Citation Nr: 21074692 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 16-34 993 DATE: December 16, 2021 ORDER Entitlement to a rating in excess of 20 percent for a cervical strain is denied. Entitlement to a rating in excess of 20 percent for right rotator cuff tendinitis is denied. Entitlement to a rating in excess of 10 percent for a lumbosacral strain is denied. FINDINGS OF FACT 1. At worst, the Veteran's cervical spine disability manifest by forward flexion of 25 degrees. 2. At worst, the Veteran's right rotator cuff tendinitis manifests by flexion and abduction of 80 degrees of the major extremity. 3. At worst, the Veteran's lumbosacral strain manifests by forward flexion of 70 degrees. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for a cervical strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237. 2. The criteria for a rating in excess of 20 percent for right rotator cuff tendinitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5201. 3. The criteria for a rating in excess of 10 percent for lumbosacral strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active-duty service in the U. S. Army from August 2007 to May 2012. He served in combat in the Persian Gulf and received the Combat Action Badge. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Increased Disability Ratings Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate Diagnostic Codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). The rating of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various Diagnostic Codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Where there is a question as to which of two ratings shall be applied, the higher rating 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. 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. 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, 206-8 (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, 8 Vet. App. 202. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Painful motion is an important factor of joint disability, which is entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. However, the evaluation of painful motion as limited motion only applies when the limitation of motion is noncompensable under the applicable Diagnostic Code. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain and numbness in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. See Saunders v. Wilkie, 886 F. 3d 1356 (Fed. Cir. 2018). Musculoskeletal VA examinations, to be adequate, must address particular issues when are where that are practicable and medically possible to include active and passive motion; weight bearing and non-weight bearing; range of motion of an opposing joint; and findings as to loss of motion during flare-ups. See Correia v. McDonald, 28 Vet. App. (2016); Sharp v. Shulkin, 29 Vet. App. 26 (2017). Cervical Strain The Veteran contends that he is entitled to a higher rating for his cervical strain. The RO has rated the Veteran's cervical strain under 38 C.F.R. § 4.71a, Diagnostic Code 5237. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 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 cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 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 30 percent rating is warranted for forward flexion of the cervical spine to 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 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are evaluated separately under an appropriate diagnostic code. Id. at Note 1. The Court has scrutinized the "meaning" of ankylosis. See, e.g., Dinsay v. Brown, 9 Vet. App. 79, 81 (1996) citing Dorland's Illustrated Medical Dictionary at 86 (27th ed. 1988) (Ankylosis is "immobility and consolidation of a joint due to disease, injury, or surgical procedure."); Chavis v. McDonough, No. 18-2928 (April 16, 2021) ("flare-ups resulting in symptoms more nearly approximating ankylosis can warrant a higher rating under the general rating formula"). Id. at Note 5. In October 2012, the Veteran reported for a VA cervical spine examination. The clinician confirmed the Veteran's diagnosis of cervical strain. The Veteran reported neck pain with bending. He denied flare ups. Upon physical examination, the Veteran's forward flexion was limited to 30 degrees; extension was limited to 30 degrees; right lateral flexion was limited to 40 degrees; left lateral flexion was limited to 40 degrees; right lateral rotation was limited to 50 degrees; and left lateral rotation was limited to 50 degrees. After three repetitions, these values remained unchanged, and the clinician noted that there was no additional loss of motion after repetitive use. The clinician reported functional loss of the cervical spine. Contributing factors included less movement than normal; excess fatigability; pain on movement; localized tenderness or pain upon palpation; and guarding or muscle spasm, not resulting in abnormal gait or spinal contour. Muscle strength, reflex examination and sensory examination were all normal. The clinician reported neither radiculopathy nor IVDS. Whereas the clinician indicated functional impact on the Veteran's ability to work, the clinician provided no guidance as to the nature of this impact. In December 2019, the Veteran reported for another VA cervical spine examination. The clinician continued the diagnosis of cervical strain. The Veteran reported neck pain, endorsing flare ups with exercising and prolonged driving. The Veteran also reported functional loss when doing certain exercises and with prolonged activity. Upon physical examination, the Veteran's forward flexion was limited to 30 degrees; extension was limited to 30 degrees; right lateral flexion was limited to 30 degrees; left lateral flexion was limited to 30 degrees; right lateral rotation was limited to 50 degrees; and left lateral rotation was limited to 50 degrees. After three repetitions, these values remained unchanged; the clinician indicated that there was no additional loss of motion after repetitive use. The clinician reported pain at all indices of motion. Even though examination did not take place after repetitive use over time, the clinician did report that examination took place during a flare up. As such, the clinician indicated identical losses in ranges of motion degrees (at all indices) as articulated above. Contributing factors to functional loss included pain and fatigue; localized tenderness or pain to palpation; and less movement than normal secondary to pain and fatigue. Muscle strength, reflex examination and sensory examination were all normal. The clinician reported neither radiculopathy nor IVDS. The clinician indicated functional impact on the Veteran's ability to work, including decreased range of motion with prolonged activitiessuch as driving more than one hour due to pain. In September 2021, the Veteran reported for another VA cervical spine examination The Veteran denied having flare ups, though he indicated functional loss in the form of difficulty with prolonged head movements. Upon physical examination, the Veteran's forward flexion was limited to 30 degrees; extension was limited to 30 degrees; right lateral flexion was limited to 30 degrees; left lateral flexion was limited to 30 degrees; right lateral rotation was limited to 60 degrees; and left lateral rotation was limited to 60 degrees. After three repetitions, these values remained unchanged. After repeated use over time, the clinician opined that the Veteran's forward flexion would be limited an additional five degrees at all indices due to pain. There was no evidence of guarding or muscle spasm. Muscle strength, reflex examination, and sensory examination were all normal. The clinician reported neither radiculopathy, IVDS, nor ankylosis. Here, functional impact on the Veteran's ability to work included decreased range of motion with prolonged activities such as prolonged or repetitive head turning (due to pain). The Veteran contends that his cervical strain is more severe than that contemplated by a 20 percent rating. The Veteran is competent to report discernable symptoms of pain and achiness. The Board has considered the Veteran lay statements. 38 C.F.R. § 3.159(a)(2). The Veteran's reporting of discernable symptoms is competent and assigned some probative weight, particularly those reported during medical examinations; however, upon review of the evidence of record the Veteran does not possess the specialized orthopedic education, training, or experience to offer medical diagnoses, statements, or opinions as to the clinical severity of a cervical spine disorder. 38 C.F.R. § 3.159(a)(1). The evidence is summarized above. The Board finds that the weight of evidence is against granting a rating in excess of 20 percent for a cervical strain. The Board acknowledges the Veteran's lay reports of symptoms and that there has been functional loss due to pain after repetitive use, pain during flare-ups, and with prolonged activity. However, even considering the Veteran's lay reports of symptoms and functional loss, the degree of additional limitation during flare-ups and after repetitive use over time did not result in limitation of motion more nearly approximating forward flexion of the cervical spine to 15 degrees or less; or favorable ankylosis of the entire cervical spine. In this regard, the Veteran reported flare ups in only one of the three VA examinations of record. As already reported, the examining clinician indicated Veteran was being tested during a flare up and measured the Veteran's forward flexion on flare up as limited to 30 degrees. The Board reiterates that during the appellate period, at worst, the Veteran's forward cervical flexion is limited to 25 degrees. No clinician of record indicated the presence of ankylosis or symptoms analogous of such. Chaves, No. 18-2928. As articulated above, no clinician reported the presence of IVDS. Consequently, a rating for IVDS in not possible. See 38 C.F.R. § 4.71a. Likewise, the competent lay and medical evidence of record fail to disclose any neurological abnormalities with connexity to the Veteran's cervical strain. For the foregoing reasons, the preponderance of the evidence is against the Veteran's claim for a rating in excess of 20 percent for service-connected cervical strain. In denying such, the Board finds the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Right Rotator Cuff Tendinitis The Veteran contends that he is entitled to a rating in excess of 20 percent for right rotator cuff tendinitis. The RO has rated the Veteran's right rotator cuff tendinitis under 38 C.F.R. § 4.71a, Diagnostic Code 5201, for limitation of motion of the arm. Under Diagnostic Code 5201, limitation of motion of the arm at shoulder level warrants a 20 percent rating for both the major and the minor extremity. Limitation of motion of the arm midway between side and shoulder warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Limitation of motion of the arm to 25 degrees from side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint. 38 C.F.R. § 4.71a, Diagnostic Code 5201. Diagnostic Code 5201 "does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of the arm." Yonek v. Shinseki, 722 F. 3d 1355, 1358 (Fed. Cir. 2013). During the pendency of the instant appeal, VA promulgated new regulations governing ratings for musculoskeletal system and muscle disabilities, effective February 7, 2021. See 85 Fed. Reg. 76,453 (Nov. 30, 2020). When a law or regulation changes during the pendency of a veteran's appeal, the version most favorable to the veteran applies, absent congressional intent to the contrary. The amended rating criteria, if favorable to the claim, can be applied only for periods from the effective date of the regulatory change; however, the old regulations will be considered for the periods both before and after the change was made. See 38 U.S.C. § 5110 (g); 38 C.F.R. § 3.114; VAOPGCPREC 3-2000, 65 Fed. Reg. 33,422 (2000); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Consequently, the Veteran is entitled to application of the criteria that are most favorable to his claim, with the exception that an award based upon the amended regulations may not be made effective before the effective date of the change. Effective February 7, 2021, VA amended Diagnostic Code 5201 to reflect that limitation of motion may be shown by flexion and/or abduction and clarified the degrees of limitation of motion that correspond to each rating. Now, limitation of motion at the shoulder level (flexion and/or abduction limited to 90 degrees) warrants a 20 percent rating for both the major and minor extremity. Limitation of motion of the arm midway between side and shoulder level (flexion and/or abduction limited to 45 degrees) warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Flexion and/or abduction limited to 25 degrees from the side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint. In October 2012, the Veteran reported for a VA examination. The clinician provided a diagnosis of right rotator cuff tendinitis. The Veteran endorsed flare ups evinced through increased pain, at an occasional frequency with overhead lifting. Upon physical examination, right shoulder flexion was limited to 140 degrees and abduction was limited to 100 degrees. After three repetitions, ranges of motion remained unchanged. The clinician reported functional loss as less movement than normal, excess fatigability, pain on movement, and swelling. There was both localized tenderness or pain on palpation and right shoulder guarding. Muscle strength was normal. There was no evidence of ankylosis. Hawkins' impingement and empty can tests were positive. In December 2019, The Veteran reported for a VA examination. The Veteran reported having constant pain and stiffness. He also reported experiencing flare ups with cold weather; lifting objects in excess of 15 pounds; during prolonged driving; when it rains; and when he reaches overhead. Upon physical examination right shoulder flexion was limited to 100 degrees; abduction was limited to 100 degrees; and both external and internal rotation were limited to 50 degrees. Pain was present at all indices. After three repetitions, ranges of motion remained unchanged. Both after repetitive use over time and on flare up, ranges of motion remained unchanged. The clinician reported that examination occurred during a flare up (hence the ranges of motion mirrored those above). Functional loss consisted of less movement than normal. Muscle strength was normal. There was no evidence of muscle atrophy or ankylosis. Hawkins' impingement test was positive. There was no shoulder instability, dislocation, or labral pathology. Neither clavicle, scapula, AC joint, or sternoclavicular joint conditions were suspected. There was no evidence of any humerus condition. The Veteran reported occasional use of a right shoulder sling. The clinician reported functional impact on the Veteran's ability to work as a limitation with lifting objects in excess of 15 to 20 pounds. In September 2021, the Veteran reported for his latest VA examination. The Veteran reported experiencing moderate flare ups after overhead lifting. Functional loss included difficulty with overhead lifting. Upon physical examination right shoulder flexion was limited to 90 degrees; abduction was limited to 90 degrees; and both external and internal rotation were limited to 80 degrees. The clinician reported pain upon flexion and abduction. After three repetitions, ranges of motion remained unchanged. Both after repetitive use over time and on flare up, right shoulder flexion was assessed to be limited to 80 degrees; abduction to 80 degrees; and both external and internal rotation to 80 degrees. There was no evidence of muscle atrophy or ankylosis. Hawkins' impingement test was positive. There was no shoulder instability, dislocation, or labral pathology. Neither clavicle, scapula, AC joint, or sternoclavicular joint conditions were suspected. There was no evidence of any humerus condition. The Veteran reported occasional use of a right shoulder sling. The clinician reported functional impact on the Veteran's ability to work as a limitation with lifting objects in excess of 35 pounds overhead because of pain. The Veteran contends that his right rotator cuff tendinitis is more severe than that contemplated by a 20 percent rating. The Veteran is competent to report discernable symptoms of pain and achiness. The Board has considered the Veteran lay statements. 38 C.F.R. § 3.159(a)(2). The Veteran's reporting of discernable symptoms is competent and assigned some probative weight, particularly those reported during medical examinations; however, upon review of the evidence of record the Veteran does not possess the specialized orthopedic education, training, or experience to offer medical diagnoses, statements, or opinions as to the clinical severity of right rotator cuff tendinitis. 38 C.F.R. § 3.159(a)(1). The evidence is summarized above. The Board finds that the weight evidence is against a rating in excess of 20 percent for right rotator cuff tendinitis. The evidence of record shows that the Veteran is right-handed. See VA examinations of record. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain during flare-ups, and pain with overhead lifting. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that he experiences weekly flare ups would not result in symptoms more nearly approximating limitation of motion of the arm midway between side and shoulder level of the major extremity or limitation of motion of the arm to 25 degrees from the side of the major or minor extremity. In this regard, the Board notes that at worse, even on flare up and after repetitive use over time, the Veteran's right shoulder flexion has only been limited to 80 degrees and abduction has been limited to 80 degrees. The midway point between side and shoulder level on the right is 45 degrees, as clarified by the February 7, 2021 amended Diagnostic Code. Despite the amended Diagnostic Code, indicating that limitation of motion may be shown by flexion and/or abduction, the Veteran's abduction has at its most severe been limited to 80 degrees. As such, the amended criteria do not provide for a higher rating. The Board has considered whether any other Diagnostic Codes related to disabilities of the shoulder would provide for a higher rating. However, the evidence does not reflect that the symptoms would warrant a higher rating under a different Diagnostic Code. See 38 C.F.R. § 4.71a. In this regard, there is neither evidence of ankylosis, humerus impairment, nor clavicular or scapula impairment. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's appeal for a rating in excess of 20 percent for right rotator cuff tendinitis. In denying such, the Board finds the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Lumbosacral Strain The Veteran contends that he is entitled to a rating in excess of 10 percent for his lumbosacral strain. The Veteran's lumbosacral strain is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5237. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. As already noted, any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. In October 2012, the Veteran reported for VA thoracolumbar spine examination. The clinician provided a diagnosis of lumbosacral strain. The Veteran reported low back pain. He denied flare ups. Upon physical examination, the Veteran's forward flexion was limited to 80 degrees; extension was limited to 20 degrees; right lateral flexion was limited to 20 degrees; left lateral flexion was limited to 20 degrees; right lateral rotation was limited to 30 degrees; and left lateral rotation was limited to 30 degrees. After three repetitions, these values remained unchanged, and the examiner noted that there was no additional los of motion after repetitive use. Functional loss of the thoracolumbar spine included contributing factors of less movement than normal, excess fatigability and pain on movement. The clinician reported localized tenderness or pain to palpation as well as guarding or muscle spasm. However, these symptoms did not result in abnormal gait or spinal contour. Muscle strength, reflex examination and sensory examination were all normal. There was no evidence of either radiculopathy, IVDS, or ankylosis. The clinician did report functional impact on the Veteran's ability to work, but the clinician did not provide any specific guidance or examples of such. In December 2019, the Veteran reported for a VA thoracolumbar spine examination The Veteran conveyed that his back pain had worsened. He also reported flare-ups with prolonged lifting and prolonged driving. The Veteran reported functional loss with prolonged activities, including driving and carrying items. Upon physical examination, the Veteran's forward flexion was limited to 80 degrees; extension was limited to 20 degrees; right lateral flexion was limited to 20 degrees; left lateral flexion was limited to 20 degrees; right lateral rotation was limited to 20 degrees; and left lateral rotation was limited to 20 degrees. After three repetitions, these values remained unchanged, and the clinician indicated that there was no additional loss of range of motion. Pain was present at all indices. Though the Veteran was not being examiner after repetitive use over time, the clinician opined that examination took place during a flare-up. Thus, upon flare-ups, ranges of motion replicated those reported above. Pain and fatigue contributed to functional loss. There was evidence of localized tenderness or pain to palpation. Additional factors contributing to the Veteran's disability included less movement than normal secondary to pain and fatigue. Muscle strength, reflex examination and sensory examination were all normal. There was no evidence of either radiculopathy, IVDS, or ankylosis. The clinician indicated functional impact on the Veteran's ability to work as decreased range of motion with prolonged activities such as sitting in excess of 45 minutes. In September 2021, the Veteran reported for a VA thoracolumbar spine examination. The Veteran reported having flare-ups on a weekly basis, of moderate severity, precipitating by bending and heavy lifting. The Veteran endorsed Functional loss as difficulty with bending and heavy lifting. Upon physical examination the Veteran's forward flexion was limited to 80 degrees; extension was limited to 20 degrees; right lateral flexion was limited to 20 degrees; left lateral flexion was limited to 20 degrees; right lateral rotation was limited to 30 degrees; and left lateral rotation was limited to 30 degrees. After three repetitions, these values remained unchanged. For repeated use over time, the clinician provided that the Veteran's forward flexion would be limited to 70 degrees, while the other ranges would remain unchanged. While the Veteran was not to be tested during a flare up, the same motion estimates as after repeated use over time were provided. There were no additional factors contributing to the Veteran's disability. Muscle strength, reflex examination and sensory examination were all normal. There was no evidence of either radiculopathy, IVDS, or ankylosis. The clinician indicated functional impact on the Veteran's ability to work as difficulty with frequent bending and lifting more than 40 pounds. The Veteran contends that his lumbosacral strain is more severe than that contemplated by a 10 percent rating. The Veteran is competent to report discernable symptoms of pain and achiness. The Board has considered the Veteran lay statements. 38 C.F.R. § 3.159(a)(2). The Veteran's reporting of discernable symptoms is competent and assigned some probative weight, particularly those reported during medical examinations; however, upon review of the evidence of record the Veteran does not possess the specialized orthopedic education, training, or experience to offer medical diagnoses, statements, or opinions as to the clinical severity of a lumbosacral strain. 38 C.F.R. § 3.159(a)(1). The evidence is summarized above. The Board finds that the weight of evidence is against a rating in excess of 10 percent for a lumbosacral strain. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain after repetitive use, pain during flare-ups, and with prolonged activity. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that flare-ups or repetitive use over time caused pain would not result in limitation of motion more nearly approximating 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. In this regard, the Veteran reported flare ups in two of the three VA examinations. The 2019 clinician indicated that the Veteran was being tested during a flare-up and measured the Veteran's forward flexion on flare up as limited to 80 degrees. During the 2021 examination, the clinician reported that both after repetitive use over time and during flare-ups, forward flexion was limited to 70 degrees. Furthermore, the lowest combined range of motion of the thoracolumbar spine of record is 170 degrees, as per the December 2019 VA examination. The possibility of granting a higher rating for IVDS is not possible. As articulated above, no medical evidence of record discloses that the Veteran has ever received a diagnosis of IVDS. For the foregoing reasons, the preponderance of the evidence is against the Veteran's claim for a rating in excess of 10 percent for his service-connected lumbosacral strain. In denying such, the Board finds the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. B. J. KOMINS Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Georgio Comninos, 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.