Citation Nr: 18161166 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 10-11 607 DATE: December 28, 2018 ORDER 1. Entitlement to a rating in excess of 10 percent for left hip degenerative changes is denied. 2. A 30 percent rating for left knee degenerative changes is granted for the period from June 1, 2016 to April 14, 2017, subject to regulations governing payment of monetary awards; ratings for left knee degenerative changes in excess of 10 percent prior to February 5, 2016 and in excess of 30 percent for post total knee replacement (TKR)) knee disability from June 1, 2018 are denied. 3. Entitlement to a rating in excess of 20 percent for residuals of left ankle sprain is denied. FINDINGS OF FACT 1. The Veteran’s left hip disability is not shown to have been manifested by flexion limited to 45 degrees; extension limited to 5 degrees; limitation of rotation with inability to toe-out more than 15 degrees, or limitation of adduction of the right thigh resulting in inability to cross the legs, or limitation of abduction with motion lost beyond 10 degrees; or separately ratable neurological impairment. 2. Prior to February 5, 2016 the Veteran’s left knee degenerative changes were manifested by painful motion, with flexion no less than to 125 degrees and with full extension; from June 1, 2016 to April 14, 2017 the left knee disability manifestations were approximately equivalent to (but not greater than) minimal residuals of a total knee replacement, and chronic residuals of severe painful motion or weakness in the knee were not shown; from June 1, 2018 chronic TKR residuals of severe painful knee motion or weakness are not shown at any time. 3. The Veteran’s residuals of left ankle sprain are not shown to have been manifested by ankylosis. CONCLUSIONS OF LAW 1. A rating in excess of 10 percent for left hip degenerative changes is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes (Codes) 5003, 5251-5255. 2. The Veteran’s service connected left knee disability warrants staged ratings of 10 percent (and no higher) prior to February 5, 2016; 30 percent (and no higher) from June 1, 2016 to April 14, 2017; and 30 percent (and no higher) from June 1, 2018. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Codes 5003, 5055, 5260, 5261. 3. A rating in excess of 20 percent for residuals of left ankle sprain is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, Code 5271. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from July 1967 to April 1971. These matters are before the Board on appeal from February 2008 and February 2010 rating decisions. In April 2015, a Travel Board hearing was held before the undersigned; a transcript is in the record. In December 2015, the matters were remanded. In November 2011, VA received from the Veteran’s attorney (on his behalf) a notice of disagreement (NOD) with a denial of service connection for anxiety (he has already been awarded service connection for an anxiety disorder, PTSD, which is rated 100 percent). The matter is pending response to the NOD by the agency of original jurisdiction (AOJ). Increased Ratings Disability evaluations are determined by application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In determining the disability evaluation, VA has a duty to acknowledge and consider all regulations, which are potentially applicable, based upon the assertions and issues raised in the record and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When the evaluation of a disability is based on limitation of motion, there must be consideration, in conjunction with the otherwise applicable Code, of any additional functional loss the veteran may have due to other factors as described in 38 C.F.R. §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Such factors include more or less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, and deformity or atrophy from disuse. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the veteran. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997). A rating higher than the minimum compensable rating is not assignable under a diagnostic code relating to range of motion where pain does not cause a compensable functional loss. Rather, the “pain must affect some aspect of ‘the normal working movements of the body’ such as ‘excursion, strength, speed, coordination, and endurance,’” as defined in 38 C.F.R. § 4.40, before a higher rating may be assigned. See Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011) (noting that while “pain may cause a functional loss, pain itself does not constitute a functional loss,” and, is therefore, not grounds for entitlement to a higher disability rating). 1. A rating in excess of 10 percent for left hip degenerative changes is denied. On November 2007 VA examination, the Veteran reported hip pain. On physical examination, he had full range of motion of the left hip. Flexion was to 120 degrees with no pain or discomfort. Internal rotation was to 30 degrees, external rotation was to 45 degrees, abduction was to 30 degrees, and adduction was to 24 degrees, each with no pain or discomfort. There was tenderness to palpation along the greater trochanter bursal region and no tenderness elsewhere. No palpable defects or deformities were felt, and there was no fatigability or muscle weakness. The impression was left hip strain. There were no neurologic findings. On January 2010 VA examination, there were no gross abnormalities, atrophy, or trophic skin changes of the left hip. Adduction was from 0 to 35 degrees with pain at 35 degrees. Extension was to 20 degrees without pain, and flexion was to 60 degrees without painful limitation. Abduction was to 20 degrees without painful limitation. External rotation was from 0 to 40 degrees and internal rotation was from 0 to 30 degrees, without painful limitation. X-rays were normal. There were no neurological findings. The diagnosis was mild left hip strain. At the April 2015 Board hearing, the Veteran testified that he had a radiating pain from his left buttock down to the back of the knee and sometimes the ankle, which had worsened over time. He testified that he could not stand for extended periods of time, and if he sat for extended periods had to get up and move around. On August 2017 VA examination, the diagnosis was left hip osteoarthritis. The Veteran reported flare-ups of the hip/thigh with pain. He did not report any functional loss or functional impairment of the joint. On physical examination, flexion was to 90 degrees, extension was to 10 degrees, abduction was to 20 degrees, and adduction was to 20 degrees. Adduction was not limited such that the Veteran could not cross his legs. External rotation was to 40 degrees and internal rotation was to 20 degrees. The range of motion itself did not contribute to a functional loss. Pain was noted on flexion and extension but did not result in/cause functional loss. There was no evidence of pain with weight bearing. There was no objective evidence of localized tenderness or pain on palpation of the joint. There was no objective evidence of crepitus. There was no additional loss of function or range of motion after three repetitions. Muscle strength testing was 5/5 for flexion, extension, and abduction; there was no reduction in muscle strength. There was no ankylosis of the hip. There was no malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. There was no pain on passive range of motion or when non-weight bearing. On September 2018 VA peripheral nerves examination, the Veteran reported a history of multiple ankle breaks, bilateral knee pain and knee replacements, and left hip osteoarthritis. He reported that right sided sciatica had been diagnosed in the past. He reported pain radiating down his hip and lateral leg to his foot, on both sides, and numbness in the lateral leg below the knee to the foot. He was noted to have a history of chronic lower back pain and had been referred for possible surgery. Following physical examination, the diagnosis was bilateral L5-S1 radiculopathy, with involvement of the sciatic nerve bilaterally. The examiner opined that overall, the Veteran’s history is most consistent with bilateral lower lumbar radiculopathies, and the cause for his radiculopathies is likely his lower back degeneration (compression of the lower lumbar roots in the back). The examiner opined that one would not expect the left hip degeneration to cause radicular symptoms and, therefore, the left hip neurological impairment is less likely as not proximately due to or the result of left hip degenerative changes (because it is more likely related to his back). Additional VA treatment records throughout the appeal period show symptoms similar to those found on the VA examinations described above. The Veteran’s left hip disability is rated as left hip degenerative changes under Codes 5003, 5251, 5252, and 5253. A 10 percent rating has been assigned for limited motion of the hip due to pain. Under Code 5003, degenerative arthritis is rated based on limitation of motion of the affected joint. Under Code 5251, a 10 percent rating is warranted for extension of the thigh limited to 5 degrees. Under Code 5252, a 10 percent rating is warranted for flexion of the thigh limited to 45 degrees, a 20 percent rating is warranted for flexion of the thigh limited to 30 degrees, a 30 percent rating is warranted for flexion of the thigh limited to 20 degrees, and a 40 percent rating is warranted for flexion of the thigh limited to 10 degrees. Under Code 5253, a 10 percent rating is warranted for limitation of rotation of the thigh with inability to toe-out the affected leg more than 15 degrees, or for limitation of adduction of the thigh resulting in inability to cross the legs; a 20 percent rating is warranted for limitation of abduction of the thigh resulting in motion lost beyond 10 degrees. [Codes 5250, 5254, and 5255 do not apply, as there is no evidence of left hip ankylosis or flail joint, or malunion or nonunion of the femur.] The reports of the VA examinations, the VA treatment records, lay statements and hearing testimony, overall, provide evidence against this claim, as they do not show that symptoms of the Veteran’s left hip disability produced extension limited to 5 degrees, inability to toe-out the left leg more than 15 degrees, or limitation of adduction of the thigh resulting in inability to cross the legs, so as to meet, or approximate, the criteria for an increased rating based on either limited extension or limited adduction. Similarly, the evidence does not show that symptoms of the left hip disability produced flexion limited to 30 degrees, so as to meet or approximate the criteria for a rating in excess of 10 percent for limited flexion. Therefore, the Board finds that the criteria for an increased rating for the Veteran’s left hip disability are not met, and an increased rating is not warranted. Regarding whether a separate rating is warranted for associated neurological impairment, the September 2018 VA examiner opined that the Veteran’s left lower extremity neurological complaints reflect lumbosacral radiculopathy (and do not represent separately ratable neurological impairment due to hip disability). The opinion is probative evidence in the matter as it is based on examination and interview of the Veteran and review of relevant history. The provider included rationale that cites to medical principles (that the symptoms arise from compression of lumbar nerve roots). There is no competent evidence to the contrary. Therefore, a separate rating for neurological impairment is not warranted. 2. Increases in staged ratings for left knee disability (allowed in part; denied in part). On November 2007 VA examination, the Veteran reported knee pain. An MRI found no definitive meniscal tear; there were some degenerative changes seen with mild infrapatellar tendinopathy and strain apparently of the popliteal muscle with mild patellofemoral degeneration. On physical examination, there was no varus deformity, erythema, edema, effusion, or ecchymosis of the knee, and no atrophy of the musculature. He was mildly tender to palpation along the pes anserine bursa and mildly over the medial joint line. McMurray’s test was positive. Range of motion was from 0 to 135 degrees both passively and actively without any pain or functional impairment, and there was no fatigability. There was no pain with varus or valgus stress and no laxity. Lachman’s test and negative anterior drawer were negative. There was mild tenderness to palpation in the popliteal region and mild retropatellar crepitus with motion. There was no subluxation or instability. The impression was left knee degenerative changes. There were no neurologic findings. On January 2010 VA examination, there were no gross abnormalities of the left knee. Range of motion was from 0 to 125 degrees without pain. There was minimal subpatellar crepitation with extension and flexion of the knee. There was no joint swelling or effusion. McMurray’s sign was negative. The collateral and cruciate ligaments are intact and there was no rotatory instability. X-rays showed very slight narrowing of the tibiofemoral joint space with a minimal retropatellar spur on the upper pole of the patella. There were no neurological findings. The diagnosis was mild left knee degenerative joint disease. At the April 2015 Board hearing, the Veteran testified that a partial knee replacement had been recommended. He testified that he had recently received a cortisone shot to the left knee and was able to walk without a knee brace he had been using. He testified that he has increased knee pain at the end of each day and it becomes painful to bend the knee; he testified that the knee did not give way. He testified that recent MRIs showed a sprained ACL and a torn meniscus, for which a scope was scheduled in the near future. On February 5, 2016, the Veteran underwent a left partial knee replacement; on post-operative followup, the surgeon opined that the Veteran would need 3 to 6 months for recovery. A May 2016 rating decision assigned a temporary total (postsurgical convalescence) rating from February 5, 2016 to June 1, 2016, and a 10 percent rating from June 1, 2016. On April 14, 2017, the Veteran underwent revision of the partial knee replacement, and conversion to a TKR with bone grafting. The operative report notes that following the partial knee replacement the Veteran had continuing knee pain, and opted for a TKR. A May 2017 rating decision granted a schedular post-TKR rating from April 14, 2017 to June 1, 2018; a 30 percent rating was assigned from June 1, 2018. On August 2017 VA examination, the Veteran was noted to have undergone total knee replacement surgery in April 2017. He reported left knee pain with flare-ups. He did not report having any functional loss or functional impairment of the knee. On physical examination, flexion of the left knee was to 90 degrees and extension was to 0 degrees; the range of motion itself did not contribute to functional loss. Pain with flexion was noted on examination, but did not result in/cause functional loss. There was no evidence of pain with weight bearing. There was no objective evidence of localized tenderness or pain on palpation of the knee. There was no objective evidence of crepitus. There was no additional functional loss or range of motion loss after three repetitions. Muscle strength was 5/5 for flexion and extension; there was no reduction in muscle strength. There was no ankylosis. There was no history of recurrent subluxation, lateral instability, or recurrent effusion. There was no joint instability; Lachman, posterior drawer, medial instability, and lateral instability tests were normal. There was no meniscus condition. The residuals of TKR included intermediate degrees of residual weakness, pain, or limitation of motion. The Veteran did not use any assistive devices for locomotion. There was no pain on passive range of motion or when non-weight bearing. On September 2018 VA peripheral nerves examination, the Veteran reported a history of multiple ankle breaks, bilateral knee pain and knee replacements, and left hip osteoarthritis. He reported that right sciatica had been diagnosed in the past. He reported pain radiating down his hip and lateral leg to his foot, on both sides. He reported numbness in the lateral leg below the knee to the foot. He was noted to have a history of chronic lower back pain and had been referred for possible surgery. Following physical examination, the diagnosis was bilateral L5-S1 radiculopathy, with involvement of the sciatic nerve bilaterally. The examiner opined that overall, the Veteran’s history is most consistent with bilateral lower lumbar radiculopathies, and the cause for his radiculopathies is likely his lower back degeneration (compression of the lower lumbar roots in the back). The examiner opined that numbness/tingling and radiating pain in the left lower extremity would be related to the Veteran’s back, and not knee, disability. Additional VA treatment records throughout the appeal period show symptoms largely similar to those found on the VA examinations described above. Under Code 5003, degenerative arthritis established by X-ray findings is rated based on limitation of motion under the appropriate Codes for the specific joints involved. When the limitation of motion of the specific joints involved is noncompensable under the appropriate Codes, a 10 percent rating is warranted for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added, under Code 5003. The criteria for rating knee disabilities are found in Codes 5256 to 5263. Code 5256 provides for ratings from 30 to 60 percent for ankylosis of a knee. Under Code 5257, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability, a 20 percent rating is warranted for moderate recurrent subluxation or lateral instability, and a 30 percent rating is warranted for severe recurrent subluxation or lateral instability. Code 5258 provides for a 20 percent rating for dislocated semilunar cartilage with frequent episodes of “locking”, pain, and effusion into the joint. Under Code 5259, a 10 percent rating is warranted for cartilage, semilunar, removal of, symptomatic. Under Code 5260, limitation of knee flexion to 60 degrees or more warrants a 0 percent rating, to 45 degrees warrants a 10 percent rating, to 30 degrees warrants a 20 percent rating, and to 15 degrees warrants a 30 percent rating. Under Code 5261, limitation of knee extension to 5 degrees warrants a 0 percent rating, to 10 degrees warrants a 10 percent rating, to 15 degrees warrants a 20 percent rating, to 20 degrees warrants a 30 percent rating, to 30 degrees warrants a 40 percent rating, and to 45 degrees warrants a 50 percent rating. Code 5262 provides for ratings for impairment due to malunion or nonunion of the tibia and fibula. Code 5263 provides for a 10 percent rating for acquired (traumatic) genu recurvatum. 38 C.F.R. § 4.71a. Post-TKR knee disability os rated under Code 5055 (for prosthetic replacement, defined as “total replacement of the joint”), which provides for a 100 percent rating for 1 year following implantation of prosthesis, a 60 percent rating for chronic residuals of severe painful motion or weakness in the joint, and a 30 percent (minimum) rating for weakness, pain, or limitation of motion. 38 C.F.R. § 4.71a. [Diagnostic codes 5256, 5258, 5259, 5262, and 5263 have no applicability in this matter, as the pathology, manifestations, or impairment in the rating criteria for those Codes (ankylosis, dislocated semilunar cartilage, symptomatic removal of semilunar cartilage, malunion or nonunion of tibia or fibula, or genu recurvatum) are not shown. 38 C.F.R. § 4.71a.] As noted above, the Veteran has been assigned total ratings for the left knee disability from February 5, 2016 to June 1, 2016, and from April 14, 2017 to June 1, 2018; those periods are not for consideration. At the outset, the Board notes that much of the Veteran’s treatment for his left knee disability was by private providers. He was asked, pursuant to the Board’s December 2015 remand to submit complete records of his private treatment (or identify the providers and submit authorizations for VA to obtain the records on his behalf). His response to the request was limited. As private records cannot be obtained by VA without the Veteran’s co-operation, it will be assumed for purposes of this decision that any pertinent private records outstanding are either unavailable or do not support the Veteran’s claim. Addressing the distinct periods of varying disability in turn, the Board notes that prior to February 5, 2016 the Veteran’s left knee disability has been rated 10 percent for limitation of motion/flexion or painful motion with X-ray confirmed degenerative arthritis (under Codes 5003-5260). To warrant an increase in the rating assigned for that period, the evidence would have to show limitation of flexion to 30 degrees, compensable (at 10 degrees) limitation of extension, or recurrent subluxation or lateral instability. The evidence of record does not show that any such criteria were met. At no time prior to February 5, 2016 is the Veteran’s left knee flexion shown to have been limited to 30 degrees (flexion has not been found limited to less than 125 degrees, even with factors such as pain, use, and weight-bearing considered); extension was consistently found to be full. Furthermore, while the Veteran has reported use of a knee brace, instability was not found. Tests for instability on November 2007 and January 2010 examinations were normal. And at the April 2015 Board hearing the Veteran himself testified that (while he found it painful to bend the knee at the end of a day) the knee did not give way. Consequently, a separate rating for knee instability was not warranted, and a rating in excess of 10 percent for the left knee was not warranted prior to February 5, 2016. As was noted above, from February 5, 2016 to June 1, 2016 the left knee was rated 100 percent, and that period is not for consideration. More problematic is the period from June 1, 2016 to April 14, 2017 (when the Veteran underwent TKR surgery and a total rating was again assigned-properly under Code 5055). The records pertaining to the period are sparse, and the precise nature and severity of the left knee disability following the post-surgical convalescence period is not clear. What is known (from the notation on the operative report) is that the result of the February 2016 surgery was less than optimal; the Veteran continued to complain of pain, to the extent that upon being advised of the related risks he opted for revision/conversion to a TKR on April 14, 2017. This evidence suggests a knee disability of greater severity than is reflected by the rating assigned based on painful motion. Considering the limitations imposed by the lack of more detailed information regarding the status of the left knee during this period (and affording the Veteran every benefit of the doubt in the matter possible), the Board finds that the disability is most appropriately rated by analogy (as the prosthesis was less than a total knee, but there is no specific Code for partial knee replacement; see 38 C.F.R. § 4.20) to the criteria in Code 5055, and warrants the 30 percent minimum rating provided under that Code. A higher rating for that period is not warranted as chronic residuals of severe painful motion or weakness are not shown by the records made available. From June 1, 2018, the Veteran’s left knee has been assigned a 30 percent rating under Code 5055, for postoperative TKR with intermediate degrees of residual weakness, pain or limitation of motion. To warrant an increase in the rating assigned, the evidence would have to show chronic residuals consisting of severe painful motion or weakness in the affected extremity, i.e. the left leg. The evidence of record does not show a level of disability. On August 2017 VA examination, the Veteran did not report having any functional loss or functional impairment of the knee; flexion was to 90 degrees and extension was to 0 degrees, and although pain was noted on exam with flexion, it did not result in or cause functional loss. Additionally, there was full muscle strength for flexion and extension. Significantly, the Veteran was not using assistive devices for locomotion (which supports that there was not severe pain or weakness). Indeed, the examiner opined that the residuals of total knee joint replacement included intermediate degrees of residual weakness, pain, or limitation of motion (consistent with the 30 percent rating assigned). The Board notes that the August 2017 examination took place only 4 months after the Veteran’s total knee surgery, and 10 months before the June 1, 2018 effective date of the 30 percent rating for postoperative residuals; there is no evidence of worsening since (and logically, it may reasonably be assumed that the knee continued to improve over the remainder of the convalescent period). Consequently, a rating in excess of 30 percent for post-TKR left knee disability from June 1, 2018 is not warranted. Regarding the allegation that a separate rating is warranted for associated neurological impairment, the September 2018 VA examiner opined that the cause of the Veteran’s lower extremity neurological symptoms was lumbar radiculopathy, and not any neurological impairment due to knee disability (including from surgery residuals). As with the rating for hip disability, the Board finds that opine probative evidence (and in the absence of competent evidence to the contrary, persuasive. A separate rating for neurological impairment associated with the service-connected left knee disability is not warranted. 3. A rating in excess of 20 percent for residuals of left ankle sprain is denied. On November 2007 VA examination, the Veteran reported continued left ankle pain and swelling and instability. He reported that his ankle gave way sometimes, and his pain was worse with prolonged ambulation and excessive activity or attempts at exercise. Review of an ankle MRI showed a 1-inch heel split to the tip of the lateral malleolus with retromalleolar subluxation of the peroneal tendons with stress and tear of the anterior talofibular ligament with thickening of the anterior talofibular gutter. On physical examination, there was no edema, erythema, or ecchymosis of the ankle. Dorsiflexion was to 10 degrees and plantar flexion was to 45 degrees with pain at 45 degrees over the top of the foot but no functional impairment. Resistance to internal and external rotation showed 5/5 strength with internal rotation and plantar flexion but no functional impairment. There was some tenderness to palpation along the posterior aspect of the fibula and the tip of the medial malleolus. Over the insertion of the deltoid ligament, there was increased translation with anterior drawer by 2 millimeters, left compared to right. There was mild pain over the ATF ligament but no joint effusion. There was discomfort at the insertion of the Achilles but no palpable defect or deformity was felt. Squeeze test was negative. He was nontender over the fifth metatarsal base. The impression was left ankle sprain, old fracture, with tendon rupture and some moderate residual pain with antalgic gait. There were no neurologic findings. On January 2010 VA examination, the Veteran wore a lower ankle brace for the ankle because of weakness and tenderness. On physical examination, there were no gross abnormalities of the ankle. Range of motion of the ankle was dorsiflexion of 0 to 10 degrees and plantar flexion of 0 to 40 degrees without pain. There was no evidence of muscle atrophy. The Veteran was able to stand on toes and heels without difficulty, and he was able to squat. There were no neurological findings. The diagnosis was left ankle sprain with sequelae. On August 2011 VA examination, the Veteran reported intermittent ankle pain and decreased range of motion, for which he occasionally used an Arizona brace. On physical examination, dorsiflexion was to 10 degrees, further limited by arthrofibrosis at 10 degrees. Plantar flexion was to 30 degrees without painful limitation. There was 15 degrees of inversion and eversion without painful limitation. There was mild discomfort along the lateral aspect of the ankle. There was no evidence of any frank ankle instability. The impression was posttraumatic left ankle, very mild arthrosis, with X-ray findings of a small spur at the medial malleolus. There were no neurologic findings, subluxation, or instability. At the April 2015 Board hearing, the Veteran testified that his ankle is weakened and tends to roll as he walks or steps off a curb, and that in February 2009 he was given an Arizona brace to stabilize the ankle. He testified that he wore an ankle brace daily, and that his ankle had given out and caused him to fall, sustaining knee and shoulder injuries. He testified that surgery had been recommended but he did not want to undergo surgery. On August 2017 VA examination, the Veteran reported multiple ankle sprains since service; the diagnosis was left lateral collateral ligament sprain. He reported flare-ups with pain. He did not report any functional loss or functional impairment of the ankle. On physical examination of the left ankle, dorsiflexion was from 0 to 10 degrees, and plantar flexion was from 0 to 30 degrees. Range of motion itself did not contribute to functional loss. Pain was noted on dorsiflexion but did not result in/cause functional loss. There was no evidence of pain with weight bearing. There was no objective evidence of localized tenderness or pain on palpation of the joint. There was no additional loss of function or range of motion after three repetitions. Muscle strength was 5/5 for plantar flexion and dorsiflexion, and there was no reduction in muscle strength. There was no ankylosis of the ankle. Left ankle instability or dislocation was suspected; anterior drawer and talar tilt tests showed no laxity compared with the opposite side. The Veteran reported regular use of an ankle brace. There was no pain on passive range of motion or when non-weight bearing. Additional VA treatment records throughout the appeal period show symptomatology largely similar to that found on the VA examinations and records described above. The Veteran’s residuals of left ankle sprain are rated under Code 5271 (for limitation of ankle motion). Under Code 5271, a (maximum) 20 percent rating is assigned for marked limited motion of the ankle. Ankle disability may alternatively be rated under criteria in Codes 5270 (for ankylosis of the ankle) and 5272 through 5274 (for ankylosis of the subastragalar or tarsal joint, malunion of the os calcis or astragalus, and astragalectomy). 38 C.F.R. § 4.71a. At the outset, the Board notes that Codes 5270, 5272, 5273, and 5274 do not have applicability in this matter, as there is no evidence that the left ankle, subastragalar joint, or tarsal joint are ankylosed, that there is malunion of the os calcis or astragalus, or that the Veteran underwent astragalectomy (i.e., the pathology addressed by those Codes). An increase from the 20 percent rating assigned for the Veteran’s residuals of left ankle sprain would require ankylosis in plantar flexion or dorsiflexion. A close review of the record found that ankylosis of the ankle has not been noted at any time; therefore, a rating in excess of 20 percent is not warranted. Significantly, whenever range of motion studies were conducted, the Veteran was found to have motion in the ankle, i.e., the ankle was not in a fixed position. Once again it is noteworthy that on 2017 examination (for another disability) it was reported that the Veteran ambulates without assistive devices. The criteria for a rating higher than 20 percent for the Veteran’s left ankle disability are not met, and an increased rating is not warranted. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Schechner, Counsel