Citation Nr: 20036780 Decision Date: 05/28/20 Archive Date: 05/28/20 DOCKET NO. 16-58 819A DATE: May 28, 2020 ORDER Entitlement to an initial rating in excess of 50 percent for major depressive disorder prior to February 9, 2015 is denied. Entitlement to a rating of 70 percent, but no higher, for major depressive disorder beginning February 9, 2015 is granted. Entitlement to an initial compensable rating for perirectal well-differentiated papillary mesothelioma (hereinafter “mesothelioma”) is denied. Entitlement to a rating in excess of 10 percent for lumbosacral strain prior to August 30, 2019 is denied. Entitlement to a rating in excess of 40 percent for lumbosacral strain beginning August 30, 2019 is denied. Entitlement to a rating in excess of 10 percent for residuals of a left hip strain is denied. REMANDED Entitlement to an effective date earlier than January 25, 2018 for the grant of service connection for mesothelioma is remanded. Entitlement to a total rating based on individual unemployability due to service-connected disability (TDIU) is remanded. FINDINGS OF FACT 1. Prior to February 9, 2015, the Veteran’s major depressive disorder more closely approximated social and occupational impairment with reduced reliability and productivity and was not manifested by social and occupational impairment with deficiencies in most areas or total social and occupational impairment. 2. Beginning February 9, 2015, the Veteran’s major depressive disorder more closely approximate social and occupational impairment with deficiencies in most areas; and was not manifested by total social and occupational impairment. 3. Throughout the appeal period, the Veteran’s mesothelioma was asymptomatic. 4. Prior to August 30, 2019, the Veteran’s lumbosacral strain was manifested with flexion to 80 degrees at worst and subjective complaints of pain without limitation of the thoracolumbar spine to greater than 30 degrees but not greater than 60 degrees or limitation of the combined range of motion of the thoracolumbar spine to not greater than 120 degrees; muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour; ankylosis; intervertebral disc syndrome resulting in incapacitating episodes; right lower extremity radiculopathy; or associated neurological impairment of the bowel or bladder. 5. Beginning August 30, 2019, the Veteran’s lumbosacral strain was manifested with flexion to 15 degrees at worst, without ankylosis, intervertebral disc syndrome resulting in incapacitating episodes; right lower extremity radiculopathy; or associated neurological impairment of the bowel or bladder. 6. The Veteran’s residuals of a left hip strain is manifested by complaints of pain, and limitation of motion but has not been productive of flexion limited to 30 degrees or more, abduction limited beyond 10 degrees, extension limited to five degrees, adduction limited so as to be unable to cross legs, rotation limited so as to be unable to toe-out more than 15 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, ankylosis, fail joint, or impairment of the femur. CONCLUSIONS OF LAW 1. Prior to February 9, 2015, the criterial for an initial rating in excess of 50 percent for major depressive disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9434. 2. Beginning February 9, 2015, the criterial for a 70 percent rating for major depressive disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9434. 3. The criteria for an initial compensable rating for mesothelioma have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7344. 4. The criteria for a rating in excess of 10 percent for lumbosacral strain prior to August 30, 2019 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 5. The criteria for a 40 percent rating for lumbosacral strain beginning on August 30, 2019 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 6. The criteria for a rating in excess of 10 percent for residuals of a left hip strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5250-5253. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1988 to July 1991. These matters come to the Board of Veterans’ Appeals (Board) on appeal from September 2013 and August 2018 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction of this appeal is currently with the RO in Oakland, California. This case was most recently before the Board in June 2019, at which time the claims of entitlement to increased ratings for a lumbosacral strain, left hip strain, and major depressive disorder were remanded to the Agency of Original Jurisdiction (AOJ) for further development. The appeal has now been returned to the Board for appellate action. In a September 2019 rating decision, the AOJ awarded a 40 percent rating for a lumbosacral strain, effective August 30, 2019. The Veteran is presumed to seek the maximum available benefit for a disability. As such, this claim is still considered to be on appeal. See AB. Brown, 6 Vet. App. 35, 38 (1993). The United States Court of Appeals for Veterans Claims (Court) has held that a claim for entitlement to a TDIU, either expressly raised by the Veteran or reasonably raised by the record, is part of the claim for an increased rating. See Rice v. Shinseki, 22 Vet. App. 447 (2009). In this case, the Veteran’s attorney asserted that the Veteran was unable to work due to his service-connected disabilities, and indicated he wished to have a claim for entitlement to a TDIU to be considered an inferred issue in conjunction with any and all claims currently on appeal. Accordingly, in light of the Court’s holding in Rice, the issue of entitlement to a TDIU has been raised by the record and is within the jurisdiction of the Board. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. It is permissible to switch diagnostic codes to reflect more accurately a claimant’s current symptoms. See Read v. Shinseki, 651 F. 3d 1296, 1302 (Fed. Cir. 2011). 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 concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. When an evaluation of a disability is based upon limitation of motion, the Board must also consider, in conjunction with the otherwise applicable DC, any additional functional loss the Veteran may have sustained by virtue of other factors as described in 38 C.F.R. §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Such factors include more or less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, and deformity or atrophy from disuse. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the Veteran. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran’s claims. 2. Major Depressive Disorder The Veteran asserts that his major depressive disorder is worse than the 50 percent rating currently assigned. Specifically, the Veteran seems to assert that the severity of his major depressive disorder results in occupational impairment that results in an inability to sustain gainful employment. The Veteran’s MDD is rated under Diagnostic Code 9434. Diagnostic Code 9434 uses the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, Diagnostic Code 9434. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). Under the General Rating Formula, a 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9434. A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id. The maximum schedular rating of 100 percent is warranted when there is total occupational and social impairment due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation or own name. Id. In addition, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the lengths of remissions, and the Veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a). The rating agency shall assign an evaluation based on all evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. Id. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation on the basis of social impairment. The Board notes that with regard to the use of the phrase “such as” in 38 C.F.R. § 4.130 (General Rating Formula for Mental Disorders), ratings are assigned according to the manifestations of particular symptoms. However, the use of the phrase “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve only as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the evidence considered in determining the level of impairment under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. Instead, VA must consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment. The Board notes that the revised DSM-5, which, among other things, eliminates Global Assessment of Functioning (GAF) scores, applies to appeals certified to the Board after August 4, 2014, as is the case here. See 79 Fed. Reg. 45, 093 (Aug, 4, 2014). Consequently, the Board will not consider the previously assigned GAF scores in determining the outcome of this case. See Golden v. Shulkin, No. 16-1208 (February 23, 2018). In evaluating psychiatric disorders, the VA has adopted and employs the nomenclature in the rating schedule based upon the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, of the American Psychiatric Association (DSM-V). See 38 C.F.R. § 4.130. A review of the record reveals that the Veteran has exclusively sought mental health treatment from VA facilities, as well as treatment for his other health needs. To the extent that the Veteran’s VA treatment records contain information relevant to the severity of his mental health, to include mental health screenings, the Board will summarize this evidence. Turning to the evidence, the medical evidence of record reflects that the Veteran endorsed psychiatric symptomatology that included depressed mood; bereavement; irritability; lack of motivation to perform activities of daily living, to include getting out of bed and shaving; significant impatience and irritability; agoraphobia; frequent panic symptoms; nightmares; exaggerated startle response; crying easily; hypervigilance; excessive guilt; lack of energy; difficulty concentrating and/or making decisions; memory problems; low sex drive; intrusive thoughts; avoidance of stimuli; hopelessness or despondence that had improved; dysphoria; sleep deprivations; occasional auditory hallucinations; occasional visual hallucinations; passive suicidal ideation and thoughts of death; social isolation; avoidance of crowds; paranoia that resulted in arming himself after running into an acquaintance he did not remember; and feelings of distress. Notably, a VA treatment record indicates the Veteran had ameliorating factors of his mental health symptoms that included having children in the home, a sense of responsibility to his family, reality testing ability, positive coping skills; positive problem-solving skills, positive therapeutic relationship, future oriented plans, and the ability and willingness to participate in his treatment. See November 2014 VA treatment record. A March 2017 VA treatment record indicates the Veteran reported “shadows” that he believed others did not see. An April 2017 VA treatment record indicates the Veteran had a good relationship with all seven of his children, and with his grandchildren. A September 2017 VA treatment record indicates the Veteran discovered his daughter’s murdered body, had become “absorbed” with her estate and grandson’s well-being, and that he felt he was at a point where he wanted to “give up,” but denied suicidal ideation. He indicated he had thoughts about stopping his diabetes medication and letting his body die. Further, an October 2017 VA treatment record indicates the Veteran reported sleep deprivation over the past 10 days, with nightmares, and auditory hallucinations during the day. The Veteran was afforded a VA examination in August 2013. At that time, the examiner diagnosed major depressive disorder, single episode, moderate, chronic. The Veteran reported he had two failed marriages, but that he maintained excellent relationships with his children and had stayed involved in their lives. He did not have many friends, but he had at least one good friend with a trusting relationship. He reported that when he was not with his children he mostly stayed at home. The Veteran reported his second marriage ended as a result of his lack of intimacy and lack of communication that was associated with his mood disturbance. The examiner opined the Veteran’s major depressive disorder manifested in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. Symptoms associated with his major depressive disorder included depressed mood; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; flattened affect; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Other symptoms reported by the Veteran included that he used to be very social but now he did not like being around people; had no energy; had no interest in working on projects at home; no longer felt productive; would get frustrated that he could not get around or do things like he used to; and had very restless sleep, and only 4 hours of sleep a night. In an August 2013 VA Form 21-4138 Statement in Support of Claim, the Veteran reported that he had become withdrawn, felt depressed, and was anti-social. He reported he could only sleep three or four hours a night due to his back and hip pain, and that he had reduced attention span. He stated he lost interest in the things he used to enjoy. He stated he had difficulty with toileting and bathing due to his physical pain. A February 2015 private psychiatric assessment by Dr. H.H-G. indicated that the Veteran had seven children, and lived with his two youngest daughters. The Veteran reported keeping his struggles to himself as to not burden others; was socially withdrawn; had assistance performing daily living tasks, and that his live-in friend maintained the household chores and prepared meals; that he needed reminders to attend to personal hygiene; and was able to maintain his finances with some difficulty. He reported that he showered three times a week, and was limited as a result of his mental health symptoms in combination with his physical pain and limitations. Dr. H.H-G. indicated that she believed the Veteran’s MDD and social impairment were “emotionally debilitating,” and that generally, the DSM stated individuals with such symptoms typically had suicidal ideation, few friends, and an inability to keep a job. Dr. H.H-G. then indicated the Veteran had occupational and social impairments. In that regard, she noted the Veteran had passive suicidal ideation in September 2012; reported auditory and visual hallucinations; chronic sleep impairment; insomnia; broken sleep; mild memory loss; near-continuous panic; near-continuous depression; difficulty in functioning effectively; difficulty establishing and maintaining relationships; difficulty adapting to stressful circumstances including work; intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene; and panic attacks. The Veteran reported he had physical and mobility limitations; and that his debilitating depression caused a remarkable decline in his quality of life. Dr. H.H-G. indicated the Veteran could not sustain stress from a competitive work environment, and could not be expected to engage in gainful activity as a result of his major depressive disorder. She opined that the Veteran’s major depressive disorder manifested in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The February 2015 private evaluation noted that symptoms associated with his major depressive disorder included depressed mood; anxiety; panic attacks that occur weekly or less often; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; flattened affect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a work-like setting; inability to establish and maintain effective relationships; suicidal ideation; persistent delusions or hallucinations; neglect of personal appearance and hygiene; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. Other symptoms attributable to his major depressive disorder included ongoing difficulty with his symptom pattern with an inability to enjoy the simplest of activities. Mental status examination at this time showed the Veteran had normal attention; variable concentration; complaints of increased trouble with short-term memory; struggling to remember basic information; normal speech, although brief; appropriate thought content; goal-directed thought; hallucinations; average knowledge; average intellect; average capacity for abstraction; average judgment; anxious and nervous mood; restricted affect; feelings of being anxious and depressed; suspiciousness; vagueness; paranoia; and cautious when interacting with the examiner. During the February 2015 private evaluation, Dr. H.H-G. indicated the Veteran would miss three or more days per month as a result of mental health symptoms; would need to leave three or more days per month as a result of mental health symptoms; and that he would have trouble with concentration more than three days per month, and would not stay focused for at least seven hours of the eight hour workday. She indicated that if the Veteran were subjected to the normal pressures and constructive conditions of a job, he would respond inappropriately about once per month, and that he would react in a violent manner. The Veteran was afforded a VA examination in August 2019. At that time, the examiner diagnosed major depressive disorder, with anxious distress, recurrent, moderate. The Veteran reported that since his last VA examination, he did not have any relationships with his family members; and that he struggled to make and maintain social relationships. He said he had three friends that he had since childhood, and he talked to them once a year. He was currently living in Florida alone. He reported he had retired in 2010, and that he had an “okay” relationship with his co-workers and supervisors; and that he mostly worked by himself. He was not taking psychotropic medication, but he was participating in group and individual therapy and counseling. He stated he did not believe that medication or therapy helped, and that he wanted to be left alone. The examiner opined the Veteran’s major depressive disorder manifested in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. Symptoms associated with major depressive disorder included depressed mood; anxiety; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a work-like setting; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. The Veteran presented as on time to the appointment; alert; oriented to all spheres; casually dressed; adequately groomed; made appropriate eye contact; anxious mood; congruent affect; evidenced a crying spell during the evaluation; speech that was logical, intact, and goal-directed; initiated spontaneous conversation on a few instances; through process within the normal range; polite; cooperative; and put forth a strong effort. He denied any hallucinations and/or delusional thought; and denied homicidal and/or suicidal ideation and/or intent. He appeared to be a reliable historian. Other symptoms attributable to his major depressive disorder included irritability. The examiner noted the Veteran’s major depressive disorder was recurrent with associated symptoms of anxiety. Further review of the record shows that the Veteran receives VA treatment and from private treatment providers for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has reported mental health symptoms that are worse than those noted above. Based on the foregoing, the Board finds that prior to February 9, 2015, a rating in excess of 50 percent for PTSD is not warranted. In this regard, the Board finds that, prior to February 9, 2015, such disability was manifested by occupational and social impairment with reduced reliability and productivity without more severe impairment with reduced reliability and productivity with deficiencies in most areas, or total occupational and social impairment. Specifically, the totality of the Veteran’s psychiatric symptomatology is contemplated by the currently assigned 50 percent rating under the General Rating Formula. Prior to February 9, 2015, the record reflects that the Veteran had his children in his home, had positive coping skills, had positive problem-solving skills, had a positive therapeutic relationship, with future oriented plans, and was able and willing to participate in his treatment. See November 2014 VA treatment record. Moreover, at his August 2013 VA examination, the Veteran reported he maintained “excellent” relationships with all seven of his children and stayed involved in their lives and had at least one good friend with a trusting relationship. Further, at his August 2013 VA examination the Veteran indicated his second marriage ended as a result of his lack of intimacy and lack of communication, showing adequate judgment and significant insight into his own behavior and symptomatology. Prior to February 9, 2015, the Veteran had not exhibited nor reported delusions, suicidal ideation, homicidal ideation, nor auditory or visual hallucinations at any time. In fact, the Veteran consistently denied such symptoms. The Board notes that the February 2015 private psychiatric assessment indicates the Veteran had suicidal ideation in September 2012, but also indicates that the Veteran denied suicidal or homicidal ideation on that day. Thus, the Board finds that while the Veteran may have experienced some symptoms contemplated by a 70 percent rating, namely one incident of possible passive suicidal ideation in September 2012, the overwhelming majority of the remaining symptoms were either contemplated by, or more consistent with, a 50 percent rating. Further, while the Veteran reported chronic sleep impairment, failed marriages, some social isolation and lack of energy and productivity, he reported consistently good relationships and regular social interactions with all of his children and friend. Moreover, the Board finds that the criteria for a 70 percent rating under the General Rating Formula are not met, prior to February 9, 2015. In that regard, the record does not show occupational and social impairment with deficiencies in most areas. The record does not show, the Veteran has not alleged, suicidal intent, homicidal ideations or intent, obsessional rituals, intermittently illogical or obscure speech, impaired impulse control, or spatial disorientation. While the Veteran reported experiencing anxiety and depression, there was no indication that these symptoms were continuous or that they were similar to the severity, frequency or duration that affected his ability to function independently, appropriately and effectively. VA treatment records and examination reports dated during the appeal period consistently show that he has been clean and casually dressed as well as neatly groomed. Regarding the Veteran’s ability to establish and maintain effective relationships, the Board notes that he maintained a good relationship with his adult children, and that he had a relationship with his grandchildren. He also reported having one close friend with whom he had a trusting relationship. Further, although the Veteran was shown to have some difficulty in toileting and bathing, the Veteran himself asserted that this difficulty was as a result of his physical limitations and not as a result of mental health symptoms. See August 2013 VA Form 21-4138. With regard to mood, the Veteran has displayed some deficiency. He has reported irritability, anxiety and depression during prior to February 9, 2015 and has been found to be depressed. In addition, his reported sleep difficulties which would be consistent with deficiencies in mood. However, the Veteran’s judgment has been consistently found to not be impaired. Thought processes have been consistently found to be appropriate. Moreover, there have been no findings of, and the Veteran has not reported, psychosis, delusions, inappropriate behavior or obsessive/ritualistic behavior. Finally, the Veteran did not attend school or attempt schooling during the appellate period, and was retired. Therefore, occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking or mood has not been demonstrated and a 70 percent rating is not warranted prior to February 9, 2015. In sum, prior to February 9, 2015, the Veteran experienced occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. In short, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran’s symptoms resulted in the level of impairment required for a 70 percent rating prior to February 9, 2015, and accordingly the criteria for a 70 percent rating is not warranted. However, beginning February 9, 2015, the Board finds that a 70 percent rating for PTSD is warranted. In this regard, the Board finds that beginning February 9, 2015, such disability was manifested by occupational and social impairment with deficiencies in most areas, without more severe impairment resulting in total occupational or social impairment. Specifically, the totality of the Veteran’s psychiatric symptomatology is contemplated by a 70 percent rating under the General rating Formula. Beginning February 9, 2015, the record reflects that the Veteran exhibited symptoms of social isolation and withdrawal, needed assistance performing daily living tasks and chores, exhibited difficulty in maintaining personal hygiene, suicidal ideation, auditory and visual hallucinations, insomnia and chronic sleep impairment, near-continuous depression, panic attacks, debilitating depression, a marked decline in his quality of life, hallucinations, and paranoia. See February 2015 private psychiatric assessment. The Board notes that after February 9, 2015, the Veteran began reporting auditory and visual hallucinations, and stated he saw “shadows” that he believed others did not see; and that he began to report passive suicidal ideation after the murder of his daughter. See March 2017 and September 2017 VA treatment records. Further, at his August 2019 VA examination, the Veteran reported that he no longer had relationships with his family members, struggled to make and maintain social relationships, and only spoke to a few of his childhood friends once a year. He also presented at the August 2019 VA examination with a crying spell during the evaluation. The Board notes that in April 2017, the Veteran reported he had a good relationship with his children and grandchildren, but that it seems to appear that after the murder of his daughter, his mental health symptoms increased in severity in all aspects of his life. The Board finds that the criteria for a 100 percent rating under the General Rating Formula are not met. While the Veteran may have experienced some symptoms contemplated by a 100 percent rating, namely some social isolation and an intermittent ability to perform some activities of daily living (including maintenance of minimal personal hygiene), the majority of the remaining symptoms were either contemplated by, or more consistent with, a 70 percent rating. Further, while the Veteran reported he no longer had relationships with family members, he reported some contact with three childhood friends and hence was not totally socially impaired. Moreover, the Veteran always presented as adequately groomed, casually dressed, and with appropriate eye contact; and without gross impairment in thought processes or communication, and did not have persistent delusions or hallucinations. The Veteran consistently presented as oriented to time and place, and was not a persistent danger of hurting himself or others. There was no evidence of memory loss or homicidal ideations or intent. Moreover, the Veteran has generally been found to have appropriate hygiene and appearance although sometimes asserting he had difficulty with maintaining appropriate hygiene without assistance. While the Veteran reported hallucinations, there is no evidence or suggestion that such hallucinations were persistent and there was no evidence of perceptual disturbances such as mania or psychosis found on mental status examination. The Veteran’s thought processes were found to not be impaired while his thought content was not found to include delusions. Additionally, none of the Veteran’s PTSD symptoms are similar in severity, frequency, or duration as found necessary for the assignment of a 100 percent rating. In sum, beginning February 9, 2015, the Veteran experienced occupational and social impairment with occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. In short, the preponderance of the evidence weighs for finding that the severity, frequency, and duration of the Veteran’s symptoms resulted in the level of impairment required for a 70 percent rating, but not higher beginning February 9, 2015 and accordingly the assignment of a 70 percent rating beginning February 9, 2015 is warranted. In assessing the severity of the major depressive disorder, the Board has considered the competent lay assertions regarding symptoms experienced and observed. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). However, the criteria needed to support higher ratings as the required medical findings that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher rating pursuant to any applicable criteria at any point pertinent to this appeal. The Veteran’s belief that he is entitled to a higher rating for his major depressive disorder is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination report and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran’s general belief that he is entitled to a higher rating. The Board has considered whether a staged rating under Hart, supra is appropriate; however, the Board finds that his symptomatology has been stable throughout each period on appeal. Therefore, assigning further staged rating is not warranted. The Veteran and/or his representative has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Consequently, resolving all doubt in the Veteran’s favor, the Board will grant a 70 percent rating for PTSD, but no higher, beginning on February 9, 2015. However, the Board finds that the preponderance of the evidence is against the assignment of an initial rating higher than 50 percent prior to February 9, 2015. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990) 3. Mesothelioma The Veteran asserts that his service-connected mesothelioma is worse than the noncompensable rating currently assigned. Specific argument in support of this appeal has not been provided. The Veteran has been assigned a noncompensable rating under Diagnostic Code 7344 for his mesothelioma. Under Diagnostic Code 7344, benign neoplasms (exclusive of skin growths) are to be evaluated under an appropriate diagnostic code, depending on the predominant disability or specific residuals after treatment. 38 C.F.R. § 4.114. The first step, then, is to identify the symptoms and functional disability the Veteran has had during the appeal period due to his mesothelioma. The Veteran has not identified facts, evidence, or argument that would support a compensable rating and has not specified the symptoms or functional limitations that he believes would warrant a compensable rating for his mesothelioma (or residuals thereof). Turning to the clinical evidence of record, an October 2017 private treatment record indicates that the Veteran had unspecified mesothelioma that had resolved. A June 2018 VA examination indicates the Veteran had a diagnosis of perirectal well differentiated papillary mesothelioma that was diagnosed in 2017. At this time, the examiner found the Veteran’s condition required the daily use of oral bronchodilators; but did not require the use of inhaled medications, antibiotics, or oxygen therapy. The examiner found there were no other pertinent physical findings, complications, conditions, signs or symptoms, related to his mesothelioma; and indicated that the disability was mild. Moreover, the examiner noted the Veteran’s mesothelioma would not impact his ability to work. An August 2018 VA examination indicates the Veteran’s mesothelioma did not require continuous medication for control; nor had the Veteran had surgical treatment for an intestinal condition. The Veteran did not have any signs or symptoms attributable to any non-surgical non-infectious intestinal conditions. He did not have any episodes of bowel disturbance with abdominal distress, or exacerbations or attacks; nor did he have any weight loss; nor did he have any malnutrition, serious complications or other general health effects attributable to his mesothelioma. He was shown to have benign neoplasms related to his mesothelioma; and was not undergoing any treatment nor did he have any residual conditions or complications related to such. There were no other pertinent physical findings, complications, conditions, signs, symptoms, or scars shown. The examiner noted the Veteran’s mesothelioma was mild, asymptomatic, and an incidental diagnosis; and that it did not impact his ability to work. An October 2018 VA treatment record indicates the Veteran had no further treatment for his mesothelial hyperplasia. After review of the above evidence, the Board finds that there are no symptoms or functional impairments related to the Veteran’s service-connected mesothelioma. Specifically, the Board notes that the June 2018 and August 2018 VA examiners indicated the Veteran’s mesothelioma was mild and asymptomatic. Moreover, the treatment records indicate that the Veteran had resolved mesothelioma that no longer required treatment. Moreover, the Veteran has not reported any symptoms or functional impairments related to his mesothelioma. The Veteran’s belief that he is entitled to a higher rating for his mesothelioma is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination report and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran’s general belief that he is entitled to a higher rating. The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran’s service-connected mesothelioma; however, the Board finds that his symptomatology referable to such disability has been stable throughout the period on appeal. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, supra. Further, in reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s higher rating claim. As such, that doctrine is not applicable in the instant appeal, and his increased rating claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 4. Lumbosacral Strain The Veteran asserts that his lumbosacral strain is worse than the rating currently assigned. Specific argument in support of this appeal has not been provided. The Veteran’s lumbosacral strain is rated as 10 percent prior to August 30, 2019, and 40 percent disabling thereafter under Diagnostic Code 5237. Diagnostic Code 5237 is part of the General Rating Formula for Disease and Injuries of the Spine (General Rating Formula). Under the General Rating Formula, a 10 percent rating is assigned when forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine is greater than 120 degrees but not greater than 235 degrees; or when there is 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. A 20 percent rating is assigned when forward flexion of the thoracolumbar spine 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 when 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. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine to 30 degrees or less; or, for favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the thoracolumbar spine. A maximum schedular 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. Note (1) to the General Rating Formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. The General Rating Formal also provides alternative rating criteria for Intervertebral Disc Syndrome (IVDS). Here, there is no evidence that the Veteran’s disability has resulted in IVDS requiring prescribed bed rest. On this basis, the Board finds that it need not further discuss these alternative rating criteria. Rather, the Veteran was consistently shown to not have IVDS. The Veteran was afforded a VA examination in August 2013. At that time, the Veteran reported constant severe pain that was sharp, burning, and rated a 9 out of 10 pain intensity. He reported his low back pain prevented him from driving, walking without the assistance of a walker, cooking, shopping, and sleeping. He reported daily pain medication that helped “mildly for a few hours,” and denied flare-ups. Range of motion measurements were as follows: forward flexion to 80 degrees, with objective evidence of painful motion at 70 degrees; extension to 25 degrees, with objective evidence of painful motion at 25 degrees; and bilateral lateral flexion and bilateral lateral rotation to 30 degrees or greater each, without objective evidence of painful motion. The examiner noted that unless otherwise documented, there was no objective evidence of pain on range of motion, passive range of motion was unchanged from active range of motion and on repetitive testing, and range of motion values were unchanged from baseline values; and no pain, fatigue, weakness or incoordination was noted. The examiner noted that the Veteran was not experiencing a flare-up on examination, and would only be speculative to report additional range of motion loss based on flare-ups and/or with repeated use over time. There was no additional loss of range of motion after repetitive-use testing. Factors of functional loss were less movement than normal, and pain on movement. The Veteran was shown to have tenderness that was superficial and diffuse and/or nonanatomic tenderness; and had movements that produced pain, without actually causing that movement, such as axial loading and pain on simulated rotation. The Veteran did not have muscle spasm or guarding. The Veteran’s muscle strength testing and sensory examination was normal, with no signs of muscle atrophy or radiculopathy. The Veteran did not have IVDS. The Veteran endorsed the regular use of a brace and walker as a normal mode of locomotion for his low back, hip, and bilateral knee conditions. Functioning was not so diminished that the Veteran would be equally served with amputation with prosthesis. Diagnostic imaging studies did not document arthritis, vertebral fracture, or any other significant diagnostic test findings and/or results. The examiner noted the Veteran reported he had to quit his job because he could not perform his job duties; but noted that the Veteran’s lumbosacral strain should not preclude light duty or sedentary employment, and that strenuous physical employment was limited given the service-connected spine condition. The Veteran was afforded another VA examination in August 2019. At that time, the Veteran reported severe daily, dull, achy pain, that was not related to position, movement, or activity. He denied flare-ups. Range of motion measurements were as follows: forward flexion to 15 degrees; extension to 5 degrees; bilateral lateral flexion to 15 degrees each; right lateral flexion to 20 degrees; and left lateral rotation to 15 degrees. The examiner noted that the Veteran’s active and passive ranges of motion were the same in all planes, and that the Veteran stated he experienced subjective pain symptoms with both weight-bearing and nonweight-bearing. There was no additional loss of range of motion after repetitive-use testing. Factors of functional loss included reduced range of motion. Pain was noted on examination and caused functional loss on all range of motion movements. The Veteran was shown to have diffuse severe bilateral paraspinal muscle tenderness throughout the thoracolumbar spine. The Veteran had muscle spasm and guarding that resulted in an abnormal gait or abnormal spinal contour. There were no additional factors contributing to his disability. The Veteran’s muscle strength testing was normal, with no signs of muscle atrophy. His sensory examination showed decreased sensation to light tough testing in the left foot and toes. The Veteran was shown to have radicular pain or any other signs or symptoms due to radiculopathy that was manifested by moderate constant pain in the left lower extremity, and mild numbness in the left lower extremity. The examiner noted the Veteran had mild radiculopathy of the left side. There was no ankylosis of the spine. There were no other neurologic abnormalities or findings related to his lumbosacral spine. The Veteran did not have IVDS. The Veteran endorsed the constant use of a cane as a normal mode of locomotion. Functioning was not so diminished that the Veteran would be equally served with amputation with prosthesis. The examiner noted the Veteran’s lumbosacral strain would impact his work in that it manifested in problems with lifting and carrying, and pain. The examiner noted that passive range of motion testing could not be performed or was not medically appropriate, and that the spine had no contralateral joint. Further review of the record shows that the Veteran receives VA treatment and from private treatment providers for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has reported back symptoms that are worse than those noted in the various VA examination reports of record and there are no ranges of motion measurements documented in the VA treatment notes of record. Based on the foregoing, the Board finds that prior to August 30, 2019 a rating in excess of 10 percent for a lumbosacral strain is not warranted. In this regard, the Board finds that prior to August 30, 2019, such disability was manifested by forward flexion of the spine that was, at worst, 80 degrees with a combined range of motion 225 degrees. Muscle spasm, guarding, or localized tenderness resulting in abnormal gait or abnormal spinal contour or a vertebral body fracture with loss of 50 percent or more of the height were not shown by the record or alleged by the Veteran. Specifically, at his August 2013 VA examination, the Veteran was not shown to have muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. Although the Veteran has credibly reported lumbar spine pain, the evidence of record does not support a rating higher than 10 percent based on range of motion. Specifically, at no point prior to August 30, 2019 has the Veteran’s lumbosacral strain been characterized by forward flexion of the thoracolumbar spine that is greater than 30 degrees but not greater than 60 degrees or that the combined range of motion of the thoracolumbar spine was not greater than 120 degrees, even in contemplation of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca, supra. At his August 2013 VA examination, his flexion was to be to 80 degrees with pain beginning at 70 degrees. Although pain may cause functional loss, pain itself does not constitute functional loss. Mitchell, supra. Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id.; see 38 C.F.R. § 4.40. Here, the VA treatment records and VA examinations do not reveal additional functional impairment, including additional limitation of motion, on account of pain, weakness, etc, that is not already contemplated by the assigned 10 percent rating. Burton, supra; 38 C.F.R. § 4.59. Thus, prior to August 30, 2019, a higher rating is not warranted for the Veteran’s lumbosacral strain even in consideration of painful motion and other factors such as weakness, fatigability, lack of endurance, and incoordination. Beginning August 30, 2019, the Board finds that the Veteran is not entitled to a rating in excess of 40 percent for his lumbosacral strain. In this regard, the Board finds that beginning August 30, 2019, such disability was manifested by forward flexion of the spine that was, at worst, 15 degrees without ankylosis. Specifically, at his August 2019 VA examination, the Veteran was not shown to have ankylosis of the spine. Although the Veteran has credibly reported lumbar spine pain, the evidence of record does not support a rating higher than 40 percent. Finally, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court’s holdings in Correia and Sharp. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016), and Sharp v. Shulkin, 29 Vet. App. 26 (2017). In this case, the August 2013 VA examination was conducted prior to Correia and Sharp and provides only partial information as described above. The Board notes that the VA examination did not test the opposite joint; however, the spine does not have an opposite joint. Pain was noted on examination in the August 2013 VA examination report. The effect of pain on range of motion is described above. Regarding repeated use over time, the Board notes that August 2013 VA examiner conducted repetitive-use testing and concluded that there was no additional limitation in range of motion. Regarding flare-ups, the Board acknowledges that the August 2013 VA examiner was not able to provide an opinion regarding additional functional impairment during flare-ups. However, the Board finds that all information required for rating purposes was provided. The August 2013 VA examiner indicated that the Veteran did not report experiencing any flare-ups and so he did not provide an estimate as to functional impairment during flare-ups. The Veteran’s belief that he is entitled to higher ratings for his lumbosacral strain is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination reports and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran’s general belief that he is entitled to higher ratings. In addition to considering the orthopedic manifestations of a lumbosacral strain, VA regulations also require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. However, the Veteran has not alleged, and the evidence does not show, that he has bladder impairment or bowel impairment and/or neurological impairment as a result of his service-connected lumbosacral strain. The August 2013 and August 2019 VA examination reports found that the Veteran did not have any neurologic abnormalities related to the spine such as bowel or bladder problems or right lower extremity radiculopathy. Moreover, the Veteran is already in receipt of separate ratings for left lower extremity radiculopathy. Therefore, the Board finds that, at no time during the appeal period, has the Veteran’s lumbosacral strain resulted in neurological impairment warranting a separate rating. The Veteran’s belief that he is entitled to a higher rating for his lumbosacral strain is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination report and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran’s general belief that he is entitled to a higher rating. The Board has also considered whether further staged ratings under Hart, supra, are appropriate for the Veteran’s service-connected lumbosacral strain; however, the Board finds that his symptomatology referable to such disability has been stable throughout each period on appeal. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, supra. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 10 percent prior to August 30, 2019, and in excess of 40 percent thereafter for his lumbosacral strain. Consequently, the benefit of the doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 5. Residuals of a Left Hip Strain The Veteran asserts that his residuals of a left hip strain is worse than the rating currently assigned. Specifically, the Veteran asserts that he has constant stabbing pains in his left hip that has now moved to his left shoulder and neck, resulting in an inability to walk or stand without the use of a walker and/or back brace. See August 2013 VA Form 21-4138 Statement in Support of Claim. The Veteran’s residuals of a left hip strain is rated as 10 percent disabling under Diagnostic Code 5252. Disabilities of the hip are evaluated under the General Rating Formula for Rating Diseases and Injuries of the Hip and Thigh. 38 C.F.R. § 4.71a, Diagnostic Codes 5250-5253. The criteria for rating the Veteran’s disability are set forth in a General Rating Formula for evaluating diseases and injuries of the hip as follows: Diagnostic Code 5250 provides a 60 percent rating for favorable ankylosis of the hip in flexion at an angle between 20 degrees and 40 degrees and slight adduction or abduction; a 70 percent rating for intermediate ankylosis; and a 90 percent rating for extremely unfavorable ankylosis, with the foot not reaching the ground, or necessitating crutches. 38 C.F.R. § 4.71a. Under Diagnostic Code 5251, limitation of extension of the thigh, a 10 percent rating is assigned for extension limited to 5 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5252, limitation of flexion of the thigh, a 10 percent rating is assigned for flexion limited to 45 degrees. 38 C.F.R. § 4.71a. A 20 percent disability rating is assigned where flexion is limited to 30 degrees; 30 percent where flexion is limited to 20 degrees; and 40 percent where flexion is limited to 10 degrees. Id. Under Diagnostic Code 5253, impairment of the thigh, a 10 percent rating is assigned for limitation of rotation of the affected leg with an inability to toe-out more than 15 degrees and limitation of adduction where the legs cannot be crossed. 38 C.F.R. § 4.71a. A 20 percent rating is assigned for limitation of abduction with motion lost beyond 10 degrees. Id. The Schedule provides that the normal flexion of the hip is from zero degrees to 125 degrees and normal abduction of the hip is from zero degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II. Degenerative arthritis is rated based on limitation of motion under the appropriate diagnostic codes for the specific joint involved. Id. at Diagnostic Code 5003. The Veteran was afforded a VA examination in August 2013. At that time, the Veteran reported constant soreness with a “catching” sensation that caused sharp pain. He reported daily pain medication that helped “mildly for a few hours,” and denied flare-ups. Range of motion measurements were as follows: flexion was to 115 degrees, with objective evidence of painful motion at 90 degrees; and extension was greater than 5 degrees, with no objective evidence of painful motion. Abduction was not lost beyond 10 degrees, adduction was not limited such that the Veteran could not cross legs, and rotation was not limited such that the Veteran could not toe-out more than 15 degrees. The examiner noted that unless otherwise documented, there was no objective evidence of pain on range of motion, passive range of motion was unchanged from active range of motion and on repetitive testing, and range of motion values were unchanged from baseline values; and no pain, fatigue, weakness or incoordination was noted. The examiner noted that the Veteran was not experiencing a flare-up on examination, and would only be speculative to report additional range of motion loss based on flare-ups and/or with repeated use over time. Range of motion measurements were detailed as follows: flexion against gravity was from zero to 110 degrees, with pain from 90 to 110 degrees, passive range of motion was from zero to 115 degrees, with pain from 90 to 115 degrees, and no additional loss of motion on repetitive use; extension against gravity was from zero to 30 degrees, without pain, and passive range of motion was from zero to 30 degrees, without pain, and no additional loss of motion on repetitive use; abduction against gravity was from zero to 40 degrees, with pain at 40 degrees, and passive range of motion was from zero to 40 degrees, with pain at 40 degrees, and no additional loss of motion on repetitive use; adduction against gravity was from zero to 25 degrees, without pain, and passive range of motion was from zero to 0 degrees, without pain, and no additional loss of motion on repetitive use; internal rotation against gravity was from zero to 35 degrees, with pain from 30 to 35 degrees, passive range of motion was from 0 to 35 degrees, with pain from 30 to 35 degrees, and no additional loss of motion on repetitive use; and external rotation against gravity was from zero to 50 degrees, with pain at 50 degrees, passive range of motion was from zero to 50 degrees, with pain at 50 degrees, and no additional loss of motion on repetitive use. The Veteran could cross his legs and could toe out greater than 15 degrees. There were no additional limitation in range of motion after repetitive use testing. Factors of functional loss were less movement than normal, and pain on movement. During the August 2013 VA examination, the Veteran was not shown to have localized tenderness or pain to palpation of the left hip. The Veteran’s muscle strength testing was normal, with no signs of muscle atrophy. There was no ankylosis of the hip. The Veteran did not have malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. He did not have a total hip joint replacement nor had arthroscopic or other hip surgery. The Veteran endorsed the regular use of a walker as a normal mode of locomotion for his low back, hip, and bilateral knee conditions. Functioning was not so diminished that the Veteran would be equally served with amputation with prosthesis. Diagnostic imaging studies were not available. The examiner noted the Veteran’s left hip strain would impact his ability to work, and noted that it should not preclude light duty or sedentary employment, and that strenuous physical employment was limited given the service-connected hip condition. The examiner noted that the Veteran’s subjective complains during the examination appeared out of proportion to the objective examination findings. A May 2018 VA treatment record indicates the Veteran complained of left foot pain that started at his hip, and traveled down to the foot. He reported the pain was throbbing in nature and would vary in severity from a 6 out of 10 pain intensity, to at worst, a 10 out of 10 pain intensity. He reported pain that was worse with resting, and that a cream alleviated some symptoms. The Veteran was afforded another VA examination in August 2019. At that time, the Veteran reported that he experienced more pain in his hip the more he was on his feet, and that he would have to stop whatever he was doing because of the severity of his pain. Range of motion measurements of the left hip were as follows: flexion was to 80 degrees; extension was to 10 degrees; abduction was to 15 degrees; and adduction was to 0 degrees. Adduction was limited such that the Veteran could not cross his legs. External rotation was to 15 degrees; and internal rotation was to 5 degrees. The examiner noted that the Veteran’s active and passive ranges of motion were the same in all planes, and that the Veteran stated he experienced subjective pain symptoms with both weight-bearing and nonweight-bearing. There was no additional loss of range of motion after repetitive-use testing. Factors of functional loss included reduced range of motion. Pain was noted on examination and caused functional loss on all range of motion movements. The Veteran was examined immediately after repetitive use testing; and pain, weakness, fatigability, or incoordination was not shown to significantly limit functional ability. The Veteran was not examined during a flare-ups; and the examination was neither medically consistent or inconsistent with the Veteran’s statements describing functional loss during flare-ups; and that an opinion could not be provided without resorting to mere speculation. There were no additional factors contributing to his disability. The Veteran’s muscle strength testing was normal, with no signs of muscle atrophy. There was no ankylosis of the hip. The Veteran did not have malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. The Veteran endorsed the constant use of a cane as a normal mode of locomotion as a result of his lumbosacral strain. Functioning was not so diminished that the Veteran would be equally served with amputation with prosthesis. Diagnostic imaging studies were not available. The examiner noted the Veteran’s residuals of a left hip strain would not impact his ability to work. Further review of the record shows that the Veteran receives VA treatment and from private treatment providers for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has reported left hip symptoms that are worse than those noted in the various VA examination reports of record and there are no ranges of motion measurements documented in the VA treatment notes of record. Based on the foregoing, the Board finds that a rating higher than 10 percent is not warranted for the Veteran’s residuals of a left hip strain. At his August 2013 VA examination, left hip flexion was noted to be 115 degrees and 80 degrees at his August 2019 VA examination. Although pain was noted on flexion range of motion in the both of these examinations, such did not result in or cause additional functional loss even in contemplation of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca, supra. Although pain may cause functional loss, pain itself does not constitute functional loss. Mitchell, supra. Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id.; see 38 C.F.R. § 4.40. Here, the VA treatment records and VA examinations do not reveal additional functional impairment, including additional limitation of motion, on account of pain, weakness, etc, that is not already contemplated by the assigned 10 percent rating. Burton, supra; 38 C.F.R. § 4.59. Thus, a higher rating is not warranted for the Veteran’s residuals of a left hip strain based on limitation of flexion even in consideration of painful motion and other factors such as weakness, fatigability, lack of endurance, and incoordination. With regard to abduction, the clinical evidence does not show that it was lost beyond 10 degrees. The August 2013 VA examination report found abduction to be to beyond 10 degrees and the Veteran was able to cross his legs. Abduction was found to be to 15 degrees in the August 2019 VA examination report and the Veteran was not able to cross his legs. With regard to rotation, the clinical evidence does not show that the Veteran could not toe-out more than 15 degrees on the affected leg. The August 2013 VA examination report found external rotation to be to 50 degrees and internal rotation to be to 35 degrees in the left hip. The August 2019 VA examination report found external rotation to be to 15 degrees and internal rotation to be to 5 degrees. In addition, the August 2013 VA examination report found left hip extension to be to greater than 5 degrees while the August 2019 VA examination report found it to be to 10 degrees. Although pain was noted on range of motion in both the August 2013 and August 2019 VA examination reports, such did not result in or cause additional functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca, supra. Therefore, a higher or separate rating cannot be granted based on limitation of abduction, rotation or extension. The Board also considered the applicability of 38 C.F.R. § 4.71a, Diagnostic Codes 5250, 5254, 5255. However, a review of the record indicates that at no time during the pendency of the appeal has the Veteran’s residuals of a left hip strain been manifested by ankylosis, hip flail joint, or malunion or nonunion of the femur. Accordingly, these Diagnostic Codes are not applicable. Finally, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court’s holdings in Correia and Sharp. See Correia v. McDonald, supra, and Sharp v. Shulkin, supra. In this case, the August 2013 VA examination was conducted prior to Correia and Sharp and provides only partial information as described above. The Board notes that the VA examination did not test the opposite joint; however, pain was noted on examination in the August 2013 VA examination report. The effect of pain on range of motion is described above. Regarding repeated use over time, the Board notes that August 2013 and August 2019 VA examiners conducted repetitive-use testing and concluded that there was no additional limitation in range of motion. Regarding flare-ups, the Board acknowledges that the August 2013 VA examiner was not able to provide an opinion regarding additional functional impairment during flare-ups. However, the Board finds that all information required for rating purposes was provided. The August 2013 VA examiner indicated that the Veteran did not report experiencing any flare-ups and so he did not provide an estimate as to functional impairment during flare-ups. In addition, the August 2019 VA examiner determined that the examination was neither medically consistent or inconsistent with the Veteran’s statements describing functional loss during flare-ups. The Veteran’s belief that he is entitled to higher ratings for his residuals of a left hip strain is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination reports and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran’s general belief that he is entitled to a higher rating. The Board has also considered whether a staged rating under Hart, supra is appropriate for the Veteran’s service-connected residuals of a left hip strain; however, the Board finds that his symptomatology referable to such disability has been stable throughout the period on appeal. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, supra. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 10 percent for residuals of a left hip strain. Consequently, the benefit of the doubt rule does not apply and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. REASONS FOR REMAND 1. Earlier Effective Date – Service Connection for Mesothelioma The Veteran submitted a timely notice of disagreement with an August 2018 rating decision granting entitlement to service connection for mesothelioma and indicated he disagreed with the effective date assigned. However, a statement of the case (SOC) has not yet been issued addressing such claim. Where a notice of disagreement has been filed with regard to a claim, and a statement of the case has not been issued, the appropriate Board action is to remand the claim for issuance of a statement of the case. Manlincon v. West, 12 Vet. App. 238 (1999). Thus, a remand is required for the AOJ to issue a statement of the case with regard to the Veteran’s claim for entitlement to an effective date earlier than January 25, 2018, for the grant of service connection for mesothelioma. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). 2. Entitlement to a TDIU The Veteran’s attorney generally suggested that the Veteran was unable to work due to his service-connected disabilities in an April 2020 submission. See April VA Form 21-8940. The Veteran reported that he last worked in 2010, and indicated that he left his last job due to disability. As such matter has not been developed or adjudicated by the AOJ, remand is necessary. The matters are REMANDED for the following action: (Continued on the next page)   1. Issue an SOC as to the issue of entitlement to an effective date earlier than January 25, 2018 for the grant of service connection for perirectal well-differentiated papillary mesothelioma, in response to the timely NOD that the Veteran filed in October 2018. Send the Veteran and his representative a SOC that addresses the issue of entitlement to an effective date earlier than January 25, 2018 for the grant of service connection for perirectal well-differentiated papillary mesothelioma. If the Veteran perfects an appeal by submitting a timely VA Form 9, the issue should be returned to the Board for further appellate consideration. 2. Conduct the appropriate development to adjudicate the claim of entitlement to a TDIU, to include providing any necessary VA examinations. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to discuss the effects of the Veteran’s service-connected disabilities on any occupational functioning and activities of daily living. Thereafter, adjudicate his claim for a TDIU. Kristy L. Zadora Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, 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.