Citation Nr: 20005672 Decision Date: 01/23/20 Archive Date: 01/23/20 DOCKET NO. 18-36 484 DATE: January 23, 2020 ORDER The claim for entitlement to service connection for joint pain is dismissed. Entitlement to an effective date prior to February 6, 2014, for the award of service connection for cervical degenerative disc disease is denied. Entitlement to an effective date prior to February 6, 2014, for the award of service connection for degenerative disc disease is denied. Entitlement to an effective date prior to February 6, 2014, for the award of service connection for right shoulder strain is denied. Entitlement to an initial rating in excess of 20 percent for service-connected cervical degenerative disc disease is denied. Entitlement to an initial rating in excess of 40 percent for service-connected degenerative disc disease is denied. Entitlement to an initial rating in excess of 20 percent for service-connected right shoulder strain is denied. Entitlement to an initial rating in excess of 10 percent for service-connected right knee patellofemoral syndrome is denied. Entitlement to an initial rating in excess of 10 percent for service-connected right orchiectomy is denied. REMANDED Service connection for a right hip disability is remanded. Service connection for a left hip disability is remanded. REFERRED ISSUE The issue of entitlement to service connection for right shoulder rotator cuff tear and labral tear was raised by the record. This issue, however, is not currently developed or certified for appellate review. Accordingly, this matter is referred to the Regional Office (RO) for appropriate consideration. FINDINGS OF FACT 1. On September 2019, prior to the promulgation of a decision in the appeal, the Board received notification from the Veteran, through his attorney, that a withdrawal of the appeal for service connection for joint pains is requested. 2. The Veteran’s claim for service connection for cervical degenerative disc disease was received by VA on February 6, 2014; the claim was not received within a year of separation from active duty. 3. A claim for service connection for cervical degenerative disc disease was not received by VA prior to February 6, 2014. 4. The Veteran’s claim for service connection for degenerative disc disease (of the lumbar spine) was received by VA on February 6, 2014; the claim was not received within a year of separation from active duty. 5. A claim for service connection for degenerative disc disease (of the lumbar spine) was not received by VA prior to February 6, 2014. 6. The Veteran’s claim for service connection for a right shoulder condition was received by VA on February 6, 2014; the claim was not received within a year of separation from active duty. 7. A claim for service connection for a right shoulder condition was not received by VA prior to February 6, 2014. 8. The Veteran’s cervical degenerative disc disease manifests with limitation of flexion of the cervical spine greater than 15 degrees; ankylosis is not more nearly approximated. 9. The Veteran’s degenerative disc disease is manifest by forward flexion of the thoracolumbar spine greater than 30 degrees; ankylosis is not more nearly approximated. 10. The Veteran’s right shoulder strain more nearly approximates limitation of motion at shoulder level of the major extremity. 11. The Veteran’s right knee patellofemoral syndrome manifests with flexion to at least 45 degrees. 12. The Veteran’s right testis has been removed. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the issue of entitlement to service connection for joint pain by the Veteran, through his attorney, have been satisfied. 38 U.S.C. § 7105; 38 C.F.R. § 20.205. 2. The criteria for an effective date prior to February 6, 2014, for the award of service connection for cervical degenerative disc disease have not been satisfied. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.157, 3.400. 3. The criteria for an effective date prior to February 6, 2014, for the award of service connection for degenerative disc disease have not been satisfied. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.157, 3.400. 4. The criteria for an effective date prior to February 6, 2014, for the award of service connection for right shoulder strain have not been satisfied. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.157, 3.400. 5. The criteria for an initial rating in excess of 20 percent for service-connected cervical degenerative disc disease have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5243. 6. The criteria for an initial rating in excess of 40 percent for service-connected degenerative disc disease have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5237. 7. The criteria for an initial rating in excess of 20 percent for service-connected right shoulder strain have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5201. 8. The criteria for an initial rating in excess of 10 percent for service-connected right knee patellofemoral syndrome have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5260. 9. The criteria for an initial compensable rating for service-connected right orchiectomy have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.115b, Diagnostic Code 7524. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1987 to September 1987, December 1991 to June 1991, and January 2003 to May 2004, to include service in the Southwest Asia Theater of Operations. The Veteran had additional periods of Reserve duty and National Guard service. The Veteran was awarded a Combat Action Badge, among other decorations. Withdrawn Issue The Board of Veterans’ Appeals (Board) may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 19.55. Withdrawal may be made by the appellant or by his or her authorized representative. Id. In this case, in a September 2019 statement the Veteran withdrew his appeal as to the issue of service connection for joint pain. As there remain no allegations of errors of fact or law for appellate consideration regarding the issue of service connection for joint pain, the Board does not have jurisdiction over this issue, and it is dismissed. Effective Date 1. Prior to February 6, 2014 for the award of service connection for cervical degenerative disc disease. 2. Prior to February 6, 2014 for the award of service connection for degenerative disc disease. 3. Prior to February 6, 2014 for the award of service connection for right shoulder strain. The Veteran seeks an effective date prior February 6, 2014 for the award for service connection for cervical degenerative disc disease, degenerative disc disease of the lumbar spine, and right shoulder strain. Unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a). Generally, the effective date of an evaluation and award of service-connected compensation is the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. In a January 2016 statement the Veteran, through his attorney, stated that he disagreed with the January 2015 decision to include the denials for service connection, effective dates, and ratings assigned. The Board notes that the February 6, 2014 claims for service connection represents the only claims for service connection for these conditions. As this was the date the claims for service connection were received by VA (unless received within a year of separation from active service), this is the earliest effective date that can be assigned for service connection for his neck, back and right shoulder disabilities. The evidence of record indicates that the Veteran last separated from a period of active service in May 2004, which was reported by the Veteran on his claim received in February 2014. The Board received no other communication from the Veteran that could be considered an earlier claim. Given the above, entitlement to an effective date earlier than February 6, 2014 for the award of service connection for cervical degenerative disc disease, degenerative disc disease, and right shoulder strain is denied. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. Increased Rating 4. Cervical degenerative disc disease in excess of 20 percent. The Veteran contends his cervical spine disability is more severe than the currently assigned rating. The issue on appeal stems from the original award for service connection, effective February 6, 2014. Regulations specify that disabilities of the spine should be evaluated under the General Rating Formula for Diseases and Injuries of the Spine (Spinal Formula). 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. When intervertebral disc syndrome (IVDS) is present, it is to be evaluated under the Spinal Formula unless it is more favorable to rate under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula). Ratings under the Spinal Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. As relevant to the cervical spine, the Spinal Formula provides for a 20 percent disability rating when forward flexion of the cervical spine is greater than 15 degrees but not greater than 30 degrees, when the combined range of motion of the cervical spine is not greater than 170 degrees, or when muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent disability rating is assigned for forward flexion of the cervical spine to 15 degrees or less, or favorable ankylosis of the entire cervical spine. A 40 percent disability rating is assigned for unfavorable ankylosis of the entire cervical spine. A 100 percent rating is assigned with unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Spinal Formula. For Department of Veterans Affairs (VA) compensation purposes, normal forward flexion of the cervical spine is to 45 degrees and the normal combined range of motion is 340 degrees. Id., Note (2). Associated objective neurologic abnormalities should be rated separately under an appropriate diagnostic code. Id., Note (1). Alternatively, the IVDS Formula provides for rating based on the total duration of incapacitating episodes. 38 C.F.R. § 4.71a, IVDS Formula. Incapacitating episodes are defined as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id., Note (1). A 20 percent disability rating is assigned with incapacitating episodes having a total duration of at least 2 weeks during a 12-month period. A 40 percent evaluation was assigned for incapacitating episodes having a total duration of at least four weeks, but less than six weeks during the past twelve months; and a 60 percent evaluation was assigned for incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, DC 5243, Incapacitating Episodes Formula. In this case, incapacitating episodes of the requisite duration to support a higher disability rating are not shown. The Veteran underwent VA cervical spine examinations in November 2014 and April 2019. Range of motion testing was performed and showed, at worst, forward flexion to 30 degrees. During examination the Veteran was asked about pain, flare-ups, and functional limitations, and relevant testing was performed, to include testing for pain and testing to reveal any additional functional limitations in certain circumstances, such as after repetitive use. The November 2014 examiner explained that the Veteran was seen by orthopedics in 2007 for his neck and back and diagnosed with degenerative disc disease and was on a profile. The examiner stated the Veteran reported a dull daily bothersome posterior neck pain with stiffness and flare-ups consisted of a “kink” in the neck after sleep that took a few days to work out. In April 2019, the Veteran reported about six times a year he wakes and cannot move his neck at all and has pain all the time with radiation into his right shoulder. No report suggests that the specific findings on examination, in terms of range of motion, would change to the degree required for a higher rating during a flare-up, after repetitive use, due to pain, or with weight bearing, nor does any other evidence of record to include the Veteran’s lay statements. While the Veteran has essentially stated that he has reduced motion in his spine, he has not described a range of motion which would warrant a higher rating. In this regard, during examination he did report flare-ups but described the flare-ups as consisting of increased pain and stiffness and limitation of motion. While the Veteran reported six times a year when he wakes up he cannot move his neck at all, the Board finds the Veteran’s statements do not show the requisite limitation of motion necessary for a higher rating, and do not provide competent evidence to suggest ankylosis of the cervical spine, a medical determination. Further, to the extent that the Veteran has reported complete inability to move his neck during flare-ups approximately six times per year, the Board does not find such reports credible. The Board notes that during the prior examination in November 2014 the Veteran reported that flare-ups occasionally “result in a kink” in his neck that would take a few days to “work-out.” The Board finds that these reports are inconsistent as “working out” such a kink would involve some movement of the neck. Further, none of the other medical evidence of record, including private treatment records and VA treatment records report cervical flexion to 15 degrees or less, including during flare-ups or after repetitive use. Specifically, physical therapy notes from the Grand Junction VA Medical Center report limitation of cervical rotation, but not cervical flexion. Additionally, records from Rocky Mountain Orthopaedic Associates report limited rotation of the neck. Absent indication by the Veteran or other evidence suggesting additional limitation of motion during flare-up or after repetitive use over time there is no reason to suspect range of motion is limited any more than reflected during examination and additional inquiry in this regard is unnecessary. Given the above, a higher rating is not warranted based on limitation of motion. The Board also finds that the evidence does not demonstrate that the Veteran experiences incapacitating episodes as asserted by the Veteran through his attorney. See September 2019 Statement. The rating formula defines incapacitating episodes as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. The evidence does not indicate that the Veteran has been prescribed bed rest by a physician during the appeal period, much less symptoms that would approximate prescribed bed rest of total duration of at least four weeks during a 12-month period. As such, a higher rating based upon incapacitating episodes is not warranted. Regarding relevant neurological findings, the April 2019 examiner noted the Veteran has radiculopathy of the right upper extremity diagnosed in 2019. The Veteran is compensated for right upper extremity radiculopathy effective April 29, 2019. The November 2014 examiner reported the Veteran does not have radiculopathy and there is no other evidence in significant conflict with these findings. The record is absent evidence of radiculopathy due to the Veteran’s cervical spine disability prior to April 2019. Therefore, the Board finds there are no other symptoms which should be addressed by a separately-assigned disability rating. 5. Degenerative disc disease in excess of 40 percent. The Veteran contends his lumbar spine disability is more severe than the currently assigned rating. The issue on appeal stems from the original award for service connection, effective February 6, 2014. As relevant to the thoracolumbar spine, the Spinal Formula provides for a 20 percent disability rating when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, when the combined range of motion of the thoracolumbar spine is not greater than 120 degrees, or when muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent disability rating is assigned for forward flexion of the thoracolumbar spine to 30 degrees or less, or with favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine and a 100 percent rating is assigned with unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Spinal Formula. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is to 90 degrees and the normal combined range of motion is 240 degrees. Id., Note (2). Associated objective neurologic abnormalities should be rated separately under an appropriate diagnostic code. Id., Note (1). Alternatively, the IVDS Formula provides for rating based on the total duration of incapacitating episodes. 38 C.F.R. § 4.71a, IVDS Formula. Incapacitating episodes are defined as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id., Note (1). A 20 percent disability rating is assigned with incapacitating episodes having a total duration of at least 2 weeks during a 12-month period. A 40 percent evaluation was assigned for incapacitating episodes having a total duration of at least four weeks, but less than six weeks during the past twelve months; and a 60 percent evaluation was assigned for incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, DC 5243, Incapacitating Episodes Formula. In this case, incapacitating episodes of the requisite duration to support a higher disability rating are not shown. During the appeal period the Veteran underwent VA examinations in June 2014 and April 2019. Range of motion testing was performed and showed, at worst, forward flexion to 30 degrees. During examination the Veteran was asked about pain, flare-ups, and functional limitations, and relevant testing was performed, to include testing for pain and testing to reveal any additional functional limitations in certain circumstances, such as after repetitive use. Ankylosis of the spine is not shown by the medical evidence or alleged by the Veteran. No report suggests that the specific findings on examination, in terms of range of motion, would change to the degree required for a higher rating during a flare-up, after repetitive use, due to pain, or with weight bearing, nor does any other evidence of record to include the Veteran’s lay statements. While the Veteran has essentially stated that he has reduced motion in his spine, he has not described a range of motion which would warrant a higher rating. In this regard, during the June 2014 examination the examiner described the Veteran’s low back pain as gradual in onset related to cumulative stresses in military service. In April 2019 the Veteran reported a burning pain sensation in his back at the surgical site and a sensation of pins and needles in the right calf after extended standing or walking. The examiner reported the Veteran has a lifting restriction of 50 pounds. The Veteran’s statements do not show the requisite limitation of motion necessary for a higher rating and do not reflect ankylosis. Treatment records do not show greater limitation of motion than the examination findings. Absent indication by the Veteran or other evidence suggesting additional limitation of motion during flare-up or after repetitive use over time there is no reason to suspect range of motion is limited any more than reflected during examination and additional inquiry in this regard is unnecessary. Given the above, a higher rating is not warranted based on limitation of motion. The Board also that the evidence does not demonstrate that the Veteran experiences incapacitating episodes of the lumbar spine that would warrant a rating in excess of 40 percent. While the Veteran has been diagnosed with IVDS of the lumbar spine, the evidence does not indicate that the Veteran has been prescribed bed rest beyond his period of his post-surgical convalescence. The evidence does not report that the Veteran was prescribed bed rest outside of this period in excess of at least six weeks during a 12-month period. As such, a higher rating based upon incapacitating episodes is not warranted. Regarding relevant neurological findings, the April 2019 examiner noted the Veteran has radiculopathy of the lower extremities. The Veteran is compensated for right and left lower extremity radiculopathy associated with degenerative disc disease effective April 9, 2015. The November 2014 examiner reported the Veteran does not have radiculopathy and there is no other evidence in significant conflict with these findings. The record is absent evidence of radiculopathy due to the Veteran’s back disability prior to April 2015. Therefore, the Board finds there are no other symptoms which should be addressed by a separately-assigned disability rating. 6. Right shoulder strain in excess of 20 percent. The Veteran contends that he is entitled to a higher rating for his right shoulder strain as the disability is more severe than the currently assigned rating. The issue on appeal stems from the original award for service connection, effective February 6, 2014. The Veteran’s right shoulder strain is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5201, for limitation of motion of the arm. Under Diagnostic Code 5201, limitation of motion of the arm at shoulder level warrants a 20 percent rating for both the major and minor extremity. Limitation of motion of the arm midway between side and shoulder warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Limitation of motion of the arm to 25 degrees from side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint. 38 C.F.R. § 4.71a, Diagnostic Code 5201. Diagnostic Code 5201 “does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of the arm.” Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for right shoulder strain. The evidence of record shows that the Veteran’s right arm is his dominant (major) extremity as reported during VA examination. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain, and pain during flare-ups. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that he has shoulder flare-ups three times a year and pain and stiffness of an unclear duration affecting working overhead would not result in symptoms more nearly approximating limitation of motion of the arm midway between side and shoulder level of the major extremity or limitation of motion of the arm to 25 degrees from the side of the major or minor extremity. For example, during VA examination in June 2014 the examiner reported right shoulder function is good but the Veteran experiences infrequent flare-ups. During VA examination in April 2019 the Veteran reported painful motion and that five to six times a year he cannot lift his right shoulder. He described functional impact as the Veteran’s inability to raise his arm above shoulder height. The Board has considered whether any other Diagnostic Codes related to disabilities of the shoulder would provide for a higher disability rating. However, the evidence does not reflect that the symptoms would warrant a higher rating under a different Diagnostic Code. See 38 C.F.R. § 4.71a. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s appeal for a rating in excess of 20 percent for right shoulder strain. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 7. Right knee patellofemoral syndrome in excess of 10 percent. The Veteran contends that he is entitled to a higher rating as the disability is more severe than the currently assigned rating. The issue on appeal stems from the original award for service connection, effective February 6, 2014. During the period on appeal, the knee is rated 10 percent disabling under Diagnostic Code 5260 due to limitation of flexion of the knee. After review of the evidence of record, the Board concludes that the Veteran’s functional impairment of the right knee does not more nearly approximate the functional limitation required for a higher or separate rating. Separate ratings can be assigned for knee disabilities when none of the symptomatology overlaps and the separate rating is based on additional disabling symptomatology; this includes separate ratings based on limitation of flexion (Diagnostic Code 5260), limitation of extension (Diagnostic Code 5261), lateral instability or recurrent subluxation (Diagnostic Code 5257), and meniscal conditions (Diagnostic Codes 5258, 5259). See VAOPGCPREC 23-97, 62 Fed. Reg. 63,603 (1997); VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998); VAOPGCPREC 9-2004; 69 Fed. Reg. 59,988 (2004); Lyles v. Shulkin, 29 Vet. App. 107 (2017). The normal range of motion of the knee is from 0 degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71, Plate II. Limitation of flexion warrants 10, 20, and 30 percent ratings when limitation is to 45 degrees, 30 degrees, and 15 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Limitation of extension warrants 10, 20, 30, 40, and 50 percent ratings when limitation is to 10 degrees, 15 degrees, 20 degrees, 30 degrees, and 45 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5261. A 10 percent rating can also be assigned for the knee joint if there is painful motion without compensable limitation of motion. 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Code 5003; see also Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that the applicability of 38 C.F.R. § 4.59 is not limited to arthritis claims). Recurrent subluxation and lateral instability of the knee warrants a 10, 20, or 30 percent rating if slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Ratings can also be assigned when the knee disability affects the meniscus, with a 20 percent rating for dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint and a 10 percent rating for removal of semilunar cartilage (e.g., meniscectomy) and current residual symptoms. 38 C.F.R. § 4.71a, Diagnostic Codes 5258, 5259. Ratings can also be assigned for impairment of the tibia or fibula, genu recurvatum, or ankylosis of the knee. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5262, 5263. In this case the evidence does not reflect and the Veteran does not allege that he has tibia or fibula impairment, genu recurvatum, or ankylosis of either knee. As such, those diagnostic codes are not for application. Range of motion testing was performed during VA examinations in June 2014 and April 2019, and was at worst 80 degrees of flexion. Limitation of extension to 0 degrees or less was not found. At the examinations, the Veteran was asked about pain, flare-ups, and functional limitations, and relevant testing was performed by the examiner, to include testing for pain and testing to reveal any additional functional limitations in certain circumstances, such as after repetitive use. The report does not suggest that the specific findings on examination, in terms of range of motion, would change to the degree required for a higher rating during a flare-up, after repetitive use, due to pain, or with weight bearing, nor does any other evidence of record to include the Veteran’s lay statements. While the Veteran has essentially stated that he has reduced motion in his knee, he has not described a range of motion less than that found on examination. In this regard, during the examinations he did report flare-ups but described the flare-ups as consisting of increased pain. Likewise, in September 2019 he asserted the assigned rating does not reflect that flare-ups reported during examination of increased pain and limping and difficulty climbing stairs. The Veteran’s statements do not show the requisite limitation of motion necessary for a higher or separate rating. Treatment records do not show greater limitation of motion than the examination findings. The Board notes that increased pain alone does not warrant a compensable disability rating. See Mitchell v. Shinseki, 25 Vet. App. 32 (Aug. 23, 2011) (holding that pain alone does not constitute functional loss, but is just one fact to be considered when evaluating functional impairment. The Court agreed that pain alone as a basis for a higher rating would produce such “absurd results” as for example where a claimant who experiences very slight pain throughout the range of motion of the knee would receive a 50 percent disability rating under DC 5261 and a 30 percent disability rating under DC 5260, whereas a claimant who experiences actual limitation of flexion to 30 degrees and limitation of extension to 20 degrees would only receive disability ratings of 20 percent and 30 percent respectively). There is no persuasive evidence of record that the Veteran’s increased pain during flare-ups results in functional loss that warrants a higher rating for limitation of flexion of the right knee. To the extent that the Veteran’s condition results in periodic limping and difficulty climbing stairs, the Board finds that these functional limitations are contemplated in the Veteran’s current rating for limitation of flexion. Limitation of flexion of the knee and painful motion of the knee result in disturbance of motion of the knee and use of the knee. Absent indication by the Veteran or other evidence suggesting additional limitation of motion during flare-up or after repetitive use over time there is no reason to suspect range of motion is limited any more than reflected during examination and additional inquiry in this regard is unnecessary. Given the above, even when considering the knee pain’s impact on physical activities, a higher or separate rating is not warranted based on limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5260, 5261. To the extent the Veteran reports experiencing instability of his knee the Board notes that he is compensated for right knee instability associated with service-connected right knee patellofemoral syndrome, rated 10 percent effective April 29, 2019. Notably, there are specific medical tests that are designed to reveal instability and laxity of the joints. These tests were administered by medical professionals in this case in June 2014 and April 2019. In June 2014 the testing revealed no instability or laxity. The record reflects the April 2019 VA examiner identified right knee instability after clinical evaluation. Given the tests performed are generally recognized in the medical community as diagnostic for instability and subluxation, the results are afforded high probative value. In addition, the testing results are given more probative weight than the Veteran’s lay statements. While the Veteran may experience a feeling that his knee may give way or is unstable, if subluxation or lateral instability were present to a slight degree, as required for a separate compensable rating, the Board would expect that this would have been identified during previous examination. See 38 C.F.R. §§ 4.31, 4.71a, Diagnostic Code 5257. Instead, the medical record is absent evidence of right knee instability prior to April 2019. Hence, the most probative evidence is against a separate rating for the knee under Diagnostic Code 5257. 38 C.F.R. § 4.71a. 8. Right orchiectomy in excess of 10 percent. The Veteran contends that he is entitled to a higher rating as the disability is more severe than the currently assigned rating. The issue on appeal stems from the original award for service connection, effective February 6, 2014. The Veteran’s removal of the right testicle has been rated under Diagnostic Code 7524 (for testis, removal), which provides a zero percent rating for removal of one testis and a 30 percent rating for removal of both testes. An accompanying Note states that, in cases of the removal of one testis as the result of a service-incurred injury or disease, other than an undescended or congenitally undeveloped testis, with the absence or nonfunctioning of the other testis unrelated to service, an evaluation of 30 percent will be assigned for the service-connected testicular loss. The Note also provides that a testis which is undescended or congenitally undeveloped is not a ratable disability. A Footnote following Diagnostic Code 7524 provides that review should be conducted for entitlement to special monthly compensation (SMC) under § 3.350 of this chapter. 38 C.F.R. § 4.115b, Diagnostic Code 7524. The Board notes that the Veteran was in receipt of a noncompensable rating for a right testicular disability and SMC on account of anatomical loss of a creative organ until February 1, 2019, the effective date for the severance of service connection and entitlement to SMC. The Veteran underwent VA examination in June 2014 to evaluate the current severity of his disability. The examiner reported the Veteran developed a palpable abnormality of the right testis in August 2013. He reported an ultrasound study was abnormal showing cystic changes with possible neoplasm. He reported cystic right testis was removed in October 2013 with no cancer present. The examiner reported there was no renal, voiding, or erectile dysfunction, and no history of male reproductive organ infections. He reported the Veteran’s left testicle is normal. Accordingly, the Board finds that a higher evaluation is not warranted for the Veteran’s service-connected right orchiectomy. The medical evidence weighs against a finding that the Veteran’s left testis is nonfunctioning. REASONS FOR REMAND Service connection for a right hip disability. Service connection for a left hip disability. The Veteran contends he has bilateral hip pain and limited motion. The April 2019 VA examiner diagnosed right hip strain since 2016. The examiner opined that the Veteran’s right and/or left hip disability is less likely incurred in or caused by the complaints of low back pain radiating to the hips during service, and not secondary to a service-connected disability because the record reflects the Veteran slipped on ice after separation from service and hurt his hip. Service treatment records reflect that in June 2004 the Veteran was treated for complaints of radiating pain in the hips. The evidence of record reflects the Veteran had periods of reserve and national guard duty after separation from active service in May 2004. The Board finds remand is warranted to obtain the Veteran’s complete personnel file and a supplemental medical opinion. The matters are REMANDED for the following actions: 1. Please take appropriate action in regard to the referred claim (referenced above) for service connection for a right shoulder rotator cuff tear and labral tear that was raised by the record in a June 2019 examination, but has not yet been adjudicated by the AOJ. 2. Undertake appropriate efforts to obtain the Veteran’s complete service personnel records, to include all documents pertaining to his service in the Army National Guard and Army Reserve. Verify all active duty for training and inactive duty training dates for alleged service in the National Guard and Reserve from May to June 2005. Document all requests for information as well as all responses in the claims file. 3. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current disability of the bilateral hips onset during service or is otherwise related to an in-service injury, event, or disease, to include the Veteran’s June 2004 complaints of radiating hip pain. The examiner should also address whether any current disability of the hips is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) service-connected degenerative disc disease. The examiner should offer a separate opinion for the right and left hip. (Continued on the next page)   The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. Patrick M. Johnson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Gonzalez, 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.