Citation Nr: 21063665 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 18-41 748 DATE: October 15, 2021 ORDER Entitlement to an increased rating of 10 percent disability rating, but no higher, for right knee iliotibial band syndrome from August 9, 2016, is granted. Entitlement to a 10 percent rating, but no higher, for right knee instability for the entire appellate time frame, from August 9, 2016, is granted. Entitlement to a 40 percent disability rating, but no higher, from August 9, 2016, for right rotator cuff syndrome is granted. FINDINGS OF FACT 1. From August 9, 2016, the Veteran's right knee iliotibial band syndrome manifested in painful motion but did not manifest in limited flexion of 60 degrees. 2. For the entire appellate time frame, from August 9, 2016, the Veteran's right knee disability manifested in slight instability, but did not manifest in moderate instability. 3. Throughout the entire period on appeal, the Veteran's right shoulder disability has been manifested by limited motion to 20 degrees from the side of a major joint. CONCLUSIONS OF LAW 1. The criteria for entitlement to a 10 percent disability rating, but no higher, for right knee iliotibial band syndrome from August 9, 2016, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code (DC) 5260. 2. The criteria for entitlement to a 10 percent rating for right knee instability from August 9, 2016, have been met, but no higher. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5257. 3. The criteria for entitlement to a 40 percent disability rating, but no higher, from August 9, 2016, for right rotator cuff syndrome have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5201. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 2003 to August 2009. These matters come to the Board of Veterans' Appeals (Board) on appeal from a December 2016 rating decision issued by the Department of Veterans' Affairs (VA) Regional Office (RO). These matters were previously before the Board prompting a May 2020 decision wherein the Board denied a compensable disability rating for limitation of flexion for iliotibial band syndrome, right knee; granted a separate 10 percent disability rating for right knee instability; and denied a rating in excess of 20 percent for right shoulder rotator cuff syndrome. Thereafter, the Veteran appealed to the United States Court of Appeals for Veterans Affairs (CAVC or "the Court"). In February 2021, the Court issued a Memorandum Decision setting aside the Board's May 2020 decision and remanded for further proceedings. Specifically, the Court remanded the Veteran's increased rating claim for right knee iliotibial band syndrome as inextricably intertwined with his increased rating claim for right knee lateral instability, which was remanded to define terms within the applicable diagnostic code, and the Veteran's increased rating claim for a right shoulder disability for additional reasons and bases in light of the Veteran's lay statements. Thus, the matters have returned to the Board for further consideration consistent with the Court's Memorandum Decision. The Board notes as part of the May 2020 decision, the Board recognized Rice v. Shinseki and determined that the Veteran has not argued, nor does the record otherwise reflect, that the Veteran's right knee and / or right shoulder disabilities render him unemployable. The Board found a claim for TDIU had not been raised. On appeal to the Court, the Veteran did not challenge this finding. Additionally, TDIU was not discussed by the Court as part of the February 2021 Memorandum Decision. As such, the Board finds this TDIU has not been raised and is not before the Board. The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Increased Rating The Veteran contends his right knee and right shoulder disabilities and symptoms related thereto entitle him to increased ratings. Here, the Veteran's right knee disability is currently rated under DC 5260 for right knee iliotibial band syndrome at a noncompensable rating from August 14, 2009, and 10 percent disabling from May 25, 2020; and separately rated under DC 5257 for right knee instability as 10 percent disabling from August 9, 2016; noncompensable from August 18, 2020; and 10 percent disabling from December 14, 2020. The Veteran's right shoulder disability is rated under DC 5201 for right rotator cuff syndrome as 10 percent disabling from August 14, 2009; 20 percent disabling from August 9, 2016; and 40 percent disabling from May 25, 2020. The Board notes the Veteran was granted service connection for right rotator cuff syndrome and right knee iliotibial band syndrome in a September 2009 rating decision. The Veteran did not appeal or submit additional evidence within a year of the September 2009 rating decision. As such, it became a final decision. Thereafter, the Veteran filed an increased rating claim regarding only the right shoulder in January 2014 prompting a June 2014 rating decision. The Veteran did not appeal or submit additional evidence in the year following the June 2014 rating decision. On August 9, 2016, the Veteran filed another increased rating claim for the right knee and right shoulder. Thus, the Board will consider the severity of his right knee and right shoulder from the date of receipt of the claim, August 9, 2016, or up to one year prior to VA's receipt of the Veteran's increased rating claim, to the extent an increase in severity is factually ascertainable. See 38 C.F.R. § 3.400(o)(2). The Board also notes, the Veteran filed another increased rating claim regarding the right knee and right shoulder while these claims were pending before the Court. The RO developed the Veteran's increased rating claims including additional VA examinations which will be addressed in more detail below. Because the Veteran's right knee disability ratings and right shoulder disability rating remains at less than totally disabling or less than 100 percent, the entire period remains on appeal before the Board. See AB v. Brown, 6 Vet. App. 35 (1993) (a claim for an original or an increased rating remains in controversy when less than the maximum available benefit is awarded). Disability evaluations are determined by the application of a schedule of ratings that is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. The Veteran's entire history is reviewed when making disability evaluations. See Schafrath v. Derwinski, 1 Vet. App. 589 (1995). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of his symptoms. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; separate ratings may be assigned for distinct disabilities resulting from the same injury only where the symptomatology for one condition is not duplicative or overlapping with the symptomatology of the other condition. See 38 C.F.R. § 4.14; see also Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119, 126-127 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007); Francisco v. Brown, 7 Vet. App. 55, 58 (1994). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). Painful motion is entitled to a minimum 10 percent rating, even if there is no actual limitation of motion. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021). VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. Regarding the right knee, again, the Veteran's right knee disability is currently rated under DC 5260 for right knee iliotibial band syndrome and separately rated under DC 5257 for right knee instability. Under DC 5260, flexion of the leg limited to 60 degrees is rated noncompensably (0 percent) disabling; flexion of the leg limited to 45 degrees is rated 10 percent disabling; flexion of the leg limited to 30 degrees is rated 20 percent disabling; and flexion of the leg limited to 15 degrees is rated 30 percent disabling. Under pre-amended DC 5257, slight recurrent subluxation or lateral instability will be rated as 10 percent disabling, moderate recurrent subluxation or lateral instability will be rated as 20 percent disabling, and severe recurrent subluxation or lateral instability warrants a 30 percent rating. Effective February 7, 2021, DC 5257 was amended to provide ratings for recurrent subluxation or lateral instability. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability and a medical provider prescribing both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. A 20 percent rating is warranted for either (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribing a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribing either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. DC 5257 also provides for ratings based on patellar instability. A 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker. A 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. Note [1] to DC 5257 states that for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note [2] to DC 5257 states that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration. Also relevant to any discussion of knee disabilities are the criteria under Diagnostic Codes 5256 through 5263. 38 C.F.R. § 4.71a. Under DC 5256, favorable ankylosis of the knee, in full extension or in slight flexion between 0 degrees and 10 degrees warrants a 30 percent disability rating; ankylosis in flexion between 10 degrees and 20 degrees warrants a 40 percent disability rating; ankylosis in flexion between 20 degrees and 45 degrees warrants a 50 percent disability rating; and extremely unfavorable ankylosis in flexion at an angle of 45 degrees or more warrants a 60 percent disability rating. Under DC 5258, a claimant is entitled to a 20 percent rating for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. Under DC 5259, a 10 percent evaluation is assigned for symptomatic removal of semilunar cartilage. Under DC 5261, extension of the leg limited to 5 degrees is rated noncompensably (0 percent) disabling; extension of the leg limited to 10 degrees is rated 10 percent disabling; extension of the leg limited to 15 degrees is rated 20 percent disabling; extension of the leg limited to 20 degrees is rated 30 percent disabling; extension of the leg limited to 30 degrees is rated 40 percent disabling; and extension of the leg limited to 45 degrees is rated 50 percent disabling. Under pre-amended DC 5262, a 10 percent rating is warranted for malunion of the tibia and fibula with slight knee or ankle disability. A 20 percent rating is warranted for malunion of the tibia and fibula with moderate knee or ankle disability. A 30 percent rating is warranted for malunion of the tibia and fibula with marked knee or ankle disability. A maximum 40 percent rating is warranted with nonunion of the tibia and fibula, with loose motion, requiring a brace. Effective February 7, 2021, DC 5262 is amended to provide for a 40 percent rating for nonunion of the tibia and fibula, with loose motion, requiring brace. Malunion of the tibia and fibula are to be evaluated under diagnostic codes 5256, 5257, 5260, or 5261 for the knee or 5270 or 5271 for the ankle, whichever results in the highest evaluation. Separate ratings are also provided for medial tibial stress syndrome (MTSS) or shin splints. Under DC 5263, a 10 percent rating is warranted for genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated). The Board notes that the terms "slight," "mild," "moderate," "moderately severe," and "severe" are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. According to Merriam Webster's Collegiate Dictionary 999 (11th Ed. 2007), "slight" means small in amount. "Moderate" means limited in scope or effect. "Severe" means very painful or harmful or of a great degree. Although a medical examiner's use of descriptive terminology such as "mild" is an element of evidence to be considered by the Board, it is not dispositive of an issue. The Board must evaluate all evidence in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Normal ranges of motion of the knee are to 0 degrees in extension, and to 140 degrees in flexion. 38 C.F.R. § 4.71, Plate II. Regarding the right shoulder, the Veteran's right shoulder disability is rated DC 5201 for right rotator cuff syndrome. Under pre-amended DC 5201, limitation of motion of the arm at shoulder level warrants a 20 percent rating for both the major and minor extremity. Limitation of motion of the arm midway between side and shoulder warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Limitation of motion of the arm to 25 degrees from side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint. 38 C.F.R. § 4.71a, Diagnostic Code 5201. Diagnostic Code 5201 "does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of the arm." Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013). Effective February 7, 2021, VA amended DC 5201 to reflect that limitation of motion may be shown by flexion and / or abduction and clarified the degrees of limitation of motion that correspond to each rating. Now, limitation of motion at the shoulder level (flexion and/or abduction limited to 90 degrees) warrants a 20 percent rating for both the major and minor extremity. Limitation of motion of the arm midway between side and shoulder level (flexion and/or abduction limited to 45 degrees) warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Flexion and/or abduction limited to 25 degrees from the side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint. 1. Entitlement to a 10 percent disability rating, but no higher, for right knee iliotibial band syndrome from August 9, 2016, is granted. The Veteran's right knee iliotibial band syndrome is rated 0 percent disabling under Diagnostic Code 5260, for limited flexion, prior to May 25, 2020, and 10 percent from May 25, 2020. The Veteran contends his right knee disabilities warranted a higher disability rating. Upon review, the Board finds a 10 percent disability rating for right knee iliotibial band syndrome, but no higher, is warranted for the entire appellate time frame, from August 9, 2016. Turning to the relevant evidence of record, imaging in 2017 revealed minimal arthritis in the right knee. See June 2017 VA treatment records. The Veteran reported experiencing right knee pain that is worsening. He stated that his knee sometimes "gives out" while he is walking. See March 2017 VA treatment records. In 2018, the Veteran reported experiencing right knee pain that is worsening. See March 2018 VA treatment records. In 2019, the Veteran reported experiencing right knee pain. See July 2019 VA treatment records. The pain was noted to be chronic and worsening. Imaging revealed minor arthritis. See June 2019 VA treatment records. The Veteran stated that his right knee has "doubled in size" and that his knee "gives out" while walking. See July 2019 VA Form 20-0996. He also conveyed experiencing constant swelling and pain and that his knee is continuing to worsen. In 2020, the Veteran continued to report experiencing right knee pain that has worsened over the past four years. Edema and erythema were not indicated. The Veteran stated that his knee "gives out" while walking sometimes. See July 2020 VA treatment records. The Veteran's spouse stated that the Veteran experiences pain daily and is unable to do the activities and duties that he used to do. See May 2020 buddy statement. She generally stated that the Veteran is constantly in pain and unable to sleep due to pain, stiffness, and numbness. She also conveyed that the Veteran's knee "gives out" while walking or with other activities which causes pain and falling. The Veteran has been afforded multiple VA examinations to determine the severity of his right knee disability during the pendency of this claim. The first examination occurred in October 2016 during which a diagnosis of right knee iliotibial band syndrome was found. See October 2016 VA examination. The Veteran reported intermittent medical attention for the right knee since separation from service but no specific treatment. He reported the condition is worsening. The Veteran conveyed intermittent flare-ups that occur without apparent provocation a couple times a month each lasting 3-4 hours. He also stated that his right knee "gives out randomly" while walking. He denied experiencing swelling and locking. The examiner indicated the Veteran did not experience flare-ups. Additional functional loss or impairment was noted as pain and "at times, it could get me hurt depending on when it decides to give out." Initial range of motion (ROM) testing revealed normal results of 0 to 140 degrees flexion and 140 to 0 degrees extension. Pain was not noted on examination and there was no objective evidence of tenderness or pain. There was evidence of crepitus. Repetitive use testing was able to be performed without additional loss of function or ROM. Pain was noted to significantly limit functional ability with repeated use over time, but a ROM estimate was unable to be described because the Veteran was not examined immediately after repetitive use and the examiner was not able to replicate a loss in ROM. Muscle strength testing revealed normal results without atrophy. Ankylosis was not indicated. A history of recurrent subluxation, lateral instability, or recurrent effusion were not found. Joint stability testing was performed revealing normal results. A meniscus condition was not found. Assistive devices were not indicated. The examiner opined that the Veteran's right knee condition did not impact his ability to perform any occupational tasks. Following this examination, the Veteran stated that the VA examiner erroneously indicated he did not experience flare-ups. See February 2017 Notice of Disagreement. The Veteran conveyed that he has flare-ups "constantly" and is "always in pain." The Veteran also stated that he experiences swelling, but during the examination certain areas were not swollen or inflamed. See August 2018 Form 9. He reported that during the examination he could not make his knee "give out" but that it does happen often. He stated that just because he did not screen when the knee was touched or bent during the evaluation does not mean that he does not experience problems. Another VA examination occurred in August 2020 during which the examiner noted a diagnosis of right knee iliotibial band syndrome and instability. See August 2020 VA examination. The Veteran reported progressive worsening, weakness, "giving out", locking, popping, and constant and dull aching pain. The Veteran reported experiencing flare-ups that occur several times a week for a week where the right knee gives out causing a fall. Functional loss was reported to include running, extended walking, walking on uneven surfaces, and climbing, especially into a work vehicle. Initial ROM testing revealed normal results of 0 to 140 degrees flexion and 140 to 0 degrees extension. Tenderness was noted on examination. There was evidence of pain with weight bearing and no evidence of crepitus. Repetitive use testing was completed without additional loss of function or ROM. Pain, fatigue, weakness, and lack of endurance were noted to significantly limit functional ability with repeated use over time and during flare-ups, which was estimated in ROM to be 0 to 125 degrees flexion and 125 to 0 degrees extension. Additional factors contributing to the disability included disturbance of locomotion and interference with standing. The examiner noted the Veteran walks with a limp due to right knee pain and extended standing causes increased pain. The examiner noted reduction in muscle strength for flexion and extension. Muscle atrophy was not found. Ankylosis was not indicated. A history of recurrent subluxation, lateral instability, or recurrent effusion were not found. Joint stability testing was performed revealing normal results. A meniscus condition was not found. A deformity of the right knee was not found in comparison to the left knee. Occasional use of a brace for right knee pain was noted. Functional impact on the ability to perform occupational tasks was noted to include missing 0-1 week of work in the last 12 months, increased knee pain and weakness with climbing into bulldozer and with extended periods of walking or standing. There was objective evidence of pain on passive ROM testing but no objective evidence of pain with non-weight bearing. Most recently the Veteran was afforded a VA examination in January 2021. See January 2021 VA examination. Right knee instability and iliotibial band syndrome were noted as diagnoses. The Veteran stated that his right knee disabilities have worsened / progressed, and he is experiencing constant pain. Flare-ups were not reported. The Veteran conveyed functional loss or impairment because standing and walking hurts the right knee, he is no longer able to run, and his knee gives out while using the stairs. Initial ROM testing revealed abnormal results of 0 to 90 degrees flexion and 90 to 0 degrees extension. The abnormal ROM contributes to functional loss because the Veteran is unable to fully bend the knee. Pain was noted on examination with flexion. Objective evidence of localized tenderness or pain was found as well as pain with weight bearing. There was no evidence of crepitus. Repetitive use testing was completed without additional loss of function or ROM. Pain was noted to significantly limit functional ability with repeated use over time but with the same ROM results of 0 to 90 degrees flexion and 90 to 0 degrees extension. Pain, fatigue, weakness, lack of endurance, and incoordination were not found to significantly limit functional ability with flare-ups and the same ROM was indicated. Muscle strength testing was normal. Muscle atrophy and ankylosis were not found. A history of recurrent subluxation or recurrent effusion were not indicated. Slight lateral instability was found. Joint stability testing was performed with abnormal results found with medial instability. A meniscus condition was not found. Constant use of a knee brace was reported. Functional impact on the ability to perform occupational tasks was noted to be an impacted ability to kneel, squat, climb ladders, walk and stand for prolonged duration, and lift heavy weights. There was no objective evidence of pain on non-weight bearing. Passive ROM testing was the same as active ROM. There was no objective evidence of pain on passive ROM testing. The Board finds that the August 2020 VA examination is adequate to determine the current nature, extent, and severity of the Veteran's right knee disability. The requirements of DeLuca, Correia, and Sharp were all addressed by the examiner and the Veteran's own descriptions of his limitations were taken into account in determining functional impact and additional loss in terms of range of motion with repetitive use over time and during flare-ups. DeLuca, 8 Vet. App. At 202; Correia, 28 Vet. App. at 158; Sharp, 29 Vet. App. at 32. Therefore, the Board finds that the examination results, along with the other medical evidence of record, provide an adequate basis upon which to evaluate the right knee disability. From August 9, 2016 Based on the aforementioned and in light of the additionally obtained evidence including multiple VA examinations, the Board finds a 10 percent disability rating, but no higher, for right knee iliotibial band syndrome is warranted from August 9, 2016. Throughout the entire period on appeal, the Board notes the Veteran's right knee ROM was limited to 0 to 90 degrees flexion and 90 to 0 degrees extension, at worst, including during flare-ups and with repeated use. This was revealed in the January 2021 VA examination. The August 2020 VA examiner found ROM was limited to 0 to 125 degrees flexion and 125 to 0 degrees extension during flare-ups and with repeated use. Contrarily, the October 2016 VA examiner indicated the Veteran did not experience flare-ups, however, under the description of medical history, there appears to be a typographical error that suggests flare-ups were occurring during this period. Indeed, the examiner stated, "he has intermittent lateral knee that occurs without apparent provocation a couple times a month each time lasting 3-4 hours." Upon additional review, and in light of the Veteran's lay statements of experiencing flare-ups that were not reported by the examiner, the Board finds this is likely a typographical error that was indeed referencing flare-ups. Regardless, the Board will provide the Veteran the benefit of the doubt and consider the most limited ROM estimate provided for the entire period on appeal, 90 degrees extension and flexion. Under DC 5260, these ROMs remain noncompensable. The Board notes because the Veteran's limitation of motion is noncompensable under DC 5260, the RO assigned a 10 percent rating for painful motion and swelling effective May 25, 2020, under 38 C.F.R. § 4.59 during the pendency of this claim. Upon additional review, including consideration of the Veteran's lay statements of symptoms in relation to his increase rating claim, the Board finds a 10 percent disability rating is warranted under 38 C.F.R. § 4.59 from August 9, 2016, for painful motion that remains noncompensable under DC 5260. As directed by the Court, this is especially in consideration of the Veteran's competent and credible reports of experiencing pain in the right knee that examiners have determined causes functional loss but remains noncompensable in terms of ROM. The Board finds that the Veteran's disability is fully capable of evaluation under the rating schedule. The Board has also considered whether there is a specific factually ascertainable increase in severity of the Veteran's right knee disability in the year prior to his increased rating claim but finds the record lacks evidence of such. The Veteran's reported functional loss and pain associated with his right knee disability, are appropriately compensated for as 10 percent disabling for painful motion. In reaching the above conclusions for the rating period on appeal, the Board has considered the Veteran's functional loss due to pain, weakness, fatigability, lack of endurance, or pain on movement of the right knee joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca, 8 Vet. App. 202. The Veteran has consistently contended he is entitled to an increased rating due to his knee disability including as due to the functional impact his pain and limited range of motion has on his ability to work. His disability is rated based upon limited range of motion for which he underwent multiple ROM tests. The Board has considered the most limited ROM reported during the entire period on appeal, which remains noncompensable. Accordingly, in this case, the Veteran's reports of pain, functional loss, and limited range of motion are addressed by his awarded 10 percent disability rating for painful motion. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). Instability under DC 5257 is addressed in more detail below. The other potential diagnostic codes are inapplicable here because there is no medical evidence in support. Indeed, the Veteran's right knee is not ankylosed (i.e., frozen). While each of the VA examiners have found the Veteran's right knee was not ankylosed, consideration must still be given to whether he is functionally ankylosed. Chavis v. McDonough, 34 Vet. App. 1, 20 (2021). Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). The Veteran has not contended, nor does the record reflect, his right knee is immobile. Rather, the Veteran has limited mobility with symptoms including pain. Thus, DC 5256 is not for application. The knee disability does not affect the tibia, fibula, or genu recurvatum and, therefore, DCs 5262 and 5263 are not for application. DC 5259 is not applicable as the Veteran has not had semilunar cartilage removed in the left knee. DC 5258 is not applicable because while the Veteran may experience episodes of locking pain, neither effusion nor dislocated semilunar cartilage has been found. Further, the Veteran's symptoms of locking or giving way have been compensated for under DC 5257 for instability. Regarding DC 5261, a higher disability rating would not be achieved through limitation of extension as ROM testing revealed ROM that was not limited to 15 degrees extension. In fact, the most limited ROM extension was 90 degrees, which is noncompensable under DC 5261. Based on the above, the Board finds a 10 percent disability rating, but no higher, is warranted for painful motion under 38 C.F.R. § 4.59 from August 9, 2016, for right knee iliotibial band syndrome. 2. Entitlement to a 10 percent rating, but no higher, for right knee instability for the entire appellate time frame, from August 9, 2016, is granted. As part of the Board's May 2020 decision, the Veteran was granted a separate rating for right knee instability under DC 5257 at 10 percent disabling. The RO, since that time, reduced the Veteran's right knee instability to 0 percent, effective August 18, 2020, and increased back to 10 percent, effective December 14, 2020. For reasons outlined below, the Board finds a 10 percent rating is warranted under DC 5257 for the entirety of the appellate time frame, from August 9, 2016, but no higher. The Court specifically directed the Board to define the terms utilized within DC 5257 for assignment of ratings including "slight," "moderate," and "severe." Accordingly, as mentioned above, the terms "slight," "mild," "moderate," "moderately severe," and "severe" are not defined in the rating schedule. 38 C.F.R. § 4.6. According to Merriam Webster's Collegiate Dictionary 999 (11th Ed. 2007), "slight" means small in amount. "Moderate" means limited in scope or effect. "Severe" means very painful or harmful or of a great degree. Although a medical examiner's use of descriptive terminology such as "mild" is an element of evidence to be considered by the Board, it is not dispositive of an issue. The Board must evaluate all evidence in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Here, the Board awarded a 10 percent disability rating under DC 5257 for slight recurrent subluxation or lateral instability. Based on the evidence of record, the Board determined the Veteran competently and credibly conveyed experiencing episodes of his knee giving way or "giving out." This is corroborated by the buddy statements of record. Upon examination, however, in October 2016, the VA examiner found the Veteran did not experience instability and the corresponding instability testing revealed normal results. The August 2020 VA examiner also found the Veteran did not have a history of lateral instability which was confirmed through joint stability testing revealing normal results. Most recently, the January 2021 VA examiner noted the Veteran has slight lateral instability that was confirmed through abnormal medial instability joint testing but normal stability testing for the anterior, posterior, and lateral. The Board notes the January 2021 VA examination indicated 1+ medial instability. Based on the Veteran's lay statements of his knee giving way occasionally while walking and causing him to fall in conjunction with the January 2021 VA examiner's most recent stability testing results revealing 1+ medial instability, the Board finds the Veteran's right knee instability more nearly approximates a 10 percent rating for slight instability for the entire period on appeal. Indeed, his instability occurs with a small amount of frequency, but no higher. Thus, an increased rating is not warranted. In so finding, the Board finds the frequency and severity of the Veteran's right knee instability has not amounted to moderate, limited in scope or effect. Consideration of amended DC 5257 is not necessary here as medical evidence has not been submitted or obtained after February 7, 2021, the date the amended DC 5257 went into effect. Again, the Board notes the RO assigned a noncompensable rating for right knee instability from August 18, 2020, to December 13, 2020, based on the VA examination revealing normal joint stability testing, noting that the reduction did not affect the Veteran's current combined percentage of disability for compensation. The Board finds, however, a 10 percent disability rating for joint instability is warranted for the entire period on appeal beginning August 9, 2016. While the August 2020 VA examiner noted normal joint stability testing, the Veteran continued to report his right knee "gives out" as part of the examination. Under the pre-February 7, 2021, criteria for DC 5257, the Court determined in English v. Wilkie, that objective medical evidence is not required to establish lateral knee instability so objective medical evidence cannot be categorically found more probative than lay evidence with respect to this Diagnostic Code. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). Given English, the Board has carefully considered the Veteran's lay evidence throughout the appellate time frame describing instability despite normal testing in August 2020. Thus, resolving any doubt in favor of the Veteran, the Board finds the 10 percent disability rating under DC 5257 is warranted for the entire period on appeal. Based on the above, a 10 percent disability rating, but no higher, is warranted for right knee instability under DC 5257 as the Veteran's symptoms more nearly approximate slight instability from August 9, 2016. The Board finds the preponderance of the evidence is against a rating in excess of 10 percent for right knee instability. As such, the benefit-of-the-doubt doctrine is not for application and the claim must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). 3. Entitlement to a 40 percent disability rating, but no higher, from August 9, 2016, for right rotator cuff syndrome is granted. At the outset, the Board notes the Court directed the Board to provide additional reasons and bases for denying a 20 percent disability rating for right rotator cuff syndrome in the May 2020 decision including consideration of the Veteran's lay statements. Upon additional review and development, the Board finds a 40 percent disability rating, but no higher, is warranted from August 9, 2016. Turning to the relevant evidence of record, in 2016, the Veteran complained of right shoulder pain. See November 2016 VA treatment records. He reported experiencing constant pain that interrupts sleep and worsens with movements. He explained he installs internet and cable where he carries a "heavy" ladder over his right shoulder daily. In 2017, the Veteran complained of continued right shoulder pain. See March 2017 VA treatment records. In May, he reported right shoulder pain noting that he works as a wire technician and spends "extensive time" lifting and reaching. See May 2017 VA treatment records. In 2018, the Veteran complained of right shoulder pain explaining it is chronic but flared due to "lifting paint cans yesterday." See March 2018 VA treatment records. He went to the emergency department for shoulder pain after "lifting." See March 2018 VA treatment records. Imaging did not reveal significant findings. Pain was noted with movement and a baseline of "aches and pains" prior to the lifting injury. In 2019, the Veteran stated that his right shoulder movement has "degraded tremendously" referencing imaging obtained. See VA Form 20-0996. He continued to complain of right shoulder pain, stating that he has limited ROM and is unable to lift overhead or the joint "pops." See May 2019 VA treatment records. In May, he reported experiencing worsening right shoulder joint pain over the past three months. See May 2019 VA treatment records. Imaging in June revealed mild arthritis. See June 2019 VA treatment records. In July, the Veteran again conveyed anterior right shoulder pain with limited ROM. He stated he remains unable to lift overhead or joint "pops." See July 2019 VA treatment records. In 2020, the Veteran reported experiencing continued right shoulder pain. See July 2020 VA treatment records. Imaging revealed mild arthritis. The Veteran reported experiencing ROM to approximately 90 degrees stating, "If I go further it pops." Multiple buddy statements were submitted to the record. The Veteran's mother conveyed he experiences shoulder pain. See June 2019 buddy statement. The Veteran's spouse stated that the Veteran experiences pain daily and is unable to do the activities and duties that he used to do. See May 2020 buddy statement. She generally stated that the Veteran is constantly in pain and unable to sleep due to pain, stiffness, and numbness. The Veteran was afforded multiple VA examinations during the period on appeal to determine the severity of his right shoulder disability. The first examination occurred in October 2016 during which right rotator cuff syndrome was noted as a diagnosis. See October 2016 VA examination. The Veteran reported his symptoms have progressively worsened. Three years prior to the examination, the Veteran reported attending physical therapy without improvement. He also stated he receives injections with improvement for about a month. The Veteran reported discussing right shoulder surgery with providers. He described "constant global right shoulder pain" that is worse with lying on the right side and with lifting more than 5 pounds. He conveyed his right shoulder sometimes "catches" causing increased pain for days when lowering the arm. The Veteran did not report experiencing flare-ups of the right shoulder. Functional loss or functional impairment of the joint was indicated as impaired sleep and impaired mobility. The Veteran said, "It affects my life pretty regular." ROM testing revealed abnormal results with flexion 0 to 125 degrees, abduction 0 to 130 degrees, external rotation 0 to 75 degrees, and internal rotation 0 to 60 degrees. The abnormal ROM contributes to functional loss because the Veteran is unable to fully reach overhead. Pain was noted on examination with flexion, abduction, and external rotation that causes functional loss. There was evidence of pain with weight bearing. Objective evidence of localized tenderness or pain on palpitation of the joint was not indicated. There was no objective evidence of crepitus. The Veteran was able to complete repetitive-use testing with at least three repetitions. Observed repetitive use testing revealed ROM limited to 0 to 120 degrees flexion, 0 to 125 degrees abduction, 0 to 75 degrees external rotation, and 0 to 60 degrees internal rotation. Pain was noted to cause the additional ROM loss. The examiner also found the Veteran has less movement than normal and interference with lifting and reaching in the right shoulder. Muscle strength testing revealed normal results. The Veteran does not have muscle atrophy or ankylosis. A right shoulder rotator cuff condition was indicated with a positive Hawkins' impingement test, negative empty can test, negative external rotation / infraspinatus strength test, and negative lift-off subscapularis test. Shoulder instability, dislocation, or labral pathology was not suspected. A clavicle, scapula, and acromioclavicular joint or sternoclavicular joint condition was not suspected. The examiner found the Veteran does not have loss of head, nonunion, or fibrous union of the humerus or malunion of the humerus with moderate or marked deformity. The Veteran did not report use of an assistive device. The examiner did not indicate any other pertinent physical findings, complications, conditions, signs, or symptoms related to the right shoulder. The examiner found the Veteran's right shoulder impacts his ability to perform occupational tasks due to a limited ability to reach and lift. Following this examination, the Veteran stated that the VA examiner erroneously indicated he did not experience flare-ups. See February 2017 Notice of Disagreement. The Veteran conveyed that he has flare-ups "constantly" and is "always in pain." The Veteran also stated that he experiences swelling, but during the examination certain areas were not swollen or inflamed. See August 2018 Form 9. He reported experiencing constant shoulder pain with a description of the degree of bending that could be tolerated, but that the examiner pushed the Veteran beyond his mobility to obtain results. Another VA examination occurred in August 2020 where right rotator cuff syndrome was again noted. See August 2020 VA examination. The Veteran reported that the condition has progressively worsened over time. He conveyed constant pain with limited ROM affected by getting "catching / popping" and "extreme" pain trying to go past ROM where catching occurs. He also reported experiencing sleep disturbance. The Veteran was noted to be right hand dominant. Flare-ups were reported daily lasting for "several hours" due to increased use of the right arm or moving in the "wrong way." The Veteran reported experiencing functional loss as lifting anything with the right arm, raising the arm above shoulder level, inability to reach backwards for wallet from right pocket, and difficulty with holding children, opening doors, golfing, and driving. ROM testing revealed abnormal results with 0 to 30 degrees flexion, 0 to 30 degrees abduction, 0 to 70 degrees external rotation, and 0 to 75 degrees internal rotation. The abnormal ROM contributes to functional loss with lifting anything with the right arm, raising the arm above shoulder level, inability to reach backwards for wallet from right pocket, and difficulty with holding children, opening doors, and golfing. Pain was noted on examination with each movement. There was objective evidence of localized tenderness or pain described as tenderness to touch on the right shoulder. There was evidence of pain with weight bearing and objective evidence of crepitus. Observed repetitive use testing was completed without additional loss of function or ROM. Pain, fatigue, weakness, and lack of endurance were noted to significantly limit functional ability with repeated use over time with ROM estimates of 0 to 25 degrees flexion, 0 to 25 degrees abduction, 0 to 65 degrees external rotation, and 0 to 65 degrees internal rotation. The examination was not completed during a flare-up but the examiner opined pain, fatigue, weakness, lack of endurance, and incoordination significantly limits functional ability with flare-ups with ROM limited to 0 to 20 degrees flexion, 0 to 20 degrees abduction, 0 to 60 degrees external rotation, and 0 to 60 degrees internal rotation. Additional factors of disability were noted to be sleep disturbance due to pain and pain with driving extended periods. A reduction in muscle strength was noted with forward flexion and abduction. Muscle atrophy and ankylosis were not indicated. A right rotator cuff condition was indicated with positive Hawkins' impingement testing, positive empty-can test, positive external rotation / infraspinatus strength test, and positive lift-off subscapularis test. Shoulder instability, dislocation, or labral pathology was not suspected. A clavicle, scapula, acromioclavicular joint, or sternoclavicular joint condition was not suspected. The Veteran did not have loss of head, nonunion, or fibrous union of the humerus. The Veteran did not have malunion of the humorous with moderate or marked deformity. Occasional use of a brace was noted. The examiner opined that the Veteran's right shoulder disability impacts his ability to perform occupational tasks due to 0-1 week of work time lost in the past 12 months, trouble climbing up and into a bulldozer as well as difficulty operating a bulldozer with the dominant arm due to lack of strength and pain and limited ROM. The Veteran was most recently afforded a VA examination in January 2021 during which right rotator cuff syndrome was noted. See January 2021 VA examination. The Veteran reported his condition has progressed / worsened describing constant pain as the current symptoms. Flare-ups were reported as episodes of "really sharp pain" on the right shoulder a "few times a month." The Veteran reported functional loss as pain reaching overhead. ROM testing revealed 0 to 60 degrees flexion, 0 to 60 degrees abduction, 0 to 90 degrees external rotation, and 0 to 40 degrees internal rotation. Pain on examination was noted with flexion, abduction, and internal rotation. There was objective evidence of localized tenderness or pain on the anterior shoulder and AC joint with moderate severity. There was evidence of pain with weight bearing. No evidence of crepitus was found. The Veteran was able to complete repetitive-use testing without additional loss of function or ROM. Pain was noted to significantly limit functional ability with repeated use over time with a ROM estimate of 0 to 60 degrees flexion, 0 to 60 degrees abduction, 0 to 90 degrees external rotation, and 0 to 40 degrees internal rotation. Pain was noted to cause functional loss during flare-ups with a ROM estimate of 0 to 60 degrees flexion, 0 to 60 degrees abduction, 0 to 90 degrees external rotation, and 0 to 40 degrees internal rotation. Normal muscle strength testing results were reported. Muscle atrophy and ankylosis were not indicated. A right rotator cuff condition was suspected with the Veteran being unable to perform the Hawkins' impingement test, empty-can test, external rotation / infraspinatus strength test, and lift-off subscapularis test. Shoulder instability, dislocation, or labral pathology was not suspected. AC joint osteoarthritis of the right side was indicated which affects ROM of the shoulder. The examiner opined that it is well recognized in medical literature that chronic joint injuries precipitate arthritis changes, which are now manifested and validated by imaging. There was tenderness on palpitation of the right AC joint. Cross-body abduction testing was positive on the right side. Loss of head, nonunion, or fibrous union of the humerus was not indicated. Malunion of the humerus with moderate or marked deformity was not found. The Veteran was noted to use a right shoulder sling occasionally. Functional impact on the ability to perform occupational tasks was indicated based on an impacted ability to reach overhead, climb ladders, and lift heavy weights. There was no objective evidence of pain on non-weight bearing. Passive ROM was the same as active ROM. Objective evidence of pain on passive ROM testing was not indicated. The Board finds that the August 2020 VA examination is adequate to determine the current nature, extent, and severity of the Veteran's right shoulder disability. The requirements of DeLuca, Correia, and Sharp were all addressed by the examiner and the Veteran's own descriptions of his limitations were taken into account in determining functional impact and additional loss in terms of range of motion with repetitive use over time and during flare-ups. DeLuca, 8 Vet. App. At 202; Correia, 28 Vet. App. at 158; Sharp, 29 Vet. App. at 32. Therefore, the Board finds that the examination results, along with the other medical evidence of record, provide an adequate basis upon which to evaluate the right shoulder disability. From August 9, 2016 The Board finds, based upon additional review as well as newly obtained VA examinations, that a 40 percent disability rating under DC 5201, but no higher, is warranted for the entire period on appeal from August 9, 2016. While the Board previously relied upon the October 2016 VA examination, in light of the newly obtained VA examinations in conjunction with the Veteran's lay statements, the Board now finds the October 2016 VA examination did not reflect the Veteran's contentions of flare-ups. Indeed, as directed by the Court, the Board has given additional consideration to the Veteran's lay statements of flare-ups and limitations related to the right shoulder during the entire period on appeal. The August 2020 VA examiner corroborated the Veteran's contentions of experiencing flare-ups including frequency, duration, and precipitating factors. While alleviating factors were not addressed by the August 2020 VA examiner, the January 2021 VA examiner indicated the Veteran's flare-ups are alleviated by medication. The August 2020 VA examiner opined that the Veteran's flare-ups of the right shoulder would limit ROM to 0 to 20 degrees flexion, 0 to 20 degrees abduction, 0 to 60 degrees external rotation, and 0 to 60 degrees internal rotation due to pain, fatigue, weakness, lack of endurance, and incoordination. The Board finds the Veteran competently reported experiencing flare-ups but notes the Veteran is not competent to render a determination regarding ROM. Accordingly, the Board will consider the August 2020 VA examiner's ROM estimate during flare-ups from the date of the claim in light of the Veteran's consistent contentions of experiencing flare-ups that were not reported by the October 2016 VA examiner. While the Veteran declined experiencing flare-ups during the October 2016 VA examination, subsequent statements note he experiences flare-ups that were not noted during the examination. Resolving any doubt in favor of the Veteran, the Board finds the Veteran experiences flare-ups of the right shoulder and a rating is warranted from the date of claim as it was not until the August 2020 VA examination that a ROM based on flare-ups was available. Under DC 5201, a 40 percent rating is warranted for limited motion of the arm to 25 degrees from the side for the major joint. The evidence of record indicates the Veteran is right-handed and again the August 2020 VA examiner opined ROM was limited to 20 degrees flexion during flares. Accordingly, the Veteran's limited ROM during flare-ups warrants a 40 percent disability rating. Consideration of amended DC 5201 is not necessary here as medical evidence has not been submitted or obtained after February 7, 2021, the date the amended DC 5201 went into effect. The Board notes a 40 percent disability rating for the major joint is the highest schedular rating for limited motion of the arm. As such, there is no basis to award a higher rating. The Board has also considered whether there is a specific factually ascertainable increase in severity of the Veteran's right shoulder disability in the year prior to his increased rating claim but finds the record lacks evidence of such. The Veteran's reported functional loss and pain associated with his right shoulder disability, are now accounted for by his 40 percent disability rating under DC 5201. The Board finds that the Veteran's disability is fully capable of evaluation under the rating schedule. In reaching the above conclusions for the rating period on appeal, the Board has considered the Veteran's functional loss due to pain, weakness, fatigability, lack of endurance, or pain on movement of the right shoulder joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca, 8 Vet. App. 202. His disability is rated based upon limited range of motion for which he underwent multiple ROM tests. The Board has based his disability rating on the most limited flexion ROM during flare-ups, 0 to 20 degrees flexion and 20 to 0 degrees abduction. In this case, the Veteran's reports of pain, functional loss, and limited range of motion are addressed by his awarded 40 percent disability rating. The Board has considered whether any other Diagnostic Codes related to disabilities of the shoulder would provide for a higher disability rating. However, the evidence does not reflect that the symptoms would warrant a higher rating under a different Diagnostic Code. See 38 C.F.R. § 4.71a. While the January 2021 VA examiner indicated the Veteran now has AC joint osteoarthritis of the right side and that it is well recognized in medical literature that chronic joint injuries precipitate arthritis changes, a rating for osteoarthritis would not produce a higher disability rating. Further, the January 2021 VA examiner found that while the Veteran now has AC joint osteoarthritis, he does not experience dislocation, nonunion, or malunion. Thus, a separate compensable rating under DC 5203 is not warranted. In such a circumstance, DC 5203 notes to rate on impairment of function of contiguous joint, which has already been done under DC 5201. Further, the record lacks evidence of ankylosis of the scapulohumeral articulation. While each of the VA examiners have found the Veteran's right shoulder was not ankylosed, consideration must still be given to whether he is functionally ankylosed. Chavis, 34 Vet. App. at 20. Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). The evidence of record does not indicate the Veteran experienced functional ankylosis. Rather, while the Veteran experienced impacted ROM and symptoms including pain, the record indicates he is still able to use his right shoulder and it is not immobile. Thus DC 5200 is not for application. Further, none of the VA examiners have found impairment or malunion of the humerus rendering DC 5202 not applicable. While the Veteran stated that he experienced "popping" with movement, none of the VA examiners found recurrent dislocation of the scapulohumeral joint. The Board notes the August 2020 VA examiner considered the Veteran's statement regarding "popping", but still found based upon examination that the Veteran did not experience dislocation of the scapulohumeral joint, which the Board finds more probative. (Continued on the next page) Thus, a 40 percent disability rating, but no higher, under DC 5201 for the right shoulder disability is warranted from August 9, 2016. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.C. Allen, Associate 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.