Citation Nr: 21077027 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 16-18 486 DATE: December 28, 2021 ORDER An initial disability rating in excess of 10 percent prior to May 17, 2021 and in excess of 20 precent thereafter for residuals, left hip stress fracture is denied. An initial compensable disability rating for residuals, left hip stress fracture, limitation of flexion is denied. Entitlement to a separate noncompensable (zero percent) disability rating, but no higher, from January 25, 2014 for residuals, left hip stress fracture, limitation of extension is granted. An initial compensable disability rating for residuals, left tibia stress fracture is denied. REMANDED Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. Prior to May 17, 2021, the Veteran's left hip disability resulted in limitation of abduction to, at most, 45 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. 2. As of May 17, 2021, the Veteran has been assigned the maximum schedular rating for impairment of the thigh manifested by limitation of adduction, abduction, and rotation of the right hip. 3. For the entire appeal period, the Veteran's flexion of the left hip was limited to, at most, 80 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. 4. For the entire appeal period, the Veteran's extension of the left hip was limited to, at most, 15 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. 5. For the entire appeal period, the Veteran's left hip disability did not result in ankylosis of the hip, flail joint of the hip, or impairment of the femur. 6. For the entire appeal period, the Veteran's residuals, left tibia stress fracture is not manifested by either malunion of the left tibia and fibula with a slight knee disability which required treatment for no less than 12 consecutive months and was unresponsive to either shoe orthotics or other conservative treatment; such disability was also manifested by full flexion and extension, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination or as a result of repetitive motion and/or flare-ups, without ankylosis, recurrent subluxation or lateral instability, dislocation or removal of semilunar cartilage, or genu recurvatum. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent prior to May 17, 2021, and in excess of 20 percent thereafter for residuals, left hip stress fracture have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5253. 2. The criteria for an initial compensable rating for residuals, left hip stress fracture, limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5252. 3. The assignment of the separate rating for limitation of extension of the left hip, evaluated as zero percent, but no higher, from January 25, 2014 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5251. 4. The criteria for an initial compensable rating for residuals, left tibia stress fracture have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5299-5262. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 2013 to January 2014. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in August 2014 by a Department of Veterans Affairs (VA) Regional Office. In October 2018 and April 2021, the Board remanded the appeal for additional development. While on remand, a May 2021 rating decision awarded a separate noncompensable rating for residuals, left hip stress fracture, limitation of extension as of May 17, 2021. Thus, such issue has been included in the appeal and the case now returns for further appellate review. Furthermore, in September 2021, the Board notes that the Veteran submitted a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) and requested direct review of the evidence considered by the Agency of Original Jurisdiction (AOJ) in the May 2021 rating decision under the Appeals Modernization Act (AMA). However, the claims for increased ratings regarding his left hip disability were still pending under the legacy appeal system. Thus, the September 2021 Notice of Disagreement is invalid and such claims will not be adjudicated pursuant to the AMA. Increased Ratings 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. 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. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in 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. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 38 C.F.R. § 4.40. 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). 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 nonweight-bearing and, if possible, with the range of the opposite undamaged joint." 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. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). Furthermore, the Veteran has not raised any other issues other than her claim for a TDIU, which will be addressed below, nor have any other issues been reasonably raised by the record with regard to the increased rating claims adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 1. Entitlement to an initial rating in excess of 10 percent prior to May 17, 2021 and in excess of 20 precent thereafter for residuals, left hip stress fracture. 2. Entitlement to an initial compensable rating for residuals, left hip stress fracture, limitation of flexion. 3. Entitlement to an initial compensable rating for residuals, left hip stress fracture, limitation of extension from May 17, 2021. The Veteran's residuals of left hip stress fracture are evaluated as 10 percent disabling as of January 25, 2014, the date of service connection, and 20 percent disabling as of May 17, 2021, pursuant to DC 5253. 38 C.F.R. § 4.71a. The Veteran is also in receipt of a separate noncompensable rating for left hip limitation of flexion, effective January 25, 2014, pursuant to DC 5252. Additionally, in the May 2021 rating decision, the AOJ awarded a separate noncompensable rating for left hip limitation of extension as of May 17, 2021, pursuant to DC 5251. Here, the Board will review the entirety of the evidence with consideration of higher and/or additional separate ratings for the Veteran's service-connected left hip disability. Normal range of hip motion is 125 degrees of flexion, 140 degrees of extension, and 45 degrees of abduction. 38 C.F.R. § 4.71, Plate II. Diagnostic Code 5251 provides that limitation of extension of the thigh to 5 degrees warrants a 10 percent rating. Diagnostic Code 5252 provides that limitation of flexion of the thigh to 45 degrees warrants a 10 percent rating. Flexion limited to 30 degrees warrants a 20 percent rating. Flexion limited to 20 degrees warrants a 30 percent rating and flexion limited to 10 degrees warrants a 40 percent rating. Diagnostic Code 5253 provides that impairment of the thigh resulting in limitation of rotation of the affected leg such that the veteran cannot toe-out more than 15 degrees warrants a 10 percent rating. Impairment of the thigh resulting in limitation of adduction and an inability to cross legs warrants a 10 percent rating. Impairment of the thigh resulting in limitation of abduction and motion lost beyond 10 degrees warrants a 20 percent rating. 38 C.F.R. § 4.71a. In this regard, for the appeal period prior to May 17, 2021, Diagnostic Code 5253 provides that, in order to assign a rating in excess of 10 percent based on impairment of the thigh, the evidence must demonstrate limitation of abduction with motion lost beyond 10 degrees. However, the June 2014 VA examination reflects limitation of abduction to 45 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 or flare-ups. Additionally, October 2019 and November 2019 VA treatment records noted that her left hip range of motion was within normal limits. Thus, such findings do not support the assignment of a rating in excess of 10 percent for her left hip disability prior to May 17, 2021. The Veteran also asserts that her left hip disability warrants compensable ratings based on additional limited range of motion, specifically to include extension and flexion. As noted above, Diagnostic Codes 5251 and 5252 provide compensable ratings for extension limited to five degrees and flexion limited to 45 degrees, respectively. Medical records show that for the entire appeal period, extension was limited to, at most, 15 degrees while flexion was limited to, at most, 80 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 or flare-ups. Thus, such findings do not support the assignment of compensable ratings for limitation of extension and flexion for the entire appeal period. Despite the fact that the Veteran does not meet the criteria for a compensable rating for limitation of flexion and extension, and his functional impairment resulting from pain and limited motion is already contemplated in his currently assigned 10 percent rating based on painful motion of the left hip, the AOJ granted a separate noncompensable rating for limitation of flexion, effective January 25, 2014. However, a separate rating for limitation of extension was not effective until May 17, 2021. Nonetheless, the Board finds that an effective date of January 25, 2014, but no earlier, is warranted for the assignment of the noncompensable rating for limitation of extension. In this regard, the AOJ awarded such rating based on limitation of extension beyond 5 degrees, effective from the date of the May 17, 2021 VA examination. However, the Veteran also had limitation of extension beyond 5 degrees during her June 2014 VA examination, which was limited to 30 degrees. Thus, a separate noncompensable rating for residuals, left hip stress fracture, limitation of extension is warranted for the entire appeal period stemming from the January 25, 2014, date of service connection for the Veteran's left hip disability. As mentioned previously, the Veteran is in receipt of a 20 percent rating for her left hip disability as May 17, 2021, pursuant to DC 5253. In this regard, on such date, the Veteran underwent a VA examination at which time initial range of motion testing revealed flexion to 90 degrees, extension to 20 degrees, abduction to 15 degrees, adduction to 15 degrees, external rotation to 20 degrees, and internal rotation to 20 degrees. Adduction was limited such that the Veteran could not cross her legs. There was no additional loss of range of motion following repetitive use testing; however, following repeated use over time and during flare-ups, the examiner estimated that flexion would be limited to 80 degrees, extension would be limited to 15 degrees, abduction would be limited to 10 degrees, and adduction would be limited to 10 degrees, and external and internal rotation would be limited to 15 degrees. Based on such findings, the May 2021 rating decision awarded an increased rating of 20 percent for the Veteran's residuals, left hip stress fracture, which is the maximum schedular rating under DC 5253. Based on the foregoing, initial ratings in excess of 10 percent prior to May 17, 2021 and in excess of 20 precent thereafter for residuals, left hip stress fracture under DC 5253 are not warranted. Specifically, as previously discussed, the record does not show that prior to May 17, 2021, the Veteran had limitation of adduction with motion lost beyond 10 degrees. Rather, such was limited to, at most 45 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 or flare-ups. Furthermore, as of May 17, 2021, the Veteran is in receipt of the maximum schedular rating for her left hip disability under DC 5253. Thus, higher ratings based on limitation of the thigh are not warranted for either period on appeal. Additionally, as discussed previously, as of January 25, 2014, but no earlier, a separate noncompensable rating for residuals, left hip stress fracture, limitation of extension is warranted. However, initial compensable ratings for limitation of extension and flexion are not warranted as the Veteran's extension was limited to at most 15 degrees and flexion was limited to at most 80 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 or flare-ups. The Board has also considered whether higher and/or separate ratings are warranted under any other applicable Diagnostic Code. However, as the medical evidence does not reflect ankylosis of the hip, flail joint of the hip, or impairment of the femur, higher and/or separate ratings are not warranted under Diagnostic Codes 5250, 5254, or 5255. 38 C.F.R. § 4.71a. In reaching its conclusions in the instant case, the Board acknowledges the Veteran's belief that her left hip disabilities are more severe than as reflected by the current assigned disability ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe her symptomatology, she is not competent to provide an opinion regarding the severity of her symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged her reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than her own reports regarding the severity of her disabilities. The Board has also considered whether additional staged ratings under Fenderson, supra, are appropriate for the Veteran's service-connected left hip disabilities; however, the Board finds that her symptomatology has been stable throughout each period on appeal. Thus, the assignment of additional staged ratings for such disabilities is not warranted. Therefore, initial ratings excess of in excess of 10 percent prior to May 17, 2021, and in excess of 20 precent thereafter for residuals, left hip stress fracture is not warranted. Additionally, an initial compensable rating for limitation of flexion is not warranted and, as of January 25, 2014, but no earlier, an initial compensable rating for limitation of extension is warranted. Consequently, the Board finds that higher or additional ratings for the Veteran's left hip disability are not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's initial rating claims, such doctrine is inapplicable in the instant appeal and the claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 4. Entitlement to an initial compensable rating for residuals, left tibia stress fracture. The appeal period before the Board begins on January 25, 2014, the date service connection was awarded for residuals, left tibia stress fracture. Such disability has been rated as noncompensably disabling for the entire appeal period pursuant to DC 5299-5262, represents an unlisted musculoskeletal disability rated on the provisions pertaining to impairment of the tibia and fibula. See 38 C.F.R. § 4.20 (providing that when an unlisted condition is encountered, it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous); 38 C.F.R. § 4.27 (providing that unlisted disabilities will be rated by analogy under a diagnostic code built up using the first 2 digits from that part of the Rating Schedule most closely identifying the body part or system affected and by using "99" for the last 2 digits, with an additional diagnostic code used to identify the basis for the evaluation assigned following a hyphen). The Board notes that, during the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select DCs "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110 (g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38U.S.C. §5110 (g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38U.S.C. §5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Under the former criteria for DC 5262, a 10 percent rating is assigned for malunion of tibia and fibula with slight knee or ankle disability. 38 C.F.R. § 4.71a. A 20 percent rating is assigned for malunion of the tibia and fibula with moderate knee or ankle disability. Id. A 30 percent rating is assigned for malunion of the tibia and fibula with marked knee or ankle disability. A 40 percent rating, the maximum schedular rating available, is assigned for nonunion of the tibia and fibula with loose motion requiring a brace. Id. According to Merriam Webster's Collegiate Dictionary (11th Ed. 2007), "slight" means small in amount. "Moderate" means limited in scope or effect. "Marked" means having a distinctive or emphasized character. Under the version of DC 5262 that became effective on February 7, 2021, a noncompensable rating is assigned for medial tibial stress syndrome (MTSS) or shin splints requiring treatment for less than 12 consecutive months of one of both lower extremities. A 10 percent rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to either show orthotics or other conservative treatment of one or both lower extremities. A 20 percent rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment for one lower extremity. A 30 percent rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment of both lower extremities. A 40 percent rating is assigned for nonunion of the tibia and fibula, with loose motion, requiring brace. 38 C.F.R. § 4.71a, DC 5262. Malunion of the tibia and fibula must be evaluated under Diagnostic Codes 5256, 5257, 5260, or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation. Id. Initially, the Board notes that Diagnostic Codes 5256 (ankylosis of the knee), 5257 (knee joint instability and/or subluxation), 5258, and 5259 (dealing with meniscal injuries) are not for application, as the Veteran retains movement of the knee and there is neither evidence nor assertion of left knee instability or meniscal damage. See 38 C.F.R. § 4.71a. Neither is there evidence of painful or restricted movement of the left knee or ankle, so as to warrant rating the Veteran's left tibia stress fracture residuals under Diagnostic Codes 5260 (limitation of flexion of the leg), 5261 (limitation of extension of the leg), 5270 (ankylosis of the ankle), or 5271 (limited motion of the ankle). In this regard, turning to the evidence of record, on VA examination in June 2014, the examiner noted that the Veteran had an asymptomatic 2013 left tibia stress fracture with residual intermittent pain. Specifically, the Veteran reported that she had recurrent pain in the left leg, which she described as intermittent shooting sharp pains from the left hip to the mid left tibia. The examiner noted the Veteran had function loss and/or function impairment of the knee and lower leg as she had increased pain in the left lower extremity with standing greater than 30 minutes. The Veteran also reported she could not return to her job prior to entering the military, which was as a salesperson at Party City because she could not stand for 8 hours daily with only one or two 15-minute breaks. With regard to the Mitchell criteria, the examiner noted that she could not resolve this issue without resorting to mere speculation as any effect of flares or repetitive motion would vary from incident to incident in intensity and severity. She also noted that these events would occur unobserved by her; thus, for these reasons, she could not determine any increased loss of motion or functional impairment without resorting to mere speculation. Nonetheless, the Veteran did not report flare-ups during the examination. Additionally, the June 2014 left knee and left tibia X-rays were normal. In this regard, such revealed that there was no left tibia fracture or dislocation seen and that the left knee joint space was well maintained and the compartments were unremarkable with normal alignment. Subsequent treatment records indicate that the Veteran continued to complain of left leg pain; however, the Veteran also had passive/active left knee range of motion within full limits in October 2018. November 2019 X-rays also revealed that she had a normal left tibia. In May 2021, the Veteran underwent another VA examination and the Veteran reported that her current symptoms included swelling and numbness when she overused. She also reported flare-ups of the left knee that occurred 4 times per week and that such were severe and could last over a day. She also stated that such flare-ups were precipitated by her weight gain. The Veteran also reported that flexing her knee down was difficult, which made bending and squatting hard. Nonetheless, upon examination, her left knee revealed full ranges of motion, 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 or flare-ups. Passive range of motion was also normal and there was pain with weight-bearing and such caused functional loss as she had trouble standing, sitting, walking for extended periods of time, using stairs, kneeling, and squatting. X-rays of the left tibia-fibula also showed no evidence for fracture or other significant bone, joint, or soft tissue abnormality. The examiner further noted that the stress fracture did not affect the left knee or ankle range of motion. Based on the foregoing, the Board finds that the preponderance of the evidence is against an initial compensable disability rating for the Veteran's service-connected left tibia disability. Specifically, for the next-higher rating under the former rating criteria to be warranted under DC 5262, the evidence must demonstrate at least malunion of the left tibia and fibula with slight knee or ankle disability. The Board acknowledges the Veteran's reports of left lower extremity pain. However, even considering the Veteran's lay reports of symptoms regarding her left tibia, the medical evidence of record, to include the June 2014 VA examination and X-rays, as well as post-service treatment records prior to February 7, 2021, is silent for evidence of any malunion of the left tibia and fibula with a slight knee or ankle disability. As such, an initial compensable disability rating is not warranted under the former rating criteria for Diagnostic Code 5262. Under the amended rating criteria for Diagnostic Code 5262, the Board also finds that the preponderance of the evidence is against an initial compensable disability rating for the Veteran's service-connected left tibia disability. Here, the medical evidence of record from February 7, 2021 to the present does not demonstrate that her left tibia disability required treatment for no less than 12 consecutive months and was unresponsive to either shoe orthotics or other conservative treatment as noted by the May 2021 VA examiner. As such, an initial compensable disability rating for her left tibia disability under the amended criteria for Diagnostic Code 5262 is not warranted. In reaching its conclusion in the instant case, the Board acknowledges the Veteran's belief that her left tibia disability is more severe than as reflected by the currently assigned disability rating. However, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding her observable symptomatology, she is not competent to provide an opinion regarding the severity of her symptomatology in accordance with the rating criteria. See Woehlaert, supra. Ultimately, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged her reported symptoms, and described the manifestations of her left tibia disability in light of the rating criteria to be more persuasive than her own reports regarding the severity of such disability. The Board has also considered whether staged ratings under Fenderson, supra, are appropriate for the Veteran's service-connected left tibia disability; however, the Board finds that her symptomatology has been stable throughout the appeal period. Therefore, assigning staged ratings for such disability are not warranted. In sum, the Board finds that an initial compensable rating for the Veteran's residuals, left tibia stress fracture is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the instant claim, such doctrine is inapplicable and it must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 5. Entitlement to a TDIU. The Board finds that a remand is warranted as additional development is needed to adjudicate the Veteran's claim for a TDIU. In this regard, in her June 2021 Veteran's Application for Increased Compensation for Unemployability (VA Form 21-8940), the Veteran reported that she last held employment on June 10, 2021 as a behavior teacher and was working 20 hours per week. However, in July 2021, the Veteran's employer submitted a Request for Employment Information in Connection with Claim for Disability Benefits (VA Form 21-4192) revealing that the Veteran was currently employed as a part-time employee working 10 to 15 hours per week, but did not qualify for benefits at this time. However, no other information was provided, including the Veteran's salary. Thus, the Board finds that a remand is necessary as the Veteran should be requested to complete and submit an updated VA Form 21-8940. On remand, the AOJ should also contact the Veteran's employer to complete another VA Form 21-4192 with all the requested information noted, including the Veteran's salary. The matter is REMANDED for the following action: The Veteran should be requested to complete and submit an updated VA Form 21-8940, listing her complete employment and educational history, to include part-time and seasonal employment. The AOJ should also contact the Veteran's employer regarding her employment and request that such entity complete and return VA Form 21-4192, or other appropriate form, detailing the dates of the Veteran's employment and the salary she earned while employed. Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Clark 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.