Citation Nr: 21061571 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 15-32 452 DATE: October 4, 2021 ORDER Entitlement to an initial 10 percent evaluation, but no higher, from March 11, 2013 to September 7, 2015 for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear is granted. Entitlement to an initial 20 percent evaluation, but no higher, from September 8, 2015 to July 7, 2021 for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear is granted. Entitlement to an initial evaluation in excess of 20 percent from July 8, 2021 to the present for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear is denied. FINDINGS OF FACT 1. Resolving all reasonable doubt in favor of the Veteran, from March 11, 2013 to September 7, 2015, the Veteran's recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear is characterized by painful motion of the left shoulder. 2. Resolving all reasonable doubt in favor of the Veteran, from September 8, 2015 to July 7, 2021, the Veteran's recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear more closely approximates recurrent dislocation of humerus at scapulohumeral joint with infrequent episodes and guarding of movement only at shoulder level. 3. From July 8, 2021 to the present, the Veteran's recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear manifests flexion limited to no less than 130 degrees and abduction limited to no less than 120 degrees. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial 10 percent evaluation from March 11, 2013 to September 7, 2015 for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. 2. The criteria for entitlement to an initial 20 percent evaluation from September 8, 2015 to July 7, 2021 for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5201, 5202. 3. The criteria for entitlement to an initial evaluation in excess of 20 percent from July 8, 2021 to the present for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5201, 5202. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Marine Corps from November 1997 to November 2001 and in the U.S. Army from April 2004 to September 2009 with additional periods of service in the Army National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which, in pertinent part, granted service connection for left shoulder strain and assigned a noncompensable evaluation, effective March 11, 2013. The Veteran appealed for an initial compensable evaluation. In May 2019 correspondence, the Veteran withdrew his request for a Board hearing. In April 2021, the Board remanded the issue on appeal for additional development. As the actions specified in the remand have been substantially completed, the matter has been properly returned to the Board for appellate consideration. See Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). During the pendency of the appeal, the RO issued an August 2021 rating decision granting a 20 percent evaluation for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear, effective July 8, 2021. The Veteran continued to appeal for a higher initial evaluation for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear. AB v. Brown, 6 Vet. App. 35 (1993) (holding that a claimant is presumed to be seeking the maximum rating). Duties to Notify and Assist Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159. The Veteran has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Increased Evaluation 1. Entitlement to an initial 10 percent evaluation from March 11, 2013 to September 7, 2015 for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear 2. Entitlement to an initial 20 percent evaluation from September 8, 2015 to July 7, 2021 for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear 3. Entitlement to an initial evaluation in excess of 20 percent from July 8, 2021 to the present for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear The Veteran asserts that his service-connected left shoulder disability is worse than his current evaluations reflect. Specifically, in a March 2014 Notice of Disagreement (NOD), the Veteran reported having increased pain and limitations of use over time. He said that his left shoulder disability had a profound effect on normal daily activities and that his strength, mobility, and stability were limited. Additionally, the Veteran said that his left shoulder problems would limit the types of jobs and sustainability for which he would be applying following his school graduation. In a September 2015 VA Form 9, the Veteran disputed the assessment made at his December 2013 VA examination, because it was based on a single moment or evaluation of discomfort and range of motion. The Veteran explained that due to his left shoulder disability, he had chronic subluxation and pain and weakness and instability of the joint, which forced him to limit his job and career search to work that would not require regular shoulder exertion. Finally, in a May 2019 statement, the Veteran reported that his left shoulder was now falling asleep when he held it relaxed at his side. He also said that he was unable to lift his arm straight up above his head. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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 for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. Because the level of disability may have varied over the course of the claim, the rating may be "staged" higher or lower for segments of time during the period under review in accordance with such variations. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). In initial-rating cases, where the appeal stems from a granted claim of service connection with respect to the initial evaluation assigned, VA assesses the level of disability from the effective date of service connection. See Fenderson, 12 Vet. App. at 125; 38 U.S.C. § 5110; 38 C.F.R. § 3.400. It should also be noted that, when evaluating disabilities of the musculoskeletal system, 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. DeLuca v. Brown, 8 Vet. App. 202 (1995). Further, 38 C.F.R. § 4.45 provides that consideration also be given to decreased movement, weakened movement, excess fatigability, incoordination, and pain on movement, swelling, and deformity or atrophy of disuse. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40; DeLuca, 8 Vet. App. at 205. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology or evidenced by visible behavior of the claimant undertaking the motion. Id. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Id. The factors involved in evaluating, and rating disabilities of the joints include weakness; fatigability; incoordination; restricted or excess movement of the joint, or pain on movement. 38 C.F.R. § 4.45. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Painful motion is considered limited motion at the point that pain actually sets in. See VAOPGCPREC 09-1998. 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. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). However, pyramiding, that is the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a Veteran's service-connected disability. 38 C.F.R. § 4.14. The Veteran's service-connected left shoulder disability has been currently evaluated as noncompensable, effective March 11, 2013, and as 20 percent disabling effective July 8, 2021, under 38 C.F.R. § 4.71a, Diagnostic Code 5201. However, VA is required to evaluate the Veteran's disability under the most appropriate rating criteria that will provide the most benefit to the Veteran. The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, diagnosis, and demonstrated symptomatology. Any change in diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). The Board notes that VA has amended the rating criteria for musculoskeletal system disabilities effective from February 7, 2021. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after February 7, 2021. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. With respect to disabilities of the shoulder, 38 C.F.R. § 4.71a, Diagnostic Codes 5200 through 5203 set forth the relevant provisions. However, in this case, the evidence does not demonstrate ankylosis of the shoulder (Diagnostic 5200) or impairment of clavicle or scapula (Diagnostic Code 5203), thus, the diagnostic codes pertaining to such impairments are not applicable. Handedness for the purpose of a dominant extremity rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. The injured hand, or the most severely injured hand, of an ambidextrous individual will be considered the dominant hand for rating purposes. 38 C.F.R. § 4.69. In this case, the evidence (e.g., December 2013 VA examination) shows that the Veteran is right-handed. Consequently, for rating purposes, the left shoulder is the minor upper extremity. Prior to February 7, 2021, Diagnostic Code 5201 for limitation of motion of the arm, pertinent to the major upper extremity, provides a minimum 20 percent rating for limitation of motion of the arm at the shoulder level. A 30 percent rating is assigned of limitation of motion of the arm midway between side and shoulder level. A 40 percent rating is assigned for limitation of motion of the arm to 25 degrees from side. Under Diagnostic Code 5201 for limitation of motion of the arm, pertinent to the minor upper extremity, a minimum 20 percent rating is assigned for limitation of motion of the arm at shoulder level. A 20 percent rating is assigned for limitation of motion of the arm midway between side and shoulder level. A 30 percent rating is assigned for limitation of motion of the arm to 25 degrees from side. Effective February 7, 2021, Diagnostic Code 5201 for limitation of motion of the arm, pertinent to the major upper extremity, provides a minimum 20 percent rating for limitation of motion of the arm at shoulder level (flexion and/or abduction limited to 90 degrees). A 30 percent rating is assigned for limitation of motion of the arm midway between side and shoulder level (flexion and/abduction limited to 45 degrees). A 40 percent rating is assigned for limitation of motion of the arm flexion and/or abduction limited to 25 degrees from side. Under Diagnostic Code 5201 for limitation of motion of the arm, pertinent to the minor upper extremity, a minimum 20 percent rating is assigned for limitation of motion of the arm at shoulder level (flexion and/or abduction limited to 90 degrees). A 20 percent rating is assigned for limitation of motion of the arm midway between side and shoulder level (flexion and/abduction limited to 45 degrees). A 30 percent rating is assigned for limitation of motion of the arm flexion and/or abduction limited to 25 degrees from side. Prior to February 7, 2021, Diagnostic Code 5202 for other impairment of humerus, pertinent to the major upper extremity, provides a 20 percent rating for malunion of the humerus with moderate deformity. A 30 percent rating is assigned for malunion of the humerus with marked deformity. A 20 percent rating is assigned for recurrent dislocation of humerus at scapulohumeral joint with infrequent episodes and guarding of movement only at shoulder level. A 30 percent rating is assigned for recurrent dislocation of humerus at scapulohumeral joint with frequent episodes and guarding of all arm movements. A 50 percent rating is assigned for fibrous union of humerus. A 60 percent rating is assigned for nonunion of humerus (false flail joint). A 80 percent rating is assigned for loss of head of humerus (flail shoulder). Under Diagnostic Code 5202 for other impairment of the humerus, pertinent to the minor upper extremity, a 20 percent rating is assigned for malunion of the humerus with moderate deformity. A 20 percent rating is assigned for malunion of the humerus with marked deformity. A 20 percent rating is assigned for recurrent dislocation of humerus at scapulohumeral joint with infrequent episodes and guarding of movement only at shoulder level. A 20 percent rating is assigned for recurrent dislocation of humerus at scapulohumeral joint with frequent episodes and guarding of all arm movements. A 40 percent rating is assigned for fibrous union of humerus. A 50 percent rating is assigned for nonunion of humerus (false flail joint). A 70 percent rating is assigned for loss of head of humerus (flail shoulder). Effective February 7, 2021, Diagnostic Code 5202 for other impairment of humerus, pertinent to the major upper extremity, provides a for malunion of the humerus with moderate deformity. A 30 percent rating is assigned for malunion of the humerus with marked deformity. A 20 percent rating is assigned for recurrent dislocation of humerus at scapulohumeral joint with infrequent episodes and guarding of movement only at shoulder level (flexion and/or abduction at 90 degrees). A 30 percent rating is assigned for recurrent dislocation of humerus at scapulohumeral joint with frequent episodes and guarding of all arm movements. A 50 percent rating is assigned for fibrous union of humerus. A 60 percent rating is assigned for nonunion of humerus (false flail joint). A 80 percent rating is assigned for loss of head of humerus (flail shoulder). Under Diagnostic Code 5202 for other impairment of the humerus, pertinent to the minor upper extremity, a 20 percent rating is assigned for malunion of the humerus with moderate deformity. A 20 percent rating is assigned for malunion of the humerus with marked deformity. A 20 percent rating is assigned for recurrent dislocation of humerus at scapulohumeral joint with infrequent episodes and guarding of movement only at shoulder level (flexion and/or abduction at 90 degrees). A 20 percent rating is assigned for recurrent dislocation of humerus at scapulohumeral joint with frequent episodes and guarding of all arm movements. A 40 percent rating is assigned for fibrous union of humerus. A 50 percent rating is assigned for nonunion of humerus (false flail joint). A 70 percent rating is assigned for loss of head of humerus (flail shoulder). Normal range of motion of the shoulder is from 0 to 180 degrees of flexion, from 0 to 180 degrees of abduction, and from 0 to 90 degrees of internal and external rotation. 38 C.F.R. § 4.71, Plate I. At a December 2013 VA examination, the Veteran reported having flare-ups, which was described as reduction in strength and stability. Range of motion testing revealed left shoulder flexion to 180 degrees without pain and left shoulder abduction to 180 degrees without pain. Following repetitive use testing, there was no additional limitation in range of motion. No functional loss for the left upper extremity was found. The December 2013 VA examiner concluded that there were contributing factors of pain, weakness, fatigability and/or incoordination, but there was no additional limitation of functional ability of the left shoulder during flare-ups or repeated use over time. No guarding of either shoulder was found. The Veteran's left shoulder had normal muscle strength testing results. No ankylosis was noted. Rotator cuff conditions testing results were negative. The December 2013 VA examiner found that the Veteran's left shoulder had no history of mechanical symptoms, no history of recurrent dislocation (subluxation) of the glenohumeral (scapulohumeral) joint, and no acromioclavicular joint condition or any other impairment of the clavicle or scapula. Overall, the December 2013 VA examiner diagnosed the Veteran with left shoulder strain. VA treatment records from December 2016 to October 2017 document that the Veteran sought treatment for his left shoulder problems. He complained of having left shoulder pain and numbness. At a July 2021 VA examination, the Veteran reported having symptoms of left shoulder pain and stiffness with recurrent subluxation and dislocation. The Veteran reported having flare-ups, which were described as increased pain, stiffness, and decreased range of motion, occurred every two to three months, and lasted three to five days. When symptomatic, the Veteran had difficulty with most shoulder movements, had difficulty with activities of daily living, including driving, and was also unable to lift or carry items. Range of motion testing revealed left shoulder flexion to 160 degrees with pain and left shoulder abduction to 150 degrees with pain. The July 2021 VA examiner found that pain, fatigability, and weakness significantly limited functional ability with repeated use over time. With repeated use over time, the Veteran's left shoulder flexion was further limited to 150 degrees, and his left shoulder abduction was further limited to 140 degrees. The July 2021 VA examiner found that pain, fatigability, and weakness significantly limited functional ability with flare-ups. With flare-ups, the Veteran's left shoulder flexion was further limited to 130 degrees, and his left shoulder abduction was further limited to 120 degrees. No ankylosis was noted. The July 2021 VA examiner found that there was left shoulder instability, dislocation, or labral pathology and left shoulder mechanical symptoms. There were infrequent episodes and guarding of movement only at shoulder level (flexion and/or abduction at 90 degrees). Overall, the July 2021 VA examiner concluded that the Veteran's diagnoses for left rotator cuff tendonitis, left labral tear, left glenohumeral joint instability, and left glenohumeral joint dislocation/recurrent dislocation was a correction of the previous diagnosis. Finding that the Veteran's left shoulder strain had resolved, the July 2021 VA examiner determined that the Veteran's in-service left shoulder injury resulted in a labral tear as well as a probable rotator cuff pathology. Finally, the July 2021 VA examiner found that the disruption of the integrity of the glenohumeral joint as a result of the injury created glenohumeral joint instability with the subsequent development of recurrent left glenohumeral joint subluxation/dislocation. Based on a careful review of all the subjective and clinical evidence, and resolving all reasonable doubt in favor of the Veteran, the Board finds that from March 11, 2013 to September 7, 2015, his service-connected left shoulder disability warrants a minimum 10 percent initial evaluation under 38 C.F.R. § 4.59 for painful motion. Viewing the evidence in the light most favorable to the Veteran, the Board finds that the subjective reports made in the March 2014 NOD provide the most probative evidence concerning the extent of the Veteran's left shoulder symptoms during this appeal period. Although the December 2013 VA examiner found that the Veteran did not have painful motion upon objective evaluation, the Veteran disputed those findings and explained that his pain and limitation of use had increased over time. Given the overall record, the Board finds that the Veteran's statements concerning the nature and extent of his left shoulder symptoms are both competent and credible. Thus, the Board concludes that from March 11, 2013 to September 7, 2015, the Veteran's service-connected left shoulder disability warrants a minimum 10 percent initial evaluation for painful motion under 38 C.F.R. § 4.59. However, neither the available clinical findings nor the subjective reports support a higher 20 percent evaluation under Diagnostic Code 5201, as the Veteran's left shoulder did not manifest flexion and/or abduction limited to the shoulder level. Accordingly, the Veteran's service-connected left shoulder disability is no more than 10 percent disabling from March 11, 2013 to September 7, 2015. Based on a careful review of all the subjective and clinical evidence, and resolving all reasonable all doubt in favor of the Veteran, the Board finds that from September 8, 2015 to July 7, 2021, his service-connected left shoulder disability warrants a higher 20 percent initial evaluation under Diagnostic Code 5202. On that basis, the Board finds that the clinical findings at the July 2021 VA examination coupled with the competent and credible reports by the Veteran on his September 2015 VA Form 9 provide the most probative evidence concerning the extent and severity of his left shoulder symptoms. Given that the July 2021 VA examiner determined that the Veteran's diagnosis for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear was a correction of the previous diagnosis for left shoulder strain, which had resolved, the Board finds that the Veteran's service-connected left shoulder disability was worse than the clinical findings of the December 2013 VA examination documented. Notably, the July 2021 VA examiner also explained how the Veteran's left shoulder symptoms had progressed since his in-service injury. Finally, at the July 2021 VA examination, the VA examiner found that the Veteran's left shoulder had infrequent episodes and guarding of movement only at shoulder level (flexion and/or abduction at 90 degrees). Based on the available evidence, the Board finds that the September 2015 reports that the Veteran experienced chronic subluxation and pain and weakness and instability of the joint provides the earliest indication of when the Veteran's symptoms were consistent with a 20 percent evaluation under Diagnostic Code 5202 for recurrent dislocation of the humerus at scapulohumeral joint with infrequent episodes, and guarding of movement only at shoulder level of a minor extremity. However, the available evidence does not support a higher 30 percent initial evaluation for a minor extremity, as the Veteran's left shoulder did not manifest flexion and/or abduction limited to 25 degrees from the side under Diagnostic Code 5201. Furthermore, the available evidence does not support a higher 40 percent evaluation for a minor extremity, as the Veteran's left shoulder disability did not manifest fibrous union of the humerus under Diagnostic Code 5202. Accordingly, the Board concludes that the Veteran's service-connected left shoulder disability is no more than 20 percent disabling from September 8, 2015 to July 7, 2021. Finally, based on a careful review of all the subjective and clinical evidence, the Board finds that from July 8, 2021 to the present, the Veteran's service-connected left shoulder disability does not warrant a higher 30 percent initial evaluation under Diagnostic Code 5201 for a minor extremity. In other words, the Veteran's left shoulder disability did not manifest flexion and/or abduction limited to 25 degrees from the side. Rather, the clinical findings at the July 2021 VA examiner show that the Veteran's left shoulder flexion was limited to no less than 130 degrees and abduction was limited to no less than 120 degrees. Notably, these findings took into consideration the functional loss exhibited by repeated use over time and flare-ups of the Veteran's left shoulder disability. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board notes that a higher 30 percent evaluation is not available under Diagnostic Code 5202 for a minor extremity. Nevertheless, the Veteran's service-connected left shoulder disability also does not warrant a higher 40 percent evaluation under Diagnostic Code 5202 for a minor extremity. In other words, the Veteran's left shoulder disability did not manifest fibrous union of the humerus. Therefore, the Board concludes that from July 8, 2021 to the present, there is no basis upon which to award a higher 30 percent initial evaluation for the Veteran's service-connected left shoulder disability under Diagnostic Code 5201 or a higher 40 percent initial evaluation under Diagnostic Code 5202. Accordingly, the Board finds that from July 8, 2021 to the present, the Veteran's service-connected left shoulder disability is no more than 20 percent disabling. In summary, resolving all reasonable doubt in favor of the Veteran, from March 11, 2013 to September 7, 2015, a 10 percent initial evaluation, but no higher, for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear is warranted. Further, resolving all reasonable doubt in favor of the Veteran, from September 8, 2015 to July 7, 2021, a 20 percent initial evaluation, but no higher, for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear is warranted. Therefore, the higher initial evaluation claims must be granted. However, from July 8, 2021 to the present, the preponderance of the evidence weighs against finding in favor of the Veteran's higher than 20 percent initial evaluation claim for recurrent left glenohumeral joint subluxation/dislocation, with rotator cuff tendonitis and labral tear is warranted. Therefore, the benefit-of-the-doubt rule does not apply, and the higher initial evaluation claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Journet Shaw, 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.