Citation Nr: 21003423 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 16-56 524 DATE: January 21, 2021 ORDER Entitlement to an initial 10 percent rating, but no more, for gastroesophageal reflux disease (GERD) for the entire appeal period prior to August 27, 2020 is granted. Entitlement to an initial rating in excess of 10 percent for GERD is denied. Entitlement to an initial evaluation in excess of 10 percent for a right shoulder condition prior to August 27, 2020 is denied. Entitlement to an initial evaluation in excess of 20 percent beginning August 27, 2020 is denied. Entitlement to an initial evaluation in excess of 10 percent for a right knee condition is denied. Entitlement to an initial evaluation in excess of 10 percent for a right ankle condition is denied. FINDINGS OF FACT 1. For the entirety of the appeal period, the Veteran’s GERD is shown to have been productive of symptoms that include infrequent episodes of epigastric distress as well as pyrosis. 2. For the entirety of the appeal period, the Veteran’s GERD is not shown to be productive of severe impairment of health and has not resulted in symptoms accompanied by substernal or arm or shoulder pain. 3. Prior to August 11, 2020, the Veteran’s right shoulder was manifested by pain; from August 11, 2020, that pain is found to result in limitation of motion at the shoulder level. 4. The Veteran’s right knee condition is manifested by flexion limited to 110 degrees, full extension, and no ankylosis, impairment of the tibia or fibula, instability, or dislocated semilunar cartilage. 5. The Veteran’s right ankle degenerative joint disease is manifested by pain and intermittent swelling resulting in no more than moderate impairment, and no ankylosis, malunion of the os calcis or astralgus, or astralgalectomy. CONCLUSIONS OF LAW 1. The criteria for an initial rating of 10 percent, but no more, for GERD have been met for the entirety of the appeal period. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.114, Diagnostic Code 7399-7346. 2. The criteria for an initial rating in excess of 10 percent for GERD have not been met. 38 U.S.C.§§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.114, Diagnostic Code 7399-7346. 3. The criteria for an initial rating in excess of 10 percent prior to August 11, 2020, and in excess of 20 percent therefrom, for a right shoulder condition have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.40, 4.45, 4.71a, Diagnostic Codes 5200-5203. 4. The criteria for entitlement to an initial rating in excess of 10 percent for a right knee condition have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.3, 4.14, 4.40, 4.59, 4.71a, Diagnostic Code 5260. 5. The criteria for entitlement to an initial rating in excess of 10 percent for a right ankle condition have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.321, 4.71a, Diagnostic Code 5010-5271. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2001 to December 2013. These matters were last before the Board in January 2020, whereupon they were remanded to the Agency of Original Jurisdiction (AOJ) for further development of the record. Following the issuance of a September 2020 supplemental statement of the case continuing the denial of the claims, the case was returned to the Board for its adjudication. While this matter was before the AOJ, it issued a September 2020 rating decision granting a 10 percent initial rating for GERD and a 20 percent initial rating for a right shoulder condition, both effective August 11, 2020. As these increased evaluations do not represent a full grant of the benefits sought, entitlement to a higher rating for both GERD and a right shoulder condition are still on appeal.  AB v. Brown, 6 Vet. App. 35, 38 (1993).  The Veteran testified at a July 2019 videoconference hearing before the undersigned Veterans Law Judge. Moreover, the question of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) has not been raised before the Board at this time. Rice v. Shinseki, 22 Vet. App. 447 (2009). Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple (“staged”) ratings may be assigned for different periods of time during the pendency of the appeal. See generally Fenderson v. West, 12 Vet. App. 119 (1999). Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55 (1994); 38 C.F.R. § 4.2. Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. See generally Hart v. Mansfield, 21 Vet. App. 505 (2007). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. In every instance where the rating schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met.  38 C.F.R. § 4.31. In determining the appropriate rating for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Factors of joint disability include increased or limited motion, weakened movement, excess fatigability, incoordination, and painful movement, including during flare-ups and after repeated use. DeLuca v. Brown, 8 Vet. App. 202, 206-08 (1995); 38 C.F.R. § 4.45. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant.  38 C.F.R. § 4.40. Additionally, “pain itself does not rise to the level of functional loss as contemplated by the VA regulations applicable to the musculoskeletal system.” Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). Pain in a particular joint may result in functional loss, but only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.  Id.; 38 C.F.R. § 4.40. Under 38 C.F.R. § 4.59, painful joints are entitled to at least the minimum compensable rating for the joint. 1. GERD The Veteran seeks a higher initial rating for his service-connected GERD, which is rated as noncompensable prior to August 27, 2020 and as 10 percent disabling therefrom. The ratings at issue were assigned pursuant to 38 C.F.R. § 4.114, Diagnostic Code 7399-7346. As GERD is not listed specifically in the Rating Schedule, the use of a hyphenated diagnostic code here indicates that the GERD has been rated as analogous to the evaluation for a hiatal hernia. 38 C.F.R. § 4.20 (providing for rating by analogy). Under Diagnostic Code 7346, a 10 percent disability rating is warranted with two or more of the symptoms for the 30 percent evaluation, though of less severity. A 30 percent disability rating is warranted for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 60 percent disability rating is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia, or other symptom combinations productive of severe impairment of health. During the appeal period, the Veteran was first afforded a VA examination to evaluate the severity of the GERD in March 2014, during which he reported that he began to experience heartburn twice a month 18 to 24 months prior to the examination. He also endorsed experiencing infrequent episodes of epigastric distress. After an in-person evaluation, the VA examiner found that the GERD did not result in any impairment of occupational functioning. Pursuant to the Board’s remand instructions, the Veteran was afforded a new VA examination to evaluate the severity of the GERD in August 2020, during which he again endorsed experiencing chronic heartburn. He also detailed that his heartburn would wake him up at night about three times per month due to his vomiting. After an in-person evaluation, the examiner noted symptoms of pyrosis, reflux, regurgitation, and pain, as well as sleep disturbances, nausea, and vomiting. In summation, the examiner found that the GERD resulted in impairment of occupational functioning, as the Veteran needed to take breaks from work when he experienced GERD symptoms. During the July 2019 hearing, the Veteran detailed that he experienced chronic heartburn that he treated with over-the-counter medication. A review of available VA medical records does not show any specific treatment for GERD symptomatology. Upon review of the record, the Board finds that a 10 percent rating, but no more, is warranted for GERD for the entirety of the appeal period. As detailed above, to warrant the minimum 10 percent rating, the GERD must be manifested by at least two of the symptoms listed for the 30 percent rating, although at a lesser severity. On the March 2014 examination, it was noted that the Veteran exhibited heartburn and infrequent epigastric distress. As such, although these symptoms occurred only infrequently, the Board still finds that the Veteran symptoms have satisfied the criteria for the minimum rating under Diagnostic Code 7346 for the entirety of the appeal. That being said, in order to qualify for the higher 30 percent rating, the Veteran’s GERD symptoms must be accompanied by substernal or arm or shoulder pain and be productive of considerable impairment of health. This is not shown by the record. Indeed, during the July 2019 hearing, the Veteran indicated that he was able to manage his symptoms with over-the-counter medication. The Board has considered whether a higher or separate rating is warranted for the Veteran’s GERD under any other potentially applicable Diagnostic Code and finds he is not entitled to a higher or separate rating under any other potentially applicable codes ranging from Diagnostic Codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348, inclusive. It is noted that 38 C.F.R. § 4.113 provides that there are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia, and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title “Disease of the Digestive System” do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding outlined in § 4.14. Specifically, the Board finds that the Veteran’s GERD does not result in symptomatology that is not contemplated by Diagnostic Code 7346 and, consequently, a higher or separate rating is not warranted under any other potentially applicable Diagnostic Code other than those prohibited by regulation. The Board recognizes that the rating criteria for assessing the severity of GERD do not specifically contemplate the use of medication to ameliorate symptoms and that the Veteran has reported the use of medication to treat his symptoms throughout the appeal. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). Nevertheless, the Board finds that, even when considering the symptoms the Veteran may experience when not aided by the ameliorative effect of medication, a higher rating is not warranted, as there is no probative evidence indicating that, absent medication, the Veteran would experience considerable or severe impairment of health. Therefore, while the Board is granting a 10 percent rating for the appeal period prior to August 27, 2020, a rating in excess of that 10 percent is denied. 2. Right Shoulder The Veteran is currently in receipt of a 10 percent initial rating for his right shoulder condition for the entirety of the appeal period pursuant to the Board’s January 2020 decision. As stated, while on remand, the AOJ awarded an increased 20 percent rating for the right shoulder condition effective August 11, 2020. The Veteran seeks an increased initial rating for the condition for the entirety of the appeal. It is noted that the Veteran’s right shoulder is his dominant shoulder. The AOJ assigned the 10 percent rating under 38 C.F.R. § 4.71a, Diagnostic Code 5203, which allows for a 10 percent rating for malunion of the clavicle or scapula or for nonunion of the clavicle or scapula without loose movement (in either shoulder). A maximum 20 percent rating is assigned for nonunion of the clavicle or scapula with loose movement or for dislocation of the clavicle or scapula (in either shoulder). Diagnostic Code 5203 also allows a disability to be rated based on impairment of function of the contiguous joint. The AOJ assigned the increased 20 percent rating under 38 C.F.R. § 4.71a, Diagnostic Code 5201, which concerns limitation of motion of the arm at shoulder level. Under Diagnostic Code 5201, a 20 percent rating is warranted for both the major and minor extremity for any such limitation. Limitation of motion of the arm midway between the side and shoulder warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Limitation of motion of the arm to 25 degrees from the side warrants a maximum 30 percent rating for the minor extremity and a maximum 40 percent rating for the major extremity. 38 C.F.R. § 4.71a, Diagnostic Code 5201. It is also noted that Diagnostic Code 5201 “does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of the arm.” Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013). The Board will not consider the applicability of 38 C.F.R. § 4.71a, Diagnostic Code 5200, which concerns ankylosis of the scapulohumeral articulation of the major upper extremity, as there is no evidence of ankylosis of the right shoulder. Similarly, the Board will not further consider the applicability of 38 C.F.R. § 4.71a, Diagnostic Code 5202, which concerns malunion and/or recurrent dislocation of the major humerus, as there is no evidence that there is such an issue with the Veteran’s major humerus. The severity of the right shoulder condition was first evaluated in a March 2014 VA examination, during which he reported that he experienced chronic right shoulder pain that was aggravated when he lifted his arms above his head. He also endorsed experiencing flare-ups of additional pain that in his opinion limited his ability to use his right arm. The examiner stated that they were unwilling to estimate the degree of any additional impairment of functioning following a flare-up of right shoulder symptomatology without resorting to speculation and referred to the lack of additional loss of range of motion during repetitive use testing. Range of motion testing revealed no loss of flexion and abduction reduced to 175 degrees, with no evidence of painful motion and no additional loss of range of motion following repetitive use testing. Additional testing revealed no loss of muscle strength, instability, tenderness on palpation, ankylosis or rotator cuff conditions. In summation, the examiner found that the right shoulder condition would prevent the Veteran from completing work duties that required him to reach and use his arms above his head; moreover, the examiner found that the Veteran was limited in repetitive lifting pushing or carrying more than 75 pounds repetitively. Pursuant to the Board’s January 2020 remand instructions, the Veteran was scheduled for a new VA shoulder examination in August 2020, during which he reported that he experienced chronic right shoulder pain which was not alleviated with the use of pain medication or heat and ice. He also stated that he could not lift his right arm above his head. When queried, he endorsed experiencing flare-ups of right shoulder pain, especially after a day of work, occurring about four time per month and lasting for 24 to 36 hours. Range of motion testing revealed no abnormalities, although the examiner did note pain throughout all ranges of motion as well as localized tenderness over the acromioclavicular (AC) joint on palpation. The examiner did not find evidence of crepitus or pain with weight-bearing. There was no additional loss of motion with repetitive use, but the examiner did estimate that the Veteran would exhibit 10 degrees of lost range of motion throughout the right shoulder during a flare-up of pain. Further testing revealed no loss of muscle strength, ankylosis, or rotator cuff conditions. In summation, the examiner found that the right shoulder condition would result in occupational impairment due to the Veteran’s inability to lift repeatedly; the examiner estimated the Veteran would lose zero to one week of work in the last 12 months. During the July 2019 hearing, the Veteran detailed that he experienced chronic right shoulder pain that significantly worsened with any overhead movement. He also related that he was restricted in any physical activities that involved such overhead movement, to specifically include swimming or throwing. A review of available VA medical records does not show any specific treatment for right shoulder symptomatology. Upon review of the claims file, the Board does not find that an initial rating in excess of 10 percent is warranted for the right shoulder condition prior to August 11, 2020. To begin, it is noted that the AOJ assigned the 20 percent rating under Diagnostic Code 5201 pursuant to 38 C.F.R. § 4.59, in acknowledgement of the Veteran’s demonstrated painful motion of his right arm on the August 2020 VA examination. While the Board certainly will not disturb this increase on appeal, it notes that the prior 10 percent rating under Diagnostic 5203 also provided the minimum compensation for the painful right shoulder that is specified in 38 C.F.R. § 4.59. See also DeLuca, 8 Vet. App. at 202. Moreover, prior to the August 2020 VA examination, there was no objective medical evidence clearly demonstrating that the Veteran experienced a compensable degree of limitation of his right arm motion. In addition, in consideration of the prior rating under Diagnostic Code 5203, there is no evidence of loose movement or dislocation of the clavicle or scapula, which would be necessary for the increased 20 percent rating. Accordingly, a rating in excess of 10 percent is not warranted for the right shoulder prior to August 11, 2020. As for the period from August 11, 2020, the Board reiterates that it will not disturb the currently assigned 20 percent rating; that being said, as that rating was already assigned in consideration of the Veteran’s demonstrated right arm pain pursuant to 38 C.F.R. § 4.59, there is no evidence to support the 20 percent rating under Diagnostic Code 5201, much less a rating in excess of that 20 percent. As a 20 percent rating is the highest possible rating available for the right shoulder condition under Diagnostic Code 5203, the Board need not consider whether the Veteran would be entitled to a higher rating under an alternative Diagnostic Code. Thus, the Board finds that an initial rating for the right shoulder condition in excess of 10 percent prior to August 11, 2020, and in excess of 20 percent thereafter, is not warranted. The preponderance of the evidence is against the Veteran’s claim, and there is no doubt to be resolved. 38 U.S.C. § 5107(b). 3. Right Knee The Veteran is currently in receipt of a 10 percent initial rating for a right knee condition, characterized patellofemoral pain syndrome. He seeks a rating in excess of that 10 percent for the entirety of the appeal. The 10 percent rating was assigned pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5260, pertaining to limitation of flexion. Under Diagnostic Code 5260, a 10 percent rating is assigned when flexion is limited to 45 degrees; a 20 percent rating is assigned when flexion is limited to 30 degrees; and a 30 percent rating is assigned when flexion is limited to 15 degrees. The Board will consider additional diagnostic codes pertinent to the evaluation of knee disabilities in order to determine the highest possible evaluation for the right knee condition during the entire period of the appeal. However, in considering the applicability of those diagnostic codes, the Board finds that Diagnostic Codes 5256 (ankylosis of the knee), 5257 (recurrent subluxation or lateral instability), 5258 (dislocated semilunar cartilage), 5259 (symptomatic removal of semilunar cartilage) and 5263 (genu recurvatum) are not applicable in this instance, as the medical evidence does not show that the Veteran experiences these conditions. Under Diagnostic Code 5261, limitation of extension of the leg, a noncompensable rating is assigned when extension is limited to 5 degrees; a 10 percent rating is assigned when extension is limited to 10 degrees; a 20 percent rating is assigned when extension is limited to 15 degrees; a 30 percent rating is assigned when extension is limited to 20 degrees; a 40 percent rating is warranted for extension limited to 30 degrees; and a 50 percent rating is assigned when extension is limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. The standardized description of joint measurements is provided in Plate II under 38 C.F.R. § 4.71a. For VA purposes, “normal” extension and flexion of the knee is from zero to 140 degrees, and references to normal motion below indicate that the Veteran, in fact, had motion from zero to 140 degrees. 38 C.F.R. § 4.71a, Plate II. The Board notes that separate ratings under Diagnostic Code 5260 and Diagnostic Code 5261 may be assigned for disability of the same knee joint. See VAOPGCPRC 9-2004. The severity of the right knee condition was first evaluated in a March 2014 VA examination, during which the Veteran reported that he had been experiencing intermittent right knee pain since service that he was able to largely avoid so long as he wore supportive shoes while walking. The Veteran further stated that the knee pain was not limiting and that he did not experience flare-ups of pain. Range of motion testing revealed no abnormalities, and there also were no abnormalities following repetitive use testing. Additional testing revealed no loss of muscle strength, instability, tenderness on palpation, or patellar subluxation/dislocation. In summation, the examiner found that the right knee condition would not result in any impairment of occupational functioning. Pursuant to the Board’s January 2020 remand instructions, the Veteran was afforded a new VA knee examination in August 2020, during which he detailed that he experienced chronic right knee pain. He also reported that his knee popped regularly. When queried, he endorsed experiencing flare-ups of right knee pain after sitting for an extended period of time, which necessitated that he straighten his leg out. According to the Veteran, his right knee pain prevented him from running. Range of motion testing revealed flexion reduced to 110 degrees and no loss of extension. The examiner noted that there was pain during the evaluation but did not find that it resulted in functional loss. The examiner did not find evidence of crepitus or pain with weight-bearing. There was no additional loss of motion with repetitive use, but the examiner did estimate that the Veteran would exhibit 10 degrees of lost range of flexion during a flare-up of pain. Further testing revealed no loss of muscle strength, ankylosis, or instability. In summation, the examiner found that the right knee condition would result in occupational impairment due to the Veteran having to take breaks from the sitting position every 30 minutes; the examiner estimated the Veteran would lose zero to one week of work in the last 12 months. During the July 2019 hearing, the Veteran detailed that he experienced chronic right knee pain with intermittent popping of the knee joint. He also stated that he was restricted in his ability to stand as well as drive a vehicle for long periods of time as due to the right knee condition. A review of available VA medical records does not show any specific treatment for right knee symptomatology. Upon consideration of the evidence, the Board finds that a rating in excess of 10 percent is not warranted for the right knee condition at any point during the appeal period. The available evidence, to specifically include the March 2014 and August 2020 VA examinations, does not reflect that the Veteran experiences any of the symptomatology that would warrant a compensable rating under any of the possible applicable diagnostic criteria. He has not exhibited a loss of flexion or extension that would warrant a compensable rating. 38 C.F.R. § 4.71a, Diagnostic Codes 5260, 5261. Although the Veteran has reported experiencing popping in his right knee, there is no indication that he experiences any dislocated semilunar cartilage, and he has never reported any episodes of “locking” and/or effusion into either knee joint. 38 C.F.R. § 4.71a, Diagnostic Code 5258. The Board also reiterates that there is no evidence of ankylosis (Diagnostic Code 5256), impairment of the tibia or fibula (Diagnostic Code 5262), or recurrent subluxation or lateral instability (Diagnostic Code 5257). In considering the propriety of the 10 percent rating, the Board notes that it has taken into consideration the Veteran’s credible reporting of his having experienced pain upon ambulation in his right knee. However, the Board’s prior decision granting entitlement to a 10 percent rating for the right knee condition already contemplated the degree of impairment stemming from this pain; as such, the Board finds that the Veteran is already being compensated for the disability represented by his documented knee pain, even when considering any new evidence that has surfaced since the January 2020 Board decision. See 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 202; see also 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010. As such, in light of the lack of evidence suggesting that the Veteran experiences any of the potentially compensable symptomatology available under any of the possible Diagnostic Codes, the Board cannot establish a rating for the right knee in excess of 10 percent. The preponderance of the evidence is against the Veteran’s claim, and there is no doubt to be resolved. 38 U.S.C. § 5107(b). 4. Right Ankle The Veteran is currently in receipt of a 10 percent initial rating for a right ankle condition, characterized as degenerative joint disease of the right ankle. He seeks an increased rating for the condition for the entirety of the appeal period. The 10 percent rating in this case was assigned pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5010-5271. Hyphenated Diagnostic Codes are utilized when a rating under one Diagnostic Code requires use of an additional Diagnostic Code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. In this particular case, the hyphenated diagnostic code in this case indicates that the right ankle condition is manifested as traumatic arthritis under 5010, to be rated as limitation of motion of the right ankle pursuant to Diagnostic Code 5271. The Board also notes that Diagnostic Code 5010 provides that where limitation of motion is noncompensable under the appropriate diagnostic code, a rating of 10 percent may be applied to each such major joint or group of minor joints affected by limitation of motion. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Furthermore, a 20 percent rating is warranted for x-ray evidence of arthritis with evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Code 5003. The 20 percent and 10 percent ratings based on x-ray findings will not be combined with ratings based on limitation of motion. Id., Note 1. In addition, the 20 percent and 10 percent ratings based on x-ray findings will not be utilized in rating conditions listed under diagnostic codes 5013 to 5024. Diagnostic Code 5271 evaluates the ankle disability based on limitation of motion with moderate limitation of motion of the ankle warranting a 10 percent evaluation and marked limitation of motion warranting a 20 percent evaluation. Normal range of motion in an ankle is considered to be 20 degrees of dorsiflexion and 45 degrees of plantar flexion. 38 C.F.R. § 4.71, Plate II. The severity of the right ankle condition was first evaluated in a March 2014 VA examination, during which the Veteran reported that he would easily roll his right ankle if he did not wear high top shoes. According to the Veteran he would only experience right ankle pain after he rolled his ankle, which he characterized as a flare-up causing him to walk with an antalgic gait. Range of motion testing revealed no abnormalities, and there also were no abnormalities following repetitive use testing. Additional testing revealed no loss of muscle strength, instability, tenderness on palpation, or ankylosis. In summation, the only impairment of occupational functioning acknowledged by the examiner was that the Veteran would require an accomodation to allow him to wear high top shoes during work. In addition, the examiner noted that they were unwilling to estimate any additional loss of range of motion during a flare-up of pain without resorting to speculation. Pursuant to the Board’s January 2020 remand instructions, the Veteran was afforded a new VA ankle examination in August 2020, during which he detailed that he experienced chronic right ankle pain requiring him to wear steel toe boots and/or an ankle brace in order to walk. When queried, he endorsed experiencing flare-ups of right ankle pain if he rolled his ankle while walking, which apparently occurred about once per month and caused him significant pain lasting for half of a day. According to the Veteran, his right ankle pain prevented him from running. Range of motion testing revealed no abnormalities, with dorsiflexion to 20 degrees and plantar flexion to 45 degrees. The examiner noted that there was pain during the evaluation but did not find that it resulted in functional loss; however, it was noted that the Veteran exhibited localized tenderness on palpation over the medial ankle. The examiner did not find evidence of crepitus or pain with weight-bearing. There was no additional loss of motion with repetitive use, and the examiner did not estimate that there would be any additional loss of range of motion during a flare-up of pain; however, they did find that during a flare-up the Veteran would experience additional pain and fatigue of the right ankle. Further testing revealed no loss of muscle strength, ankylosis, or instability. In summation, the examiner found that the right ankle condition would result in occupational impairment due to the Veteran having to take a break to sit after standing or walking for an extended period of time; the examiner estimated the Veteran would lose zero to one week of work in the last 12 months. During the July 2019 hearing, the Veteran detailed that he will roll his right ankle if he walks on it for an extended period of time and does not wear high-top shoes or boots. According to the Veteran, he would experience significant pain and right ankle would swell up if he did roll his ankle while walking. A review of available VA medical records does not show any specific treatment for right ankle symptomatology. Upon consideration of the evidence, the Board does not find that an initial rating in excess of 10 percent is warranted for the right ankle condition. Although it is acknowledged that the Veteran has credibly asserted that he experiences right ankle pain and swelling after rolling his right ankle, there is no indication from the evidence that the resulting functional impairment is any greater than “moderate” in severity. The Veteran still readily works a full-time job requiring him to ambulate regularly, and he was not evaluated as exhibiting any loss of range of motion on either of the VA ankle examinations. Moreover, while the rating schedule does contemplate reduced range of motion on account of pain, the Veteran did not exhibit painful motion of the right ankle resulting in functional loss on either VA examination. Thus, even considering the Veteran’s documented complaints of right ankle pain, the Board does not find that a rating in excess of 10 percent is warranted in contemplation of any additional functional loss stemming from right ankle pain. See 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 202; see also 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010. The current 10 percent rating is warranted for moderate impairment of function due to degenerative joint disease pursuant to Diagnostic Code 5003, and the preponderance of the evidence is against a determination that the Veteran has exhibited “marked” impairment of right ankle function. Accordingly, the preponderance of the evidence of record reflects that the Veteran’s current 10 percent disability rating for right ankle degenerative joint disease adequately compensates him for his symptoms, including pain and occasional swelling. In making this determination the Board has also considered other potentially applicable diagnostic codes for the Veteran’s right ankle condition; in this case diagnostic codes potentially applicable are 5270 (ankylosis of the ankle in plantar flexion), 5272 (ankylosis of the subastragalar or tarsal joint), 5273 (malunion of the os calcis or astralgus) and 5274 (astralgalectomy). However, as the Veteran does not exhibit any of these manifestations of right ankle disability, there is no possibility of an alternate and/or separate evaluation under these Diagnostic Codes. In summation, the Board cannot establish a rating for the right ankle condition in excess of 10 percent. The preponderance of the evidence is against the Veteran’s claim, and there is no doubt to be resolved. 38 U.S.C. § 5107(b). A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher M. Collins, 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.