Citation Nr: 21072055 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 15-10 895 DATE: December 2, 2021 ORDER Entitlement to an initial disability rating in excess of 10 percent prior to April 12, 2021, and in excess of 40 percent since, for service-connected thoracolumbar spondylosis (back disability) is denied. Entitlement to an initial disability rating in excess of 10 percent prior to July 1, 2020, and in excess of 20 percent since, for service-connected left (minor) distal bicep tendon rupture (left bicep disability) is denied. FINDINGS OF FACT 1. Prior to April 12, 2021, the Veteran's back disability was manifested by forward flexion greater than 60 degrees and a combined range of motion greater than 120 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, ankylosis, incapacitating episodes due to intervertebral disc syndrome (IVDS), or other neurologic abnormalities. 2. Since April 12, 2021, the Veteran's back disability was not manifested by either favorable or unfavorable ankylosis, or IVDS. 3. Prior to July 1, 2020, the Veteran's left (minor) bicep disability manifested functional loss due to pain, weakness, and limited motion, but was not limited at shoulder level or midway between side and shoulder level. 4. Since July 1, 2020, the Veteran's left (minor) bicep disability has not been manifested by limitation of motion flexion and/or abduction limited to 25 degrees from side. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent prior to April 12, 2021, for the Veteran's service-connected back disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5242. 2. The criteria for a rating in excess of 40 percent since April 12, 2021, for the Veteran's service-connected back disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, DC 5242. 3. The criteria for a rating in excess of 10 percent prior to July 1, 2020, for the service-connected left (minor) distal bicep tendon rupture have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.56, 4.71a, DC 5201. 4. The criteria for a rating in excess of 20 percent since July 1, 2020, for the service-connected left (minor) distal bicep tendon rupture have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.56, 4.71a, DC 5201. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from December 1977 to April 1978 and from September 2007 to May 2010, with additional service in the Air Force National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2010 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2018, the Veteran testified at a hearing before a Veterans Law Judge (VLJ). A transcript of that hearing is of record. In correspondence dated in April 2021, the Board notified the Veteran that the VLJ who held his December 2018 hearing was no longer employed by the Board. The Veteran was notified of his right to request another optional Board hearing. He was also informed that the Board would assume he did not wish to have another hearing if he did not respond within 30 days from the date of the letter. The Veteran subsequently responded within 30 days, notifying VA that he did not wish to appear at another Board hearing. As such, the Board will proceed with adjudication of the Veteran's claims on appeal. In May 2019, the Board remanded the issues of entitlement to service connection for bilateral hearing loss and sinusitis, and increased ratings for thoracolumbar spondylosis and a left bicep disability. The Veteran was granted service connection for bilateral hearing loss and sinusitis in rating decisions issued in November 2020 and May 2021, respectively. As these grants represent the full benefits sought for these two issues, they are no longer on appeal before the Board. In addition, the May 2021 rating decision increased evaluation of the Veteran's thoracolumbar spondylosis from 10 percent to 40 percent disabling, effective April 12, 2021; and increased the evaluation of the left distal bicep tendon rupture disability from 10 percent to 20 percent disabling, effective July 1, 2020. As these increased ratings do not reflect the maximum ratings possible under the applicable DCs, and as the Veteran is presumed to be seeking the highest possible ratings, these increased rating claims remain on appeal before the Board. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, and the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When rating musculoskeletal disabilities on the basis of limited motion of a joint, VA must consider functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. §§ 4.40 and 4.45 are to be considered only in conjunction with diagnostic codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). Painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Where functional loss is alleged due to pain upon motion, the function of the musculoskeletal system and movements of joints must still be analyzed. DeLuca v. Brown, 8 Vet. App. 202 (1995). A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80 (1997). Similarly, painful motion alone does not constitute limited motion for the purposes of rating under diagnostic codes pertaining to limitation of motion. However, pain may result in functional loss if it limits the ability to perform normal movements with normal excursion, strength, speed, coordination, or endurance. Functional loss due to pain is to be rated at the same level as functional loss caused by some other factor that actually limited motion. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Thoracolumbar spondylosis The Veteran's back disability is evaluated at 10 percent disabling prior to April 12, 2021, and 40 percent disabling since, under DC 5242. Ratings under the General Rating Formula for Diseases and Injuries of the Spine are made 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. Such provides for a 20 percent rating where there is 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. Finally, a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. Note (1): Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Effective February 7, 2021, VA's Schedule, 38 C.F.R. Part 4, was amended with regard to rating musculoskeletal disorders. Fed. Reg. 76453 (November 30, 2020) (codified at 38 C.F.R. § 4.71a). When 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. VAOPGCPREC 3-2000; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The revised musculoskeletal regulations do not provide for retroactive application; thus, the amendments may be applied as of, but not prior to, February 7, 2021. Hence, VA has made clear that its intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. The changes effective February 7, 2021 under 38 C.F.R. § 4.71a, DC 5242 do not apply to the rating schedule itself but added instruction to classify disabilities associated with all non-IVDS disabilities under DC 5242. As such, DC 5242 now reflects "Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome (also, see either [DC] 5003 or 5010)." Here, the changes do not impact the general rating formula, and evaluation of the Veteran's disability under the pre- and post-February 7, 2021 regulations is not required. As an initial matter, the Board notes that the record does not show, and the Veteran does not contend, that he ever had IVDS, to include incapacitating episodes. Thus, the IVDS Rating Formula would not allow for higher ratings for the Veteran's back disability at any point during the appellate periods. At a March 2010 VA examination, the Veteran reported having pain in his lower back. He described the pain as constant and severe, radiating to the right leg and foot. There was no history of flare-ups or incapacitating episodes in the prior 12 months. On examination, range of motion measurements revealed forward flexion to 70 degrees, extension to 8 degrees, right and left lateral flexion to 20 degrees, and right and left lateral rotation to 25 degrees. It was noted that the Veteran walked with a normal gait. There was no ankylosis and no scoliosis. It was also noted that the lumbar paravertebral muscles were tight, and there was tenderness in the lumbosacral area. Neurologic examination showed normal sensory, normal motor, and normal deep tendon reflexes. There was additional functional loss due to pain, weakness, fatigue, and lack of endurance after repetitive use testing. Additional functional loss was measured to 5 degrees of all ranges of motion due to pain after repetitive use testing. A December 2014 examiner noted that the Veteran had diagnoses of thoracolumbar spondylosis and radiculopathy. The Veteran testified at the December 2018 Board hearing that his back disability had worsened since he separated from service. He stated that he had limited movement and pain in both of his legs. Both VA and private treatment records obtained for this appellate period document increased symptoms of low back pain. At an October 2020 VA examination, the Veteran reported intermittent pain in the mid to lower back. He explained that the pain was primarily right-sided. He denied having flare-ups of the thoracolumbar spine. The Veteran reported having functional loss or functional impairment of the thoracolumbar spine as difficulty lifting heavy things and not being able to stand for long periods. On examination, range of motion measurements revealed forward flexion to 85 degrees, extension to 20 degrees, right lateral flexion to 20 degrees, left lateral flexion to 15 degrees, and right and left lateral rotation to 25 degrees. It was noted that range of motion resulted in function loss, described as difficulty with heavy lifting, prolonged standing, walking, and the inability to run. All ranges of motion exhibited pain. Pain was noted to result in functional loss. There was no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the thoracolumbar spine. There was evidence of pain with weight bearing. The Veteran was able to perform repetitive-use testing with at least three repetitions, with no additional loss of function or range of motion. He was not examined immediately after repetitive use over time. The examiner noted that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. Pain, fatigue, and lack of endurance were noted to significantly limit functional ability with repeated use over a period of time. In terms of range of motion, forward flexion was measured to 70 degrees, extension to 10 degrees, right lateral flexion to 20 degrees, left lateral flexion to 10 degrees, and right and left lateral rotation to 20 degrees. The examination was not conducted during a flare up, with the examiner indicating that the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss during flare up. It was noted that pain, weakness, fatigability, or incoordination did not significantly limit functional ability with flare ups. The examiner estimated range of motion measurements after flare ups as forward flexion limited to 85 degrees, extension to 20 degrees, right lateral flexion to 20 degrees, left lateral flexion to 15 degrees, and right and left lateral rotation to 25 degrees. The Veteran did not have guarding or muscle spasm of the thoracolumbar spine. Muscle strength testing results were all normal. Reflex and sensory examination results were also normal. The examiner diagnosed the Veteran with radiculopathy. Ankylosis and IVDS were not present, and there were no other neurologic abnormalities. The examiner indicated that x-rays revealed levoconvex scoliosis of the lumbar spine, and degenerative disc disease (DDD) and degenerative joint disease (DJD) of the thoracolumbar spine. He noted that the thoracolumbar spine condition impacted the Veteran's ability to work, as the Veteran had trouble with heavy lifting, walking, and standing. The examiner further remarked that there was no objective evidence of pain on non-weight bearing, and no objective evidence to support the claimed spondylosis condition at the time of the examination. At an April 2021 VA examination, the examiner diagnosed the Veteran with thoracolumbar spondylosis and bilateral lower extremity radiculopathy and indicated that the Veteran's condition had progressed or worsened. The Veteran reported chronic back pain that radiated to the bilateral lower extremities, which was associated with numbness and tingling. He also reported having severe flare ups, which occurred daily for several hours, with intense pain and precipitating factors such as bending, sitting, and lifting. During a flare-up of symptoms, the Veteran stated that he was unable to do any heavy lifting. He reported functional loss or functional impairment of the thoracolumbar spine as having to avoid doing any heavy lifting around the house because it hurts his back. On examination, range of motion measurements revealed forward flexion to 40 degrees; extension to 5 degrees; and right lateral flexion, left lateral flexion, and right and left lateral rotation to 10 degrees. It was noted that range of motion resulted in function loss, described as difficulty with heavy lifting, prolonged standing, walking, and the inability to run. All ranges of motion exhibited pain. Passive range of motion testing was not performed, with the examiner noting that it was contraindicated, in that, it could cause the Veteran severe pain or the risk of further injury. There was evidence of pain on active motion. Pain was noted to result in functional lossthe examiner explained that the Veteran had a decreased capacity for bending secondary to his back condition. There was evidence of crepitus and localized tenderness or pain on palpation of the joint or associated soft tissue of moderate severity at the midline lumbar spine, which was determined to be consistent with thoracolumbar spondylosis. The Veteran was able to perform repetitive-use testing with at least three repetitions, with no additional loss of function or range of motion. He was not examined immediately after repetitive use over time or during a flare-up. The examiner noted that procured evidence (statements from the Veteran) suggested that pain significantly limited functional ability with repeated use over a period of time or during a flare-up. Range of motion measurements during a flare-up and after repetitive use over time were estimated as forward flexion to 20 degrees, while extension, right lateral flexion, left lateral flexion, right and left lateral rotation were each limited 5 degrees. It was further noted that the Veteran had localized tenderness and muscle spasms of the thoracolumbar spine, which did not result in abnormal gait or abnormal spinal contour. The examiner explained that the Veteran experienced tenderness to palpation of the lumbar spine consistent with thoracolumbar spondylosis. There was no guarding. Muscle strength testing results were all normal. On reflex examination, the right and left knees were hypoactive. Sensory examination results were normal. Ankylosis and IVDS were not present, and there were no other neurologic abnormalities. Based on the evidence of record, the Board finds that a disability rating in excess of 10 percent prior to April 12, 2021 is not warranted for the Veteran's back disability. As noted above, to warrant a 20 percent disability rating under the General Rating Formula, forward flexion of the thoracolumbar spine must be limited to at least 60 degrees; the combined range of motion must be limited to at least 120 degrees; or muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. However, review of the evidence does not reveal symptomatology consistent with a 20 percent rating for this period. Specifically, range of motion testing conducted during the March 2010 and October 2020 VA examinations revealed forward flexion, at most, to 70 degrees, even with pain, and a combined range of motion of 138 degrees and 170 degrees, respectively. Although the examinations reflected additional functional loss due to pain, weakness, fatigue, and lack of endurance after repetitive use testing, the additional functional loss did not reflect forward flexion to at least 60 degrees or combined range of motion to at least 120 degrees. Thus, range of motion measurements do not more nearly approximate those required for a rating in excess of 10 percent under the General Rating Formula. Additionally, the evidence does not indicate that the Veteran had muscle spasms or guarding severe enough to result in abnormal gait or abnormal spinal contour at any point prior to April 12, 2021. The October 2020 examination report shows that the Veteran did not have guarding or muscle spasm of the thoracolumbar spine. As such, a rating in excess of 10 percent for the Veteran's back disability prior to April 12, 2021 is not warranted. Turning to the period since April 12, 2021, the Board finds that a rating in excess of 40 percent is not warranted under the General Rating Formula. As referenced above, to warrant the next-higher rating of 50 percent, the evidence must reflect unfavorable ankylosis of the entire thoracolumbar spine. At no point during the appellate period was ankylosis, favorable or unfavorable, present. None of the three VA examinations revealed ankylosis. Thus, a rating in excess of 40 percent since April 12, 2021 for the Veteran's back disability is not warranted. The Board has also considered whether separate ratings for associated objective neurologic abnormalities are warranted at any time throughout the appeal period, pursuant to Note (1) of the General Rating Formula. Except for bilateral lower extremity radiculopathy, the Veteran does not contend, and the evidence does not show, that there are neurologic abnormalities associated with the Veteran's back disability, to warrant separate ratings. [The Board notes that the Veteran is already service-connected for bilateral lower extremity radiculopathy, effective October 2, 2020, for which he was assigned a 10 percent rating for each lower extremity.] In reaching the foregoing determinations, the Board acknowledges the Veteran's sincerely held belief that his back disability is more severe than that which is reflected by the currently assigned ratings, and notes he is competent to describe his symptoms and their effects on his daily life. See Jandreau, supra; Layno supra; Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). However, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). The Board finds instead that the medical evidence, in which professionals with medical expertise examined the Veteran, completed necessary testing, considered his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria, is more persuasive than his own reports regarding the severity of such conditions. The Board has also considered whether additional staged ratings under Hart, supra, are appropriate for the Veteran's service-connected back disability; however, the Board finds that his symptomatology has been stable throughout each appeal period. Therefore, the Board finds that increased ratings for the Veteran's back disability are not warranted. In reaching such determination, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claims, that doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7; Gilbert, supra. The claims for a rating in excess of 10 percent prior to April 12, 2021, and a rating in excess of 40 percent since April 12, 2021, for the service-connected back disability, are denied. Left Bicep Disability The Veteran is in receipt of a 10 percent evaluation from June 1, 2010 to June 30, 2020, and a 20 percent evaluation since July 1, 2020, for his left distal bicep tendon rupture under DC 5201. 38 C.F.R. § 4.71a. He is seeking a higher rating for each appellate period. As a preliminary matter, the Veteran's right hand is his dominant hand. As such, his left bicep disability is evaluated based on the criteria for the minor arm. Under DC 5201, the minor arm is evaluated as follows: limitation of motion to shoulder level (i.e., 90 degrees) warrants a 20 percent rating; motion limited midway between the side and shoulder level (i.e., less than 90 degrees but more than 25 degrees shoulder motion) warrants a 20 percent rating; and motion limited to 25 degrees or less from the side is rated at 30 percent. 38 C.F.R. § 4.71a. Normal ranges of motion of the shoulder are flexion (forward elevation) from 0 degrees to 180 degrees, abduction from 0 degrees to 180 degrees, external rotation from 0 degrees to 90 degrees, and internal rotation from 0 degrees to 90 degrees. 38 C.F.R. § 4.71, Plate I. In assessing the severity of limitation of shoulder motion, it is necessary to consider both forward flexion and abduction. See Mariano v. Principi, 17 Vet. App. 305, 317-18 (2003). At the March 2010 VA examination, the Veteran reported no history of flare-ups of the rupture of the bicep tendon. He complained of pain on flexion of the left bicep muscle. He was able to move the left elbow joint, but was limited. He reported that he was also able to perform activities of daily living, but that the left elbow tires easily. On examination, there was no wound of entry or exit. There was no tissue loss. The muscle involved was the left bicep muscle and its distal tendon insertion. There were mild adhesions along the anterior elbow and complete rupture of the left bicep tendon. The bone and nerves were intact. There was limited movement of the left elbow. Range of motion measurements showed left elbow flexion limited to 124 degrees; extension to -20 degrees; pronation to 50 degrees; and supination to 50 degrees. Muscle strength was 4/5. There was no muscle herniation. There was additional functional loss due to pain, weakness, and easy fatigability after repetitive use testing. The examiner noted that the additional functional loss could not be measured in degrees. The passive left elbow flexion was 130 degrees, and the strength of the left biceps muscle was 4/5. On a July 2020 VA examination for shoulder and arm conditions, the Veteran reported having chronic left shoulder pain and weakness. He reported flare-ups, described as difficulty raising his arm or lifting anything over 10 pounds when his bicep is tired. He also explained that he has difficulty lifting anything with his left arm, reaching over his head, or grabbing and lifting anything. On examination, range of motion measurements revealed flexion to 140 degrees, abduction to 140 degrees, external rotation to 80 degrees, and internal rotation to 80 degrees. Pain was noted on examination, resulting in functional loss. Each range of motion exhibited pain. There was objective evidence of localized tenderness or pain on palpation over the middle and distal right bicep, with palpable tenderness over the empty cubital fossa, described as moderately severe. The examiner explained that this was directly related to the Veteran's left bicep tendon wear with surgical repair. There was evidence of pain with weight bearing and no objective evidence of crepitus. The Veteran was able to perform repetitive-use testing with at least three repetitions, with additional loss of function or range of motion after three repetitions. However, he was not examined immediately after repetitive use over time or during a flare up. The examiner indicated that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time or during a flare up. Range of motion results after three repetitions, after repeated use over time, and during a flare up were estimated as flexion to 130 degrees, abduction to 130 degrees, external rotation to 80 degrees, and internal rotation to 70 degrees. Factors such as pain, fatigue, weakness, and lack of endurance resulted in functional loss after three repetitions, repeated use over time, and during a flare up. Muscle strength testing results showed 4/5 each, for forward flexion and abduction. The Veteran did not have muscle atrophy. Ankylosis was not present. Rotator cuff condition was not suspected, and there was no instability. A clavicle, scapula, acromioclavicular (AC) joint or sternoclavicular joint condition was not suspected. The Veteran did not have loss of head (flail shoulder), nonunion (false flail shoulder), or fibrous union of the humerus. There was no objective evidence of pain on non-weight bearing. The examiner remarked that the Veteran's left bicep tendon tear causes weakness of the left arm, which impacts the Veteran's ability to lift more than 10 pounds over his shoulder, or to do any repetitive activities with the left shoulder. The Board has reviewed additional VA treatment records during this period. The medical evidence does not reveal range of motion findings consistent with a higher evaluation. Based on the evidence of record, the Board finds that a rating in excess of 10 percent is not warranted prior to July 1, 2020. There is no evidence to indicate that the Veteran's limitation of motion of the left arm was at shoulder level or midway between side and shoulder level, to warrant the next-higher 20 percent rating under DC 5201. The March 2010 VA examination measured flexion to, at most, 124 degrees, even after repetitive use testing, and accounting for pain. The Veteran reported functional loss due to pain, weakness, and loss of motion, but these factors are already contemplated in the 10 percent rating assigned for the period prior to July 1, 2020. Thus, the next-higher 20 percent rating is not warranted for this appellate period. A rating in excess of 20 percent is not warranted for the period since July 1, 2020. During this appellate period, recorded range of motion findings document left arm flexion and abduction at shoulder level or slightly below, decidedly greater than midway between the side and shoulder level (flexion and/or abduction limited to 45 degrees). In addition, medical records do not document ankylosis, impairment of the clavicle or scapula, or impairment of the humerus during this period. As a result, a higher evaluation under DCs 5200, 5202, and 5203 is not warranted. [The Board notes that the Veteran has already been assigned separate ratings under DC 5206 (limitation of flexion of the forearm) and 5213 (impairment of the left elbow).] The 20 percent evaluation contemplates pain on motion, and limitation of flexion and abduction to shoulder level and midway between side and shoulder level for the minor arm. To warrant a higher 30 percent evaluation, there must be the functional equivalent of flexion and/or abduction limited to 25 degrees from side. The July 2020 VA examination and other medical evidence of record indicate that the Veteran was able to raise his left arm (flexion and abduction) to greater than 90 degrees, or greater than shoulder level, throughout this period. As such, the Board finds that an evaluation in excess of 20 percent is not warranted for the period since July 1, 2020. (Continued on the next page) The Board has considered the Veteran's report of arm and shoulder pain and functional loss during this appellate period. See DeLuca, supra. However, neither the lay nor clinical evidence demonstrated painful motion that functionally limits arm and shoulder motion beyond that contemplated by the current evaluation. See 38 C.F.R. § 4.59. The Board acknowledges that the Veteran experienced shoulder pain and reported flare-ups of pain. 38 C.F.R. §§ 4.40, 4.45. However, the slight additional limitation of motion, for e.g., from 140 degrees to 130 degrees of flexion after repetitive use testing and flare-ups, was not sufficient to warrant a higher evaluation. Accordingly, the Board finds that the symptoms associated with the Veteran's service-connected left bicep disability did not more nearly approximate the criteria for an evaluation in excess of 10 percent prior to July 1, 2020, and in excess of 20 percent thereafter, under DC 5201. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Trowers, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.