Citation Nr: 21000465 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 17-00 180 DATE: January 5, 2021 ORDER Entitlement to a rating in excess of 20 percent for service-connected compression fracture of the L-1 vertebral body is denied. Entitlement to a rating in excess of 10 percent for service-connected degenerative joint disease of the cervical spine from March 28, 2012 to December 9, 2019, and in excess of 20 percent since December 9, 2019, is denied. FINDINGS OF FACT 1. For the appeal period, the Veteran’s service-connected compression fracture of the L-1 vertebral body has been manifested by thoracolumbar forward flexion greater than 30 degrees but not greater than 60 degrees without ankylosis of the lumbar spine or intervertebral disc syndrome (IVDS) with incapacitating episodes having a total duration of at least 4 weeks during a 12-month period. 2. From March 28, 2012 to December 9, 2019, the Veteran’s service-connected degenerative joint disease of the cervical spine manifested as forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees without muscle spasm, guarding, or localized tenderness resulting in abnormal gait or abnormal spinal contour or vertebral body fracture with loss of 50 percent or more of the height. 3. Since December 9, 2019, the Veteran’s service-connected degenerative joint disease of the cervical spine has manifested as forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees without muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. CONCLUSIONS OF LAW 1. For the entire appeal period, the criteria for entitlement to a rating in excess of 20 percent for service-connected compression fracture of the L-1 vertebral body have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5010, 5235-5243. 2. From March 28, 2012 to December 9, 2019, the criteria for entitlement to a rating in excess of 10 percent for service-connected degenerative joint disease of the cervical spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 3. Since December 9, 2019, the criteria for entitlement to a rating in excess of 20 percent for service-connected degenerative joint disease of the cervical spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from December 1972 to May 1973, September 1981 to December 1981, September 1985 to October 2004, November 2004 to September 2005, September 2006 to December 2007, and from November 2009 to March 2012. An October 2019 Board decision remanded the issues on appeal for further development. development has been accomplished, and the appeal has now been returned to the Board for further action. Stegall v. West, 11 Vet. App. 268 (1998). The Veteran was afforded a hearing before the undersigned in June 2019. A copy of the transcript is of record. Increased Rating Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. 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 rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § § 4.3. A veteran’s entire history is to be considered when making disability evaluations. See 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). When an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). In a claim for increased rating for already service-connected disability, a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation. Hart v. Mansfield, 21 Vet. App. 505, 509- 10 (2007). 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 the symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian life. Generally, the degree of disability specified is considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § § 4.1. In evaluating musculoskeletal disabilities, consideration is given to additional functional limitation due to factors such as pain, weakness, fatigability, and incoordination. 38 C.F.R. §§ 4.40 and 4.45; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Diagnostic codes predicated on limitation of motion do not prohibit consideration of a higher rating based on functional loss due to pain on use or due to flare-ups under 38 C.F.R. §§ 4.40, 4.45, and 4.59. Johnson v. Brown, 9 Vet. App. 7 (1996). However, in Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the United States Court of Appeals for Veterans Claims (Court) clarified that there is a difference between joint motion pain as opposed to pain that actually places further limitation of the particular range of motion. Disability of the musculoskeletal system is the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The examination upon which ratings are based must adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. When all the evidence is assembled, a determination will be made on the claim. Reasonable doubt will be resolved in favor of the Veteran. If there is a preponderance of the evidence against the claim, the claim will be denied. If the evidence supports the claim or is in relative equipoise, the Veteran will prevail. 38 U.S.C. § 5107 (b); 38 C.F.R. § §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 1. Entitlement to a rating in excess of 20 percent for service-connected compression fracture of the L-1 vertebral body. At his June 2019 hearing, the Veteran testified that his service-connected lumbar back disability caused frequent pain and immobilization which caused incapacitation episodes occurring two or three times annually. His service-connected lumbar spine disability has been in effect intermittently since January 24, 1976 having been discontinued upon multiple re-entries into active service. Currently, his service-connected lumbar spine disability is rated as 20 percent disabling effective March 28, 2012. It is rated under Diagnostic Code 5010-5235. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned; the additional code is shown after a hyphen. 38 C.F.R. § 4.27. In this case, Diagnostic Code 5010 provides that traumatic arthritis will be rated as degenerative arthritis under Diagnostic Code 5003. See 38 C.F.R. § 4.71a. Under Diagnostic Code 5003, degenerative arthritis, when established by x-ray findings, will be rated on the basis of limitation of motion under the appropriate Diagnostic Codes for the specific joint or joints involved. When limitation of motion of the specific joint or joints involved is noncompensable under the appropriate Diagnostic Codes, a rating of 10 percent is for application for each such major joint affected by limitation of motion to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Diagnostic Code 5235 contemplates vertebral fracture or dislocation. Diagnostic Codes 5235 to 5243 (for, respectively, vertebral fracture or dislocation; sacroiliac injury and weakness; lumbosacral or cervical strain; spinal stenosis; spondylolisthesis or segmental instability; ankylosing spondylitis; spinal fusion; degenerative arthritis of the spine; and intervertebral disc syndrome), have the same analysis under the General Rating Formula for Diseases and Injuries to the Spine. In pertinent part, forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis warrants a 20 percent rating. Forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine warrants a 40 percent rating. Unfavorable ankylosis of the entire thoracolumbar spine warrants a 50 percent rating. Unfavorable ankylosis of the entire spine warrants a 100 percent rating. 38 C.F.R. § 4.71a, General Rating Formula for Diagnostic Codes 5235-5243. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be rated separately, under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula, Note (1). For VA compensation purposes, normal range of motion of the thoracolumbar spine is 90 degrees of forward flexion, 30 degrees of extension, 30 degrees of left and right lateral flexion, and 30 degrees of left and right lateral rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees, consisting of the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right lateral rotation. See 38 C.F.R. § 4.71a, General Rating Formula, Note (2) and Plate V. Moreover, for VA compensation purposes, unfavorable ankylosis is 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. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. See 38 C.F.R. § 4.71a, General Rating Formula, Note (5). Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 10 percent evaluation is warranted for incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent evaluation is warranted for incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent evaluation is warranted for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent evaluation is warranted for incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (1). If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of chronic orthopedic and neurologic manifestations or incapacitating episodes, whichever method results in a higher evaluation for that segment. Id., Note (2). An October 2016 VA examination report noted diagnoses of degenerative arthritis of the lumbar spine as well as IVDS and lower right extremity radiculopathy. The Veteran reported pain while sleeping, worsening pain with prolonged sitting or standing, poor posture, and intermittent use of a cane for ambulation. He described functional loss as decreased range of motion, excess fatiguability, and trouble with prolonged use. He also reported flareups with increased activity and overuse with a frequency of once a week lasting all day. Forward flexion measured 80 degrees, and extension measured 20 degrees. Pain was noted on all range of motion testing. Repeated use and flareups were noted to caused pain, fatigue, weakness, and incoordination. The examiner noted guarding which did not cause abnormal gait or spinal contour. The examiner further noted there was no ankylosis, other neurologic abnormalities related to the disability, or vertebral body fracture with loss of 50 percent or more of the height. No bed rest as prescribed by a physician related to IVDS was noted. A December 2019 VA examination report reflects the Veteran’s complaints of stiffness, numbness, and an occasional limp as a result of his lumbar spine disability. Forward flexion measured 90 degrees, and extension measured 30 degrees. There was no pain noted on examination. The examiner noted that the Veteran’s reported flareups caused pain but there was no further estimated loss of range of motion. The examiner also did not note ankylosis, neurologic disabilities related to the lumbar spine, diagnosis of IVDS, or other physical findings. The examiner did note vertebral body fracture with loss of 50 percent or more of the height. Medical treatment records reflect similar findings as the VA examination reports of record and do not contain any range of motion measurements. After review, the Board finds that the preponderance of the evidence of record weighs against the assignment of a rating in excess of 20 percent for service-connected compression fracture of the L-1 vertebral body. At no time during the appeal period has there been any objective medical evidence of forward flexion of the thoracolumbar spine measured at 30 degrees or less or ankylosis of the lumbar spine. In addition, there is no indication that the Veteran has had any incapacitating episodes. As previously noted, an incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note (1). In fact, the evidence of record shows that the Veteran has not been prescribed bed rest by a physician at any point during the appeal. Moreover, the December 2019 VA examiner stated that the Veteran did not have intervertebral disc syndrome of the thoracolumbar spine, and the October 2016 VA examiner stated that although the Veteran had IVDS, he had no incapacitating episodes. As such, to the extent these criteria are for application, the Veteran has not been shown to have met the criteria for an increased evaluation under Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. The Board finds the opinions of the December 2019 and October 2016 VA examiners highly credible, probative, and persuasive against a higher rating because the opinions are based on the Veteran’s pertinent medical history as well as the results of a physical examination, and both give a thorough, well-explained rationale for all opinions; the report provides an adequate basis for the diagnosis and opinions rendered. See generally Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Veteran is competent to report certain obvious symptoms of his thoracolumbar spine disability but not to identify a specific level of disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994). Competent evidence concerning the nature and extent of the Veteran’s service-connected disability has been provided by the VA medical professional who examined him. The medical findings adequately address the criteria under which this disability is evaluated. The Board accords the objective medical findings greater weight than subjective complaints of increased symptomatology. Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). The Board additionally considered whether there are any other Diagnostic Codes which could apply to the Veteran’s current thoracolumbar spine disability. Diagnostic Code 5242 allows for a rating under Diagnostic Code 5003 for arthritis. Diagnostic Code 5003 provides for a compensable rating only if one is not available under the general formula; thus, it is not applicable to this case. The Board therefore finds that there are no other potentially applicable Diagnostic Codes by which a higher rating can be assigned. The Board further finds that a separate disability rating is not warranted because the evidence does not demonstrate that the Veteran suffers from a separate neurological disability distinct from his already service-connected thoracolumbar spine disability that he has not already been granted service connection for. See Bierman v. Brown, 6 Vet. App. 125, at 129-32 (1994). Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition was not “duplicative of or overlapping with the symptomatology” of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). The Board notes that the Veteran has previously been granted service connection for right lower extremity radiculopathy associated with his lumbar spine disability. The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. However, an evaluation in excess of 20 percent for the Veteran’s thoracolumbar spine disability is not warranted on the basis of functional loss due to pain or weakness in this case, as the Veteran’s symptoms are supported by pathology consistent with the assigned 20 percent rating. In this regard, the Board observes that the Veteran complained of pain during both of the VA examinations of record for the appeal period. However, the effect of the pain in the Veteran’s back is contemplated in the currently assigned disability evaluations. The Veteran’s complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant an increased evaluation. Thus, the Board concludes that the Veteran’s lumbar disability has not more closely approximated the criteria for a rating in excess of 20 percent for the appeal period. Thus, a rating in excess of 20 percent for the Veteran’s lumbar spine disability is not warranted, there is no basis for staged rating of the Veteran’s disability, and the preponderance of the evidence is against a higher rating for the thoracolumbar spine disability for the appeal period. Therefore, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 2. Entitlement to a rating in excess of 10 percent for service-connected degenerative joint disease of the cervical spine from March 28, 2012 to December 9, 2019, and in excess of 20 percent since December 9, 2019. The Veteran was discharged from active service on March 27, 2012. His service-connected cervical spine disability has been in effect from January 1, 2008 to November 29, 2009 until he re-entered active service. In his February 2012 increased rating claim, he asserted that his service-connected cervical spine disability was more severe than his rating currently reflects. A July 2020 rating decision granted an increase of 20 percent for the cervical spine disability effective December 9, 2019. The service-connected cervical spine disability was rated as 10 percent disabling from March 28, 2012 to December 9, 2019, and as 20 percent thereafter. It is rated under Diagnostic Code 5242. Diagnostic Code 5242 indicates that degenerative arthritis should be evaluated under the General Rating Formula for Diseases and Injuries to the Spine. As noted earlier, under the General Rating Formula, with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, a 10 percent evaluation is warranted when there is forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; 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 evaluation is warranted when there is forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; the combined range of motion of the thoracolumbar spine not greater than 120 degrees; the combined range of motion of the cervical spine not greater than 170 degrees; or, 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 30 percent evaluation is warranted when there is forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent evaluation is warranted when there is unfavorable ankylosis of the entire cervical spine; forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diagnostic Codes 5235-5243. 38 C.F.R. § 4.71a, General Rating Formula, Note (1), (2), and (5) are similarly applicable to this appeal. An October 2016 VA examination report recorded the Veteran’s reports of cervical spine flare ups described as severe pain and stiffness which occur several times per month with an all day duration. The flare ups were reported as having a functional impairment of decreased range of motion and excess fatigability. Forward flexion measured 35 degrees, with a 20 degree extension. Pain was noted on examination and caused functional loss. There was no loss of range of motion after repeated use. The examiner noted flareups of the disability caused pain, weakness, and fatigue. The examiner also noted guarding which did not result in abnormal gait or spinal contour. Although less movement than normal was noted, the examiner did not find any ankylosis of the spine. Cervical arthritis was documented. A December 2019 VA examination report noted the Veteran’s complaints of nerve pain and limited mobility. The Veteran also reported non-daily flareups described as an increase of pain with functional impairment described as inability to turn the head as normal. Flexion measured 25 degrees, and extension measured 20 degrees without pain on examination. Pain caused functional loss but not further loss of range of motion was estimated after repeated use or during a flareup. The examiner did not find guarding, muscle spasm, ankylosis, diagnosed IVDS, related neurologic abnormalities, or other pertinent physical findings. Medical treatment records reflect similar complaints as noted by the VA examiners of record; however, medical treatment notes do not contain any range of motion measurements. After review, the Board finds that the preponderance of the evidence of record weighs against the assignment of a rating in excess of 10 percent for the service-connected cervical spine disability from March 28, 2012 to December 9, 2019, and in excess of 20 percent since December 9, 2019. While the Veteran has reported pain and flareups of his cervical spine disability, from March 28, 2012 to December 9, 2019, his cervical spine range of motion was limited to 35 degrees of forward flexion and spasms or guarding resulting in abnormal gait or abnormal spinal contour have not been shown at any time. Further, from March 28, 2012 to December 9, 2019, there are no records indicating IVDS or prescribed incapacitating episodes, and there is no objective evidence of other related neurological abnormalities. Since December 9, 2019 (the date of the examination of record which first evidenced objective medical evidence of worsening), cervical forward flexion measured 25 degrees without spasms or guarding resulting in abnormal gait or abnormal spinal contour. The Board notes that the Veteran has asserted that his cervical spine disability warrants a greater disability rating. However, objective findings in the record do not support this. The Veteran is competent to report certain obvious symptoms of his lumbar spine disability but not to identify a specific level of disability. Barr v. Nicholson, 21 Vet. App. 303 (2007). Competent evidence concerning the nature and extent of the Veteran’s service-connected disability has been provided by the VA medical professional who examined him. The medical findings adequately address the criteria under which this disability is evaluated. The Board accords the objective medical findings greater weight than subjective complaints of increased symptomatology. Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). The Board additionally considered whether there are any other Diagnostic Codes which could apply to the Veteran’s current cervical spine disability. Diagnostic Code 5242 allows for a rating under Diagnostic Code 5003 for arthritis. Diagnostic Code 5003 provides for a compensable rating only if one is not available under the general formula; thus, it is not applicable to this case. The Board therefore finds that there are no other potentially applicable Diagnostic Codes by which a higher rating can be assigned. The Board further finds that a separate disability rating is not warranted because the evidence does not demonstrate that the Veteran suffers from a separate neurological disability distinct from his already service-connected cervical spine disability. See Bierman v. Brown, 6 Vet. App. 125, at 129-32 (1994). Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one disorder was not “duplicative of or overlapping with the symptomatology” of the other disorder. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. However, an evaluation in excess of 10 percent for the Veteran’s cervical spine disability from March 28, 2012 to December 9, 2019, and in excess of 20 percent since December 9, 2019, is not warranted on the basis of functional loss due to pain or weakness in this case, as his symptoms are supported by pathology consistent with the assigned ratings. In this regard, the Board observes that the Veteran has continually complained of cervical spine pain and flareups causing pain and functional impairment during the appeal period. However, the effect of the pain in the Veteran’s cervical spine is contemplated in the currently assigned disability evaluations. The Veteran’s complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant an increased evaluation. (Continued on next page) Thus, the Board finds that the weight of the evidence is against the claim for a rating in excess of 10 percent for service-connected cervical spine disability from March 28, 2012 to December 9, 2019, and in excess of 20 percent since December 9, 2019. The preponderance of the evidence is against this issue, and the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Peden 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.