Citation Nr: 20007868 Decision Date: 01/30/20 Archive Date: 01/30/20 DOCKET NO. 14-17 206 DATE: January 30, 2020 ORDER Entitlement to a rating in excess of 10 percent for left knee instability is denied. Entitlement to a separate rating of 10 percent, but no higher, for painful left knee limitation of motion is granted, subject to the regulations governing the payment of monetary awards. Entitlement to a 20 percent, but no higher, rating for a right ankle disability is granted, subject to the regulations governing the payment of monetary awards. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran’s left knee disability has been manifested by no more than slight lateral instability. 2. Throughout the appeal period, the Veteran left knee disability has been manifested by flexion at most limited to 45 degrees with pain and no limitation of extension. 3. Throughout the appeal period, the Veteran’s right ankle disability has been manifested by symptoms of limitation of motion, pain, and instability that most nearly approximate a moderate right ankle disability. CONCLUSIONS OF LAW 1. Throughout the appeal period, the criteria for a rating in excess of 10 percent for lateral instability of the left knee are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5257. 2. Throughout the appeal period, the criteria for a separate 10 percent, but no higher, rating for painful limitation of motion of the left knee are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Codes 5003, 5260, 5261. 3. Throughout the appeal period, the criteria for a 20 percent, but no higher, rating for a right ankle disability are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5262, 5271. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1996 to October 2003. This matter is on appeal from a September 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The case was previously before the Board in February 2018 when it was remanded for further development. The appeal previously included the issue of service connection for a lumbar spine disability. An October 2019 rating decision awarded service connection for a lumbar spine disability, evaluated as 10 percent, effective November 1, 2003. As that award is considered a full grant of the claim seeking service connection for a lumbar spine disability, the issue is not before the Board and will not be addressed further herein.   Increased Rating In general, disability evaluations are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity caused by a given disability, and separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). With respect to a claim for an increased rating for an already service-connected disability, a Veteran may experience multiple distinct degrees of disability that might result in different levels of compensation. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). The following analysis is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. Degenerative and/or traumatic arthritis as shown by X-ray studies are rated based on limitation of motion of the affected joint. 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010. When, however, the limitation of motion is noncompensable under the appropriate diagnostic code, a rating of 10 percent may be applied to each such major joint or group of minor joints affected by limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Thus, with or without degenerative arthritis, 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; see Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In Petitti v. McDonald, 27 Vet. App. 415 (2015), the United States Court of Appeals for Veterans Claims (Court) rejected VA’s argument that § 4.59 requires painful motion, such that the mere presence of joint pain is not sufficient. Id. at 428-29. The Court held that under § 4.59, “the trigger for a minimum disability rating is an actually painful, unstable, or malaligned joint,” explaining that § 4.59 speaks to both painful motion of joints and actually painful joints. Id. at 425. Moreover, the Court held that § 4.59 does not require “objective” evidence but can be satisfied with lay and other non-medical evidence. Id. at 429. When evaluating musculoskeletal disabilities, VA may consider granting a higher rating in cases in which the claimant experiences additional functional loss due to pain, weakness, excess fatigability, or incoordination, to include with repeated use or during flare-ups, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996). 1. Left Knee The Veteran contends that he is entitled to an increased rating for his service-connected left knee disability, which is currently evaluated at 10 percent under Diagnostic Code 5299-5257 for recurrent subluxation or lateral instability. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27. Here, the hyphenated diagnostic codes indicate that the Veteran’s left knee disability is rated under the criteria for recurrent subluxation or lateral instability (Diagnostic Code 5257). Under Diagnostic Code 5257, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability, a 20 percent rating is warranted for moderate recurrent subluxation or lateral instability, and a 30 percent rating is warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a. The Veteran may also be assigned separate ratings for limitation of motion under Diagnostic Code 5260 or 5261 in addition to instability under Diagnostic Code 5257. See VAOPGCPREC 23-97 (July 1, 1997). Separate ratings under DC 5260 and DC 5261 may also be assigned for disability of the same joint. VAOPGCPREC 9-2004 (Sept. 17, 2004). Under Diagnostic Code 5260, a 10 percent rating is warranted where flexion is limited to 45 degrees, a 20 percent rating is available where flexion is limited to 30 degrees, and a 30 percent rating is warranted where flexion is limited to 15 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5261, a 10 percent rating is warranted where extension of the knee is limited to 10 degrees, a 20 percent rating is warranted where extension is limited to 15 degrees, a 30 percent rating is warranted where extension is limited to 20 degrees, a 40 percent rating is warranted where extension is limited to 30 degrees, and a 50 percent rating is warranted where extension is limited to 45 degrees. 38 C.F.R. § 4.71a. Normal ranges of motion of the knee are to 0 degrees in extension, and 140 degrees in flexion. 38 C.F.R. § 4.71, Plate II. Consideration of other Diagnostic Codes for rating a knee disability (5256, 5258, 5259, 5262, 5263) is inappropriate in this case as the Veteran’s left knee disability does not include the pathology or symptoms required in the criteria for those Diagnostic Codes (ankylosis, cartilage impairment, cartilage removal, malunion or nonunion of the tibia or fibula, or genu recurvatum). 38 C.F.R. § 4.71a. In this case, an October 2010 VA examination notes that the Veteran has had intermittent pain in the medial aspect of the knee with occasional mild swelling with no redness, heat, or drainage. The Veteran reported gradually worsening pain as 5 on a scale of 1 to 10. He reported flareups of 7/10 pain occurring approximately twice a month, lasting 30 minutes to an hour. The flareups were brought on by weather changes or activities such as jogging. He reported wearing a brace most of the time. He described an occasional buckling sensation but no locking. Flexion went to 150 degrees and extension went to 0 degrees, and there was no pain with flexion or extension. Following three repetitions, there was no further loss of function with repetitive use due to pain, weakness, fatigability, lack of endurance, or incoordination. There was no laxity with varus or valgus stress testing and anterior and posterior drawer signs were negative. McMurray’s sign was also negative. There was no swelling or effusion of the knee. Gait and full squat were normal. In January 2014, a friend of the Veteran submitted a statement saying that he has witnessed the Veteran experience difficulty walking for an extensive amount of time due to pain, inability to stand or sit for a long period of time due to the discomfort, and occasional stumbling because his knees give out. During a January 2014 hearing before a Decision Review Officer (DRO), the Veteran reported knee pain that feels like pins and needles when kneeling. In February 2014, the Veteran submitted a Left Knee Journal in which he credibly and competently documented the symptoms of his left knee disability from May 2011 to November 2013. The Veteran described symptoms including popping, pinpoint pain, a burning sensation, soreness, dull pain, an inability to kneel or put pressure on the knee, difficulty with weight bearing, and throbbing. During a June 2014 VA examination, the examiner noted that the Veteran reported when the joint was used repeatedly over a period of time there was pain, weakness, fatigability, or incoordination that significantly limits functional ability. The Veteran described this as being moderate medial pain with over use and that it was better after rest or using a knee brace. Left knee flexion ended at 130 degrees with objective evidence of painful motion at 45 degrees. There was no limitation of extension. After repetitive-use testing, left knee flexion ended at 130 degrees with no limitation of extension. The examiner noted excess fatigability, incoordination with impaired ability to execute skilled movements smoothly, pain on movement, and disturbance of locomotion. The Veteran had tenderness or pain to palpation. Anterior and posterior joint stability testing was normal. Medial-lateral instability testing was 1+ (0 to 5 millimeters). The examiner indicated that the knee exam was stable for the anterior cruciate ligament, but there was mild pseudo ligament laxity in the medial compartment. The examiner noted no evidence or history of recurrent patellar subluxation or dislocation and no medial tibial stress syndrome, stress fractures, chronic exertional compartment syndrome, or any other tibial or fibular impairment. He noted mild residual medial arthrosis and noted that the Veteran uses an occasional knee brace with activity. He noted diagnostic test findings of mild medial joint space loss, slightly arthritic. October 2014 VA treatment records note that the Veteran reported intermittent left knee pain and was encouraged to wear a left knee brace all of the time. He reported no giving way sensation but did report occasional buckling on uneven ground. August 2016 VA treatment records note complaints of left knee instability. April 2017 VA treatment records note mild instability of the left knee. During a September 2019 VA examination, the examiner noted that the Veteran reported flareups involving a burning sensation with pain under the knee cap that occurs randomly. He reported that he cannot kneel or walk more than 3 miles. Left knee flexion was to 100 degrees, and extension was to 0 degrees. Range of motion itself was noted to contribute to functional loss in that the Veteran was unable to kneel or walk more than 3 miles. Pain was noted on flexion and external rotation. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue, evidence of pain with weight bearing, and objective evidence of crepitus. The Veteran was able to perform repetitive-use testing with at least three repetitions with no additional loss of function or range of motion. The examiner noted that pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over a period of time with flexion being further limited to 90 degrees. Extension was not further limited. Factors that caused this functional loss included pain, fatigue, weakness, and lack of endurance. The examination was not conducted during a flareup, but the examiner estimated flexion to 90 degrees and extension to 0 degrees during a flareup due to pain, fatigue, weakness, and lack of endurance. No ankylosis was noted, and the examiner noted no history of recurrent subluxation or lateral instability. The examiner performed joint stability testing, and no joint instability was noted. Regarding the rating for left knee instability under DC 5257, the Board finds that a preponderance of the evidence is against a finding that the Veteran is entitled to a rating in excess of 10 percent based on recurrent subluxation or lateral instability at any time during the appeal period. The Veteran has provided competent and credible lay statements describing intermittent popping and occasional stumbling. See English v. Wilkie, 30 Vet. App. 347 (2018). The evidence reflects the Veteran wears a left knee brace to help with knee stability. Joint stability showed normal anterior and posterior joint stability with medial-lateral instability at most from 0 to 5 millimeters as shown on June 2014 VA examination. At that time, the examiner explained that these objective findings represented no more than mild instability. There is no other evidence, including competent and credible lay statements, that indicates the severity of the Veteran’s left knee instability has more nearly approximated moderate recurrent subluxation or lateral instability. As such, the Board finds that the Veteran’s left knee instability more nearly approximates the criteria for the currently assigned 10 percent rating, and that a higher rating based on instability or recurrent subluxation is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5257. Additionally, the Board finds that a separate 10 percent evaluation is warranted pursuant to § 4.59 and under Diagnostic Code 5260 due to an actually painful left knee joint and limitation of flexion with painful motion for the entire period on appeal. Although arthritis in the knee was not noted until the June 2014 VA examination, the October 2010 examination reflected that the Veteran experienced flare ups of pain in the knee with movement and a January 2014 lay statement confirms that the lay witness had observed the Veteran having pain in the knee that caused difficulties in walking, standing, and sitting. Thus, a separate compensable rating is warranted throughout the appeal period based on an actually painful knee joint with limitation of flexion. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5003, 5260. The record reflects that the Veteran’s left knee disability has not manifested with limitation of flexion of less than 45 degrees, even when considering pain and functional impairment. For example, the September 2019 VA examiner explained that even during flare ups or after repeated use over time, the Veteran’s limitation of flexion was limited to no less than 90 degrees. The record also does not reflect limitation of extension or pain or other functional impairment with limitation of extension that would warrant a separate compensable rating under Diagnostic Code 5261. The examinations of record have shown full extension to 0 degrees with no evidence of pain, even during flare up and after repetitive use. As such, a preponderance of the evidence is against awarding a separate compensable rating under Diagnostic Code 5261. In summary, the Board finds that a preponderance of the evidence is against a finding that a rating in excess of 10 percent is warranted under Diagnostic Code 5257. The evidence also more nearly approximates that a separate 10 percent, but no higher, rating is warranted under Diagnostic Code 5260 for limitation of flexion with pain during the entire appeal period. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Codes 5260, 5261. 2. Right Ankle The Veteran contends that he is entitled to an increased rating for his service-connected right ankle disability. The Veteran’s right ankle disability is currently assigned a 10 percent rating under 38 C.F.R. § 4.71a, Diagnostic Code 5271, for limitation of motion of the ankle. Diagnostic Codes 5270 and 5271 assign disability ratings based on limitation of motion of the ankle. Under Diagnostic Code 5271, a 10 percent rating is warranted for moderate limitation of motion. A 20 percent rating is warranted for marked limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5271. While the schedule of ratings does not provide any information as to what manifestations constitute “moderate” or “marked” limitation of ankle motion, guidance can be found in VBA’s M21-1 Adjudication Procedures Manual. Specifically, the M21-1 states that moderate limitation of ankle motion is present when there is less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion, while marked limitation of motion is demonstrated when there is less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. See VBA Manual M21-1, III.iv.4.A.3.k. Normal range of motion of the ankle includes plantar flexion from 0 degrees to 45 degrees and dorsiflexion (extension) from 0 degrees to 20 degrees. 38 C.F.R. § 4.71a, Plate II. Higher ratings are assignable under Diagnostic Code 5270 for ankylosis of the ankle. Under Diagnostic Code 5270, ankylosis of the ankle in plantar flexion less than 30 degrees warrants a 20 percent rating. If ankylosed in plantar flexion between 30 degrees and 40 degrees, or in dorsiflexion between 0 degrees and 10 degrees, a 30 percent rating is warranted. If ankylosed in plantar flexion at more than 40 degrees, or in dorsiflexion at more than 10 degrees, or with abduction, adduction, inversion or eversion deformity, a 40 percent rating is warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5270. Under Diagnostic Code 5262, for tibia and fibula impairment, malunion with a slight ankle disability warrants a 10 percent rating; malunion with a moderate ankle disability warrants a 20 percent rating; and malunion with a marked ankle disability warrants a 30 percent rating. Evidence of nonunion of the tibia and fibula with loose motion requiring a brace warrants a 40 percent evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5262. In this case, an October 2010 VA examination report notes that the Veteran described gradual worsening of his right ankle pain, which he described on the lateral aspect of the ankle with frequent episodes of rolling and swelling. The Veteran described the right ankle pain in the lateral aspect usually rating 2 on a scale of 1 to 10 with flareups of 8/10 pain about once a month if he rolls his ankle. He reported that increased pain lasts a few hours and is relieved by stretching and gentle walking. He denied redness or drainage. He also reported occasionally feeling a hot sensation at the area of swelling and wearing an ankle brace occasionally. The examiner noted there was no swelling, ecchymosis, or deformity of the right ankle on examination. There was mild tenderness to palpation of the lateral ankle with dorsiflexion to 15 degrees, plantar flexion to 45 degrees, and full inversion and eversion. There was no further loss of function with repetitive use due to pain, weakness, fatigability, lack of endurance, or incoordination following 3 repetitions. There was a negative drawer sign and no laxity of the ankle noted. During the January 2014 hearing before the DRO, the Veteran reported episodes in which he rolls his ankle. During a June 2014 VA examination, the examiner noted that that “the ankle can still twist (invert)” and that the Veteran uses a brace for the right ankle. The Veteran reported flare-ups. The examiner indicated that the Veteran experiences limitation in range of motion due to repeated use over a period of time; however, he stated that the limitation of range of motion could not be estimated. He noted that the right ankle can roll over easily with excessive activity and that the Veteran uses a brace. He noted that the brace usually protects the ankle but that he could have mild pain without the brace. Initial range of motion measurements showed right ankle plantar flexion to 45 degrees with no objective evidence of painful motion and right ankle dorsiflexion to 20 degrees and no objective evidence of painful motion. The Veteran was able to perform repetitive-use testing with 3 repetitions and no additional loss in range of motion post-test. The examiner indicated that functional impairment after repetitive use was manifested by slight tenderness with hard inversion over the lateral ligaments. The Veteran had localized tenderness or pain on palpation of the joints/soft tissue of the right ankle. Muscle strength testing was normal. Joint stability testing showed right side laxity on inversion/eversion stress testing. The Veteran had no ankylosis of the ankle, subtalar, or tarsal joints. The Veteran reported occasional brace use for the right ankle when stressed. The examiner noted imaging studies that showed “current x-ray notwithstanding, minor incidental findings not arthritis” with 3 views of the right ankle weight-bearing small posterior calcaneal spur, accessory ossicle on the dorsal aspect between the talus and navicular bone, and no significant change from the previous study in October 2010. The Veteran was provided with an additional VA examination in September 2019. She noted a history of a sprained right ankle that continued to roll with persistent pain since. She noted that he wears a right ankle wrap for treatment and that his right ankle gives out at random moments. The Veteran reported flare-ups that he stated feel like a dull knot in the joint that feels tight within the joint. He stated that he cannot walk more than 3 miles or walk on uneven surfaces. Initial range of motion testing was abnormal or outside of normal range with dorsiflexion to 15 degrees and plantar flexion to 40 degrees. The examiner noted that the pain noted on examination causes functional loss for dorsiflexion and plantar flexion with evidence of pain with weight bearing. The Veteran was able to perform repetitive-use testing with at least three repetitions with no additional loss of function or range of motion. The examiner estimated that pain, fatigue, weakness, and lack of endurance with repeated use over time and during flare ups resulted in an estimated range of motion of dorsiflexion to 10 degrees and of plantar flexion to 30 degrees. There was no ankylosis. The Veteran had normal muscle strength and no muscle atrophy. Stability testing revealed laxity during the anterior drawer test and no laxity during the talar tilt test. The examiner noted that the Veteran’s disability impacts his ability to walk more than 3 miles or walk on uneven surfaces. Upon review of the record, the Board finds that a preponderance of the evidence is against a finding that the Veteran’s right ankle disability more nearly approximates the criteria for marked limitation in range of motion under the currently assigned Diagnostic Code 5271. In this regard, the record does not reflect that the Veteran’s right ankle disability manifested at any point during the appeal period with less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion, even when considering the estimated additional limitation in range of motion during flare-ups with pain, fatigue, weakness, and lack of endurance. As indicated above, on September 2019 VA examination, limitation of dorsiflexion was estimated to be to 10 degrees and of plantar flexion to 30 degrees even during flare ups and after repeated use over time. As such, a rating in excess of 10 percent due to limitation in motion of the right ankle is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5271. In examining the evidence, the Board concludes that the Veteran’s ankle disability is more appropriately rated by analogy under Diagnostic Code 5262. Although the evidence does not reflect tibia and fibula impairment, the evidence reflects the Veteran’s right ankle disability is manifested by symptoms extending beyond limitation of motion and pain. Specifically, the evidence also reflects instability of the ankle. VA can change the Diagnostic Code that a particular disability is rated under so long as the rating under that Diagnostic Code has not been in effect for 20 years. 38 C.F.R. 3.951(b); see Murray v. Shinseki, 24 Vet. App. 420, 425 (2011). VA must explain the change in the Diagnostic Code. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Here, service connection for the right ankle disability has been effective since November 1, 2003; therefore, it has not been effective for 20 years. As the Veteran’s right ankle disability demonstrates symptoms beyond limitation of motion throughout the period on appeal, the Board concludes that rating by analogy to Diagnostic Code 5262 best reflects the impairment caused by the Veteran’s right ankle disability. See Butts v. Brown, 5 Vet. App. 532, 538 (1993). In addition, changing the Diagnostic Code from 5271 to 5262 does not reduce the Veteran’s rating; rather it affords the Veteran a higher rating. Accordingly, the Veteran is not prejudiced by this change of Diagnostic Code. The Board finds that the evidence most nearly approximates assignment of a 20 percent, but no higher, rating under Diagnostic Code 5262 for moderate right ankle disability. The Veteran has provided competent and credible reports of frequent rolling and twisting of his right ankle throughout the entire period on appeal. See English v. Wilkie, 30 Vet. App. 347 (2018). Additionally, there has been objective evidence of instability shown on June 2014 and September 2019 VA examinations. As noted above, the record also reflects moderate limitation of dorsiflexion and plantar flexion with pain, fatigue, weakness, and lack of endurance. Such findings most nearly approximate a moderate ankle disability. The Board finds the preponderance of the evidence is against a finding that the Veteran’s ankle disability more nearly approximates marked ankle disability, as the record reflects that the Veteran can walk up to three miles notwithstanding instability and limitation of motion. Additionally, as noted above, limitation of motion has been limited to no more than dorsiflexion to 10 degrees and plantar flexion to 30 degrees even during flare ups and after repeated use over time. As such, the Board concludes that symptoms of the Veteran’s ankle disability reflect no more than a moderate right ankle disability. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5262. Increased or separate evaluations under other potentially applicable Diagnostic Codes have also been considered. See Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). The evidence of record does not show that the Veteran has ankylosis, a heel bone fracture, or has had an astragalectomy. Therefore, a rating under Diagnostic Codes 5270, 5272, 5273, or 5274 is not warranted. 38 C.F.R. §§ 4.7, 4.71a.   In sum, a 20 percent, but no higher, rating by analogy under Diagnostic Code 5262 for moderate ankle disability is warranted throughout the period on appeal. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. H. White, 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.