (abduction), even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. Initially, the Board notes that the record, including all the VA examinations of record, indicates that the Veteran is right hand dominant. As such, the provisions related to the major extremity are not applicable to the instant case. Thus, to establish entitlement to a higher 30 percent rating under DC 5201, there must be evidence that the Veteran’s ability to lift his arm from the side is limited to 25 degrees. During the entire appeal period, the Veteran’s left shoulder forward flexion and abduction were limited to, at most, 80 and 45 degrees, respectively. See October 2009 VA examination; September 2017 VA Examination. Even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, the Board finds that he is not entitled to a rating in excess of 20 percent under DC 5201. Specifically, as demonstrated during the March 2008 (160, 90 degrees), October 2009 (95, 45 degrees), March 2013 (90, 100 degrees), and September 2017 (80, 80 degrees) VA examinations, the Veteran had pain on motion, but there is no indication that such resulted in additional functional loss that more nearly approximates limitation of the left arm to 25 degrees from the side. Additionally, while the Veteran endorsed flare-ups during the September 2017 examination, he described his flare-ups as increased pain and difficulty doing overhead tasks, which are symptoms contemplated by the currently assigned 20 percent rating. Further, while the Veteran has endorsed pain, weakness, stiffness, and fatigability related to his left shoulder disability, and the VA examiners acknowledged functional loss due to such symptoms, the Board finds that they do not more nearly approximates limitation of the left arm to 25 degrees from the side. See DeLuca, supra; Mitchell, supra. Therefore, the Veteran is not entitled to an initial rating in excess of 20 percent under DC 5201. The Board further finds that a separate or higher rating is not warranted under any other potentially applicable DCs related to the shoulder. In this regard, the evidence, to include VA examination reports and treatment records, does not show, nor does the Veteran contend, that he has ankylosis of the scapulohumeral articulation, impairment of the humerus, or impairment of the clavicle or scapula. Consequently, separate or higher ratings are not warranted under DCs 5200, 5202 and 5203, respectively. The Board notes that, at the September 2017 examination, the Veteran reported experiencing spasms and pain from his neck into his left shoulder and left upper extremity that causes him to lose his grip on objects and, as such, has considered whether the assignment of a separate rating is warranted for neurological impairment related to his left shoulder disability. However, such symptoms were attributed at such time to cervical radiculopathy associated with his degenerative changes in his cervical spine, and are thus unrelated to his left shoulder disability. Accordingly, the assignment of separate ratings for such symptoms is not warranted. 2. Entitlement to an initial rating in excess of 10 percent prior to March 22, 2008, and 20 percent thereafter for lumbar spine arthritis. The Veteran’s back disability has been rated as 10 percent disabling as of September 27, 2005, and 20 percent disabling as of March 22, 2008, pursuant to DC 5010-5242. DC 5010 directs that the evaluation of traumatic arthritis be conducted under DC 5003 pursuant to degenerative arthritis, which is detailed in the preceding section. DC 5242 provides that degenerative arthritis of the spine is evaluated under the General Rating Formula for Disease and Injuries of the Spine (General Rating Formula). In this regard, 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. Such provides for a 20 percent rating where there is forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. Finally, a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. Note (1): Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. IVDS may be evaluated under either the General Rating Formula or under the IVDS Formula, whichever method results in the higher evaluation when all disabilities are combined. See 38 C.F.R. § 4.25 (combined ratings table). In this regard, the IVDS Rating Formula provides that a 20 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note (1) provides that an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. As an initial matter, the Board notes that the record does not show, and the Veteran does not contend, that he ever had an incapacitating episode of IVDS that required physician prescribed bed rest. Thus, the IVDS Formula would not allow for a higher rating at any point pertinent to the appeal period. In this regard, despite undergoing numerous VA examinations throughout the period on appeal, the only time the Veteran was noted to have IVDS was during the September 2017 VA examination. However, at such time, the examiner also noted the Veteran had never had an incapacitating episode due to IVDS that has required bed rest. Further, resolving all doubt in the Veteran’s favor, the Board finds that an initial 20 percent rating, but no higher, for the entire appeal period is warranted. In denying an initial rating in excess of 20 percent, the Board finds that the record does not reflect, nor do the Veteran’s statements and testimony show, that his ROM was limited to the extent necessary to warrant such a higher rating under the General Rating Formula at any point pertinent to the appeal period. The Veteran’s back disability was originally assigned a 10 percent rating as of September 27, 2005, and a 20 percent rating as of March 22, 2008, based primarily on a March 2008 VA examination and contemporary treatment records. In this regard, the Veteran’s treatment records prior to March 22, 2008, show he complained of pain and stiffness in his lower back, and sought physical therapy treatment. Notably, a May 2005 VA treatment record reflects that the Veteran complained of low back pain on forward flexion to 30 degrees. Thereafter, in March 2008, a VA examiner noted that the Veteran had symptoms of chronic low back pain and stiffness since service, and his symptoms had progressively become worse. He was tested for ROM of his lumbar spine, which resulted in findings of forward flexion limited to 45 degrees with pain on movement. Accordingly, the Veteran was granted the 20 percent rating as of the date of such examination. However, the Board finds that such 20 percent rating is warranted for the entire appeal period. In this regard, the March 2008 examination was the first examination the Veteran underwent which accurately measured his ROM; however, such does not mean that his limitation of motion to such extent started at such time. Rather, the evidence of record from that period shows the opposite. In this regard, the May 2005 treatment record noted pain on forward flexion to 30 degrees. While the exact range of testing is unknown, and the construction of the notation implies that the Veteran had greater ROM than 30 degrees, it weighs in favor of the Veteran’s contention that his restriction of flexion was likely less than 60 degrees. Therefore, the Board resolves all doubt in the Veteran’s favor, and finds that the findings from the March 2008 VA examination are consistent with his functional limitation from his lumbar spine arthritis prior to such date. Thus, an initial 20 percent rating for such period on appeal is warranted. In this regard, the Board acknowledges that physical therapy records from January to August 2008 include frequent measures of the Veteran’s lumbosacral ROM. Such measurements, taken primarily every week from January to March and July to August of that year, show flexion to 25 percent for the former period, and flexion to 10 percent for the latter period. However, the Board affords such findings little probative weight as it is unclear the manner in which the testing was done, and what the corresponding limitation in degrees, as found in the rating schedule, the findings would equal. Particularly, if the Board were to correlate the findings directly to the rating schedule, the Veteran would have been measured at less than 10 degrees of flexion. Such findings are otherwise unsupported and directly contradicted by the record, to include the findings from contemporaneous VA examinations. Notwithstanding the award of an initial 20 percent rating, the Board finds that a higher initial rating is not otherwise warranted. In this regard, as noted previously, the Veteran had flexion to 45 degrees and a combined ROM of the thoracolumbar spine to 145 degrees upon active and passive ROM testing, without further limitation due to pain or following repetitive use, at the March 2008 VA examination. At an October 2009 VA examination, the Veteran was noted to have lower back pain since service that had gotten progressively worse, with measured flexion to 50 degrees and a combined ROM of the thoracolumbar spine to 130 degrees upon ROM testing, without further limitation due to pain or following repetitive use. At both VA examinations, no associated neurological abnormalities, ankylosis, flare-ups, or other symptomatology was noted. Thereafter, the Veteran underwent a VA examination in March 2013. Upon ROM testing, he had forward flexion limited to only 70 degrees and a combined ROM of the thoracolumbar spine to 165 degrees, with pain and following repetitive use. He was also noted to have guarding and/or spasms that resulted in an abnormal gait and abnormal spinal contour, which is contemplated in the currently assigned 20 percent rating. As above, the Veteran did not report flare-ups or ankylosis. In February 2015, the Veteran was afforded another VA examination. Upon ROM testing at such time, he had forward flexion limited to 50 degrees and a combined ROM of the thoracolumbar spine to 150 degrees with pain, to include on weight bearing, and following repetitive use. He was again noted to have guarding and/or spasms that resulted in an abnormal gait and abnormal spinal contour, which is contemplated in the currently assigned 20 percent rating, and used a cane on a constant basis and a walker on a regular basis. The examiner noted that the Veteran did not report flare-ups, nor did he have ankylosis or associated neurological abnormalities. The Veteran most recently underwent a VA examination in September 2017. The examiner noted the Veteran pain on movement which causes functional loss, and the Veteran reported experiencing flare-ups for the first time characterized by increased pain. However, the examiner was unable to perform ROM testing as it was unsafe to do so based on pain and a sense of instability. Thus, the examiner was unable to obtain ROM measurements or comment on the functional impact of his flare-ups of limitation of motion. In March 2018, the September 2017 examiner provided an addendum in order to provide an retrospective opinion of the previous examinations of record in light of the Court’s holding in Correia v. McDonald, 28 Vet. App. 158 (2016). However, the examiner responded that she was unable to provide such opinions without resorting to speculation as such findings were not discussed at such prior examinations. Jones v. Shinseki, 23 Vet. App. 382 (2010). Based on the foregoing, the Board finds that an initial rating in excess of 20 percent under the General Rating Formula is not warranted for the Veteran’s back disability. In this regard, at no time pertinent to the appeal did such disability result in forward flexion limited to 30 degrees or less, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. Specifically, as previously noted, the Veteran’s forward flexion was noted at its worst to be limited to 45 degrees in the March 2008 VA examination, and such limitation does not reach the level necessary for a higher rating. In this regard, the examiner noted the Veteran’s pain on motion and passive ROM, but found that there was no additional loss on passive ROM or after repetitive use. Further, the Veteran’s ROM testing has remained relatively consistent throughout the appeal period, in fact, resulting in greater ROM in every examination. The Board notes the Veteran’s treatment records during the relevant time period note back pain, as well as notes of lumbar flexion limited to 15 percent in a physical therapy note from March 2015. However, as above, such treatment notes do not show a limitation of motion warranting a higher rating as it is unclear how the measurements would correspond to a measurement in degrees. Moreover, such findings might imply a limitation of flexion to 13 degrees, which is directly contradicted by the contemporaneous February 2015 VA examination at which time revealed flexion to 50 degrees. Lastly, the Board acknowledges the Veteran’s reports that his back disability has worsened, and indeed the record reflects that his disability has progressed to include IVDS, as well as guarding and localized tenderness resulting in an abnormal gait and spinal contour; however, such symptomatology is contemplated in his currently assigned rating. Therefore, at no time during the entire period on appeal did the Veteran’s back disability result in forward flexion limited to 30 degrees or less, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. Furthermore, the record does not show ankylosis. Accordingly, an initial rating in excess of 20 percent for the Veteran’s back disability is not warranted under the General Rating Formula. Further, the Board has also considered whether separate ratings for associated objective neurological abnormalities are warranted pursuant to Note (1) of the General Rating Formula. In this regard, the Veteran has denied any associated neurological abnormalities, and none have been found on examination. In this regard, while the Veteran has reported radicular pain in treatment records, the General Rating Formula specifically contemplates pain, regardless of whether it radiates or not. Furthermore, while the Veteran was noted to have some decrease in sensation and numbness in his lower extremities during the March 2013 and February 2015 VA examinations, such symptoms were attributed to his service-connected diabetes mellitus and are separately rated. Furthermore, imaging conducted during the appeal period reflects no disc herniation, nerve root impingement, or canal or neural foraminal stenosis. Consequently, separate ratings for objective neurological abnormalities associated with the Veteran’s back disability are not warranted. Other Considerations In reaching its conclusions, the Board acknowledges the Veteran’s belief that his left shoulder and back symptoms are more severe than the current disability ratings reflect. The Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of his left shoulder and back disabilities. The Board has also considered whether staged ratings under Fenderson, supra, are appropriate for the Veteran’s service-connected disabilities; however, the Board finds that his symptomatology has been stable throughout the period on appeal. Therefore, assigning staged ratings for such disabilities is not warranted. Further, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the claims adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). In reaching the foregoing determinations, the Board has applied the benefit of the doubt doctrine and resolved all doubt in the Veteran’s favor. However, insofar as the Board has denied higher or separate ratings, the preponderance of the evidence is against such aspects of the Veteran’s claims. Therefore, the benefit of the doubt doctrine is not applicable and such increased rating claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jonathan M. Estes, Associate Counsel