Citation Nr: 21066556 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 14-16 383 DATE: November 1, 2021 ORDER Entitlement to a rating higher than 30 percent for bilateral pes planus, prior to May 29, 2018, is denied. Entitlement to a rating higher than 50 percent for bilateral pes planus, as of May 29, 2018, is denied. Entitlement to a rating higher than 10 percent for a low back disability, prior to May 29, 2018, is denied. Entitlement to a rating higher than 20 percent for a low back disability, as of May 29, 2018, is denied. Entitlement to a rating higher than 10 percent for right lower extremity radiculopathy is denied. Entitlement to a rating higher than 10 percent for left lower extremity radiculopathy is denied. Entitlement to a rating higher than 10 percent for a right knee disability is denied. Entitlement to a rating higher than 10 percent for a left knee disability is denied. Entitlement to a rating higher than 10 percent for a right knee scar is denied. Entitlement to a rating higher than 0 percent for a right knee scar is denied. REMANDED Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. FINDINGS OF FACT 1. Prior to May 29, 2018, bilateral pes planus was manifested by pain on use with pain accentuated on use and swelling on use. 2. As of May 29, 2018, bilateral pes planus was manifested by pain on the use of both feet that was accentuated on use with lack of endurance. 3. Prior to May 29, 2018, a lumbar spine disability was manifested by no more than limitation of motion of thoracolumbar spine flexion to approximately 90 degrees with pain; no ankylosis or incapacitating episodes requiring bed rest prescribed by a physician were shown. 4. As of to May 29, 2018, a lumbar spine disability was manifested by no more than limitation of motion of thoracolumbar spine flexion to approximately 45 degrees with pain; no ankylosis or incapacitating episodes requiring bed rest prescribed by a physician were shown. 5. The Veteran has experienced no more than mild incomplete paralysis of the right sciatic nerve. 6. The Veteran has experienced no more than mild incomplete paralysis of the left sciatic nerve. 7. Throughout the period of appeal, a right knee disability has been manifested by flexion limited to 50 degrees and extension, overall, to 0 degrees; it has not been manifested by flexion limited to 30 degrees or less, extension limited to 10 degrees or less, ankylosis, objective evidence of recurrent subluxation or lateral instability, dislocated or removed semilunar cartilage, impairment of the tibia and fibula, or genu recurvatum. 8. Throughout the period of appeal, a left knee disability has been manifested by flexion limited to 60 degrees and extension, overall, to 0 degrees; it has not been manifested by flexion limited to 30 degrees or less, extension limited to 10 degrees or less, ankylosis, objective evidence of recurrent subluxation or lateral instability, dislocated or removed semilunar cartilage, impairment of the tibia and fibula, or genu recurvatum. 9. Throughout the period of appeal, the preponderance of the evidence shows that the Veteran has had no more than one service-connected scar that has been shown to be tender and painful. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating higher than 30 percent for bilateral pes planus, prior to May 29, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.59, 4.7, 4.71a, Diagnostic Code 5276. 2. The criteria for entitlement to a disability rating higher than 50 percent for bilateral pes planus, as of May 29, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.59, 4.7, 4.71a, Diagnostic Code 5276. 3. The criteria for entitlement to a disability rating higher than 10 percent for a low back disability, prior to May 29, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.59, 4.7, 4.71a, Diagnostic Codes 5237-5243. 4. The criteria for entitlement to a rating higher than 20 percent for a low back disability, as of May 29, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.59, 4.7, 4.71a, Diagnostic Codes 5237-5243. 5. The criteria for entitlement to a rating higher than 10 percent for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8520. 6. The criteria for entitlement to a rating higher than 10 percent for left lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8520. 7. The criteria for entitlement to a rating higher than 10 percent for a right knee disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.40, 4.45, 4.71a, Diagnostic Codes 5256-5263. 8. The criteria for entitlement to a rating higher than 10 percent for a left knee disability have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.40, 4.45, 4.71a, Diagnostic Codes 5256-5263. 9. The criteria for entitlement to a rating higher than 10 percent for a right knee scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.118, Diagnostic Codes 7801-7805. 10. The criteria for entitlement to a rating higher than 0 percent for a right knee scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.118, Diagnostic Codes 7801-7805. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 2002 to April 2006. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2010 rating decision of the North Little Rock, Arkansas, Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran presented testimony at a board hearing before the undersigned Veterans Law Judge in January 2017. A transcript of that hearing is of record. In March 2018, February 2020, and March 2021, the Board remanded the issues on appeal to the Agency of Original Jurisdiction (AOJ) for further development. As part of the requested development, the AOJ attempted to obtain the Veteran's Vocational Rehabilitation folder. In April 2021, the AOJ was informed that the Veteran's Vocational Rehabilitation file was mistakenly placed in the files marked for destruction in June 2017, and the hard copy of the file was no longer available. The AOJ obtained a summary of what was in the case management system regarding the Veteran's Vocational Rehabilitation folder. In light of the efforts of the AOJ to obtain the Vocational Rehabilitation folder, the treatment records that have been obtained and associated with the record, the obtaining of the requested medical opinions, and the further adjudicatory actions taken by the AOJ, the Board finds that there has been substantial compliance with the remand requests. Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008); Dyment v. West, 13 Vet. App. 141 (1999). Increased Ratings Disability ratings are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). When the appeal arises from an initial assigned rating, consideration must be given to whether staged ratings should be assigned to compensate entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999). However, staged ratings are also appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007). The rating of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. However, that does not preclude the assignment of separate ratings for separate and distinct symptomatology where none of the symptomatology justifying a rating under one diagnostic code is duplicative of or overlapping with the symptomatology justifying a rating under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259 (1994). The rating of a service-connected disability involving a joint rated on limitation of motion requires adequate consideration of functional loss due to pain and functional loss due to weakness, fatigability, incoordination, or pain on movement of a joint. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portrays the anatomical damage, and the functional loss, with respect to these elements. In addition, the regulations state that the functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the veteran undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. When rating the joints, inquiry will be directed as to whether there is less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. 38 C.F.R. § 4.45. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. 1. Entitlement to a rating higher than 30 percent for bilateral pes planus, prior to May 29, 2018 Diagnostic Code 5276 provides that a 10 percent rating is warranted for moderate acquired flat foot with weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral. A 20 percent rating is assigned for severe unilateral acquired flat foot with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is warranted for severe bilateral acquired flat foot with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is also warranted for pronounced unilateral acquired flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. A maximum 50 percent rating is warranted for bilateral acquired flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276. At an October 2009 VA examination, the Veteran stated that his feet tired from walking and standing. He did not require medication. The Veteran had not developed any signs of abnormal footwear such as calluses or bunions. The examiner noted that the Veteran's feet showed very mild tenderness involving each arch. There was no tenderness of the plantar fascia insertion. The patellar tendon and calcaneus were in proper alignment in both feet. No valgus or varus deformity was recognized. Circulatory, temperature, and appearance of the feet was normal other than mild depression of each arch. At an April 2014 VA examination, the examiner diagnosed pes planus of both feet. The Veteran reported having pain on use and manipulation of both feet. There were no characteristic calluses of either foot. The Veteran's symptoms were not relieved by arch supports or orthotics. The Veteran did not have extreme tenderness of plantar surface of either foot. The Veteran had decreased longitudinal arch height of both feet on weight-bearing. There was no objective evidence of marked deformity or marked pronation of either foot. The weight-bearing line fell over or was medial to the great toe of both feet. There was no lower extremity deformity other than pes planus. There was no inward bowing of either Achilles' tendon. The Veteran did not have marked inward displacement or severe spasm of the Achilles tendon on manipulation. Imaging studies did not show degenerative or traumatic arthritis. The examiner found that the range of motion of all toes was normal. There was no additional weakness, fatiguability, decreased range of motion, or loss of joint function with repetitive use or flare-ups. At a January 2017 Board hearing, the Veteran stated that he had aching feet. He had tried using insoles, and they did not help. Prior to May 29, 2018, the Board finds that the preponderance of the evidence is against a rating higher than 30 percent for bilateral pes planus. The Veteran clearly experienced bilateral pain on use with pain accentuated on use and swelling on use. However, the evidence does not indicate that the foot disability was manifested by marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, or severe spasm of the tendo achillis on manipulation. Therefore, the Board finds that the symptoms the Veteran experiences do not more nearly approximate those described under the criteria for a 50 percent rating prior to May 29, 2018. Accordingly, the Board finds that the preponderance of the evidence is against the claim for a rating higher than 30 percent for bilateral pes planus prior to May 29, 2018. Thus, the claim for a higher rating prior to May 29, 2018 must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to a rating higher than 50 percent for bilateral pes planus, as of May 29, 2018 At a May 2018 VA examination, the examiner diagnosed pes planus of both feet. The Veteran reported increased foot pain with walking. He was unable to stand or walk for long periods of time. No flare-ups were reported. The examiner indicated that the Veteran had pain on the use of both feet that was accentuated on use. The Veteran did not have pain on manipulation of the feet. There was no indication of swelling on use of the feet. The Veteran did not have characteristic calluses on either foot. The Veteran used arch supports for both feet. There was tenderness of plantar surfaces on both feet. The Veteran had decreased longitudinal arch height of both feet on weight bearing. There was no objective evidence of marked deformity of either foot. There was not marked pronation of either foot. The weight-bearing line did not fall over the medial to great toe of either foot. The Veteran did not have marked inward displacement and severe spasm of the Achilles' tendon on manipulation of either foot. The Veteran did not have Morton's neuroma or metatarsalgia. The Veteran did not have any toes affected by hammer toe. The Veteran did not have hallux valgus, hallux rigidus, or acquired pes cavus. There was no malunion or nonunion of the tarsal or metatarsal bones. The examiner specified that the Veteran did not have any other foot injuries or other foot conditions not already described. There was pain on physical examination of both feet that did not contribute to functional loss. There was pain on weight bearing and lack of endurance of both feet. There was increased pain of both feet with standing and walking. Imaging studies were conducted and did not reveal degenerative or traumatic arthritis of either foot. Based on the evidence of record, the Board finds that the criteria for the assignment of a rating higher than 50 percent have not been met for the period from May 29, 2018 for bilateral pes planus. According to 38 C.F.R. § 4.71a, Diagnostic Code 5276, the maximum schedular rating available for bilateral pes planus is 50 percent. As the Veteran is service connected for bilateral flatfoot, a higher schedular rating is not available under 38 C.F.R. § 4.71a, Diagnostic Code 5276. As no higher schedular rating is available, and no other Diagnostic Code is more appropriate for rating, an increased schedular rating is not warranted. AB v. Brown, 6 Vet. App. 35 (1993); Sabonis v. Brown, 6 Vet. App. 426 (1994). The Board has considered the Veteran's complaints on examination in addition to the other lay statements of record but finds them to be consistent with medical findings that were identified by an impartial medical examiner during the course of the requested examination. Accordingly, the Board finds that the preponderance of the evidence is against the claim for a rating higher than 50 percent for bilateral pes planus from May 29, 2018. Thus, the claim for a higher rating as of May 29, 2018, must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to a rating higher than 10 percent for a low back disability, prior to May 29, 2018 Disabilities of the spine are rated under the General Rating Formula for Rating Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5242. Intervertebral disc syndrome is rated under the General Formula for Rating Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. 38 C.F.R. § 4.71a, Diagnostic Code 5243. Under the General Rating Formula for Rating Diseases and Injuries of the Spine, with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease, a 10 percent rating for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, the combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in an abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71a. A 20 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 38 C.F.R. § 4.71a. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine of 30 degrees or less; or, unfavorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a. Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate Diagnostic Code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1). For VA compensation purposes, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees, and left and right lateral rotation are 0 to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. 38 C.F.R. § 4.71a, Plate V, General Rating Formula for Diseases and Injuries of the Spine, Note (2). The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (4). In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion. Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (3). For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (0 degrees) always represents favorable ankylosis. The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). Disability of the thoracolumbar and cervical spine segments are to be rated separately, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. The rater is to round each range of motion measurement to the nearest five degrees. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (6). Diagnostic Code 5243 provides that intervertebral disc syndrome is to be rated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes provides that a 10 percent rating is warranted for intervertebral disc syndrome with incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months. A 20 percent rating is warranted with incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent rating is warranted with incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A 60 percent rating is warranted with incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. An incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (1). If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, each segment is to be rated on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (2). At an October 2009 VA examination, the Veteran reported experiencing low back pain. X-rays had shown some mild scoliosis. There had been no incapacitating events within the prior year. No flare-ups were reported. The examiner did not see any major scoliosis. There was no motor weakness or foot drop. There was no sensory deficit. Forward flexion of the lumbar spine was to 95 degrees without pain, weakness, fatigability, or loss of endurance. Extension backwards was to 30 degrees. Lateral flexion was to 30 degrees on both the right and the left. Rotation was to 30 degrees on both the right and the left. At an April 2014 VA examination, the Veteran reported experiencing daily pain with occasional spasms. He said he could lift 25 pounds and walk one mile. No flare-ups were reported. The examiner measured forward flexion of the thoracolumbar spine to 90 degrees or greater with objective evidence of painful motion at 60 degrees. Extension was to 30 degrees or greater with pain at 20 degrees. Right lateral flexion was to 30 degrees or greater with pain at 20 degrees. Left lateral flexion was to 30 degrees with pain at 15 degrees. Right lateral rotation was to 30 degrees or greater with pain at 15 degrees. Left lateral rotation was to 30 degrees or greater with pain at 10 degrees. There was no additional limitation in any of the ranges of motion following repetitive-use testing. The Veteran experienced incoordination, pain on movement, and disturbance of locomotion. There were muscle spasms of the thoracolumbar spine which did not result in abnormal gait or abnormal spinal contour. Muscle strength testing was normal. Reflex examination was normal. Sensory examination was normal. The examiner specified that the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. There were no other neurologic findings related to the back condition. There was no ankylosis of the spine. The examiner specified that the Veteran did not have intervertebral disc syndrome. Imaging studies did not document arthritis. The Veteran did not have a thoracic vertebral fracture with loss of 50 percent or more of height. The examiner stated that there was no additional weakness, fatigability, decreased range of motion, or loss of joint function with repetitive use or flare-ups. There was no lumbar radiculopathy found. At a January 2017 Board hearing, the Veteran stated that he experienced throbbing pain in the back if he sat for more than two hours. He had difficulty bending over. On review of all the evidence of record, both lay and medical, the Board finds that the Veteran's back disability has not more nearly approximated the criteria for a rating higher than 10 percent at any time prior to May 29, 2018. No ankylosis, either favorable or unfavorable, has been shown. Moreover, at no time has the evidence found forward flexion of the lumbar spine limited to 60 degrees or less. The VA examinations showed forward flexion, at worst, limited to 90 degrees with pain after repetitive motion. Therefore, the Board finds that flexion was not limited to 60 degrees of less. As reviewed above, the combined range of motion of the thoracolumbar spine has been greater than 120 degrees throughout the period of appeal. The other treatment records show continuing complaints of pain. However, the treatment records do not show functional impairment that more nearly approximates the range of motion criteria to support a higher rating under the General Rating Formula, even considering the Veteran's subjective complaints. Similarly, the evidence does not show muscle spasm or guarding severe enough to result in an abnormal gait. The Board has also considered the Veteran's reported impairment of function and has considered additional limitations of motion due to pain, incoordination, fatigability, excess motion, weakened motion, or on flare up. Even considering additional limitation of motion or function of the spine due to pain or other symptoms such as weakness, fatigability, pain, or incoordination the evidence still does not show that the back disability more nearly approximates the criteria for a higher rating. On repetitive use testing, range of motion of the spine did not show flexion of the thoracolumbar spine limited to 60 degrees or less, and while the Veteran experienced pain during flare-ups, overall he remained able to function. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The factors that may additionally limit motion and function were considered and assessed by the examination reports. The VA examiners noted less movement than normal, pain on movement, and interference with sitting, standing, and weight-bearing. The Veteran described flare-ups were manifested by increased pain but continued ability to function. The Board finds that pain and reduced range of motion is fully contemplated in the current 10 percent rating assigned. The Board has also considered whether a higher rating could be assigned under the intervertebral disc syndrome formula based on incapacitating episodes. Notably, the April 2014 VA examiner specified that the Veteran does not have intervertebral disc syndrome. The evidence shows that prior to May 29, 2018, the Veteran was never prescribed bed rest by a physician as due to intervertebral disc syndrome. Therefore, he has not been shown to have incapacitating episodes requiring bed rest prescribed by a physician and treatment by a physician of a total duration of at least two weeks. The Veteran's radiculopathy will be discussed below. There are no further neurological disabilities which have been attributed to the Veteran's lumbar spine disability by a medical professional. The competent evidence does not show any other objective neurologic abnormalities associated with the low back disability so as to warrant any higher or separate rating prior to May 29, 2018. Accordingly, the Board finds that the preponderance of the evidence is against the claim for a rating higher than 10 percent for a low back disability prior to May 29, 2018, and the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 4. Entitlement to a rating higher than 20 percent for a low back disability, as of May 29, 2018 At a May 2018 VA examination, the Veteran reported experiencing daily, mild, constant flare-ups. The Veteran was unable to sit for long periods of time or stand without increased pain. The examiner measured forward flexion of the thoracolumbar spine to 60 degrees. Extension was to 25 degrees. Right left lateral flexion was to 20 degrees. Left lateral flexion was to 25 degrees. Right lateral rotation was to 20 degrees. Left lateral rotation was to 20 degrees. Pain was noted on all ranges of motion, the pain did not result in or cause functional loss. There was evidence of pain with weight bearing. Repetitive use testing was not performed due to the Veteran's fear of pain. The Veteran did not have guarding or muscle spasm of the thoracolumbar spine. There was no muscle atrophy. Reflex examination was normal. Sensation to light touch was normal for the right lower extremity and decreased for the left foot and toes. Straight leg raising test was positive bilaterally. There was mild pain, paresthesias and/or dysesthesias, and numbness in the left lower extremity. There was involvement of the sciatic nerve for the left lower extremity. There were no signs of radiculopathy of the right lower extremity. The examiner indicated that the radiculopathy which affected the left lower extremity was mild. There were no other neurologic abnormalities or findings related to the thoracolumbar spine. There was no ankylosis of the spine. The examiner specified that the Veteran did not have intervertebral disc syndrome of the thoracolumbar spine. Imaging studies had been performed, and there was no evidence of documentation. The Veteran did not have a thoracic vertebral fracture with loss of 50 percent or more of height. The examiner stated that passive range of motion of the spine testing was not performed as it was not feasible to do in a safe and reasonable manner. The examiner found no objective evidence of pain when the spine was in a non-weight bearing position at rest. At an April 2020 VA examination, the examiner diagnosed lumbosacral strain. The Veteran described experiencing flare-ups of increased pain that limited the ability to bear weight. The flare-ups could occur 15 days a monthly. The Veteran stated that he was able to walk one-half of a mile and stand for 30 minutes. He was able to ascend one to two flights of stairs, and he could pick up 30 pounds off of the floor. The examiner observed forward flexion of the thoracolumbar spine to 45 degrees. Extension was to 10 degrees. Right lateral flexion was to 10 degrees. Left lateral flexion was to 15 degrees. Right lateral rotation was to 20 degrees. Left lateral rotation was to 20 degrees. Pain was noted on all ranges of motion. There was evidence of pain on weight bearing. There was no additional loss of function or range of motion after repetitive use testing. The examiner stated that there was no additional limitation of functional ability with flare-ups. There was muscle spasm which did not result in abnormal gait or abnormal spinal contour. No guarding was present. Muscle strength testing was normal. There was no muscle atrophy. Reflex examination was normal. Sensory examination was normal. Straight leg raising test was normal. The Veteran experienced mild intermittent pain, paresthesias, and/or dysesthesias, and numbness of the bilateral lower extremities. The examiner specified that there was mild involvement of the sciatic nerve bilaterally. The examiner stated that the Veteran did not have any other neurologic abnormalities or findings related to his back condition. There was no ankylosis of the spine. The examiner stated that the Veteran did not have intervertebral disc syndrome. X-rays were reviewed, and arthritis was not documented. The Veteran did not have a thoracic vertebral fracture with loss of 50 percent or more of height. The examiner specified that there was pain with non-weight bearing that limited the Veteran's ability to drive. There was pain with passive ranges of motion and weight bearing. On review of all the evidence of record, both lay and medical, the Board finds that the Veteran's back disability has not more nearly approximated the criteria for a rating higher than 20 percent at any time as of May 29, 2018. No ankylosis, either favorable or unfavorable, has been shown. Moreover, at no time has the evidence found forward flexion of the lumbar spine limited to 30 degrees or less. The VA examinations showed forward flexion, at worst, limited to 45 degrees with pain after repetitive motion. Therefore, the Board finds that flexion was not limited to 30 degrees of less. Again, treatment records show continuing complaints of pain and flare-ups. However, the treatment records do not show functional impairment that more nearly approximates the range of motion criteria to support a higher rating under the General Rating Formula, even considering the Veteran's subjective complaints. The Board has also considered the Veteran's reported impairment of function and has considered additional limitations of motion due to pain, incoordination, fatigability, excess motion, weakened motion, or on flare up. Even considering additional limitation of motion or function of the spine due to pain or other symptoms such as weakness, fatigability, pain, or incoordination the evidence still does not show that the back disability more nearly approximates the criteria for a higher rating. On repetitive use testing, range of motion of the spine did not show flexion of the thoracolumbar spine limited to 30 degrees or less, and while the Veteran experienced pain during flare-ups, overall he remained able to function. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The factors that may additionally limit motion and function were considered and assessed by the examination reports. The VA examiners noted less movement than normal, pain on movement, and interference with sitting, standing, and weight-bearing. The Veteran described flare-ups were manifested by increased pain but continued ability to function. The Board finds that pain and reduced range of motion is fully contemplated in the current 20 percent rating assigned. The Board has also considered whether a higher rating could be assigned under the intervertebral disc syndrome formula based on incapacitating episodes. Notably, both VA examiners specified that the Veteran does not have intervertebral disc syndrome. The evidence shows that from May 29, 2018, the Veteran was never prescribed bed rest by a physician as due to intervertebral disc syndrome. Therefore, he has not been shown to have incapacitating episodes requiring bed rest prescribed by a physician and treatment by a physician of a total duration of at least four weeks. The Veteran's radiculopathy will be discussed below. There are no further neurological disabilities which have been attributed to the Veteran's lumbar spine disability by a medical professional. The competent evidence does not show any other objective neurologic abnormalities associated with the low back disability so as to warrant any higher or separate rating as of May 29, 2018. Accordingly, the Board finds that the preponderance of the evidence is against the claim for a rating higher than 20 percent for a low back disability as of May 29, 2018, and the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 5. Entitlement to a rating higher than 10 percent for right lower extremity radiculopathy 6. Entitlement to a rating higher than 10 percent for left lower extremity radiculopathy Diagnostic Code 8520 provides the rating criteria for paralysis of the sciatic nerve. Disability ratings of 10 percent, 20 percent, 40 percent, and 60 percent are assigned for incomplete paralysis that is mild, moderate, moderately severe, or severe. Complete paralysis of the sciatic nerve is rated 80 percent and contemplates no active movement possible of muscles below the knee. 38 C.F.R. § 4.124a, Diagnostic Code 8520. The term incomplete paralysis indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The rating schedule does not define the terms mild, moderate, or severe as used in the diagnostic codes. Instead, adjudicators must evaluate all of the evidence and make a decision that is equitable and just. 38 C.F.R. § 4.6. At an April 2014 VA examination, sensation to light touch was normal for the bilateral lower extremities. The examiner stated that the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. At a May 2018 VA examination, sensation to light touch was normal for the right lower extremity and decreased for the left foot and toes. Straight leg raising test was positive bilaterally. There were mild pain, paresthesias, and/or dysesthesias, and numbness in the left lower extremity. There was involvement of the sciatic nerve for the left lower extremity. There were no signs of radiculopathy of the right lower extremity. The examiner indicated that the radiculopathy which affected the left lower extremity was mild. At an April 2020 VA examination, the Veteran experienced mild intermittent pain, paresthesias, and/or dysesthesias, and numbness of the bilateral lower extremities. The examiner specified that there was mild involvement of the sciatic nerve bilaterally. The Board finds that the objective evidence shows no more than mild incomplete paralysis of the right and left side sciatic nerve. Notably, the April 2014 VA examiner did not find any radiculopathy; the May 2018 VA examiner specified that the Veteran only had left lower extremity radiculopathy, and that radiculopathy was mild; and the April 2020 VA examiner opined that there was mild involvement of the sciatic nerve bilaterally. All examiners considered the Veteran's subjective reports in offering their objective observations, and as the VA examiners were objective medical professionals who had the training necessary to make competent and credible medical statements, the Board finds the opinions of the VA examiners to be the most probative evidence of record. As the evidence shows that the Veteran experiences no more than mild incomplete paralysis, the currently assigned 10 percent ratings assigned for radiculopathy of each lower extremity is proper. The preponderance of the evidence is against the assignment of any higher ratings. There are no other neurological disabilities which have been attributed to the back disability by a medical professional. The competent evidence does not show any other objective neurologic abnormalities associated with the back disability so as to warrant any separate rating. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of ratings greater than 10 percent for radiculopathy of each lower extremity. The Board finds that the preponderance of the evidence is against the assignment of any higher rating. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 7. Entitlement to a rating higher than 10 percent for a right knee disability 8. Entitlement to a rating higher than 10 percent for a left knee disability Normal range of motion of the knee is to 0 degrees extension and to 140 degrees flexion. 38 C.F.R. § 4.71a, Plate II. Under Diagnostic Code 5260, limitation of flexion of the knee is rated 10 percent for flexion limited to 45 degrees. A 20 percent rating is assigned for flexion limited to 30 degrees. A 30 percent rating is assigned for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under Diagnostic Code 5261, limitation of extension of the knee is rated 10 percent for extension limited to 10 degrees. A 20 percent rating is assigned for extension limited to 15 degrees. A 30 percent rating is assigned for extension limited to 20 degrees. A 40 percent rating is assigned for extension limited to 30 degrees. A 50 percent rating is assigned for extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. In addition, separate ratings may be assigned for compensable limitation of both flexion and extension, or for limitation of motion and instability or subluxation of the knee, or meniscal pathology. However, a separate rating can only be assigned where additional compensable symptomatology is shown that is not duplicative of that used to assign another rating. 38 C.F.R. § 4.14; VAOPGCPREC 09-04 (2004), 69 Fed. Reg. 59990 (2004);VAOPGCPREC 23-97 (1997), 62 Fed. Reg. 63604 (1997); VAOPGCPREC 9-98 (1998), 63 Fed. Reg. 56704 (1998); Lichtenfels v. Derwinski, 1 Vet. App. 484 (1991). At an October 2009 VA examination, the Veteran reported that both knees were painful. He wore a brace on his right knee. He said that he could not stand for longer than a half an hour. He could squat halfway. The Veteran stated that he used a knee brace because of instability. The examiner could not demonstrate any patellar instability. There was no valgus or varus deformity. The examiner measured right knee flexion to 140 degrees with mild pain but no weakness, fatigability, or loss of endurance. The left knee was stable. There was no patellar laxity or knee joint laxity. Left knee flexion was to 140 degrees with no pain, weakness, fatigability, or loss of endurance. The examiner reiterated that no instability of either knee could be demonstrated on stress testing. At an April 2014 VA examination, the Veteran reported experiencing daily pain in both knees. He experienced crepitus and occasional swelling. He wore a brace on the right knee. No flare-ups of either knee were reported. Right knee flexion was measured to 140 degrees or greater with pain at 75 degrees. Right knee extension was to 0 degrees with no objective evidence of painful motion. Left knee flexion was measured to 140 degrees or greater with pain at 75 degrees. Left knee extension was to 0 degrees with no objective evidence of painful motion. There was no additional limitation of range of motion of either knee following repetitive-use testing. The Veteran experienced incoordination, pain on movement, and disturbance of locomotion. Joint stability testing resulted in normal stability. There was no evidence or history of recurrent patellar subluxation or dislocation. Imaging studies were performed and did not reveal arthritis or patellar subluxation. The examiner specified that there was no additional weakness, fatiguability, decreased range of motion, or loss of joint function with repetitive use or flare-ups. At a January 2017 Board hearing, the Veteran stated that the right and left knees gave out and were painful. He experienced swelling, and used ice packs and heating pads. At a May 2018 VA examination, the Veteran reported experiencing painful ambulation with long durations of standing and sitting. The Veteran stated that he experienced continuous pain. He was unable to wear heavy boots. At times, the Veteran stated that he was unable to walk or stand. The examiner measured right knee flexion to 110 degrees and flexion to 0 degrees. Left knee flexion was to 110 degrees, and extension was to 0 degrees. Pain was noted on all ranges of motion, but pain did not result in or cause functional loss. There was no evidence of pain with weight bearing. The Veteran did not perform repetitive use testing due to fear of pain. There was no muscle atrophy or ankylosis. There was no history of recurrent subluxation or lateral instability of either knee. Joint stability testing was performed, and there was no instability of either knee. Imaging studies were performed, and there was no degenerative or traumatic arthritis. There was objective evidence of pain on passive range of motion testing and when the joints were used in nonweight-bearing. At an April 2020 VA examination, the Veteran reported experiencing knee pain, stiffness, and swelling. He experienced flare-ups of increased pain that occurred with increased weight bearing. The Veteran reported that he could walk a half mile and stand for 30 minutes. With difficulty, he could ascend one to two flights of stairs. He tried to avoid squatting. Right knee flexion was to 50 degrees, and extension was to 0 degrees. Left knee flexion was to 60 degrees, and extension was to 0 degrees. Pain was observed on flexion of both knees. There was evidence of pain with weight bearing. There was no additional functional loss or loss of range of motion of either knee after repetitive use. The examiner stated that pain, weakness, fatigability, or incoordination did not significantly limit functional ability of either knee with flare-ups. Muscle strength testing was normal, and there was no muscle atrophy. There was no ankylosis of either knee. There was no history of recurrent subluxation, lateral instability, or recurrent effusion of either knee. Joint stability testing was performed, and there was no instability of either knee. X-rays were reviewed and did not document degenerative or traumatic arthritis. There was pain of both knees with non-weight bearing and passive ranges of motion. The Board finds that the preponderance of the evidence is against the assignment of any higher or separate rating under Diagnostic Code 5260 for limitation of flexion of the right or left knee at any time during the course of the appeal. Concerning the right knee, the evidence shows that flexion of the knee was limited, at worst, to 50 degrees, with consideration of pain. Concerning the left knee, the evidence shows that flexion of the knee was limited, at worst, to 60 degrees, with consideration of pain. The flexion measurements are consistent with no more than a 0 percent rating under Diagnostic Code 5260. The Board also finds that the weight of the evidence is against assigning a higher rating throughout the period of appeal under Diagnostic Code 5261 for limitation of extension for right or left knee. The evidence shows that extension of the right and left knee was to 0 degrees throughout the period of appeal. Considering the record as a whole, the extension measurements are consistent with no more than a 0 percent rating under Diagnostic Code 5261. The Veteran has repeatedly reported that he experiences pain. He has reported pain to each medical examiner, and he has additionally discussed his pain in repeated submissions to the AOJ. Because of the Veteran's painful limitation of knee motion, and other symptoms, the presently assigned disability rating of 10 percent based on painful motion for each knee is warranted. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40, 4.45, 4.59. However, the Board finds that the preponderance of the evidence is against the assignment of any higher or additional separate rating for limitation of motion of the right or left knee. The rating assigned has considered additional functional loss due to pain and other factors. Turning to instability, the Board concludes that a separate compensable rating is not warranted at any time throughout the period of appeal for the right or left knee. Significantly, all of the VA examiners indicate that the Veteran's knees were stable on objective observation. To whatever extent the Veteran may assert that the right or left knee is unstable, the Board finds that the objective medical evidence outweighs the subjective complaints, as the medical evidence was created by trained health care providers objectively performing professional duties following objective testing, which determined there was not objective evidence of recurrent lateral instability or subluxation. The Board finds that those objective medical findings are more persuasive because of the training and experience of the medical professionals. In light of those medical records, the Board finds that a separate disability rating is not warranted at any time during the period of appeal for instability of either knee. In addition, subluxation of either knee is not shown. None of the treatment records, to include X-ray and MRI findings, show dislocated or removed semilunar cartilage of either knee. Thus, Diagnostic Codes 5258 and 5259 cannot serve as a basis for an increased or separate rating. Finally, in considering the applicability of other diagnostic codes, the Board finds that Diagnostic Codes 5256 (ankylosis of the knee), 5262 (impairment of the tibia and fibula), and 5263 (genu recurvatum) are not applicable, as the medical evidence does not show that the Veteran has any of those conditions. The Board notes that the Veteran's functional loss was considered as the medical evidence shows that the Veteran has consistently complained of pain. 38 C.F.R. §§ 4.40, 4.45. However, the limitation of motion and functional loss documented in the medical records as resulting from pain, including flare-ups, is contemplated in the disability ratings now currently assigned. Moreover, although the Veteran had pain on repetitive motion, that pain did not result in limitation of flexion or extension to the level that any separate or higher rating would be warranted. There is otherwise no evidence of additional significant impairment of motor skills, muscle function, or strength attributable to the Veteran's knee disability, beyond what is already being compensated. Consequently, the Board finds that a higher rating based on functional loss is not warranted for either knee. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of any higher or separate rating for either the right or left knee disability and the claims must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 9. Entitlement to a rating higher than 0 percent for a right knee scar 10. Entitlement to a rating higher than 10 percent for a right knee scar A June 2010 rating decision established service connection for a right knee scar and assigned a 0 percent rating, effective September 14, 2009, pursuant to Diagnostic Code 7805. The Veteran subsequently perfected an appeal concerning the rating assigned. A March 2018 Board remand characterized the issue as entitlement to a compensable rating for right knee scars. After completing the requested development, a May 2019 rating decision assigned an initial 10 percent rating for "residual surgical painful scar, right knee effective September 14, 2009" pursuant to Diagnostic Code 7804. Within the May 2019 decision, the AOJ additionally assigned a separate 0 percent disability rating for "scar, right knee" effective September 14, 2009, pursuant to Diagnostic Code 7802. In response to the actions of the AOJ, in February 2020, the Board listed two separate issues: entitlement to an initial rating in excess of 10 percent for a painful right knee scar and entitlement to an initial rating in excess of 0 percent for a right knee scar. The Board remanded the issues to provide the Veteran a VA examination to clarify the number and nature of the service-connected scar. On review of the entire record, and in light of the development completed by the AOJ, the Board finds that there is a single service-connected right knee scar. The applicable rating criteria for scars were amended effective August 13, 2018. However, the change did not affect the criteria concerning Diagnostic Code 7804. The timing of that change requires the Board to consider the claim under both the previous regulations and the newly amended criteria for the diagnostic code, and apply the criteria which yields a higher rating. VAOPGCPREC 7-2003 (2003), 69 Fed. Reg. 25179 (2004); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Amended rating criteria, if favorable to the claim, can be applied only on and after the effective date of the regulatory change. The old regulation applies prior to the effective date of regulatory change. The old regulation and the new regulation are both considered for the period after the change was made. VAOPGCPREC 3-00 (2000), 65 Fed. Reg. 33422 (2000). An increase in benefits cannot be awarded earlier than the effective date of the change in law pursuant to which the award is made. 38 U.S.C. § 5110 (g); 65 Fed. Reg. 33422 (2000). Both before and after August 13, 2018, the schedular criteria provide that under Diagnostic Code 7804, one or two scars that are unstable or painful warrant a 10 percent rating. Three or four scars that are unstable or painful warrant a 20 percent rating. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. If one or more scars are both unstable and painful, add 10 percent to the rating that is based on the total number of unstable or painful scars. 38 C.F.R. § 4.118, Diagnostic Code 7804. At an October 2009 VA examination, the examiner measured a 10-centimeter scar over the right patella which was well healed. The examiner specified that there were no other scars. At an April 2014 VA examination, the examiner stated that the Veteran had a scar from previous knee surgery. The examiner indicated that the scar was not painful or unstable. The scar was not due to a burn. The scar was linear and measured 10 centimeters long. The scar did not result in limitation of function. The scar was slightly hyperpigmented. At a January 2017 Board hearing, the Veteran stated that a right knee scar was painful. At a May 2018 VA examination, the examiner specified that the Veteran had one painful scar. The scar was not unstable or due to a burn. The scar was on the right lower extremity, was linear, and measured 6 centimeters long. The scar was tender to palpation. The surface contour was elevated on palpation. The scar did not result in limitation of function. There were no other pertinent findings. At an April 2020 VA examination, the examiner observed that the Veteran had one painful scar. The scar was not unstable or due to a burn. The scar was on the right anterior knee and measured 5 centimeters by 1 centimeter. The approximate total area affected was 4 square centimeters. There was no underlying tissue damage. The scar did not result in limitation of function, to include limitation of motion. There were no other pertinent physical findings. Considering the evidence under the both the old and new rating criteria, the Board finds that a rating higher than 10 percent is not warranted. None of the evidence indicates that the Veteran has three or more scars that are painful or unstable. None of the evidence of record indicates that the service-connected scar or scars are unstable, cause any limitation of motion, or cover an area of at least 39 square centimeters or 6 square inches. Thus, a compensable rating is not warranted under Diagnostic Code 7801, 7802, or 7805. Therefore, a rating higher than 10 percent is not warranted throughout the period of appeal. The Board is mindful that various Diagnostic Codes have been employed in prior ratings of the Veteran's service-connected scar. However, the assignment of a particular Diagnostic Code is completely dependent on the facts of a particular case. Butts v. Brown, 5 Vet. App. 532 (1993). One diagnostic code may be more appropriate than another based on such factors as the Veteran's relevant medical history, his current diagnosis, and demonstrated symptomatology. Here, the Board finds that the most appropriate Diagnostic Code is 7804, as the rating criteria enumerated under Diagnostic Code best account for the symptomatology of the Veteran's service-connected scar, as described above. The Board finds that the preponderance of the evidence is against the assignment of any higher or separate compensable ratings for right knee scar. Therefore, the claim for increased rating is denied. REASONS FOR REMAND 1. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. In July 2021 correspondence, the Veteran's representative specifically argued that the Veteran is unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities. That argument raises the issue of entitlement to TDIU. The AOJ has not yet considered the claim of entitlement to TDIU. Thus, the Board finds that, after giving the Veteran an opportunity to file a formal claim for a TDIU, and completing the other actions noted below, the AOJ should adjudicate that matter in the first instance, to avoid any prejudice to the Veteran. Bernard v. Brown, 4 Vet. App. 384 (1993). The matters are REMANDED for the following action: 1. Furnish to the Veteran a VA Form 21-8940, to enable him to file a formal application for TDIU. 2. Send the Veteran and representative a letter requesting that the Veteran furnish any additional information or evidence pertinent to the claim for TDIU. The letter should specifically notify the Veteran of the criteria to establish entitlement to TDIU and supply a form to apply for TDIU. 3. After conducting appropriate development, adjudicate the issue of entitlement to TDIU. If any decision is adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Layton, 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.