Citation Nr: 21075408 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 15-16 291 DATE: December 20, 2021 ORDER An initial rating in excess of 20 percent for service-connected right shoulder degenerative joint disease (DJD), to include whether a separate compensable rating is warranted for other impairment of the humerus, for accrued benefits purposes, is denied. A rating in excess of 20 percent for service-connected residuals of fractures to the right tibia and fibula, for accrued benefits purposes, is denied. A separate rating of 10 percent, but no higher, for the service-connected residuals of fractures to the right tibia and fibula, based on instability, for accrued benefits purposes, is granted. A compensable rating for service-connected osteoarthritis of the right first metatarsal phalangeal joint, for accrued benefits purposes, is denied. FINDINGS OF FACT 1. Since the effective date of service connection, the Veteran's right shoulder disability has manifested by motion of the major arm limited to no worse than shoulder level, without additional limitation of function during a flare-up; and, without fibrous union of the humerus, nonunion of the humerus, loss of head of the humerus; neither ankylosis nor impairment of the clavicle or scapula has been shown. 2. For the entire appeal period, the Veteran's left knee kas manifested by flexion limited to, at most, 80 degrees, extension limited to, at most 5 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups; and there is no evidence of ankylosis, genu recurvatum, or tibial and fibular impairment. 3. For the entire appeal period, service-connected arthritis of the left knee has manifested by endorsed slight lateral instability; moderate or severe instability of the left knee has not been demonstrated at any time during the appeal period. 4. The record is absent of any competent evidence of foot or toe pain causing functional loss due to osteoarthritis; moreover, there is no x-ray evidence of arthritis involving two or more major or minor joint groups. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 20 percent for service-connected right shoulder DJD, for accrued benefits purposes, have not been met. 38 U.S.C. §§ 1155, 5107, 5121A; 38 C.F.R. §§ 3.1010, 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5201-5003. 2. The criteria for entitlement to a rating in excess of 20 percent for service-connected residuals of fractures to the right tibia and fibula, for accrued benefits purposes, are not met. 38 U.S.C. §§ 1155, 5107, 5121A; 38 C.F.R. §§ 3.1010, 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5256-5263. 3. The criteria for entitlement to a separate disability rating for 10 percent, but no higher, for service-connected residuals of fractures to the right tibia and fibula, based on slight instability, for accrued benefits purposes, have been met. 38 U.S.C. §§ 1155, 5107, 5121A; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257. 4. The criteria for entitlement to a compensable rating for service-connected osteoarthritis of the right first metatarsal phalangeal joint, for accrued benefits purposes, have not met. 38 U.S.C. §§ 1155, 5107, 5121A; 38 C.F.R. §§ 3.1010, 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5003. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1961 to August 1977 and June 1982 to September 1985. In May 2013, the Veteran filed an increased rating claim for his service-connected right shoulder DJD, residuals of fractures to the right tibia and fibula and osteoarthritis of the right first metatarsal phalangeal joint. The Veteran died in April 2019, while his claims were pending at the Agency of Original Jurisdiction (AOJ). The appellant is the Veteran's surviving spouse, and she was substituted to complete the claims that were pending at the time of the Veteran's death. This case comes before the Board of Veterans' Appeals (Board) on appeal from a June 2014 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. In that rating decision, the RO granted service connection for right shoulder DJD, and assigned an initial 10 percent disability rating, effective from May 13, 2013, granted an increased rating to 20 percent for fractures to the right tibia and fibula, effective from May 13, 2013, and continued to deny a compensable rating for the right first metatarsal phalangeal joint. VA received the appellant's notice of disagreement (NOD) in July 2014. The AOJ issued a statement of the case in February 2015. VA received the appellant's VA Form 9, substantive appeal to the Board, in April 2015. In March 2016, the Veteran testified at a video conference Board hearing before a Veterans Law Judge. The claims file contains a transcript of that proceeding. In a September 2021 letter, VA informed the appellant that the Veterans Law Judge that held the Veteran's hearing was no longer with the Board and was apprised of her right to another hearing before a current Veterans Law Judge. The appellant declined the request for another hearing in November 2021. In October 2017, the Board granted an increased rating of 20 percent for the service-connected right shoulder DJD and remanded several other issues on appeal. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). The Court issued an August 2018 Joint Motion for Remand (JMR) as to the issue of a rating for the service-connected right shoulder DJD and the case was returned to the Board. In February 2019 and November 2020, the Board remanded the case for further development and adjudicative action. Increased Rating as a Substitute Claimant for Accrued Benefits Purposes Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14 (2018). 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). During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective from February 7, 2021. 83 Fed. Reg. 230 (Nov. 30, 2020). The United States Supreme Court has held that statutes generally may not be construed to have retroactive effect unless their language requires that result. See Landgraf v. USI Film Products, 511 U.S. 244 (1994). As it pertains to veterans law, in Kuzma v. Principi, the Federal Circuit held that the Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. See Kuzma v. Principi, 341 F .3d 1327 (Fed. Cir. 2003). Thus, the amended regulation cannot be applied prior to the effective date unless the regulation explicitly provides otherwise. In other words, the old and new regulations are for consideration with regard to rating the Veteran's disability, and he/she is entitled to the more favorable regulation; however, if the revised criteria are more favorable to the Veteran, the revised criteria may not be applied until the effective date of the change. 38 U.S.C. § 5110(g). With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved 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." See Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. See Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). 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). 1. Entitlement to an initial rating in excess of 20 percent for service-connected right shoulder DJD, to include whether a separate compensable rating is warranted for other impairment of the humerus. The appellant seeks an initial rating in excess of 20 percent for the Veteran's service-connected right shoulder disability, initially rated pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5201-5003. Hyphenated codes are used when a rating under one Diagnostic Code requires use of an additional Diagnostic Code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. Disabilities of the shoulder and arm are rated under Diagnostic Codes 5200 through 5203 which distinguish between the major (dominant) extremity and the minor (non-dominant) extremity. 38 C.F.R. § 4.71a. The evidence shows the Veteran to be right-hand dominant. See March 2019 VA examination. Given such, the applicable rating will be assigned under the "Major" rating. As noted above, the AOJ has rated the Veteran's right shoulder disability under 38 C.F.R. § 4.71a, Diagnostic Code 5201. Under the pre-amended Diagnostic Code 5201, limitation of motion in the major extremity is as follows: limitation to shoulder level warrants a rating of 20 percent; limitation to midway between side and shoulder level warrants a rating of 30 percent; and limitation of motion to 25 degrees from the side warrants a rating of 40 percent. Recent amendments to Diagnostic Code 5201, effective February 7, 2021, clarify that limitation of motion of the arm to shoulder level is equivalent to flexion and/or abduction limited to 90 degrees and limitation of motion to midway between side and shoulder level is equivalent to flexion and/or abduction limited to 45 degrees. 85 Fed. Reg. 76,453; 38 C.F.R. § 4.71a, Diagnostic Code 5201. Normal ranges of shoulder flexion and abduction are from 0 to 180 degrees, and external and internal rotations are from 0 to 90 degrees. 38 C.F.R. § 4.71, Plate I. In determining whether a veteran has limitation of motion to shoulder level, it is necessary to consider forward flexion and abduction. See Mariano v. Principi, 17 Vet. App. 305, 314-316 (2003). The Federal Circuit has held that the plain language of 38 C.F.R. § 4.71a confirms that a veteran is only entitled to a single disability rating under Diagnostic Code 5201 for each arm that suffers from limited motion at the shoulder joint. The Diagnostic Code 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. See Yonek v. Shinseki, 722 F.3d 1355 (Fed. Cir. 2013). Here, the evidence shows the Veteran was unable to raise his arm above his shoulder. Under Diagnostic Code 5003, arthritis shown by X-ray imaging is rated based on limitation of motion of the affected joint or joints. When limitation of motion is noncompensable under a limitation of motion code, but there is at least some limitation of motion, a 10 percent rating may be assigned for each major joint or group of minor joints so affected. 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. In the absence of limitation of motion, X-ray evidence of arthritis involving two or more major joints or two or more minor joint groups, will warrant a rating of 10 percent. If there are occasional incapacitating exacerbations, a 20 percent rating is assigned for the arthritis without limitation of motion involving two or more major joints or two or more minor joint groups. The above ratings are to be combined, not added under Diagnostic Code 5003. 38 C.F.R. § 4.71a, Diagnostic Code 5003, Note 1. Under 38 C.F.R. § 4.45, for purposes of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae are considered groups of minor joints. The Veteran reported for VA shoulder examinations in April 2014, March 2019, and April 2019. And for the appellant, the AOJ ordered an addendum medical opinion in June 2021. After suffering several strokes, Veteran was unable to perform testing during the March 2019 and April 2019 examinations. As such the analysis devolves from the April 2014 physical examination and subsequent June 2021 addendum opinion. A VA examiner in April 2014 determined that the Veteran had pain, weakness and limited motion of the right shoulder, his dominant shoulder. The pain began at 95 degrees of flexion (slightly above shoulder level, or 90 degrees). Right shoulder internal and external rotation ended at 65 degrees and pain began at 65 degrees. There was no additional functional loss after repetitive use and the Veteran did not report additional functional loss during flare-ups. Although the examiner also noted that right shoulder arthritis had been documented upon x-ray, the other examination findings confirm limited motion of the right shoulder to a compensable degree. Accordingly, a rating under the limitation of motion code is applicable in this case. As noted above, forward flexion of the right shoulder is limited to just above shoulder level; however, internal and external rotation are limited to 65 degrees (normal is 90 degrees). Although the rating criteria do not specifically account for rotation of the arm, this additional limitation of motion, coupled with the fact that the Veteran could only flex his right arm to just above shoulder level, more nearly approximates limited motion of the right shoulder to shoulder level, thereby warranting the assignment of a 20 percent rating under Diagnostic Code 5201. To warrant the next higher, 30 percent rating, the Veteran's limitation of flexion of the right arm would have to more nearly approximate that of midway between his side and shoulder level. The evidence of record does not disclose such. The Board has also considered whether any other Diagnostic Code applicable to the shoulder would afford the Veteran a higher rating. The April 2014 VA examination shows that the Veteran had a history of recurrent dislocation of the glenohumeral (scapulohumeral joint) which resulted in guarding of movement, but only at the shoulder level. Under Diagnostic Code 5202, infrequent episodes of recurrent dislocation of the humerus at the scapulohumeral joint with guarding of movement only at the shoulder level warrants a 20 percent rating. Frequent episodes of recurrent dislocation of the humerus at the scapulohumeral joint with guarding of all arm movements warrants a 30 percent rating for the dominant arm. The Veteran's symptoms, as noted above, correspond to a 20 percent rating, but no higher, under Diagnostic Code 5202. Consequently, a rating under Diagnostic Code 5202 would not afford the Veteran a rating in excess of the 20 percent rating under Diagnostic Code 5201. Thus, the question before the Board is whether the Veteran is entitled to a separate rating under Diagnostic Code 5202 due to "guarding" noted by the April 2014 VA examiner. In the June 2021 VA addendum opinion, upon review of the evidence, the examiner found the following: [C&P] exam for the shoulder in 2014 noted guarding at the shoulder level. The question whether guarding was present was related to any history of instability or dislocation of the right shoulder. The guarding mentioned in the specific section of the exam is related to the tensing or contraction of a muscle in anticipation of possible pain or discomfort. [The] Veteran is service connected for right shoulder degenerative arthritis and the service-connected condition does not include a history of recurrent dislocations or history of instability. Further review of the Veteran's medical treatment records shows [that the] Veteran sustained a right shoulder genu labrum tear which was repaired [on] October 2, 1995. An orthopedic note [of] Feb. 28, 1995 gives a clear history of onset regarding the history of injury for the right shoulder and the note indicates the right shoulder instability which required surgery was sustained in an [motor vehicle accident] Jan. 10, 1995. Therefore, based on this, the voluntary muscle tensing in anticipation of pain of the affected muscle or joint is connected to the Veteran's history of injury from an [motor vehicle accident] Jan 10, 1995 which resulted in a diagnosis not previously mentioned a right shoulder impingement syndrome with genu labrum tear [status post] surgical repair. Therefore, the service-connected right shoulder DJD is less likely than not manifested by a separate symptom noted a[s] guarding, since this was related to the history of instability which is caused by the Veteran's injury of the right shoulder during an [motor vehicle accident] Jan. 10, 1995. Additionally, a separate rating under Diagnostic Code 5202 would constitute pyramiding because a dislocation also results in pain, weakness and limited motion, the symptoms of which are already accounted for in the rating under Diagnostic Code 5201. Thus, the assignment of two separate ratings in this case would compensate the Veteran twice for the same symptomatology. This would result in pyramiding, contrary to the provisions of 38 C.F.R. § 4.14. Based on these findings, the Veteran's orthopedic manifestations of his right shoulder disability are consistent with a 20 percent rating, but no higher. Additionally, as there is no evidence of ankylosis, or impairment of the clavicle or scapula, the Diagnostic Codes pertaining to such impairments are not for application. 38 C.F.R. § 4.71a, Diagnostic Codes 5200, 5203. 2. Entitlement to a rating in excess of 20 percent for residuals of fractures to the right tibia and fibula. The appellant seeks an initial rating in excess of 20 percent for the Veteran's service-connected right knee disability, currently rated pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5262. In this case, Diagnostic Code 5262 rates impairment of the tibia and fibula. During the appeal period the Veteran reported for VA knee examinations in March 2019 and April 2019. In the March 2019 VA knee examination, the examiner diagnosed status post fractures right tibia and fibula; in the April 2019 examination the examiner diagnosed knee joint osteoarthritis in both knees. In the March 2019 VA knee examination, the Veteran reported that his condition had "stayed the same." He further reported instability and flare-ups which resulted in stabbing pain and limitation of motion. Due to a recent stroke, the Veteran was in a wheelchair and unable to have his range of motion or reported instability tested. However, the examiner noted pain during rest or non-movement, with diffuse knee pain moderate in severity, as well as pain and lack of endurance contributing to functional loss. The examiner further noted 0/5 muscle strength, no ankylosis, and no meniscal conditions, no shin splints, no genu recurvatum, and no tibial or fibular impairment. The examiner concluded that the functional impact of the Veteran's disability limited his capacity for carrying heavy objects singularly or moderate weight repeatedly; reduced capacity for tasks that require repeat knee bending; and the Veteran may experience increased pain with prolonged standing, walking, sitting, weight bearing, and ambulating on uneven ground. The results of the April 2019 examination are consistent with the March 2019 examination, with no additional evidence provided. According to VA treatment records the Veteran reported that his knee "gives out" despite therapy and he was considering a knee brace. See August 2016, December 2016 and June 2017 physical therapy. Diagnostic Code 5262 (prior to February 7, 2021) provides that malunion of the tibia and fibula with a mild knee or ankle disability warrants a 10 percent rating, a moderate knee or ankle disability warrants a 20 percent rating, and a marked knee or ankle disability warrants a 30 percent rating. Additionally, a maximum rating of 40 percent is warranted where there is nonunion of the tibia and fibula with loose motion requiring the use of a brace. As of February 7, 2021, Diagnostic Code 5262 directs that malunion of the tibia and fibula be rated under Diagnostic Code 5270 (ankylosis of the ankle) or 5271 (limited motion of the ankle), whichever results in the highest evaluation. The revision further provides that a 40 percent is warranted for nonunion of the tibia and fibula with loose motion requiring the use of a brace and added rating criteria for ratings for medial tibial stress syndrome or shin splints. The rating schedule does not define the terms "moderate" or "marked," although the order of this terminology indicates that each term encompasses more serious symptomatology. Therefore, the Board must evaluate the evidence of record and reach a decision that is equitable and just. 38 C.F.R. § 4.6. Although an element of evidence to be considered by the Board, the use of terminology such as "moderate" by VA examiners and others is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. Id. In addition to the VA knee examinations noted above, the Veteran reported for a VA ankle examination in April 2019. The examiner diagnosed status post tibia and fibula fracture and noted that he was unable to assess the Veteran's range of motion or repeated use because of the Veteran's recently suffered multiple strokes. The examiner found objective evidence of pain during palpitation of the joint but no crepitus, ankylosis, or joint instability. The examiner further found muscle weakness and atrophy as secondary residuals of the Veteran's multiple strokes. Here, there is no evidence of malunion of the tibia and fibula or ankylosis of the ankle. Thus, a rating in excess of 20 percent under Diagnostic Code 5262 is not warranted. Diagnostic Code 5256 pertains to ankylosis of the joint. Here, there is no evidence of ankylosis, therefore, a separate rating under Diagnostic Code 5256 is not warranted. Prior to February 7, 2021, Diagnostic Code 5257 provides for the assignment of a 10 percent rating when there is slight recurrent subluxation or lateral instability, a 20 percent rating when there is moderate recurrent subluxation or lateral instability, and a 30 percent rating for severe recurrent subluxation or lateral instability. The United States Court of Appeals for Veterans Claims recently held that nothing in Diagnostic Code 5257 provides that objective medical evidence is required or is to be favored over lay evidence in determining whether to assign a rating for lateral instability of the knee. See English v. Wilkie, 30 Vet. App. 347, 349 (2018). Here, due to the Veteran's recent stroke the examiner was unable to test instability. However, in light of English, there is lay evidence from the Veteran that he experienced instability. Id. As noted above, the Veteran reported symptoms of instability during his physical therapy in August 2016, December 2016, and June 2017. The Veteran specifically reported that his right knee gives out and he was considering a knee brace. There is no reason to doubt the Veteran's credibility in this regard. Accordingly, with resolution of all doubt in favor of the Veteran, a separate 10 percent rating for instability, but no higher, for the right knee, under Diagnostic Code 5257 is warranted. 38 U.S.C. § 4.71a. Although there is lay evidence of joint instability, the evidence reveals no more than slight lateral instability in the right knee. Moreover, the Veteran's endorsed symptoms of his right knee giving way, are not consistent with moderate or severe impairment as he did not describe symptoms occurring on any consistent basis nor did he report a history of multiple falls due to instability. Normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II. Diagnostic Code 5260 provides for a noncompensable rating where flexion of the leg is only limited to 60 degrees. For a 10 percent rating, flexion must be limited to 45 degrees. A 20 percent rating is warranted where flexion is limited to 30 degrees. A 30 percent rating may be assigned when flexion is limited to 15 degrees. Here, due to the Veteran's recent stroke, the examiner was unable to test ranges of motion. Hence, based upon the April 2014 VA knee examination, the Veteran's right knee flexion was limited to 85 degrees, and to 80 degrees after repeated use. Diagnostic Code 5261 provides for a noncompensable rating where extension of the leg is limited to 5 degrees. A 10 percent rating requires extension limited to 10 degrees. A 20 percent rating is warranted where extension is limited to 15 degrees. A 30 percent rating may be assigned where the evidence shows extension limited to 20 degrees. For a 40 percent rating, extension must be limited to 30 degrees. Finally, where extension is limited to 45 degrees, a 50 percent rating may be assigned. Here, based on his April 2014 VA knee examination, the Veteran's right knee extension was limited 5 degrees. Based upon these findings, a rating in excess of 20 percent under Diagnostic Code 5260 and 5261 is not warranted. 38 C.F.R. § 4.71a Similarly, as the evidence of record does not demonstrate dislocation or removal of semilunar cartilage, impairment of the tibia or fibula, or genu recurvatum at any time during the pendency of the appeal, Diagnostic Codes 5258, 5259 and 5263 are not for application. The Veteran is competent to describe certain discernable symptoms associated with these disabilities, such as pain and limited motion. The Board has considered the Veteran's history and reported symptoms, including as presented in the medical evidence discussed above, and the Board finds that these variables are contemplated by the ratings that have been assigned. Moreover, the competent medical evidence of record offers detailed specific findings pertinent to the rating criteria; as such, this evidence is the most probative evidence when evaluating the pertinent symptoms of the service-connected disabilities at issue. As such, the Veteran's lay reports concerning matters that he is competent to address, do not, in this case, outweigh the competent medical evidence with regard to the specialized evaluations of functional impairment, symptom severity, and details of clinical features of the service-connected conditions at issue. In summary, the assignment of separate 10 percent ratings for mild instability of the right knee is warranted; however, the preponderance of the evidence is against the Veteran's claim of entitlement to a rating in excess of 20 percent for his service-connected residuals of fractures to the right tibia and fibula. 3. Entitlement to a compensable rating for service-connected osteoarthritis of the right first metatarsal phalangeal joint. The appellant seeks an initial rating in excess of 20 percent for the Veteran's service-connected right knee disability, rated pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5003. Under Diagnostic Code 5003, arthritis shown by x-ray studies is rated based upon limitation of motion of the affected joint or joints. When limitation of motion is noncompensable under a limitation of motion code, but there is satisfactory evidence of painful motion, as is the case here, a 10 percent rating may be assigned for each major joint or group of minor joints so affected. 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. In the absence of limitation of motion, x-ray evidence of arthritis involving two or more major joints or two or more minor joint groups, will warrant a rating of 10 percent. If there are occasional incapacitating exacerbations, a 20 percent rating is assigned for the arthritis without limitation of motion involving two or more major joints or two or more minor joint groups with incapacitating episodes. The above ratings are to be combined, not added under Diagnostic Code 5003. 38 C.F.R. § 4.71a, Diagnostic Code 5003, Note 1. Under 38 C.F.R. § 4.45, for purposes of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae are considered groups of minor joints. During the March 2019 VA examination, the examiner diagnosed only hallux rigidus of the right foot. The Veteran reported pain as painful motion of the foot/toes, but no flare-ups or functional impairment. The examiner found the Veteran's symptoms to be mild or moderate with functional loss resulting in less movement than normal, pain on movement, and limitation of motion of the great toe. The examiner further found the functional impact of the Veteran's condition to include increased pain with limitation for activities which require great toe motion. Based upon the examiner's findings attributing the limitation of motion and pain due to the hallux rigidus diagnosis, not arthritis, a compensable rating under Diagnostic Code 5003 is not warranted. 38 C.F.R. § 4.71a. There evidence of record is absent of any evidence to the contrary. As the preponderance of the evidence is against the appellant's claim of entitlement to a compensable rating for the service-connected osteoarthritis of the right first metatarsal phalangeal joint, the benefit of the doubt doctrine is inapplicable, and the appellant's claims for increased ratings here must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). B. J. KOMINS Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Ardalan, 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.