Citation Nr: 21062962 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 10-34 236 DATE: October 12, 2021 ORDER Entitlement to service connection for right lower extremity sural and deep peroneal neuropathy, secondary to service-connected right ankle degenerative joint disease, on a causation basis, is granted. Entitlement to an initial 10 percent rating, from May 1, 2009, for degenerative joint disease of the 1st metatarsophalangeal joint of the left foot, is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to an initial rating higher than 10 percent for degenerative joint disease of the 1st metatarsophalangeal joint of the left foot is denied. Entitlement to an initial 10 percent rating, but no higher, from May 1, 2009, for left foot scar, status post neuroma removal, is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to an initial 20 percent rating, from March 1, 2015 (except for a period when a temporary 100 percent rating was in effect), for right ankle degenerative joint disease (previously characterized as shin splints of the right lower extremity with impairment of the ankle), is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to an initial rating higher than 10 percent, prior to March 1, 2015, and a rating higher than 20 percent, since that date (except for periods when temporary 100 percent ratings were in effect), for right ankle degenerative joint disease (previously characterized as shin splints of the right lower extremity with impairment of the ankle), is denied. REMANDED Entitlement to service connection for respiratory disability, other than exercise induced anaphylaxis, is remanded. Entitlement to service connection for bilateral eye disability, other than retinal hole surrounded by a ring of pigment, inferiorly, left eye, is remanded. Entitlement to an initial compensable rating for exercise induced anaphylaxis is remanded. FINDINGS OF FACT 1. The evidence is at least evenly balanced as to whether the Veteran's right lower extremity sural and deep peroneal neuropathy is caused by his service-connected right ankle degenerative joint disease. 2. Since the May 1, 2009 effective date of service connection, the Veteran's degenerative joint disease of the 1st metatarsophalangeal joint of the left foot has been manifested by left foot pain and stiffness. 3. The evidence is at least evenly balanced as to whether, since the May 1, 2009 effective date of service connection, the Veteran's left foot scar, status post neuroma removal, has been manifested by occasional scar pain. 4. From the May 1, 2009 effective date of service connection through February 28, 2015, the Veteran's right ankle degenerative joint disease was manifested by limitation of ankle motion to at most 20 degrees of dorsiflexion and 45 degrees of plantar flexion; there was no additional significant additional loss of motion due to such factors as pain, weakness, lack of endurance, fatigability, or incoordination with repeated use over time and during flare ups; there was no actual ankylosis, functional equivalent of ankylosis, malunion of the os calcis or astragalus, or astragalectomy. 5. Since March 1, 2015, the Veteran's right ankle degenerative joint disease has been manifested by limitation of ankle dorsiflexion to between 0 degrees and 10 degrees and limitation of plantar flexion to between 10 degrees and 45 degrees; there is no actual ankylosis, functional equivalent of ankylosis, malunion of the os calcis or astragalus, or astragalectomy. CONCLUSIONS OF LAW 1. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for right lower extremity sural and deep peroneal neuropathy, as secondary to service-connected right ankle degenerative joint disease, on a causation basis, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for an initial 10 percent rating, from May 1, 2009, for degenerative joint disease of the 1st metatarsophalangeal joint of the left foot, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71A, Diagnostic Code (DC) 5003. 3. The criteria for an initial rating higher than 10 percent for degenerative joint disease of the 1st metatarsophalangeal joint of the left foot are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.71A, Diagnostic Code (DCs) 5003, 5276-5284 (in effect prior to and since February 7, 2021). 4. With reasonable doubt resolved in favor of the Veteran, the criteria for an initial 10 percent rating, but no higher, from May 1, 2009, for left foot scar, status post neuroma removal, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.118, Diagnostic Codes (DC) 7800-7805 (in effect prior to and since August 13, 2018). 5. The criteria for an initial 20 percent rating, from March 1, 2015, for right ankle degenerative joint disease, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71A, Diagnostic Code (DC) 5003, 5010, 5271. 6. The criteria for an initial rating higher than 10 percent, prior to March 1, 2015, and a rating higher than 20 percent, since that date, for right ankle degenerative joint disease, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71A, Diagnostic Code (DC) 5003, 5010, 5262, 5270, 5270 (in effect prior to and since February 7, 2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1989 to April 2009. These matters initially came before the Board of Veterans' Appeals (Board) from a November 2009 rating decision. In September 2013, the agency of original jurisdiction (AOJ) awarded a temporary 100 percent rating for the Veteran's service-connected right ankle disability due to surgical or other treatment requiring convalescence, from March 21, 2013 through April 30, 2013. A noncompensable (0 percent) rating was resumed from May 1, 2013. In March 2017, the AOJ awarded a temporary 100 percent rating for the service-connected right ankle disability due to surgical or other treatment requiring convalescence, from November 2, 2016 through January 31, 2017. A noncompensable (0 percent) rating was resumed from February 1, 2017. As the Veteran was granted 100 percent ratings from March 21, 2013 through April 30, 2013 and from November 2, 2016 through January 31, 2017 for his service-connected right ankle disability, the ratings for this disability during these periods will not be addressed by the Board. Cf. AB v. Brown, 6 Vet. App. 35, 38 (1993). In June 2016, the Board remanded these matters to schedule the Veteran for a Board hearing before a Veterans Law Judge (VLJ). The Veteran testified before a VLJ at a January 2017 hearing. The Board subsequently sent the Veteran a letter in January 2018 which informed him that the Board was unable to produce a written transcript of the January 2017 hearing and asked him to indicate whether he wanted to attend a new hearing. The Veteran responded in February 2018 that he wished to attend a new Board hearing. He subsequently testified before the undersigned VLJ at an October 2018 hearing and a transcript of the hearing has been associated with his claims file. In April 2019, the Board remanded these matters for further development. In June 2020, the AOJ awarded a 20 percent rating for shin splints of the right lower extremity with impairment of the ankle, from February 12, 2020. In October 2020, the Board again remanded these matters for further development. In March 2021, the AOJ assigned an effective date of May 1, 2009 for the award of a 10 percent rating for right ankle degenerative joint disease. In July 2021, the AOJ assigned a 10 percent rating for degenerative joint disease of the 1st metatarsophalangeal joint of the left foot, from January 19, 2021. As for characterization of the issues on appeal, the evidence reflects that the Veteran has experienced right lower extremity neurological disability associated with his service-connected right ankle disability. Consistent with VA's duty to maximize benefits, the Board must consider all possible schedular bases for separate ratings, including secondary service connection, before considering whether an extraschedular rating is warranted to address symptoms not contemplated by the applicable diagnostic code. Morgan v. Wilkie, 31 Vet. App. 162, 167 (2018). In this regard, the United States Court of Appeals for Veterans Claims (Court) has held that 38 C.F.R. § 3.155 (d)(2) requires that, when entitlement to secondary service connection is raised, a formal claim for secondary service connection need not be filed, rather, VA must consider those "complications" in connection with the claim on appeal. Bailey v. Wilkie, 33 Vet. App. 188 (2021). As the evidence reflects that the Veteran has right lower extremity neurological disability that is associated with his service-connected right ankle disability, the Board has expanded the appeal to include the issue of entitlement to service connection for right lower extremity sural and deep peroneal neuropathy, as secondary to service-connected right ankle degenerative joint disease. As a final preliminary matter, in the April 2019 and October 2020 remands, the Board instructed the AOJ to, among other things, ask the Veteran to identify any outstanding treatment records and to complete the appropriate authorization form to allow VA to obtain any outstanding private medical records, obtain all outstanding VA treatment records, and afford the Veteran examinations to assess the severity of his service-connected left foot disability, left foot scar, and right ankle disability and to obtain medical opinions as to the extent to which his disabilities have worsened throughout the claim period. Pursuant to the Board's remands, the Veteran was asked to identify any outstanding treatment records and to complete the appropriate authorization form to allow VA to obtain any outstanding private medical records by way of December 2019 and October 2020 letters. Copies of the authorization forms (VA Forms 21-4142a and 21-4142) were included with the letters. Also, all relevant outstanding VA and private treatment records were obtained and associated with the claims file, the Veteran was afforded examinations to assess the severity of his service-connected left foot disability, left foot scar, and right ankle disability in February 2020, January 2021, and June 2021, and opinions were provided as to the extent to which his disabilities have worsened throughout the claim period. Therefore, the AOJ substantially complied with the Board's pertinent remand instructions. See Dyment v. West, 13 Vet. App. 141, 146- 47 (1999); Stegall v. West, 11 Vet. App. 268 (1998). I. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is also warranted for disability that is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310. Entitlement to service connection for right lower extremity sural and deep peroneal neuropathy, secondary to service-connected right ankle degenerative joint disease The Board finds, for the following reasons, that the Veteran has right lower extremity sural and deep peroneal neuropathy, and that the evidence is at least evenly balanced as to whether this disability is caused by his service-connected right ankle degenerative joint disease. The Veteran has reported that he experiences right lower extremity numbness associated with his service-connected right ankle disability. In this regard, J.S. Park, M.D. reported in a March 2019 letter that he was treating the Veteran for right ankle problems and that the Veteran underwent a right ankle reconstruction. Although he was doing well post-operatively, he did have "sural and deep peroneal neuropathy," among other problems. Moreover, the reports of VA ankle examinations dated in February 2020, January 2021, and June 2021 indicate that the Veteran's right ankle disability caused his right foot to evert, which caused numbness. While there is no clear and direct opinion that the Veteran's right lower extremity neurological disability is caused by his service-connected right ankle disability, the findings and diagnoses noted above in essence support the conclusion that the evidence is at least evenly balanced as to whether he has current right lower extremity sural and deep peroneal neuropathy which is caused by his service-connected right ankle disability. There is no medical opinion contrary to this conclusion. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, service connection for right lower extremity sural and deep peroneal neuropathy, secondary to service-connected right ankle degenerative joint disease, on a causation basis, is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. II. Higher Initial Ratings Disability ratings are determined by the application of rating criteria set forth in the VA Schedule for Rating Disabilities (38 C.F.R. Part 4) based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155. Where service connection has been granted and the assignment of an initial rating is disputed, separate ratings may be assigned for separate periods of time based on the facts found. In other words, the ratings may be "staged." Fenderson v. West, 12 Vet. App. 119, 125-126 (1999). If two ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. In evaluating a disability, the Board considers the current examination reports considering the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. Disabilities evaluated on the basis of limitation of motion require VA to apply the provisions of 38 C.F.R. § 4.40, 4.45, pertaining to functional impairment. The Court has instructed that in applying these regulations VA should obtain examinations in which the examiner determines whether the disability is manifested by weakened movement, excess fatigability, incoordination, pain, or flare-ups. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. The examiner should also determine the point, if any, at which such factors cause functional impairment. Moreover, the joints involved should be tested for pain on both active and passive motion, in weight bearing and non weight-bearing and, if possible, with the range of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158 (2016); Mitchell v. Shinseki, 25 Vet. App. 32, 43-4 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § 4.59. The Board notes that during the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71A were amended effective February 7, 2021. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110 (g); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110 (g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Kuzma, 341 F. 3d 1327. Therefore, the Board will consider the Veteran's claims under the former criteria prior to February 7, 2021, and both the former and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. 1. Entitlement to a higher initial rating for degenerative joint disease of the 1st metatarsophalangeal joint of the left foot, rated noncompensable prior to January 19, 2021 and 10 percent disabling since that date The Veteran's degenerative joint disease of the 1st metatarsophalangeal joint of the left foot is rated under 38 C.F.R. § 4.71A, DC 5003 as degenerative arthritis. Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate codes for the specific joint or joints involved. If the limitation of motion is noncompensable, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 20 percent evaluation is merited for X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. A 10 percent evaluation is merited for X-ray evidence of involvement of two or more major joints or two or more minor joint groups. 38 C.F.R. § 4.71a, DC 5003. This diagnostic code was not significantly amended by the regulatory changes. In claims for higher ratings for musculoskeletal disabilities, where a veteran has a noncompensable rating and complains of pain on motion, the veteran may be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011). In Petitti v. McDonald, 27 Vet. App. 415 (2015), the Court held that under 38 C.F.R. § 4.59, "the trigger for a minimum disability rating is an actually painful, unstable, or malaligned joint," and it explained that 38 C.F.R. § 4.59 speaks to both painful motion of joints and actually painful joints. Id. at 425. Moreover, the Court held that 38 C.F.R. § 4.59 does not require "objective" evidence, but can be satisfied with lay and other non-medical evidence. Id. at 429. The provisions of 38 C.F.R. § 4.59 are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton, supra; Id. Moreover, the plain language of § 4.59 indicates that it is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable, or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is being evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346, 354 (2016). Considering the pertinent evidence in light of the applicable rating criteria and considerations, the Board finds that, for the following reasons, the Veteran's degenerative joint disease of the 1st metatarsophalangeal joint of the left foot warrants an initial 10 percent rating, but no higher, since the May 1, 2009 effective date of service connection. The Veteran reported during an April 2009 VA examination that he experienced localized pain in the base of the left big toe which occurred approximately 2 times per week for 2 days at a time. He was able to function without medication while experiencing pain. The pain was aching and sharp in nature, 5/10 in intensity, occurred spontaneously, and was relieved spontaneously. There was no pain, weakness, stiffness, swelling, or fatigue at rest or while standing or walking. The bone condition was never infected, the Veteran was never hospitalized for his foot disability, had not undergone any surgery, and did not experience any functional impairment due to the foot disability. He used orthotics to treat his disability. Examination revealed that the Veteran's gait and posture were normal, that there were no signs of abnormal weight-bearing or breakdown, callosities, or any unusual shoe wear pattern, and that the Veteran did not require any assistive device for ambulation. There was no edema, disturbed circulation, weakness, atrophy of the musculature, tenderness, heat, redness, or signs of deformity. There was active motion of the metatarsophalangeal joint of the great toes bilaterally, weight bearing and non weight bearing alignment of the Achilles tendon was normal bilaterally, and there was no pes planus, pes cavus, hammer toes, Morton's metatarsalgia, hallux valgus, or hallux rigidus. There was no functional limitation of standing or walking, and the Veteran did not require the use of any corrective shoe wear. X-rays of the left foot were normal. A March 2013 operation report from Sentara Northern Virginia Medical Center, a July 2016 statement from the Veteran, his testimony during the October 2018 Board hearing, and the report of a February 2020 VA foot examination indicate that the Veteran experienced occasional left toe pain that varied in intensity throughout the day, and that he used orthotics to treat his symptoms. He underwent a left foot metatarsal osteotomy in March 2013. There were no flare ups of his foot disability and there was no functional loss/impairment of the left foot. He did not have any Morton's neuroma, metatarsalgia, hammertoes, hallux valgus, hallux rigidus, or pes cavus. He had a history of a neuroma excision at the 3rd intermetatarsal of the left foot in 2008 and this condition was mild, but the condition did not chronically compromise weight bearing, did not require arch supports, custom orthotic inserts, or shoe modifications, and there were no residual signs or symptoms due to foot surgery. At the time of the February 2020 examination, there was no left foot pain or left lower extremity functional loss, functional ability was not significantly limited by pain, weakness, fatigability, or incoordination during flare ups or when the foot was used repeatedly over a period of time, and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. The Veteran did not use any assistive devices and there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. X-rays revealed left foot arthritis. The Veteran was diagnosed as having degenerative joint disease of the 1st metatarsophalangeal joint of the left foot. This disability would negatively impact any occupation that required prolonged standing, weight bearing, or ambulation. The Veteran reported during a January 2021 VA foot examination that he experienced achy left foot/big toe pain and stiffness when walking on uneven terrain. There were no flare ups of foot symptoms and no other functional loss/impairment of the left foot. The Veteran had a left foot Morton's neuroma, but no metatarsalgia, hammertoes, hallux valgus, hallux rigidus, pes cavus, or any other foot injuries/conditions. He underwent a left 3rd intertarsal neuroma removal in 2008 and there were no residual signs or symptoms due to foot surgery. There was no left foot pain or lower extremity functional loss at the time of the examination, functional ability was not significantly limited by pain, weakness, fatigability, or incoordination during flare ups or when the foot was used repeatedly over a period of time, and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. Moreover, the Veteran did not use any assistive devices for his left foot (shoe inserts were used for the right foot) and there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. X-rays revealed left foot arthritis. Diagnoses of left foot Morton's neuroma and degenerative joint disease of the 1st metatarsophalangeal joint were provided. This disability did not impact the Veteran's ability to work. The examiner who conducted the January 2021 examination noted that there was no objective evidence of left foot pain during active range of motion, passive range of motion, weight bearing, or non weight bearing. The examiner also indicated that there was no point at which the Veteran's disability increased in severity based on his history and physical examination. He reported that he experienced occasional pain and stiffness when walking on uneven terrain. A June 2021 VA foot examination report indicates that the Veteran experienced achy left foot pain and stiffness when walking on uneven terrain. There were no flare ups of foot symptoms and no functional loss/impairment of the left foot. The Veteran had a left foot Morton's neuroma (which was surgically treated and had no residuals), but no metatarsalgia, hammertoes, hallux valgus, hallux rigidus, pes cavus, or any other foot injuries/conditions. He underwent a left 3rd intertarsal neuroma removal in 2008 and there were no residual signs or symptoms due to foot surgery. There was no left foot pain or lower extremity functional loss at the time of the examination, functional ability was not significantly limited by pain, weakness, fatigability, or incoordination during flare ups or when the foot was used repeatedly over a period of time, and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. Moreover, the Veteran did not use any assistive devices for his left foot (shoe inserts were used for the right foot) and there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. The Veteran was diagnosed as having left foot Morton's neuroma and degenerative arthritis. This disability did not impact his ability to work. The above evidence indicates that during the entire claim period, the Veteran's service-connected left foot disability has been manifested by occasional foot pain and stiffness which have limited his ability to stand and ambulate. The Board acknowledges that there was no evidence of left foot arthritis during the April 2009 examination and that x-rays were normal at that time. However, in light of the evidence of actual left foot pain which results in functional impairment, and the Court's holding in Petitti, and with resolution of all reasonable doubt in the Veteran's favor, the Board finds that the minimum, compensable rating for the foot (i.e.,10 percent) is warranted for degenerative joint disease of the 1st metatarsophalangeal joint of the left foot since the May 1, 2009 effective date of service connection. See Petitti, 27 Vet. App. at 424-30; Burton, 25 Vet. App. at 3-5 ; 38 C.F.R. § 4.73, DC 5321. The Board also finds, however, that a rating higher than 10 percent is not warranted at any time during the claim period. Specifically, the only symptoms of the Veteran's degenerative joint disease of the 1st metatarsophalangeal joint of the left foot are occasional foot pain and stiffness with ambulation. He has not reported any flare ups of foot symptoms, there has been no significant functional impairment due to pain, weakness, fatigability, or incoordination during flare ups or when the foot is used repeatedly over a period of time, he has not exhibited an impaired gait due to his service-connected left foot disability, and he has not used any assistive devices due to his left foot disability. Also, there has been no evidence of any acquired flat foot, weak foot, claw foot (pes cavus), metatarsalgia, hallux valgus, hallux rigidus, hammertoes, malunion/nonunion of the tarsal or metatarsal bones, or plantar fasciitis during the claim period, and the Veteran is not service-connected for any of these disabilities. Therefore, higher and/or separate ratings are not warranted under either the old or revised versions of DCs 5269 or 5276-5283. The only other diagnostic code under which a rating higher than 10 percent is available for the foot is DC 5284 (foot injuries, other). Under both the old and the revised musculoskeletal rating criteria, DC 5284 provides a 10 percent rating for moderate foot injury, a 20 percent rating for moderately severe foot injury, and a 30 percent rating for severe foot injury. In light of the fact that the only symptoms associated with the Veteran's left foot disability are occasional pain and stiffness, the fact that he has not experienced any impaired gait due to his foot disability, and the fact that he does not require any assistive devices for ambulation due to his left foot disability, the Board finds that the symptoms of his foot disability reflect at most a moderate foot injury/condition. Therefore, a higher rating under DC 5284 is not warranted at any time during the claim period. Moreover, the Veteran has not contended, and the evidence does not otherwise reflect, that he has completely lost all functional use of the left foot, with no effective function remaining other than that which would be equally well served by an amputation stump with a suitable prosthetic appliance. This finding was specifically made during the February 2020, January 2021, and June 2021 VA examinations and the Veteran has retained the ability to ambulate. Thus, a higher rating of 40 percent under DC 5284 for loss of use of the foot is also not warranted at any time during the claim period. In sum, the Veteran's service-connected degenerative joint disease of the 1st metatarsophalangeal joint of the left foot has resulted in impairments that most closely approximate the criteria for a 10 percent rating, but no higher, under DC 5003 since the May 1, 2009 effective date of service connection. 2. Entitlement to an initial compensable rating for left foot scar, status post neuroma removal The Veteran's left foot scar, status post neuroma removal is rated under 38 C.F.R. § 4.118, DC 7805. The Board notes that VA amended the criteria for rating skin disabilities during the claim period, effective from August 13, 2018. With regard to the effective date of the new criteria, VA indicated in the Supplementary Information to the Final Rule that its "intent is that the 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 Veteran's claim in this case was pending prior to the August 13, 2018 effective date of the new criteria, and therefore, the Board will consider both the old and new criteria and apply the more favorable criteria. Under both the old and the revised version of DC 7805, any disabling effects of scars not otherwise ratable under the other diagnostic codes pertaining to scars are to be rated under an appropriate diagnostic code. 38 C.F.R. § 4.118, DC 7805 (in effect prior to and since August 13, 2018). In order to warrant a compensable rating under the old version of the other appropriate diagnostic codes, a scar would need to involve the head, face or neck and have at least one characteristic of disfigurement (DC 7800); be deep and nonlinear and affect an area or areas exceeding at least 6 square inches (39 square centimeters) (DC 7801); be superficial and nonlinear and affect an area or areas of 144 square inches (929 square centimeters) or greater (DC 7802); or be unstable or painful (DC 7804). 38 C.F.R. § 4.118, DCs 7800-7804 (in effect prior to August 13, 2018). In order to warrant a compensable rating under the new version of the other appropriate rating criteria, a scar would need to involve the head, face or neck and have at least one characteristic of disfigurement (DC 7800); be associated with underlying soft tissue damage and affect an area or areas exceeding at least 6 square inches (39 square centimeters) (DC 7801); not be associated with underlying soft tissue damage, but affect an area or areas of 144 square inches (929 square centimeters) or greater (DC 7802); or be unstable or painful (DC 7804). 38 C.F.R. § 4.118, DCs 7800-7804 (in effect since August 13, 2018). As for unstable or painful scars, the following ratings apply under both the old and the revised version of DC 7804: a 10 percent rating is warranted one or two scars that are unstable or painful; a 20 percent rating is warranted for three or four scars that are unstable or painful; and a 30 percent rating is warranted for five or more scars that are unstable or painful. 38 C.F.R. § 4.118, DC 7804 (in effect prior to and since August 13, 2018). Considering the pertinent evidence in light of the applicable rating criteria and considerations, the Board finds, for the following reasons, that the Veteran's left foot scar, status post neuroma removal has been manifested by symptoms of the type and extent, frequency, and/or severity, as appropriate, to warrant an initial 10 percent rating, but no higher, since the May 1, 2009 effective date of service connection. The April 2009 VA examination report indicates that the Veteran had a left foot scar which measured 4 centimeters by 0.1 centimeters. The scar was linear, superficial, and not painful, there was no skin breakdown, and there was no underlying tissue damage, inflammation, edema, or keloid formation. The scar was not disfiguring, did not limit the Veteran's motion, and did not cause any other limitation of function. The Veteran was diagnosed as having scar, left foot, status post neuroma removal. In his July 2016 statement, the Veteran reported that his left foot neuroma removal had completely healed and that the initial pain which was the basis for the surgery was gone. However, his foot had never returned to normal function. The Veteran reported during the October 2018 Board hearing that his left foot scar was painful to the touch, but did not bleed. The scar pain was present ever since his initial surgery in 2008. The report of a February 2020 VA scars examination indicates that the Veteran had scarring at the posterior 3rd toe of the left foot due to neuroma removal and metatarsal osteotomy. The scarring was not painful, unstable with frequent loss of covering of skin over the scar, or due to burns. Examination revealed that the scar was located on the 3rd metatarsal of the left foot and measured 4 centimeters long by 0.1 centimeters wide. The examiner did not note that the scar was tender to palpation or unstable upon inspection, and the scar was not associated with any underlying soft tissue damage. The scar did not result in limitation of function and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. The scar did not impact the Veteran's ability to work. A January 2021 VA scar examination report and the reports of the January 2021 and June 2021 VA foot examinations reflect that the Veteran had a scar on the posterior 3rd metatarsal of the left foot due to neuroma removal and a 3rd metatarsal osteotomy. The scar was not painful, unstable with frequent loss of covering of skin over the scar, or due to a burn. The scar measured 4 centimeters in length and between 0.1 and 0.2 centimeters in width, the examiner did not note that the scar was tender to palpation or unstable upon inspection, and the scar was not associated with any underlying soft tissue damage. The scar did not result in limitation of function and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. The scar did not impact the Veteran's ability to work. Also, the examiner noted that based on the findings during the examination and the Veteran's history, there was no point at which the scar increased in severity. The Veteran reported that his left foot symptoms had resolved since his second left foot surgery. The above evidence reflects that the Veteran has experienced a single left foot scar. Although the examinations conducted the claim period have indicated that the Veteran's scar was not painful at the time of the examinations, he reported during the October 2018 Board hearing that the scar has been painful to the touch during the entire claim period. The Veteran is competent to report left foot scar pain. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Moreover, despite the absence of pain during the examinations conducted during the claim period, there is otherwise nothing to explicitly contradict his report of left foot scar pain since his initial 2008 surgery. Thus, in light of the Veteran's reports, the Board finds that the evidence is at least evenly balanced as to whether the Veteran has experienced a single painful left foot scar during the entire claim period. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, an initial 10 percent rating for left foot scar, status post neuroma removal, is warranted under either the old or the revised version of DC 7804, since the May 1, 2009 effective date of service connection. The Board also finds that a rating higher than 10 percent for left foot scar, status post neuroma removal is not warranted at any time during the claim period. Specifically, the scar does not involve the head, face, or neck and there is only a single left foot scar that does not involve an area of at least 6 square inches (39 square centimeters), is not unstable, is not associated with any underlying soft tissue damage, and does not have any other disabling effects. Hence, there is no basis upon which to grant any separate and/or rating higher than 10 percent for the Veteran's left foot scar, status post neuroma removal, under any applicable diagnostic code pertaining to scars under either the old or new rating criteria at any time since the effective date of service connection. Therefore, an initial 10 percent rating, but no higher, for left foot scar, status post neuroma removal, from May 1, 2009, is warranted. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.118, DCs 7800-7805 (in effect prior to and since August 13, 2018). 3. Entitlement to a higher initial rating for right ankle degenerative joint disease, rated 10 percent disabling prior to February 12, 2020 and 20 percent disabling since that date (except for periods when temporary 100 percent ratings were in effect) The Veteran's right ankle degenerative joint disease is rated under 38 C.F.R. § 4.71A, DCs 5010-5271. 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. Here, the use of DCs 5010-5271 reflects that the Veteran's ankle disability is partially described as traumatic arthritis under DC 5010 and that the rating assigned is based on limitation of ankle motion under DC 5271. Prior to the February 7, 2021 regulatory changes, traumatic arthritis was rated under the same diagnostic criteria as degenerative arthritis. 38 C.F.R. § 4.71A, DC 5010 (in effect prior to February 7, 2021). The rating criteria for degenerative arthritis under DC 5003 are set forth in the section above pertaining to the Veteran's degenerative joint disease of the 1st metatarsophalangeal joint of the left foot. Since the regulatory changes, post-traumatic arthritis under DC 5010 is rated as limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with § 4.25. 38 C.F.R. § 4.71A, DC 5010 (in effect since February 7, 2021). Limitation of motion of the ankle is rated under DC 5271. Prior to the February 7, 2021 regulatory changes, under DC 5271, a 10 percent rating is warranted for moderate limitation of ankle motion and a 20 percent rating is warranted for marked limitation of ankle motion. 38 C.F.R. § 4.71A, DC 5271 (in effect prior to February 7, 2021). The terms "moderate" and "marked" are not defined in VA regulations prior to the regulatory change, and the Board must arrive at an equitable and just decision after having evaluated the evidence. 38 C.F.R. § 4.6. As of February 7, 2021, under the amended criteria, a 10 percent rating is warranted for moderate limitation of ankle motion (defined as less than 15 degrees of dorsiflexion or less than 30 degrees of plantar flexion) and a 20 percent rating is warranted for marked limitation of ankle motion (defined as less than 5 degrees of dorsiflexion or less than 10 degrees of plantar flexion). 38 C.F.R. § 4.71A, DC 5271. The normal ranges of motion of the ankle are 20 degrees of dorsiflexion and 45 degrees of plantar flexion. 38 C.F.R. § 4.71A, Plate II. Considering the pertinent evidence in light of the applicable rating criteria and considerations, the Board finds, for the following reasons, that the Veteran's right ankle degenerative joint disease has not met or approximated the criteria for a rating in excess of 10 percent at any time from the May 1, 2009 effective date of service connection through February 28, 2015. A 20 percent rating, but no higher, is warranted from March 1, 2015. The April 2009 VA examination report indicates that the Veteran experienced localized right ankle pain which occurred approximately 2 times per day and lasted for hours at a time. The pain occurred spontaneously, was aching in nature, 2/10 in severity, elicited by constant use (i.e., driving), and relieved by rest. The Veteran was able to function while experiencing pain without medication. He also reported weakness, stiffness, giving way, lack of endurance, fatigability, and misalignment of the hip, knee, and foot. There was no swelling, heat, redness, locking, or dislocation. The Veteran did not undergo any joint replacement and he reported that he did not experience any functional impairment. Examination revealed that the Veteran's posture and gait were normal, that there were no signs of abnormal weight bearing, breakdown, callosities, or any unusual shoe wear pattern, and that he did not require any assistive devices for ambulation. There were no signs of right ankle edema, effusion, weakness, tenderness, redness, heat, subluxation, guarding of movement, or deformity. The ranges of right and left ankle motions were recorded and dorsiflexion was to 20 degrees and plantar flexion was to 45 degrees. The right ankle function was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. X-rays of the right ankle revealed degenerative arthritic changes, but no malunion to the os calcis or malunion of the astragalus. The Veteran was diagnosed as having degenerative arthritis of the right ankle. A March 2013 operation report from Sentara Northern Virginia Medical Center and a December 2013 examination report from Potomac Podiatry Group indicate that the Veteran underwent a right ankle reconstruction in March 2013 and that the ranges of right ankle motion were within normal limits at the time of the December 2013 examination. The Veteran was diagnosed as having a resolved right ankle reconstruction. Treatment records from Fast Track PT dated from April 2015 to June 2015, a November 2015 examination report from Orthopaedic Center of Central Virginia, treatment records from OrthoVirginia dated in February and March 2016, a May 2016 examination report from the University of Virginia Health System, a July 2016 statement the Veteran, treatment records from the University of Virginia Health System dated from August 2016 to May 2017, and the Veteran's testimony during the October 2018 Board hearing indicate that he suffered a right ankle injury in March 2015 and experienced worsening right ankle pain, stiffness, instability, swelling, and weakness. The stiffness was worst first thing in the morning, the pain was exacerbated with running and weight bearing for extended periods of time, and his symptoms limited his ability to cycle, run, and walk. Examinations revealed that there was mild right ankle soft tissue swelling laterally consistent with prior surgery, tenderness to palpation over the inferior aspect of the lateral malleolus, pain with resisted eversion, and slight tenderness over the peroneal tendons. The ranges of right ankle motion were recorded as being dorsiflexion to between 0 degrees and 6 degrees and plantar flexion to between 45 degrees and 60 degrees. The Veteran reported during a February 2020 VA ankle examination that he experienced right ankle instability, fatigue, pain (3-8/10 in severity depending on activity), and weakness. He treated his symptoms by limiting his activities. Flare ups of increased ankle pain occurred, during which the Veteran had to push through certain weight bearing activities. He was able to ambulate normally, was limited by a high pain threshold, was able to stand for approximately 1 hour to teach, had to sit and rest after long walks, and was limited in his ability to walk on inclines. The ranges of right and left ankle motions were tested and right ankle motions were recorded as being dorsiflexion to 10 degrees and plantar flexion to 25 degrees. The ranges of motion themselves contributed to a functional loss in that there was weakness, fatigability, and loss of range of motion. There was pain associated with ankle dorsiflexion and plantar flexion and the pain caused functional loss. There was moderate tenderness/pain on deep soft tissue palpation of the medial/lateral malleoli and there was evidence of pain with weight bearing and crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions and there was no additional loss of function or range of motion after three repetitions. He was not being examined immediately after repetitive use over time or during a flare up and the examination was neither medically consistent nor inconsistent with his statements describing functional loss with repetitive use over time and during flare ups. Pain, fatigue, weakness, lack of endurance, and incoordination significantly limited functional ability with repeated use over time and the examiner who conducted the February 2020 examination indicated that the ranges of right ankle motion with repeated use over time would be dorsiflexion and plantar flexion both to 20 degrees. Functional ability was not significantly limited by pain, weakness, fatigability, or incoordination during flare ups. There were additional factors contributing to disability in terms of less movement than normal, weakened movement (loss of tendon, weakened step up on uneven ground), swelling (more after long periods of load bearing), deformity (goose egg appearance, swelling to right lateral malleoli), instability of station (frequent twisting), disturbance of locomotion (ankle felt as if it would give way, causing frequent falls), and interference with standing (limits prolonged standing). Moreover, muscle strength associated with right ankle plantar flexion and dorsiflexion was impaired (4/5), but there was no muscle atrophy. There was no ankylosis, ankle instability/dislocation was not suspected, he did not have shin splints, stress fractures, Achilles tendonitis, Achilles tendon rupture, or malunion of the calcaneus (os calcis) or talus (astragalus), and he did not have a telectomy (astragalectomy). He underwent an exosteotomy of the talus and tibia in 2008 and the residual of the surgery was degenerative arthritis. There was a right foot callous to plantar surface, posterior to 3rd, 4th, and 5th metatarsals and there was scarring associated with the right ankle disability. The Veteran did not use any assistive devices as a normal mode of locomotion and there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. A diagnosis of degenerative arthritis of the right ankle, status post exostectomy tibia-fibular, distal malleoli, was provided. This disability impacted the Veteran's ability to work in that it was negatively affected by occupations requiring prolonged weight bearing, standing, or ambulation. Moreover, the examiner who conducted the February 2020 examination noted that there was objective evidence of pain on passive range of motion testing and when the joint was used in non weight-bearing. The report of a VA ankle examination dated in January 2021 indicates that the Veteran experienced right ankle pain (1-8/10 in intensity depending upon activity level) and fatigue with prolonged standing and walking. He treated his symptoms by self-limiting his activities, stretching, and performing pool exercises. There were no flare ups of ankle symptoms. There was functional loss/impairment of the ankle in that the Veteran was unable to stand or walk for long periods. The ranges of right and left ankle motions were tested and right ankle motions were recorded as being dorsiflexion to 10 degrees and plantar flexion to 20 degrees. The ranges of motion themselves contributed to a functional loss in that there was weakness, fatigability, and loss of range of motion. There was pain associated with ankle dorsiflexion and plantar flexion and the pain caused functional loss. There was moderate tenderness/pain on deep soft tissue palpation of the medial/lateral malleoli and there was evidence of pain with weight bearing and crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions and there was no additional loss of function or range of motion after three repetitions. He was not being examined immediately after repetitive use over time or during a flare up, the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time, and the examination was neither medically consistent nor inconsistent with his statements describing functional loss during flare ups. Pain and fatigue significantly limited functional ability with repeated use over time and the examiner who conducted the January 2021 examination indicated that the ranges of right ankle motion with repeated use over time would be dorsiflexion to 10 degrees and plantar flexion to 20 degrees. Functional ability was not significantly limited by pain, weakness, fatigability, or incoordination during flare ups because the Veteran denied flare ups. There were no additional factors contributing to disability. Moreover, muscle strength associated with right ankle plantar flexion and dorsiflexion was normal (5/5) and there was no muscle atrophy. There was no ankylosis, ankle instability/dislocation was not suspected, the Veteran did not have shin splints, stress fractures, Achilles tendonitis, Achilles tendon rupture, or malunion of the calcaneus (os calcis) or talus (astragalus), and he did not have a telectomy (astragalectomy). He underwent an exosteotomy of the talus and tibia in 2008 and there were no residuals of the surgery. There was scarring associated with the right ankle disability, but there were no other pertinent physical findings, complications, conditions, signs, or symptoms. The Veteran did not use any assistive devices as a normal mode of locomotion and there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. A diagnosis of shin splints of the right lower extremity with moderate impairment of the ankle was provided. This disability impacted the Veteran's ability to work in that he was unable to stand and teach for more than one hour at a time without stopping to take a break. The examiner who conducted the January 2021 examination noted that there was objective evidence of pain on passive range of motion testing and when the joint was used in non weight-bearing. Also, the examiner reported that based on the findings during the examination and the Veteran's history, there was no point at which his right ankle disability increased in severity. He denied any new treatments for his right ankle disability since the February 2020 examination. The Veteran reported during a June 2021 VA ankle examination that he experienced right ankle pain (1-8/10 in intensity depending upon activity level) and fatigue with prolonged standing and walking. He treated his symptoms by self-limiting his activities, stretching, and performing pool exercises. There were no flare ups of ankle symptoms. There was functional loss/impairment of the ankle in that the Veteran was unable to stand or walk for long periods. He had a history of giving out/instability of his ankle, but he had not rolled his ankle in many years. The ranges of right and left ankle motions were tested and right ankle motions were recorded as being dorsiflexion to 5 degrees and plantar flexion to 20 degrees. The passive ranges of ankle motion were the same as the active ranges of motion. The ranges of motion themselves contributed to a functional loss in that there was weakness, fatigability, and loss of range of motion. There was pain associated with ankle dorsiflexion and plantar flexion with weight bearing, non weight bearing, active motion, passive motion, and on rest/non-movement, and the pain caused functional loss in that decreased range of motion was necessary for walking on uneven terrain. There was moderate tenderness/pain on deep soft tissue palpation of the malleoli and there was objective evidence of crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions and there was no additional loss of function or range of motion after three repetitions. He was not being examined immediately after repetitive use over time and pain and fatigability significantly limited functional ability with repeated use over time. The examiner who conducted the June 2021 examination indicated that the ranges of right ankle motion with repeated use over time would be dorsiflexion to 5 degrees and plantar flexion to 10 degrees. There were no additional factors contributing to disability. Moreover, there was no muscle atrophy or ankylosis and ankle stability testing was normal. The Veteran had a history of shin splints (medial tibial stress syndrome) for which he had received treatment for less than 12 consecutive months, the condition was resolved and there were no residuals, and the condition did not affect knee ranges of motion. He underwent reduction, stabilization, and exostectomy surgeries in 2008, 2013, and 2016 and the residuals of the surgeries were decreased range of ankle motion and pain. There was scarring associated with the right ankle disability, but there were no other pertinent physical findings, complications, conditions, signs, or symptoms. The Veteran did not use any assistive devices as a normal mode of locomotion and there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. The Veteran was diagnosed as having degenerative arthritis of the right ankle, status post exostectomy tibia-fibular, distal malleoli. This disability impacted his ability to work in that he was unable to stand and teach for more than one hour at a time without stopping to take a break. The examiner who conducted the June 2021 examination noted that the severity of the Veteran's right ankle disability had worsened since 2009. Specifically, during surgeries in 2013 and 2016, the level of severity during that time would be severe due to surgical intervention needed and there would have been a significant level of functional impairment during that time, to include significantly decreased range of motion during the surgery and recovery. A. Period Prior to March 1, 2015 The above evidence reflects that during the claim period prior to March 1, 2015, right ankle dorsiflexion and plantar flexion were to 20 degrees and 45 degrees, respectively, during the April 2009 VA examination. These findings, by themselves and without consideration of potential functional impairment, are contemplated by no more than a 10 percent rating for limitation of ankle motion under the old version of DC 5271 (i.e., moderate limitation of ankle motion), as the ranges of ankle motion were normal. As for functional impairment, there was pain, weakness, lack of endurance, and fatigability associated with the Veteran's right ankle. The Veteran reported during the April 2009 examination that he did not experience any functional impairment due to his right ankle disability, and the examiner who conducted the examination specified that ankle function was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. The Veteran did not report any flare ups during the April 2009 examination. The Veteran is competent to report the symptoms associated with his service-connected right ankle disability, and the Board has no reason to challenge the credibility of his contentions. See Jandreau, 492 F.3d at 1377; Buchanan, 451 F.3d at 1337. Regardless of the competent and credible reports of pain and other functional impairments, the preponderance of the evidence nonetheless supports the conclusion that the Veteran's ankle symptoms most closely approximated the criteria for at most a 10 percent rating for painful limitation of ankle motion under DC 5271 during the entire period from the May 1, 2009 effective date of service connection through February 28, 2015. Specifically, the above evidence reflects that the pain and other functional impairments were not so severe, frequent and/or prolonged to warrant the next higher percent rating at any time during this period. A preponderance of the evidence shows that even considering pain and other functional factors, the Veteran's ankle symptoms were not shown to have been so disabling to actually or effectively result in limitation of ankle motion more closely approximating marked limitation of motion under the old criteria. Moreover, there was no evidence of ankle ankylosis during this period. Ankylosis is defined in general as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Colayong v. West, 12 Vet. App. 524 (1999) (citing Dorland's Illustrated Medical Dictionary (28TH Ed. 1994) at 86). The Court has held that a veteran may be entitled to a rating based on ankylosis if he experiences the functional equivalent of ankylosis when considering the provisions of 38 C.F.R. §§ 4.40 and 4.45. Chavis v. McDonough, 34 Vet. App. 1, 23-24 (2021). In this case, the Board finds that even considering ankle pain and other functional factors, the Veteran did not experience the functional equivalent of ankle ankylosis at any time during this period. In other words, a preponderance of the evidence shows that even considering pain and other functional factors, the Veteran's ankle symptoms were not so disabling to actually or effectively result in immobility or fixation of the ankle at any point in the ranges of ankle motion. Therefore, a higher rating is not warranted on the basis of ankylosis/functional equivalent of ankylosis at any time during this period. See 38 C.F.R. § 4.71A, DC 5270 (in effect prior to February 7, 2021). Lastly, there is no evidence of any malunion of the os calcis or astragalus or any astragalectomy. Thus, no separate and/or higher ratings are warranted on the basis of any such impairments at any time during the claim period prior to March 1, 2015. See 38 C.F.R. § 4.71A, DCs 5272-5274 (in effect prior to February 7, 2021). Overall, the Veteran's right ankle disability resulted in painful right ankle motion that was no more than 10 percent disabling under DC 5271 during the entire claim period prior to March 1, 2015. Accordingly, an initial rating higher than 10 percent for right ankle degenerative joint disease is not warranted at any time during this period. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.71A, DCs 5270-5274 (in effect prior to February 7, 2021). B. Period Since March 1, 2015 The above evidence reflects that during the claim period since March 1, 2015, right ankle dorsiflexion has been limited to between 0 and 10 degrees and plantar flexion has been limited to between 10 and 45 degrees. In light of the Veteran's reported symptoms during this period, the range of motion measurements recorded during this period (especially the limitation of ankle dorsiflexion), and with resolution of reasonable doubt in favor of the Veteran, the Board finds that the symptoms of his service-connected right ankle degenerative joint disease have most closely approximately the criteria for a 20 percent rating under the old version of DC 5271 (which contemplates marked limitation of ankle motion) during this entire period. It is unclear exactly when the Veteran's right ankle impairment worsened following the April 2009 VA examination, but the private treatment records dated from April 2015 to May 2017 indicate that he injured his ankle in March 2015 and that ankle dorsiflexion was decreased to between 0 and 6 degrees. Therefore, the Board finds that March 1, 2015 is the earliest that it is factually ascertainable that the Veteran's right ankle symptoms met the criteria for a 20 percent rating under DC 5271. The Board also finds, however, that a rating higher than 20 percent is not warranted at any time during the claim period since March 1, 2015. The 20 percent rating that has been awarded for the service-connected right ankle disability is the maximum schedular rating for limitation of ankle motion under DC 5271. Evaluating an ankle disability under DC 5270 or DC 5272 requires a finding of ankylosis. In this case, the absence of ankle ankylosis was specifically noted during the February 2020, January 2021, and June 2021 VA examinations. Also, despite the significantly limited ranges of ankle motion during this period, the Board finds that even considering ankle pain, occasional flare ups, and other functional factors, the Veteran has not experienced the functional equivalent of ankle ankylosis at any time during this period. In other words, a preponderance of the evidence shows that even considering pain, flare ups, and other functional factors, the Veteran's ankle symptoms have not been shown to be so disabling to actually or effectively result in immobility or fixation of the ankle at any point in the ranges of ankle motion. Therefore, a higher rating is not warranted on the basis of ankylosis/functional equivalent of ankylosis at any time during this period. See 38 C.F.R. § 4.71A, DC 5270 (in effect prior to and since February 7, 2021). Moreover, there is no evidence of any malunion of the os calcis or astragalus or any astragalectomy. Thus, no separate and/or higher ratings are warranted on the basis of any such impairment at any time during the claim period. See 38 C.F.R. § 4.71A, DCs 5272-5274 (in effect prior to and since February 7, 2021). In sum, during the claim period since March 1, 2015, the Veteran's right ankle disability has resulted in limitation of ankle motion that is no more than 20 percent disabling under DC 5271. Accordingly, a 20 percent rating, but no higher, from March 1, 2015, for right ankle degenerative joint disease, is warranted. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.71A, DCs 5270-5274. 4. Additional Considerations As a final point, the Board notes that in conjunction with the higher rating issues decided herein, no other related issues have been raised by the Veteran or his representative, and no other such issues have been reasonably raised by the record. 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). REASONS FOR REMAND 1. Entitlement to an initial compensable rating for exercise induced anaphylaxis is remanded. The Veteran was afforded a VA skin examination in January 2021 to assess the severity of his service-connected exercise induced anaphylaxis. He reported during the examination that due to his anaphylaxis, he would develop "head to toe hives" which would resolve over the course of one hour. The examiner who conducted the examination indicated that although the Veteran had a skin condition, he was not experiencing any symptoms at the time of the examination. Therefore, the examiner noted that the Veteran's disability involved none of his total body area or exposed areas. In light of the Veteran's report of "head to toe hives" associated with his service-connected exercise induced anaphylaxis, and as the issue of entitlement to a higher initial rating for this disability must otherwise be remanded for compliance with the Board's October 2020 remand, the Board finds that a remand is necessary to obtain an appropriate medical opinion as to the extent of the skin manifestations of the Veteran's exercise induced anaphylaxis during periods of flare up of the disability. Moreover, in the April 2019 and October 2020 remands, the Board instructed the AOJ to afford the Veteran an appropriate examination to assess the severity of his service-connected exercise induced anaphylaxis and to obtain a retrospective medical opinion addressing the severity of the disability during the entire claim period since May 2009. Pursuant to the Board's remand, the Veteran was afforded the VA skin examination in January 2021. The examiner who conducted the examination noted that there was no point at which the Veteran's disability had increased in severity, but she only explained that the Veteran had denied having to use medication for an anaphylactic episode or to be seen at the emergency room since the February 2020 examination. In other words, the examiner did not address the entire claim period back to May 2009. Hence, a remand is also required for adequate completion of the development requested in the April 2019 and October 2020 remands. Stegall v. West, 11 Vet. App. 268, 271 (1998) Also, the evidence indicates that there may be outstanding relevant VA treatment records. The most recent VA treatment records in the claims file are from the Salem Vista electronic records system and are dated to January 2019. Any VA treatment records are within VA's constructive possession, and must be obtained regardless of their relevance as long as they are sufficiently identified. Sullivan v. McDonald, 815 F.3d 786, 793 (Fed. Cir. 2016) (VA has a duty to assist in obtaining sufficiently identified VA medical records regardless of their relevance). See also Jones v. Wilkie, 918 F.3d 922 (Fed. Cir. 2019) (confirming the holding in Sullivan). A remand is required to allow VA to obtain them. 2. Entitlement to service connection for respiratory disability (other than exercise induced anaphylaxis) and bilateral eye disability (other than retinal hole surrounded by a ring of pigment, inferiorly, left eye) are remanded. As the record currently stands, there is no evidence of any current respiratory or eye disabilities other than exercise induced anaphylaxis and retinal hole surrounded by a ring of pigment, inferiorly, left eye. As explained above, additional treatment records are being sought upon remand. Since these treatment records may document evidence of respiratory and eye disabilities, the claims of service connection for respiratory disability and bilateral eye disability are being remanded, as well. The matters are REMANDED for the following action: 1. Obtain the Veteran's outstanding VA treatment records from the Salem Vista electronic records system for the period since January 2019; and all such relevant records from any other sufficiently identified VA facility. 2. After all efforts have been exhausted to obtain and associate with the claims file any additional treatment records, obtain an addendum opinion from an appropriate clinician regarding the severity of the Veteran's exercise induced anaphylaxis during the entire claim period. The AOJ should only arrange for the Veteran to undergo an in-person examination if deemed necessary in the judgment of the individual designated to provide the opinion. Based on a review of the record and the Veteran's description of his symptoms during a period of exacerbation, the clinician should report the percentage of the Veteran's entire body and the percentage of his exposed areas affected by the skin manifestations of his service-connected exercise induced anaphylaxis during periods of flare up of the disability. The clinician should also, based on a review of all pertinent medical evidence and lay assertions, indicate whether, at any point since May 1, 2009, the Veteran's service-connected exercise induced anaphylaxis has increased in severity, and, if so, the approximate date(s) of any such change(s), and the extent of severity of the disability at each stage (to include identification of the percentages of the Veteran's entire body and exposed areas affected during any such stage, and the nature, extent, and duration of any required treatment during any such stage). The clinician must provide reasons for each opinion given. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Elwood, 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.