Citation Nr: 18158281 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 16-15 547A DATE: December 14, 2018 ORDER Entitlement to service connection for arthritis of multiple unspecified joints is denied. Entitlement to service connection for vertigo is granted. Entitlement to a rating in excess of 20 percent for service-connected residuals, thoracic spine injury, back strain is denied. Entitlement to a rating in excess of 10 percent for service-connected residuals, fracture of left patella is denied. Entitlement to a rating in excess for 20 percent for right shoulder capsulorrhaphy (strain) with residual scar is denied. Entitlement to a total disability rating based upon individual unemployability (TDIU) due to service-connected disabilities prior to April 30, 2013 is denied. FINDINGS OF FACT 1. The probative evidence does not demonstrate that the Veteran’s currently diagnosed osteoarthritis of the right hand manifested during, or as a result of, active military service, or manifested to a compensable degree within one year of service discharge. 2. The probative evidence demonstrates the Veteran’s vertigo began during active service. 3. The Veteran’s back disability was manifested by flexion to 55 degrees, with pain, and combined range of motion to greater than 120 degrees, with no evidence of ankylosis. 4. The Veteran’s residuals, fracture of left patella was manifested by flexion of 140 degrees and full extension, with no evidence of ankylosis, recurrent subluxation, or lateral instability. 5. The service-connected right shoulder capsulorrhaphy (strain) with residual scar was manifested by complaints of pain but the Veteran was able to move his arm more than 45 degrees in abduction (limitation of motion was not limited to midway between the side and shoulder). 6. It is factually ascertainable that the Veteran’s service connected disabilities rendered him unemployable beginning April 30, 2013. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for arthritis of multiple unspecified joints have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 2. The criteria for entitlement to service connection for vertigo have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 3. The criteria for entitlement to a rating in excess of 20 percent for service-connected residuals, thoracic spine injury, back strain have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.71a, Diagnostic Code 5237 (2017). 4. The criteria for entitlement to a rating in excess of 10 percent for service-connected residuals, fracture of left patella have not been met. 38 U.S.C. § 1155, 513A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321(b)(1), 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5260 (2017). 5. The criteria for entitlement to a rating in excess for 20 percent for right shoulder capsulorrhaphy (strain) with residual scar have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.C. §§ 4.7, 4.71a, Diagnostic Code 5299-5201 (2017). 6. The criteria for the assignment of a TDIU due to service-connected disabilities were met beginning April 30, 2013. 38 U.S.C. §§ 1155, 5110 (2012); 38 C.F.R. §§ 3.340, 3.341, 3.400, 4.16, 4.18, 4.19 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1986 to April 1993. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2013 rating decision which granted an increased rating for the Veteran’s service-connected residuals, thoracic spine injury, back strain to 20 percent, denied an increased rating for service-connected residuals, fracture of left patella (knee strain), reduced the Veteran’s service-connected right shoulder capsulorrhaphy to 10 percent, effective December 6, 2012, and denied service connection for arthritis to joints; and a June 2014 rating decision which denied service connection for vertigo. The Veteran did not request a Board hearing. Service Connection Under applicable law, service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (a) (2017). Establishing service connection generally requires competent evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d) (2017). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A lay witness is competent to testify as to the occurrence of an in-service injury or incident where such issue is factual in nature. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In some cases, lay evidence will also be competent and credible on the issues of diagnosis and etiology. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Specifically, lay evidence may be competent and sufficient to establish a diagnosis where (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d at 1377; see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). A layperson is competent to identify a medical condition where the condition may be diagnosed by its unique and readily identifiable features. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App. 370, 374 (2002). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. 1. Entitlement to service connection for arthritis of multiple unspecified joints The Veteran asserts that his arthritis in the joints is due to his military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of osteoarthritis of the right hand, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran’s service treatment records are silent for complaints, treatment, or diagnosis related to arthritis of any joint. VA treatment records show the Veteran was diagnosed with osteoarthritis of the right hand in May 2015, approximately two decades after separation from service. There is no persuasive medical evidence or persuasive credible lay evidence that the Veteran's claimed disorder manifested to a compensable degree within a year of his separation of service or had its onset in service and continued ever since service. Therefore, service connection based on presumptive service connection for a chronic disease or based on a theory of continuity of symptomatology is not warranted. While the Veteran believes his osteoarthritis of the right hand is related to his active service, the Board reiterates that the preponderance of the evidence weighs against findings that arthritis of the joints occurred in service. The Veteran has not met his burden of proof, and thus the evidence of record is insufficient to substantiate the claim for service connection. See Madden v. Gober, 125 F.3d 1477, 1480-81 (Fed. Cir. 1997) (explicitly rejecting the argument that "the Board must accept a veteran's evidence at face value, and reject or discount it only on the basis of rebuttal evidence proffered by the agency" and holding that the Board must determine "the weight and probity of evidence in the light of its own inherent characteristics and its relationship to other items of evidence"). Therefore, entitlement to service connection for arthritis of the joints is not warranted. 2. Entitlement to service connection for vertigo The Veteran contends his vertigo is due to his exposure to fumes during active duty service. The Board concludes that the Veteran has a current diagnosis of vertigo that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The June 2018 VA examination shows the Veteran has a current diagnosis of vertigo, and the June 2018 VA examiner opined that the Veteran’s vertigo is at least as likely as not related to an in-service injury, event, or disease, as shown in service treatment records documenting the Veteran having symptoms of vertigo in November 1987, February 1988, and July 1992. The rationale was that there is evidence of current, chronic, and continuous treatment and care for vertigo. There is no contrary opinion of record. Based on the foregoing, the Board finds that entitlement to service connection for vertigo is warranted. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. The Board attempts to determine the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10. When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If there is a question as to which evaluation to apply to a veteran’s disability, 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. A Veteran’s entire history is to be considered when making disability evaluations. See 38 C.F.R. 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where the issue involves the assignment of a disability rating following the initial award of service connection for that disability, as is the case here, the entire history of the disability must be considered, and separate ratings can be assigned for separate periods of time based on the facts found, a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). In making all determinations, the Board must fully consider the lay assertions of record. A Veteran is competent to report on that of which he or she has personal knowledge. Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine on a case by case basis whether a veteran’s particular disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376 -77 (Fed. Cir. 2007). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991). Equal weight is not necessarily accorded to each piece of evidence contained in the record; not every item of evidence necessarily has the same probative value. 3. Entitlement to a rating in excess of 20 percent for service-connected residuals, thoracic spine injury, back strain The Veteran contends that he is entitled to a higher rating for his service-connected residuals, thoracic spine injury, back strain. The criteria for rating disabilities of the spine are listed under Diagnostic Codes 5235 to 5243. All service-connected spine disabilities are evaluated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), unless the spinal disability is rated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (Incapacitating Episodes Rating Formula). 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. Diagnostic Code 5243 provides that intervertebral disc syndrome can be evaluated under either the General Rating Formula or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever results in a higher rating when all disabilities are combined. 38 C.F.R. § 4.71a. Under the General Rating Formula, 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, a 30 percent rating is warranted if forward flexion of the cervical spine is 15 degrees or less or if there is favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted if forward flexion of the thoracolumbar spine is to 30 degrees or less or if there is favorable ankylosis of the entire thoracolumbar spine. Unfavorable ankylosis of the entire thoracolumbar spine warrants a 50 percent rating, and unfavorable ankylosis of the entire spine warrants a 100 percent rating. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. There are several notes set out after the diagnostic criteria, which provide the following: first, associated objective neurologic abnormalities are to be rated separately under an appropriate diagnostic code. Second, for purposes of VA compensation, 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 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. Third, 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 the regulation. Fourth, each range of motion should be rounded to the nearest 5 degrees. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. The Veteran was afforded a VA examination in December 2012 that showed flexion to 55 degrees, with evidence of pain at 30 degrees. Repetitive use testing showed flexion to 55 degrees. Total combined range of motion for the thoracolumbar spine was 205 degrees. The Veteran related he has back pain which is worsened by standing on hard surfaces for a long time, prolonged sitting, and riding in a vehicle for a long time. The VA examiner noted the Veteran had less movement than normal and pain on movement. The Veteran stated putting on socks and shoes is impossible. See February 2015 Statement in Support of Claim. He related walking and sitting is painful, and getting out of bed is so difficult that he needs assistance to do so. Id. The Veteran was afforded a VA examination in September 2018 that showed flexion upon initial and repetitive use testing to 60 degrees, with no evidence of pain. Total combined range of motion for the thoracolumbar spine was 210 degrees. The Veteran did not have ankylosis. In light of the lay and medical evidence, the Board finds that a rating in excess of 20 percent is not warranted. Testing showed flexion to, at worst, 55 degrees, with pain, no additional loss of motion or pain after repetitive use, and total combined range of motion to, at least, 205 degrees. VA treatment records do not show decreased range of motion or ankylosis to warrant a higher rating. The Board has also considered whether the Veteran is entitled to a higher rating due to functional impairment under the provisions of 38 C.F.R. §§ 4.40 and 4.45. See DeLuca, 8 Vet. App. at 206-07. While the Veteran reports back pain and limited range of motion, these symptoms are specifically contemplated by his rating. Pain alone does not warrant a higher disability rating. See Mitchell v. Shinseki, 25 Vet. App. 32 (Aug. 23, 2011) (holding that pain alone does not constitute functional loss, but is just one fact to be considered when evaluating functional impairment. The Court agreed that pain alone as a basis for a higher rating would produce such “absurd results” as for example where a claimant who experiences very slight pain throughout the range of motion of the knee would receive a 50 percent disability rating under DC 5261 and a 30 percent disability rating under DC 5260, whereas a claimant who experiences actual limitation of flexion to 30 degrees and limitation of extension to 20 degrees would only receive disability ratings of 20 percent and 30 percent respectively). There is no persuasive evidence of record that the Veteran’s subjective complaints of pain rise to the level of an individual who actually experiences functional loss at the level of 40 percent. Moreover, no evidence shows favorable ankylosis of the entire spine. For VA purposes, unfavorable ankylosis is a condition in which 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 on the costal margin of the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. 38 C.F.R. § 4.71a, Note 5. Fixation of a spinal segment in neutral position (0 degrees) always represents favorable ankylosis. Id. Here, the evidence shows that the Veteran maintains range of motion in his back. Additionally, there is no evidence that the Veteran experiences limited breathing, a limited line of vision, restriction of the mouth, or gastrointestinal symptoms as a result of his back disability. Accordingly, he is not entitled to a rating in excess of 20 percent for ankylosis or similar symptoms. Additionally, the Veteran’s IVDS did not manifest with incapacitating episodes to warrant a higher rating under DC 5243. The Board recognizes the Veteran’s sincere belief that he is entitled to a higher rating. The Board, however, finds that the lay evidence is outweighed by the competent and credible medical evidence that evaluates the true extent of the impairment associated with the Veteran’s back disability based on objective data coupled with the lay complaints. In this regard, the Board notes that the VA examiners have the training and expertise necessary to administer the appropriate tests for a determination of the type and degree of the impairment associated with the Veteran’s complaints. For these reasons, greater evidentiary weight is placed on the examination findings in regard to the type and degree of impairment. Therefore, entitlement to an increased rating for residuals, thoracic spine injury is not warranted. 4. Entitlement to a rating in excess of 10 percent for service-connected residuals, fracture of left patella The Veteran contends that he is entitled to a higher rating for his service-connected residuals, fracture of left patella. Diagnostic Code 5260 provides ratings based upon the limitation of flexion in the leg. A 20 percent rating is assigned when flexion is limited to 30 degrees. A 30 percent rating is assigned when flexion is limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. The Veteran was afforded a VA examination in December 2012 which showed flexion to 140 degrees, with pain, and to 140 degrees after repetitive use testing. Extension was zero, or no limitation of extension. The Veteran related he has resting knee pain which is worsened by walking, running, and climbing stairs. The Veteran had normal joint stability and no recurrent subluxation or dislocation. The Veteran stated he has difficulty walking, standing, and climbing stairs due to hs left knee disability. See February 2015 Statement in Support of Claim. The Veteran was afforded a VA examination in September 2018 which showed flexion to 120 degrees, with pain, and to 120 degrees after repetitive use testing. Extension was zero, or no limitation of extension. There was no ankylosis, no recurrent subluxation, lateral instability, or recurrent effusion. There was no joint instability. In light of the lay and medical evidence, the Board finds that a rating in excess of 10 percent is not warranted. Testing showed flexion, at worst, to 120 degrees, with pain. Medical records do not show a decreased range of motion. The VA General Counsel held that a knee disability may receive separate ratings under diagnostic codes evaluating instability (Diagnostic Code 5257) and those evaluating range of motion (Diagnostic Codes 5003, 5010, 5256, 5260, and 5261). See VAOPGCPREC 23- 97. Diagnostic Code 5257 provides ratings for recurrent subluxation or lateral instability of the knee. A 10 percent rating is warranted for slight subluxation or lateral instability. A 20 percent rating is warranted for moderate subluxation or lateral instability. A 30 percent rating is warranted for severe knee subluxation or lateral instability. The Board observes that the words “slight,” “moderate,” and “severe” are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. Diagnostic Code 5261 provides ratings based upon the limitation of extension in the leg. A noncompensable rating is assigned when extension is limited to 5 degrees. A 10 percent rating is assigned when extension is limited to 10 degrees. A 20 percent rating is assigned when extension is limited to 15 degrees. A 30 percent rating is assigned when extension is limited to 20 degrees. A 40 percent rating is assigned when extension is limited to 30 degrees. A 50 percent rating is assigned when extension is limited to 45 degrees. Id. The objective medical evidence reflects that the Veteran’s greatest limitation of range of motion was 120 degrees in flexion, which would result in a noncompensable evaluation under Diagnostic Code 5260. Limitation of extension is not compensable pursuant to Diagnostic Code 5261 at any time during the appeal period and therefore, a higher rating under this Diagnostic Code is not warranted. Evaluations under another diagnostic code is also not warranted. The evidence does not show the Veteran has ankylosis of the left knee, recurrent subluxation, or lateral instability to warrant a rating under DC 5256 or 5257. The Board has also considered whether the Veteran is entitled to a higher rating due to functional impairment under the provisions of 38 C.F.R. §§ 4.40 and 4.45. See DeLuca, 8 Vet. App. at 206-07. While the Veteran reports left knee pain and limited range of motion, these symptoms are specifically contemplated by his rating. Pain alone does not warrant a higher disability rating. See Mitchell v. Shinseki, 25 Vet. App. 32 (Aug. 23, 2011) (holding that pain alone does not constitute functional loss, but is just one fact to be considered when evaluating functional impairment. The Court agreed that pain alone as a basis for a higher rating would produce such “absurd results” as for example where a claimant who experiences very slight pain throughout the range of motion of the knee would receive a 50 percent disability rating under DC 5261 and a 30 percent disability rating under DC 5260, whereas a claimant who experiences actual limitation of flexion to 30 degrees and limitation of extension to 20 degrees would only receive disability ratings of 20 percent and 30 percent respectively). There is no persuasive evidence of record that the Veteran’s subjective complaints of pain rise to the level of an individual who actually experiences functional loss at the level of 20 percent. No examination showed flexion 30 degrees or less, or extension to 15 degrees or more. The Board recognizes the Veteran’s sincere belief that he is entitled to a higher rating. The Board, however, finds that the lay evidence is outweighed by the competent and credible medical evidence that evaluates the true extent of the impairment associated with the Veteran’s left knee disability based on objective data coupled with the lay complaints. In this regard, the Board notes that the VA examiners have the training and expertise necessary to administer the appropriate tests for a determination of the type and degree of the impairment associated with the Veteran’s complaints. For these reasons, greater evidentiary weight is placed on the examination findings in regard to the type and degree of impairment. Therefore, entitlement to an increased rating for residuals, fracture of left patella is not warranted. 5. Entitlement to a rating in excess of 20 percent for right shoulder capsulorrhaphy (strain) with residual scar The Veteran’s right shoulder disability is currently rated as 20 percent under DC 5201, regarding limitation of motion of arm. See 38 C.F.R. § 4.71a, DC 5201. In particular, limitation of motion of the arm is to be rated under DC 5201. 38 C.F.R. § 4.71a, DC 5201. Normal ranges of upper extremity motion are defined by VA regulations as follows: forward elevation (flexion) from zero to 180 degrees; abduction from zero to 180 degrees; internal and external rotation to 90 degrees; and finally, lifting the arm to shoulder level is lifting it to 90 degrees. 38 C.F.R. § 4.71a, Plate I (2017). Pursuant to DC 5201, a 30 percent disability rating is warranted for limitation of the motion of the major extremity midway between the side and shoulder level on the major side, while such impairment of the minor side warrants a 20 percent disability rating. Id. A maximum schedular 40 percent disability rating is warranted for limitation of motion of the arm to 25 degrees from the side on the major side, which such impairment on the minor side warrants a 30 percent disability rating. Id. The Veteran contends that he is entitled to a higher rating for his service-connected right shoulder capsulorrhaphy with residual scar. The Veteran is right hand dominant. See December 2012 VA examination. The Veteran’s right shoulder disability is rated on the major side. The Veteran was afforded a VA examination in December 2012 which showed flexion to 140 degrees, with painful motion at 90 degrees. Abduction was to 130 degrees, with painful motion at 90 degrees. There was no ankylosis, guarding, or localized tenderness or pain on palpation of joints. The Veteran related he experiences pain in his right shoulder, cannot pick up things from the floor, cannot raise his arms above his shoulder, and has difficulty driving. The Veteran stated that he has a difficult time using his right arm and the pain is excruciating. See February 2015 Statement in Support of Claim. Upon September 2018 VA examination, the Veteran’s right shoulder flexion was to 150 degrees, abduction was to 150 degrees, and external rotation and internal rotation were to 60 degrees, with pain. The Veteran reports after repeated use and flare-ups, the loss of range of motion is variable, depending on how strenuously the joint was used. At its worst, the Veteran cannot move it at all due to pain and weakness but there are other times where the range of motion loss is minimal. The Board finds that the level of impairment that is demonstrated in this case does not reflect that motion of the Veteran’s right arm is limited to midway between the side and shoulder level, or 45 degrees, to warrant a 30 percent evaluation under DC 5201. Range of motion testing revealed, at worst, 140 degrees flexion, 130 degrees abduction, internal rotation to 60 degrees and external rotation to 60 degrees. The Board notes that functional loss of the musculoskeletal system may be due to pain, supported by adequate pathology and evidence by visible behavior of the claimant undertaking the motion. See DeLuca at 202 (1995); 38 C.F.R. § 4.40. However, pain alone does not warrant a higher rating. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). The Veteran’s complaint of right shoulder pain did not result in functional loss sufficient to produce a higher rating. Thus, even considering the Veteran’s subjective complaints of pain, the medical evidence of record does not support any additional limitation of motion in response to repetitive motion that would support an evaluation in excess of the 20 percent assigned. Finally, the Board has considered whether there may be any other relevant Diagnostic Code that would allow for a higher or separate disability rating throughout the appeal period. However, there is no evidence of ankylosis of the scapulohumeral articulation, impairment of the humerus, or impairment of the clavicle and scapula, and as such a higher or separate disability rating is not available. See 38 C.F.R. § 4.71a, Diagnostic Codes 5200, 5202, 5203. Specifically, the September 2018 VA examiner noted that there was no ankylosis of the right shoulder. Additionally, the examiner noted there was no shoulder instability, dislocation, or labral pathology suspected. The Veteran also did not have loss of head (flail shoulder), nonunion (false flail shoulder), or fibrous union of the humerus, or malunion of the humerus with moderate or marked deformity, or malunion or nonunion of the clavicle or scapula. Therefore, an increased or separate disability rating is not warranted under DCs 5200, 5202, 5203. There were also no compensable residuals associated with the scar. 38 C.F.R. § 4.118. The Veteran is competent to report on symptoms and credible in his belief that he is entitled to a higher rating. His competent and credible lay evidence, however, is outweighed by competent and credible medical evidence that evaluates the true extent of the shoulder impairment based on objective data coupled with the lay complaints. In this regard, the Board notes that the VA examiners have the training and expertise necessary to administer the appropriate tests for a determination on the type and degree of the impairment associated with the Veteran’s complaints. For these reasons, greater evidentiary weight is placed on the examination findings in regard to the type and degree of impairment. In sum, the weight of the credible evidence demonstrates that the Veteran’s right shoulder disability does not warrant a rating in excess of 20 percent under the relevant diagnostic codes and an increased rating is not warranted. Finally, the evidence of record shows that it is factually ascertainable that the Veteran is unemployable due to a combination of physical and mental disabilities beginning April 30, 2013. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Alexia E. Palacios-Peters, Associate Counsel