Citation Nr: 21004668 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 09-14 322 DATE: January 27, 2021 ORDER Entitlement to a disability rating in excess of 40 percent prior to December 1, 2008, and in excess of 30 percent thereafter for chronic right shoulder dislocation is denied. Entitlement to a disability rating in excess of 30 percent prior to December 1, 2008, and in excess of 20 percent thereafter for chronic left shoulder dislocation is denied. Entitlement to a disability rating in excess of 20 percent prior to October 4, 2016, in excess of 30 percent between October 4, 2016 and October 17, 2019, and in excess of 40 percent thereafter for right shoulder impingement syndrome is denied. Entitlement to a disability rating in excess of 20 percent for left shoulder impingement syndrome is denied. REMANDED Entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. During the appeal period, the Veteran’s right shoulder dislocation is manifested by recurrent dislocation of the scapulohumeral joint with frequent episodes and guarding of all arm movement of the major extremity. 2. Prior to December 1, 2008, the Veteran’s left shoulder dislocation is manifested by recurrent dislocation of the scapulohumeral joint with frequent episodes and guarding of all arm movement of the minor extremity. 3. From December 1, 2008, the Veteran’s left shoulder dislocation is rated as 20 percent disabling, which is the maximum schedular rating permitted for impairment of the clavicle or scapula. 4. Prior to October 4, 2016, the Veteran’s right shoulder impingement syndrome is manifested by limitation of motion at shoulder level of the major extremity. 5. From October 4, 2016 to October 17, 2019, the Veteran’s right shoulder impingement syndrome is manifested by limitation of motion at midway between side and shoulder level of the major extremity. 6. From October 17, 2019, the Veteran’s right shoulder impingement syndrome is manifested by limitation of motion to 25 degrees from the side of the major extremity. 7. During the appeal period, the Veteran’s left shoulder impingement syndrome is manifested by limitation of motion at the shoulder level or, at worst, midway between side and shoulder level of the minor extremity. CONCLUSIONS OF LAW 1. Prior to December 1, 2008, the criteria for a rating in excess of 40 percent, and in excess of 30 percent thereafter for right shoulder dislocation have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5202. 2. Prior to December 1, 2008, the criteria for a rating in excess of 30 percent, and in excess of 20 percent thereafter for left shoulder dislocation have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5299-5202, 5299-5203. 3. The criteria for a rating in excess of 20 percent prior to October 4, 2016, in excess of 30 percent from October 4, 2016 to October 17, 2019, and in excess of 40 percent thereafter for right shoulder impingement syndrome have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5201. 4. During the appeal period, the criteria for a rating in excess of 20 percent for left shoulder impingement syndrome have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5201. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from April 1999 to December 2000. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2008 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded the matters in November 2010, February 2012, December 2015, September 2016, May 2017, January 2018, and January 2019 to the Agency of Original Jurisdiction (AOJ) for additional development, and the matters have since returned for further appellate review. The remand instructions have been substantially complied with and additional remand is unnecessary. Increased Rating Disability ratings 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 (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria.”). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Procedural History By way of history, the Veteran filed an increased rating claim in April 2008 for his bilateral shoulder dislocation disabilities. In a September 2008 rating decision, the RO reduced the Veteran’s awards for the Veteran’s bilateral shoulder disabilities to 10 percent each, effective December 1, 2008. The Veteran appealed this decision, and the Board resolved the reduction issues in the November 2010 and December 2015 decisions. In an August 2015 rating decision, the RO granted separate disability ratings for left and right shoulder impingement syndrome with 20 percent evaluations each effective August 24, 2015. Subsequently, in the December 2015 decision, the Board granted entitlement to a 30 percent rating for right shoulder dislocation effective December 1, 2008, a 20 percent rating for right shoulder impingement syndrome effective December 1, 2008, and a 20 percent rating for left shoulder impingement effective December 1, 2008. In a September 2016 decision, the Board remanded the matters to the AOJ for a VA examination. The RO, in an October 2016 rating decision, increased the rating of the right shoulder impingement syndrome to 30 percent effective October 4, 2016, the date of a VA examination. In a subsequent May 2017 decision, the Board remanded the matters to the AOJ for a VA examination in compliance with Correia v. McDonald, 28 Vet. App. 158 (2016). The Board, in a January 2018 decision, remanded the matters again for failure to address flare-ups. Most recently, in a January 2019 decision, the Board remanded the matters again for a VA examination in compliance with Correia. Thereafter, in an August 2020 rating decision, the RO increased the rating for the Veteran’s right shoulder impingement syndrome to 40 percent effective October 17, 2019, the date of a VA examination. Each disability is addressed below in determining whether higher ratings are warranted. Examinations Reviewing the evidence, the Veteran was afforded multiple VA examinations during the appeal period to address his bilateral shoulder disabilities. The Veteran initially presented for a VA examination in June 2008. His right hand is his dominant hand. The Veteran reported working at a department store as a manager in the automotive parts section, a job he is able to perform if he is careful not to have recurrent dislocations. He reported continuing to have bilateral shoulder dislocations with the right side worse than the left side. The dislocations occur once a day or multiple times a day, but he does not take any medications for relief. He reported no flare-ups or incoordination, and has some fatigue and loss endurance in his right shoulder. Right shoulder range of motion (ROM) testing revealed flexion and abduction from 0 to 130 degrees with pain, external rotation from 0 to 80 degrees, and internal rotation from 0 to 90 degrees with pain. Left shoulder flexion and abduction was from 0 to 150 degrees with mild pain, and internal and external rotation from 0 to 90 degrees with mild pain. The Veteran had 0 to 20 degrees of adduction bilaterally. With repetitive motion, there was no change in motion, coordination, fatigue, weakness, endurance, or pain level of the right or left shoulder. The Veteran was afforded a VA examination in February 2011. He reported burning pain with movement and any elevation of his shoulders above the chest starts giving him a feeling of subluxation and dislocation the right greater than the left. He reported no periods of flare up. He indicated working as a support manager at a department store but had to quit working because of his shoulders. Right shoulder evaluation showed forward flexion and abduction from 0 to 110 degrees with pain, and external and internal rotation from 0 to 90 degrees with pain. He had right rotator cuff weakness with impingement signs and symptoms. He had tenderness over the acromioclavicular joint which is prominent. Left shoulder flexion and abduction was from 0 to 180 degrees with pain from 90 to 180 degrees. External and internal rotations was from 0 to 90 degrees with pain. Evaluation revealed clicking in the acromioclavicular joint with range of motion. He had shoulder impingement signs and symptoms. There were no additional limitations following repetitive use other than increased pain without further loss of motion. There was no flare ups and no effect of incoordination, fatigue, weakness, or lack of endurance on his joint function. The Veteran presented for a VA examination in August 2015. The Veteran reported chronic pain anteriorly and superiorly with recurrent subluxations frequently. His pain increased with lifting and overhead work. He reported currently working as a manager in retail. He did not report flare-ups. Physical examination of the right and left shoulders revealed range of motion of flexion from 0 to 90 degrees, abduction from 0 to 80 degrees, external rotation from 0 to 70 degrees, and internal rotation from 0 to 60 degrees with pain. The Veteran was not examined immediately after repetitive use over time though examination findings were neither consistent nor inconsistent with the Veteran’s statements describing functional loss. The examiner could not opine regarding whether pain, weakness, fatigability, or incoordination limit functional ability with repeated use over time. An inability to engage in overhead work and repetitive lifting was noted. Muscle strength for forward flexion and abduction was rated 4 out of 5 for the right shoulder, and 5 out of 5 for the left shoulder. The Veteran did not have muscle atrophy and there was no indication of ankylosis. Examination findings showed instability, dislocation or labral pathology with guarding of all arm movements on both shoulders. Clavicle, scapula, acromioclavicular (AC) joint or sternoclavicular joint condition was not suspected. Regarding the humerus, there was no loss of head, nonunion, or fibrous union of the humerus, or malunion of the humerus with moderate or marked deformity. In regard to employment, the examiner opined that the Veteran is unable to engage in manual labor or overhead work but is able to engage in sedentary employment. The Veteran was afforded another VA examination in September 2016. The Veteran reported constant shoulder pain with right side greater than the left side. He has difficulty in lifting a load. He reported flare-ups described as inability to pick up things. Functional loss was described as inability to lift 50 pounds dog food bag. On examination, right shoulder ROM was flexion of 0 to 145 degrees, abduction of 0 to 110 degrees, external rotation from 0 to 70 degrees, and internal rotation from 0 to 60 degrees with pain. Left shoulder ROM was flexion of 0 to 150 degrees, abduction of 0 to 110 degrees, and external and internal rotation of 0 to 75 degrees with pain. Observed repetitive use testing with at least three repetitions was performed with no additional functional loss. The examination was conducted immediately after repetitive use over time and during a flare-up. Muscle strength was normal and there was no muscle atrophy. Ankylosis was not found. The examiner noted shoulder instability, dislocation, or labral pathology. Specifically, the left shoulder had infrequent episodes and guarding of movement only at shoulder level. The right shoulder had frequent episodes and guarding of all arm movement. The examiner also noted clavicle, scapula, acromioclavicular (AC) joint, or sternoclavicular joint described as tenderness on palpation of the AC joint in the right shoulder. There was no loss of head, nonunion, fibrous union, or malunion of the humerus. Regarding employment, the examiner opined that the Veteran is an assistant manager in a local department store and primarily handles the customer issues and helps run the store. The Veteran reported the need to pick up 50 pounds dog food and if is unable to do so, he is told to go home. The examiner noted that the Veteran is capable of work which limits lifting to 5 pounds repetitively up to an hour of an 8 hour shift and 20 pounds for momentary lifting. The examiner noted that he cannot do any work that requires pushing, pulling, or overhead activities such as shelfing retail items. In an October 2016 addendum examination, the examiner found that active ROM for both shoulders were similar to the September 2016 findings. With passive ROM, right shoulder flexion was 0 to 160 degrees, abduction was 0 to 125 degrees, external rotation was 0 to 70 degrees, and internal rotation was 0 to 60 degrees. In the left shoulder, flexion was 0 to 150 degrees, abduction was 0 to 130 degrees, and external and internal rotation was 0 to 75 degrees. Examination of ROM on weight bearing in the right shoulder was flexion of 0 to 60 degrees, abduction of 0 to 45 degrees, and external rotation was 0 to 70 degrees. Left shoulder of flexion was 0 to 100 degrees, 0 to 70 degrees for abduction, and 0 to 75 degrees for external rotation. The examiner opined that the Veteran is capable of working as he is able to do sedentary managerial work without significant limitation or restriction. Further, he can work with certain accommodations such as lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. He is also limited in situation of lifting 20 pounds, of repetitive lifting to 5 pounds, and restrictions to pushing, pulling, and gross handling. He can operate a machine without problems such as a forklift. The examiner was afforded another examination in June 2017. The Veteran reported continuing to work as a support manager at a store and has complained of pain in both shoulders. He complained of painful clicking and popping, occasional swelling, and achy burning sensation to his pain with no locking. He reported missing work due to shoulder pain and lack of sleep due to pain. He has to limit overhead work and lifting. He reported flare-ups anywhere from every other day to once per week which will cause him to limit use of the shoulders and the need to relax. His flare-ups can last from 1 to 7 days. Functional loss reported as limited lifting and overhead motion. Evaluation of the right shoulder ROM showed flexion, abduction, external rotation, and internal rotation of 0 to 90 degrees, each, with pain. Left shoulder ROM was flexion of 0 to 110 degrees, abduction of 0 to 100 degrees, and external and internal rotation of 0 to 90 degrees with pain. Observed repetitive use testing was tested with no additional functional loss. The Veteran was examined immediately after repetitive use over time. The examination was not conducted during a flare-up and the examiner could not determine if pain, weakness, fatigability or incoordination would significantly limit functional ability with flare-ups. Muscle strength was normal and there was no muscle atrophy. Ankylosis was not found. Shoulder instability, dislocation or labral pathology was suspected with frequent episodes in both shoulders. Clavicle, scapula, acromioclavicular (AC) joint or sternoclavicular joint condition was suspected with right AC joint degenerative joint disease (DJD) and tenderness on palpation of the AC joint, both in the right shoulder. There was no loss of head, nonunion, fibrous union, or malunion of the humerus. Regarding employment, the examiner opined that the shoulders would limit work that requires prolonged repetitive heavy lifting, carrying, and overhead work. The examiner noted that his shoulders would not limit light to sedentary work up to chest level. The Veteran underwent another examination in April 2018. During the examination, the Veteran reported chronic generalized bilateral shoulder pain, increased with repetitive use, overhead use, and lifting. He did not report flare-ups. Evaluation of the right shoulder ROM showed flexion of 0 to 70 degrees, abduction of 0 to 45 degrees, external rotation of 0 to 60 degrees, and internal rotation of 0 to 50 degrees with pain. Left shoulder ROM showed flexion of 0 to 80 degrees, abduction of 0 to 60 degrees, external rotation of 0 to 70 degrees, and internal rotation of 0 to 60 degrees with pain. Observed repetitive use was performed with no additional functional loss. The Veteran was not examined immediately after repetitive use over time and the examiner could not determine if pain, weakness, fatigability or incoordination would significantly limit functional ability after repetitive use over time. Muscle strength was normal and there was no indication of muscle atrophy. Ankylosis was not found. Shoulder instability, dislocation or labral pathology was suspected with frequent episodes and guarding of all arm movements in both shoulders. Clavicle, scapula, acromioclavicular (AC) joint or sternoclavicular joint condition was not suspected. Regarding employment, the examiner opined that the Veteran is unable to engage in light, moderate, or heavy manual labor, or engage in overhead work and repetitive lifting. He is able to engage in sedentary, sitting work, such as data entry, phone service representative. Most recently, the Veteran presented for a VA examination in October 2019. The Veteran reported symptoms of chronic daily pain and recurrent dislocation of bilateral shoulders. He did not report flare-ups, and reported functional loss described as being unable to lift heavy objects or perform any overhead tasks. Evaluation of right shoulder ROM showed flexion of 0 to 70 degrees, abduction of 0 to 30 degrees, external rotation of 0 to 50 degrees, and internal rotation of 0 to 30 degrees with pain. Left shoulder ROM showed flexion of 0 to 70 degrees, abduction of 0 to 50 degrees, external rotation of 0 to 50 degrees, and internal rotation of 0 to 40 degrees with pain. The Veteran was able to perform repetitive use testing without additional functional loss. With repeated use over time, right shoulder ROM was estimated as flexion of 0 to 65 degrees, abduction of 0 to 25 degrees, external rotation of 0 to 45 degrees, and internal rotation of 0 to 30 degrees with pain. Left shoulder ROM on repeated use over time was estimated as flexion of 0 to 65 degrees, abduction of 0 to 45 degrees, external rotation of 0 to 45 degrees, and internal rotation of 0 to 35 degrees with pain. Muscle strength was rated 4 out of 5, with no indication of muscle atrophy. There was no ankylosis found. Shoulder instability, dislocation or labral pathology was suspected with frequent episodes in both shoulders. There was no clavicle, scapula, acromioclavicular (AC) joint or sternoclavicular joint condition suspected. There was no loss of head, nonunion, fibrous union, or malunion of the humerus. Regarding employment, it was noted that the Veteran is unemployed and lost about a week work time in the last 12 months. The Veteran reported being unable to lift heavy objects or perform any overhead tasks due to his chronic bilateral shoulder dislocation and impingement of bilateral shoulders, among others. As the Veteran reported at the October 2019 examination that the shoulder disabilities have progressively worsened over time, it would not be appropriate to apply findings from any examination to a period prior to the examination. Treatment records are not in significant conflict with the examination results. The Board finds the examination results are sufficient for purposes of rating the shoulder disabilities. Testing for pain has been conducted in both active and passive motion and in weight-bearing and nonweight-bearing. 38 C.F.R. § 4.59. Passive range of motion and weight-bearing range of motion testing has been performed. The Veteran denied flare-ups of his shoulder disabilities at all the examinations except for the September 2016 and June 2017 examinations; however, the September 2016 examination was performed during a flare-up and is probative as to functioning during flare-up. Examination findings from 2016 and 2017 were made after repetitive use over time and estimates of range of motion after repetitive use over time were provided in October 2019. Notably, the Veteran has been asked on numerous occasions to describe any flare-ups and the functional effects of his disabilities. He has done so but has not identified any additional range of motion loss of either shoulder resulting from flare-ups, repetitive use over time, weight-bearing, or during passive motion. To the extent his comments could be interpreted as suggesting additional decrease in motion, no details have been provided such that an examiner would be able to retroactively estimate range of motion during an unobserved set of circumstances. The Board is not opining on what a medical professional is or is not capable of determining; that is, the Board is not attempting to make a medical determination. Instead, the Board is noting that a question cannot be answered without underlying information and that underlying facts and information are not available in this case. 1. Shoulder Dislocation Right Shoulder Dislocation Rating prior to December 1, 2008 The Veteran’s right shoulder dislocation is rated under 38 C.F.R. § 4.71a, DC 5202. DC 5202 provides, with respect to the major arm, that impairment of the humerus with recurrent dislocation of the scapulohumeral joint with infrequent episodes and guarding of movement only at shoulder level should be rated as 20 percent disabling. A 30 percent rating is provided for impairment of the humerus with recurrent dislocation of the scapulohumeral joint with frequent episodes and guarding of all arm movements. A 50 percent rating is provided for impairment of the humerus with fibrous union. A 60 percent rating is provided for impairment of the humerus with nonunion, and an 80 percent rating is provided for impairment with loss of head. A 20 percent rating may also be awarded under this code for malunion of the humerus with moderate deformity. A 30 percent rating is awarded with malunion of the humerus with marked deformity. For the period prior to December 1, 2008, the Veteran is rated 40 percent under DC 5202, although the June 2004 rating decision suggests the 40 percent rating was actually assigned based on a condition analogous to ankylosis. See 38 C.F.R. § 4.71a, Diagnostic Code 5200 (2004). A review of the evidence of record, including the June 2008 VA examination, indicates there is no ankylosis of the Veteran’s right shoulder. Nevertheless, the Board will not disturb the already assigned favorable 40 percent rating prior to December 1, 2008. A higher rating of 50 percent is not warranted as the evidence continues to show no evidence of ankylosis. In addition, higher ratings are not warranted under DC 5202 because the evidence is against a finding that there is impairment of the humerus with fibrous union, nonunion or loss of head. Right Shoulder Dislocation Rating from December 1, 2008 For this period on appeal, the Veteran is rated 30 percent under DC 5202 for recurrent dislocation of at scapulohumeral joint with frequent episodes and guarding of all movements. A review of the evidence of record does not show any evidence of loss of head, nonunion, fibrous union, or malunion of the humerus to warrant a higher rating. As such, a rating in excess of 30 percent from December 1, 2008 for right shoulder dislocation is not warranted. Left Shoulder Dislocation Rating Prior to December 1, 2008 For the period prior to December 1, 2008, the Veteran is rated 30 percent under DC 5299-5202. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. Diagnostic Codes ending in “99” are used when there is no specifically applicable diagnostic code and the disability is rated by analogy, and DC 5202 is for other impairment of the humerus. Again, the Board notes that the June 2004 rating decision suggests the 30 percent rating was actually assigned based on a condition analogous to ankylosis. See 38 C.F.R. § 4.71a, Diagnostic Code 5200 (2004). A review of the evidence of record, including the June 2008 VA examination, indicates there is no ankylosis of the Veteran’s left shoulder. Nevertheless, the Board will not disturb the already assigned favorable 30 percent rating prior to December 1, 2008. A higher rating of 40 percent is not warranted as the evidence continues to show no evidence of ankylosis. In addition, higher ratings are not warranted under DC 5202 because the evidence is against a finding that there is impairment of the humerus with fibrous union, nonunion or loss of head. Left Shoulder Dislocation Rating from December 1, 2008 For this period on appeal, the Veteran is rated 20 percent under Diagnostic Code 5299-5203. Under DC 5203, a 20 percent evaluation, the maximum available under this section for the minor shoulder, is assignable for dislocation of the clavicle or scapula, or nonunion with loose movement. A higher rating in excess of the 20 percent evaluation is not warranted for the minor shoulder, as there is no evidence of ankylosis under DC 5200 or other impairments of the humerus under DC 5202. Notably, if the dislocations were to be rated under DC 5202 the same rating would still be warranted. Overall, the dislocations of the left shoulder are adequately compensated during this period. The evidence is against a finding that there is impairment of the humerus with fibrous union, nonunion or loss of head. Thus, the Board finds that a rating in excess of 20 percent from December 1, 2008 for the left shoulder dislocation is not warranted. 2. Shoulder Impingement Syndrome The Veteran’s right shoulder impingement syndrome is rated under Diagnostic Code 5201. Regarding the major shoulder, under Diagnostic Code 5201, limitation of the arm at shoulder level warrants 20 percent rating. Limitation of motion of the arm midway between side and shoulder level warrants a 30 percent rating. Limitation of motion of the arm to 25 degrees from the side warrants a maximum 40 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5201. Right Shoulder Impingement Rating prior to October 4, 2016 For this period on appeal, the Veteran is rated at 20 percent for his dominant shoulder. The evidence of record does not show evidence of limitation of motion midway between the side and shoulder level. Thus, a disability rating in excess of 20 percent for right shoulder impingement prior to October 4, 2016 is not warranted. Right Shoulder Impingement Rating for the period from October 4, 2016 to October 16, 2019 For this period on appeal, the Veteran is rated at 30 percent. The evidence of record does not show evidence of limitation of motion to 25 degrees from the side of the dominant arm. Thus, a disability rating in excess of 20 percent for right shoulder impingement for this period on appeal is not warranted. Right Shoulder Impingement Rating from October 17, 2019 For this period on appeal, the Veteran is rated at 40 percent, the maximum allowable rating for the major shoulder based on limitation of motion. A rating higher than 40 percent is not warranted as the evidence does not show ankylosis (Diagnostic Code 5200) or fibrous union, nonunion, or loss of head of the humerus (Diagnostic Code 5202), the next available higher ratings for the right shoulder disability. Left Shoulder Impingement Rating For the duration of the appeal period, the Veteran is currently rated at 20 percent under Diagnostic Code 5201 for his minor shoulder disability. A review of the evidence of record does not show that limitation of the left shoulder is to 25 degrees from the side, the next higher rating under Diagnostic Code 5201. Thus, a rating in excess of 20 percent for the left shoulder disability is not warranted. REASONS FOR REMAND The Board finds that additional development is necessary prior to deciding the claim of entitlement to a TDIU. In reviewing the record, it was noted during various times that the Veteran was employed as a manager at a department store. However, during the October 2019 VA examination, the examiner noted that the Veteran was unemployed from the same department store due to his shoulder disability. The Board finds that a remand is necessary to determine the Veteran’s current employment status. The matters are REMANDED for the following action: Request that the Veteran complete a VA Form 21-8940 (Veteran’s Application for Increased Compensation Based on Unemployability). If necessary, send a VA Form 21-4192 (Request for Employment Information in Connection with a Claim for Disability Benefits) to the Veteran’s former employers. Any necessary development as a result of the information provided by the Veteran should be undertaken. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mathew 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.