Citation Nr: 21068680 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 15-19 334 DATE: November 12, 2021 ORDER From January 1, 2013 to August 6, 2019, a rating greater than 10 percent for degenerative disc disease (DDD) of the lumbar and thoracic spine; intervertebral disc syndrome (IVDS) ("back disability") is denied. From August 6, 2019 to June 2, 2021, a rating greater than 20 percent for a back disability is denied. From June 2, 2021 to the present, a rating greater than 40 percent for a back disability is denied. Prior to June 2, 2021, a rating greater than 10 percent for right bicep strain is denied. After June 2, 2021, a rating greater than 40 percent for right bicep strain is denied on an extraschedular basis. Prior to August 6, 2019, a compensable rating for left knee, arthritis with shin splints ("left knee disability") is denied. Prior to August 6, 2019, a compensable rating for right knee, arthritis with shin splints ("right knee disability") is denied. After August 6, 2019, a rating greater than 10 percent for a left knee disability is denied. After August 6, 2019, a rating greater than 10 percent for a right knee disability is denied. Prior to August 6, 2019, a compensable rating for left ankle tendonitis is denied. After August 6, 2019, a rating greater than 10 percent for left ankle tendonitis is denied. An initial compensable rating for minimal osteoarthritis 1st carpometacarpal left hand ("left hand disability") is denied. REMANDED Entitlement to a compensable initial rating for right leg scar is remanded. Entitlement to a compensable initial rating for history of heat injury with rhabdomyolysis is remanded. FINDINGS OF FACT 1. From January 1, 2013 to August 6, 2019, a back disability manifested by subjective complaints of chronic pain; objective findings did not demonstrate forward flexion between 30 and 60 degrees, combined range of motion not greater than 120 degrees, or muscle spasm or guarding. 2. From August 6, 2019 to June 2, 2021, a back disability manifested by subjective complaints of chronic and radiating pain; objective findings did not demonstrate forward flexion to 30 degrees or less, favorable ankylosis of the entire spine, or IVDS productive of incapacitating episodes. 3. From June 2, 2021 to the present, a back disability manifested by subjective complaints of chronic and radiating pain; objective findings did not demonstrate unfavorable ankylosis of the entire thoracolumbar spine, or IVDS productive of incapacitating episodes. 4. Prior to June 2, 2021, a right bicep strain was moderate in severity; objective findings did not demonstrate debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. 5. After June 2, 2021, the Veteran is in receipt of the maximum schedular rating for right bicep strain; this disability was not productive of an exceptional or unusual disability picture, marked interference with employment, or frequent periods of hospitalization. 6. Prior to August 6, 2019, left and right knee arthritis was established via x-ray, absent objective evidence of compensable loss of motion, swelling, muscle spasm, or painful motion. 7. After August 6, 2019, left and right knee disabilities manifested by subjective reports of pain and flare-ups; objective testing did not show flexion limited to 30 degrees or extension limited to 10 degrees bilaterally. 8. Prior to August 6, 2019, left ankle tendonitis did not manifest by subjective reports of pain, weakness, or lack of endurance; objective testing did not show abnormal range of motion or a moderate disability picture. 9. After August 6, 2019, left ankle tendonitis manifested by subjective reports of pain; objective testing showed moderate, but not marked, limitation of motion. 10. At no time during the period on appeal did the Veteran's left hand disability show limitation of motion of the thumb with a gap of one to two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. CONCLUSIONS OF LAW 1. From January 1, 2013 to August 6, 2019, the criteria for a rating greater than 10 percent for DDD of the lumbar and thoracic spine; IVDS have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5243. 2. From August 6, 2019 to June 2, 2021, the criteria for a rating greater than 20 percent for DDD of the lumbar and thoracic spine; IVDS have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5243. 3. From June 2, 2021 to the present, the criteria for a rating greater than 40 percent for DDD of the lumbar and thoracic spine; IVDS have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5242. 4. Prior to June 2, 2021, the criteria for a rating greater than 10 percent for right bicep strain have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.73, DC 5399-5305. 5. After June 2, 2021, the criteria for a rating greater than 40 percent for right bicep strain on an extraschedular basis have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.73, DC 5305. 6. Prior to August 6, 2019, the criteria for a compensable rating for left knee, arthritis with shin splints have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5003-5260. 7. Prior to August 6, 2019, the criteria for a compensable rating for right knee, arthritis with shin splints have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5003-5260. 8. After August 6, 2019, the criteria for a rating greater than 10 percent for left knee, arthritis with shin splints have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5003-5260. 9. After August 6, 2019, the criteria for a rating greater than 10 percent for right knee, arthritis with shin splints have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5003-5260. 10. Prior to August 6, 2019, the criteria for a compensable rating for left ankle tendonitis have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5271. 11. After August 6, 2019, the criteria for a rating greater than 10 percent for left ankle tendonitis have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5271. 12. The criteria for a compensable initial rating for minimal osteoarthritis 1st carpometacarpal left hand have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5003-5228. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty for training (ACDUTRA) in the United States Army Reserve from October 1989 to February 1990, and on active duty in the United States Army from May 2002 to January 2013, including foreign service in Iraq. For his meritorious service, the Veteran was awarded (among other decorations) the Combat Action Ribbon and Bronze Star Medal. These appeals were most recently remanded by the Board in March 2021 for additional development, which has since been completed. See Stegall v. West, 11 Vet. App. 268, 271 (1998). At that time, the Board also remanded four appeals seeking service connection for neck, left ear, abdominal, and rosacea disabilities. Service connection for such was awarded in an August 2021 rating decision. As this constitutes a complete grant of the pending claims and the Veteran has not expressed dissatisfaction with these awards as assigned, these matters are no longer for the Board's consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). Finally, the Veteran has been in receipt of a total disability rating based on individual unemployability over the course of the entire appeal period here. Absent a contention that his unemployability is due to any of the specific disabilities currently before the Board, this issue has not been further raised. Increased Ratings The Veteran remains in pursuit of higher ratings for several of his service-connected disabilities, as set forth herein. Disability ratings are determined by the applications of the VA's Schedule for Rating Disabilities. 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 service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Of note, several of the Veteran's appeals relate to disabilities of the musculoskeletal system. The rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended, effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Kuzma, 341 F. 3d 1327. Therefore, the Board will consider the Veteran's relevant appeals under both the old and new criteria, and the criteria that is more favorable will be applied. Back Disability As to the Veteran's back disability, he is currently in receipt of a 10 percent rating from January 1, 2013 to August 6, 2019 under DC 5243; a 20 percent rating from August 6, 2019 to June 2, 2021 under DC 5243; and a 40 percent rating from June 2, 2021 to the present under DC 5242. As an initial matter, the alteration of the DC used to evaluate the service-connected disability is of no consequence here, as the criteria under DCs 5242 and 5243 are identical. Thus, the Board will continue to evaluate the Veteran under the DCs as currently assigned. From January 1, 2013 to August 6, 2019 For the above period, the Veteran is pursuing a rating greater than 10 percent under DC 5243. Given the period on appeal, the amended regulations do not apply. As there is no evidence of IVDS during this time, the Formula for Rating IVDS Based on Incapacitating Episodes is also inapplicable. Rather, a 20 percent rating is available upon evidence of the following: 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. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. Further, normal combined range of motion (referencing the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation) for the thoracolumbar spine is 240 degrees. 38 C.F.R. § 4.71a, DC 5243 at Note (2). Although the Veteran did not undergo VA examination during the specific period on appeal, a May 2012 examination is sufficiently contemporaneous for consideration herein. At that time, his gait and posture were normal, and spasms and guarding were explicitly denied. The Veteran's spinal curvature was normal and symmetrical, and no abnormal curvatures were observed. Range of motion testing showed forward flexion to 90 degrees; active flexion was to 80 degrees. As calculated by the Board, combined range of active motion totaled 230 degrees. Repetitive motion did not result in additional loss of motion secondary to pain, weakness, or lack of endurance. See DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). The examiner concluded that it would be pure speculation to estimate additional loss of motion secondary to repetitive use or flare-ups. VA and private treatment records spanning the period on appeal reflect a similar disability picture to that assessed above. Notably, reports of muscle spasm or guarding are absent from these records, and there is no evidence of greater loss of motion than that assessed in May 2012. Accordingly, there is no basis upon which to award a rating greater than 10 percent for the Veteran's back disability from January 1, 2013 to August 6, 2019. Objective medical evidence shows no spasm or guarding during this time, or limitation of motion commensurate with the criteria for a higher rating, even with the presence of pain, weakness, or lack of endurance. DeLuca, 8 Vet. App. at 206-07. Instead, the Veteran's disability picture is fully contemplated in the criteria for a 10 percent rating as currently assigned, and the appeal is hereby denied. From August 6, 2019 to June 2, 2021 For the above period, the Veteran is pursuing a rating greater than 20 percent under DC 5243. The amended regulations indicate that DC 5243 should only be assigned to IVDS when there is disc herniation with compression and/or irritation of the adjacent nerve root; otherwise, DC 5242 is to be assigned. The prevailing VA examination during the period on appeal was conducted in August 2019, and does not definitively establish the requisite disability picture under the amended regulations. However, there is also no negative evidence on this point. Thus, the Board will continue to utilize DC 5243 in assessing the Veteran's back disability during the above period on appeal. Such a finding causes no harm to the Veteran, as the actual rating criteria are identical under the old and new regulations. Accordingly, a 40 percent rating is available to the Veteran with evidence of the following: Forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine; or IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. Normal range of motion remains as defined in the section above. Upon consideration of the record, a rating greater than 20 percent is not warranted for the Veteran's back disability during the period on appeal. During August 2019 VA examination, the Veteran described sharp, throbbing, and constant daily pain that radiated into his legs. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Unprovoked flares were also reported. The Veteran treated his symptoms with various medications, laser ablation, and physical therapy. Upon physical examination, ankylosis was explicitly denied. Although the Veteran presented with IVDS, his symptoms did not require bed rest or treatment prescribed by a physician at any time in the prior 12 months. Initial range of motion testing showed forward flexion to 60 degrees, which resulted in difficulty bending or squatting. Pain was noted on flexion but not with weight-bearing. Repetitive use did not result in additional loss of motion, and symptoms such as pain, weakness, lack of endurance, incoordination, and fatigue were not said to contribute to functional loss with repeated use. However, pain, weakness, and fatigue were estimated to significantly limit functional ability with repeated use over time and during flare-ups, resulting in forward flexion to 40 degrees. VA and private treatment records spanning the period on appeal also document the Veteran's reports of chronic lower back pain and limited motion. Critically, this body of evidence does not reflect a consistent history of forward flexion limited to 30 degrees or less, favorable ankylosis, or incapacitating episodes of IVDS, nor has the Veteran testified of such. Accordingly, the Veteran has not shown such limitation of flexion, ankylosis, or history of incapacitating episodes due to IVDS as to warrant a grant of this appeal. Even at its most severe, forward flexion was not limited to less than 30 degrees at any time, whether due to the presence of pain, weakness, and fatigue, or with repeated or prolonged use. Rather, the Veteran's full disability picture, including forward flexion beyond 30 degrees and chronic lower back pain, is contemplated in the criteria for a 20 percent rating, as currently assigned. Accordingly, the appeal seeking a rating greater than 20 percent for the Veteran's lower back disability from August 6, 2019 to June 2, 2021 must be denied. Insofar as the Veteran reported radiating lower extremity pain, the August 2019 examiner also diagnosed right lumbar radiculopathy. The Veteran is separately service-connected for this disability and has not initiated an appeal with respect to this award. Accordingly, the symptoms related to the Veteran's radiculopathy are covered by the distinct award of service connection and do not merit consideration herein. 38 C.F.R. § 4.14 (prohibiting the pyramiding of symptoms). From June 2, 2021 to the Present For the above period, the Veteran is pursuing a rating greater than 40 percent under DC 5242. Again, the amended regulations change only the disability designation under various back DCs, but not the criteria under which the symptoms are to be evaluated. Thus, the use of DC 5242 during the period on appeal will not be altered at this time. Accordingly, a higher rating is warranted with evidence of the following: Unfavorable ankylosis of the entire thoracolumbar spine (50 percent); or IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months (60 percent). The ankylosis rating is warranted 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. Normal range of motion remains as defined above. Here, a rating greater than 40 percent is not warranted for the Veteran's back disability during the period on appeal. He underwent VA examination in June 2021. At that time, the Veteran reported intermittent pain with bimonthly flareups, which were "severe" and precipitated by overexertion. The Veteran also described numbness in the lower extremities, and limitations with standing, walking, bending, and carrying heavy objects. Upon evaluation, both ankylosis and incapacitating episodes due to IVDS were explicitly denied. Such a history is similarly absent from contemporaneous VA and private treatment records, nor has the Veteran offered any testimony to this effect. Thus, the Veteran does not present with such symptomatology as to warrant a higher rating in this instance. Rather, his full disability picture is contemplated in the criteria for the 40 percent rating as currently assigned, and the appeal seeking a higher rating from June 2, 2021 to the present is denied. In offering this conclusion, the Board again acknowledges the Veteran's reports of radiating lower extremity pain, which are encompassed in the separate awards of service connection for right and left lower extremity radiculopathy during the period on appeal. Id. Right Bicep Strain With respect to the Veteran's right bicep disability, he is currently in receipt of a 10 percent rating prior to June 2, 2021 and a 40 percent rating thereafter. During the earlier period on appeal, he was rated under DC 5399-5305. Generally, hyphenated diagnostic codes are used when an unlisted disability is at issue. See 38 C.F.R. § 4.27. The second diagnostic code provides further detail regarding the origins of the unlisted disability, the bodily functions affected, the symptomatology, and anatomical location. Thus, the diagnostic code following the hyphen is the diagnostic code by which the disability is evaluated by analogy. Accordingly, the Veteran's disability was rated as an injury to muscle group V. He was subsequently rated under DC 5305 only. However, the criteria under which he is evaluated remains intact during both periods on appeal, such that the Board will not disturb the DCs assigned at this time, to no negative impact on the Veteran. DC 5305 pertains to muscle group V and includes the flexor muscles of the elbow, including the biceps, brachialis, and brachioradialis. The function of these muscle groups is listed as elbow supination (long head of biceps as stabilizer of the shoulder joint), and flexion of the elbow. For purposes of evaluation, the Veteran's right extremity is dominant. See, e.g., August 2019 and June 2021 VA examinations. Prior to June 2, 2021 Prior to June 2, 2021, the Veteran is seeking a rating greater than 10 percent for his right bicep disability under DC 5399-5305. A 30 percent rating is warranted with evidence of the following: Moderately severe injury. Pursuant to 38 C.F.R. § 4.56, muscle disabilities are evaluated according to the type of injury, history and complaint, and objective findings. A moderately severe muscle disability is a through and through or deep penetrating wound by a small high velocity missile or a large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. A history consistent with this type of injury should include hospitalization for a prolonged period of treatment of the wound, with a record of cardinal symptoms consisting of loss of power, weakness, lowered threshold of fatigue, pain, impairment of coordination and uncertainty of movement, and, if present, evidence of inability to keep up with work requirements. Objective findings would include entrance and (if present) exit scars indicating a track of a missile through one or more muscle groups. Objective findings would also include indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side should demonstrate positive evidence of impairment. 38 C.F.R. § 4.56(d)(3). Upon review of the record, a rating greater than 10 percent is not warranted for the Veteran's right bicep disability prior to June 2, 2021. His injury was first assessed during May 2012 VA examination. At that time, he described a history of severe muscle pain but denied fatigue or the inability to move. Pain medication helped with managing his symptom, although flare-ups were also reported upon pushing or pulling. Upon evaluation, the Veteran's muscle strength was estimated as a 4/5, without tissue loss. Bunching on contraction was recorded. Related debridement, infections, sloughing, or scarring are not indicated in the evaluation report. Muscle strength testing yielded normal results. The Veteran underwent subsequent VA examination in August 2019. Sharp pain was reported with use of the right arm, in addition to flares multiple times per month. Functional impairment was described as difficulty with lifting and twisting. Debridement, infections, and sloughing were unreported, and scarring was explicitly denied. The examiner did not report any related hospitalizations, but did find objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. VA and private treatment records spanning the period on appeal document the Veteran's right bicep injury and related pain, and do not otherwise contradict the examiners' findings to any notable degree. Based on the foregoing, there is no basis for the assignment of a rating greater than 10 percent for the Veteran's right bicep disability prior to June 2, 2021. At no time during the period on appeal did he show a moderately severe disability picture, as evidenced by such symptoms as debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring as specifically delineated in VA regulations. Rather, his disability was primarily productive of intermittent pain, which is directly contemplated in the rating as currently assigned. Accordingly, this appeal is hereby denied. After June 2, 2021 For the above period, the Veteran is in receipt of the maximum 40 percent rating for his disability under DC 5305. Accordingly, his appeal may only be granted if entitlement to a higher rating is established on an extraschedular basis. The record does not support such a finding in this case. Notably, the Veteran underwent VA examination of this disability in June 2021, during which he reported consistent weakness on the right side. Objective examination established that palpation showed loss of deep fascia; some impairment of muscle tonus and substance were also noted. Elbow flexion showed less than normal strength, but normal strength was observed during all other strength testing. Muscle atrophy was also documented. VA regulations hold that a severe muscle disability results from through and through or deep penetrating wound due to high-velocity missile, or large multiple low-velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. History and complaints are like those required for a moderately severe disability, but worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. Objective findings include ragged, depressed, and adherent scars indicating wide damage to muscle groups in missile track; palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area; muscles swell and harden abnormally in contraction; tests of strength, endurance or coordinated movements compared with corresponding muscles of the uninjured side indicate severe impairment of function; X-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile; adhesion of scar to a long bone; diminished muscle excitability to pulsed electrical current in electrodiagnostic tests; visible or measurable atrophy; adaptive contraction of an opposing muscle group; atrophy of muscle groups not in the track of the missile; and induration or atrophy of an entire muscle group. 38 C.F.R. § 4.56(d)(4). Thus, the Veteran's current disability picture is fully contemplated in the current rating criteria for a severe disability. Critically, there is no evidence showing that the Veteran's right bicep disability has caused marked interference with his employability or necessitated periodic hospitalizations at any time. See, e.g., VA and private treatment records. Importantly, neither the Veteran nor his representative have presented any specific argument as to why an increased rating is warranted on an extraschedular basis in this case. Thus, the evidence does not reflect that the Veteran's service-connected right bicep strain is so exceptional in nature as to not be fully contemplated by the rating schedule after June 2, 2021. Rather, there are no unusual clinical pictures presented, nor is there any other factor which takes the disability outside the usual rating criteria. Thus, even with the favorable resolution of doubt, the Veteran has not carried the burden of demonstrating that his disability is of such a nature that referral for extraschedular evaluation is warranted. 38 C.F.R. § 3.321(b)(1); Thun v. Peake, 22 Vet. App. 111 (2008). For the preceding reasons, this appeal is denied. Left and Right Knee Arthritis As the above appeals require similar analyses, they will be addressed simultaneously herein. Currently, the Veteran is in receipt of noncompensable ratings for his left and right knee disabilities prior to August 6, 2019 and 10 percent ratings thereafter. Both disabilities have been rated under DC 5003-5260 for limitation of flexion. However, the Board will consider all potentially relevant DCs in assessing the merits of these appeals. The Schedule provides that the normal range of motion of the knee is from zero degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II. Prior to August 6, 2019 First, the Veteran is pursuing compensable ratings for his bilateral knee disabilities prior to August 6, 2019. Higher ratings or the assignment of separate, compensable service-connected disabilities may be warranted upon evidence of the following: Flexion limited to 45 degrees (10 percent under DC 5260); or Extension limited to 10 degrees (10 percent under DC 5261). Other DCs pertaining to the knee include DC 5256 (ankylosis), DC 5257 (recurrent subluxation or lateral instability), DC 5258 (dislocation of semilunar cartilage), DC 5259 (removal of the semilunar cartilage), and DC 5263 (genu recurvatum). These disorders are not shown in the record for the period on appeal, such that application of these DCs is not warranted bilaterally. See, e.g., May 2012 VA examination. Upon review of the record, the appeals seeking compensable ratings for bilateral knee disabilities prior to August 6, 2019 must be denied. X-rays taken during May 2012 VA examination show minimal patellofemoral osteophytosis bilaterally, with knees otherwise intact. The Veteran's left knee was also examined at that time. Range of motion testing showed active range of motion from zero to 125 degrees; such limitation was considered normal given the type of injury. There was no additional loss of motion with repetition due to pain, weakness, or lack of endurance. DeLuca, 8 Vet. App. at 206-07. The Veteran presented with a normal gait and no objective signs of pain. The joints also showed no deformity, swelling, crepitus, or instability. VA and private treatment records spanning the period on appeal corroborate the Veteran's bilateral knee arthritis, but are otherwise silent for reports of related pain or limitation of motion. Accordingly, the Veteran is properly in receipt of noncompensable ratings for his bilateral knee disabilities prior to August 6, 2019. The provisions of DC 5003 clearly establish that degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate DCs for the specific joint or joints involved. Where, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate DCs, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a. Here, the Veteran's diagnoses of bilateral arthritis are confirmed by the May 2012 x-rays. However, there is no competent medical evidence of related limitation of motion which would warrant a compensable rating under the DCs pertaining to knee disabilities. Moreover, the record is silent for objective evidence of swelling, muscle spasm, or painful motion throughout the entire period on appeal, including during the aforementioned examination. In the total absence of such evidence, a compensable rating is not warranted for the Veteran's knee disabilities prior to August 6, 2019. The appeals are denied on this basis. After August 6, 2019 The Veteran is further pursuing ratings greater than 10 percent for his bilateral knee disabilities after August 6, 2019. Higher ratings or the assignment of separate, compensable service-connected disabilities may be warranted upon evidence of the following: Flexion limited to 30 degrees (20 percent under DC 5260); or Extension limited to 10 degrees (10 percent under DC 5261). These criteria remain intact under both the old and amended regulations. Again, the evidence does not reflect that the other knee DCsincluding 5256, 5257, 5258, 5259, 5262, and 5263are applicable to these appeals, whether under the old or amended regulations. See, e.g., August 2019 and June 2021 VA examinations. Additionally, the record does not support a grant of these appeals. Notably, the Veteran underwent VA examination in August 2019, at which time he reported daily, sharp pain bilaterally. For the right knee, initial range of motion testing showed flexion from 0 to 85 degrees and extension from 85 to 0 degrees; for the left knee, such testing showed flexion from 0 to 95 degrees and extension from 95 to 0 degrees. Pain was observed with flexion and extension bilaterally and was said to contribute to functional impairment, including difficulty squatting or using the stairs. There was no evidence of pain with weight-bearing bilaterally, but there was evidence of crepitus. The Veteran was able to perform repetitive use testing without further loss of motion, and additional symptoms of pain, fatigue, weakness, lack of endurance, and incoordination were unreported. DeLuca, 8 Vet. App. at 206-07. However, the examiner estimated that pain, fatigue, and weakness would contribute to additional loss with repeated use over time and during flare-ups. The estimated additional loss was flexion from 0 to 65 degrees and extension from 65 to 0 degrees for the right knee, and flexion from 0 to 75 degrees and extension from 75 to 0 degrees for the left knee. The Veteran underwent additional VA examination in June 2021, at which time he reported bilateral pain, crepitus, and pressure; however, a history of instability or swelling was denied. For the right knee, initial range of motion testing showed flexion to 100 degrees and extension to zero degrees. Pain was noted on flexion in active and passive motion but did not result in functional loss. The same results were observed in passive range of motion. There was evidence of crepitus and patellar swelling. The Veteran could perform repetitive use, with flexion to 90 degrees and extension to zero degrees. Pain was observed with repetitive use, but additional symptoms of fatigability, weakness, lack of endurance, or incoordination were not found to produce functional loss. Id. Additional loss of motion was not estimated for repeated use over a period of time, but was estimated to 85 degrees of flexion and zero degrees of extension during flare-ups. As a result, the Veteran showed interference with standing and sitting. With respect to the left knee, initial range of motion (both active and passive) testing showed flexion to 100 degrees and extension to zero degrees. Pain was noted on flexion in active and passive motion. There was evidence of crepitus and patellar swelling. The Veteran could perform repetitive use without additional loss of motion. Pain, fatigability, weakness, lack of endurance, or incoordination were not found to produce functional loss with repetitive use. Id. Additional loss of motion was also not estimated for repeated use over a period of time, but was estimated to 90 degrees of flexion and zero degrees of extension during flare-ups. As a result, the Veteran showed interference with standing and sitting. VA and private treatment records do not deviate from the above findings to any significant degree, to include objective testing which shows more severe limitation of motion than that documented during the Veteran's examinations. Thus, the appeals seeking ratings greater than 10 percent for bilateral knee disabilities after August 6, 2019 are denied. Compellingly, the Veteran did not demonstrate such limitation of motion as to warrant a higher rating under DC 5260 or a separate service-connected disability under DC 5261 at any time. Even with the presence of pain, flare-ups, or repetitive use, he continued to demonstrate far greater range of motion than that required for the appeals to be granted on this basis. Additional symptoms contributing to functional loss, such as fatigability, weakness, lack of endurance, or incoordination, are also absent from the record. Accordingly, there is no basis upon which to grant higher ratings in this case, and the appeals are hereby denied. Left Ankle Disability Currently, the Veteran is in receipt of a noncompensable rating for his left ankle disability prior to August 6, 2019 and a 10 percent rating thereafter. During both periods on appeal, he has been properly rated under DC 5271 for related limitation of motion. Words such as "moderate" and "marked" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. In this respect, normal ranges of motion of the ankle are dorsiflexion from 0 degrees to 20 degrees, and plantar flexion from 0 degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II. Prior to August 6, 2019 As set forth above, the Veteran is pursuing a compensable rating for his left ankle disability during the above period on appeal. Under DC 5271, a 10 percent rating is warranted with evidence of the following: Moderate limitation of motion. Such a disability picture is not established by the record prior to August 6, 2019. Rather, during May 2012 VA examination, the Veteran showed no deformity, swelling, crepitus, or laxity. Objective signs of pain were denied, and dorsiflexion in active range of motion was from zero to 20 degrees. With repetition, there was no additional loss of motion secondary to pain, weakness, or lack of endurance. DeLuca, 8 Vet. App. at 206-07. Plantar flexion was from zero to 45 degrees in active motion, and again, there was no additional loss of motion secondary to pain, weakness, or lack of endurance. Id. Accompanying x-rays showed multifocal cystic fluid collections measuring approximately two centimeters each, with severe focal tendinosis and partial tear of the peroneous longus tendon. VA and private treatment records support this understanding of the Veteran's disability picture during the period on appeal. Compellingly, these records are silent for reports of related functional impairment, nor did the Veteran solicit notable treatment for this disability at any time. Though neither "moderate" nor "marked" are specifically defined by the regulation, there is no definition of either term that could lead a fact-finder to determine that, as here, a veteran with full range of motion more closely approximates the more severe of two ratings. Rather, the Veteran showed normal range of motion absent objective evidence of pain, weakness, or lack of endurance, and there is no evidence that his disability interfered with his functional capacity to any meaningful degree. In instances where the Schedule does not provide a zero percent evaluation for a DC (such as DC 5271), a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. Such is the case here, where the Veteran's left ankle disability does not satisfy the requirements for a compensable disability rating during the period on appeal. As such, the appeal seeking a compensable rating prior to August 6, 2019, is denied. After August 6, 2019 The Veteran is also pursuing a rating greater than 10 percent for his left ankle disability after August 6, 2019. Under DC 5271, a maximum 20 percent rating is warranted upon evidence of the following: Marked limitation of motion. The February 2021 amended regulations clarify that marked limitation of motion is less than 5 degrees of dorsiflexion or 10 degrees of plantar flexion. Again, the record does not support the assignment of a higher rating during the period on appeal. The Veteran underwent two VA examinations for consideration. In August 2019, he reported daily pain which was "sharp" or "achy." Layno, 6 Vet. App. at 469. These symptoms were treated with over-the-counter medication and physical therapy. Initial range of motion testing showed dorsiflexion to 15 degrees and plantar flexion to 35 degrees. Limited motion contributed to a decreased ability to talk, run, pivot, climb, stand, or move quickly. Pain was noted on both dorsiflexion and plantar flexion and contributed to functional loss; however, there was no evidence of pain with weight-bearing. The Veteran could perform repetitive-use testing without additional loss of motion, and symptoms of pain, fatigue, weakness, lack of endurance, and incoordination were not said to contribute to functional loss. DeLuca, 8 Vet. App. at 206-07. However, pain, fatigue, and weakness were estimated to cause functional loss with repeated use over a period of time and during flare-ups. Described in terms of range of motion, dorsiflexion would then be limited to 10 degrees and plantar flexion to 25 degrees. The Veteran endorsed a similar disability picture during June 2021 VA examination, reporting pain and soreness which were exacerbated with prolonged walking. Layno, 6 Vet. App. at 469. Initial range of motion testing showed dorsiflexion to 15 degrees and plantar flexion to 40 degrees. Pain was not observed on either motion, and the above results remained intact in passive range of motion. The Veteran was able to perform repetitive-use testing, with dorsiflexion to 10 degrees and plantar flexion to 30 degrees. However, the examiner denied that pain, fatigability, weakness, lack of endurance, or incoordination contributed to functional loss or additional loss of motion, including with repeated use over time. DeLuca, 8 Vet. App. at 206-07. In contrast, pain was said to contribute to functional loss during flare-ups, estimated as 10 degrees of dorsiflexion and 25 degrees of plantar flexion. Interference with standing was reported as a result. VA and private treatment records spanning the period on appeal corroborate the Veteran's left ankle pain with moderate functional impairment, but do not contain range of motion testing showing more severe limitations than those assessed above. Accordingly, the Veteran's left ankle disability was productive of moderate and chronic pain throughout the period on appeal which interfered with prolonged ambulation. Said pain was unaccompanied by such additional symptoms as weakness, fatigability, or incoordination, and the collective evidence does not establish that this singular symptom impaired the Veteran's capacity to perform the activities of daily living to any significant degree. Instead, he consistently demonstrated only moderate limitation of motion, even with prolonged repetitive use or during flare-ups and whether under the Board's interpretation of "marked" or under the more specific amended regulations. Thus, the Veteran's full disability picture is compensated in the criteria for a 10 percent rating as currently assigned, and the appeal is hereby denied. Left Hand Disability Finally, the Veteran is pursuing a compensable initial rating for his left hand disability under DC 5003-5228. The criteria for DC 5228 were unchanged by the February 2021 amendments. Accordingly, a 10 percent rating is warranted with evidence of the following: Limitation of motion of the thumb with a gap of one to two inches (2.5 to 5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. The probative evidence weighs against a positive finding in this case. During May 2012 and August 2019 VA examinations, the Veteran did not show limitation of motion of the thumb. On both occasions, the examiner denied that the Veteran demonstrated a gap between the thumb pad and fingers, nor was a history of related functional impairment described. Although a more severe disability picture was depicted during June 2021 VA examination, the gap between the Veteran's thumb pad and fingers was estimated as only one centimeter at that time. Moreover, there was not objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue during testing, nor was pain observed on motion. These results remained intact whether in active or passive motion, and the examiner did not report that the Veteran's thumb was attempting to oppose the fingers on evaluation. VA and private treatment records do not contradict these findings to any degree. Thus, there is no basis upon which to grant this appeal. At its most severe, the Veteran's disability still showed far less severe limitation of motion than that enunciated in the criteria for a compensable rating, and the record is silent for evidence of the thumb attempting to oppose the fingers. While the criteria of DC 5003 have also been considered, there is no evidence to support a compensable rating under this DC. In the absence of such evidence, the appeal must be denied. With respect to all matters on appeal, the Board has considered the Veteran's prolonged position that higher ratings are warranted. While this argument may be offered in good faith, it is an insufficient basis upon which to grant these appeals, as the Veteran is not competent to identify a specific level of disability according to the applicable DCs, and his contentions are otherwise unsupported by objective medical evidence. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994). Instead, greater probative value has been offered to the medical evidence in assessing the severity of the Veteran's disabilities during the periods on appeal, as the examiners possess the requisite expertise to render opinions regarding the degree of impairment caused by the Veteran's disabilities and had sufficient facts and data on which to base their conclusions. In this respect, the Board finds that the medical evidence supports the determinations offered herein. The Board also clarifies that there was a significant body of medical evidence offered in support of these appeals. Although the Board is obligated to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record, but does not have to discuss each piece of evidence). Therefore, the Board ha summarized the relevant evidence herein, but affirmatively represents to the Veteran that all such records were reviewed. Additionally, neither the Veteran nor his representative have offered any specific argument as to why higher ratings are warranted in the above appeals. Thus, no other contentions or issues have been reasonably raised by the record for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND Although the Board sincerely regrets the additional delay this will cause, further development is necessary prior to the adjudication of the remaining appeals. Right Leg Scar The Board remanded this appeal in March 2021 upon its finding that an August 2019 VA examination was inadequate because it diagnosed the Veteran with a left thigh scar but provided a clinical assessment under the right lower extremity portion of the Disability Benefits Questionnaire (DBQ). Regrettably, a June 2021 VA examination demonstrates this exact same error. Thus, a remand is required for an adequate examination to be obtained. Heat Injury The Veteran's heat injury disability is currently rated by analogy under DC 6399-6354 as chronic fatigue syndrome (CFS). Although a Supplemental Statement of the Case (SSOC) was issued in August 2021, the evaluator utilized the incorrect criteria relevant to this appeal (specifically, the SSOC discusses the criteria required for a 100 percent, and not 10 percent, rating). The matter must be remanded for the issuance of a correct SSOC. The matters are REMANDED for the following actions: 1. Schedule the Veteran for a VA examination to assess the current severity of his right leg scar. The claims folder must be provided to the examiner in conjunction with the examination. All necessary tests and studies should be conducted. The examiner should offer an assessment of all pertinent symptomatology and findings, to be reported in detail in accordance with Diagnostic Code 7802. The examiner must explicitly state that it is the right leg scar being assessed, and complete the appropriate portion of the examination report (specifically, for the right lower extremity). If possible, the examiner should also clarify whether the assessments provided in August 2019 and June 2021 speak to the Veteran's right leg scar or a nonservice-connected left thigh scar. 2. Readjudicate the remaining appeals. If the benefits sought remain denied, issue an SSOC to the Veteran and his representative and provide an appropriate period for response. In doing so, the rater is advised to utilize the criteria for a 10 percent rating (and not 100) in assessing the Veteran's heat injury disability under DC 6399-6354. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Kovarovic, 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.