Citation Nr: A21016807 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 200409-77391 DATE: October 15, 2021 ORDER Entitlement to an increased evaluation in excess of 20 percent disabling from December 14, 2015 to June 4, 2017 for residuals of left rotator cuff repair (ankylosis of scapulohumeral articulation or a left shoulder disability) is denied. Entitlement to an increased evaluation in excess of 30 percent disabling from June 5, 2017 to July 31, 2019 for a left shoulder disability is denied. Entitlement to an increased evaluation in excess of 40 percent disabling from August 1, 2019 for a left shoulder disability is denied. FINDINGS OF FACT 1. From December 14, 2015 to June 4, 2017, the Veteran's left shoulder disability has not been manifested by intermediate between favorable and unfavorable ankylosis of the scapulohumeral articulation. 2. From June 5, 2017 to July 31, 2019, the Veteran's left shoulder disability has not been manifested by unfavorable ankylosis of the scapulohumeral articulation with abduction limited to 25 degrees from the side. 3. From August 1, 2019, the Veteran's left shoulder disability is rated as 40 percent disabling, which is the maximum schedular rating permitted for ankylosis of scapulohumeral articulation of the minor extremity. CONCLUSIONS OF LAW 1. The criteria for entitlement to an increased evaluation in excess of 20 percent disabling from December 14, 2015 to June 4, 2017 for a left shoulder disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes (DCs) 5010-5200. 2. The criteria for entitlement to an increased evaluation in excess of 30 percent disabling from June 5, 2017 to July 31, 2019 for a left shoulder disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DCs 5010-5200. 3. The criteria for entitlement to an increased evaluation in excess of 40 percent disabling from August 1, 2019 for a left shoulder disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DCs 5010-5200. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from March 1994 to July 1998. Rating decisions were issued under the legacy system in February 2016, August 2017, and June 2018. In March 2019, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a June 2018 rating decision. However, in August 2019, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested review of the June 2018 rating decision. In January 2020, the Veteran's representative submitted a statement clarifying that the Veteran wanted to continue with his Supplemental Claim rather than the Higher-Level Review. The Veteran's representative wrote, "Veteran is responding to VA letter dated December 9, 2019. VA informed the Veteran he had submitted a Supplemental Review as well as a Higher Level Review on the same issue. He is requesting VA continue with the Supplemental Review." In January 2020, the AOJ issued the rating decision on appeal, which increased the evaluation of residuals of left rotator cuff repair (ankylosis of scapulohumeral articulation) from 30 percent disabling to 40 percent disabling effective August 1, 2019. In April 2020, VA received a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), in which the Veteran elected the Direct Review option; therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal. 38 C.F.R. § 20.301. Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding these claims, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Increased Ratings A disability rating is determined by applying VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate DCs identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board may consider whether separate ratings may be assigned for separate periods of time whether or not the claim concerns an initial rating. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). This practice is known as "staged ratings." For the entirety of the appeal period, the Veteran's left shoulder disability is rated under 38 C.F.R. § 4.71a, DCs 5010-5200, for ankylosis of scapulohumeral articulation. Hyphenated DCs are used when a rating under one DC requires the use of an additional DC to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. Under DC 5200, favorable, abduction to 60 degrees, can reach mouth and head warrants a 20 percent rating for the minor joint and a 30 percent rating for the major joint. Intermediate between favorable and unfavorable warrants a 30 percent rating for the minor joint and a 40 percent rating for the major joint. Unfavorable, abduction limited to 25 degrees from the side warrants a maximum 40 percent rating for the minor joint and a maximum 50 percent rating for the major joint. 38 C.F.R. § 4.71a, Diagnostic Code 5200. A note to DC 5200 states that the scapula and humerus move as one piece. Id. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; 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). 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. 85 Fed. Reg. 76453 (Nov. 30, 2020). The Board notes, however, that DC 5200 was not amended. Additionally, the Board's review is limited to evidence of record at the time of the agency of original jurisdiction's decision. Because the rating schedule changed after the evidentiary window closed, there is no evidence to consider under the new criteria. Relevant to all stages on appeal, the issue of consideration of an extraschedular rating was raised by an August 2019 Supplemental Claim. In the Supplemental Claim form, the Veteran wrote, "Left shoulder/extraschedular." Additionally, in an August 2019 lay statement, the Veteran wrote, "I would like you to reconsider with the extrashedular to re-evaluate my left shoulder." Consideration of an extraschedular rating requires a three-step inquiry. The first question is whether the schedular rating criteria adequately contemplate the Veteran's disability picture. If the schedular evaluation does not contemplate the level of disability and symptomatology shown and is found inadequate, then the second inquiry is whether the exceptional disability picture exhibits other related factors, such as marked interference with employment or frequent periods of hospitalization. See Thun v. Peake, 22 Vet. App. 111 (2008). The first Thun element compares a claimant's symptoms to the rating criteria, while the second addresses the resulting effects of those symptoms. Thus, the first and second Thun elements, although interrelated, involve separate and distinct analyses. Yancy v. McDonald, 27 Vet. App. 484, 495 (2016). If the Veteran's disability picture meets the second inquiry, then the third step is to refer the case to the Director of Compensation Services to determine whether an extraschedular rating is warranted. See Thun, 22 Vet. App. 111. In regard to the first element, comparison of the Veteran's symptoms and associated functional impairment does not show that the rating criteria are inadequate to describe his disability picture. The Veteran's left shoulder disability is rated under DCs 5010-5200. The record shows that he has complaints and findings of difficulty sleeping at night, difficulty lifting anything on the left shoulder, pain when pulling up his pants or reaching to shut off a valve, inability to raise his left arm, and inability to lift heavy weights or do maneuvers with his arms above his head. DCs 5010-5200 do not specifically list all the Veteran's symptoms, and are not reasonably similar to the symptoms listed under DCs 5010-5200. In regard to the second Thun element, although the available schedular evaluations are inadequate to rate the Veteran's complaints and findings of difficulty sleeping at night, difficulty lifting anything on the left shoulder, pain when pulling up his pants or reaching to shut off a valve, inability to raise his left arm, and inability to lift heavy weights or do maneuvers with his arms above his head, the exceptional disability picture does not exhibit other related factors, such as marked interference with employment or frequent periods of hospitalization. The Veteran's complaints and findings of difficulty sleeping at night, difficulty lifting anything on the left shoulder, pain when pulling up his pants or reaching to shut off a valve, inability to raise his left arm, and inability to lift heavy weights or do maneuvers with his arms above his head are not so severe as to cause marked interference with employment or frequent hospitalizations. In this case, the Veteran's disability picture does not exhibit other related factors such as marked interference with employment or frequent periods of hospitalization that would warrant further extraschedular consideration. The threshold issue under Thun is thus not met, and further consideration of an extraschedular rating is not warranted. 1. Entitlement to an increased evaluation in excess of 20 percent disabling from December 14, 2015 to June 4, 2017 for a left shoulder disability The Veteran contends that his left shoulder disability is more severely disabling than represented by the assigned 20 percent rating from December 14, 2015 to June 4, 2017. The period on appeal begins on December 14, 2015, the date the Veteran filed his claim for an increased rating. The Veteran's left shoulder disability is rated under 38 C.F.R. § 4.71a, DCs 5010-5200, for ankylosis of the scapulohumeral articulation. The Veteran is right-handed; as such his left arm will be evaluated as the minor (non-dominant) side. See VA Examination dated January 2016. As discussed above, under DC 5200, a higher 30 percent rating is warranted for intermediate between favorable and unfavorable ankylosis of the scapulohumeral articulation. The evidence shows that his left shoulder disability has not resulted in intermediate between favorable and unfavorable ankylosis of the scapulohumeral articulation at any time from December 14, 2015 to June 4, 2017. In a January 2016 VA examination for shoulder and arm conditions, the Veteran reported that he had chronic daily constant pain of his left shoulder. He reported difficulty sleeping at night, difficulty with lifting anything on the left shoulder, and noted that pulling up his pants or reaching to shut off a valve caused pain. He took Ibuprofen and got steroid injections to his left shoulder, which helped for about three to four weeks. He did not report flare-ups of the shoulder or functional loss or impairment. Left shoulder flexion was 0 to 85 degrees, abduction was 0 to 60 degrees, external rotation was 0 to 60 degrees, and internal rotation was 0 to 90 degrees. Range of motion did not contribute to functional loss. Pain was noted on examination but did not result in or cause functional loss. There was evidence of pain with weight bearing and objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was evidence of crepitus. He was unable to perform repetitive use testing with at least three repetitions because the left shoulder was very painful with range of motion. There was obvious use of accessory muscles like the trapezius to raise the left arm in flexion and abduction. The examiner was unable to say without mere speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over a period of time. Additional contributing factors of the disability included less movement than normal due to ankylosis, adhesions, etc., weakened movement due to muscle or peripheral nerve injury, etc., instability of station, and disturbance of locomotion. Muscle strength testing was 4/5. He did not have muscle atrophy or ankylosis in the left shoulder. The Hawkins' Impingement test, empty-can test, external rotation/infraspinatus strength test, and lift-off subscapularis test were all positive. There was no shoulder instability, dislocation or labral pathology suspected. It was noted that he had AC joint arthritis which affected range of motion and caused tenderness or palpation. The cross-body abduction test was positive. He did not have loss of head, nonunion, or fibrous union of the humerus. He did not have malunion of the humerus with moderate or marked deformity. In a January 2016 consultation, the Veteran complained of left shoulder pain. He had chronic daily constant pain and minimal use of his left shoulder due to this pain and function. The left shoulder showed decreased range of motion with forward flexion to about 60 degrees, abduction to about 90 degrees, and internal rotation only to the level of iliac crest posteriorly. He had passive range of motion up to about 90 degrees forward flexion. He had obvious weakness testing of his supraspinatus and infraspinatus muscles. Subscapularis seemed to be intact. He had no deformity distally in his upper extremities. Sensation was intact. Imaging showed chronic rotator cuff arthropathy of the left shoulder. In a February 2017 VA examination for shoulder and arm conditions, the Veteran stated that he was scheduled for a left shoulder surgery, but decided to cancel the surgery. He stated that when his shoulder clicked it took his breath away pain-wise. He stated that he had steroid injections in the shoulder. He was on Tramadol for pain to the left shoulder. He reported difficulty sleeping on the left shoulder at night. He reported difficulty with lifting anything on his left shoulder. Pulling up his pants or reaching out to shut off a valve caused pain. He did not report flare-ups or having any functional loss or impairment. Flexion was 0 to 70 degrees, abduction was 0 to 65 degrees, external rotation was 0 to 60 degrees, and internal rotation was 0 to 90 degrees. Range of motion contributed to functional loss. Pain was noted on examination but did not result in or cause functional loss. There was evidence of pain with weight bearing and evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was evidence of crepitus. He was able to perform repetitive use testing with at least three repetitions with no additional functional loss or range of motion. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time. Additional contributing factors of the disability included less movement than normal due to ankylosis, adhesions, etc., weakened movement due to muscle or peripheral nerve injury, etc., disturbance of locomotion, instability due to loss of tendon function, grinding with range of motion, and use of accessory muscles for abduction and forward flexion. Muscle strength was 5/5. He did not have muscle atrophy or ankylosis on the left side. The Hawkins' Impingement test, empty-can test, external rotation/infraspinatus strength test, and lift-off subscapularis test were all positive. There was no shoulder instability, dislocation or labral pathology suspected. There was a clavicle, scapula, acromioclavicular (AC) joint or sternoclavicular joint condition suspected. It affected range of motion. There was tenderness on palpation of the AC joint. The cross-body abduction test was positive. He did not have loss of head, nonunion, or fibrous union of the humerus. He did not have malunion of the humerus with moderate or marked deformity. He stated that he had increased pain with raising his left shoulder up above 90 degrees. Turning valves for monthly checks at work took a lot of upper body strength and caused shoulder pain. He tried not to use his left shoulder very much but climbed the ladder to lift the top hatch in the warehouse. He had pain in the shoulder. He stated that he tossed and turned at night due to shoulder pain when he slept on either side. He could not hold the bucket to catch the water when he was checking the shower function for emergencies at work. In a May 2017 orthopedic examination, left upper extremity examination revealed active elevation of the left shoulder to 40 degrees passively go to 110 degrees. External rotation to the side was to about 40 degrees with about a 20 degree lag sign. His abdominal compression test was mildly positive on the left. Internal rotation was to the posterior lateral buttock. His deltoid was weak to any resisted abduction. An X-ray of the left shoulder showed left shoulder rotator cuff tear arthropathy after three previous surgeries. The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for a left shoulder disability from December 14, 2015 to June 4, 2017. The evidence of record shows that the Veteran is right-handed, as noted above. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss; this is for consideration per 38 C.F.R. § 4.59. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that he had difficulty sleeping at night and lifting anything on the left shoulder, and that pulling up his pants or reaching to shut off a valve caused pain would not result in symptoms more nearly approximating intermediate ankylosis of the minor joint. In order for the Veteran to receive a 30 percent evaluation under DC 5200, there must be intermediate between favorable and unfavorable ankylosis of the scapulohumeral articulation. At no time from December 14, 2015 to June 4, 2017, however, has the evidence shown that degree of impairment. Indeed, at no time from December 14, 2015 to June 4, 2017 was there intermediate between favorable and unfavorable ankylosis of the scapulohumeral articulation. Hence, the preponderance of the evidence is against the claim, and the claim must be denied. The Board has considered whether a higher or additional rating is available under other DCs. However, there is no evidence of humerus dislocation, malunion, fibrous union, nonunion, or flail shoulder; or dislocation, malunion or nonunion of the clavicle or scapula to support ratings under DCs 5202 or 5203. The Board notes that while there is limitation of motion of the arm during the period on appeal, given that limitation of motion is contemplated by the assigned rating based on ankylosis under DC 5200, a separate rating under DC 5201 would constitute pyramiding. As such, the Board finds that a rating in excess of 20 percent for the Veteran's service-connected left shoulder disability is not warranted. The current rating takes into consideration his complaints of difficulty sleeping at night and with lifting anything on the left shoulder, and that pulling up his pants or reaching to shut off a valve caused pain. The evidence, however, shows that even with the pain he experiences, the Veteran's left shoulder is not limited to intermediate between favorable and unfavorable ankylosis of the scapulohumeral articulation to warrant the next higher evaluation. Accordingly, the claim for a rating in excess of 20 percent disabling must be denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application, and the claim remains denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to an increased evaluation in excess of 30 percent disabling from June 5, 2017 to July 31, 2019 for a left shoulder disability The Veteran contends that his left shoulder disability is more severely disabling than represented by the assigned 30 percent rating from June 5, 2017 to July 31, 2019. The Veteran's left shoulder disability is rated under 38 C.F.R. § 4.71a, DCs 5010-5200, for ankylosis of the scapulohumeral articulation. The Veteran is right-handed; as such his left arm will be evaluated as the minor (non-dominant) side. As discussed above, under DC 5200, a higher 40 percent rating is warranted for unfavorable ankylosis of the scapulohumeral articulation with abduction limited to 25 degrees from the side. The evidence shows that his left shoulder disability has not resulted in unfavorable ankylosis of the scapulohumeral articulation with abduction limited to 25 degrees from the side at any time from June 5, 2017 to July 31, 2019. In an August 2017 VA examination for shoulder and arm conditions, the Veteran continued to have pain with motion and limitation of range of motion of the left shoulder. He reported flare-ups of the shoulder described as increased pain in shoulder with movement in flare-up. Pain increased to a nine out of 10 during flare-ups. Functional loss or impairment was described as inability to raise his left arm, lift heavy weights, or do maneuvers with his arms above him head. Flexion was 0 to 45 degrees, abduction and external rotation were 0 to 5 degrees, and internal rotation was 0 to 25 degrees. He was unable to move his arm in any functional way. No pain was noted on examination. There was evidence of pain with weight bearing and evidence of localized tenderness or pain on palpation of the joint or associated soft tissue in the left deltoid muscle area. There was evidence of crepitus. He was unable to perform repetitive use testing with at least three repetitions because, due to increased pain, he could not move his arm to do this. Pain, fatigue, weakness, and lack of endurance significantly limited functional ability with repeated use over a period of time. This was described in terms of range of motion as unchanged. Pain, fatigue, weakness, and lack of endurance significantly limited functional ability with flare-ups. This was described in terms of range of motion as unchanged. Muscle strength was 5/5. He did not have muscle atrophy or ankylosis. The examiner was unable to perform the Hawkins' Impingement test, empty-can test, external rotation/infraspinatus strength test, or lift-off subscapularis test. There was no shoulder instability, dislocation or labral pathology suspected. He did not have loss of head, nonunion, or fibrous union of the humerus. He did not have malunion of the humerus with moderate or marked deformity. He was unable to raise his left arm, lift heavy weights or do maneuvers with his arms above his head. There was pain on passive range of motion of the left shoulder. There was also pain on non-weight bearing activity of the left shoulder. In a May 2018 claim, the Veteran's representative wrote that the Veteran, "endures functional loss due to pain, fatigue, weakness and lack of endurance." In a June 2018 shoulder and arm conditions disability benefits questionnaire (DBQ), the Veteran reported that he felt his shoulder had gotten worse. He reported flare-ups described as when he moved his left shoulder. He reported having functional loss or impairment of the joint or extremity described as movement of the left shoulder since his first surgery. Flexion was 0 to 90 degrees, abduction was 0 to 50 degrees, and external and internal rotation were 0 to 30 degrees. The range of motion contributed to functional loss described as being unable to raise his arm above shoulder level due to weakness and pain. Pain was noted on examination on rest and non-movement. There was evidence of pain with weight bearing. There was no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was no evidence of crepitus. He was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion. Pain and weakness significantly limited functional ability with repeated use over a period of time. This could not be described in terms of range of motion. This was described as the Veteran could do very little with the shoulder during the exam. The examiner noted that in real time, it was inconceivable that he could do more. Additional contributing factors of the disability included less movement than normal and weakened movement. Muscle strength was 3/5. He did not have muscle atrophy. Ankylosis in the left side was described as ankylosis in abduction up to 60 degrees; can reach mouth and head (favorable ankylosis). He was unable to perform the Hawkins' Impingement test, empty-can test, external rotation/infraspinatus strength test, or the lift-off subscapularis test. Shoulder instability, dislocation or labral pathology was suspected. There was no history of mechanical symptoms or recurrent dislocation. The examiner was unable to perform the crank apprehension and relocation test. The Veteran did not have loss of head or fibrous union of the humerus. He did not have malunion of the humerus with moderate or marked deformity. Functional impact was described as essentially being limited to working using his right arm because he could not raise his left arm to shoulder level. There was evidence of pain on passive range of motion testing of the left shoulder. There was evidence of pain on non-weight bearing testing with the left shoulder. The Board finds that the preponderance of the evidence is against a rating in excess of 30 percent for a left shoulder disability from June 5, 2017 to July 31, 2019. The evidence of record shows that the Veteran is right-handed, as noted above. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain, fatigue, weakness, and lack of endurance. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that he is unable to raise his left arm, lift heavy weights or do maneuvers with his arms above his head would not result in symptoms more nearly approximating unfavorable ankylosis of the scapulohumeral articulation resulting in abduction limited to 25 degrees from the side. Under the circumstances, the Board finds the examination was performed during a flare up, which allows for consideration of the range of motion as required per 38 C.F.R. § 4.59. In order for the Veteran to receive a 40 percent evaluation under DC 5200, there must be unfavorable ankylosis of the scapulohumeral articulation resulting in abduction limited to 25 degrees from the side. At no time from June 5, 2017 to July 31, 2019, however, has the evidence shown that degree of impairment. Indeed, at no time from June 5, 2017 to July 31, 2019 was there unfavorable ankylosis of the scapulohumeral articulation resulting in abduction limited to 25 degrees from the side. The August 2017 VA examiner noted that the Veteran did not have ankylosis on the left side. Additionally, the June 2018 VA examiner noted that the Veteran had ankylosis in abduction up to 60 degrees; can reach mouth and head (favorable ankylosis), the criteria for the currently assigned 30 percent disability rating. Hence, the preponderance of the evidence is against the claim, and the claim must be denied. The Board has considered whether a higher or additional rating is available under other DCs. However, there is no evidence of humerus dislocation, malunion, fibrous union, nonunion, or flail shoulder; or dislocation, malunion or nonunion of the clavicle or scapula to support ratings under DCs 5202 or 5203. The Board notes that while there is limitation of motion of the arm during the period on appeal, given that limitation of motion is contemplated by the assigned rating based on ankylosis under DC 5200, a separate rating under DC 5201 would constitute pyramiding. As such, the Board finds that a rating in excess of 30 percent for the Veteran's service-connected left shoulder disability is not warranted. The current rating takes into consideration his complaints of inability to raise his left arm, lift heavy weights or do maneuvers with his arms above the head, as well as his claimed and measured loss in his range of motion for the left shoulder. The evidence, however, shows that even with the pain he experiences, the Veteran's left shoulder is not limited to unfavorable ankylosis of the scapulohumeral articulation resulting in abduction limited to 25 degrees from the side to warrant the next higher evaluation. Accordingly, the claim for a rating in excess of 30 percent disabling must be denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application, and the claim remains denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to an increased evaluation in excess of 40 percent disabling from August 1, 2019 for a left shoulder disability The Veteran contends that his left shoulder disability is more severely disabling than represented by the assigned 40 percent rating from August 1, 2019. The Veteran's left shoulder disability is rated under 38 C.F.R. § 4.71a, DCs 5010-5200, for ankylosis of scapulohumeral articulation. Under Diagnostic Code 5200, unfavorable, abduction limited to 25 degrees from the side warrants a maximum 40 percent rating for the minor joint and a maximum 50 percent rating for the major joint. 38 C.F.R. § 4.71a, Diagnostic Code 5200. A note to Diagnostic Code 5200 states that the scapula and humerus move as one piece. Id. The evidence of record shows that the Veteran is right-handed, as noted above. As the Veteran is in receipt of the highest schedular rating for ankylosis of scapulohumeral articulation of the minor extremity, there is no basis to award a higher rating. The Board has considered whether a higher or additional rating is available under other DCs. However, there is no evidence of humerus dislocation, malunion, fibrous union, nonunion, or flail shoulder; or dislocation, malunion or nonunion of the clavicle or scapula to support ratings under DCs 5202 or 5203. The Board notes that while there is limitation of motion of the arm during the period on appeal, given that limitation of motion is contemplated by the assigned rating based on ankylosis under DC 5200, a separate rating under DC 5201 would constitute pyramiding. As the Veteran already has the maximum schedular disability rating, the appeal is denied. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Minock 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.