Citation Nr: 20048366 Decision Date: 07/20/20 Archive Date: 07/20/20 DOCKET NO. 17-67 113 DATE: July 20, 2020 ORDER For the period prior to July 26, 2019, entitlement to a rating greater than 20 percent for residuals of a right knee injury with degenerative joint disease based on limitation of flexion is denied. For the period since July 26, 2019, entitlement to a rating greater than 30 percent for residuals of a right knee injury with degenerative joint disease based on limitation of flexion is denied. For the period since July 26, 2019, entitlement to a rating greater than 30 percent for residuals of a right knee injury with degenerative joint disease based on limitation of extension is denied. Entitlement to a separate 10 percent rating for a right knee semilunar cartilage condition is granted, subject to the laws and regulations governing the award of monetary benefits. For the period prior to July 26, 2019, entitlement to a rating greater than 20 percent for lumbar spine arthritis is denied. For the period since July 26, 2019, entitlement to a rating greater than 40 percent for lumbar spine arthritis is denied. Entitlement to service connection for a right hip disorder is denied. The issue of entitlement to service connection for a right foot disorder is dismissed. The issue of entitlement to service connection for a right shoulder disorder is dismissed. The issue of entitlement to service connection for a right ankle disorder is dismissed. REMANDED Entitlement to service connection for a headache disorder is remanded. FINDINGS OF FACT 1. For the period prior to July 26, 2019, the Veteran’s residuals of right knee injury with degenerative joint disease is not manifested by flexion limited to 15 degrees. 2. For the period since July 26, 2019, the Veteran is receiving the maximum schedular rating for residuals of right knee injury with degenerative joint disease based on limitation of flexion absent ankylosis. 3. For the period since July 26, 2019, the Veteran’s residuals of right knee injury with degenerative joint disease is not manifested by extension limited to 30 degrees. 4. The Veteran underwent a subtotal meniscectomy of the right knee during service and the evidence is at least in equipoise as to whether it is symptomatic. 5. For the period prior to July 26, 2019, the Veteran’s lumbar spine arthritis is not manifested by forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. 6. For the period since July 26, 2019, the Veteran’s lumbar spine arthritis is not manifested by unfavorable ankylosis of the entire thoracolumbar spine. 7. The preponderance of the evidence is against finding that a right hip disorder is related to active service or caused or aggravated by service-connected disability; and there is no evidence of right hip arthritis manifested to a compensable degree within one year following discharge from service. 8. Prior to the promulgation of a decision in the appeal, the Veteran’s attorney submitted correspondence indicating he wished to withdraw the claims for entitlement to service connection for right shoulder, right foot, and right ankle disorders. CONCLUSIONS OF LAW 1. For the period prior to July 26, 2019, the criteria for a rating greater than 20 percent for residuals of right knee injury with degenerative joint disease based on limitation of flexion have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Codes 5003, 5260. 2. For the period since July 26, 2019, the criteria for a rating greater than 30 percent for residuals of right knee injury with degenerative joint disease based on limitation of flexion have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Codes 5003, 5260. 3. For the period since July 26, 2019, the criteria for a rating greater than 30 percent for residuals of right knee injury with degenerative joint disease based on limitation of extension are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Codes 5003, 5261. 4. Resolving reasonable doubt in the Veteran’s favor, the criteria for a separate 10 percent rating for the right knee based on a semilunar cartilage condition are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Code 5259. 5. For the period prior to July 26, 2019, the criteria for a rating greater than 20 percent for lumbar spine arthritis are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Code 5242. 6. For the period since July 26, 2019, the criteria for a rating greater than 40 percent for lumbar spine arthritis are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Code 5242. 7. A right hip disorder was not incurred during active service, is not secondary to service-connected disability, and may not be presumed to have been incurred in active service. 38 U.S.C. § 1131; 38 C.F.R. § 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 8. The criteria for withdrawal of a substantive appeal have been met and the Board does not have jurisdiction to review the issues of entitlement to service connection for right shoulder, right foot, and right ankle disorders. 38 U.S.C. § 7105; 38 C.F.R. § 20.205. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1983 to June 1987. In May 2019, VA remanded several issues including entitlement to service connection for a psychiatric disorder. In February 2020, VA granted service connection for posttraumatic stress disorder (PTSD) with alcohol use disorder and assigned a 70 percent rating effective April 6, 2015. The grant of service connection resolved the appeal and this issue is no longer for consideration. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. VA regulations set forth at 38 C.F.R. §§ 4.40, 4.45, 4.59, provide for consideration of functional impairment due to pain on motion when evaluating the severity of a musculoskeletal disability. The United States Court of Appeals for Veterans Claims has held that a higher rating can be based on “greater limitation of motion due to pain on use.” DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Any such functional loss must be “supported by adequate pathology and evidenced by the visible behavior of the claimant.” 38 C.F.R. § 4.40. Entitlement to increased ratings for residuals of right knee injury with degenerative joint disease In September 2015, VA continued a 20 percent rating for residuals of a right knee injury with degenerative joint disease post-operative. The Veteran disagreed with the decision and perfected this appeal. In March 2020, VA increased the rating for the right knee based on limitation of flexion to 30 percent effective July 26, 2019 resulting in staged ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). VA also granted a separate 30 percent rating based on limitation of extension effective July 26, 2019. The Veteran generally asserts that the assigned ratings do not adequately reflect the severity of his disability. Degenerative arthritis established by x-ray findings will be rated based on limitation of motion under the appropriate diagnostic code for the specific joint or joints involved. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Limitation of flexion of the leg is evaluated as follows: flexion limited to 15 degrees (30 percent); flexion limited to 30 degrees (20 percent); flexion limited to 45 degrees (10 percent); and flexion limited to 60 degrees (noncompensable). 38 C.F.R. § 4.71a, Diagnostic Code 5260. Limitation of extension of the leg is evaluated as follows: extension limited to 45 degrees (50 percent); extension limited to 30 degrees (40 percent); extension limited to 20 degrees (30 percent); extension limited to 15 degrees (20 percent); extension limited to 10 degrees (10 percent); and extension limited to 5 degrees (noncompensable). 38 C.F.R. § 4.71a, Diagnostic Code 5261. Separate ratings under Diagnostic Codes 5260 and 5261 may be assigned for disability of the same joint, if none of the symptomatology on which each rating is based is duplicative or overlapping. VAOPGCPREC 9-04; 69 Fed. Reg. 59,990 (2004); 38 C.F.R. § 4.14. On VA examination in September 2015, the Veteran reported chronic daily right knee pain, locking, popping, clicking, and swelling. He denied flare-ups but described functional impairment as being unable to bear weight on his right knee for the past two months and he has been using crutches. The examiner was unable to report with any accuracy the range of motion of the right knee due to the extreme poor effort and inconsistencies on the part of the Veteran. The examiner further noted that the Veteran’s subjective complaints appeared out of proportion to the objective examination findings. There was no evidence of pain with weight bearing, localized tenderness or pain on palpation, or crepitus. The Veteran was unable to perform repetitive use testing and again, the examiner noted poor effort and inconsistencies. Strength of the right knee was reported as 0/5 in both flexion and extension, but the examiner stated that this was completely inconsistent given no muscle atrophy measured at both the calf and thigh. There was no ankylosis and no history of recurrent subluxation, lateral instability, or recurrent effusion. The examiner was unable to perform stability testing due to poor effort and inconsistencies. A history of right knee surgery was noted. The Veteran reportedly used a brace and crutches on a regular basis. Right knee x-rays showed only minimal degenerative joint disease. In a March 2016 statement, the Veteran reported his knee and lower leg are unstable and he frequently experiences a locked knee. He also feels like his knee is giving out limiting the function of the knee. On VA examination in April 2016, the Veteran reported worsened pain on awakening and stated his knee gives out on him and he has fallen a couple of times. He denied flare-ups but functional impairment was described as difficulty climbing stairs and prolonged standing. Right knee range of motion was from 0 degrees extension to 110 degrees of flexion. There was pain with flexion and evidence of pain with weight bearing. Examination revealed tenderness around the patella and there was objective evidence of crepitus. The Veteran was able to perform repetitive use testing with no additional loss of function or range of motion. Pain and lack of endurance limited functional ability although there was no additional loss of motion. Muscle strength was 5/5 with no muscle atrophy. There was no ankylosis and no history of recurrent subluxation, lateral instability, or recurrent effusion. Joint stability testing was performed and was normal. Residuals of meniscectomy were described as pain and symptoms of the knee giving way. The Veteran uses a brace on a regular basis. Regarding functional impact, the examiner noted it was moderate – pain with walking, standing, or stair climbing. In a May 2019 statement, a private physician stated that the Veteran had lost the main stabilizer of the knee in the ACL tear as well as the secondary restraint in the posterior horn of the lateral meniscus. A partial meniscectomy was necessary to alleviate the pain, but no ACL reconstruction was offered to stabilize the knee. She further stated that the knee instability had more likely contributed to the right knee degenerative process. The Veteran most recently underwent a VA examination on July 26, 2019. The examiner stated that MRI from 2011 showed right knee torn medial collateral ligament, torn medial and lateral menisci, and mild degenerative joint disease. The Veteran reported pain and difficulty ambulating. The Veteran did not report flare-ups, but this was subjective in that the flare-ups were not much different than his usual pain. Functional impairment was described as difficulty bending knees to reach down. The examiner was unable to test right knee range of motion or perform repetitive use testing due to too much pain. The examiner stated that pain would significantly limit functional ability with repeated use over time but that no change in range of motion would be expected. Pain would significantly limit functional ability with flare-ups and in terms of range of motion, this would be from 0 degrees extension to 15 degrees of flexion. Muscle strength testing was 5/5 with no atrophy. There was no ankylosis and no history of recurrent subluxation, lateral instability, or recurrent effusion. The examiner was unable to conduct joint stability testing because the Veteran was in too much pain. The examiner noted a meniscal tear but did not indicate frequent episodes of locking, pain or effusion. The Veteran uses both a brace and a walker on a regular basis. In an associated medical opinion, the examiner stated that flare-ups may last several days but were not much different than his daily complaints. Flare-ups would be caused by overuse of the knees. The main alleviating factor was getting off the knees and resting. The examiner indicated that during a flare-up right knee flexion would be limited to 15 degrees because the baseline range of motion was very poor. It was also reasonable that during a flare-up right knee extension would be limited to 20 degrees or less. The Veteran was hesitant to make any type of movement due to right knee pain. VA records show continued complaints and treatment related to the right knee. For the period prior to July 26, 2019, the criteria for a rating greater than 20 percent based on limitation of flexion are not met or more nearly approximated. The Board acknowledges that the examiner was unable to report range of motion findings on examination in September 2015, but this was due to poor effort on the part of the Veteran and not an inadequacy of the examiner or examination. Flexion on VA examination in April 2016 was reported as to 110 degrees and there is simply no evidence showing flexion limited to 15 degrees or less. There is no basis for assigning a separate evaluation for extension during this period as any limitation was noncompensable. For the period beginning July 26, 2019, the criteria for ratings in excess of 30 percent for both limitation of flexion and limitation of extension are not met or more nearly approximated. 30 percent is the maximum schedular rating for limitation of flexion absent ankylosis. There is no evidence of right knee ankylosis. Regarding extension, the Board acknowledges that the examiner stated it was reasonable that during a flare up extension would be limited to 20 degrees or less. However, there is no evidence indicating that the flare-ups happen frequently enough to represent the predominant disability picture. Considering the overall evidence, the Board does not find the disability picture more nearly approximating extension limited to 30 degrees and a higher rating is not warranted. In making these determinations, the Board has considered the Veteran’s complaints of pain and functional loss. The Veteran is competent to report his pain and perceived limitations. Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Veteran’s subjective reports, however, are not necessarily consistent with objective evidence and the Board does not find adequate pathology to support higher ratings at any time during the appeal period based on functional impairment due to pain on motion or other factors. VA General Counsel has held that a claimant who has arthritis and instability of a knee may be rated separately under Diagnostic Codes 5003 and 5257. VAOPGCPREC 23-97; 62 Fed. Reg. 63604 (1997); VAOPGCPREC 9-98; 63 Fed. Reg. 56,704 (1998). Recurrent subluxation or lateral instability of the knee warrants a 10 percent rating when slight, a 20 percent rating when moderate, and a 30 percent rating when severe. 38 C.F.R. § 4.71a, Diagnostic Code 5257. As noted, stability testing was normal in April 2016. The VA examiners were unable to perform stability testing in September 2015 and July 2019 due to poor effort and pain respectively. The May 2019 private physician reported the Veteran suffers from instability but there is no indication she examined the Veteran. Rather, her opinion was based on review of records as opposed to clinical findings. The Board acknowledges that objective medical evidence of knee instability is not required, and objective medical evidence is not categorically more probative than lay evidence. English v. Wilkie, 30 Vet. App. 347 (2018). Notwithstanding, the overall evidence does not support a finding of mild instability and a separate rating is not warranted. In this regard, the Veteran’s reports of giving way are not necessarily consistent with recurrent subluxation or lateral instability nor are they supported by clinical findings. The Veteran’s lack of effort or inability to be tested on examination also weighs against his claim. Finally, the Board will consider whether Diagnostic Codes 5258 or 5259 are for application. Cartilage, semilunar, dislocated, with frequent episodes of “locking,” pain, and effusion into the joint warrants a 20 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5258. Cartilage, semilunar, removal of, symptomatic warrants a 10 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Review of service treatment records shows that in February 1987, the Veteran underwent excision of semilunar cartilage of the knee and arthroscopy. The operative report indicates an arthroscopic subtotal meniscectomy of the posterior horn of the right lateral meniscus. MRI in 2011 shows torn medial and lateral menisci. In addition to pain and limited motion, the Veteran reported that he experiences other knee symptoms to include locking, clicking, popping and swelling. The April 2016 VA examiner described his residuals of meniscectomy as pain and giving way. Given the documented in-service partial meniscectomy and resolving reasonable doubt in his favor, he currently experiences symptoms related to same and a separate 10 percent rating is assigned under Diagnostic Code 5259. The Board does not find probative evidence supporting frequent episodes of pain, locking or effusion into the joint and a 20 percent rating under Diagnostic Code 5258 is not warranted. That is, VA examinations are repeatedly negative for any history of effusion and the Veteran’s complaints of pain and locking are contemplated in the ratings assigned under the limitation of motion codes and now Diagnostic Code 5259. In assigning the separate rating, the Board acknowledges the potential applicability of the “amputation rule,” which provides that the combined rating for disabilities affecting an extremity cannot exceed the rating assigned for an amputation which would remove the disabilities. 38 C.F.R. § 4.68. When considering the ratings assigned herein for the right knee limitation of flexion, limitation of extension, and disorder of the right knee semilunar cartilage, and depending on the applicable level of amputation, the combined ratings for the right lower extremity disabilities may exceed the rating assigned for amputation of the limb at the requisite level. 38 C.F.R. § 4.68. Nevertheless, the amputation rule does not bar the assignment of appropriate ratings for disabilities affecting an extremity. Instead it places a limit on the maximum level of compensation that can be paid, which is commensurate with the maximum level of compensation that would be paid were the limb to be amputated. Id. As such, the Board will assign all necessary ratings for the right knee disabilities as appropriate, noting only that the Veteran’s overall level of compensation for the disabilities affecting his right lower extremity may be limited to the amount payable for amputation of the right lower extremity at the elective level. Id.; see also 38 C.F.R. § 4.71a, Diagnostic Codes 5160-5165 (concerning ratings for amputation of the thigh and leg). In an April 2019 brief, the attorney argued that extraschedular consideration was warranted due to additional functional loss caused by the Veteran’s right knee disorder. He noted the Veteran walked with a knee brace and used a walker. He experiences pain with weight bearing and while climbing stairs. Additionally, it is uncomfortable for him to stand or sit for extended periods. He argues that at the very least his pain and functional limitation entitle him to an additional 10 percent. Consideration of an extraschedular rating requires a three-step inquiry. The first question is whether the schedular rating criteria adequately contemplate the Veteran’s disability picture. If the schedular evaluation does not contemplate the level of disability and symptomatology shown and is found inadequate, then the second inquiry is whether the exceptional disability picture exhibits other related factors, such as marked interference with employment or frequent periods of hospitalization. See Thun v. Peake, 22 Vet. App. 111 (2008). The first Thun element compares a claimant’s symptoms to the rating criteria, while the second addresses the resulting effects of those symptoms. Thus, the first and second Thun elements, although interrelated, involve separate and distinct analyses. Yancy v. McDonald, 27 Vet. App. 484, 495 (2016). If the Veteran’s disability picture meets the second inquiry, then the third step is to refer the case to the Director of Compensation Services to determine whether an extraschedular rating is warranted. See Thun, 22 Vet. App. 111. Regarding the first element, comparison of the Veteran’s symptoms and associated functional impairment does not show that the rating criteria are inadequate to describe his disability picture. The record shows that he has complaints and findings related to limited and painful motion, locking, and difficulties with weight bearing, sitting, standing, and ambulating. The diagnostic codes pertaining to the knee specifically address limitation of motion, instability, and symptoms following meniscectomy or meniscal damage. The Veteran’s unlisted symptoms of functional impairment are reasonably similar to the symptoms listed in the assigned Diagnostic Code. Additionally, for all musculoskeletal disabilities, the Rating Schedule contemplates functional loss, which may be manifested by, for example, decreased or abnormal excursion, strength, speed, coordination, or endurance. 38 C.F.R. § 4.40; Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). For disabilities of the joints, the Rating Schedule specifically contemplates factors such as weakened movement; excess fatigability; pain on movement; disturbance of locomotion; and interference with sitting, standing, and weight bearing. 38 C.F.R. §§ 4.45, 4.59; Mitchell, 25 Vet. App. at 37. In summary, the schedular criteria for musculoskeletal disabilities contemplate a wide variety of manifestations of functional loss and the Veteran’s unlisted symptoms, to include the need for assistive devices, are contemplated by 4.40, 4.45, and 4.59. Because the Rating Schedule was purposely designed to compensate for such functional effects of the Veteran’s disabilities in all spheres of his daily life, including at work and at home, and given the variety of ways in which the Rating Schedule contemplates functional loss for musculoskeletal disabilities, the Board concludes that the schedular rating criteria reasonably describe the Veteran’s disability picture. The threshold issue under Thun is thus not met, and further consideration of an extraschedular rating is not warranted. Entitlement to increased ratings for lumbar spine arthritis In September 2015, VA continued a 20 percent rating for lumbar spine arthritis. The Veteran disagreed with the decision and perfected this appeal. In February 2020, VA increased the rating for the low back to 40 percent from July 26, 2019 resulting in staged ratings. Hart. VA also granted service connection for right lower extremity radiculopathy and assigned a 10 percent rating effective July 26, 2019. The Veteran did not express disagreement with either the effective date or rating for radiculopathy and this issue is not for consideration. The Veteran generally asserts that the currently assigned ratings do not adequately reflect the severity of his disability. The Veteran’s lumbar spine disorder is rated as degenerative arthritis. Under the General Rating Formula for Diseases and Injuries of the Spine, 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, 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. 38 C.F.R. § 4.71a, Diagnostic Code 5242. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. Id. Unfavorable ankylosis is defined as “a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching.” Additionally, fixation of a spinal segment in neutral position (zero degrees) is “always” considered favorable ankylosis. Id. at Note 5. On VA examination in October 2014, the Veteran reported sharp pain in his back rated as a 9 on a scale of 1 to 10. He uses a TENS unit, muscle relaxers, and a back brace. He reported flare-ups stating that mornings are the worse part of his day. On physical examination, forward flexion was to 80 degrees with pain beginning at 50 degrees. Extension was to 15 degrees with pain. Right and left lateral flexion were to 20 degrees with pain beginning at 15 degrees. Right and left lateral rotation were to 30 degrees with pain beginning at 25 degrees. The Veteran was able to perform repetitive use testing with no additional limitation in range of motion. Functional impairment after repetitive use was described as less movement than normal, pain on movement, disturbance of locomotion, and interference with sitting, standing and/or weight-bearing. There was muscle spasm and guarding of the thoracolumbar spine resulting in abnormal gait or abnormal spinal contour. On VA examination in September 2015, the Veteran reported constant severe (10/10) dull, stabbing, and throbbing low back pain. He denied flare-ups or functional loss. The examiner was unable to test range of motion or perform repetitive use testing due to extreme poor effort and inconsistencies on the part of the Veteran. There was no ankylosis of the spine. The Veteran used a back support on a regular basis. On VA examination in April 2016, the Veteran reported constant pain which is worse with prolonged sitting and standing. He denied flare-ups. On range of motion testing, forward flexion was to 65 degrees; extension to 20 degrees; right and left lateral flexion to 20 degrees; and right and left lateral rotation to 30 degrees. There was pain noted on examination which causes functional loss. There was evidence of pain with weight bearing and edema and tenderness to palpation T6-L5. The Veteran was able to perform repetitive use testing with no additional loss of function or range of motion. Pain and lack of endurance would significantly limit functional ability with repeated use but there was no change in range of motion. There was muscle spasm and tenderness, but it did not result in abnormal gait or abnormal spinal contour. Additional factors contributing to disability were swelling, disturbance of locomotion, and interference with standing. There was no ankylosis of the spine. The Veteran most recently underwent a VA examination on July 26, 2019. He reported his lower back pain has worsened over time. He treats his back pain with medications and nerve blocks. He reported flare-ups described as difficulty ambulating. Functional impairment was described as difficulty with transfers and bathing. On range of motion testing, forward flexion was to 20 degrees; extension was to 10 degrees; right and left lateral flexion to 15 degrees; and right and left lateral rotation to 20 degrees. There was pain noted in all ranges of motion. There was mild tenderness or pain on palpation above the lumbar area and there was evidence of pain with weight bearing. The Veteran was able to perform repetitive use testing and the examiner stated there was additional loss of function or range of motion after 3 repetitions; however, the listed ranges following repetition were the same as above. Pain would limit functional ability with repeated use over time or during flare-ups but no change in range of motion was expected. There was no guarding or muscle spasm of the thoracolumbar spine. There was no ankylosis. The Veteran used both a brace and a walker to assist with activities of daily living. In an associated medical opinion, the examiner stated that the lumbar MRI and neurological exam were inconsistent with the Veteran’s symptoms of pain. He further stated that it was at least as likely as not that during a flare-up forward flexion would be limited to less than 30 degrees. VA records show continued complaints and treatment related to the low back to include steroid injections. For the period prior to July 26, 2019, the criteria for a rating greater than 20 percent for lumbar spine arthritis are not met or more nearly approximated. That is, forward flexion was greater than 30 degrees and there was no evidence of favorable ankylosis. The Board acknowledges that the September 2015 VA examiner was unable to test range of motion. This was not due to the severity of disability or inadequacy of the examination, but rather due to poor effort on the part of the Veteran. For the period since July 26, 2019, the criteria for a rating greater than 40 percent for lumbar spine arthritis are not met or more nearly approximated. That is, there is absolutely no evidence of ankylosis, much less unfavorable ankylosis of the entire thoracolumbar spine. In making these determinations, the Veteran’s complaints of severe pain and functional loss are acknowledged. The Veteran is competent to report his level of pain and perceived limitations. Layno. The Veteran’s subjective reports, however, are noted to be inconsistent with objective evidence and the Board does not find adequate pathology to support higher ratings at any time during the appeal period based on functional impairment due to pain on motion or other factors. In an April 2019 brief, the attorney argued that the Veteran was entitled to an extraschedular rating. Specifically, that the schedular rating does not contemplate the full disability picture because the Veteran uses braces and a walker and experiences pain with weight bearing, and while standing and climbing stairs. The attorney argues that the Veteran experiences severe functional limitations and that his employer recently made workplace accommodations. The regulations pertaining to consideration of an extraschedular rating are set forth in the prior section. Regarding the first element, comparison of the Veteran’s symptoms and associated functional impairment does not show that the rating criteria are inadequate to describe his disability picture. The record shows that he has complaints and findings of various functional limitations related to his low back disorder to include limitation of motion and difficulty walking, standing, and sitting. Diagnostic Code 5242 does not specifically list all the Veteran’s symptoms. The Veteran’s symptoms of functional impairment are reasonably similar to the symptoms listed in the assigned Diagnostic Code. That is, the general rating formula considers limitation of motion and applies with or without symptoms such as pain, stiffness, or aching in the area of the spine affected by residuals of injury or disease. Additionally, for all musculoskeletal disabilities, the Rating Schedule contemplates functional loss, which may be manifested by, for example, decreased or abnormal excursion, strength, speed, coordination, or endurance. 38 C.F.R. § 4.40; Mitchell, 25 Vet. App. at 37. For disabilities of the joints, the Rating Schedule specifically contemplates factors such as weakened movement; excess fatigability; pain on movement; disturbance of locomotion; and interference with sitting, standing, and weight bearing. 38 C.F.R. §§ 4.45, 4.59; Mitchell, 25 Vet. App. at 37. In summary, the schedular criteria for musculoskeletal disabilities contemplate a wide variety of manifestations of functional loss. The Veteran’s complaints of functional loss, disturbance of locomotion, interference with sitting, standing, and weight bearing, and painful motion are clearly contemplated by 4.40, 4.45, and 4.59. Because the Rating Schedule was purposely designed to compensate for such functional effects of the Veteran’s disabilities in all spheres of his daily life, including at work and at home, and given the variety of ways in which the Rating Schedule contemplates functional loss for musculoskeletal disabilities, the Board concludes that the schedular rating criteria reasonably describe the Veteran’s disability picture. The threshold issue under Thun is thus not met, and further consideration of an extraschedular rating is not warranted. Service Connection Entitlement to service connection for a right hip disorder In September 2015, VA denied entitlement to service connection for right hip degenerative joint disease. The Veteran disagreed with the decision and perfected this appeal. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Service connection may also be granted on a secondary basis for a disability that is proximately due to a service-connected condition. 38 C.F.R. § 3.310(a). Service connection is also possible when a service-connected condition has aggravated a claimed condition, but compensation is only payable for the degree of additional disability attributable to the aggravation. Allen v. Brown, 7 Vet. App. 439 (1995). In October 2006, VA amended 38 C.F.R. § 3.310 to incorporate the decision in Allen except that VA will not concede aggravation unless there is medical evidence showing the baseline level of the disability before its aggravation by the service-connected disability. 38 C.F.R. § 3.310(b). In various statements and treatment records, the Veteran asserted that he injured parts of the right side of his body in service, including as a result of being jumped, falling generally, or jumping/falling/being pushed out of a truck. While the Veteran is competent to report this information, available service records do not show evidence of a right hip injury and are negative for any complaints or findings of a chronic right hip disorder. On examination for separation in April 1987, no hip abnormalities were noted and there is no evidence of right hip arthritis manifested to a compensable degree within one year following discharge from active service. VA records suggest a post-service injury. For example, a July 1999 VA record notes the Veteran was in an auto accident in 1997 and hurt his right hip and lower back, and that he has had “right sided knee, hip and back problems since being hit by the truck.” On review, the preponderance of the evidence is against finding that any current right hip disorder is related to active service or events therein. Even assuming an in-service right hip injury, the record does not contain probative evidence relating any current disability to same. In making this determination, the Board acknowledges that the VA opinion addressed only secondary service connection but notes that the Veteran’s own conclusory generalized lay statement that a service event or illness caused his current condition is insufficient to require an examination. Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010). Accordingly, additional opinion is not needed. McLendon v. Nicholson, 20 Vet. App. 79, 85-86 (2006). Rather, the claimant appears to argue secondary service connection. In a March 2019 sworn declaration, the Veteran reported that 30 years of compensating for his right knee and lower back injuries has put an enormous amount of stress on his right hip and he has noticed a significant increase in pain over the years in his hip. In an April 2019 brief, the attorney reiterated the Veteran’s contentions and argued that the VA medical opinion was inadequate because the examiner was not qualified and did not review the file. The Veteran underwent a VA examination in September 2015. Diagnosis was degenerative joint disease right hip. The examiner stated he reviewed VA treatment records but was not able to access the Veterans Benefits Management System (VBMS) file. Following examination, the examiner opined that the Veteran’s right hip disorder was not caused or aggravated by his service-connected right knee or low back disorder. The following rationale was provided: From a biomechanical perspective, there is no clear scientific evidence to suggest that an injury to one leg can cause major problems on the lumbar spine or opposite lower extremity except for certain specific conditions, i.e., a major leg length discrepancy where the injured leg becomes significantly shorter than the normal leg by 5 cm. or more, or when a severe Trendelenburg lurch (pelvic tilt gait) develops because of injury or paralysis to one lower extremity creating extra stress in the uninjured limb and/or the spine. It would be necessary, however, for the Trendelenburg gait pattern to be severe and prolonged for it to have any significant effect on the opposite extremity or on the initiation or aggravation of arthritis of the spine. In addition, lower extremity joint force tends to increase with walking speed so that force transmission is greater for young, fit individuals than for those who are elderly and disabled with a slow gait. Thus, since the activity level of patients with chronic knee pain and/or chronic low back pain is limited, i.e., decreased walking speed; it is unlikely that their lower extremities would be subjected to greater than normal force since the overall magnitude of joint force transmission by the lower extremities is directly related to walking speed. In May 2019, the attorney submitted a nexus statement from a private orthopedic surgeon, Dr. M.C. She noted that no service records dealt with a right hip injury, but low back pain and right sacroiliac joint injury were treated. The Veteran also suffered a right knee injury while jumping from a military vehicle. It was her professional opinion that the knee injury contributed to the degenerative changes in the right knee but cannot be responsible for the degenerative changes to the right hip. She reviewed the above noted VA opinion rationale and stated that she concurred with the statement that the hip degenerative arthritis was most likely not related to the above-mentioned injuries. She further stated that “[a]s far as the low back and right Sacro-iliac joints are concerned, it remains difficult to assess but it is less likely to be responsible for the degenerative changes of the hip.” In July 2019, a VA examiner was asked whether the Veteran’s right hip pain was a neurological manifestation of his low back disorder. The response indicated that it was at least as likely as not due to the low back disability. VA subsequently granted service connection for right lower extremity radiculopathy which arguably contemplates the right hip pain associated with neurologic manifestations of the back. The Veteran though has a separate diagnosis of right hip degenerative joint disease and the question remains whether it is secondary to service-connected disability. As set forth, the VA opinion was negative. The Board acknowledges the concerns as to the adequacy of the VA examination - to include the examiner’s qualifications and the lack of file review. The Veteran, however, submitted a private nexus opinion from an orthopedic surgeon which was also negative and concurred with the VA opinion. The record simply does not contain probative evidence supporting the claim. The Veteran’s contentions are acknowledged but he has not shown that he has the medical training, experience, or expertise to be competent to provide a medical etiology opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Veteran’s unsupported lay statements are not sufficient to establish secondary service connection. The preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. The claim is denied. Entitlement to service connection for right shoulder, right foot, and right ankle disorders In September 2015, VA denied entitlement to service connection for a right foot disorder. In April 2016, VA denied entitlement to service connection for right shoulder and right ankle disorders. The Veteran disagreed with the decisions and perfected this appeal. In April 2019, the attorney submitted correspondence titled “Letter Explaining Conditions to be Briefed.” In the letter, he stated that the Veteran withdraws the following claims: service connection for right shoulder, foot, and ankle conditions. On review, this letter was faxed to the VA Claims Intake Center. In May 2019, the Board remanded these issues for further development. On July 3, 2019, the attorney correspondence withdrawing the claims was again faxed to the VA Claims Intake Center where it was subsequently uploaded into VBMS. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Withdrawal may be made by the appellant or authorized representative. Id. In the present case, the appellant, through his authorized representative, has withdrawn his appeal concerning entitlement to service connection for right shoulder, right foot, and right ankle disorders. The Board acknowledges that due to the delay in uploading the correspondence, the issues were remanded in May 2019 and a supplemental statement of the case was subsequently furnished. Notwithstanding, the withdrawal was effective when received by the Board. 38 C.F.R. § 20.205. Hence there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review these issues and they are dismissed. REASONS FOR REMAND Entitlement to service connection for a headache disorder In April 2016, VA denied entitlement to service connection for headaches. The Veteran disagreed with the decision and perfected this appeal. In an April 2019 brief, the attorney argued that the elements for service connection were established. In May 2019, the Board noted that the Veteran reported he was being seen by a neurologist in Tampa for headaches. These records were to be obtained on remand. On review, additional records from the VA Medical Center in Tampa were added to the claims folder in July 2019. While these records show a past medical history of chronic headache disorder, they do not show treatment by a neurologist for migraines. The remand also directed that once all directed development had been achieved, the AOJ was to readjudicate the appeal and if any benefits remained denied, issue a supplemental statement of the case. In March 2020, VA furnished a supplemental statement of the case, but it did not include the issue of service connection for a headache disorder. Accordingly, this issue must be remanded. Stegall v. West, 11 Vet. App. 268 (1998) (a remand by the Board confers on the claimant, as a matter of law, a right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand). The matter is REMANDED for the following action: 1. Readjudicate the issue of entitlement to service connection for a headache disorder. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. LAURA E. COLLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Carsten, 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.