Citation Nr: 21005239 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 16-41 040 DATE: January 29, 2021 ORDER An initial rating in excess of 10 percent for a service-connected scar, surgical removal of lateral left clavicle, is denied. An initial 20 percent rating, but not higher, for a service-connected left shoulder acromioclavicular (AC) joint condition from April 30, 2015, to August 26, 2020, is granted. A rating in excess of 20 percent for a service-connected left shoulder AC joint condition (left shoulder disability) from August 27, 2020, forward, is denied. FINDINGS OF FACT 1. During the entire appellate period, the Veteran’s service-connected left shoulder scar has not been manifested by three or four unstable or painful scars. 2. Resolving all doubt in favor of the Veteran, prior to August 27, 2020, his service-connected left shoulder disability was manifested by pain in the affected joint, without motion of the arm limited to 25 degrees from side. 3. Since August 27, 2020, the Veteran’s service-connected left shoulder disability has not been manifested by motion of the arm limited to 25 degrees from side. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for a service-connected left shoulder scar have not been met during the entire appellate period. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.118, Diagnostic Code (DC) 7804. 2. The criteria for an initial 20 percent rating, and no more, for a service-connected left shoulder disability from April 30, 2015, to August 26, 2020, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.31, 4.71, 4.71a, DCs 5201, 5203. 3. The criteria for a rating in excess of 20 percent for a service-connected left shoulder disability since August 27, 2020, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.31, 4.71, 4.71a, DCs 5201, 5203. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 2013 to April 2015. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2015 rating decision that awarded service connection for a scar, surgical removal of lateral left clavicle (claimed as left shoulder condition and scar) and assigned an initial 10 percent disability rating, effective April 30, 2015. In his December 2015 notice of disagreement, the Veteran asserted that the 10 percent rating for his condition was “incomplete” as his condition was manifested by additional left shoulder disability, to include pain, limited motion, loss of muscle mass and strength, and nonunion of the joint. In a February 2016 rating decision, the RO awarded a separate, noncompensable rating for a left shoulder AC joint condition under Diagnostic Code 5203, effective April 30, 2015. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994) (Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition was not duplicative of or overlapping with the symptomatology of the other condition.). Thereafter, the Veteran continued to express dissatisfaction with the ratings assigned for his left shoulder disability, to include the scar and AC joint condition. See January 2019 Hearing transcript. In January 2019, he testified via videoconference before the undersigned Veterans Law Judge (VLJ) of the Department of Veterans Affairs (VA) Board of Veterans’ Appeals (Board), seated at the Board’s Central Office in Washington, D.C. A transcript of the hearing has been associated with the claims file. In January 2019, the Board remanded the Veteran’s increased rating claim to the VA Regional Office (RO) for additional development. The claims file has been returned to the Board for adjudication. Since that time, the RO, in a September 2020 rating decision, granted an increased rating for the Veteran’s left shoulder AC joint disability, from noncompensable to 20 percent disabling, effective August 27, 2020, and included this issue in its September 2020 Supplemental Statement of the Case (SSOC). The Veteran’s increased rating claim for his service-connected left shoulder disorder, to include a scar and AC joint disability, is an initial, increased rating claim pending under the Legacy system, rendering any disagreement with the September 2020 rating decision moot. The RO, in its September 2020 rating decision, also granted service connection for a scar of the left clavicle, rated as noncompensably disabling, effective August 13, 2018. However, the Veteran is already service connected for his left shoulder scar, such is the subject of the present appeal, and has been service connected since April 30, 2015. There is no evidence or assertion that there exists a second left shoulder scar that requires consideration by the Board in its adjudication of the present appeal; in fact, the RO, when it described the scar warranting service connection in its September 2020 rating decision, described such as having the precise location and measurements as the existing service-connected left shoulder scar.   Increased Ratings Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disability. 38 U.S.C. § 1155. Separate diagnostic codes identify the various disabilities. Id. It is necessary to rate the disability from the point of view of the Veteran working or seeking work, 38 C.F.R. § 4.2 and to resolve any reasonable doubt regarding the extent of the disability in the Veteran’s favor. 38 C.F.R. § 4.3. If there is a question as to which rating to apply to the Veteran’s disability, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Here, on appeal are the initial ratings, from the December 2015 and February 2016 rating decisions granting service connection for left shoulder scar and left shoulder disability, and assigning such an initial 10 percent and noncompensable ratings, respectively, each effective April 30, 2015. The severity of the disabilities is thus to be considered during the period from the initial assignment of the disability ratings, April 30, 2015, to the present. Fenderson v. West, 12 Vet. App. 119 (1999). Additionally, in determining the present level of a disability for any increased rating claim, the Board must consider the application of staged ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran bears the burden of presenting and supporting a claim for benefits. 38 U.S.C. § 5107 (a). In its evaluation, the Board considers all information and lay and medical evidence of record. 38 U.S.C. § 5107 (b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board gives the benefit of the doubt to the claimant. Id. In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board has considered the Veteran’s claims and decided entitlement based on the evidence. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to these claims. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 1. Entitlement to an initial rating in excess of 10 percent for service-connected left shoulder scar. The Veteran’s service-connected left shoulder scar is currently rated as 10 percent disabling pursuant to 38 C.F.R. § 4.118, DC 7804, for scars, unstable or painful. 38 U.S.C. § 4.118, DC 7804. DC 7800 contemplates burn scars or other disfigurement of the head, face, or neck; DC 7801 contemplates burns scars or scars due to other causes, not of the head, face, or neck, that are deep and nonlinear; DC 7802 contemplates burns scars or scars due to other causes, not of the head, face, or neck, that are superficial and nonlinear; and DC 7805 contemplates scars, other, and other effects of scars evaluated under DCs 7800, 7801 7802, and 7804. 38 C.F.R. § 4.118, DCs 7800, 7801, 7802, 7804. In a November 2015 Disability Benefits Questionnaire (DBQ) of the Veteran’s left shoulder disability, he complained that his left shoulder scar was tender if it was touched or if clothes rubbed against it. Physical examination revealed no scars that were painful or unstable, no scars having a total area greater than 39 square centimeters or located on the head, face, or neck, and no scars with a frequent loss of covering of the skin; the left shoulder scar measured 7 centimeters by .2 centimeters. In a November 2015 DBQ of the Veteran’s left shoulder scar, he presented with a stable, well-healed, residual scar from his January 2015 surgery. He complained that his scar was “touchy” and sensitive to light touch, stroking, or even clothes rubbing against it, and reported that these types of stimulation caused a burning sensation, worse if the scar was pinched or pressed on. Physical examination revealed one painful scar, and no scars that were unstable or with the frequent loss of covering of the skin, deep or non-linear, superficial non-linear, scars that were both painful and unstable, or burn scars; the left shoulder scar, a linear stable scar, measured 7 centimeters over the area of the left acromioclavicular joint. There was no objective evidence of pain or other symptoms when examined, limitation of function, other pertinent physical findings, complications, conditions, signs, or symptoms, or impact on the ability to work. During his January 2019 Board hearing, the Veteran complained that when his left shoulder scar was pushed it was uncomfortable, and that such is ugly and tender. He reported a sensation of fire when the scar was touched, “almost like nerve damage,” and he noted that he had to wear soft fabrics, so his scar was not touched. In an August 2020 DBQ of the Veteran’s left shoulder disability, physical examination revealed no scars that were painful, unstable, or having a total area equal to greater than 39 square centimeters, or scars of the head, face, or neck; the left shoulder scar measured 7 centimeters by .5 centimeters. In an August 2020 DBQ of the Veteran’s left shoulder scar, he complained that his scar still hurt. Physical examination revealed no scars that were unstable or with the frequent loss of covering of the skin, burn scars, or scars with underlying tissue damage; the left shoulder scar measured 7 centimeters by .5 centimeters. There was no limitation of function including limitation of motion, other pertinent physical findings, complications, conditions, signs, or symptoms, or impact on the ability to work. As the Veteran’s left shoulder scar does not involve his head, face, or neck, DC 7800 does not apply in the present appeal. While the Veteran’s scars are due to other causes than burns and are not of the head, face, and neck, his scars have not been described as deep and nonlinear or superficial and nonlinear; DCs 7801 and 7802 requiring such do not apply in the present appeal. As the rating criteria contemplate the Veteran’s scars, unstable or painful, without remaining symptoms considered by any other criteria, DC 7805, contemplating scars, other, and other effects of scars evaluated under DCs 7800, 7801 7802, and 7804, is also not applicable in the present appeal. 38 C.F.R. § 4.118, DCs 7800, 7801, 7802, 7803, 7805. The Board thus finds that the Veteran’s left shoulder scar is properly rated under DC 7804, contemplating scars, unstable or painful, and considers whether such may serve as a basis for an increased rating. Under DC 7804, one or two scars that are unstable or painful warrant a 10 percent rating, three or four such scars warrant a 20 percent rating, and five or more such scars warrant a maximum 30 percent rating. 38 C.F.R. § 4.118, DC 7804. The VA examiner, in November 2015, described the Veteran’s left shoulder scar as painful. The Veteran is competent to report pain in his left shoulder scar. Layno, 6 Vet. App. 465, 470. No party argues that the Veteran’s left shoulder scar is not manifested by pain, and the sensation of fire when touched or pressed on or bothered by fabric. Such represents the totality of the Veteran’s complaints related specifically to his left shoulder scar. To the extent that he may intend to assert that his service-connected left shoulder scar is associated with nerve or muscle damage, the Board finds that his assertion is not competent, as such represents a complex medical question. There is no evidence that he has the requisite medical expertise or training to diagnose nerve or muscle damage related to his service-connected left shoulder scar. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). His lay statements as to such thus lack probative value, as they are not competent. In any event, the Veteran’s general assertions as to nerve and muscle damage related to his left shoulder disability are considered in the adjudication herein of his claim of entitlement to an initial increased rating for his service-connected left shoulder disability. Thus, the remaining inquiry before the Board is how many unstable or painful scars exist, as DC 7804 requires three or four scars that are unstable or painful for an increased rating, a 20 percent rating. 38 C.F.R. § 4.118, DC 7804. As there is no evidence or assertion that the Veteran has three or four unstable or painful left shoulder scars, DC 7804, the only applicable rating criteria, may thus not serve as a basis for an initial rating in excess of 10 percent. Id. The Board has considered whether an increased rating might be warranted for any period of time during the pendency of this appeal. Fenderson, 12 Vet. App. 119; Hart, 21 Vet. App. 505. However, based on the above, the weight of the evidence demonstrates that an initial rating in excess of 10 percent for a service-connected left shoulder scar is not warranted. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. 49. 2. Entitlement to an initial compensable rating for a service-connected left shoulder disability prior to August 27, 2020, and a rating in excess of 20 percent since. The Veteran’s service-connected left shoulder disability has been rated as noncompensably disabling prior to August 27, 2020, and as 20 percent disabling since, pursuant to DCs 5203-5201, contemplating impairment of the clavicle or scapula, and limitation of motion of the arm, respectively. 38 C.F.R. § 4.71a, DCs 5203, 5201. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. In a November 2015 DBQ of the Veteran’s left shoulder disability, the examiner noted a left acromioclavicular injury with acromioclavicular joint arthritis and surgery during service. No diagnosis was provided. The Veteran reported that his right hand was his dominant hand, and reported no flare-ups of left shoulder symptoms, and no functional loss or impairment; he reported left shoulder scar tenderness. He presented with normal range of motion, flexion and abduction each to 180 degrees and external and internal rotation each to 90 degrees, without pain on examination and without pain on weight-bearing; there was no objective evidence of localized tenderness or pain on palpation, crepitus, ankylosis, rotator cuff condition, instability, loss of head, nonunion or fibrous union, malunion, or use of assistive devices. The cross-body adduction test was negative. There were normal muscles; strength was normal. The Veteran was able to perform repetitive motion, without additional loss of range of motion. He was not being examined immediately after repetitive use over time; the examiner reported that the examination was medically consistent with the Veteran’s statements regarding any functional loss with repetitive use over time and pain, weakness, fatigue, or incoordination did not significantly limit functional ability with repetitive use over time. There were no other pertinent physical findings, complications, conditions, signs, or symptoms, and there was no impact on the Veteran’s ability to perform any type of occupational tasks. There was no functional impairment such that no effective functions remain other than that which would be equally well-served by amputation. VA treatment records dated over the course of the appeal, in as early as November 2016, demonstrate the Veteran’s complaints of left shoulder pain. In April 2018, the Veteran described his left shoulder pain as throbbing. In February 2019, he complained of left shoulder pain, constant and sharp; physical examination revealed limited range of motion and weakness in the left shoulder when compared to the right shoulder. In July 2019, the Veteran reported that his left shoulder pain radiated to his mid-back and caused nerve pain in the left hand. In May 2020, he presented with an exacerbation of left shoulder pain. During his January 2019 Board hearing, the Veteran reported that there was a problem with his VA examination, that while the examiner reported that he had normal range of motion, he could not raise his left arm to shoulder level and his left shoulder was pushed and it was uncomfortable. He asserted that he had nerve damage, limited motion, limited strength, and pain, and that he had lost a couple of jobs due to his limited motion. In an August 27, 2020, DBQ of the Veteran’s left shoulder disability, he was diagnosed with left acromioclavicular joint osteoarthritis. He reported flare-ups of left shoulder symptoms, two-to-three times monthly, mild in nature, lasting four days, precipitated by activity and alleviated by rest, without functional loss or impairment. He presented with abnormal range of motion, flexion and abduction each to 110 degrees and external and internal rotation each to 60 degrees; there was pain on examination in all planes, but such did not result in functional loss. There was objective evidence of tenderness to palpation, without pain on weight-bearing, non-weight-bearing, or passive motion. The Veteran was able to perform repetitive use testing, without additional loss of function or loss of range of motion. The examination was performed immediately after repetitive use, there was no pain, weakness, fatigue, or incoordination that significantly limited functional ability. The examination was not conducted during a flare-ups and was neither medically consistent nor inconsistent with the Veteran’s statements as to functional loss during a flare-up. No pain, weakness, fatigue, incoordination significantly limited functional ability during a flare-up. The Veteran had normal muscle strength; there was no atrophy, ankylosis, crepitus, instability, dislocation, or labral pathology or rotator cuff condition suspected. There was no use of assistive devices, loss of head, malunion, or a humeral condition that impacted range of motion of the shoulder. There were no other pertinent physical findings, complications, conditions, signs, or symptoms. There was no functional impairment such that no effective functions remain other than that which would be equally well-served by amputation. The impact of his left shoulder disability on his ability to work included being able to frequently lift 10 pounds and occasionally lift 20 pounds overhead. In an August 27, 2020, DBQ of the Veteran’s peripheral nerves, he was not diagnosed with a disability of the nerves related to his left shoulder. The examiner cited VA treatment showing left shoulder complaints without peripheral neuropathy. The Veteran had no symptoms of a peripheral nerve condition, including constant pain, intermittent pain, paresthesias and/or dysesthesias, or numbness. Strength, deep tendon reflexes, and sensation to light touch were normal. There were no trophic changes. There was no use of assistive devices. There were no other pertinent physical findings, complications, conditions, signs, or symptoms. There was no functional impairment such that no effective functions remain other than that which would be equally well-served by amputation. There was no impact on the ability to work. In an August 27, 2020, DBQ of the Veteran’s muscles, he was not diagnosed with a disability of the muscles related to his left shoulder. The examiner cited VA treatment showing left shoulder complaints without a muscle diagnosis, including results of December 2013 magnetic resonance imaging (MRI), dated prior to the current appellate period, revealing normal muscle size. There were no penetrating or non-penetrating muscle injuries, injuries to a muscle group of the shoulder girdle or arm, known fascial defects or evidence of fascial defects associated with any muscle injuries, or muscle injuries that affect any muscle substance or function. There were no signs or symptoms attributable to any muscle injury including loss of power, weakness, lowered threshold of fatigue, fatigue or pain, impairment of coordination, or uncertainty of movement. Muscle strength testing was normal and there was no muscle atrophy. There was no use of assistive devices. There were no other pertinent physical findings, complications, conditions, signs, or symptoms. There was no functional impairment such that no effective functions remain other than that which would be equally well-served by amputation. There was no impact on the ability to work. As the Veteran’s left shoulder disability has not been diagnosed as, and there is no evidence of assertion of, ankylosis of the scapulohumeral articulation or impairment of the humerus, DCs 5200 and 5202 requiring such do not apply in the present appeal. 38 C.F.R. § 4.71a, DCs 5200, 5202. The Board thus finds that the Veteran’s left shoulder disability is properly rated under DCs 5203-5201, contemplating impairment of the clavicle or scapula, and limitation of motion of the arm, respectively, and considers whether such may serve as bases for an increased rating or separate ratings. 38 C.F.R. § 4.71a, DCs 5201, 5203. Under DC 5203, contemplating impairment of the clavicle or scapula, a 10 percent rating is warranted for malunion; a 10 percent rating is also warranted for nonunion, without loose movement; a 20 percent rating is warranted for nonunion, with loose movement; and a 20 percent rating is warranted for dislocation. 38 C.F.R. § 4.71a, DC 5203. Under DC 5201, contemplating limitation of motion of the arm, a minimum 20 percent rating is warranted for limitation of motion of the minor or major upper extremity at shoulder level; a 20 percent rating is also warranted for limitation of motion of the minor upper extremity midway between side and shoulder; and a maximum 30 percent rating is warranted for limitation of motion of the minor upper extremity to 25 degrees from side. 38 C.F.R. § 4.71a, DC 5201. See 38 C.F.R. § 4.31 (providing that in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation will be assigned when the requirements for a compensable evaluation are not met). Normal forward flexion of a shoulder and normal abduction is from 0 to 180 degrees and normal external and internal rotation is from 0 to 90 degrees. 38 C.F.R. § 4.71; Plate I. In the November 2015 DBQ, the Veteran reported that his right hand was his dominant hand thus rendering his left shoulder the minor joint as it pertains to the rating criteria. As there is no evidence or assertion of malunion, nonunion, or dislocation of the left shoulder, DC 5203, contemplating impairment of the clavicle or scapula and providing ratings for such symptoms, may not serve as a basis for an increased rating in the present appeal. 38 C.F.R. § 4.71a, DC 5203. The Board thus turns its attention to DC 5201, contemplating limitation of motion of the arm. 38 C.F.R. § 4.71a, DC 5201. Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation of parts of the system, to perform the normal working movements of the body with normal excursion, strength, coordination, and endurance. 38 C.F.R. § 4.40. The functional loss may be due to the loss of part or all of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, and evidenced by visible behavior of the claimant undertaking the motion. Id. Weakness is as important as limitation of motion, and a body part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.40, 4.45; see also DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability; actually painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of sections 4.40 and 4.45 pertaining to functional impairment. DeLuca, 8 Vet. App. at 207-08. In applying these regulations, VA must obtain examinations in which the examiner determines whether the disability was manifested by pain, weakened movement, excess fatigability, incoordination, and flare-ups which resulted in functional loss. These determinations, if feasible, should be expressed in terms of the degree of additional range-of-motion loss due to those factors. DeLuca, 8 Vet. App. at 207-08; see also Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Functional loss of a joint can give rise to a higher schedular rating, to include if such functional loss is due to pain, but pain itself does not rise to the level of functional loss contemplated by VA regulations. See Mitchell, 25 Vet. App. at 37-38. VA examinations for musculoskeletal conditions must also include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint, and elicit relevant information as to the Veteran’s flares or ask him to describe additional functional loss, if any, he suffered during flares and then estimate the functional loss. 38 C.F.R. § 4.59; Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26, 35 (2017). As discussed above, for the period prior to August 27, 2020, during the November 2015 DBQ, the Veteran demonstrated normal range of motion, without pain, flare-ups of left shoulder symptoms, or functional loss or impairment, which warrants a noncompensable rating under DC 5201. 38 C.F.R. §§ 4.31, 4.71a, DC 5201. For the period since August 27, 2020, during the August 27, 2020, DBQ, the Veteran demonstrated flexion and abduction each to 110 degrees and external and internal rotation each to 60 degrees with pain not resulting in functional loss and flare-ups not resulting in functional loss or impairment, which warrants a noncompensable rating under DC 5201, as such motion is not limited to at least shoulder level or midway between side and shoulder level. Id. As the August 27, 2020, DBQ considered range of motion testing for pain in active, passive, non-weight-bearing, and weight-bearing motion, and addressed the Veteran’s reported flare-ups of left shoulder symptoms, considering the severity, frequency, duration, and precipitating and relieving factors, as well as resulting functional limitation or impairment, such is adequate under Correia and Sharp and remedies any corrective action needed related to the November 2015 DBQ. The RO, in its September 2020 rating decision, applied 38 C.F.R. § 4.59 and considered that the Veteran’s painful left shoulder joint warranted the minimum compensable rating for the joint, and assigned his service-connected left shoulder disability a 20 percent rating, for limitation of motion of the arm under DC 5201, effective August 27, 2020. Indeed, while the November 2015 DBQ recorded that the Veteran did not report pain in the affected joint, the Board has considered the Veteran’s lay statements and VA treatment records dated prior to August 27, 2020. As discussed above, in as early as November 2016, the Veteran complained of left shoulder pain during VA treatment and in February 2019, during the period prior to August 27, 2020, he complained of left shoulder pain and demonstrated limited range of motion and weakness. Such was not of record at the time of the RO’s February 2016 rating decision that granted service connection for a left shoulder disability and assigned the same an initial noncompensable rating, effective April 30, 2015. Based on such, the Veteran’s pain in the affected joint, his left shoulder disability, recorded during VA treatment in as early as November 2016, and his lay statements describing left shoulder pain prior to August 27, 2020, and specifically during the November 2015 VA examination, the Board applies the provisions of 38 C.F.R. § 4.59 and DeLuca and grants herein an initial 20 percent rating for a service-connected left shoulder disability, the minimum compensable rating for the joint, and no more, for limitation of motion of the arm under DC 5201. 38 C.F.R. § 4.71a, DC 5201. As to whether there is a basis for a rating in excess of 20 percent for a service-connected left shoulder disability under DC 5201, requiring motion of the arm limited to 25 degrees from side, at any time during the appeal, the Board finds that there is none. The Board has considered the Veteran’s January 2019 Board hearing testimony in which he asserted that the VA examiner, in November 2015, did not properly measure his range of motion, that he could not raise his left arm to shoulder level. To the extent that such represents lay statements of motion of arm limited to 25 degrees from side, review of the November 2015 DBQ indicates that such is complete, there is no indication that the examiner did not properly record the Veteran’s complaints or range of motion testing results. The Board cannot reconcile the Veteran’s assertion that he was both unable to raise his left arm to shoulder level and the examination report showing full range of motion, motion not in any way as severe as motion limiting one from raising their arm to shoulder level. It is significant that five years later, when the Veteran did demonstrate abnormal range of motion, he did not demonstrate such so severe as to limit him from raising his left arm to shoulder level. The Veteran is competent to report that he was unable to lift his left arm to shoulder level during the November 2015 DBQ. Layno, 6 Vet. App. 465, 470. However, the Board finds that his assertion in this regard is not credible, and thus lacking in probative value, based on the contemporaneous medical evidence of record, the detailed examination report showing normal range of motion without pain or functional limitation and silent for any left shoulder symptoms beyond that of a painful scar. As a finder of fact, when considering whether lay evidence is satisfactory, the Board may properly consider internal inconsistency of the statements, facial plausibility, and consistency with other evidence submitted on behalf of the appellant, and the claimant’s demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F. 3d 604 (Fed. Cir. 1996). The Board has also considered the instance of treatment in February 2019 during which the Veteran demonstrated limited range of motion in the left shoulder when compared to the right shoulder. However, the treatment records dated at that time did not include results of range of motion testing; there is thus no evidence upon which the Board may consider to determine if the Veteran’s left shoulder motion, accounting for any weakness, was limited to 25 degrees from side, as is required for a rating in excess of 20 percent under DC 5201. 38 C.F.R. § 4.71a, DC 5201. The Board has also considered results of the August 27, 2020, DBQ, the only evidence, medical or lay, of the Veteran’s service-connected left shoulder disability dated during the period since August 27, 2020. At that time, he demonstrated flexion and abduction each to 110 degrees and external and internal rotation each to 60 degrees with pain not resulting in functional loss and flare-ups not resulting in functional loss or impairment. As discussed, such warrants a noncompensable rating under DC 5201, as such motion is not limited to at least shoulder level or midway between side and shoulder level. 38 C.F.R. § 4.71a, DC 5201. The 20 percent rating in place for a service-connected left shoulder disability already considers 38 C.F.R. § 4.59 and DeLuca and provides the minimum compensable rating for the affected joint for limitation of motion of the arm under DC 5201. There is no evidence or assertion, and thus no basis for consideration of any pain resulting in limited motion, of motion limited to 25 degrees from side, as is required for a higher rating, the maximum rating, 30 percent, under DC 5201. 38 C.F.R. § 4.71a, DC 5201. Finally, the Board has considered the Veteran’s January 2019 Board hearing testimony wherein he asserted that his service-connected left shoulder disability, in pertinent part, was manifested by nerve damage and limited strength. The Board, in its January 2019 remand, based on the Veteran’s lay statements, directed the RO to afford the Veteran VA examinations beyond that of the general shoulder examination, specifically, examinations specific to nerve and muscle disabilities to ascertain if there were symptoms of his service-connected left shoulder disability related to nerve and muscle damage that warranted consideration in any increased rating claim(s) or separate ratings. As discussed above, the August 2020 DBQs of the Veteran’s peripheral nerves and muscles, as well as his VA treatment records, were all silent for any diagnoses of nerve or muscle disabilities. There is no evidence that the Veteran, while reporting complains of the sensations he attributes to nerve or muscle damage, has the requisite medical expertise or training to diagnose nerve or muscle disabilities related to his service-connected left shoulder disability; his assertions are thus not competent and lack probative value. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). While the Veteran himself reported, during VA treatment in July 2019, left shoulder pain that radiated to his mid-back and caused nerve pain in the left hand, a nerve disability was not diagnosed or reported resultant to physical examination by the treatment provider; his lay statements rendered to the treatment provider are not competent and lack probative value. Id. While pain, in this case, the nerve and muscle pain that the Veteran may report, that results in functional impairment may constitute a disability, even in the absence of an underlying diagnosis, there is no evidence of such in the present appeal. Saunders v. Wilkie, 886 F.3d 1356, 1365-66 (Fed. Cir. 2018). The VA examiners, in August 2020, provided detailed accounts of symptoms and functional limitations that could be attributed to nerve or muscle disabilities; there were none. (Continued on the next page)   In summary, resolving all doubt in favor of the Veteran, an initial rating of 20 percent, and no more, for a service-connected left shoulder disability, is warranted prior to August 27, 2020, however, the preponderance of the evidence reflects that during the entire appellate period, the symptoms of the Veteran’s service-connected left shoulder disability do not warrant a rating in excess of 20 percent. Fenderson, 12 Vet. App. 119; Hart, 21 Vet. App. 505. Thus, the claim of entitlement to an initial compensable rating for a service-connected left shoulder disability prior to August 27, 2020, is granted and the claim of entitlement to a rating in excess of 20 percent for a service-connected left shoulder disability since August 27, 2020, is denied. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. 49. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.