Citation Nr: 21073941 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 15-05 922 DATE: December 13, 2021 ORDER Entitlement to an evaluation in excess of 40 percent for a lumbar spine disability prior to July 11, 2014, is denied. Entitlement to an evaluation in excess of 30 percent for left shoulder disability prior to December 29, 2006, is denied. Entitlement to an evaluation in excess of 50 percent for a left shoulder humeral head replacement from February 1, 2008, is denied. REMANDED Entitlement to Special Monthly Compensation (SMC) at the housebound rate is remanded. FINDINGS OF FACT 1. For the periods of prior to July 11, 2014, from July 11, 2014 to June 18, 2017, and from October 1, 2017, the Veteran's lumbar spine disability is manifested by no more than subjective complaints of pain and stiffness without objective evidence of forward flexion limited to 30 degrees or less. Nor did it manifest as unfavorable ankylosis of the thoracolumbar spine. 2. Prior to December 29, 2006, the Veteran's left shoulder disability was manifested by additional functional loss approximating limitation of motion to 25 degrees from side. It was not manifested by ankylosis. 3. From February 1, 2008, the Veteran's left shoulder disability was manifested by chronic residuals consisting of severe, painful motion or weakness. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 40 percent for a lumbar spine disability prior to July 11, 2014, from July 11, 2014 to June 18, 2017, and from October 1, 2017 have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5241. 2. The criteria for an evaluation in excess of 30 percent for a left shoulder disability prior to December 29, 2006 have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. 3. The criteria for an evaluation in excess of 50 percent a left shoulder disability from February 1, 2008 have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5099-5051. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Marine Corps from March 1975 to March 1995. The Veteran died in December 2020. The appellant is the Veteran's surviving spouse, who has been substituted for the Veteran pursuant to 38 U.S.C. § 5121A (2012). Historically, in a June 2007 rating decision, the Agency of Original Jurisdiction (AOJ) granted service connection for replacement of left shoulder humeral head (left shoulder disability) with a noncompensable evaluation effective October 3, 2006; 100 percent effective December 29, 2006; and 20 percent effective February 1, 2008. The AOJ also continued a 10 percent evaluation of L2-3 laminectomy and L2 hemilaminectomy with L5-S1 decompression (lumbar spine disability). The Veteran submitted new and material evidence as to these issues within a year, hence, the claims remained pending. In a September 2008 rating decision, the AOJ denied the Veteran's extension of a temporary evaluation based on surgical or other treatment necessitating convalescence for his left shoulder prosthetic surgery, continued his 10 percent evaluation for lower back disability, continued his 20 percent disability rating for left shoulder disability, and granted service connection for scars in the lumbar and left shoulder area effective July 22, 2008. In a July 2013 rating decision, the AOJ granted convalescence from August 1, 2011 to October 31, 2011 based on surgical or other treatment for his right upper extremity. In an October 2014 rating decision, the AOJ granted service connection for painful surgical scars, left shoulder and back with an evaluation of 10 percent effective November 6, 2009, and 30 percent effective July 11, 2014. The AOJ also granted service connection for bilateral lower extremity radiculopathy with an evaluation of 20 percent per lower extremity, effective July 11, 2014. The AOJ also increased the Veteran's lower back disability to 20 percent effective June 10, 2009 and 40 percent effective July 11, 2014. In an August 2017 rating decision, the Veteran was granted convalescence from June 19, 2017 to October 1, 2017 for surgical treatment to his lower back. In a December 2018 decision by the Board of Veterans' Appeals (Board), the Board denied, inter alia, entitlement to a lumbar spine disability evaluation in excess of 40 percent throughout the period on appeal; and denied entitlement to a left shoulder evaluation in excess of 30 percent prior to December 29, 2006, and in excess of 50 percent from February 1, 2008. That determination was subsequently appealed to the United States Court of Appeals for Veterans Claims (Court), which in a June 2020 Memorandum Decision, vacated the Board's December 2018 decision in part, and, in so doing, remanded the appellant's case to the Board for action consistent with that Memorandum Decision. In particular, the Court set aside those portions of the December 2018 Board decision that denied higher evaluations for a lumbar spine disability throughout the period on appeal, and for a left shoulder evaluation in excess of 30 percent prior to December 29, 2006, and in excess of 50 percent effective February 1, 2008 to the extent that the Board failed to address the reasonably raised issue of entitlement to SMC at the housebound rate. Additionally, the Board observes that the appellant and her representative have raised additional issues which are in various stages of appellate development. However, these issues have not been fully developed for appellate review. Therefore, these issues are not for the Board's consideration as part of this decision. Increased Rating Disability evaluations are determined by comparing a Veteran's present symptomatology with criteria set forth in the VA's Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's entire history is reviewed when making disability evaluations. Id. generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where, as in the present case, entitlement to compensation has already been established and increase in disability rating is at issue, present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Therefore, although the Board has thoroughly reviewed all evidence of record, the more critical evidence consists of the evidence generated during the appeal period. Further, the Board must evaluate the medical evidence of record since the filing of the claim for increased rating and consider the appropriateness of a "staged rating" (i.e., assignment of different ratings for distinct periods of time, based on the facts). See Hart v. Mansfield, 21 Vet. App. 505 (2007). 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 these elements. The 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 innervation, 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. §§ 4.40, 4.45; see also DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). The factors involved in evaluating, and rating, disabilities of the joints include weakness; fatigability; incoordination; restricted or excess movement of the joint, or pain on movement. 38 C.F.R. § 4.45. The Board notes that VA amended 38 C.F.R. § 4.71a with respect to disorders of the musculoskeletal system. However, this new amendment is not applicable to the current appeal, as it did not become effective until February 7, 2021. 1. Entitlement to an evaluation in excess of 40 percent for a lumbar spine disability prior to July 11, 2014 The Veteran's lumbar spine disability received an evaluation of 40 percent prior to July 11, 2014, from July 11, 2014 to June 18, 2017, and from October 1, 2017 under 38 C.F.R. § 4.71a, Diagnostic Code 5241, pertaining to diseases and injuries of the spine. The appellant asserts that the Veteran's lumbar spine disability warrants a higher evaluation throughout the appeal period. Importantly, the AOJ granted a temporary 100 percent disability rating for the Veteran's lumbar spine disability from June 19, 2017 to September 30, 2017. Hence, as the Veteran has the highest schedular rating available for his lumbar spine disability between those dates, the Board will consider whether the Veteran is entitled to a higher disability rating prior to July 11, 2014, from July 11, 2014 to June 18, 2017, and from October 1, 2017. Under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), 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, unfavorable ankylosis of the entire spine warrants a 100 percent rating. Unfavorable ankylosis of the entire thoracolumbar spine warrants a 50 percent rating. Forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine, warrants a 40 percent rating. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id. Also, potentially applicable to the Veteran's claim is Diagnostic Code 5243, pertaining to Intervertebral Disc Syndrome (IVDS). Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 20 percent evaluation is warranted with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent evaluation is assigned for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a 60 percent evaluation is assigned for incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. See 38 C.F.R. § 4.71a, Diagnostic Code 5243. Turning to the record, in June 2009 a VA examination was conducted in connection with the Veteran's claim. A diagnosis of status post laminectomy compression fracture of the thoracic spine at T10-11-12 in 1979, and subsequent procedures, was rendered. Physical examination noted that lumbar flattening was positive and that thoracolumbar spine ankylosis was negative. Further, the examiner noted right spasm, but no atrophy, no guarding, no pain with motion, no tenderness, no weakness, and no abnormal gait or abnormal spinal contour. Range of motion testing revealed flexion limited to 40 degrees and extension limited to 5 degrees. The examiner noted that the Veteran was unable to complete repetitive testing due to pain. In July 2014, another VA examination was conducted to determine the severity of the Veteran's lumbar spine disability. Diagnoses of degenerative arthritis of the spine, IVDS, spinal fusion, spinal stenosis, residuals of surgical lumbar laminectomy, residuals of lumbar fusion, lumbar arthritis, and lumbar degenerative disc disease were found. The Veteran reported a surgical history in 1990, 2000 (lumbar laminectomy), and 2004 (lumbar fusion). Range of motion testing revealed forward flexion limited to 30 degrees and extension limited to 5 degrees. There was no evidence of muscle spasms, guarding, or atrophy. Muscle strength testing and deep tendon reflexes were normal. There was no ankylosis. IVDS was found, but the Veteran had not had any incapacitating episodes over the past 12 months due to IVDS. An additional VA examination was performed in January 2018. Diagnoses of degenerative arthritis of the spine and lumbar radiculopathy were noted. Range of motion testing revealed flexion limited to 25 degrees and extension was limited to 30 degrees. There was no evidence of guarding or muscle spasm. Muscle strength testing was reduced for bilateral hip flexion and bilateral knee extension. There was no evidence of muscle atrophy. Deep tendon reflexes were hypoactive at the bilateral knees and absent at the bilateral ankles. There was no evidence of ankylosis. IVDS was identified but the Veteran did not have any episodes that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. Based on the evidence as discussed above, the Board finds that an evaluation in excess of 40 percent for a lumbar spine disability for the periods prior to July 11, 2014, from July 11, 2014 to June 18, 2017, or from October 1, 2017, is not warranted. Specifically, the evidence shows the Veteran's lumbar spine disability symptoms more closely approximate a 40 percent rating during these periods because the Veteran has forward flexion of the thoracolumbar spine up to 25 degrees. There is no evidence, between all examinations performed during these periods, indicating that the Veteran experienced unfavorable ankyloses of the entire thoracolumbar spine. Indeed, it was specifically found that the Veteran did not have ankylosis during the examinations during these periods. Nevertheless, the appellant has asserted that the Veteran's spinal fusion surgery equates to ankylosis. VA defines unfavorable ankylosis as 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 coastal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurological symptoms due to nerve root stretching. See 38 C.F.R. § 4.71a, Diagnostic Code 5241, Note (5). However, multiple VA clinicians did not find that the Veteran's lumbar spine was fixed in a particular position and have repeatedly stated the Veteran did not have ankylosis. Moreover, although limited, the Veteran consistently demonstrated upon examination that he could move his lumbar spine. Therefore, the record does not show that the Veteran had unfavorable ankylosis prior to July 11, 2014, from July 11, 2014 to June 18, 2017, or from October 1, 2017. Further, the Board has also considered whether the Veteran's lumbar spine disability resulted in a level of functional loss greater than that already; contemplated by the assigned rating for these periods. DeLuca, 8 Vet. App. at 206; 38 C.F.R. §§ 4.40, 4.45. However, upon review, the Board finds this impairment does not rise to the level of functional loss greater than that already contemplated in the disability rating assigned because the Veteran had motion in his lumbar spine up to 25 degrees flexion, which is greater than the required findings for a 50 percent rating based on limitation of motion. As such, the Board finds that the level of functional impairment of the Veteran's back disability from July 11, 2014 to June 18, 2017, and from October 1, 2017, is contemplated by the 40 percent rating. Moreover, although the Veteran was found to have IVDS during multiple VA examinations, the evidence does not reflect that the Veteran experienced any incapacitating episodes requiring bed rest and treatment by a physician for the requisite duration at any time during the appeal period. Specifically, under Diagnostic Code 5243, a 60 percent evaluation would require at least six weeks of incapacitating episodes. However, the medical evidence does not show bed rest prescribed by a physician for the requisite duration. Therefore, the criteria for a higher rating under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes have not been met. In accordance with Note 1 under the General Rating Formula for Diseases and Injuries of the Spine, any associated objective neurologic abnormalities are evaluated separately under an appropriate Diagnostic Code. Review of the medical evidence shows that there are no other neurological findings associated with the service-connected spine disability. As such, no additional disability ratings are warranted for neurological abnormalities. Therefore, the Board finds the preponderance of the evidence weighs against the assignment of an evaluation in excess of 40 percent for the Veteran's service-connected lumbar spine disability prior to prior to July 11, 2014, from July 11, 2014 to June 18, 2017, and from October 1, 2017. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. 2. Entitlement to an evaluation in excess of 30 percent for left shoulder arthritis for the period prior to December 29, 2006 The Veteran's left shoulder disability had been rated non-compensable under Diagnostic Code 5099-5051 prior to December 29, 2006, which is the date of his left shoulder replacement surgery. However, the Board finds that the Veteran's left shoulder disability prior to December 29, 2006, warrants a 30 percent evaluation, but no higher, under Diagnostic Code 5201, Notably, the Veteran was awarded a temporary 100 percent disability rating for his left shoulder disability from December 29, 2006 to January 31, 2008, under Diagnostic Code 5099-5051. Hence, as the Veteran has the highest schedular rating available for his left shoulder disability between those dates, the Board will consider whether the Veteran is entitled to a higher disability rating for the period prior to December 29, 2006. Shoulder disabilities are rated under Diagnostic Codes 5200 through 5203 of 38 C.F.R. § 4.71a. Diagnostic Code 5200 addresses ankylosis of the scapulohumeral articulation. Diagnostic Code 5201 addresses limitation of arm motion, while Diagnostic Code 5202 deals with other impairment of the humerus. Diagnostic Code 5203 addresses impairment of clavicle or scapula. 38 C.F.R. § 4.71a. Those criteria are used for rating disabilities due to limitation of arm motion and provide different rating schedules depending on whether the arm involved is major (dominant) or minor (non-dominant). The Veteran has reported during treatment and examinations that he is right-hand dominant. Under Diagnostic Code 5201, limitation of arm motion at shoulder level warrants a 20 percent disability rating. 38 C.F.R. § 4.71a, Diagnostic Code 5201. A 20 percent disability rating is warranted for limitation of arm motion midway between side and shoulder level. A 30 percent disability rating is warranted for limitation of arm motion to 25 degrees from side (i.e., abduction). Id. Normal ranges of shoulder motion include flexion (forward elevation) from 0 degrees to 180 degrees, abduction (elevation of the arm to the side) 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. § 4.71a, Plate I. When assigning a disability rating, some of the regulations preceding the rating schedule add flexibility to the listed Diagnostic Codes. 38 C.F.R. § 4.59 is one such regulation. In Petitti v. McDonald, 27 Vet. App. 415, 424 (2015), the Court noted that § 4.59 "explain[s] how to arrive at proper evaluations under the DCs appearing in the disability rating schedule." The provisions of § 4.59 acknowledge that a claimant's disability may cause actual pain or painful motion but still not be severe enough to warrant a compensable rating under the appropriate Diagnostic Code. Accordingly, when there is evidence of painful motion, § 4.59 operates to provide at least the minimum compensable rating available under the Diagnostic Code for the joint. See Sowers v. McDonald, 27 Vet. App. 472, 478 (2016). While § 4.59 adds flexibility to the rating schedule, it is also limited by the terms of the appropriate Diagnostic Code for the joint. Thus, if the appropriate Diagnostic Code for the joint does not provide a compensable rating, a claimant is not entitled to a minimum rating. Id. at 481 ("Section 4.59 may intend to compensate painful motion, but it does not guarantee a compensable rating."). Sowers highlights the importance of the Diagnostic Code under which the Veteran is rated because § 4.59 operates within the parameters of the Diagnostic Code. Where the record contains evidence of an actually painful, unstable, or malaligned joint or periarticular region, § 4.59 is potentially applicable. See Southall-Norman v. McDonald, 28 Vet. App. 346, 354 (2016). Turning to the record, in an October 2006 statement, the Veteran reported that he had painful motion in his left shoulder. Therefore, the Veteran is at least entitled to a minimum disability rating under 5201 prior to December 29, 2006, or 20 percent. Further, the Board finds that a higher rating is warranted based on additional functional loss due to pain, weakness, fatigability, or incoordination. See DeLuca, 8 Vet. App. at 204-07; see also 38 C.F.R. §§ 4.40, 4.45, 4.59. Specifically, private treatment records from September 2006 reveal that the Veteran had flexion limited to 150 degrees in both active and passive motion, while the Veteran's opposite joint had normal range of motion. Additionally, muscle strength testing was reported as reduced, and the examiner noted deep crepitus. Moreover, further private treatment records from December 2006 show that the Veteran's surgeon found the Veteran's chronic glenohumeral osteoarthritis so severe that it warranted a prosthetic. Importantly, under anesthesia during the Veteran's left shoulder replacement surgery, examination revealed that the Veteran lacked about 30 percent of his end range of motion in all directions. Accordingly, the Board finds that at a minimum, the Veteran lost 30 percent of his end range motion before factors such as pain, weakness, and incoordination were considered. Thus, taking the private examiner's characterization of the Veteran's left shoulder disability, along with decreased strength and significant differences between the Veteran's left and right shoulders, the Board finds the Veteran's limitation of motion approximates to 25 degrees from side before surgery. Before the surgery, the Veteran did not have and had not described ankylosis of the left shoulder. Further, the evidence of record does not indicate humerus, clavicle, or scapula impairment other than severe osteoarthritis. Therefore, ratings under 5200, 5202, or 5203 are not warranted. All potentially applicable Diagnostic Codes have been considered. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The Board acknowledges the appellant's contentions that the Veteran's service-connected left shoulder disability warrants an increased evaluation. Lay people are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the appellant and the Veteran are competent to provide statements of symptoms which are observable to the senses and there is no reason to doubt their credibility. However, the Board must emphasize that neither the appellant nor the Veteran is not competent to interpret accurately clinical findings pertaining to musculoskeletal disorders, to include a left shoulder disability, as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1) (2018). See also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Furthermore, the opinions and observations of the appellant and Veteran alone cannot meet the burden imposed by the rating criteria under 38 C.F.R. § 4.71a with respect to determining the severity of the Veteran's service-connected left shoulder disability. See Moray v. Brown, 5 Vet. App. 211, 214 (1993); see also Davidson v. Shinseki, 581 F.3d 1313 (2009). Consequently, the Board finds examinations conducted by trained medical professionals are more probative in determining the severity of the Veteran's service-connected left shoulder disability. Accordingly, the Board finds the Veteran's left shoulder disability for the period prior to December 29, 2006 more closely approximates the criteria for a 30 percent rating under Diagnostic Code 5201. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 3. Entitlement to an evaluation in excess of 50 percent for a left shoulder humeral head replacement from February 1, 2008 The Veteran's left shoulder disability is rated as 50 percent disabling under Diagnostic Code 5099-5051 by analogy and has retained that disability rating throughout the appellate period. The Veteran contends that a higher evaluation is warranted for the period from February 1, 2008. This disability is rated under Diagnostic Code (DC) 5099-5051. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the disability rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27 (2019). Unlisted disabilities requiring rating by analogy will be coded first with the numbers of the most closely related body part and "99." 38 C.F.R. § 4.27. DC 5000 pertains to the Schedule of Ratings Musculoskeletal System. DC 5051 pertains to shoulder replacement (prosthesis). 38 C.F.R. § 4.114, Diagnostic Codes 5000, 5051. Diagnostic Code 5051 entails shoulder replacement with a prosthesis. The Veteran is entitled to a 50 percent disability rating with chronic residuals of minor shoulder consisting of severe, painful motion or weakness in the affected extremity. With intermediate degrees of residual weakness, pain, or limitation of motion, VA is to rate the shoulder by analogy to diagnostic codes 5200 and 5203. 38 C.F.R. § 4.71a, Diagnostic Code 5051. Turning to the record, in March 2008, the Veteran was afforded a VA examination in connection with his claim. At the time of the examination, the Veteran reported that he could not raise his left shoulder beyond chest level or bear weight with his left arm without significant pain. Likewise, a November 2015 VA examination found that the Veteran's left shoulder had pain that worsened with use; the Veteran had limited motion, and weakness in his left shoulder. The examiner determined that the Veteran had very little function of his shoulders and he had constant pain. Equally, at a January 2018 VA examination, the examiner determined that the Veteran had minimal left shoulder function and had pain at rest with any movement. In light of the evidence as discussed above, the Board finds that the Veteran is entitled to a 50 percent disability rating under Diagnostic Code 5099-5051 from February 1, 2008. Specifically, the Veteran had consistently reported severe painful motion and/or weakness following his left shoulder joint replacement. Moreover, as noted above, the Veteran is right-hand dominant, therefore, the Veteran's evaluation is based on impairment of a minor joint. Additionally, a higher evaluation is not warranted under Diagnostic Code 5099-5051, as the 100 percent evaluation criteria only pertains to one year following implantation of prosthesis. The Board acknowledges the appellant's contentions that the Veteran's service-connected left shoulder disability warrants an increased evaluation for the period from February 1, 2008. Lay people are competent to report on matters observed or within their personal knowledge. See Layno, 6 Vet. App. at 470. Therefore, the appellant and the Veteran are competent to provide statements of symptoms which are observable to their senses and there is no reason to doubt their credibility. However, the Board must emphasize that neither the appellant nor the Veteran are competent to interpret accurately clinical findings pertaining to musculoskeletal disorders, to include a left shoulder disability, as this requires highly specialized knowledge and training. 38 C.F.R. § 3.159 (a)(1) (2018). See also Jandreau, 492 F.3d at 1376-77. Furthermore, the opinions and observations of the appellant and the Veteran alone cannot meet the burden imposed by the rating criteria under 38 C.F.R. § 4.71a with respect to determining the severity of the Veteran's service-connected left shoulder disability. See Moray, 5 Vet. App. at 214; see also Davidson, 581 F.3d at 1313. Consequently, the Board finds examinations conducted by trained medical professionals are more probative in determining the severity of the Veteran's service-connected left shoulder disability. Accordingly, the Board finds the Veteran's left shoulder disability for the period from to February 1, 2008, more closely approximates the criteria for a 50 percent rating under Diagnostic Code 5099-5051. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert, 1 Vet. App. at 53. REASONS FOR REMAND As discussed above, the appellant contends that the Veteran is entitled to SMC at the housebound rate for the entire period on appeal. Historically, the Veteran was granted SMC at the housebound rate in a January 2019 rating decision with an effective date of March 2, 2009. Later, in an August 2020 rating decision, the AOJ determined that the grant of SMC at the housebound rate in the January 2019 rating decision constituted a clear and unmistakable error (CUE), because the Veteran had a total disability rating based on individual unemployability (TDIU) based on multiple disabilities and not based on a single disability. Further, in the same rating decision the AOJ granted SMC at the housebound rate from December 26, 2006 through January 31, 2008 based on the Veteran's 100 percent rating for convalescence. Finally, a December 2020 rating decision discontinued the grant of SMC at the housebound rate after March 1, 2021. This rating was generated in the interim between the case returning from CAVC and substitution. In this regard, the Boards observes that SMC at the housebound rate is warranted for a period of convalescence. See VAOPGCPREC 21-94 (Dec. 13, 1994) (holding that the statutory provisions authorizing payment at the SMC(l) rate for aid and attendance to not require that the need be permanent as a predicate to such an award, and that to the extent that 38 C.F.R. § 3.352 suggests that the need be permanent, that title is inconsistent with the governing statutes). However, the Board notes that the Veteran had two additional periods of convalescence that were not granted SMC at the housebound rate. Specifically, from August 1, 2011 through October 31, 2011 for surgical treatment to his right upper extremity the Veteran was rated as 100 percent disabled. Also, from June 19, 2017 through September 30, 2017, the Veteran was rated as 100 percent disabled for surgical treatment to his lower back. In light of the Court's determination that the Board failed to address the reasonably raised issue of entitlement to SMC at the housebound rate in its December 2018 decision, the Board finds that a remand is required for the AOJ to examine why there is no assignment of SMC at the housebound rate during the additional periods of convalescence discussed above. This will also give the appellant's representative the opportunity to represent on this issue or changed circumstance at the AOJ level and afford appropriate due process. The matters are REMANDED for the following action: The AOJ is directed to review the claims file to determine if SMC at the housebound rate is warranted for the Veteran's periods of convalescence from August 1, 2011 through October 31, 2011 and from June 19, 2017 through September 30, 2017. This determination should include consideration and adjudication of whether SMC at the housebound rate is otherwise applicable to any other period on appeal. All findings should be clearly set out. If the appellant and her representative are not satisfied, a supplemental statement of the case should be issued, and the matter returned to the Board. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Scanlan, 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.