Citation Nr: 21002017 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 14-10 994A DATE: January 12, 2021 ORDER Entitlement to service connection for varicose veins to include as secondary to the Veteran’s service-connected left hip impairments and right knee impairment is denied. Entitlement to a rating in excess of 20 percent for internal derangement of the right knee prior to May 2, 2016 is denied. Entitlement to a 30 percent rating for internal derangement of the right knee from May 2, 2016 to December 10, 2017 is granted. Entitlement to a rating in excess of 10 percent for left hip degenerative joint disease is denied. Entitlement to a compensable rating for left hip limitation of flexion is denied. Entitlement to a compensable rating for left hip limitation of abduction is denied. Entitlement to a total disability rating due to individual unemployability (TDIU) prior to February 1, 2019 is denied. FINDINGS OF FACT 1. The Veteran’s varicose veins are not secondary to any service-connected disabilities to include impairments of the left hip and right knee and are not otherwise related to an in-service injury or disease. 2. Prior to May 2, 2016, the Veteran’s internal derangement of the right knee was manifested by a limitation of motion equivalent to flexion limited to 30 degrees and extension limited to 15 degrees. 3. From May 2, 2016 to December 10, 2017, the Veteran’s internal derangement of the right knee was manifested by ankylosis in a favorable angle in full extension or in slight flexion between 0 and 10 degrees. 4. Throughout the period on appeal, the Veteran has had pain associated with left hip degenerative joint disease that is confirmed by x-ray evidence. 5. Throughout the period on appeal, the Veteran has not had left hip flexion limited to 45 degrees or less, nor has he had additional limitation of motion to warrant a separate compensable evaluation. 6. From December 11, 2017 to January 31, 2019, the Veteran’s right knee total replacement resulted in a total impairment. 7. From December 11, 2017 to February 1, 2019, the remainder of the Veteran’s service-connected impairments do not render him unable to obtain or maintain substantially gainful employment. 8. Prior to December 11, 2017, the Veteran’s service connected impairments do not meet the schedular requirements for a TDIU. CONCLUSIONS OF LAW 1. The criteria for service connection for varicose veins due to service or a service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). 2. Prior to May 2, 2016, the criteria for a disability rating greater than 20 percent for internal derangement of right knee have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.7, 4.10, 4.71a, Diagnostic Code (DC) 5260 (2020). 3. Beginning May 2, 2016 to December 10, 2017, the criteria for a 30 percent disability rating for internal derangement of right knee have been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.7, 4.10, 4.71a, DC 5256 (2020). 4. The criteria for entitlement to a rating in excess of 10 percent for left hip degenerative joint disease have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.71a, DCs 5003-5251 (2020). 5. The criteria for entitlement to a compensable rating for left hip degenerative joint disease, flexion of the left thigh have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5003-5252 (2020). 6. The criteria for entitlement to a compensable rating for left hip degenerative joint disease, impairment of the left thigh have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5003-5253 (2020). 7. Prior to February 1, 2019, the criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.18, 4.25 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from March 1970 to January 1972. These matters come before the Board of Veterans’ Affairs (Board) from March 2014 and April 2017 rating decisions. In November 2018, the Board remanded the issues for additional development. In a September 2019 rating decision, the Veteran was granted an increased, 60 percent, rating for residuals of the right knee following a total knee replacement effective February 1, 2019. This is the highest schedular rating for a total knee replacement following surgery. As such, the Board finds that the issue of an increase rating from February 1, 2019 for the Veteran’s total right knee replacement has been fully satisfied. However, as higher ratings remain for the period prior to the Veteran’s 100 percent rating for a total knee replacement, the issue of an increase rating prior to December 11, 2017 remains before the Board. Also in a September 2019 rating decision, the Veteran was granted a TDIU effective February 1, 2019. The Board finds the issue of entitlement to a TDIU prior to February 1, 2019 is still at issue. Thus, the Board has considered the Veteran’s entitlement to a TDIU prior to February 1, 2019 herein. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (noting that nexus may be demonstrated by a showing of continuity of symptomatology where the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a)). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. 1. Entitlement to service connection for varicose veins to include as secondary to the Veteran's service-connected left hip impairments and right knee impairment The Veteran seeks service connection for varicose veins. A September 2019 VA examination noted the Veteran has had varicose veins for approximately 30 years. Further, VA medical center (VAMC) treatment notes document varicose veins. See generally VAMC treatment dated October 2013-December 2018. Thus, the first element of service connection is established. However, the preponderance of the evidence is against finding the second element of service connection has been met. The Veteran’s service treatment records (STRs) do not include any complaints, findings, or diagnoses varicose veins. Further, the Veteran has not made any statements regarding experiencing symptoms of varicose veins during service. Thus, the second element of service connection must fail. The question remains if the Veteran’s currently diagnosed varicose veins are secondary to one of his service-connected disabilities to include degenerative joint disease of the left hip and the impairment of the right knee. The Veteran was afforded a VA examination in September 2019. The examiner found the Veteran had a diagnosis of varicose veins. The examiner opined the Veteran’s varicose veins, which have been present for approximately thirty years, were less likely than not related to the Veteran’s service-connected right knee condition. The examiner noted the Veteran’s distribution of varicose veins was on both lower extremities. In a November 2019 addendum opinion, the VA examiner further opined the Veteran’s varicosed veins were not secondary to or aggravated beyond their natural progression by his service connected left hip conditions. The examiner noted that the Veteran’s varicose veins were present long before the Veteran’s left hip bursitis and degenerative joint disease of the left hip and right knee. The examiner stated there was no objective findings, which would be noted in their distribution, that the varicose veins would be related to any of the Veteran’s service-connected impairments. The Board notes in May 2016 the Veteran submitted an article from the Heart, Lung, and Blood Institute at the NIH regarding varicose veins. The Veteran contended this article supported that his varicose veins were related to his service-connected right knee. The Veteran also testified at the May 2018 Board hearing that he believed his right knee impairment caused his varicose veins. The etiology of the Veteran’s varicose veins and their relationship to his right knee involves a complicated medical analysis; it does not appear that the Veteran has sufficient medical expertise in order for the Board to afford the opinion any probative value. See Jandreau v. Shinseki, 492 F.3d 1372 (Fed. Cir. 2007). As such, his statements are afforded limited probative weight. Accordingly, the Board finds that the weight of the evidence is against finding the Veteran’s varicose veins are related to his active service or a service-connected disability. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.310. As the preponderance of the evidence is against the claim, further application of the benefit-of-the-doubt doctrine is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Board is grateful for the Veteran’s honorable service, and this decision is not meant to detract in any way from the Veteran’s service. Unfortunately, however, for the reasons and bases discussed above, the competent and probative evidence of record preponderates against a finding that the Veteran’s varicose veins are service connected. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R. Part 4. The percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. 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 may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995). In addition, when assessing the severity of a musculoskeletal disability that, as here, is at least partly rated on the basis of limitation of motion, VA must also consider the extent to which the Veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent (“flare-ups”) due to symptoms such as pain. See also 38 C.F.R. §§ 4.40, 4.45. 2. Entitlement to a rating in excess of 20 percent for degenerative joint disease of the right knee prior to December 11, 2017 The Veteran contends he is entitled to an increased rating for his internal derangement of the right knee. As noted above on December 11, 2017 the Veteran was granted a 100 percent rating for a total knee replacement. Prior to the Veteran’s total knee replacement, the Veteran’s internal derangement of the right knee was rated under Diagnostic Code 5260 for limitation of flexion of the knee. Knee disabilities are unique in the rating code, as they are one of a few orthopedic disabilities in which a Veteran may receive multiple ratings based on separate symptoms in the same joint. While the law generally prevents considering the same symptoms under various diagnoses to support separate ratings, some of the relevant DCs for the knee have been interpreted to apply to different functions of the knee, therefore warranting separate consideration. Specifically, the evidence may warrant separate ratings for limitation of flexion of the knee, limitation of extension of the knee, and lateral instability and recurrent subluxation of the knee. The Board will explore all possibilities in this case. DC 5260 rates based on limitation of flexion. When flexion of the leg is limited to 60 degrees, a noncompensable rating is warranted. When flexion is limited to 45 degrees, a 10 percent rating is warranted. Flexion limited to 30 degrees warrants a 20 percent rating, while flexion limited to 15 degrees warrants the maximum 30 percent rating. DC 5261 rates based on limitation of extension. That code provides that when extension is limited to 5 degrees, a noncompensable rating is assigned. Extension limited to 10 degrees warrants a 10 percent rating. When limitation of extension is at 15 degrees, a 20 percent rating is warranted. Extension limited to 20 degrees warrants a 30 percent rating. Extension limited to 30 degrees warrants a 40 percent rating. Lastly, extension limited to 45 degrees warrants the maximum, 50 percent rating. The diagnostic criteria applicable to recurrent subluxation or lateral instability is found at 38 C.F.R. § 4.71a, DC 5257. Under that code, slight impairment is assigned a 10 percent rating, moderate impairment a 20 percent rating, and severe impairment a 30 percent rating. Other DCs pertaining to the knee include DC 5258, under which a maximum 20 percent rating is warranted for dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint. DC 5259 holds that symptoms due to the removal of the semilunar cartilage of either knee warrant a 10 percent rating, which is the maximum rating under the diagnostic code. Because DCs 5258 and 5259 have been interpreted as already contemplating limitation of motion of the knee generally (which means it contemplates limitation of flexion and extension), the law does not allow for a separate rating under DCs 5259 and 5260 and/or 5261, because that would be compensating the same limitation of motion more than once. The diagnostic criteria applicable to impairment of the tibia and fibula are found at 38 C.F.R. § 4.71a, DC 5262. Under that code, a 10 percent evaluation is warranted when malunion of the tibia and fibula is productive of slight knee or ankle disability. A 20 percent evaluation is warranted when malunion of the tibia and fibula is productive of moderate knee or ankle disability, and a 30 percent evaluation is warranted when such disability is marked. A 40 percent evaluation is warranted for nonunion of the tibia and fibula, with loose motion, requiring a brace. Finally, the diagnostic criteria applicable to knee replacement (prosthesis) are found at 38 C.F.R. § 4.71a, DC 5055. As during the relevant period at issue, the Veteran had not yet had a knee replacement, this code is inapplicable. Turning to the evidence, the Veteran was afforded a VA examination in February 2012. The Veteran noted difficulties with stairs and bending at the knee. Range of motion testing showed right knee flexion to 130 degrees and extension to zero degrees. There was no loss of range of motion after three repetitions. The examiner noted pain on movement, swelling, disturbance of locomotion, and interference with sitting, standing, and weight bearing. Muscle strength and joint stability were normal. In June 2014, VAMC treatment notes indicate the Veteran’s right knee retained a full range of motion, there was no joint line tenderness or instability. See VAMC treatment dated June 24, 2014. Upon VA examination in May 2016, the Veteran reported flare ups of the knee occurring daily resulting in a loss of function due to pain and swelling. Range of motion testing showed right knee flexion to 100 degrees and extension to 10 degrees. The examiner found no additional functional loss following repetitive use and declined to provide an opinion regarding flare ups. Muscle strength testing and joint stability were normal. Ankylosis was found to be in a favorable angle with full extension or in slight flexion between zero and 10 degrees. Upon VA examination in March 2017, the Veteran reported daily flare ups of the knee resulting in pain with prolonged standing and walking. The Veteran denied experiencing instability. Range of motion testing showed flexion to 100 degrees and extension to zero degrees. There was no additional functional loss found after three repetitions nor was there additional functional loss with flare ups. Muscle strength testing and joint stability testing were normal. No ankylosis was found. VAMC treatment notes indicate that the Veteran sought a total knee replacement due to the failure of conservative treatment. He indicated his pain was an 8 out of 10. He stated that he had moderate limitations to activities of daily living. He denied any buckling or giving way. See VAMC treatment dated November 21, 2017. In May 2018, the Veteran testified prior to his knee replacement surgery his knee gave way once per week. In June 2019, a private nurse practitioner, L.M., noted the Veteran had underwent a total knee replacement in 2017 due to pain and instability. The Board finds that this statement is not supported by the objective evidence of record which indicates that the Veteran did not demonstrate objective instability prior to his total knee replacement. On the basis of the evidence of record, prior to May 2, 2016, the Board finds that the evidence of record does not demonstrate that the Veteran would be entitled to a rating in excess of the 20 percent currently assigned. The Veteran’s flexion was not shown to be limited to 20 degrees, extension limited to 20 degrees, nor any evidence of ankylosis as would be required to warrant a higher rating. Beginning May 2, 2016, the Board finds that the right knee impairment, which has been manifested by painful motion and flare ups, more nearly approximates the rating criteria for a 30 percent rating for ankylosis of the knee in a favorable angle in full extension or in slight flexion between 0 and 10 degrees. As noted by the May 2016 VA examiner, the Veteran’s knee impairment demonstrated favorable ankylosis. The Board notes that while the Veteran’s knee impairment did not demonstrate evidence of ankylosis at the March 2017 VA examination, the Veteran’s knee impairment was so severe that he elected for a total knee replacement several months following this examination. Considering the totality of the evidence of record, the Board finds the Veteran’s right knee impairment warrants an increased 30 percent rating beginning May 2, 2016 through December 11, 2017, the date of the Veteran’s total knee replacement. The Board has considered other potentially appropriate diagnostic codes; however, there is no evidence dislocated cartilage semilunar with frequent episodes of locking, pain and effusion, instability, a limitation of extension, or impairments of the tibia or fibula, which would be required for any additional ratings of the knee. Thus, the ratings are assigned for limitation of flexion prior to May 2016 and favorable ankylosis beginning in May 2016 are appropriate. The Board has considered whether additional functional impairment due to factors such as pain, weakness and fatigability demonstrate additional limitation of motion or function to warrant a higher rating. See 38 C.F.R. §§ 4.40, 4.45, 4.59 and DeLuca, 8 Vet. App. at 206-07. To the extent that the Veteran claims that his pain caused additional loss of movement especially when his knees flared-up, the Board finds that the Veteran’s subjective complaints of pain have been contemplated in the current rating assignment, as the current ratings are based on the objectively demonstrated reduced motion. However, the Veteran’s loss of motion to include pain still was within the range of the disability ratings assigned under Diagnostic Code 5260 and 5256. Therefore, the clinical findings do not demonstrate that the Veteran’s symptoms result in additional functional limitation to a degree that would support a rating in excess of the current disability ratings, even with consideration of whether there was additional functional impairment due to DeLuca factors. See Mitchell, 25 Vet. App. at 43 (“pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system”). The extent that the Veteran contends that he is entitled to an evaluation in excess of those currently assigned for right knee, the Veteran is competent to report symptoms such as pain and limited motion. Layno v. Brown, 6 Vet. App. 465 (1994). The Veteran is also credible in his belief that he is entitled to higher evaluations. However, the Veteran is not competent to offer a medical opinion, as to the relative severity of his right knee disability, as doing so requires medical knowledge and expertise the Veteran has not been shown to possess. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (2006). Therefore, in assigning the disability ratings, the Board relies upon the competent, probative opinions provided by the medical professionals and on the objective medical evidence of record. In conclusion, entitlement to an evaluation in excess of 20 percent internal derangement of the right knee is not warranted prior to May 2, 2016. From May 2, 2016 to December 10, 2017, a 30 percent disability rating is granted. In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against assignment of higher evaluations than those established herein, that doctrine is not applicable. See 38 U.S.C. § 5107(b). 3., 4., & 5. Entitlement to a rating in excess of 10 percent for left hip degenerative joint disease and entitlement to compensable ratings for limitations of flexion and abduction The Veteran contends he is entitled to an increased rating for his service-connected left hip impairments. The Veteran is currently rated as 10 percent disabled for degenerative joint disease of the left hip under DC 5003-5251 for limitation of extension. The Veteran is also service connected for limitation of flexion of the left hip under DC 5003-5252 and limitation of abduction of the left hip under DC 5003-5253, which are both noncompensable. Due to the similar nature of the impairments, they will be discussed together herein. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number will be “built-up” as follows: the first two digits will be selected from that part of the schedule most closely identifying the part, or system of the body involved, in this case, the musculoskeletal system, and the last two digits will be “99” for all unlisted conditions. Then, the disability is rated by analogy under a diagnostic code for a closely related disability that affects the same anatomical functions and has closely analogous symptomatology. 38 C.F.R. §§ 4.20, 4.27. Under Diagnostic Code 5003, degenerative arthritis established by x-ray findings is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a. Here, degenerative joint disease has been established by x-ray findings and objective evidence of painful motion of the hip has been documented. Thus, the applicable Diagnostic Codes for limitation of motion here are Diagnostic Codes 5251, 5252 and 5253. The Board has considered all potentially applicable diagnostic codes that rate his left hip disability to determine those most appropriate or more advantageous to the Veteran in this case. Thus, the Board will analyze whether a disability rating higher than 10 percent may be awarded under Diagnostic Code 5251 (limitation of extension), 5252 (limitation of flexion of thigh), and 5253 (impairment of the thigh, contemplating limitation of abduction). The Board notes that Veteran’s range of motion of left hip may be rated separately. Separate evaluations may be assigned under Diagnostic Codes 5251 (extension), 5252 (flexion), and 5253 (abduction, adduction, or rotation) for disability of the same joint. Under Diagnostic Code 5251, a maximum 10 percent rating is warranted for extension of the thigh limited to 5 degrees. Under Diagnostic Code 5252, a 10 percent rating is warranted for limitation of flexion of the thigh to 45 degrees; a 20 percent rating is warranted for limitation of flexion of the thigh to 30 degrees; a 30 percent rating for limitation of flexion to 20 degrees; and a 40 percent rating for limitation of flexion to 10 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5253 (impairment of the thigh), a 10 percent rating is warranted if the Veteran is unable to cross his legs or cannot toe-out more than 15 degrees; a 20 percent rating is warranted for impairment of the thigh, for limitation of abduction of motion lost beyond 10 degrees. 38 C.F.R. § 4.71a. The Board finds that Diagnostic Code 5250 (ankylosis of the hip), which allows for disability ratings of 60, 70 and 90 percent, is not for application in this case. That is, the medical evidence of record clearly shows that the Veteran’s left hip is not ankylosed at any level. Although the Veteran’s left hip disability does manifest in some limitation of motion from pain and stiffness, it is not in a fixed position without motion at any degree or angle, nor does the Veteran contend otherwise. Diagnostic Codes 5254 (hip, flail joint) and 5255 (impairment of the femur) are also not for application in this case. The medical evidence of record does not show that the Veteran has flail joint, and/or fracture of the shaft or anatomical neck of the femur with nonunion, fracture of the surgical neck of femur with false joint, or malunion or nonunion of the femur. Turning to the evidence, the Board observes that the Veteran has received extensive VA treatment for complaints of bilateral hip pain. However, range of motion testing is not documented. Upon VA examination in August 2013, the Veteran was diagnosed with arthritis and bursitis of the left hip. Range of motion testing showed flexion limited to 100 degrees; extension ends at 0 degrees; abduction is not lost beyond 10 degrees; adduction was not limited such that the Veteran cannot cross his legs; and rotation is not limited that he cannot toe-out more than 15 degrees. The examiner noted that the Veteran would have the additional functional loss following repetitive use to include pain on movement, disturbance of locomotion, and interference with sitting, standing, and/or weight bearing. Muscle strength testing was normal. There was no evidence of ankylosis. Upon VA examination in May 2016, the Veteran reported weekly flare ups of the hip aggravated by prolonged standing, walking, climbing ladders, or stairs with loss of function due to pain. Range of motion testing showed flexion limited to 90 degrees; extension to 25 degrees; abduction to 25 degrees; adduction to 15 degrees; and external rotation to 40 degrees. The Veteran’s adduction was not limited such that the Veteran cannot cross his legs. The examiner stated an opinion regarding additional functional loss during a flare up could not be provided. Muscle strength testing was normal, and there was no evidence of ankylosis. Upon VA examination in March 2017, the Veteran reported flare ups of the ups resulting in daily pain lasting several hours as a result of prolonged standing and walking. Range of motion testing showed flexion limited to 110 degrees; extension to 25 degrees; abduction to 25 degrees; adduction to 25 degrees; and external rotation to 45 degrees. The Veteran’s adduction was not limited such that the Veteran cannot cross his legs. Range of motion testing following repetition resulted in flexion to 90 degrees. The examiner found the Veteran would not have any additional limitations during flare ups. Muscle strength testing was normal, and there was no evidence of ankylosis. In May 2018, the Veteran testified that his left hip impairment resulted in flare ups of pain. He stated that he had difficulties performing the movements that were requested of him at the March 2017 VA examination to include difficulty crossing his legs. Upon VA examination in September 2019, the Veteran did not report any flare ups of the hip. Range of motion testing showed flexion limited to 90 degrees; extension to 10 degrees; abduction to 35 degrees; adduction to 15 degrees; and external rotation to 45 degrees. The Veteran’s adduction was not limited such that the Veteran cannot cross his legs. There was no additional loss of range of motion following observed repetitive use. Muscle strength testing was normal, and there was no evidence of ankylosis. Considering the above, the Board finds that the Veteran is not entitled to an evaluation in excess of 10 percent for left hip degenerative joint disease, nor is he entitled to an initial compensable evaluation for left hip degenerative joint disease based on flexion or abduction of the thigh. Presently, the Veteran is shown to have a 10 percent evaluation for his noncompensable limitation of extension and painful motion under Diagnostic Code 5003-5251. The objective evidence notes that throughout the entire appellate period, the Veteran would not be entitled to a compensable rating under limited motion under Diagnostic Codes 5251, 5252, or 5253. The Veteran’s extension was never limited to 5 degrees. The Veteran’s flexion was never limited to 45 degrees. The Veteran was able to toe-out beyond 15 degrees and cross his legs. Therefore, the Veteran’s left hip is rated properly at 10 percent under Diagnostic Code 5003 arthritis confirmed by x-ray imaging with additional complaints of pain. Regarding the Veteran’s limitation of flexion and limitations of abduction, the Board reflects that generally a noncompensable evaluation is not awarded a separate evaluation. Nevertheless, insofar as such as been separately evaluated in this case, the Board finds that compensable evaluations under Diagnostic Codes 5003-5252 or 5003-5253 are not warranted in this instance. The Board has considered whether additional functional impairment due to factors such as pain, weakness and fatigability demonstrate additional limitation of motion or function to warrant a higher rating. See 38 C.F.R. §§ 4.40, 4.45, 4.59 and DeLuca, 8 Vet. App. at 206-07. To the extent that the Veteran claims that his pain caused additional loss of movement especially when his hips flared-up, the Board finds that the Veteran’s subjective complaints of pain have been contemplated in the current rating assignment, as the current ratings are based on the objectively demonstrated reduced motion. However, the Veteran’s loss of motion to include pain still was within the range of 10 percent disability rating under Diagnostic Code 5003. Further, the March 2017 examiner opined the Veteran would not have any additional functional limitations during flare ups. Therefore, the clinical findings do not demonstrate that the Veteran’s symptoms result in additional functional limitation to a degree that would support a rating in excess of the current, 10 percent disability rating, even with consideration of whether there was additional functional impairment due to DeLuca factors. See Mitchell, 25 Vet. App. at 43 (“pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system”). The extent that the Veteran contends that he is entitled to an evaluation in excess of 10 percent for the degenerative joint disease of the left hip, the Veteran is competent to report symptoms such as pain and limited motion. Layno v. Brown, 6 Vet. App. 465 (1994). The Veteran is also credible in his belief that he is entitled to higher evaluations. However, the Veteran is not competent to offer a medical opinion, as to the relative severity of his left hip disability, as doing so requires medical knowledge and expertise the Veteran has not been shown to possess. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (2006). Therefore, in assigning the disability ratings, the Board relies upon the competent, probative opinions provided by the medical professionals and on the objective medical evidence of record. Therefore, entitlement to an evaluation in excess of 10 percent left hip degenerative joint disease is not warranted for the entire period on appeal, nor is the Veteran entitled to an initial compensable evaluation for left hip degenerative joint disease based upon limited flexion or limitation of abduction. In reaching these conclusions, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against assignment of higher evaluations, that doctrine is not applicable. See 38 U.S.C. § 5107(b). 3. Entitlement to a total disability rating due to individual unemployability (TDIU) prior to February 1, 2019 VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that the Veteran is precluded, by reason of his service- connected disabilities, from obtaining and maintaining substantially gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. Total disability ratings for compensation based on individual unemployability may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). The central inquiry is, “whether the veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the Veteran’s education, special training, and previous work experience, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The evidence shows that prior to February 1, 2019, the Veteran was service connected for a right knee impairment rated as 20 percent disabling prior to May 2, 2016, 30 percent disabling from May 2, 2016 to December 10, 2017, and 100 percent disabling from December 10, 2017 to February 1, 2019. The Veteran was also service connected for left hip degenerative joint disease and left knee degenerative joint disease, which were each 10 percent disabling. Finally, the Veteran is service connected for limitation of flexion of the left hip, limitation of abduction of the left hip, and a surgical scar of the right knee, which are all noncompensable. The Veteran’s combined evaluation for compensation was 40 percent prior to May 2, 2016, 50 percent from May 2, 2016 to December 10, 2017, and 100 percent from December 11, 2017 to January 31, 2019. 38 C.F.R. § 4.25. For the period prior to the Veteran’s 100 percent rating, the Veteran’s service-connected impairments, to include the Veteran’s right knee, also do not meet the schedular requirements to be considered for a TDIU. Further, the evidence of record does not suggest that the Veteran was unable to maintain or sustain substantially gainful employment due to his service-connected impairments. Rather, the evidence of record indicates that he continued to work through 2017. A claim for a TDIU cannot be dismissed as moot despite the Veteran already having an overall total rating. Bradley v. Peake, 22 Vet. App. 280 (2008). Rather, the Board must look at the evidence to see whether, excluding the disorder for which a 100 percent rating is in effect, the Veteran has additional service-connected disorders which are productive of unemployability. For the period during which, the Veteran was receiving a 100 percent rating, the additional service-connected impairments of the right hip, left knee, and right knee scar not meet the schedular requirements to be considered for a TDIU. Further, the evidence of record does not suggest that the Veteran was unable to maintain or sustain substantially gainful employment due to his service-connected impairments of the left hip, left knee, and right knee scar.  Accordingly, a TDIU prior to February 1, 2019 is denied. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Laura C. Owens 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.