Citation Nr: 21069782 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 20-20 954A DATE: November 19, 2021 ORDER Entitlement to service connection for cervical strain with degenerative arthritis as secondary to intervertebral disc syndrome is denied. Entitlement to a rating in excess of 20 percent for intervertebral disc syndrome prior to September 18, 2019, and in excess of 40 percent thereafter, is denied. Entitlement to an initial rating in excess of 10 percent for a right knee strain with meniscal tear is denied. Entitlement to a separate 10 percent rating, but no higher, for left knee instability for the period on appeal prior to February 7, 2021 is granted. From February 7, 2021, forward, a rating of 20 percent, but no higher, for left knee instability is granted. Entitlement to a rating in excess of 10 percent for a left knee disability other than instability is denied. Entitlement to a compensable rating for left knee surgical scars is denied. Entitlement to a compensable rating for right knee scars prior to September 18, 2019, and in excess of 10 percent thereafter, is denied. Entitlement to a rating in excess of 20 percent for a right shoulder disability prior to September 18, 2019, and in excess of 30 percent thereafter, is denied. Entitlement to a compensable rating for right shoulder scar is denied. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the right lower extremity sciatic nerve for the period on appeal prior to September 18, 2019 is denied. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the left lower extremity sciatic nerve for the period on appeal prior to September 18, 2019 is denied. From September 18, 2019, forward, a rating of 40 percent, but no higher, for radiculopathy of the right lower extremity sciatic nerve is granted. From September 18, 2019, forward, a rating of 40 percent, but no higher, for radiculopathy of the left lower extremity sciatic nerve is granted. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the right lower extremity femoral nerve for the period on appeal prior to September 18, 2019 is denied. Entitlement to an initial rating in excess of 10 percent for radiculopathy of the left lower extremity femoral nerve for the period on appeal prior to September 18, 2019 is denied. From September 18, 2019, forward, a rating of 20 percent, but no higher, for radiculopathy of the right lower extremity femoral nerve is granted. From September 18, 2019, forward, a rating of 20 percent, but no higher, for radiculopathy of the left lower extremity femoral nerve is granted. Entitlement to an effective date prior to September 6, 2018 for the award of service connection for radiculopathy of the right lower extremity femoral nerve is denied. Entitlement to an effective date prior to September 6, 2018 for the award of service connection for radiculopathy of the left lower extremity femoral nerve is denied. Entitlement to an effective date prior to September 6, 2018 for the award of service connection for radiculopathy of the right lower extremity sciatic nerve is denied. Entitlement to an effective date prior to September 6, 2018 for the award of service connection for radiculopathy of the left lower extremity sciatic nerve is denied. Entitlement to an effective date prior to September 6, 2018 for the award of service connection for a right knee strain with meniscal tear is denied. Entitlement to an effective date prior to September 6, 2018 for the award of service connection for right knee scars is denied. Entitlement to an effective date prior to September 6, 2018 for the award of service connection for a right shoulder scar is denied. Entitlement to an effective date prior to September 6, 2018 for the award of a 20 percent rating for a right rotator cuff tear is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) for the period on appeal prior to September 18, 2019 is remanded. FINDINGS OF FACT 1. The Veteran's cervical strain with degenerative arthritis is not etiologically related to his service-connected intervertebral disc syndrome. 2. The Veteran's intervertebral disc syndrome is characterized by pain and limitation of flexion to 60 degrees prior to September 18, 2019, and by forward flexion of 30 degrees or less thereafter. It is not characterized by requiring bed rest prescribed by a physician. 3. The Veteran's right knee strain with meniscal tear is rated as 10 percent disabling, which is the maximum schedular rating permitted for symptomatic removal of semilunar cartilage. 4. The Veteran's left knee disability has been manifested by mild lateral instability since January 15, 2019 and patellar instability requiring a brace prescribed by a medical provider from February 7, 2021, forward. 5. The Veteran's left knee disability is otherwise manifest by a functional limitation of motion equivalent to a 10-degree extension after accounting for limitations due to pain, weakness, and fatigability. 6. The Veteran's left knee scars measure less than 77 sq. cm combined and do not result in separate functional loss. 7. The Veteran's right knee scars measured less than 77 sq. cm combined, were not painful, and did not result in functional loss prior to September 18, 2019; thereafter, the right knee scars worsened to a single painful scar less than 77 sq. cm combined without functional loss. 8. The Veteran's right shoulder disability is manifested by a limitation of motion to the shoulder level of the major extremity prior to September 18, 2019 and to less than 20 percent thereafter. 9. The Veteran's right shoulder scar measures less than 77 sq. cm. 10. The Veteran's right and left lower extremity sciatic radiculopathy most nearly approximates moderate incomplete paralysis prior to September 18, 2019, and thereafter most nearly approximates moderately severe incomplete paralysis 11. The Veteran's right and left lower extremity femoral radiculopathy most nearly approximates mild incomplete paralysis prior to September 18, 2019, and thereafter most nearly approximates moderate incomplete paralysis 12. The Veteran first submitted a claim for disability compensation for radiculopathy, right knee strain, right knee scars, and right shoulder scar on September 6, 2018. 13. The Veteran submitted a claim for an increased rating for his right shoulder disability on September 6, 2018, and his right shoulder disability did not appreciably worsen on a discernable date during the prior year. CONCLUSIONS OF LAW 1. The criteria for service connection for cervical strain with degenerative arthritis due to service-connected intervertebral disc syndrome are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for a rating in excess of 20 percent prior to September 18, 2019 and in excess of 40 percent thereafter for intervertebral disc syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5243. 3. The criteria for a rating in excess of 10 percent for right knee strain with meniscal tear have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5259. 4. From September 16, 2018 to February 6, 2021, the criteria for a separate rating of 10 percent, but no higher, for left knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5257. 5. From February 7, 2021, forward, the criteria for a rating of 20 percent, but no higher, for left knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5257 (2021). 6. The criteria for a rating in excess of 10 percent for a left knee disability other than instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5261. 7. The criteria for a compensable disability rating for left knee surgical scars have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DC 7801. 8. The criteria for a compensable disability rating prior to September 18, 2019 or in excess of 10 percent thereafter for right knee scars have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DC 7801. 9. The criteria for a rating in excess of 20 percent prior to September 18, 2019, or in excess of 30 percent thereafter for right shoulder rotator cuff tear have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5201. 10. The criteria for a compensable disability rating for right shoulder scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DC 7801. 11. Prior to September 18, 2019, the criteria for an initial rating in excess of 10 percent for radiculopathy of the right lower extremity sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a DC 8520. 12. Prior to September 18, 2019, the criteria for an initial rating in excess of 10 percent for radiculopathy of the left lower extremity sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a DC 8520. 13. From September 18, 2019, forward, the criteria for an initial rating of 40 percent, but no higher, for radiculopathy of the right lower extremity sciatic nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a DC 8520. 14. From September 18, 2019, forward, the criteria for an initial rating of 40 percent, but no higher, for radiculopathy of the left lower extremity sciatic nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a DC 8520. 15. Prior to September 18, 2019, the criteria for an initial rating in excess of 10 percent for radiculopathy of the right lower extremity femoral nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a DC 8526. 16. Prior to September 18, 2019, the criteria for an initial rating in excess of 10 percent for radiculopathy of the left lower extremity femoral nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a DC 8526. 17. From September 18, 2019, forward, the criteria for an initial rating of 20 percent, but no higher, for radiculopathy of the right lower extremity femoral nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a DC 8526. 18. From September 18, 2019, forward, the criteria for an initial rating of 20 percent, but no higher, for radiculopathy of the left lower extremity femoral nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a DC 8526. 19. The criteria for entitlement to an effective date prior to September 6, 2018 for the award of service connection for radiculopathy of the left lower extremity femoral nerve have not been met. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2). 20. The criteria for entitlement to an effective date prior to September 6, 2018 for the award of service connection for radiculopathy of the left lower extremity sciatic nerve have not been met. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2). 21. The criteria for entitlement to an effective date prior to September 6, 2018 for the award of service connection for radiculopathy of the right lower extremity femoral nerve have not been met. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2). 22. The criteria for entitlement to an effective date prior to September 6, 2018 for the award of service connection for radiculopathy of the right lower extremity sciatic nerve have not been met. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2). 23. The criteria for entitlement to an effective date prior to September 6, 2018 for the award of service connection for a right knee strain with meniscal tear have not been met. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2). 24. The criteria for entitlement to an effective date prior to September 6, 2018 for the award of service connection for right knee scars have not been met. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2). 25. The criteria for entitlement to an effective date prior to September 6, 2018 for the award of service connection for right shoulder scar have not been met. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2) 26. The criteria for entitlement to an effective date prior to September 6, 2018 for the award of aa 20 percent rating for right rotator cuff tear have not been met. 38 U.S.C. § 5110(b)(3); 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from August 1983 to November 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2019 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for right and left lower extremity peripheral neuropathy of the sciatic and femoral nerves, each rated 10 percent disabling, effective September 6, 2018; service connection for right knee strain with meniscal tear, rated 10 percent disabling, effective September 6, 2018; service connection for a right shoulder scar, rated 0 percent disabling, effective September 6, 2018; and service connection for a right knee scar, rated 0 percent disabling, effective September 6, 2018. The RO also granted a 20 percent rating for the right rotator cuff tear, effective September 6, 2018. Finally, the RO denied increased ratings for IVDS, a left knee disability, and left knee surgical scars, and service connection for a cervical spine disability. In an October 2020 rating decision, during the pendency of this appeal, the RO increased the rating for IVDS from 20 to 40 percent, effective September 18, 2019. The RO also increased the ratings for right and left lower extremity sciatic nerve peripheral neuropathy from 10 percent to 40 percent, effective September 18, 2019, and increased the ratings for right and left lower extremity femoral nerve peripheral neuropathy from 10 to 20 percent, effective September 18, 2019. Because less than the maximum available benefit for a schedular rating was awarded and because the increased ratings were not awarded for the entirety of the claims period, the claims remain before the Board. See Fenderson v. West, 12 Vet. App. 119, 126 (1999); AB v. Brown, 6 Vet. App. 35 (1993). In a January 2021 rating decision, during the pendency of this appeal, the RO, in pertinent part, increased the rating for a right rotator cuff tear from 20 percent to 30 percent, effective September 18, 2019. The RO also awarded a separate 10 percent rating for painful scars of the right knee, effective September 18, 2019. Id. In the January 2020 notice of disagreement, the Veteran disagreed with the failure to include consideration of total disability including due to individual unemployability. As the Veteran has clearly raised the issue of unemployability as part of the present appeal, the Board has jurisdiction of the derivative TDIU claim. See Rice v. Shinseki, 22 Vet. App. 447 (2009). As the Veteran is already in receipt of a combined 100 percent rating, effective September 18, 2019, consideration of entitlement to a TDIU has been limited to the period on appeal prior to September 18, 2019. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). 1. Entitlement to service connection for cervical strain with degenerative arthritis as secondary to intervertebral disc syndrome The Veteran contends that his cervical strain with degenerative arthritis is secondary to his lower back intervertebral disc syndrome. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will consider only entitlement to secondary service connection. Although the Veteran's service treatment records include symptoms of a sore neck in September 1984, this did not reasonably raise a claim for direct service connection. The neck soreness was not described as the result of an injury but was raised as part of a varied collection of symptoms ultimately diagnosed as hyperbilirubinemia and possible Gilbert Syndrome. These symptoms and diagnoses do not suggest a relationship exists to his current diagnosis. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or was aggravated beyond its natural progress by, service-connected disability. The Board concludes that, although the Veteran has a current disability, the preponderance of the evidence is against finding that the Veteran's disability is proximately due to or the result of, or aggravated beyond its natural progression by, service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). VA examined the Veteran in January 2019. The examiner found that the Veteran's lower back and cervical spine disabilities were unrelated because the cervical spine was not a weight bearing joint and would not likely be impacted by the disability in the lower back. The examiner considered the Veteran's lower back history but did not believe it connected. The Board finds this opinion to be adequate and highly probative, as it is based on examination of the Veteran and review of the record, and included a rationale. Although the Veteran claimed his cervical neck secondary to his lower back, he has not submitted evidence to support his original filing. Moreover, the issue is medically complex as it requires knowledge of the interaction of multiple anatomical systems. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the weight of the evidence supports a finding that the Veteran's cervical spine disability is not secondary to his lower back disability; therefore, service connection must be denied. 2. Entitlement to a rating in excess of 20 percent prior to September 18, 2019 and 40 percent thereafter for intervertebral disc syndrome The Veteran contends that he is entitled to a higher rating for his intervertebral disc syndrome. The Veteran's intervertebral disc syndrome is rated under 38 C.F.R. § 4.71a, DC 5243. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, 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 abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted 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. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Although the rating criteria for evaluating spinal disabilities were amended effective February 7, 2021, it was not modified in a way that is pertinent to this evaluation. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). For VA compensation purposes, unfavorable ankylosis is a condition in which the entire thoracolumbar 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 neurological symptoms due to nerve root stretching. Fixation of the spine in a neutral position (zero degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71a General Rating Formula for Diseases and Injuries of the Spine Note 5. a. The Board finds that the preponderance of the evidence is against a rating in excess of 40 percent for intervertebral disc syndrome after September 18, 2019. A rating in excess of 40 percent is warranted only for unfavorable ankylosis of the spine. VA examined the Veteran most recently in October 2020. The examiner opined that the Veteran's spine was not ankylosed. This weighs against a higher rating as unfavorable ankylosis is required for a higher rating. Moreover, even if the Veteran's limited range of motion were considered a functional ankylosis, his range of motion exceeds zero degrees in both flexion and extension. As described in Note 5, a neutral or zero-degree ankylosis is always considered favorable ankylosis. Favorable ankylosis is rated at 40 percent, the same as his current rating. The Veteran was also diagnosed with radiculopathy due to his spine. The examiner explained however that this was the same condition as what was previously service connected as peripheral neuropathy. There is no evidence of neurological manifestations of the low back disability other than radiculopathy. As the Veteran is already service connected and separately rated for radiculopathy as a neurological manifestation of the low back disability, further discussion here is not warranted. b. The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for intervertebral disc syndrome prior to January 15, 2019. VA examined the Veteran in January 2019. Forward flexion was 0 to 60 degrees; extension was 0 to 15 degrees; and right and left lateral flexion and extension were each 0 to 30 degrees. The examiner opined that the range of motion and back pain did not contribute to functional loss. The examiner also reported that the examination was occurring during a flare up and there were no additional limitations from the flareup. No bed rest had been prescribed. The examination supports a 20 percent rating. A 20 percent rating is appropriate for flexion greater than 30 but no more than 60. The Veteran's flexion is 60 degrees, which is just below the cut off between 10 and 20 percent. In addition, although the examination reported pain, the examiner opined that the pain did not have a functional impact. This weighs against an upward adjustment. Although the later October 2020 examination reported more severe symptoms, the examiner also reported that the Veteran's condition had worsened over time, which is consistent with the larger range of motions reported in the January 2019 examination. The Veteran's representative argued in his June 2021 submission that "record evidence" confirmed that a higher rating of 40 percent was warranted. The Board agrees that 40 percent is warranted for some periods, but not for the period prior to the January 2019 VA examination as the evidence does not indicate a more limited range of motion for that period. c. The Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for intervertebral disc syndrome from January 15, 2019 to September 18, 2019. The record is less clear between January and September 2019. In general, an increase in disability rating occurs when it is ascertainable that an increase has occurred. 38 C.F.R. § 3.400(o). The record during this period does not contain an indication that the Veteran's spine worsened beyond the January 2019 examination that would support a higher rating. For example, records indicated that the Veteran reported back pain during the intervening period, but not that it was more severe or limiting than the pain in January 2019. The Veteran reported back pain and tightness in his June 2020 statement in support of TDIU, but this is already after the start of his 40 percent rating. Thus, the evidence indicates that the Veteran's worsening occurred sometime after the September 18, 2019 dates for which he is already rated at 40 percent. Because the record does not suggest that his back appreciably worsened between January and September 2019, the Board finds the earlier January 2019 examination report more probative and finds that the Veteran's back did not worsen during that period enough to warrant a 40 percent rating. Although the rating criteria provide for an alternative method of rating for intervertebral disc syndrome, this method is not applicable as the Veteran has not been prescribed bed rest. Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 3. Entitlement to an initial rating in excess of 10 percent for a right knee strain with meniscal tear. The Veteran contends that he is entitled to a higher rating for his right knee strain with meniscal tear. The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case" and the Board can choose the diagnostic code to apply so long as it is supported by reasons and bases as well as the evidence. Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, diagnosis, and demonstrated symptomatology. Any change in diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). The Veteran was previously rated under 38 C.F.R. § 4.71a, DC 5260. See January 2021 VA Rating Decision Codesheet. However, the Veteran's flexion was not limited to a compensable amount. See January 2019 and January 2021 VA knee examination reports. However, the evidence reflects that the Veteran had arthroscopic surgery on the right knee in 1990 and still related pain. See January 2021 VA knee examination report. Therefore, the Board has recharacterized the Veteran's disability to be rated under DC 5259. See Butts, supra. Under DC 5259, a 10 percent rating is warranted for symptomatic removal of semilunar cartilage. 38 C.F.R. § 4.71a, DC 5259. As the Veteran is in receipt of the highest schedular rating for dislocation of symptomatic removal of semilunar cartilage, there is no basis to award a higher evaluation. The Board has also considered the other diagnostic codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). VA examined the Veteran in January 2019. The examiner measured the Veteran's flexion and extension from 0 to 110 degrees. He found that the range of motion did not cause a loss of function and that pain existed, but also did not cause a loss of function including during a flare up or repetitive use. The Veteran's right knee was not ankylosed and was not subject to recurrent subluxation or lateral instability. The examiner also found that the Veteran had a meniscal condition that caused pain and locking. VA examined the Veteran again in January 2021. The examiner measured the Veteran's flexion and extension from 0 to 80 degrees. He found that the range of motion did not cause a loss of function, but that flare ups caused functional loss equivalent to flexion and extension between 0 to 70 degrees. The knee was not ankylosed and was not subject to recurrent subluxation or lateral instability. The examiner found that the Veteran had a meniscal condition that caused joint pain, but not frequent locking. DC 5256 is not applicable because the Veteran's knee is not ankylosed. DC 5258 is not applicable because he does not have dislocated semilunar cartilage. DCs 5260 and 5261 are applicable, but the Veteran's flexion and extension are not limited sufficiently to warrant compensable ratings. In addition, although a minimum compensable rating can be available for pain, this rating would be at most 10 percent, which equals the Veteran's existing rating. A rating under both codes would also be impermissible pyramiding because they both would be based upon knee pain as the symptom to award the rating. DC 5262 does not apply because the Veteran's tibia and fibula are not impaired. DC 5263 does not apply because the Veteran does not have genu recurvatum. The rating code sheet describes the right knee as "right knee strain with meniscal tear associated with s/p left knee partial meniscectomy with early osteoarthritis now with meniscal tear and instability with limitations of extension." Although this description mentions instability, which implicates DC 5257, the referenced instability refers to the Veteran's left knee not the right. The phrase "associated with s/p left knee . . ." indicates that the right knee is secondary to the left knee condition and the following language (including the instability) is part of the description of the left and not applicable to the right knee. This is confirmed by looking at the rating code sheet for the left knee, which is the verbatim text. Moreover, the June 2011, January 2019, and January 2020 VA examinations tested for and did not find any instability of the right knee, and the Veteran specifically identified his left knee as the one that gave out. For these reasons, a separate compensable rating under DC 5257 for recurrent subluxation or lateral instability of the right knee is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a rating in excess of 10 percent for his right knee. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra. 4. Entitlement to a rating in excess of 10 percent for a left knee disability. The Veteran contends that he is entitled to a higher rating for his left knee. The Veteran's left knee is rated under 38 C.F.R. § 4.71a, DC 5261, for limitation of extension of the leg. Under DC 5261, a noncompensable rating is warranted for extension limited to 5 degrees. A 10 percent rating is warranted for extension limited to 10 degrees. A 20 percent rating is warranted for extension limited to 15 degrees. A 30 percent rating is warranted for extension limited to 20 degrees. A 40 percent rating is warranted for extension limited to 30 degrees. A 50 percent rating is warranted for extension limited to 45 degrees. 38 C.F.R. § 4.71a, DC 5261. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). For the reasons explained below, the Board finds that the preponderance of the evidence is against a rating in excess of 10 percent under DC 5261. However, an additional separate 10 percent rating for left knee lateral instability is warranted. Diagnostic Code 5261 VA examined the Veteran in January 2019. The examiner found that the Veteran's left knee could extend to 0 degrees normally, but that repeated use or flare ups would limit that extension to 10 degrees due to pain, fatigue, weakness, and lack of endurance. The overall functional impact of the Veteran's knee disabilities was difficulty with prolonged walking, running, kneeling, squatting, and climbing stairs. The examiner accounted for the functional impairments and described them as an additional limitation on the range of extension and as knee instability. Although the Veteran has separately complained of pain, the examiner accounted for pain during a flareup and described that pain in terms of an additional limitation of motion. As the Veteran's functional limitations are described by the rating criteria, an increased rating is not warranted. VA examined the Veteran again in January 2021. The examiner found that the Veteran could flex and extend his knee from 0 to 80 degrees normally and from 0 to 70 degrees with repeated use or during a flare up. The overall functional impairment was decreased ability to lift more than 25 pounds and stand, walk, or sit for extended periods of time. The latter examination does not support an increased rating because the ranges of motion provided, even accounting for flare ups and repeated use, would not be compensable. Therefore, the currently assigned minimum 10 percent rating based on painful motion is appropriate. Diagnostic Code 5257 In addition to the rating under DC 5261, the Veteran's left knee disability should also have been rated under DC 5257 for lateral instability. Effective February 7, 2021, VA amended the rating criteria for disabilities of the knee and leg. The amended DC 5257 provides ratings for other impairment of the knee based on recurrent subluxation or instability, and patellar instability. Only the original rating criteria applies prior to February 7, 2021; thereafter, whichever rating criteria is more favorable shall apply. For patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A maximum 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Note (1) provides that, for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note (2) provides that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as a surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). The January 2019 VA examiner found that the Veteran did not have a prior history of lateral instability, but had developed lateral instability rated at 1+ in severity. This measure of lateral instability is the least severe of the three ratings (1+, 2+, and 3+) and represents 0 to 5mm of instability. Accordingly, a 10 percent rating for the least severe "slight" lateral instability is the most appropriate. The Veteran reported that his knee had given out prior to the examination and so the rating should apply to the entire period. The January 2021 examination does not support a higher rating for instability of the left knee. That examiner found that the Veteran's knees had normal stability, which weighs in favor of, if anything, a non-compensable rating. As the evidence does not indicate that an actual improvement occurred, however, the Board finds that a 10 percent rating, but no higher, is warranted for left knee instability for the entire period on appeal. In addition, a 20 percent rating, but no higher, is warranted for left knee instability under the new version of DC 5257, effective February 7, 2021. The Veteran was prescribed a "patella stabilizer with buttress" brace in April 2020. This qualifies as a "brace, cane, or walker". However, the maximum 30 percent rating is not warranted under the revised version of DC 5257, as the Veteran reported cane use before his brace was prescribed, but did not obtain a "prescription by a medical provider" for both the brace and cane. Other Diagnostic Codes The Board has also considered the other diagnostic codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). DC 5256 is not appropriate because the Veteran's knee is not ankylosed (literally or functionally). DC 5258 is not appropriate because the Veteran does not have currently dislocated semilunar cartilage, and even if he did, rating under 5258 would be impermissible pyramiding since it contemplates the same pain as used to increase the rating for DC 5261. DC 5259 is applicable, but a separate compensable rating under this code would constitute impermissible pyramiding as it requires symptomatic residuals of removal of cartilage, but the symptoms that the Veteran experiences, such as pain, weakness, and fatigue, are contemplated by the compensable ratings currently assigned under DCs 5257 and 5261. DC 5260 is not appropriate because the measured flexion is well above the compensable limitation of 45 degrees. DC 5262 is not applicable because there is no impairment of the tibia or fibula. DC 5263 is not applicable without genu recurvatum, which is not indicated here. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a rating in excess of 10 percent for extension of the left knee for the entire period on appeal. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. However, a separate 10 percent rating is warranted for left knee instability under DC 5257 for the entire period on appeal prior to February 27, 2021, and a 20 percent rating is warranted for left knee instability under DC 5257 from February 27, 2021, forward. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra. 5. Entitlement to a compensable rating for left knee surgical scars. The Veteran contends that he is entitled to a compensable rating for his left knee surgical scars. The Veteran's left knee surgical scars are rated under DC 7805 for other scars (including linear scars) and other effects of scars evaluated under DCs 7800, 7801, 7802, and 7804. The Board notes that VA amended the criteria for rating skin disabilities, effective from August 13, 2018. However, DC 7805 was not changed by the August 13, 2018 amendments. DC 7805 instructs that any disabling effects not considered in a rating provided under DCx 7800-04 should be evaluated under an appropriate DC. VA examined the Veteran in January 2019. The examiner noted three scars on the left knee. None of the scars were painful, tender to palpitation, unstable on inspection, or had underlying soft tissue damage. The total scar area was 0.6 cm2 on the left knee. The examiner opined that scars did not result in any limitation of function for the Veteran. VA again examined the Veteran in October 2020. The examiner again noted three scars on the left knee, and further noted that they had underlying soft tissue damage. None of the scars were painful, tender to palpitation, or unstable on inspection. The total scar area was 0.6 cm2 on the left knee. The examiner opined that the scars caused no limitation of function for the Veteran. The Board finds that the preponderance of the evidence is against the assignment of a compensable rating for the Veteran's scars under DC 7805 as there are no disabling effects. The Board has also considered the other diagnostic codes pertaining to scars. However, the Veteran's left knee scars are not of the head, face, or neck, and are not deep and nonlinear, as is required for a rating under DC 7800. Although the left knee scars are associated with underlying soft tissue damage, they do not cover an area or areas of 77 sq. cm. or greater, as is required for a rating under DCs 7801 and 7802. Moreover, the Veteran's left knee scars not unstable or painful, as is required for a rating under DC 7804. Therefore, DCs 7800, 7801, 7802, and 7804, as in effect both prior to and from August 13, 2018, are inapplicable. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a compensable rating for left knee scars. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra. 6. Entitlement to a compensable rating for a right knee scar prior to September 18, 2019, and a rating in excess of 10 percent thereafter. Prior to September 18, 2019, the Veteran is in receipt of a noncompensable rating for a right knee scar under DC 7802 for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. Thereafter, the Veteran is in receipt of a 10 percent rating under DC 7804 for unstable or painful scars of the right knee. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, DC 7804 was not changed by the August 13, 2018 amendments. Under DC 7804, one or two scars that are unstable or painful scars warrants a 10 percent rating. Three or four scars that are unstable or painful scars warrants a 20 percent rating. Five or more scars that are unstable or painful warrants a 30 percent rating. 38 C.F.R. § 4.118. Note 1 to DC 7804 instructs that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. The Board finds that the weight of the evidence is against the assignment of a rating in excess of 10 percent under DC 7804 because the Veteran's scar is not manifest by three or four scars that are unstable or painful. VA examined the Veteran in January 2019. The examiner noted four scars on the right knee. None of the scars were painful, tender to palpitation, unstable on inspection, or had underlying soft tissue damage. The total scar area was 2.35 cm2 on the right knee. The examiner opined that scars had no limitation of function for the Veteran. VA examined the Veteran again in January 2021. The examiner noted that the Veteran's right knee scarring had become worse over time and that there was one painful scar. The examiner measured a single scar on the right knee of 4cm in length and 4cm2 in total area. The scar was not unstable on inspection or had underlying soft tissue damage. The examiner opined that the scars had no limitation of function for the Veteran. Although the January 2019 examiner reported four scars, he did not report any of them were painful. The January 2021 examiner reported that the scaring had worsened and that there was only one single, larger, painful scar. Accordingly, the Board finds that the two examinations represent a progression of the severity of the right knee scar(s), rather than conflicting opinions. Normally, the transition from one rating to another is based upon the date of the disease's progression. However, the Veteran has already been granted a 10 percent rating beginning September 18, 2019, and the Board will not disturb that rating. As the evidence of record does not indicate that the Veteran's right knee scar worsened during the period between the January 2019 examination and the September 18, 2019 effective date of the currently assigned 10 percent rating, a higher rating is not warranted prior to September 18, 2019. The Board has also considered whether higher or separate ratings are warranted under the other diagnostic codes pertaining to scars. However, the Veteran's right knee scar is not of the head, face, or neck, is not deep and nonlinear, and is not associated with underlying soft tissue damage. Although the right knee scar is superficial and not associated with underlying soft tissue damage, it does not cover an area or areas of 144 square inches or greater. Therefore, DCs 7800 through 7802, as in effect both prior to and beginning August 13, 2018, are inapplicable. Finally, the evidence of record shows there are no other disabling effects of the right knee scar, such that a rating under DC 7805, under the versions in effect both prior to and beginning August 13, 2018, is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a compensable rating prior to September 18, 2019 or a rating in excess of 10 percent thereafter for a right knee scar. As the weight of the evidence is against the claim, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra. 7. Entitlement to a rating in excess of 20 percent for a right shoulder disability prior to September 18, 2019, and in excess of 30 percent thereafter. The Veteran contends that he is entitled to a higher rating for his right shoulder disability status post rotator cuff tear operation. As a foundational matter, ratings based on function impairment of the upper extremities are predicated upon which extremity is the major extremity, with only one extremity being considered major. 38 C.F.R. § 4.69. The medical evidence in this case reflects that the Veteran is right-hand dominant. See January 2019 VA examination report. Therefore, his right upper extremity is considered the major extremity. The Veteran's right shoulder disability is rated under 38 C.F.R. § 4.71a, DC 5201, for limitation of motion of the arm. Under DC 5201, limitation of motion of the arm at shoulder level warrants a 20 percent rating for the major extremity. Limitation of motion of the arm midway between side and shoulder warrants a 30 percent rating for the major extremity. Limitation of motion of the arm to 25 degrees from side warrants a maximum 40 percent rating for the major extremity. 38 C.F.R. § 4.71a, DC 5201. DC 5201 "does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of the arm." Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). This increased rating claim was submitted to VA on September 6, 2018, and the evidence does not reflect that the Veteran's right shoulder disability worsened during the year prior to the date of claim. Therefore, the Board will consider whether an increased rating is warranted for the period from September 6, 2018, forward. Turning to the evidence, VA examined the Veteran in January 2019. Right shoulder flexion was 150 degrees, abduction was 140 degrees, external rotation was 90 degrees, and internal rotation was 70 degrees. Pain was noted on the examination with all ranges of motion, but the examiner opined that it did not result in functional loss. There was no evidence of pain with weight bearing or objective evidence of crepitus. Mild to moderate localized tenderness or pain on palpation of the shoulder joint was noted. Observed repeated use and flare ups also did not result in functional losses. The examination was conducted during a flare-up. The overall functional impact was described as a difficulty with repetitive above-the-shoulder lifting, pulling, and pushing. There was objective of pain on passive range of motion testing of the right shoulder, but not on non-weight bearing testing. The Veteran wrote in June 2020 that he could not move his right arm very much. He stated that he could not raise his arm above his head or move it side to side. This is more significant functional loss than reported in the January 2019 examination. The VA examined the Veteran again in October 2020. Right shoulder flexion, abduction, internal rotation, and external rotation were each 60 degrees on both passive and active range of motion. Pain was noted with each range of motion, but did not result in/cause functional loss. There was evidence of pain with weight bearing. After repetitive use testing, right shoulder flexion, abduction, internal rotation, and external rotation were each 40 degrees, due to pain, fatigue, weakness, and lack of endurance. The VA examiner estimated that similar limitation of motion would be present immediately after repetitive use over time and during flare-ups. Decreased muscle strength (4/5) was noted, but there was no muscle atrophy or ankylosis. A right rotator cuff condition was suspected. No right shoulder instability, dislocation, or labral pathology was suspected. No clavicle, scapula, acromioclavicular joint, or sternoclavicular joint condition was suspected. The Veteran did not have a humerus condition or impairment. The functional impairments due to the right shoulder disability were described as difficulty with repetitive pinching and gripping, reaching, and lifting greater than 5 pounds due to shoulder pain. The examiner reported that the disease had progressed over time and had worsened. Based on review of the evidence, both lay and medical, the Board finds that a rating in excess of 20 percent is not warranted for the right shoulder disability from September 6, 2018 to September 17, 2019. This is based on the January 2019 VA examination report indicating that the Veteran's limitation of motion was not to 25 degrees from side or midway between side and shoulder level, as flexion was 150 degrees, abduction was 140 degrees, external rotation was 90 degrees, and internal rotation was 70 degrees. While pain was noted on the examination, the VA examiner opined that it did not result in functional loss. Furthermore, the overall functional impact of difficulty with repetitive above-the-shoulder lifting, pulling, and pushing is not consistent with the criteria for a rating in excess of 20 percent under DC 5201. Thus, the weight of the evidence supports a finding that a rating in excess of 20 percent is not warranted for the right shoulder disability from September 6, 2018 to September 17, 2019. The January 2019 examination also indicated the presence of rotator cuff instability. However, this instability did not manifest with functional loss other than difficulty lifting above the shoulder level; therefore, higher ratings based on right shoulder rotator cuff instability are not warranted at any point during the period on appeal. Furthermore, the weight of the evidence does not support a rating in excess of 30 percent for the right shoulder disability for the period on appeal from September 18, 2019, forward. This is supported by the October 2020 VA examination report, which indicated that right shoulder flexion, abduction, internal rotation, and external rotation were each at least 40 degrees on both passive and active range of motion. This is inconsistent with the criteria for a rating in excess of 30 percent under DC 5201, which requires limitation of motion of the arm to 25 degrees from side for a rating in excess of 30 percent. While pain was noted on the examination, the VA examiner opined that it did not result in additional functional loss. In addition, the reported functional impairments due to the right shoulder disability, including difficulty with repetitive pinching and gripping, reaching, and lifting greater than 5 pounds due to shoulder pain, were not consistent with or analogous to the limitation of motion of the arm to 25 degrees from side, as is required for a rating in excess of 30 percent. Thus, the weight of the evidence supports a finding that a rating in excess of 30 percent is not warranted for the right shoulder disability from September 18, 2019, forward. The Board has also considered whether any other diagnostic codes related to disabilities of the shoulder would provide for a higher disability rating. However, the evidence does not reflect that the symptoms would warrant a higher rating under DCs 5200, 5202, and 5203. See 38 C.F.R. § 4.71a. The Veteran does not have ankylosis or impairment of the humerus, scapula, or clavicle, as is required for ratings under these diagnostic codes. In conclusion, the Board finds that the weight of the evidence supports a finding that a rating in excess of 20 percent prior to September 18, 2019, and in excess of 30 percent thereafter, for right shoulder disability is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra. 8. Entitlement to a compensable rating for right shoulder scar. The Veteran is currently in receipt of a noncompensable (0 percent) rating for his right shoulder scar under 38 C.F.R. § 4.118, DC 7802, applicable to burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. He contends that a higher rating is warranted for the entire period on appeal. Turning to the evidence, VA examined the Veteran in January 2019. The examiner noted one scar on the right shoulder of 9cm by 0.5cm. The scar was not painful, tender to palpitation, unstable on inspection, or had underlying soft tissue damage. The total scar area was 4.5 cm2. The examiner opined that scars had no limitation of function for the Veteran. VA examined the Veteran again in October 2020. The examiner noted one scar on the right shoulder of 9cm by 0.1cm. The scar was not painful, tender to palpitation, unstable on inspection, but did have underlying soft tissue damage. The total scar area was 0.9 cm2. The examiner opined that scars had no limitation of function for the Veteran. Although the two examinations of record disagree on the total area of the scar and descriptions of any underlying soft tissue damage, these inconsistencies are not a bar to deciding this claim as a compensable rating is not warranted based on the scar description in either of the examination reports. DC 7801 requires at least 77 cm2 of total area to obtain a compensable rating. As the total size for the scar is less than 77 cm2 based on the measurements in both VA examination reports, a compensable rating is not warranted under either DC 7801 or 7802. As the scar caused no limitation of function, DC 7805 is also not applicable. In addition, the Veteran's right shoulder scar is not of the head, face, or neck, is not deep and non-linear, and is not unstable or painful. Therefore, DCs 7800 and 7804 are inapplicable. The Board notes that DC 7801 was amended effective August 13, 2018. However, the Veteran's claim for scarring was filed after this date, on September 6, 2018, so the prior version of DC 7801 is not for consideration. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a compensable rating for a right shoulder scar. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra. 9. Entitlement to increased initial ratings for right and left lower extremity radiculopathy of the femoral and sciatic nerves. The Veteran is currently in receipt of separate initial ratings for peripheral neuropathy of the right and left lower extremity sciatic and femoral nerves. The sciatic nerve disabilities are rated under 38 C.F.R. § 4.124a, DC 8520, applicable to paralysis of the sciatic nerve, and the femoral nerve disabilities are rated under 38 C.F.R. § 4.124a, DC 8526, applicable to paralysis of the femoral nerve. He contends that higher ratings are warranted for the entire period on appeal. Initially, the Board notes that the October 2020 VA examiner explained that the Veteran did not have peripheral neuropathy, but rather had radiculopathy due to his service-connected lower back disability. This change in etiology is not relevant to the increased rating issue on appeal, as the applicable diagnostic codes and rating criteria for sciatic and femoral nerve disabilities are the same regardless of the etiology. Next, the Board notes that the October 2020 rating decision awarded separate 40 percent ratings for peripheral neuropathy of the right and left sciatic nerves and separate 20 percent ratings for peripheral neuropathy of the right and left femoral nerves, all effective September 18, 2019. Thereafter, the January 2021 rating decision awarded separate 20 percent ratings for radiculopathy of the right and left sciatic and femoral nerves, effective September 18, 2019. The January 2021 rating decision does not appear to recognize the increased bilateral sciatic and femoral nerve ratings awarded in the October 2020 rating decision, and no reason was given other than that the sciatic nerve disabilities were not characterized by moderately severe incomplete paralysis and the femoral nerve disabilities were not characterized by severe nerve damage. The Board notes that the October 2020 VA peripheral nerve examination noted moderately severe sciatic nerve incomplete paralysis and moderate femoral nerve incomplete paralysis. Based on this evidence, and resolving all reasonable doubt in the Veteran's favor, the Board will resolve this conflict in the October 2020 and January 2021 rating decisions and find that the Veteran is currently in receipt of separate 20 percent ratings for the right and left femoral nerve disabilities and separate 40 percent ratings for the right and left sciatic nerve disabilities, effective September 18, 2019. Under DC 8520, an 80 percent disability rating is assigned for complete paralysis of the sciatic nerve, demonstrated by foot drop, no active movement possible of the muscles below the knee, and knee flexion that is weakened or (very rarely) lost. Lower disability ratings are provided for incomplete paralysis, defined by the Rating Schedule as "a degree of lost or impaired function substantially less than the type picture for complete paralysis given." A 60 percent disability rating is assigned for severe, incomplete paralysis, with marked muscular atrophy. A 40 percent disability rating is assigned for moderately severe, incomplete paralysis. A 20 percent disability rating is assigned for moderate, incomplete paralysis. A 10 percent disability rating is assigned for mild, incomplete paralysis. 38 C.F.R. § 4.124a, DC 8520. Under DC 8526, a 10 percent rating is warranted for mild incomplete paralysis, 20 percent for moderate incomplete paralysis, 30 percent for severe incomplete paralysis, and 40 percent is warranted for complete paralysis of the nerve. 38 C.F.R. § 4.124a. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. When the nerve involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "mild," "moderate," "moderately severe," and "severe." Sellers v. Wilkie, 30 Vet. App. 157 (2018) ("DC 8520 does not define 'mild,' 'moderate,' 'moderately severe,' or 'severe,' or generally associate those terms with specific symptoms"). It should also be noted that use of terminology such as "mild" and "moderate" by VA examiners or other physicians, although an element of evidence to be considered by the Board, is not dispositive of an issue. Rather than applying a mechanical formula, the Board must instead evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Turning to the evidence, the Veteran was afforded a VA peripheral nerve conditions examination in January 2019. His peripheral nerve disability symptoms included severe constant pain and paresthesias/dysesthesias of the right and left lower extremities, as well as mild numbness of the right and left lower extremities. Muscle strength testing was normal (5/5) bilaterally, and there was no muscle atrophy. Deep tendon reflexes were normal (2+) bilaterally. Sensation to light touch was decreased in the bilateral thigh/knee, lower leg/ankle, and foot/toes. There were no trophic changes. The VA examiner opined that the Veteran had mild incomplete paralysis of the right and left sciatic nerves and femoral nerves. The VA examiner opined that the functional impact of the peripheral neuropathy on the Veteran's ability to work was difficulty with repetitive bending, heaving lifting, and prolonged lying down. The Veteran was afforded another VA peripheral nerves examination in October 2020. The Veteran reported experiencing severe (10/10), constant, sharp, dull, throbbing, and burning pain of the lumbar region that radiated to his bilateral lower extremities. He indicated that the pain worsened with movement, exertion, and sometimes nothing, and was relieved only by rest, positioning, medication, and sometimes nothing. Muscle strength was decreased (4/5) with bilateral knee extension, ankle plantar flexion, and ankle dorsiflexion, but there was no muscle atrophy. Reflexes were hypoactive in the bilateral knees and ankles. Sensation was decreased in the bilateral upper anterior thigh, thigh/nee, lower leg/ankle, and foot/toes. There were no trophic changes. The VA examiner opined that the Veteran had moderately severe incomplete paralysis of the right and left sciatic nerves and moderate incomplete paralysis of the right and left femoral nerves. The October 2020 VA back conditions examination report indicates that the Veteran had decreased (4/5) muscle strength with bilateral hip flexion, knee extension, ankle plantar flexion, ankle dorsiflexion, and great toe extension. The Veteran's radiculopathy symptoms included moderate bilateral constant pain, paresthesias and/or dysesthesias, and numbness. The VA examiner opined that the Veteran had moderate radiculopathy of the right and left femoral and sciatic nerves. The VA examiner stated that the Veteran's previously diagnosed peripheral neuropathy had been corrected to radiculopathy as a more accurate diagnosis for the Veteran's condition. Based on review of the record, both lay and medical, the Board finds that initial ratings in excess of 10 percent for right and left lower extremity radiculopathy of the sciatic nerves are not warranted under DC 8520 for the period on appeal prior to September 18, 2019. During this period, the January 2019 VA examination report indicates that the Veteran's bilateral lower extremity radiculopathy was characterized by symptoms of mild numbness and severe constant pain and paresthesias/dysesthesias, as well as decreased sensation to light touch. However, there was no decrease in muscle strength or muscle atrophy. There were no tropic changes, and the VA examiner opined that the Veteran had mild incomplete paralysis of the bilateral sciatic nerves. These symptoms were wholly sensory, reflecting no more than a moderate degree of paralysis pursuant to 38 C.F.R. § 4.124a. However, the Board finds that the Veteran's bilateral lower extremity radiculopathy symptoms more nearly approximated a mild degree of paralysis of the sciatic nerves, based on the VA examiner's opinion that the Veteran had mild incomplete paralysis of the bilateral sciatic nerves. The Board finds this opinion to be highly probative, as it was based on examination of the Veteran and is supported by the evidence of record. For these reasons, the Board finds that initial ratings in excess of 10 percent are not warranted for right and left lower extremity radiculopathy of the sciatic nerves under DC 8520 for the period on appeal prior to September 18, 2019. For the period on appeal from September 18, 2019, forward, the Board finds that ratings in excess of 40 percent for right and left lower extremity radiculopathy of the sciatic nerves are not warranted under DC 8520. There is no evidence of atrophy of the right or left lower extremities, as is required for a rating in excess of 40 percent under DC 8520. See October 2020 VA examination report. Furthermore, the evidence of record does not support a finding of complete paralysis of the sciatic nerve, demonstrated by foot drop, no active movement possible of the muscles below the knee, and knee flexion that is weakened or (very rarely) lost. To the extent that the Veteran was noted to have an abnormal gait, this was attributed to his left knee and back conditions, for which he is in receipt of a separate compensable ratings which appear to account for any pain and limitation of function related to the left knee. See October 2020 VA peripheral nerves examination report. For these reasons, the Board finds that, for the period from September 18, 2019, forward, ratings in excess of 40 percent are not warranted for the Veteran's right and left lower extremity radiculopathy of the sciatic nerves. As for the Veteran's right and left lower extremity radiculopathy of the femoral nerves, the Board finds that initial ratings of 10 percent are not warranted under DC 8526 for the period on appeal prior to September 18, 2019. During this period, the January 2019 VA examination report indicated that the Veteran's bilateral lower extremity radiculopathy was characterized by symptoms of mild numbness and severe constant pain and paresthesias/dysesthesias, as well as decreased sensation to light touch. However, there was no decrease in muscle strength or muscle atrophy. There were no tropic changes, and the VA examiner opined that the Veteran had mild incomplete paralysis of the bilateral femoral nerves. These symptoms were wholly sensory, reflecting no more than a moderate degree of paralysis pursuant to 38 C.F.R. § 4.124a. However, the Board finds that the Veteran's bilateral lower extremity radiculopathy symptoms more nearly approximated a mild degree of paralysis of the femoral nerves, based on the VA examiner's opinion that the Veteran had mild incomplete paralysis of the bilateral femoral nerves. The Board finds this opinion to be highly probative, as it was based on examination of the Veteran and is supported by the evidence of record. While the Veteran reported severe pain during the January 2019 VA examination, it is unclear from the record whether such pain is attributable to a specific nerve and the Board notes that the Veteran is in receipt of separate ratings for mild incomplete paralysis of the bilateral sciatic nerves during this period. While the Veteran's representative argues in the June 2021 brief that a 20 percent rating is appropriate for moderate incomplete paralysis of the femoral nerves, this argument is conclusory, as it is not supported by an explanation or citation to specific evidence. Therefore, the Board is unable to determine why the representative thinks a 20 percent rating is warranted for the femoral nerve disabilities and is unable to fully address this contention. For these reasons, the Board finds that initial ratings in excess of 10 percent are not warranted for right and left lower extremity radiculopathy of the femoral nerves under DC 8526 for the period on appeal prior to September 18, 2019. For the period on appeal from September 18, 2019, forward, the Board finds that ratings in excess of 20 percent for right and left lower extremity radiculopathy of the femoral nerves are not warranted under DC 8526. This is based on the October 2020 VA peripheral nerves and back conditions examination reports indicating that the Veteran's femoral nerve disabilities were no more than moderate in severity, resulting in moderate incomplete paralysis of the right and left femoral nerves. The Board finds these opinions to be highly probative, as they are based on examination of the Veteran and supported by a rationale. While the October 2020 VA peripheral nerves and back conditions examination reports reflect radicular symptoms that were not wholly sensory, the Board notes that such symptoms are already contemplated by the 40 percent ratings awarded for right and left lower extremity radiculopathy of the sciatic nerves, and cannot be contemplated in conjunction with rating the femoral nerve conditions without violating the rule against pyramiding. See 38 C.F.R. § 4.14. For these reasons, the Board finds that, for the period from September 18, 2019, forward, ratings in excess of 20 percent are not warranted for the Veteran's right and left lower extremity radiculopathy of the femoral nerves under DC 8526. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, supra. 10. Entitlement to an effective date prior to September 6, 2018 for radiculopathy of the right and left lower extremity femoral nerves, radiculopathy of the right and left lower extremity sciatic nerves, a right knee strain with meniscal tear, right knee scars, and a right shoulder scar. The effective date for an award of disability compensation based on an original claim for direct service connection, if the claim is received within one year after separation from service, shall be the day following separation from active service or the date entitlement arose; otherwise, and for reopened claims, it shall be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The terms claim and application mean a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). Generally, the date of receipt of a claim is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1(r). A sympathetic reading as to all potential claims raised by the evidence is required. Szemraj v. Principi, 357 F.3d 1370 (Fed. Cir. 2004). A specific claim in the form prescribed by the Secretary of VA must be filed in order for benefits to be paid to any individual under the laws administered by the VA. 38 U.S.C. § 5101(a). Regulations defining a "claim" were revised, effective March 24, 2015. See 79 Fed. Reg. 57,660 (Sept. 25, 2014). The revision eliminated informal claims and required claims on specific forms. Prior to March 24, 2015, a claim was defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p); Brannon v. West, 12 Vet. App. 32, 34-5 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). Thus, for the period prior to March 24, 2015, any communication indicating intent to apply for a benefit under the laws administered by the VA may be considered an informal claim provided it identifies, but not necessarily with specificity, the benefit sought. See 38 C.F.R. § 3.155(a). In this case, the currently assigned effective date of September 6, 2018 stems from the receipt date of the Veteran's application for disability compensation benefits in which he first claimed nerve damage, right knee strain, right knee scars, and a right shoulder scar. There is nothing in the record prior to that date which could be construed as a claim for service connection for nerve damage, right knee strain, right knee scars, and a right shoulder scar, even under the broadest definition of a claim. As such, the RO has already assigned the earliest possible effective date for its grants of the original claims, which was determined to be September 6, 2018. Consequently, there is no legal basis upon which to grant an effective date prior to September 6, 2018, for the grants of service connection for nerve damage, right knee strain, right knee scars, and a right shoulder scar. The Board is bound by the law governing the assignment of effective dates in its determination in this case. See 38 U.S.C. § 7104(c). The claim of entitlement to an effective date earlier than September 6, 2018, for the awards of service connection for nerve damage, right knee strain, right knee scars, and a right shoulder scar must be denied. 11. Entitlement to an effective date prior to September 6, 2018 for the award of a 20 percent rating for right rotator cuff tear The effective date of an award of increased compensation is the earliest date as of which it is factually ascertainable based on all evidence of record that an increase in disability occurred, if a claim is received within one year from such date; otherwise, the effective date for increased rating is the date of the claim for increase. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2); Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010). In general, "date of receipt" means the date on which a claim, information, or evidence was received by VA. 38 C.F.R. § 3.1(r). Determining an appropriate effective date for an increased rating under the effective date regulations involves an analysis of the evidence to determine (1) when a claim for an increased rating was received and, if possible (2) when the increase in disability actually occurred. 38 C.F.R. §§ 3.155, 3.400(o)(2); see also Hazan v. Gober, 10 Vet. App. 511 (1997). As noted above, for claims received after March 24, 2015, claims are required to be on specific forms. See 38 C.F.R. § 3.151; 79 Fed. Reg. 57,660 (Sept. 25, 2014). The Court has held that the relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). In order to obtain an increased disability rating earlier than the date of the claim, the evidence must show that the increase in disability occurred within the one year period prior to the date of the increased rating claim. If the evidence showed that the increase occurred earlier than one year prior to the date of the claim, then, under the analysis in Gaston, 605 F.3d at 984, the effective date is no earlier than the date of the increased rating claim. The Federal Circuit explained that the legislative intent in enacting 38 U.S.C. § 5110(b) was to allow for a grace period of up to one year for a veteran to file the claim once he or she was aware of the increase in disability. Id. The Federal Circuit held that "consistent with the plain language of the statute and this legislative history, the only reasonable construction of 38 U.S.C. § 5110(b)(2) is that a veteran's claim for increased disability compensation must be filed within one year of an increase in the disability, as shown by the evidence, in order to obtain an effective date earlier than the date of the claim." In this case, the Veteran's increased rating for a right shoulder disability has an effective date of September 6, 2018, the date of his application for an increased rating. The record reflect an earlier claim for an increased rating for the right shoulder disability. Thus, for the Veteran to be entitled to an earlier effective date, he must have a discernable date of worsening within the one year prior to his application. The record, however, does not indicate that the Veteran's condition worsened within that one-year period. Accordingly, the earliest effective date that could be assigned for the increased rating is September 6, 2018, the date the increased rating claim was filed. Therefore, the Board finds that the claim for an effective date prior to September 6, 2018 for the award of a 20 percent rating for a right shoulder disability must be denied. REASONS FOR REMAND 1. Entitlement to a TDIU for the period on appeal prior to September 18, 2019 is remanded. In the January 2020 notice of disagreement, the Veteran disagreed with the failure to include consideration of total disability including due to individual unemployability. As the Veteran has clearly raised the issue of unemployability as part of the present appeal, the Board has jurisdiction of the derivative TDIU claim. See Rice v. Shinseki, 22 Vet. App. 447 (2009). As noted above, the issue of entitlement to a TDIU was raised by the record in the January 2020 notice of disagreement and has been added to the present appeal. However, the Veteran is not entitled to a TDIU based on his current schedular rating, even when taking into account the increased ratings awarded herein. See 38 C.F.R. § 4.16 (indicating that a TDIU is warranted where the Veteran meets certain schedular requirements but that it is VA's policy that a TDIU is warranted whenever a Veteran is unemployable due to service connected disability). As the Board cannot consider entitlement to extraschedular TDIU under 38 C.F.R. § 4.16(b) in the first instance, this issue must be remanded for referral to the Director, Compensation Service. Bowling v. Principi, 15 Vet. App. 1, 10 (2001). The matters are REMANDED for the following action: 1. Refer the issue of entitlement to a TDIU to the Director, Compensation Service, for consideration of entitlement to an extraschedular TDIU for the period on appeal prior to September 18, 2019. 2. Then, readjudicate the issue of entitlement to a TDIU for the period on appeal prior to September 18, 2019. Megan R. Thomas Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Paul Saindon, Special 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.