Citation Nr: 20004086 Decision Date: 01/16/20 Archive Date: 01/16/20 DOCKET NO. 13-06 118 DATE: January 16, 2020 ORDER Entitlement to a compensable rating for degenerative arthritis of the spine with spinal stenosis prior to November 10, 2009 is denied. Entitlement to a 10 percent rating for degenerative arthritis of the spine with spinal stenosis from November 10, 2009 to March 6, 2013 is granted subject to the laws and regulations governing the award of monetary benefits. Entitlement to a 20 percent rating for degenerative arthritis of the spine with spinal stenosis from March 7, 2013 to April 2, 2015 is granted subject to the laws and regulations governing the award of monetary benefits. Entitlement to a rating in excess of 10 percent for degenerative arthritis of the spine with spinal stenosis since April 3, 2015 is denied. Entitlement to a rating in excess of 10 percent for osteochondritis dissecans of the right ankle medial talar dome prior to April 28, 2004, is denied. Entitlement to a 20 percent rating, but no higher for osteochondritis dissecans of the right ankle medial talar dome from April 29, 2004 to July 25, 2006, is granted subject to the laws and regulations governing the award of monetary benefits. Entitlement to a rating in excess of 10 percent for osteochondritis dissecans of the right ankle medial talar dome from July 26, 2006 to June 9, 2011 is denied. Entitlement to a rating in excess of 20 percent for osteochondritis dissecans of the right ankle medial talar dome since June 10, 2011 is denied. Entitlement to a rating in excess of 10 percent for left ankle degenerative arthritis prior to June 10, 2011 is denied. Entitlement to a rating in excess of 20 percent for left ankle degenerative arthritis since June 10, 2011 is denied. Entitlement to a rating in excess of 10 percent for right hip degenerative arthritis is denied. Entitlement to a rating in excess of 10 percent for a right knee strain is denied. Entitlement to a compensable rating for hypertension prior to November 10, 2016 is denied. Entitlement to a 10 percent rating for hypertension since November 10, 2016 is granted subject to the laws and regulations governing the award of monetary benefits. Entitlement to a total disability rating based on individual unemployability due to service-connected disorders is denied. FINDINGS OF FACT 1. Prior to November 10, 2009, degenerative arthritis of the spine with spinal stenosis was not manifested by forward thoracolumbar flexion of 86 degrees or less, a combined range of motion of the thoracolumbar spine less than 236 degrees, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour, or by vertebral body fracture with loss of 50 percent or more of the height. 2. From November 10, 2009 to March 6, 2013 degenerative arthritis of the spine with spinal stenosis was manifested by muscle spasm, guarding, or localized tenderness, but not by an abnormal gait or abnormal spinal contour, forward thoracolumbar flexion of 60 degrees or less, a combined range of motion of the thoracolumbar spine of 120 degrees or less, 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. 3. From March 7, 2013 to April 2, 2015 degenerative arthritis of the spine with spinal stenosis was manifested by forward thoracolumbar flexion limited to 60 degrees or less, but not by forward thoracolumbar flexion of 30 degrees or less, or by favorable ankylosis of the entire thoracolumbar spine. 4. Since April 3, 2015, degenerative arthritis of the spine with spinal stenosis was not manifested by forward thoracolumbar flexion of 60 degrees or less, a combined range of motion of the thoracolumbar spine of 120 degrees or less, 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. 5. Prior to April 28, 2004, osteochondritis dissecans of the right ankle medial talar dome was not manifested by a marked limited of ankle motion or by ankylosis in plantar flexion of less than 30 degrees. 6. From April 28, 2004 to July 25, 2006 osteochondritis dissecans of the right ankle medial talar dome was manifested by a marked limited motion of the ankle but not by ankylosis in plantar flexion greater than 30 degrees, in dorsiflexion between zero and 10 degrees, or with abduction, adduction, inversion, or eversion deformity. 7. From July 26, 2006 to June 9, 2011, osteochondritis dissecans of the right ankle medial talar dome was not manifested by a marked limited motion of the ankle or by ankylosis in plantar flexion of less than 30 degrees. 8. Since June 10, 2011, osteochondritis dissecans of the right ankle medial talar dome was not manifested by ankylosis in plantar flexion greater than 30 degrees, in dorsiflexion between zero and 10 degrees, or with abduction, adduction, inversion, or eversion deformity. 9. Prior to June 10, 2011, left ankle degenerative arthritis was not manifested by a marked limited motion of the ankle or by ankylosis in plantar flexion of less than 30 degrees. 10. Since June 10, 2011, left ankle degenerative arthritis was not manifested by ankylosis of the ankle in plantar flexion greater than 30 degrees, in dorsiflexion between zero and 10 degrees, or with abduction, adduction, inversion, or eversion deformity. 11. Right hip degenerative arthritis is not manifested by flexion limited to 45 degrees or less, a limitation of rotation with inability to toe-out more than 15 degrees, a limitation of abduction with inability to cross the legs, or by a limitation of abduction with motion lost beyond 10 degrees. 12. A right knee strain is not manifested by flexion limited to 45 degrees or less, or extension limited to 10 degrees or more. 13. Prior to November 10, 2016, hypertension was not manifested by diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or more with a requirement for continuous medication for control. 14. Since November 10, 2016, hypertension was manifested by a history of diastolic pressure predominantly 100 or more with a requirement for continuous medication for control, but not by diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. 15. The Veteran is service connected for left knee degenerative joint disease, rated 30 percent disabling; right ankle osteochondritis dissecans of the medial talar dome rated 20 percent disabling; left ankle degenerative arthritis rated 20 percent disabling; chronic left side neck pain with degenerative spurring rated 10 percent disabling; right hip degenerative arthritis rated 10 percent disabling; left hip degenerative arthritis rated 10 percent disabling; a right knee strain rated 10 percent disabling; degenerative arthritis of the spine with spinal stenosis rated 10 percent disabling; and hypertension rated 10 percent disabling. His combined rating is 80 percent. 16. The preponderance of the evidence is against finding that the Veteran’s service-connected disabilities alone are so severe as to preclude all forms of substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to a compensable rating for degenerative arthritis of the spine with spinal stenosis prior to November 10, 2009 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5235-5243. 2. The criteria for entitlement to a 10 percent rating, but no higher for degenerative arthritis of the spine with spinal stenosis from November 10, 2009 to March 6, 2013 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5235-5243. 3. The criteria for entitlement to a 20 percent rating for degenerative arthritis of the spine with spinal stenosis from March 7, 2013 to April 2, 2015 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5235-5243. 4. The criteria for entitlement to a rating in excess of 10 percent for degenerative arthritis of the spine with spinal stenosis since April 3, 2015 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5235-5243. 5. The criteria for entitlement to a rating in excess of 10 percent for osteochondritis dissecans of the right ankle medial talar dome prior to June 10, 2011 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5270-5274. 6. The criteria for entitlement to a 20 percent rating, but no higher, for osteochondritis dissecans of the right ankle medial talar dome from April 28, 2004 to July 25, 2006 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5270-5274. 7. The criteria for entitlement to a rating in excess of 10 percent for osteochondritis dissecans of the right ankle medial talar dome July 26, 2006 to June 9, 2011 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5270-5274. 8. The criteria for entitlement to a rating in excess of 20 percent for osteochondritis dissecans of the right ankle medial talar dome since June 10, 2011 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5270-5274. 9. The criteria for entitlement to a rating in excess of 10 percent for left ankle degenerative arthritis prior to June 10, 2011 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5270-5274. 10. The criteria for entitlement to a rating in excess of 20 percent for left ankle degenerative arthritis since June 10, 2011 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5270-5274. 11. The criteria for entitlement to a rating in excess of 10 percent for right hip degenerative arthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5252, 5253. 12. The criteria for entitlement to a rating in excess of 10 percent for a right knee strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5260, 5261. 13. The criteria for entitlement to a compensable rating for hypertension prior to November 10, 2016 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101. 14. The criteria for entitlement to a 10 percent rating, but no higher, for hypertension since November 10, 2016 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101. 15. The criteria for assignment of a total disability rating based on individual unemployability due to service-connected disorders have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.18, 4.19, 4.25. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1981 to February 1990. Issues in the current appeal have been previously remanded in December 2006, April 2010, December 2011, March 2016, and July 2016. In a November 2018 rating decision, service connection for left knee degenerative joint disease was granted. The Board has held two hearings in this matter, one in August 2016 and the other in February 2018 before different Veterans Law Judges on the issues listed on the title page. The Veteran was advised of his right to a hearing before a third Veterans Law Judge; however, he waived that right in August 2018. Increased Rating Disability evaluations are determined by the 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. Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1999). Nevertheless, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as “staged” ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). The analysis is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods within the period on appeal. Where there is a question as to which of the two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. 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. It is essential that the examination on which ratings are based adequately portrays the anatomical damage, and the functional loss, with respect to these elements. In addition, functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the veteran undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Degenerative arthritis of the spine with spinal stenosis The Veteran contends that his degenerative arthritis of the spine with spinal stenosis is more severely disabling than represented by the noncompensable rating assigned prior to April 3, 2015, and the 10 percent rating assigned since April 3, 2015. The Veteran was granted entitlement to service connection for degenerative arthritis of the spine with spinal stenosis in a November 2009 rating decision, rated noncompensable effective April 20, 2009. The Veteran appealed. The appellant’s degenerative arthritis of the spine with spinal stenosis is rated under the General Rating Formula for Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a, Diagnostic Code 5242. The General Rating Formula provides a 10 percent rating where there is forward thoracolumbar flexion greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. Id. A 20 percent rating is assigned when forward thoracolumbar flexion is greater than 30 degrees, but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or, there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is warranted when forward thoracolumbar flexion is 30 degrees or less; or there is favorable ankylosis of the entire thoracolumbar spine. Id. These ratings apply 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. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. VA regulations set forth at 38 C.F.R. §§ 4.40, 4.45, 4.59 provide for consideration of functional impairment due to pain on motion when evaluating the severity of a musculoskeletal disability. However, as previously noted, the general formula for disabilities of the spine expressly states that the criteria and ratings apply “with or without symptoms such as pain.” See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. In other words, the presence of pain is already taken into account in the formula. 68 Fed.Reg. 51454 -5 (Aug. 27, 2003) (“Pain is often the primary factor limiting motion, for example, and is almost always present when there is muscle spasm. Therefore, the evaluation criteria provided are meant to encompass and take into account the presence of pain, stiffness or aching, which are generally present when there is a disability of the spine.”) After a complete review of the record, the Board finds that prior to November 10, 2009, degenerative arthritis of the spine with spinal stenosis was not manifested by forward thoracolumbar flexion of 85 degrees or less, a combined range of motion of the thoracolumbar spine of 235 degrees or less, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour, or vertebral body fracture with loss of 50 percent or more of the height. On VA examination in September 2009, the Veteran demonstrated a full range of motion of the thoracolumbar spine, with forward flexion to 120 degrees, extension to 30 degrees, left lateral flexion to 30 degrees, left lateral rotation to 30 degrees, right lateral flexion to 30 degrees, and right lateral rotation to 30 degrees. The combined range of motion was 270 degrees. Lumbar symptoms included stiffness and aching, however, there was no evidence of spasm, guarding or tenderness, and the examiner stated that the primary complaint at that time was “stiffness, rather than pain.” This evidence preponderates against finding that the Veteran’s lumbar spine disorder was manifested by forward thoracolumbar flexion of 85 degrees or less, or a combined range of motion of the thoracolumbar spine of 235 degrees or less. Indeed, the September 2009 examination revealed full range of motion of the thoracolumbar spine. The medical evidence pertinent to this period further preponderates against finding that the Veteran suffered from muscle spasm, guarding, localized tenderness or vertebral body fracture. The Board acknowledges that under 38 C.F.R. § 4.59, “the intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability” and “actually painful, unstable, or mal-aligned joints” … “are entitled to at least the minimum compensable rating for the joint.” However, the medical evidence pertinent to this period did not reveal a finding of pain on motion. Instead, the September 2009 VA examiner characterized the Veteran’s complaints as “achiness” and “stiffness rather than pain.” Accordingly, a compensable rating prior to November 10, 2009 is not warranted under 38 C.F.R. § 4.59. Based on the foregoing, the preponderance of the evidence is against finding that a compensable rating for degenerative arthritis of the spine with spinal stenosis prior to November 10, 2009 is warranted. With regard to the period from November 10, 2009 to March 6, 2013, the Board finds that degenerative arthritis of the spine with spinal stenosis was manifested by muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour, but not by forward thoracolumbar flexion of 60 degrees or less, a combined range of motion of the thoracolumbar spine of 120 degrees or less, 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 November 10, 2009 private treatment record revealed “tenderness to palpation about the lumbosacral paraspinal musculature and facet joints as well as over the posterior-superior iliac spine and sacral notches” with “mildly limited lumbar flexion and moderately limited lumbar extension with end-range pain and guarding demonstrated.” This evidence supports a finding that degenerative arthritis of the spine with spinal stenosis was manifested by tenderness and guarding. However, the evidence pertinent to this period does not suggest than any muscle spasm or guarding was severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Moreover, although the November 2009 private treatment record noted a limitation of thoracolumbar motion, no specific range of motion measurements were provided, and no such measurements pertinent to this period reveal forward thoracolumbar flexion of 60 degrees or less or a combined range of motion of 120 degrees or less. Thus, for the period from November 10, 2009 to March 6, 2013, the Board finds that a 10 percent rating, but no higher, is warranted. With regard to the period from March 7, 2013 to April 2, 2015 the Board finds that degenerative arthritis of the spine with spinal stenosis was manifested by forward thoracolumbar flexion limited to 60 degrees or less, but not by forward thoracolumbar flexion of 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. In this respect a March 7, 2013 private treatment record revealed lumbar forward flexion to 60 degrees, extension to 25 degrees, and lateral bending to 25 degrees. This evidence indicates that lumbar forward flexion was limited to 60 degrees or less. However, the evidence pertinent to this period does not contain range of motion measurements demonstrating 30 degrees or less of thoracolumbar forward flexion, and no medical evidence pertinent to this period suggests that the Veteran suffered from favorable ankylosis of the entire thoracolumbar spine. In sum, for the period from March 7, 2013 to April 2, 2015, the Board finds that a 20 percent rating, but no higher, is warranted. With regard to the period since April 3, 2015 the Board finds that degenerative arthritis of the spine with spinal stenosis was not manifested by forward thoracolumbar flexion greater than 30 degrees, but not greater than 60 degrees, a 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. In this regard, at an April 3, 2015 VA examination, the Veteran showed 70 degrees of forward flexion, 25 degrees of extension, 30 degrees of right lateral flexion, 30 degrees of left lateral flexion, 30 degrees of right lateral rotation and 30 degrees of left lateral rotation, with a combined range of motion of 215 degrees. The examiner did report guarding and muscle spasm of the thoracolumbar spine, but those symptoms did not result in abnormal gait or abnormal spinal contour. At an August 2016 Board hearing, the Veteran reported that his lumbar spine disorder was manifested by pain and stiffness. He stated that at times his muscles would “tighten up” almost causing him to fall. At a February 2018 Board hearing, the Veteran reported that his lumbar spine disorder prevented him from standing and walking for long periods, as well as from bending down and lifting heavy objects. He stated that after sitting for a long period he would need to stand up. At a VA examination in December 2018 the appellant demonstrated 80 degrees of lumbar forward flexion, 15 degrees of lumbar extension, 20 degrees of right lateral flexion, 15 degrees of left lateral flexion, 25 degrees of right lateral rotation, and 20 degrees of left lateral rotation, with a combined range of lumbar motion of 175 degrees. The examiner noted that pain was present with active and passive motion with and without weight bearing. The examiner opined that flare-ups of the thoracolumbar spine symptoms would prevent one day of work per month on average due to increased pain and stiffness. Pain, weakness, fatigability, and incoordination with repeated use were reported to limit walking, standing, lifting and bending. Although guarding and muscle spasm were present, they did not result in abnormal gait or abnormal spinal contour. As is evident, the range of motion measurements pertinent to this period reveal forward flexion in excess of 60 degrees, and a combined range of motion of the thoracolumbar spine in excess of 120 degrees. While muscle spasm and guarding were reported, the medical evidence does not indicate that they were severe enough to result in abnormal gait or spinal contour. Thus, for the period since April 3, 2015 the medical evidence preponderates against finding that a rating in excess of 10 percent is warranted. The Board acknowledges the lay and medical reports of back pain, to include on flare-up. However, the regulation is clear that the pertinent criteria and ratings apply “with or without symptoms such as pain.” See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Accordingly, higher ratings based on pain, to include on flare-up or after repetitive use are not warranted. Moreover, the record does not include evidence of any specific degree of additional limitation of motion due to pain, weakness, fatigability, incoordination, flare-ups, or after repetitive use. The September 2009 and May 2015 VA examiners found no flare-ups of the thoracolumbar spine. While the December 2018 VA examiner reported flare-ups of spine pain, the examiner did not indicate that flare-ups would produce any additional loss of range of motion. Rather the examiner opined that flare-ups would produce a loss of one day of work per month on average. Therefore, the medical evidence preponderates against finding that the Veteran’s low back symptoms more nearly approximated the criteria for a higher rating. The Board acknowledges that under 38 C.F.R. § 4.59, examination of certain joints should include testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing. Correia v. McDonald, 28 Vet. App. 158 (2016). The most recent December 2018 VA examination contained complete assessments of pain on both active and passive motion, in weight-bearing and non-weight-bearing. To the extent that other examinations cited herein did not explicitly provide these findings, the Board reiterates that the pertinent ratings of the spine apply with or without symptoms such as pain. Thus, any deficiency of the spine examinations of record in this regard is harmless, as assessment of pain in accordance with 38 C.F.R. § 4.59 would not provide a basis for the assignment of any higher rating. Additionally, to the extent that earlier examinations discussed herein did not explicitly provide findings of pain on both active and passive motion, or in weight-bearing and non-weight-bearing, they are nonetheless the most probative evidence available with regard to the severity of the disabilities at the time those examinations were conducted. Any additional medical opinion with regard to those periods would be retrospective and entitled to less probative value than the contemporaneous range of motion evidence already of record. Therefore, remand for any additional retrospective opinion is not warranted. See Soyini v. Derwinski, 1 Vet. App. 540 (1991) (remand is unnecessary where it would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the claimant). In summary, a compensable rating for degenerative arthritis of the spine with spinal stenosis prior to November 10, 2009 is denied, and a 10 percent rating from November 10, 2009 to March 6, 2013 is granted. A 20 percent rating is granted from March 7, 2013 to April 2, 2015, and entitlement to a rating in excess of 10 percent since April 3, 2015 is denied. Osteochondritis dissecans of the right ankle medial talar dome and left ankle degenerative arthritis The Veteran contends that osteochondritis dissecans of the right ankle medial talar dome and left ankle degenerative arthritis are more severely disabling than represented by the 10 percent ratings assigned prior to June 10, 2011, and the 20 percent ratings assigned since June 10, 2011. The Veteran was granted entitlement to service connection for osteochondritis dissecans of the right ankle medial talar dome in June 1991, and for left ankle degenerative arthritis in January 1992. Each disorder was rated 10 percent disabling effective from March 1, 1990. The Veteran claimed entitlement to increased ratings on January 23, 2001. Those claims were denied, and the Veteran appealed. The Veteran’s bilateral ankle disorders are rated based on limitation of motion of the ankle under Diagnostic Code 5271. 38 C.F.R. § 4.71a. Under Diagnostic Code 5271 a 10 percent rating is assigned for a moderate limited motion of the ankle and a 20 percent rating for a marked limited motion of the ankle. The terms “moderate,” and “marked” are not defined in the Rating Schedule, but the Rating Schedule does show that for the ankle the normal range of plantar flexion is from zero to 45 degrees, and the normal range of dorsiflexion is from zero to 20 degrees. 38 C.F.R. § 4.71a, Plate II. Ankle ankylosis in plantar flexion of less than 30 degrees is assigned a 20 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5270. Ratings of 30 and 40 percent are available when there is ankylosis of the ankle in plantar flexion greater than 30 degrees, in dorsiflexion between zero and 10 degrees, or with abduction, adduction, inversion, or eversion deformity. Id. "Ankylosis" is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary 94 (31st ed. 2007); Augustine v. Principi, 18 Vet. App. 505, 506 (2006). The Board finds that prior to April 28, 2004, the Veteran’s osteochondritis dissecans of the right ankle medial talar dome was not manifested by a marked limitation of motion or by ankylosis in plantar flexion of less than 30 degrees. On VA examination in April 2001 the Veteran, although he reported pain with walking, showed a full range of motion in both ankles with dorsiflexion to 20 degrees and plantar extension to 45 degrees bilaterally. Thus, for the period prior to April 28, 2004 the evidence preponderates against finding a marked limitation of right ankle motion or ankylosis. To the contrary, the VA examiner reported full range of right ankle motion. Accordingly, a rating in excess of 10 percent is not warranted for this period. For the period from April 28, 2004 to July 25, 2006 the Board finds that osteochondritis dissecans of the right ankle medial talar dome was manifested by a marked limited motion of the ankle but not by ankylosis in plantar flexion greater than 30 degrees, in dorsiflexion between zero and 10 degrees, or with abduction, adduction, inversion, or eversion deformity. In this regard on April 28, 2004 a VA examiner reported right ankle range of motion as 15 degrees of active dorsiflexion, 20 degrees of passive dorsiflexion, 15 degrees of active plantar flexion and 20 degrees of passive plantar flexion. There was noted to be a “slight complaint of pain” at the terminal degrees of both feet. The examiner described the functional impairment resulting from the ankle disorder as “moderate” and reported minimal incoordination and limp, with no weakness or fatigability. This evidence is at least in equipoise as to whether the Veteran demonstrated a marked limitation of right ankle motion from April 28, 2004 to July 25, 2006. While the examiner characterized the impact of the disabilities as “moderate” the range of motion measurements reveal a loss of more than half of normal plantar flexion. Additionally, the examiner’s indication that the Veteran exhibited pain at the end range of motion suggests that the active range of motion measurements may have more accurately represented the effective functional loss. Based on the active range of motion measurements, the Veteran retained only one third of the normal right ankle dorsiflexion and three fourths of the normal plantar flexion. The Board finds that this level of impairment more nearly approximates a “marked” limitation of ankle motion. Notably, however, the medical evidence does not support any finding of right ankle ankylosis such as to support a rating higher than 20 percent. Based on the foregoing, and after resolving reasonable doubt in the appellant’s favor, the Board finds that osteochondritis dissecans of the right ankle medial talar dome warranted a 20 percent rating, but no higher, from April 28, 2004 to July 25, 2006. For the period from July 26, 2006 to June 9, 2011, the Board finds that the Veteran’s osteochondritis dissecans of the right ankle medial talar dome was not manifested by either a marked limited ankle motion or by ankylosis in plantar flexion of less than 30 degrees. In this regard, at a July 26, 2006 VA examination the Veteran demonstrated 15 degrees of active right ankle dorsiflexion, 20 degrees of passive dorsiflexion and 45 degrees of plantar flexion. The examiner opined that the ankle disorders would have no effect on the Veteran’s ability to work, though he would be able to stand for a maximum of two minutes at a time. A February 2010 VA examination revealed 20 degrees of right ankle dorsiflexion and 30 degrees of plantar flexion. There was no objective evidence of pain with active motion, although the Veteran reported flare-ups of pain occurring weekly for one to two days. The examiner noted that the effect of flare-ups was “pain” but did not conclude that flare-ups produced any further limitation of motion. The Veteran reported being unable to walk for more than five or ten minutes at an easy pace with the opportunity to sit down and take a break or to stand for more than a few minutes at a time. The examiner characterized the overall effect of the disorder on the Veteran’s mobility as “moderate,” but opined that the disorder would have significant effects on his usual occupation, including decreased mobility, problems with lifting and carrying, weakness or fatigue, decreased strength, and lower extremity pain. This evidence preponderates against finding that the right ankle exhibited a “marked” limitation of motion from July 25, 2006 to June 9, 2011. In this regard, the most severe limitation of dorsiflexion during this period was to 15 degrees, a loss of only five degrees from normal. The most severe limitation of plantar flexion was to 30 degrees, a loss of 15 degrees, or one third of the normal range. The July 2006 VA examiner opined that the disorders would have no effect on the Veteran’s ability to work. While the February 2010 examiner opined that the right ankle disorder would have “significant” effects on the Veteran’s usual occupation, the effect on his mobility was characterized as only moderate. Overall, this evidence supports only a moderate limitation of right ankle motion. Accordingly, a rating in excess of 10 percent for this period is not warranted. With regard to the left ankle degenerative arthritis, the Board finds this disorder was not manifested by marked limitation of motion, or by ankylosis in plantar flexion of less than 30 degrees prior to June 10, 2011. On VA examination in April 2001, the Veteran was noted to have full range of motion in both ankles, with dorsiflexion to 20 degrees and plantar extension to 45 degrees bilaterally. At the April 2004 examination, left ankle range of motion was to 10 degrees of active dorsiflexion, 20 degrees of passive dorsiflexion, 35 degrees of active plantar flexion and 40 degrees of passive plantar flexion. There was a “slight complaint of pain” at the terminal degrees bilaterally. The examiner described the functional impairment resulting from both ankle disorders as “moderate” and reported minimal incoordination and limp, with no weakness or fatigability. In November 2004, a VA examiner measured left ankle range of motion at 20 degrees of dorsiflexion and 45 degrees of plantar flexion. At a July 2006 VA examination, left ankle range of motion was 20 degrees of dorsiflexion, 40 degrees of active plantar flexion and 45 degrees of passive plantar flexion. The Veteran reported being able to stand for a maximum of two minutes at a time. The examiner opined that the bilateral ankle disorders would have no effect on the Veteran’s ability to work. A February 2010 VA examination revealed 20 degrees of left ankle dorsiflexion and 30 degrees of plantar flexion. There was no objective evidence of pain with active motion, although the Veteran reported flare-ups occurring weekly for one to two days. The examiner only noted that the effect of such flare-ups was additional pain but did not indicate that flare-ups produced any further limitation of motion. The Veteran reported being able to walk for no more than five or ten minutes at an easy pace with the opportunity to sit down and take a break, and being unable to stand for more than a few minutes at a time. The examiner characterized the overall effect on the Veteran’s mobility as “moderate,” but opined that the disorder would have significant effects on his usual occupation, including decreased mobility, problems with lifting and carrying, weakness or fatigue, decreased strength, and lower extremity pain. Thus, with regard to the left ankle, the evidence preponderates against finding a marked limitation of motion prior to June 9, 2011. The most severe impairment of left ankle dorsiflexion was a limitation to 10 degrees in April 2004. Such limitation represents half the normal range of dorsiflexion, but passive dorsiflexion was full at that time and active plantar flexion was only limited to 35 degrees. The most severe impairment of left ankle plantar flexion during this period was to 30 degrees in February 2010, a loss of one third of the range of motion. The November 2004 VA examiner described the resulting functional impairment as moderate, while the February 2010 examiner found only a moderate limitation of mobility. Overall, this evidence supports only a moderate limitation of left ankle motion. There is no medical evidence to support a finding of left ankle ankylosis. Accordingly, a rating in excess of 10 percent for this period is not warranted. With regard to the period since June 10, 2011, the Board finds that the ankle disorders were never manifested by ankylosis of either ankle in plantar flexion greater than 30 degrees, in dorsiflexion between zero and 10 degrees, or with abduction, adduction, inversion, or eversion deformity. The medical evidence of record, to include June 2011, April 2015, and December 2018 VA examinations, was silent for any report of ankylosis, and range of motion findings support that the Veteran retained some range of motion in both ankles in all planes of movement. While the June 2011 VA examiner noted flare-ups of ankle symptoms, there is no indication that such flare-ups were so severe as to produce ankylosis. On the contrary, the Veteran was noted to be able to keep his flare-ups “under control by limiting his time standing or walking” and with “constant use of … an anti-inflammatory as well as pain medication.” At his August 2016 Board hearing the Veteran stated that his ankle disorders resulted in morning stiffness and difficulty with mobility, that his ankles were “bone on bone” and that he required shoe inserts. In February 2018 the Veteran testified that his ankles exhibited “a lot of instability” with cramping in cold weather. He acknowledged that he retained some movement in the ankles. As neither lay nor medical evidence indicates ankylosis of either ankle, the evidence preponderates against finding that the Veteran’s ankle disorders were manifested by such symptom. Accordingly, a rating in excess of 20 percent for either ankle disorder is not warranted since June 10, 2011. The Board acknowledges the lay and medical reports of ankle pain, weakness, fatigability, incoordination, flare-ups. However, the record does not include evidence of additional limitation of motion due to pain, weakness, fatigability, incoordination or flare-ups, nor is there any medical evidence of record that pain, weakness, fatigability, incoordination or flare-ups were productive of such a severe impairment of motion as to approximate ankylosis. Both the April 2015 and December 2018 examiners expressly denied any finding of flare-ups. While the February 2010 and June 2011 VA examiners reported flare-ups, the Board has considered those reports in its analysis as discussed above. The medical evidence preponderates against finding that the criteria for higher ratings were more nearly approximated based on these findings. The Board notes that the most recent December 2018 ankle examination included consideration of pain on both active and passive motion, in weight-bearing and non-weight-bearing. Correia. To the extent that earlier examinations discussed herein did not explicitly provide such findings or attempt to quantify loss of range of motion on flare-up, they are nonetheless the most probative evidence available with regard to the severity of the disabilities at the time those examinations were conducted. Any additional medical opinion with regard to those periods would be retrospective and entitled to less probative value than the contemporaneous range of motion evidence already of record. Therefore, remand for any additional medical opinion evidence is not warranted. In sum, for the period prior to April 28, 2004 a rating in excess of 10 percent for osteochondritis dissecans of the right ankle medial talar dome is denied. From April 28, 2004 to July 25, 2006 a 20 percent rating, but no higher for that disorder is granted, and from July 26, 2006 to June 9, 2011 a rating in excess of 10 percent is denied. For the period prior to June 10, 2011 a rating in excess of 10 percent for left ankle degenerative arthritis is denied, and ratings in excess of 20 percent for the bilateral disorders since June 10, 2011 are denied. Right hip degenerative arthritis The Veteran contends that right hip degenerative arthritis is more severely disabling than represented by the currently assigned 10 percent rating. The Veteran was granted entitlement to service connection for right hip degenerative arthritis in a November 2009 rating decision, rated 10 percent disabling effective from April 20, 2009. The Veteran claimed entitlement to an increased rating on July 12, 2012. The claim was denied, and he appealed. The normal range of hip motion is measured from zero degrees of extension to 125 degrees of flexion; abduction is measured from zero degrees to 45 degrees. 38 C.F.R. § 4.71a, Plate II. The Veteran’s right hip degenerative arthritis is currently rated under Diagnostic Code 5251 which provides for a maximum 10 percent evaluation where thigh extension is limited to five degrees or less. Id. Limitation of hip motion can also be evaluated under Diagnostic Code 5252. Under that code, a 10 percent disability evaluation is assigned for flexion of the thigh limited to 45 degrees. For a 20 percent evaluation, there must be limitation of flexion to 30 degrees. 38 C.F.R. § 4.71a. Diagnostic Code 5253 provides for evaluations based on impairment of the thigh. Limitation of adduction with inability to cross the legs is assigned a 10 percent rating and limitation of rotation with inability to “toe-out” more than 15 degrees is assigned a 10 percent rating. Limitation of abduction with motion lost beyond 10 degrees is assigned a 20 percent rating. Id. Preliminarily, the Board observes that the rating decision code sheets of record incorrectly reflect that the Veteran’s right hip disorder has been rated under Diagnostic Code 5252 pertaining to limitation of thigh flexion. However, the November 2009 narrative decision clearly states that the initial 10 percent rating was assigned on the basis of extension limited to zero degrees. Additionally, as further discussed below, the September 2009 VA examination supports that a 10 percent rating was warranted based on limitation of right hip extension, but not based on limitation of flexion. Accordingly, the notation in the rating decision code sheets which imply that the Veteran’s right hip degenerative arthritis is rated under Diagnostic Code 5252 are clearly a typographical error. For purposes of the Board’s analysis the Veteran’s right hip degenerative arthritis is rated under Diagnostic Code 5251 based on limitation of extension. Significantly, this could allow for the assignment of separate compensable ratings under another diagnostic code pertaining to the hip, to include Diagnostic Codes 5252 or 5253, if the criteria for a 10 percent rating under such code were met. For the reasons discussed below, the Board does not find that any higher or separate rating is warranted. After a complete review of the record, the Board finds that right hip degenerative arthritis has not been manifested by right hip flexion limited to 45 degrees or less, abduction with motion lost beyond 10 degrees, a limitation of adduction with inability to cross the legs, or a limitation of rotation with inability to “toe-out” more than 15 degrees. At a September 2009 VA examination, the Veteran exhibited 90 degrees of right hip flexion, extension was limited to zero degrees, and abduction to 35 degrees. He was able to cross the right leg over the left and could “toe-out” more than 15 degrees. March 2013 private treatment records document right hip flexion to 120 degrees, and external and internal rotation to 30 degrees. On VA examination in August 2013, the Veteran demonstrated 125 degrees of right hip flexion or greater. Abduction was not lost beyond 10 degrees, nor was it limited so as to prevent crossing the legs, and rotation was not limited such that the Veteran could not “toe-out” more than 15 degrees. The examiner noted that the Veteran suffered a right femur fracture in 2009 in a civilian work-related accident, and that the residuals of that injury were not service-connected. In August 2016, the Veteran testified that his right hip disability was manifested by burning pain and inflammation. A January 2017 private treatment record reflected full right hip flexion, but noted that internal and external rotation were limited. Precise range of motion measurements were not provided. A July 2018 VA examiner found that right hip range of motion was “all normal” with 125 degrees of flexion, 30 degrees of extension, 45 degrees of abduction, 25 degreed of adduction, external rotation to 60 degrees and internal rotation to 40 degrees. The examiner noted pain with active and passive motion, and in weight-bearing and non-weight-bearing, but opined that pain was not productive of further functional loss. The evidence preponderates against finding that the criteria for a higher or separate rating were met or more nearly approximated. The objective medical evidence of record indicates that the Veteran’s right hip flexion was consistently in excess of 45 degrees, abduction was consistently in excess of 10 degrees, any limitation of adduction did not prevent crossing of the legs, and any limitation of rotation did not result in an inability to “toe-out” more than 15 degrees. Accordingly, neither a rating in excess of 10 percent for this period is warranted, nor is a separate compensable rating warranted. The Board acknowledges the lay and medical reports of hip pain. However, the record does not include evidence of any specific degree of additional limitation of motion due to pain, nor is there any medical evidence of record that hip pain was productive of such severe impairment of range of motion as to approximate the criteria for a higher or separate rating. The July 2018 examiner specifically found that pain was not productive of further functional impairment. The totality of the evidence preponderates against finding that the criteria for higher ratings were more nearly approximated based on these findings. The claim is denied. Right knee strain The Veteran contends that his right knee strain is more severely disabling than represented by the currently assigned 10 percent rating. The Veteran was granted entitlement to service connection for a right knee strain in a February 2012 rating decision, rated 10 percent disabling effective August 2, 2010. The Veteran claimed entitlement to an increased rating on January 8, 2013. The claim was denied, and he appealed. A limitation of knee motion is rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261. The Veteran’s right knee strain is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under that Code a 10 percent rating is assigned when flexion of the knee is limited to 45 degrees and a 20 percent rating is assigned for flexion limited to 30 degrees. The Veteran is currently assigned the minimum compensable rating based on painful motion in the joint under 38 C.F.R. § 4.59. Under 38 C.F.R. § 4.71a, Diagnostic Code 5261, a 10 percent rating is assigned when extension of the knee is limited to 10 degrees, and a 20 percent rating is assigned when extension is limited to 15 degrees. Separate ratings may be awarded under Diagnostic Codes 5260 and 5261 based on limitation of flexion and limitation of extension of the same joint. See VAOPGCPREC 9-2004. After a complete review of the record, the Board finds that the right knee strain has not, at any time, been manifested by flexion limited to 45 degrees or less, or extension limited to 10 degrees or more. On VA examination in August 2010, the Veteran demonstrated right knee flexion and extension from zero to 90 degrees. A March 2013 private treatment record noted right knee flexion to 140 degrees and extension to zero degrees. At an August 2013 VA examination, right knee flexion was reported as 140 degrees, and extension was to zero degrees. In April 2015 a VA examiner reported 140 degrees of right knee flexion with extension to zero degrees. The examiner noted pain in flexion which did not result in further functional loss. At his August 2016 hearing, the Veteran reported that his right knee pain was “almost unbearable.” In July 2018 a VA examiner found 110 degrees of right knee flexion with extension to zero degrees. The examiner noted pain on active and passive motion and with weight-bearing and non-weight-bearing, but opined that pain did not produce additional functional loss. The totality of the most probative evidence preponderates against finding that the criteria for a higher or separate rating were met or more nearly approximated. The medical evidence of record indicates that at no point during the period on appeal has the Veteran demonstrated right knee flexion of 45 degrees or less or extension limited to 10 degrees or more. The Board acknowledges the lay and medical reports of knee pain. However, the record does not include evidence of any specific degree of additional limitation of motion due to pain, nor is there any medical evidence of record that knee pain was productive of such severe impairment of range of motion as to approximate the criteria for a higher or separate rating. Indeed, the July 2018 examiner specifically found that pain was not productive of further functional impairment. Thus, the totality of the evidence preponderates against finding that the criteria for higher ratings were more nearly approximated based on these findings. The claim is denied. Hypertension The Veteran contends that his hypertension is more severely disabling than represented by the currently assigned noncompensable rating. He was granted entitlement to service connection for hypertension in a July 2010 rating decision, rated noncompensable effective from July 14, 2010. The Veteran appealed. The Veteran’s hypertension is rated under Diagnostic Code 7101 for hypertensive vascular disease. 38 C.F.R. § 4.104. Under Diagnostic Code 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or as the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. To warrant a 20 percent rating, the evidence must show that diastolic pressure is predominantly 110 or more, or that systolic pressure is predominantly 200 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101. After a complete review of the record, the Board finds that prior to November 9, 2016, hypertension was not manifested by diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or by a history of diastolic pressure predominantly 100 or more requiring continuous medication for control. The Veteran’s service records generally reveal blood pressure readings within normal limits for VA rating purposes. 38 C.F.R. § 4.104. The VA treatment records from August 2000 to February 2016 also reflect numerous blood pressure readings in the normal range. Elevated readings were as follows: 140/92 in August 2000; 162/102 in February 2001, 149/90 in June 2002; 159/93 in May 2004; 151/94 in March 2006, 126/94 in April 2006, 145/91 in May 2006; 138/92 and 137/99 in December 2007; 172/126 and 168/113 in April 2008; 146/91, 142/101 and 152/109 in October 2008; 137/91 in December 2008, 142/94 in November 2009; 152/98 in April 2010, 160/109 in October 2011, 150/95 in March 2012, 151/102 and 152/102 in September 2012; 144/90 in October 2012; 135/93 in February 2013; 148/106 in February 2013; 141/97 in April 2013; 147/102 in June 2013; 147/92 in December 2013; 138/93, and 134/90 in January 2014; 150/92 in March 2014; 154/102, 149/102, 197/113 and 188/94 in May 2014; 156/90 in October 2014; 170/96, 149/97 and 150/94 in December 2014; 153/103 in January 2015; 147/100 in February 2015; 156/90 in May 2015; 149/98 in July 2015; 129/90 and 137/93 in September 2015; 144/96, 165/100, 165/104, 128/92 and 140/97 in October 2015; 154/96 in January 2016; 145/94 and 124/90 in February 2016. At a July 2010 VA hypertension examination, blood pressure readings of 138/84 and 136/84 were reported. An April 2015 VA examination revealed readings of 134/86, 133/87 and 132/88. The examiner noted that the Veteran used continuous medication, but did not have a history of diastolic blood pressure of 100 or more. In May 2014 the Veteran provided 29 home blood pressure readings taken between April 2014 and May 2014. 11 readings showed diastolic pressure in excess of 100, and five showed systolic pressure in excess of 160. The Board acknowledges that the Veteran was prescribed continuous medication to manage his hypertension during the period on appeal. However, the evidence preponderates against finding that diastolic pressure was predominantly 100 or more, that systolic pressure was predominantly 160 or more, or that there was a history of diastolic pressure predominantly 100 or more, prior to June 16, 2016. Significantly, among the elevated readings discussed above, the majority of systolic readings were below 100 and the majority of diastolic readings were below 160. Particularly considering the numerous additional readings which were in the normal range for VA compensation purposes, a compensable rating is not warranted for this period. With regard to the period since June 16, 2016, the Board finds that hypertension was manifested by a history of diastolic pressure predominantly 100 or more requiring continuous medication for control, but not by diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. On June 16, 2016, a VA treatment record reported a blood pressure reading of 164/100. A second June 2016 treatment record noted that the Veteran called to report home readings of 153/105 and 151/95. In October 2016, readings of 148/90, 142/88, 136/97 and 136/93 were recorded. An October 2016 VA treatment record noted home blood pressure monitoring results of 172/110, 146/95, 147/125, 157/101, 167/105, 147/79, 147/105, and 147/101. In November 2016, readings of 150/107, 171/102, 141/108, and 167/102 were recorded. A November 2016 VA treatment record noted home blood pressure monitoring results of 171/102, 141/108, and 167/103. In December 2016, readings of 142/104, 147/107, 139/102, 140/95, 135/94 and 149/108 were reported. A December 2016 VA treatment note reported home monitoring readings of 162/118, 138/88, 146/101, 138/102, 146/99, 154/104, 131/94, 146/94 and 158/106. The Veteran was noted to have been taking an inadequate dose of his hypertension medication. Thereafter, clinical readings largely returned to the normal range. Elevated readings included: 165/95 in September 2017, 154/108 in November 2017, 129/90, 127/96, and 133/94 in January 2018; as well as 122/91 in July 2018. A May 2018 VA treatment record noted the Veteran reported elevated home blood pressure readings of 131/94, 127/90, 131/96, 164/107, 128/92, and 148/102. At his February 2018 Board hearing the Veteran reported elevated home blood pressure readings of 142/96, 145/101, 148/106, 136/96, 138/102, 132/100, 151/107, 157/106, 151/101, 157/104, 151/114 and 156/109. At a VA examination in December 2018 the Veteran’s blood pressure readings were 140/92, 120/84, and 131/85. The Veteran was reported to require continuous medication for the condition, but he did not provide a history of blood pressure elevation to predominantly 100 or more. After resolving reasonable doubt in the Veteran’s favor, the evidence is at least in equipoise as to whether the Veteran’s hypertension was manifested by a history of diastolic pressure that was predominantly 100 or more since June 16, 2016. In this regard, during the six-month period from June 2016 to December 2016, the majority of diastolic blood pressure readings were in excess of 100. However, the record at no time reveals evidence of diastolic pressures predominantly 110 or more, or systolic pressures predominantly 200 or more. While there are isolated instances of diastolic blood pressure above 110, the vast majority of diastolic readings have been below that threshold. In sum, entitlement to a 10 percent rating for hypertension prior to June 16, 2016 is denied. Since June 16, 2016, a 10 percent rating, but no higher, is granted. Individual unemployability The appellant contends that his service-connected disabilities preclude him from obtaining or maintaining any form of gainful employment. As discussed above, the Veteran submitted a claim for entitlement to increased ratings for his bilateral ankle disabilities on January 23, 2001. That claim was denied, and the Veteran appealed. The claim of entitlement to a total disability evaluation based on individual unemployability due to service-connected disorders presently before the Board was inferred in connection with the claim for an increased rating for the ankles, in accordance with the holding in Rice v. Shinseki, 22 Vet. App. 447 (2009). VA will grant a total disability evaluation based on individual unemployability due to service-connected disorders when the evidence shows that a veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. A total rating for compensation purposes may be assigned where the schedular rating is less than total when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more service-connected disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16(a). For the purpose of establishing one 60 percent disability, or one 40 percent disability in combination, disabilities affecting a single body system are considered as one disability. 4.16(a). In determining whether an appellant is entitled to a total disability evaluation based on individual unemployability, neither his nonservice-connected disabilities nor advancing age may be considered. 38 C.F.R. § 4.19. The Veteran is service connected for left knee degenerative joint disease, rated 30 percent disabling; osteochondritis dissecans of the right ankle medial talar dome rated 20 percent disabling, left ankle degenerative arthritis rated 20 percent disabling, chronic left side neck pain with degenerative spurring rated 10 percent disabling, right hip degenerative arthritis rated 10 percent disabling, left hip degenerative arthritis rated 10 percent disabling, right knee strain rated 10 percent disabling, degenerative arthritis of the spine with spinal stenosis rated 10 percent disabling, and hypertension rated 10 percent disabling. His combined rating is 80 percent. As all of the Veteran’s disabilities apart from hypertension affect the orthopedic system, they are considered as one disability for the purpose of establishing one 60 percent disability, or one 40 percent disability in combination. The combined disability rating for the Veteran’s orthopedic disorders is 80 percent. As such, he meets the criteria to be potentially eligible for a total disability evaluation based on individual unemployability due to service-connected disorders under 38 C.F.R. § 4.16 (a). After a complete review of the record, the Board finds that the preponderance of the evidence is against finding that the Veteran is unable to obtain or maintain employment due to his service-connected disabilities. At an April 2001 VA examination, the Veteran was noted to be working 12 hours per day as a manufacturing technician. He was able to hop on either foot, heel-toe walk, squat and rise, but these motions provoked discomfort. In March 2004, the Veteran’s wife reported that his ankle pain prevented him from performing a job that required constant standing. In April 2004, a VA examiner opined that the Veteran’s right and left ankle disorders produced “moderate” functional impairment, and that his right knee disorder caused “slight” functional impairment. At a November 2004 VA examination, the Veteran stated his left ankle and left knee disorders required him to sit down as often as he could, though he was unable to specify how often that was. The Veteran also reported an inability to carry heavy objects, but was unable to specify how heavy of an object he could carry. He was reported to be unable to jump or play basketball. The examiner described the functional impairment caused by the left knee disorder as “slight plus.” In March 2005 a vocational rehabilitation counselor opined that the Veteran’s “present job as an electronic technician or wafer processor” was appropriate to his aptitudes and education. The counselor recommended that the Veteran work with his employer to obtain an accomodation such as “a stool to allow him to alternate sitting and standing as needed.” In a March 2006 statement, the Veteran noted that he had moved to a new department at work where he no longer was required to stand or walk as much as he had previously. He reported that this change had helped to reduce his pain. In July 2006 a VA examiner noted that the Veteran worked full time as a manufacturing technician which was described as a “sitting job.” The Veteran reported that his bilateral ankle disorders prevented him from standing for more than two minutes at a time before he needed to sit down. The examiner summarized the functional impairment attributed to the right ankle as “slight” and to the left ankle as “minimal.” In a February 2007 letter, a VA podiatrist related that the Veteran’s disabilities prevented him from lifting more than 20 pounds, climbing ladders or stairs, standing for a period in excess of three hours per eight-hour workday, or ambulating in excess of three hours per eight-hour workday. A May 2008 VA treatment record reflected that the Veteran had obtained a “sitting job” due to his ankle disorders, but that pain still made it “very difficult” for him to sit for 10 hours. At a September 2009 VA examination, the Veteran was noted to have been terminated from employment due to failure to report a criminal conviction. The examiner opined that the left-sided neck strain and lower back disorder had no effects on the Veteran’s usual daily activities. With regard to his bilateral hip disabilities, the Veteran reported being unable to stand for more than a few minutes or to walk for more than a few yards. The examiner opined, however, that the hip disabilities had no significant effects on the Veteran’s usual occupation. On a December 2009 application for a total disability rating based on individual unemployability, the Veteran reported that he was unable to work due to his right hip disability. The Veteran explained that he had recently fallen at work and fractured his right leg close to his hip. He asserted that this injury had in turn worsened all of his service-connected disabilities such as to preclude employment. The Veteran stated that he had most recently worked in November 2009 in a warehouse, with previous employment as an electrical technician and in manufacturing. The Veteran’s education included four years of high school and two years of college with an associate’s degree in applied science/electronics. At a February 2010 VA examination, the Veteran was noted to have performed previous work in a warehouse receiving shipments and using a scanner to check incoming orders. He was unemployed due to recently fracturing his femur. The examiner opined that the Veteran’s right ankle disorder would have “significant effects” on his usual occupation, and noted the bilateral ankle disorders would moderately limit mobility. He could walk no more than five or ten minutes at an easy pace with the opportunity to sit down and take a break, and was unable to stand for more than a few minutes at a time. With regard to the bilateral hip and lumbar spine conditions, the examiner stated that the Veteran could participate in employment that involved no prolonged walking or standing and he would need to be afforded the opportunity to stand up and change positions while working at a desk. He was limited to no lifting or carrying, no bending, and generally no duties that required physical activity other than walking short distances. A June 2011 VA examiner reported the Veteran was working as an electrician solderer described as a “primarily sedentary-type job.” He had not lost any time from work due to his bilateral ankle disorders. The examiner noted that if the Veteran stood for more than 15 minutes or walked for more than a block he would be looking to sit down. In April 2012 the Veteran reported that he had returned to full-time light duty at work, following his right femur fracture. In a May 2012 statement the Veteran provided an employment history stating that in January 2007 he had been terminated from a job as a remote-control operations center technician due to his right and left ankle pain. In September 2012 he found work as a solderer which was a “sitting down job.” He was laid off from that position in February 2008, and began work as an electrical technician on December 2008. He was let go from that position due to his failure to disclose information on his application. Thereafter he began working in warehouse shipping and receiving, but fractured his right femur after two weeks on the job. He reported that he began work as an electrical assembler in December 2010, which was a “sitting down job” although he still reported back and hip pain from this job. In August 2013 a VA examiner opined that the Veteran’s right hip and bilateral knee disorders produced no functional impact on his ability to work. The Veteran was provided a comprehensive VA examination in April 2015. The examiner reported no functional impact of the service-connected hypertension. The back, neck, left hip, ankle and right knee disorders were noted to interfere with employment, in that they produced pain with decreased range of motion. On this basis, the examiner opined that the Veteran’s service-connected disorders alone, or in combination, would not completely preclude him from securing and following substantially gainful sedentary employment, for which his education and occupational experience would qualify him. At his August 2016 Board hearing, the Veteran reported severe pain associated with his numerous service-connected disorders. However, he stated that he was currently working, and was able to sit and stand, but was limited in what he could do. He stated that he was “still able to function and do what I need to do.” In an October 2016 statement, the Veteran’s friend S.B. reported that on two occasions, she had observed the appellant experiencing pain after walking 30 to 40 minutes, and needing to sit down for 20 minutes. On another occasion, he needed to sit down after walking for 15 to 20 minutes. She also reported that the Veteran had pain after sitting for a prolonged period, and when getting out of bed in the morning. In a December 2016 VA treatment record the Veteran reported that he had lost a job due to absence resulting from pain. In February 2018 the Veteran reported that his pain conditions were getting worse and causing him to miss time from work. At his February 2018 Board hearing, the Veteran again reported pain associated with his service-connected disorders, which precluded walking and standing, as well as lifting heavy objects and bending down. The Veteran stated that if he sat for a prolonged period he would need to stand up. He reported that he had lost jobs because of his limitations with standing, walking, lifting and carrying. At a July 2018 VA examination, an examiner opined that the Veteran’s hip disorders were not productive of any functional effect on his ability to work. The service-connected knee disorders did limit walking, standing, kneeling and squatting. A December 2018 VA treatment record noted that the Veteran reported ankle, knee and back pain, and requested a note indicating his limitations at work. A December 2018 VA examiner found that the Veteran’s bilateral ankle disorders limited his ability to walk, stand and climb. His back disorder limited his ability to walk, stand, lift and bend. Flare-ups of low back pain reportedly caused the Veteran to miss one day of work per month on average. The Veteran’s hypertension was noted to have no effect on his ability to work. The totality of the evidence preponderates against finding that the Veteran’s service-connected disorders preclude him from obtaining or maintaining substantially gainful employment consistent with his educational and occupational experience. Notably, while the Veteran has reported several periods of unemployment and has attributed some terminations to his service-connected disabilities, he has also maintained extended periods of employment throughout the appellate term. Most recently, the December 2018 VA treatment note indicated that the Veteran was currently working. This evidence supports that the Veteran retains the capacity for gainful employment. The Board acknowledges that the Veteran’s service-connected disorders do impair his ability to perform work involving prolonged walking or standing, or involving lifting, climbing, bending or squatting. However, the medical evidence preponderates against finding that the Veteran’s service-connected disorders preclude him from performing work which primarily involves sitting down, lifting no more than 10 pounds at a time, and occasionally lifting or carrying articles like docket files, ledgers, and small tools. While the Veteran has reported pain with sitting for prolonged periods, the medical evidence of record preponderates against finding that his service-connected disorders alone preclude prolonged sitting. While a May 2008 VA treatment record stated that it was “very difficult” for the Veteran to sit for 10 hours, the February 2010 VA examiner indicated that this limitation could be overcome if the appellant could stand up and change positions. Similarly, the March 2005 vocational assessment recommended that the Veteran could obtain an accomodation which would allow him to alternate sitting and standing. The Board thus finds the evidence preponderates against finding that the service-connected disorder would preclude all employment which primarily involved sitting. The Board further observes that the Veteran has performed numerous occupations characterized as “sitting down” or “sedentary” including as a manufacturing technician and solderer. Additionally, the Veteran has four years of high school eduction and an associate’s degree in applied science/electronics. Accordingly, the evidence preponderates against finding that he lacks the occupational or educational experience necessary to obtain employment which would accommodate his functional limitations. While the question of employability is ultimately one for the Board, as the fact finder, to decide, the medical opinions of record provide highly persuasive evidence regarding whether the Veteran’s symptoms cause significant occupational impairment. See Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013). Here, the medical evidence indicates that the Veteran had some occupational impairment caused by his service-connected disabilities, but no medical examiner of record has opined that the Veteran’s service-connected disabilities completely prevent the kind of activities required for gainful employment. Accordingly, the Board finds, based on the preponderance of the evidence of record, that the Veteran’s service-connected disabilities do not preclude him from obtaining and maintaining substantially gainful employment consistent with his education and experience.   The claim of entitlement to a total disability evaluation based on individual unemployability due to service-connected disorders is denied. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Paul J. Bametzreider, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.