Citation Nr: 20042386 Decision Date: 06/23/20 Archive Date: 06/23/20 DOCKET NO. 16-26 829 DATE: June 23, 2020 ORDER Entitlement to service connection for a right hip disability, to include as secondary to service-connected bilateral ankle disabilities, is denied. Entitlement to service connection for a left hip disability, to include as secondary to service-connected bilateral ankle disabilities, is denied. Entitlement to an initial disability rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is denied. Entitlement to a rating higher than 10 percent for left ankle Achilles tendonitis with lateral instability is denied. Entitlement to a rating higher than 10 percent for right ankle Achilles tendonitis with lateral instability is denied. FINDINGS OF FACT 1. The Veteran’s right and left hip disabilities did not have onset in service or within one year of service discharge, nor were they shown to be related to any aspect of service, nor are they shown to be secondary to the service-connected bilateral ankle disorders. 2. The Veteran’s PTSD resulted in impairment that most closely approximated occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 3. Throughout the rating period on appeal, the Veteran’s service-connected right and left ankle disabilities have been manifested by pain, instability and swelling, productive of no worse than moderate limitation of bilateral ankle motion. CONCLUSIONS OF LAW 1. The criteria for service connection for a right hip disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. 2. The criteria for service connection for a left hip disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. 3. The criteria for entitlement to a rating higher than 30 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.130, Diagnostic Code 9411. 4. The criteria for a rating higher than 10 percent for right ankle Achilles tendonitis with lateral instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5271. 5. The criteria for a rating higher than 10 percent for left ankle Achilles tendonitis with lateral instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5271. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from September 1988 to September 1990, from December 1990 to March 1991, and from February 1993 to April 1995. In October 2018, the Board remanded the appeal for additional development, which has been completed. Service Connection 1. Entitlement to service connection for a right hip disability, to include as secondary to service-connected bilateral ankle disabilities 2. Entitlement to service connection for a left hip disability, to include as secondary to service-connected bilateral ankle disabilities Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.  Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting service, was aggravated therein.  38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).  To establish service connection for a disability, there must be competent evidence of the following: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or “nexus” between the present disability and the disease or injury incurred or aggravated during service. Horn v.  Shinseki, 25 Vet. App. 231, 236 (2010); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)).  In many cases, medical evidence is required to meet the requirement that the evidence be “competent.”  However, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination “medical in nature” and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007).  Service connection for certain chronic diseases may be presumed to have been incurred in service by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a).  Such a chronic disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service.  38 C.F.R. §§ 3.307(a).  When a chronic disease is shown in service, sufficient to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes.  38 C.F.R. § 3.303 (b).  To be “shown in service,” the disease identity must be established, and the diagnosis must not be subject to legitimate question.  Walker v. Shinseki, 708 F.3d 1331, 1335 (Fed. Cir. 2013); see also 38 C.F.R. § 3.303(b). There is no “nexus” requirement for compensation for a chronic disease which was shown in service, so long as there is an absence of intercurrent causes to explain post-service manifestations of the chronic disease.  Walker, 708 F.3d at 1336.  Service connection may also be granted on a secondary basis for a condition that is not directly caused by the Veteran’s service. 38 C.F.R. § 3.310. In order to prevail under a theory of secondary service connection, the evidence must demonstrate an etiological relationship between (1) a service-connected disability or disabilities and (2) the condition said to be proximately due to the service-connected disability or disabilities. Buckley v. West, 12 Vet. App. 76, 84 (1998); see also Wallin v. West, 11 Vet. App. 509, 512 (1998). In addition, secondary service connection may also be found in certain instances when a service-connected disability aggravates another condition. See Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310 (b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).  The Veteran contends that he developed a right and left hip disabilities, to include as due to his service-connected bilateral ankle disorders. The service treatment records contain no complaints, history or findings consistent with a chronic right or left hip disorder. After service, treatment records in 2012 reflect complaints of bilateral hip pain. Thus, the Veteran was not shown to have arthritis of either hip in service or within one year following discharge from service, as such, service connection cannot be established for arthritis on a presumptive basis. 38 U.S.C. § 1112 ; 38 C.F.R. §§ 3.307, 3.309. The Court has indicated that the normal medical findings at the time of separation from service, as well as the absence of any medical records of a diagnosis or treatment for many, many, years after service is probative evidence against the claim. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board where it found that Veteran failed to account for the lengthy time period after service for which there was no clinical documentation of low back condition); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (A prolonged period without medical complaint can be considered, along with other factors concerning a claimant’s health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability.). Accordingly, competent evidence linking the current disability to service is needed to substantiate the claims. On the question of a nexus between the current right or left hip disability and service or the service-connected bilateral ankle disorders, the evidence weighs against the claims. On VA examination in November 2012, the Veteran reported a history of atraumatic bilateral hip pain having onset four years later. The examiner diagnosed bilateral trochanteric bursitis, with left hip mild degenerative osteoarthritis, and opined that the right and left hip disorders were less likely proximately due to or the result of the Veteran’s service connected bilateral ankle disorders. The examiner based the opinion on a review of the medical literature which failed to support a finding that ankle injuries or disabilities, including altered gait, could cause arthritis or bursitis of the hips. On VA examination in September 2019, the examiner diagnosed bilateral trochanteric pain syndrome (includes trochanteric bursitis). Following a review of the claims file and an examination of the Veteran, the examiner opined that the right and left hip disabilities were less likely than not incurred in or caused by the claimed in-service injury, event or illness. In support of the opinion, the examiner noted that the service treatment records were silent for complaints of or a diagnosis of a right or left hip disability, and bilateral hip complaints were initially noted in 2012 in a podiatry note, approximately 15 years after military discharge. The VA examiner further opined that the right and left hip disabilities were less likely as not proximately due to or the result of his service connected bilateral ankle disabilities. The examiner explained that a review of current medical literature, including an article submitted by the Veteran in support of his claims titled “Ipsilateral hip abductor weakness after inversion ankle sprain”, he was unable to locate any widely accepted medical literature supporting a causal relationship between the service connected bilateral ankle sprains/Achilles tendonitis and the claimed right and left hip disabilities. The examiner noted that his opinion was corroborated by the fact that the Veteran’s podiatry and orthopedic treatment records failed to causally link the claimed hip conditions with the ankle disorders. Finally, the examiner opined that the right and left hip disabilities were less likely than not aggravated by the service connected bilateral ankle disorders. In support of the opinion, the examiner noted that bilateral muscle strength had not worsened since the Veteran was previously examined in 2012, and any additional limitation of motion was consistent with the natural progress of disease. The Board finds the VA examiners’ opinions to be highly probative. The opinions were based on a thorough review of the claims file, including the service treatment records and examination of the Veteran, and the opinions are internally consistent and consistent with other evidence of record. Moreover, the examiners provided adequate rationale for the opinions. Accordingly, the VA examiners’ opinions are entitled to great probative weight. See Nieves-Rodriguez, 22 Vet. App. at 304. Significantly, there is no competent medical opinion of record linking a right or left hip disability to service or a service-connected disability. Concerning the medical articles submitted by the Veteran, the Court has held that “generally, an attempt to establish a medical nexus to a disease or injury solely by generic information in a medical journal or treatise is too general and inconclusive.” Mattern v. West, 12 Vet. App. 222, 228 (1999) (citing Sacks v. West, 11 Vet. App. 314, 317 (1998)). Medical treatise evidence may indicate enough of a basis of a generic relationship to establish “a plausible causality based on objective facts.” Mattern, 12 Vet. App. at 228 (citing Wallin v. West, 11 Vet. App. 509, 514 (1998)). The medical articles are of little probative value in the present case because the medical professionals who authored the articles did not establish a nexus in this particular Veteran. Although the Veteran believes that he developed bilateral hip disabilities as secondary to the service connected bilateral ankle disorders, and he is certainly competent to report as to the observable symptoms he experiences and their history, he cannot self-diagnose because of the medically complex nature of such diagnoses. Layno v. Brown, 6 Vet. App. 1994); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board finds that the specific, reasoned opinions of the VA examiners of greater probative weight than the more general lay assertions in this regard. The examiner has training, knowledge, and expertise on which he relied to form the opinions, and the examiner provided adequate rationale for the conclusions reached. As noted, there is no competent medical evidence that supports the claims. While it is clear that the Veteran has problems, the key issue is what has caused those problems. Simply stated, both the best medical evidence in this case, and the facts of this case, provide highly probative evidence against the claims. For the reasons set forth above, the Board finds that the most probative evidence weighs against a finding that the Veteran’s right and left hip disabilities are related to his military service, or to the service-connected disorder bilateral ankle disorders. Thus, service connection for right and left hip disorders is denied. As such, the benefit of the doubt rule does not apply. See 38 U.S.C. § 5107 (b); Gilbert, supra. Increased Rating Ratings for service-connected disabilities are determined by comparing the Veteran’s symptoms with criteria listed in VA’s Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2009). The assignment of a particular diagnostic code to evaluate a disability is “completely dependent on the facts of a particular case.” See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the diagnosis, and demonstrated symptomatology. 3. Entitlement to a rating higher than 30 percent for PTSD The Veteran contends that he is entitled to a rating higher than 30 percent for his service-connected PTSD. The Veteran’s service-connected PTSD is rated under Diagnostic Codes 9411 which utilize General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. Under that Formula, a 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although found to be generally functioning satisfactorily, with routine behavior, self-care, and normal conversation), due to such symptoms as a depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders, Diagnostic Code 9411. A 50 percent rating is assigned 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. Id. A 70 percent rating is warranted for 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 the inability to establish and maintain effective relationships. Id. A 100 percent rating is assigned for 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 ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closest relatives, own occupation, or own name. Id. As the United States Court of Appeals for the Federal Circuit recently explained, evaluation under 38 C.F.R. § 4.130 is “symptom-driven,” meaning that “symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating” under that regulation. Vazquez–Claudio v. Shinseki, 713 F.3d 112, 116–17 (Fed.Cir.2013).  The symptoms listed are not exhaustive but rather “serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating.” Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002).  In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering “not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas” - i.e., “the regulation... requires an ultimate factual conclusion as to the Veteran’s level of impairment in ‘most areas.’”  Vazquez-Claudio, 713 F.3d at 117-18; 38 C.F.R. § 4.130, Diagnostic Code 9411.  Global Assessment of Functioning (GAF) scores are a scale reflecting the “psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness.” See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996) [citing the American Psychiatric Association’s DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS, Fourth Edition (DSM-IV), p. 32].  VA implemented DSM-5, effective August 4, 2014, and the VA Secretary determined that DSM-5 applies to claims certified to the Board after August 4, 2014. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014).  As the Veteran’s increased rating claim was certified to the Board after August 4, 2014, the DSM-5 is applicable to this case.  Effective August 4, 2014, VA also amended the regulations regarding the evaluation of mental disorders by removing outdated references to DSM-IV.  The amendments replace those references with references to the recently updated DSM-5.  According to DSM-5, clinicians no longer typically assess GAF scores.  The DSM-5 introduction states that it was recommended that the GAF be dropped from DSM-5 for several reasons including its conceptual lack of clarity (i.e., including symptoms, the suicide risk, and disabilities in its descriptors) and questionable psychometrics in routine practice.  The Veteran underwent a VA examination in November 2012. He complained of nightmares, avoidance of stimuli, irritability, impaired sleep, difficulty concentrating, hypervigilance, anxiety, mild memory loss, impulsive behavior and panic attacks weekly or less often. The Veteran resided with his spouse of five years. He reported being close to his mother. His occupational history post-service discharge included multiple jobs followed by steady employment as police officer. The examiner determined that while the Veteran had a mental condition, the symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. VA treatment records in 2012 documented multiple PTSD symptoms, including irritability, depression, anxiety, impaired concentration, impaired sleep, nightmares and low energy. The Veteran consistently denied suicidal ideation. In a statement in August 2014, a VA social worker noted the Veteran’s reported psychiatric symptoms, including recurrent intrusive memories, avoidance of stimuli, feelings of detachment, restricted affect, difficulty concentrating, irritability, hypervigilance and impaired sleep. The social worker opined that the Veteran’s PTSD was productive of significant social and occupational impairment, noting that the Veteran was unable to maintain long term employment until five years earlier. The social worker also noted that the Veteran had no close relationships with family or friends. In 2017, the Veteran asserted that his PTSD was escalating and causing an occupational impairment. In support of the claim for a higher rating for PTSD, the Veteran submitted a memorandum from his employer dated May 2017 regarding attendance issues. Reportedly, the Veteran had taken an excessive amount of unscheduled leave the previous year. On VA examination in September 2019, the Veteran reported chronic sleep impairment, weekly nightmares about combat, anxiety, irritability, feelings of guilt, a history of angry outbursts with physical violence, recurrent memories about combat, intrusive distressing memories and impaired concentration. The Veteran denied any suicidal or homicidal ideation. The examiner noted that the Veteran was not under psychiatric treatment. He was last seen for PTSD six times on an outpatient basis in 2014. There was no history of inpatient treatment. The examiner noted difficulty in establishing and maintaining effective work and social relationships. The examiner reported that the Veteran was married and resided with his second spouse of 14 years. He related having occasional contact with friends via texting, as well as yearly visits with a childhood friend. His mother had passed away in 2017, and he denied any contact with his father or brother. He did have regular contact with his parents in law. The Veteran had graduated high school and attended college. Post-service discharge from 1995 to 2008, he held various jobs including lawn service, carpet cleaning and merchandiser for Pepsi. Thereafter he became a police officer with the Department of Defense and most recently a customs officer with the Department of Homeland Security. His hobbies included fishing, watching TV, reading and doing household chores. The examiner described the Veteran as alert and oriented times three. He has good hygiene. His mood was anxious and affect appropriate. The examiner noted no evidence of psychosis or mania. The examiner opined that the Veteran’s psychiatric symptoms were productive of occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. An April 2020 VA treatment note recorded complaints of nightmares and being easily startled. The clinician noted that the Veteran’s thought processes were logical and linear. There was no suicidal or homicidal ideation, plan, or intent. There were no signs of mania or psychosis. Accordingly, the Board finds that throughout the appeal, the Veteran’s primary psychiatric symptoms have been consistent with the 30 percent rating. The medical evidence noted no more than mild to moderate symptoms. Although a VA social worker in August 2014, opined that the Veteran’s PTSD was productive of significant social and occupational impairment, including inability to maintain long term employment and having no close relationships with family or friends, as noted above, the evidence of record contradicts the social worker’s findings. While the Veteran reported symptoms of anxiety, nightmares, irritability, chronic sleep impairment and depression with difficulty in establishing and maintaining effective work and social relationships, the Veteran had regular contact with friends and family. He remained married to his second spouse of more than 14 years and occasionally interacted with friends via texting or visiting. He also maintained regular contact with his in-laws and reported being close to his mother prior to her passing. The Veteran enjoyed fishing, reading, watching television and doing house chores. Occupationally, the evidence shows that the while the Veteran had a history of various jobs immediately following discharge from service, he has remained employed full time since 2008 in law enforcement working for two different government agencies. Although there is some evidence of excessive absenteeism from work in 2017, there is no indication that it was due to PTSD or that his psychiatric symptoms interfered with the Veteran’ ability to perform his work duties. Significantly, the Veteran’s PTSD has required no more than sporadic outpatient treatment throughout the appeal. As for the effect of the Veteran’s symptoms on judgment, thinking, or mood, mental status examination was consistently within normal limits. Upon review of the record, the Board finds the Veteran’s reported symptoms and cognitive functioning did not result in occupational and social impairment consistent with a higher 50 percent rating. Generally, the examiners and treating clinicians who treated the Veteran described his occupational and social impairment as no more than mild to moderate, consistent with the criteria for only a 30 percent rating. The Board concludes that the medical findings on examination and treatment notes are of greater probative value than the Veteran’s allegations regarding the severity of his psychiatric disability. Accordingly, the Board finds that the preponderance of the evidence is against the claim for an initial rating in excess of 30 percent for PTSD. In the absence of 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; and disturbances of motivation and mood, the Board finds that the criteria for a 50 percent rating have not been demonstrated. Therefore, the Board finds that the evidence does not more nearly approximate the criteria for a rating of 50 percent and a rating greater than 30 percent is denied. Accordingly, a rating in excess of 30 percent rating is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. This finding does not suggest, in any way, that the Veteran does not have problems with his PTSD. A 30% rating for PTSD will cause the Veteran many problems. The only question in this case is the degree of the problem. 4. Entitlement to a rating higher than 10 percent for a right ankle disability 5. Entitlement to a rating higher than 10 percent for a left ankle disability The Veteran contends that he is entitlement to higher disability ratings for his right and left ankle disabilities. 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) (holding that the provisions of 38 C.F.R. § 4.59 are not limited to disabilities involving arthritis). Moreover, when evaluating musculoskeletal disabilities, VA may, in addition to applying the schedular criteria, assign a higher disability rating when the evidence demonstrates functional loss due to limited or excessive movement, pain, weakness, excessive fatigability, or incoordination, to include during flare-ups and with repeated use, if those factors are not considered in the rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see also DeLuca v. Brown, 8 Vet. App. 202 (1995); Burton, 25 Vet. App. at 5. The Court also held in Correia v. McDonald, 28 Vet. App. 158 (2016) that the final sentence of 38 C.F.R. §§ 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Nonetheless, a disability rating higher than the minimum compensable rating is not assignable under any diagnostic code relating to range of motion where pain does not cause a compensable functional loss. Rather, the “pain must affect some aspect of ‘the normal working movements of the body’ such as ‘excursion, strength, speed, coordination, and endurance,” as defined in 38 C.F.R. §§ 4.40, before a higher rating may be assigned. See Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011) (noting that while “pain may cause a functional loss, pain itself does not constitute a functional loss,” and, is therefore, not grounds for entitlement to a higher disability rating). The Veteran’s right and left ankle disabilities are currently rated as 10 percent disabling under Diagnostic Code 5271. 38 C.F.R. § 4.71a. 38 C.F.R. § 4.71a, Diagnostic Code 5271, provides for a rating of 10 percent when limitation of motion of the ankle is moderate. 38 C.F.R. § 4.71a. The maximum rating of 20 percent is warranted where the limitation of motion in the ankle is marked. Normal ankle motion is dorsiflexion to 20 degrees, and plantar flexion to 45 degrees. 38 C.F.R. § 4.71a, Plate II. Words such as “moderate” and “marked” are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. After reviewing the evidence of record, the Board finds that an initial rating in excess of 10 percent is not warranted for the Veteran’s right or left ankle disabilities. On VA examination in November 2012, the examiner noted a diagnosis of bilateral Achilles tendinitis and ankle instability. The Veteran endorsed flare-ups in symptoms while walking on uneven surfaces causing the ankles to twist and swell for a few days with pain. Bilateral ankle flexion was to 35 degrees and dorsiflexion was to 15 degrees. There was no additional limitation of motion with repetitive movement. Muscle strength was 5/5. There was no ankle laxity or ankylosis. The Veteran used a brace for ambulation. X-rays did not show arthritis. The examiner opined that the Veteran’s bilateral ankle disorders had no impact on the Veteran’s ability to work. VA treatment records in June 2013, show complaints of bilateral ankle pain and giving out. The clinician noted ligamentous laxity on inversion stress test with mushy endpoint. There was no tenderness over peroneal tendons. He had full range of motion of plantar flexion and circumduction. The clinician recorded an impression of bilateral ankle instability, right more symptomatic than left, and recommend Brostrom surgery in the future for lateral ligament reconstruction of the right ankle. On VA examination in September 2019, the examiner noted a diagnosis of right and left ankle Achilles tendonitis and lateral instability. The Veteran reported constant bilateral ankle pain, rated as 10/10, aggravated by walking, running, jumping. He denied any flare ups. Reportedly he treated his ankles with over the counter medication, hot soaks and used a brace ad shoes with ankle support to prevent giving out. There was no history of ankle surgery. He was under no other treatment for his ankles and reported that he had last sprained his right ankle two years earlier. Examination revealed reduced range of motion for the ankles, bilaterally, with dorsiflexion from 0 to 15 degrees and plantar flexion from 0 to 35 degrees. There was pain noted with dorsiflexion, but it did not result in or cause functional loss. Passive range of motion revealed bilateral dorsiflexion from 0 to 20 and plantar flexion from 0 to 40 degrees. There was no additional loss of motion with repetitive movements. There was pain with weight-bearing, but it did not result in or cause functional loss. The Veteran denied having flare-ups of right or left ankle symptoms. Testing revealed no laxity. Muscle strength was normal. Imaging studies were negative for degenerative or traumatic arthritis. There was no ankylosis. In sum, the Board finds that a higher 20 percent rating under 5271 is not warranted for either ankle as there is no evidence of limitation of motion or functional loss that would equate to marked limitation of motion of the ankle. See 38 C.F.R. § 4.71a, Diagnostic Code 5271. Specifically, while the Veteran has reported experiencing pain on motion, swelling, giving way and limitations in prolonged walking, motion was reduced to no more than 15 degrees dorsiflexion and 35 degrees plantar flexion bilaterally, which demonstrates more than half the normal range of motion for the ankle. Additionally, while in June 2013 a clinician noted ligamentous laxity on inversion stress test stability testing on the right, stability testing throughout the appeal revealed no abnormalities. While the Board is aware of the Veteran’s complaints of pain and instability, those symptoms are not shown by competent, objective evidence to have been so disabling as to warrant the next higher 20 percent rating for limitation of motion of either ankle under Diagnostic Code 5271. In this case, there is no objective, quantifiable evidence of additional range of motion loss due to pain on use, as alleged by the Veteran, that would equate to functional limitation to the extent that a higher rating was warranted under Diagnostic Code 5271. See DeLuca, 8 Vet. App. at 207; see also Mitchell, 25 Vet. App. at 32; Correia, 28 Vet. App. at 158; Sharp, 29 Vet. App. at 26. Therefore, the Board finds that disability ratings in excess of 10 percent for the right or left ankle are not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5271. The Board has also considered all potentially applicable provisions of the rating schedule, whether or not they have been raised by the Veteran or the record, as required by Schafrath, 1 Vet. App. 589. However, the Board has found no section that provides a basis upon which to assign increased disability ratings for any period on appeal. There has been no objective finding of ankylosis of the Veteran’s either ankle, subastragalar or tarsal joint, malunion of the os calcis or astragalus, or astragalectomy; therefore, Diagnostic Codes 5270, 5272, 5273, and 5274 are not for application. Similarly, the Board does not find any additional foot or ankle symptoms consistent with a finding of severe residuals of a foot injury or loss of use of the foot as required for higher ratings under Diagnostic Code 5284. See 38 C.F.R. § 4.71a, Diagnostic Codes 5270, 5272-5274, 5284. Again, the Board’s findings do not, in any way, suggests the Veteran does not have problems with his right and left ankles. It is important for the Veteran to understand that a disability rating at any level will cause the Veteran problems. The only question is the degree of the problems based on the criteria above. The Board finds the VA examiners’ medical findings highly probative to the issue of the severity of the Veteran’s right and left ankle disabilities. Specifically, the examiner interviewed the Veteran and conducted a physical examination. Additionally, the examination findings are consistent with other evidence of record, including treatment notes. To the extent the Veteran claims the bilateral ankle disorders are more severe than the currently assigned evaluations reflect, the Board finds that the Veteran as a lay person is competent to report observable symptoms, he experiences through his senses such pain, instability and swelling and rolling of the ankle. Layno, 6 Vet. App. 465; Jandreau, 492 F.3d 1372. However, the Board finds the medical findings, as provided in the examination reports are more persuasive and outweigh the Veteran’s statements in support of his claims for higher disability ratings than those currently assigned. As the preponderance of the evidence weighs against the Veteran’s claims, there is no reasonable doubt to be resolved, and the claims must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Finally, the Board does not find that this case raises a claim for a total disability evaluation based upon individual unemployability (TDIU). See Rice v. Shinseki, 22 Vet. App. 447, 454 (2009). The evidence of record, to include the treatment records and examination reports, shows that the Veteran remains employed full time. Therefore, a claim for TDIU has not been raised by the record and no action pursuant to Rice is warranted. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Azizi, T. 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.