Citation Nr: 21003210 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 12-15 157 DATE: January 19, 2021 ORDER For the period from January 1, 2011 to January 1, 2020, a separate 20 percent rating for recurrent dislocation of the left shoulder is granted, subject to the legal authority governing the payment of compensation. For the period of January 1, 2011 to June 1, 2015, entitlement to a rating in excess of 20 percent for left shoulder dislocation with failed surgical repair is denied. For the period of October 1, 2015 to September 11, 2016, entitlement to a rating in excess of 20 percent for left shoulder with failed surgical repair is denied. For the period of January 1, 2017 to November 14, 2018, entitlement to a rating in excess of 20 percent for left shoulder with failed surgical repair is denied. From appeal period beginning on January 1, 2020, a 50 percent rating for status-post left shoulder total arthroplasty is granted. FINDINGS OF FACT 1. From January 1, 2011 to January 1, 2020, resolving all doubt in the Veteran's favor, the recurrent dislocation of the Veteran's left shoulder was manifested by recurrent dislocation of the scapulohumeral joint with infrequent episodes and guarding of movement of the left shoulder. 2. For the period of January 1, 2011 to June 1, 2015, the Veteran’s left shoulder dislocation with failed surgical repair manifested as stiffness, weakness, crepitus and loss of range of motion of the arm, but not to 25 degrees from his side, without ankylosis of the scapulohumeral articulation, malunion of the humerus, recurrent dislocation of the humerus at the scapulohumeral joint, fibrous union of the humerus, nonunion of the humerus, flail shoulder, dislocation of the clavicle or scapula, or malunion or nonunion of the clavicle or scapula. 3. For the period of October 1, 2015 to September 11, 2016, the Veteran’s left shoulder dislocation with failed surgical repair manifested as pain and loss of range of motion of the arm, but not to 25 degrees from his side, without ankylosis of the scapulohumeral articulation, malunion of the humerus, recurrent dislocation of the humerus at the scapulohumeral joint, fibrous union of the humerus, nonunion of the humerus, flail shoulder, dislocation of the clavicle or scapula, or malunion or nonunion of the clavicle or scapula. 4. For the January 1, 2017 to November 14, 2018, the Veteran’s left shoulder dislocation with failed surgical repair manifested as pain and loss of range of motion of the arm, but not to 25 degrees from his side, without ankylosis of the scapulohumeral articulation, malunion of the humerus, recurrent dislocation of the humerus at the scapulohumeral joint, fibrous union of the humerus, nonunion of the humerus, flail shoulder, dislocation of the clavicle or scapula, or malunion or nonunion of the clavicle or scapula. 5. For the appeal period beginning on January 1, 2020, the Veteran’s left shoulder post-total arthroplasty is manifested by chronic residuals consisting of severe, painful motion and weakness in the affected extremity. CONCLUSIONS OF LAW 1. From January 1, 2011 to January 1, 2020, the criteria for a separate rating of 20 percent for recurrent left shoulder dislocation has been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.40, 4.45, 4.71a, Diagnostic Code 5202. 2. The criteria for a rating in excess of 20 percent for left shoulder dislocation with failed surgical repair for the period of January 1, 2011 to June 1, 2015 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. 3. The criteria for a rating in excess of 20 percent for left shoulder dislocation with failed surgical repair for the period of October 1, 2015 to September 11, 2016 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. 4. The criteria for a rating in excess of 20 percent for left shoulder dislocation with failed surgical repair for the period of January 1, 2017 to November 14, 2018 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. 5. The criteria for a 50 percent rating for left shoulder status post total arthroplasty beginning on January 1, 2020 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.71a, Diagnostic Code 5051. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from September 1992 to August 1995. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2011 rating decision issued by a Department of Veterans Affairs Regional Office (RO). This case has been remanded by the Board on multiple occasions, to include December 2014, July 2017, February 2018 and September 2019. The Board directed that specific private treatment records be obtained, that updated VA treatment records be obtained, and a VA examination was conducted in May 2020. The Board therefore determines that there has been substantial compliance with its previous remand. Stegall v. West, 11 Vet. App. 268 (1998). A July 2020 rating decision recharacterized the Veteran's left shoulder dislocation with failed surgical repair as status-post left shoulder total arthroplasty and assigned a 30 percent rating, effective January 1, 2020. The Veteran is presumed to seek the maximum available benefit for a disability. As such, this claim is still considered to be on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Increased Rating The Veteran has generally asserted that he is entitled to an increased rating for his left shoulder condition, post total arthroplasty, specifically because his symptoms are more severe than contemplated by the currently assigned ratings. Specific argument in support of this appeal has not been submitted. Disability evaluations are determined by evaluating the extent to which a veteran's service connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her 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 occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology, and evidenced by visible behavior of the claimant undertaking the motion. Under DeLuca v. Brown, the Board must give consideration as to whether, in addition to limitation of motion, upon repetitive use, there is increased disability or functional loss due to any weakness in the affected extremity. 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. Limited movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse as well as instability of station, disturbance of locomotion, and interference with sitting, standing and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Further, in evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The normal range of motion of the shoulder is from zero degrees of flexion (forward elevation) to 180 degrees of flexion, from zero degrees of abduction to 180 degrees of abduction, from zero degrees of external rotation to 90 degrees of external rotation, and from zero degrees of internal rotation to 90 degrees of internal rotation. 38 C.F.R. § 4.71, Plate I. Under Diagnostic Code 5201, limitation of motion of the arm at shoulder level warrants a 20 percent rating. Limitation of motion of the arm from midway between the side and shoulder level warrants a 30 percent rating for a major extremity, and 20 percent rating for a minor extremity. Limitation of motion to 25 degrees from the side warrants a 40 percent rating for a major extremity, and 30 percent rating for a minor extremity. 38 C.F.R. § 4.71a. Diagnostic Code 5201 does not provide separate ratings for limitations on flexion, extension, abduction and rotation, but rather permits only a single rating for limitation of motion of an arm. Yonek v. Shinseki, 722 F.3d 1355, 1359 (Fed. Cir. 2013). Other potentially applicable rating criteria are found at 38 C.F.R. § 4.71a, Diagnostic Codes 5200 through 5203, governing the shoulder and arm. Diagnostic Codes 5200-5203 distinguish between the major (dominant) extremity and the minor (non-dominant) extremity. The medical evidence shows that the Veteran is right-hand dominant. Therefore, the Veteran's left shoulder is his minor shoulder for rating purposes. Under Diagnostic Code 5200, ankylosis of the scapulohumeral articulation is when the scapula and humerus move as one piece. For the minor arm, favorable ankylosis, with abduction to 60 degrees (the ability to reach the mouth and head) is rated at 20 percent; intermediate, between favorable and unfavorable, ankylosis is rated at 30 percent; and unfavorable ankylosis of the scapulohumeral articulation with abduction limited to 25 degrees from the side warrants a 40 percent rating. Under Diagnostic Code 5202, for other impairment of the humerus for the minor arm, recurrent dislocation of the humerus at the scapulohumeral joint with infrequent episodes and guarding of movement only at the shoulder level is rated at 20 percent; recurrent dislocation with frequent episodes and guarding of all arm movements is rated at 20 percent; and fibrous union of the humerus is rated at 40 percent; nonunion of the humerus is rated 50 percent; and a loss of the humerus head is rated at 70 percent. Under Diagnostic Code 5203, for impairment of the clavicle or scapula in the minor arm, a malunion or nonunion without loose movement is rated at 10 percent, and a nonunion with loose movement or for dislocation of the clavicle is rated at 20 percent. During his service, the Veteran underwent a surgery for his left shoulder due to subluxation. Later in service he was involved in an accident in a military vehicle in which his left shoulder impacted the vehicle’s gun turret. Subsequent to the accident, his left shoulder progressively worsened, experiencing pain at 5/10 level consistently and regularly, eventually requiring surgery. Since then, the Veteran has undergone several corrective surgeries on his left shoulder, culminating in a total shoulder replacement (“arthroplasty”) in November 2018. The Veteran has been afforded several VA examinations during the appeal period. The Board will summarize the results of the Veteran’s various VA examinations and other medical and lay evidence, focusing primarily on the Veteran’s limitation on range of motion as well as the pain level in his left shoulder. Rating Period – January 1, 2011 to June 1, 2015 In a January 2011 private treatment note, the Veteran was at flexion zero to 170 degrees, abduction at zero to 90 degrees, internal rotation at zero to 40 degrees, and external rotation at almost 70 degrees. A March 2011 private treatment record showed flexion at zero to 175 degrees, abduction at zero to 90 degrees, internal rotation at zero to 40 degrees, and external rotation at zero to 80 degrees. These values are all outside the normal range. A February 2011 VA examination report noted that the Veteran made complaints of stiffness and weakness in the left shoulder. There were also incidences of dislocations and subluxation. The examination revealed range of motion measurements of flexion at zero to 130 degrees, internal rotation at zero to 50 degrees, and external rotation at zero to 10 degrees. The examination also found objective evidence of pain on active range of motion. There was no pain with repetition or any additional limitation due to repetition. X-rays revealed degenerative changes of the left glenohumeral joint. A March 2020 VA examination report, in conjunction with a retrospective examination, noted that estimated active and passive left shoulder range of motion revealed flexion to be 150 degrees and external rotation to be to 45 degrees and nonweight bearing range of motion had flexion to 150 degrees and external rotation to 45 degrees based on private treatment records dated in April 2015 and that further estimate would be based on speculation and not due to lack of knowledge, but rather lack of data. The examiner stated that no further estimation for range of motion based on flare-ups and repetitive motion testing could be provided as further estimation would be based on speculation, not due to lack of knowledge, but rather lack of data. The examiner noted that there was not ankylosis, impairment to the humerus, impairment to the clavicle or scapula based upon the private treatment records. The examiner also noted that although there is no documentation in the private treatment records that documents the frequency of the Veteran's reported shoulder dislocations, the Veteran's reports are taken as credible by the examiner and the condition of the clavicle and scapula were as likely as not compromised due to the frequent dislocations. Based on the foregoing, the Board finds that a rating in excess of 20 percent is not warranted for the Veteran's left shoulder dislocation with failed surgical repair at any time during the appeal period. The Veteran's left shoulder dislocation with failed surgical repair has a 20 percent rating for painful motion of the shoulder. 38 C.F.R. § 4.59 allows consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating for a particular joint. Since the Veteran demonstrated painful motion of the arm at the shoulder and there was objective evidence of tenosynovitis, the RO granted the Veteran a 20 percent rating in a July 2011 rating decision, effective January 1, 2011. During this appeal period, the Veteran's left shoulder forward flexion and abduction were limited to, at worst, 130 and 90 degrees respectively. Even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, the Board finds that he is not entitled to a rating in excess of 20 percent under Diagnostic Code 5201. Specifically, as demonstrated during the February 2011 VA examination, there is no indication that pain resulted in additional functional loss, to include a greater loss of abduction. Additionally, the Veteran denied flare-ups in February 2011 VA examination report. While the Veteran has endorsed stiffness and weakness, and the February 2011 VA examiner noted crepitus, the Board finds that they do not more nearly approximate the ability to lift his arm to only 25 degrees from his side. See DeLuca, supra; Mitchell, supra. Therefore, the Veteran is not entitled to a rating in excess of 20 percent under Diagnostic Code 5201 based upon limitation of motion. The Board finds that the Veteran's left shoulder disability is entitled to a separate rating under Diagnostic Code 5202 based upon recurrent dislocation of the scapulohumeral joint with frequent episodes and guarding of all arm movements. His left shoulder disability originated from a left shoulder dislocation, and the Board finds that the disability is manifested by moderate subluxation with guarding of movement. The Board notes that the VA examiner's finding of left shoulder recurrent dislocation and guarding does not specify if the Veteran experiences infrequent or frequent episodes which would warrant a higher 30 percent rating. Consequently, a separate rating of 20 percent under Diagnostic Code 5202 since from January 1, 2011 to January 1, 2020 is warranted for his recurrent dislocation of the left shoulder. The Board notes that such additional separate rating does not frustrate the VA's regulation against pyramiding, as the Board does not consider such symptoms to be contemplated within the Diagnostic Code under which he is currently rated. In addition, the Board has also considered whether a higher rating is warranted under any other potentially applicable diagnostic code related to the shoulders. However, the Veteran does not have ankylosis of the scapulohumeral articulation, malunion of the humerus, recurrent dislocation of the humerus at the scapulohumeral joint, fibrous union of the humerus, nonunion of the humerus, flail shoulder, or malunion or nonunion of the clavicle or scapula that affects range of motion of the shoulder joint, as documented in the VA examination reports and treatment records. Further consideration of higher or separate ratings under Diagnostic Code 5200, 5202 and 5203 is therefore not warranted. Rating Period – October 1, 2015 to September 11, 2016 The Veteran’s visit on May 13, 2016 to a private clinic documented his pain level at 7 on a 1 to 10 scale. The pain was described as “aching and sharp” and manifested constantly with intermittent worsening. The Veteran was administered an injection to the left shoulder to help ease the pain. Range of motion testing was also conducted and revealed forward flexion of 150 degrees, external rotation to 60 degrees. There was active pain noted upon movement of the affected extremity. In a subsequent visit to a private clinic on August 5, 2016 the Veteran rated his pain again at 7 on a 1 to 10 scale. The pain was noted to be mainly in the anterior aspect of his shoulder, along with a deep aching pain in the same area. The pain seemed to be worsening. The Veteran was administered an injection which eased the pain and provided some degree of relief over the next couple months. Range of motion measurements for the left shoulder were at forward flexion 150 and external rotation to 40 degrees. A March 2020 VA examination report, in conjunction with a retrospective examination, noted that estimated active and passive left shoulder range of motion revealed flexion to be 120 degrees and external rotation to be to 20 degrees and nonweight bearing range of motion had flexion to 120 degrees and external rotation to 20 degrees based on private treatment records dated in June 2015 and that further estimate would be based on speculation and not due to lack of knowledge, but rather lack of data. The examiner stated that no further estimation for range of motion based on flare-ups and repetitive motion testing could be provided as further estimation would be based on speculation, not due to lack of knowledge, but rather lack of data. The examiner noted that there was not ankylosis, impairment to the humerus, impairment to the clavicle or scapula based upon the private treatment records. During this appeal period, the Veteran's left shoulder forward flexion was limited to, at worst, 120 degrees. Even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, the Board finds that he is not entitled to a rating in excess of 20 percent under Diagnostic Code 5201. Specifically, as demonstrated during the May 2016 and August 2016 private treatment notes the Veteran had pain on motion, but there is no indication that such resulted in additional functional loss, to include a greater loss of abduction. While the Veteran has endorsed pain, the Board finds that they do not more nearly approximate the ability to lift his arm to only 25 degrees from his side. See DeLuca, supra; Mitchell, supra. Therefore, the Veteran is not entitled to a rating in excess of 20 percent under Diagnostic Code 5201. In addition, the Board has also considered whether a higher rating is warranted under any other potentially applicable diagnostic code related to the shoulders. However, the Veteran does not have ankylosis of the scapulohumeral articulation, malunion of the humerus, recurrent dislocation of the humerus at the scapulohumeral joint, fibrous union of the humerus, nonunion of the humerus, flail shoulder or malunion or nonunion of the clavicle or scapula that affects range of motion of the shoulder joint, as documented in the VA examination reports and treatment records. Further consideration of a higher or separate rating under Diagnostic Code 5200, 5202 and 5203 is therefore not warranted. Rating Period – January 1, 2017 to November 14, 2018 An October 2017 VA examination report reflects the Veteran’s reports that he suffers from shoulder flare-ups with lifting and certain range of motion. Functional loss was reported through chronic aching and reduced ability to lift objects. Range of motion testing on the left shoulder revealed measurements of flexion to 120 degrees, abduction to 70 degrees, external rotation to 80 degrees, and internal rotation to 25 degrees. The examiner noted that these measurements showed functional loss through limited range of motion and pain upon movement. Repetitive range of motion found flexion to be to 85 degrees, abduction to be to 75 degrees, external rotation was to 80 degrees and internal rotation was to 20 degrees. The examination was not conducted during a flare-up and the examiner determined that the examination was medically consistent with the Veteran's statements describing functional loss during flare-ups. The examiner determined that pain would cause functional loss during flare-ups and that flare-ups would result in flexion that was limited to 85 degrees, abduction that was limited to 70 degrees, external rotation that was limited to 80 degrees and internal rotation that was limited to 20 degrees. The examiner determined that there was ankylosis is abduction up to 60 degrees and that the Veteran can reach his mouth and head (favorable ankylosis), that there was a history of recurrent dislocation of the glenohumeral joint with guarding of movement only at the shoulder level. The examiner also noted objective evidence of localized tenderness/pain on palpation of the anterior shoulder. There was also objective evidence of crepitus noted. A May 2018 VA examination report reflects the Veteran’s complaints of shoulder pain most of the time, shoulder aching when it is not moving, and that it is aggravated with things like weeding or riding a tractor that requires movement or reaching for something. These pain flareups upon movement restricted his range of motion and resulted in functional loss. The Veteran reported that his symptoms are alleviated temporarily on occasion with medication or a cortisone injection and that his shoulder dislocates. Range of motion testing for the left shoulder measured flexion to 110 degrees, abduction to 95 degrees, external rotation to 60 degrees, and internal rotation to 75 degrees. The examiner also noted pain upon weight bearing. Pain was also noted upon flexion, abduction, and external rotation and resulted in functional loss. Repetitive use testing revealed flexion to be to 80 degrees, abduction to 90 degrees, external rotation to 45 degrees and internal rotation to 80 degrees and pain was noted to be the cause of the functional loss. The examiner noted that the examination was not conducted during a flare-up and that the examination was medically consistent with the Veteran's statements describing functional loss during flare-ups. The examiner also noted objective evidence of localized tenderness/pain on palpation of the anterior shoulder. A history of recurrent dislocation (subluxation) of the glenohumeral joint with frequent episodes and guarding of movement only at the shoulder level. The examiner noted that there was no rotator cuff condition, a clavicle condition, a scapula condition, an acromioclavicular joint or sternoclavicular joint condition, loss of head (flail shoulder), nonunion (false flail shoulder) or fibrous union of the humerus. A March 2020 VA examination report, in conjunction with a retrospective examination, noted that estimated active and passive left shoulder range of motion revealed flexion to be 120 degrees and external rotation to be to 95 degrees and that estimated range of motion with repetition over time for flexion was to 110 degrees and abduction was to 95 degrees based on the May 2018 VA examination and the Veteran’s reports. The examiner noted that the Veteran estimated that range of motion on repeated use would be similar to that noted with the May 2018 shoulder examination. The examiner noted that the Veteran had significant issue with this left shoulder, that this was a retrospective estimation given all information that is currently available and the current day interview with the Veteran. The examiner opined that it is as likely as not that the Veteran's range of motion with weight bearing in the left shoulder would be impacted at least 15 to 20 percent. The examiner noted that there was not ankylosis, impairment to the humerus, impairment to the clavicle or scapula based upon the private treatment records. During this appeal period, the Veteran's left shoulder forward flexion and abduction were limited to, at worst, 80 and 70 degrees respectively. Even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, the Board finds that he is not entitled to a rating in excess of 20 percent under Diagnostic Code 5201. Specifically, as demonstrated during the February 2011 VA examination, there is no indication that pain resulted in additional functional loss, to include a greater loss of abduction. Additionally, the October 2017 VA examiner determined that flare-ups would limit flexion to 85 degrees and abduction to 70 degrees. While the Veteran has endorsed stiffness and weakness, and the February 2011 VA examiner noted crepitus, the Board finds that they do not more nearly approximate the ability to lift his arm to only 25 degrees from his side. See DeLuca, supra; Mitchell, supra. Therefore, the Veteran is not entitled to a rating in excess of 20 percent under Diagnostic Code 5201. In addition, the Board has also considered whether a higher rating is warranted under any other potentially applicable diagnostic code related to the shoulders. However, the Veteran does not have ankylosis of the scapulohumeral articulation, malunion of the humerus, recurrent dislocation of the humerus at the scapulohumeral joint, fibrous union of the humerus, nonunion of the humerus, flail shoulder, or malunion or nonunion of the clavicle or scapula that affects range of motion of the shoulder joint, as documented in the VA examination reports and treatment records. Further consideration of higher or separate ratings under Diagnostic Code 5200, 5202 and 5203 is therefore not warranted. Rating Period – Beginning on January 1, 2020 The Veteran underwent a surgery for total replacement of his left shoulder (left shoulder arthroplasty) on November 15, 2018. After the surgery, VA assigned a 100 percent schedular rating for post-total arthroplasty, for the period of Veteran’s recovery until December 31, 2019. under Diagnostic Code 5051, which pertains to shoulder replacement/arthroplasty, After the conclusion of Veteran’s recovery period, the RO assigned a 20 percent evaluation for the Veteran’s status-post left shoulder total arthroplasty, with the effective date of January 1, 2020. This rating was later increased to 30 percent in a July 2020 rating decision. The RO rated the Veteran’s status-post left shoulder total arthroplasty pursuant to Diagnostic Code 5051, which pertains to shoulder replacement/arthroplasty. As the Veteran has indicated he is right handed, the evaluation of the criteria will correspond to the minor extremity. Under Diagnostic Code 5051, for one year following implantation of a shoulder prosthesis for a service-connected shoulder disability, a 100 percent rating is assigned. Thereafter, a 50 percent rating is assigned when there are chronic residuals consisting of severe painful motion or weakness in the affected extremity; or, a minimum 20 percent rating is assigned. When there are intermediate degrees of residual weakness, pain, or limitation of motion, these intermediate residuals are to be rated by analogy under 38 C.F.R. § 4.71a, Diagnostic Codes 5200 or 5203. The Veteran’s VA examination of March 2020 found that the Veteran suffered from significant issues with his left shoulder and that “it is as likely as not that the Veteran’s [range of motion] with weight bearing in the left shoulder would be impacted by at least 15 percent to 20 percent. Additionally, the Veteran reported to the examiner that he suffered from functional limitations with flares in the left shoulder and had pain flareup in both shoulders. The Veteran described his flareups occurring frequently, for three to four days at a time, and the degree of limitation on his range of motion due to the flareups was severe. The Veteran additionally stated that his estimated range of motion at the time of March 2020 exam was similar to that at the time of a previous May 2018 examination. The examiner further noted that the Veteran suffered from daily pain in his left shoulder with flares. The examiner found that the Veteran’s range of motion for the left shoulder measured at zero to 110 degrees for flexion, zero to 95 degrees for abduction, zero to 60 degrees for external rotation, and zero to 75 degrees for internal rotation. After the Veteran’s total shoulder replacement/arthroplasty in November 2018, his shoulder pain again improved and began to subside. The Veteran presented with a pain level of “0/10” at a follow up visit at a private treatment note in January 2019. In a checkup in February 2019, the Veteran’s pain was at “5/10”. Then the Veteran followed up again with a private provider for a check-up in October 2019, around 10 months after his total shoulder arthroplasty. This time, the report generally mentioned the Veteran’s marked improvement since his total shoulder arthroplasty, but also made specific mention of the return of Veteran’s pain flareups, noting that the Veteran suffered from persistent and recurring pain flareups at “4/10” level of pain. His pain was especially triggered upon reaching under an object and lifting it up. His range of motion was measured flexion to be to 160 degrees and external rotation to be to 50 degrees, both values being outside the normal range. For the appeal period beginning on January 1, 2020 and on review of the evidence of record, especially the March 2020 VA examination, the Board finds the Veteran has chronic residuals consisting of severe, painful motion or weakness in the left shoulder. The evidence shows he has limited mobility, cannot lift over 25 pounds with the left arm and cannot reach over his head. Range of motion testing of the left shoulder reveals flexion to 95 degrees, abduction to 20 degrees, external rotation to 25 degrees and internal rotation to 50 degrees. Objective examination, namely the empty-can test and external rotation/infraspinatus strength test, were positive, which establishes weakness. The Board finds the Veteran's reports of symptoms associated with his left shoulder credible and consistent with objective medical findings on examination. Accordingly, a 50 percent rating under Diagnostic Code 5051 for status-post left (minor) shoulder total arthroplasty is warranted. The Board finds that the preponderance of the evidence support a rating of 50 percent for the Veteran's status-post left shoulder total arthroplasty. In this regard, following the one year period after prosthesis implantation, 50 percent is the maximum rating assignable for the minor joint under Diagnostic Code 5051. The only Diagnostic Code providing a rating higher than 50 percent for the major joint is Diagnostic Code 5202, which allows a 70 percent rating when there is loss of head of the humerus (flail shoulder). Here, X-rays taken on multiple occasions do not indicate such condition; rather, they show that the humerus was replaced as part of the prostheses and it was well-seated. Further, Diagnostic Codes 5200, 5201, and 5203 for scapulohumeral articulation, limitation of motion of the arm, and impairment of the clavicle or scapula do not provide for ratings in excess of 50 percent. Furthermore, the Veteran's reports of pain, severe limitation of motion, and loss of muscle, and their resulting functional impairment, to include the inability to sit, stand, or lay down for any length of time and difficulty with lifting, are contemplated by his assigned 50 percent rating under Diagnostic Code 5051 for severe painful motion and weakness in the affected extremity. Consequently, a rating in excess of 50 percent for status-post left shoulder total arthroplasty is not warranted. Other Considerations In reaching its conclusions, the Board acknowledges the Veteran's belief that his symptoms are more severe than the current disability ratings reflect. The Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). The Board finds the medical evidence in which professionals with medical expertise examined the Veteran's disability, acknowledged his reported symptoms, and described the manifestations of such disability in light of the rating criteria to be more persuasive than his own reports regarding the severity of such condition. The Board has also considered whether further staged ratings under Hart, supra, are appropriate for the Veteran’s condition. However, the Veteran’s left shoulder disability has been stable throughout each appeal period. The Veteran and his attorney have not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Finally, the Board notes the ruling of the Court in Rice v. Shinseki, supra. In Rice, the Court held that a claim for a TDIU, either expressly raised by the Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. In this case, the Veteran reported working full-time through the appeal period. As such, Rice is inapplicable in this case. Accordingly, based on the findings and analysis above, the Board finds that a rating of 50 percent is warranted for left shoulder post-total arthoplasty, effective January 1, 2020 and that a separate rating for left shoulder dislocation was warranted from January 1, 2011 to January 1, 2020 are warranted. However, the Board finds that the preponderance of the evidence is otherwise against higher or separate ratings. Consequently, the benefit of the doubt doctrine is not applicable in such regard, and the Veteran's claim for an increased rating for status-post left shoulder total arthroplasty is otherwise denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kashif I. Ali, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.