Citation Nr: 21072575 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 20-00 889 DATE: December 3, 2021 ORDER Entitlement to an initial rating in excess of 10 percent for degenerative disc disease (DDD) and degenerative joint disease (DJD) of the cervical spine prior to June 13, 2013, and in excess of 20 percent thereafter is denied. Entitlement to SMC at the housebound rate prior to June 13, 2013 is denied. FINDINGS OF FACT 1. The Veteran's cervical spine disability for the period of March 17, 2003 to June 13, 2013 was characterized by forward flexion of the cervical spine greater than 30 degrees, but not by ankylosis, its functional equivalent, or incapacitating episodes having a duration of at least 6 weeks over a 12-month period. 2. The Veteran's cervical spine disability for the period of June 13, 2013 and thereafter is characterized by forward flexion of the cervical spine greater than 15 degrees, but not greater than 30 degrees taking into consideration functional loss during use and flare-ups. 3. The Veteran's claim for SMC at the housebound rate prior to June 13, 2013 is inextricably intertwined with the Veteran's denied increased rating claim for his cervical spine disability. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for DJD and DDD of the cervical spine have not been met for the period of March 17, 2003 to June 13, 2013. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5242, 5243. 2. The criteria for a rating in excess of 20 percent for DJD and DDD of the cervical spine have not been met for the period of June 13, 2013 and thereafter. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5242, 5243. 3. The criteria for entitlement to SMC prior to June 13, 2013, have not been met. 38 U.S.C. §§ 1114, 1155, 5107; 38 C.F.R. §§ 3.350 (a)(2), 4.3, 4.63. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy under honorable conditions from January 15, 1964 to December 19, 1965. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an August 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) which, in pertinent part, effectuated a February 2018 Board decision awarding service connection for a cervical spine disability. The RO assigned an initial 10 percent rating for degenerative disc disease and degenerative joint disease of the cervical spine from March 17, 2003, and an initial 20 percent rating for the period June 13, 2013 and thereafter. The RO also awarded the ancillary benefit of special monthly compensation at the housebound rate from June 13, 2013. The following month, VA received the Veteran's notice of disagreement with the initial ratings assigned, arguing that "at least" a 20 percent rating, with SMC at the housebound rate, was warranted for the entire period on appeal. Following the issuance of a Statement of the Case in November 2019, the Veteran perfected an appeal via his submission of a VA Form 9 in December 2019. Initial Rating Increase Disability evaluations are determined by the application of a schedule of ratings, which is based on the veteran's average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. Separate diagnostic codes identify the various disabilities. The basis of disability evaluations is the ability of the body to function under the ordinary conditions of daily life, including employment. Evaluations are based upon lack of usefulness of the part or system affected. 38 C.F.R. § 4.10. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where a claimant appeals the initial rating assigned following an award of service connection, evidence contemporaneous with the claim for service connection and with the rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence used to decide whether an [initial] rating on appeal was erroneous. Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence obtained during the appeal period indicates that the degree of disability increased or decreased following the assignment of an initial rating, staged ratings may be assigned for separate periods of time based on facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Board has considered all evidence of record as it bears on the issues before it. See 38 U.S.C. § 7104 (a) ("Decisions of the Board shall be based on the entire record in the proceeding and upon consideration of all evidence and material of record"); 38 U.S.C. § 5107 (b) ("Secretary shall consider all information and lay and medical evidence of record in a case"). Although the Board has an obligation to provide reasons and bases supporting these decisions, there is no need to discuss, in detail, the extensive evidence of record. The Federal Circuit has held that the Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the Veteran's appeal. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective enervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45. The Court has held that VA must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss under 38 C.F.R. § 4.40, which requires VA to regard as "seriously disabled" any part of the musculoskeletal system that becomes painful on use. See DeLuca v. Brown, 8 Vet. App. 202 (1995). In Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 38 C.F.R. § 4.40. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Thus, actually painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimum compensable rating for the joint. The joints should be tested for pain on both active and passive motion, in weight-bearing and non-weight bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59. In Burton v. Shinseki, 25 Vet. App. 1, 5 (2011), the Court found that, when 38 C.F.R. § 4.59 is raised by the claimant or reasonably raised by the record, even in non-arthritis context, the Board should address its applicability. With respect to the initial claim of entitlement to an initial increased rating for degenerative arthritis, cervical spine, the Veteran was last afforded a VA C&P examination in November 2017. In that opinion, the examiner found the Veteran's cervical spine condition was not proximately related to the Veteran's active-duty service. Since this examination, service connection was conceded and the Veteran was issued a disability rating of 10 percent for the Veteran's cervical spine condition from March 17, 2003, and 20 percent from June 13, 2013. The Veteran filed a notice of disagreement (NOD) asserting he is entitled to at least a 20 percent disability rating for the entire period in question, specifically from March 17, 2003 to June 13, 2013. In support thereof he cites the January 2009 and September 2012 VA examinations both of which detail the Veteran's complaints of weakness, stiffness, swelling, heat, redness, instability, locking, fatigue, and lack of endurance. Further, the Veteran asserts he had been treated for his cervical spine condition in excess of 10 years, took as many as eight Vicodin a day for pain management, and was near suicidal without Vicodin due to pain. Spine disabilities are evaluated under either the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever results in the higher evaluation when all disabilities are combined. See 38 C.F.R. § 4.71a, Diagnostic Code 5243. The Veteran's cervical spine disability is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5003-5242, which indicates degenerative arthritis and degenerative arthritis of the spine. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110 (g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110 (g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and revised rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, Diagnostic Code 5003 was only changed to clarify that it applies specifically to degenerative arthritis. Diagnostic Code 5003 provides that degenerative arthritis that is established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When there is no limitation of motion of the specific joint or joints that involve degenerative arthritis, DC 5003 provides a 20 percent rating for degenerative arthritis with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, and a 10 percent rating for degenerative arthritis with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. When there is limitation of motion of the specific joint or joints that is compensable (10 percent or higher) under the appropriate diagnostic codes, the compensable limitation of motion should be rated under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a. Additionally, the General Rating Formula for Diseases and Injuries of the Spine were not changed by the revisions to the musculoskeletal system, effective February 7, 2021. Under the applicable criteria, limitation of motion of the lumbar and cervical spine is rated under the General Rating Formula for General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). Pursuant to the General Rating Formula for Diseases and Injuries of the Spine, with or without symptoms such as pain, stiffness, or aching in the area of the spine affected by residuals of injury or disease, the following ratings will apply: A 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 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 forward flexion of the cervical spine greater than 15 degrees, but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine is not greater than 170 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. A 30 percent rating is warranted for forward flexion of the cervical spine of 15 degrees or less, or favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. 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). 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). Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the Veteran does not have IVDS and the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. 1. Entitlement to a rating greater than 10 percent for service-connected degenerative joint disease (DJD) and degenerative disc disease (DDD) of the cervical spine for the time period of March 17, 2003 to June 13, 2013 is denied. Applying the facts in this case to the criteria set forth above, the Board finds that a disability rating in excess of 10 percent is not warranted at any time prior to June 13, 2013. Specifically, although the evidence of record documents findings of limitation of motion, it indicates the Veteran has a combined range of motion of the cervical spine greater than 170 degrees. Additionally, it also indicates the Veteran has forward flexion of the cervical spine greater than 30 degrees, but not ankylosis or its functional equivalent, or incapacitating episodes having a duration of at least 6 weeks over a 12-month period. The record does not support forward flexion of the cervical spine greater than 15 degrees, but less than 30 degrees warranting an increase initial rating to at least 20 percent. See, e.g., the VA examination reports dated January 2009 and September 2012. In a recent decision, the United States Court of Appeals for Veterans' Claims (Court) noted that when evaluating a disability under VA's General Rating Formula, the criteria for a rating based on ankylosis may be met by evidence demonstrating the functional equivalent of ankylosis. Chavis v. McDonough, 34 Vet. App. 1 (2021). Therefore, ankylosis can be shown via functional loss consistent with that contemplated by ankylosis. See 38 C.F.R. §§ 4.40, 4.45; Mitchell v. Shinseki, 25 Vet. App. 32 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995). The Veteran underwent two VA examinations during the March 17, 2003 to June 13, 2013, time period one dated January 2009 and another dated September 2012. The examinations were largely similar in their objective medical findings. The Veteran in both examinations reported pain, and significant use of narcotic medication. The Veteran also reported severe flare-ups that occur daily in the January 2009 examination, and complaints of pain that significantly limit his daily activities. The Board acknowledges the Veteran's assertions that during a flare-up he is "essentially incapacitated." However, even when considering the functional limitation during a flare-up, the Veteran's symptoms do not more nearly approximate fixation of a spinal segment in neutral position (zero degrees). Despite, the Veteran's complaints of pain and daily flare-ups, the Veteran remained able to perform activities of daily living, e.g., toileting, bathing, cooking, dressing, etc., that would require the ability to move the spine. Thus, it is less likely than not that the Veteran's symptoms resulted in the functional equivalent of ankylosis of the thoracolumbar spine prior to June 13, 2013. VA examiners are required to obtain information from the Veteran as to the severity, frequency, and duration of flare-ups, as well as precipitating and alleviating factors, and the extent of functional impairment. Sharp v. Shulkin, 29 Vet. App. 26 (2017). It also requires that VA examiners estimate the additional loss of range of motion during a flare-up based on all procurable information from the record, as well as the Veteran's own statements. Id. at 34-35. If an estimate cannot be provided without resort to speculation, it must be clear whether this is due to a lack of knowledge among the medical community at large, or insufficient knowledge of the specific examiner. Id. at 36. In the January 2009 examination, the examiner noted the Veteran was alert, oriented, cooperative, and showed no signs of acute distress. The Veteran's forward flexion was to 41 degrees and favorable ankylosis was not noted. All other flexions, hyperextensions and rotations of the cervical spine were largely normal. Additionally, no additional loss of range of motion was noted with repetitive use x3. The Veteran did exhibit tenderness to palpitation but did exhibit muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. In the September 2012 examination, the examiner noted forward flexion was to 45 degrees or greater, painful motion was noted at 30 degrees. Additionally, the Veteran was noted to have a five-degree loss of range of motion (40 degrees to 35 degrees) with repetitive use x3. The Veteran exhibited no guarding, muscle spasms, abnormal gait, or radicular pain. The Veteran was noted to have intervertebral disc syndrome, but with no incapacitating episodes over the previous 12 months. The VA examiners did not estimate the Veteran's additional degree of loss of range of motion during a flare-up in either the January 2009 or September 2012 examinations. However, the VA examiner did estimate this additional loss in the June 12, 2013 examination. The loss was estimated by the examiner to be up to additional ten degrees in all planes. The Veteran's assertions regarding pain and flare-ups indicate the Veteran's condition worsened significantly from January 2009 to June 12, 2013. Considering the evidence in the light most favorable to the Veteran, even if the Board determines that the ten degrees of additional loss can reasonably be applied to the January 2009 examination, the Veteran's symptoms prior to June 13, 2013, continue to warrant only a 10 percent rating. The record does not include any medical treatment records that show the Veteran's forward flexion of the cervical was less than 30 degrees during the March 17, 2003 to June 13, 2013 time period. As such, there is no other objective evidence demonstrating symptoms producing impairment of range of motion of the cervical spine severe enough to warrant a 20 percent or more disability rating at any time prior to June 13, 2013. See 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, DC 5242. This case was remanded several times for additional development to ensure all relevant documents, including private medical records were obtained. Furthermore, in July 2020, the Veteran's representative requested that the Board hold the record open for the full 90-day period following its July 5, 2020, docketing letter, or until October 3, 2020, to permit him the opportunity to submit additional argument or evidence. The Board implicitly granted the request and has considered the additional argument received from the Veteran's representative on September 30, 2020. The Board additionally notes that the General Rating Formula for Disease and Injuries of the Spine instructs to evaluate any associated objective neurologic abnormalities separately, under an appropriate Diagnostic Code. Service treatment records from March 6, 2003, indicate the Veteran complained of constant neck pain, however the exam showed it was mostly localized into his neck with occasional radiation into his shoulders. Sensory and motor exams were all normal throughout his upper extremities. As a result, the Veteran was deemed not to have radiculopathy. Therefore, the record does not support a finding that the Veteran suffers from any additional neurological impairment due to his service connected DDD of the cervical spine. With respect to both time frames at issue, the Board notes that the Veteran has reported significant pain including flare-ups as a result of his cervical spine disability. See 38 C.F.R. §§ 4.40, 4.45; see also DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1996). These symptoms were considered by both the 10 and 20 percent assigned ratings. Critically, as detailed above, there is no evidence to corroborate additional functional limitations such as would warrant evaluations in excess of 10 percent prior to June 13, 2013. The Board is required to consider the effect of the Veteran's pain when making a rating determination and has done so in this case. The Rating Schedule does not provide for a separate rating for pain. Rather, it provides guidance for determining ratings under other diagnostic codes assessing musculoskeletal function. Spurgeon v. Brown, 10 Vet. App. 194 (1997). In this case, the Veteran is already being adequately compensated for pain and the resulting functional loss. Therefore, a rating in excess of that assigned is not warranted under the schedular criteria. Further, the Board has considered whether the Veteran is entitled to an increased disability rating under DC 5243 [intervertebral disc syndrome]. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 10 percent evaluation is warranted for incapacitating episodes having a total duration of at least one week, but less than two weeks during the past 12 months. A 20 percent evaluation is warranted for incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent disability evaluation is warranted for incapacitating episodes having a total duration of at least four weeks, but less than six weeks during the past 12 months; and a 60 percent disability evaluation is warranted for incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a. An "incapacitating episode" for purposes of totaling the cumulative time is defined as "period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician." 38 C.F.R. § 4.71a, DC 5243, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note 1. The record does not demonstrate that the Veteran experienced any recurring attacks or incapacitating episodes. There is no evidence of record demonstrating that, at any time during March 17, 2003 to June 13, 2013, a physician prescribed bed rest during such episodes to justify a higher rating under DC 5243. See the VA examination reports dated in January 2009, September 2012, and service treatment records. The record also does not include any private medical treatment records that show the appellant has ever been prescribed bed rest by a physician as a treatment for his cervical spine disability at any time during March 17, 2003 to June 13, 2013. Thus, rating the Veteran under the formula for evaluating intervertebral disc syndrome based on incapacitating episodes would not avail the Veteran in this case of an increased disability rating for his service-connected cervical spine disability. The Board has thoroughly considered the Veteran's statements in his October 2018 notice of disagreement, and his contemporaneous statements made during his January 2009 and September 2012 VA C&P examinations. However, the Board notes that the appellant's VA treatment records do not reveal his ever having been prescribed bed rest by a physician as treatment for his cervical spine. Further, the Board notes that these reports are inconsistent with both previous and later findings at VA examinations, and inconsistent with the VA treatment records as a whole. As a result, the Board affords more probative weight to the VA treatment records and VA examinations from January 2009 and September 2012, as they appear to be more consistent with the Veteran's treatment records, and the objective medical findings of record for his cervical spine disability. The Board acknowledges the evidence reflects that the Veteran complained of pain and additional functional loss due to pain. However, the evidence of record does not reflect that his cervical spine disability was so disabling as to approximate the level of impairment required for assignment of a higher rating under the limitation of motion criteria at any time during the period on appeal. The Board thus finds that the current ratings assigned for the cervical spine during the period on appeal sufficiently compensates the Veteran for the extent of his functional loss due to limited movement and pain. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). Accordingly, the Board finds that the weight of the probative evidence does not support a finding of a rating in excess of 10 percent prior to June 2013 for the Veteran's service-connected degenerative joint disease (DJD) and degenerative disc disease (DDD) of the cervical spine. The preponderance of the evidence is against the Veteran's claim for a higher rating. Consequently, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 55. 2. Entitlement to a rating greater than 20 percent for service-connected degenerative joint disease (DJD) and degenerative disc disease (DDD) of the cervical spine is denied for the period June 13, 2013 and thereafter. Applying the facts in this case to the criteria set forth above, the Board finds that a disability rating in excess of 20 percent is not warranted for the period June 13, 2013, and thereafter. Specifically, although the evidence of record documents findings of limitation of motion, it does not indicate forward flexion of the cervical spine limited to 15 degrees or less, or favorable ankylosis of the cervical spine warranting an increased rating to at least 30 percent. See, e.g., the VA examination reports dated January 2009 and September 2012. The most recent VA examination documenting the Veteran's cervical spine condition is dated June 13, 2013. In that examination, the Veteran's forward flexion was to 35 degrees with painful motion noted at ten degrees. The Veteran was able to perform repetitive motions x3. Post forward flexion after repetitive use did not result in a decrease in range of motion due to pain or weakness. However, the examiner did estimate loss of range of motion due to pain or during flare-ups would likely decrease by 10 degrees in all planes. Since the Veteran exhibited forward flexion to 35 degrees it is estimated during a flare-up his forward flexion would likely be reduced to 25 degrees warranting a rating of 20 percent. No other evidence exists substantiating an increased rating to 30 percent even taking into consideration pain on repeated use or during a flare-up. Accordingly, the Board finds that the weight of the probative evidence does not support a finding of a rating in excess of 20 percent for the period June 13, 2013 and thereafter for the Veteran's service-connected degenerative joint disease (DJD) and degenerative disc disease (DDD) of the cervical spine. The preponderance of the evidence is against the Veteran's claim for a higher rating. Consequently, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 55. 3. Entitlement to an earlier effective date for Special Monthly Compensation is denied. With regard to the effective dates assigned for the grant of SMC based upon housebound status, the Board finds the resolution of the claim for increased rating for the Veteran's cervical spine condition in excess of 20 percent prior to June 2013 has an impact on the Veteran's claim for an earlier effective date for SMC, and that the issues are inextricably intertwined. Since the Veteran's claim for an initial increased rating from 10 percent to at least 20 percent prior to June 2013 is denied, there is no longer a basis upon which to assign an earlier effective date for SMC. The record reflects that the Veteran was awarded SMC at the housebound rate effective June 13, 2013. As of that date, his service-connected posttraumatic stress disorder (PTSD) had been rated as 70 percent disabling from March 17, 2003, and he had been awarded a total rating based on individual unemployability (TDIU) due to his PTSD from that date. In addition to the single disability (PTSD) rated as totally disabling, the Veteran had service-connected right foot plantar fasciitis with DJD and plantar calcaneal spur (rated as 30 percent disabling), bilateral hearing loss (rated as 10 percent disabling), tinnitus (rated as 10 percent disabling), and his service-connected cervical spine disability (rated as 20 percent disabling, from June 13, 2013). These disabilities were independently ratable at 60 percent from that date. Because a rating in excess of 10 percent for the cervical spine disability has been denied prior to June 13, 2013, the Veteran does not meet the criteria for SMC at the housebound rate. There is no indication, nor has he contended, that he meets the criteria for SMC based on actual housebound status. Thus, there is no basis on which to assign an effective date earlier than June 13, 2013, for the award of SMC at the housebound rate. 38 U.S.C. § 1114; 38 C.F.R. § 3.350. Danette L. Mincey Veterans Law Judge Board of Veterans' Appeals 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.