Citation Nr: 21077300 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 15-01 769 DATE: December 29, 2021 ORDER Entitlement to an increased evaluation in excess of 10 percent prior to December 29, 2014 and in excess of 20 percent thereafter for varicose veins of the right lower extremity (RLE) is denied. Entitlement to an increased evaluation in excess of 10 percent prior to December 29, 2014 and in excess of 20 percent thereafter for varicose veins of the left lower extremity (LLE) is denied. Entitlement to an increased evaluation in excess of 20 percent for a left foot disorder is denied. Entitlement to an increased evaluation in excess of 10 percent for a left ankle disorder is denied. FINDINGS OF FACT 1. The evidence supports a finding that prior to December 29, 2014, the Veteran's varicose veins of the right lower extremity is manifested by intermittent edema, relieved by elevation of extremity or compression hosiery. 2. The evidence supports a finding that since December 29, 2014, the Veteran's varicose veins of the right lower extremity is manifested by persistent edema, incompletely relieved by elevation of the extremity. 3. The evidence supports a finding that prior to December 29, 2014, the Veteran's varicose veins of the left lower extremity is manifested by intermittent edema, relieved by elevation of extremity or compression hosiery. 4. The evidence supports a finding that since December 29, 2014, the Veteran's varicose veins of the left lower extremity is manifested by persistent edema, incompletely relieved by elevation of the extremity. 5. The evidence supports a finding that the Veteran's bilateral foot disability is manifested by moderately severe symptoms. 6. The evidence supports a finding that the Veteran's left ankle disorder is manifested by moderate limitation of the left ankle motion (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion). CONCLUSIONS OF LAW 1. The criteria for an increased evaluation in excess of 10 percent prior to December 29, 2014 and in excess of 20 percent thereafter for varicose veins of the RLE have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.951, 4.1-4.7, 4.104, Diagnostic Code 7120. 2. The criteria for an increased evaluation in excess of 10 percent prior to December 29, 2014 and in excess of 20 percent thereafter for varicose veins of the LLE are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.951, 4.1-4.7, 4.104, Diagnostic Code 7120. 3. The criteria for an increased evaluation in excess of 20 percent for a left foot disorder are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.17a, Diagnostic Code 5003-5284. 4. The criteria for an increased evaluation in excess of 10 percent for a left ankle disorder are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.17a, Diagnostic Code 5010-5271. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1998 to October 2004. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from an August 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Board remanded this claim for further development, which has since been substantially completed. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (2002). By way of background, the Veteran filed a claim for entitlement to service connection for the above disorders in August 2004. In the November 2004 rating decision on appeal the RO awarded service connection for the Veteran's RLE and LLE varicose veins and assigned a 10 percent disability rating effective November 1, 2004. The RO also awarded service connection for the Veteran's left foot fracture and assigned a 10 percent disability rating effective November 1, 2004. The Veteran appealed the assigned initial rating, but did not perfect. In a June 2008 rating decision, the RO assigned an increased evaluation of 20 percent effective February 15, 2008 for the Veteran's left foot fracture. In a July 2010 rating decision, the RO awarded service connection for a left ankle disorder and assigned a 10 percent evaluation effective October 22, 2009. No NODs were filed with these decisions. The Veteran filed a new informal claim in August 2011. In an August 2012 rating decision, the RO, confirmed and continued: a 20 percent disability evaluation for the service-connected left foot disability; a 10 percent disability evaluation for service-connected varicose veins (each), and a 10 percent disability evaluation for the service-connected left ankle disability. The Board remanded the Veteran's claims for additional development in a March 2019. In an October 2020 rating decision, the RO assigned an increased evaluation of 20 percent effective December 29, 2014 for the Veteran's varicose veins of the RLE and LLE. The Board again remanded the Veteran's claims for additional development in a February 2021 remand. The Veteran's claim was last adjudicated in an April 2021 supplemental statement of the case. The Veteran continues to assert entitlement to a higher ratings for her claims above. The Board also notes that the RO sent the Veteran a February 2021 VA-21-4142 letter to obtain treatment records from June 2012 to April 2021. As of this date, no reply to this request for evidence has been received from Veteran. Laws and Regulations Increased Ratings Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. A Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). 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 (2011), the Court held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id. 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. 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. 38 C.F.R. § 4.59. In Burton v. Shinseki, 25 Vet. App. 1, 5 (2011), the Court found that, when 38 C.F.R. § 4.59 is raised by the claimant or reasonably raised by the record, even in non-arthritis contexts, the Board should address its applicability. Notwithstanding the above, VA is required to provide separate evaluations for separate manifestations of the same disability which are not duplicative or overlapping. See Esteban v. Brown, 6 Vet. App. 259, 261 (1994). If it is not possible to distinguish between the respective symptoms because they are so intertwined, then the symptoms will be attributed to the service-connected disability. See 38 C.F.R. §§ 3.102, 4.14; Mittleider v. West, 11 Vet. App. 181, 182 (1998). 38 C.F.R. § 4.104 is the Schedule of Ratings for Cardiovascular System. Diagnostic Code 7120 provides a rating for varicose veins. A 10 percent disability rating is warranted for intermittent edema of the extremity or aching and fatigue in the leg after prolonged standing or walking, with symptoms relieved by elevation of extremity or compression hosiery; a 20 percent disability rating is warranted for persistent edema, incompletely relieved by elevation of the extremity, with or without beginning stasis pigmentation or eczema; a 40 percent disability rating is warranted for persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration; a 60 percent disability rating is warranted for persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration; and a 100 percent disability rating is warranted for massive board-like edema with constant pain at rest. 38 C.F.R. § 4.104, Diagnostic Code 7120. Prior to February 7, 2021, the Veteran's left ankle sprain is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5271, for limitation of motion of the ankle. Under Diagnostic Code 5271, a 10 percent rating is warranted for moderate limited motion of the ankle and a 20 percent rating is warranted for marked limited motion of the ankle. Id. Effective February 7, 2021, VA amended the rating criteria for Diagnostic Code 5271. 85 Fed. Reg. 76,453 (Nov. 30, 2020). Under the new criteria, a 10 percent rating is warranted for moderate limited motion of the ankle (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion.) A 20 percent rating is warranted for marked limited motion of the ankle (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion.) As this regulatory change was enacted during the pendency of this appeal, the Board will consider both the old and new versions of the rating criteria from the effective date and apply the version most favorable to the Veteran. Words such as "severe," "moderate," and "mild" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for a higher disability rating. Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). Also, for consideration, under Diagnostic code 5270, a 20 percent evaluation will be assigned for plantar flexion less than 30 degrees. A 30 percent evaluation will be assigned for ankle ankylosis in plantar flexion between 30 degrees and 40 degrees, or dorsiflexion between 0 degrees and 10 degrees. A 40 percent evaluation will be assigned for ankle ankylosis in plantar flexion at more than 40 degrees, or in dorsiflexion between 0 degrees and 10 degrees. C.F.R. § 4.71a, Diagnostic Code 5270. Also, for consideration, under Diagnostic code 5270, a 20 percent evaluation will be assigned for plantar flexion less than 30 degrees. A 30 percent evaluation will be assigned for ankle ankylosis in plantar flexion between 30 degrees and 40 degrees, or dorsiflexion between 0 degrees and 10 degrees. A 40 percent evaluation will be assigned for ankle ankylosis in plantar flexion at more than 40 degrees, or in dorsiflexion between 0 degrees and 10 degrees. C.F.R. § 4.71a, Diagnostic Code 5270. 38 C.F.R. § 4.71a is the Schedule of Ratings for Musculoskeletal System. Diagnostic Code 5284 provides a rating for foot injuries. A 10 percent rating is assigned for a moderate condition, 20 percent for moderately severe, and 30 percent for a severe foot injury. 38 C.F.R. § 4.71a, Diagnostic Code 5284. Also for consideration is pes planus. Under Diagnostic Code 5276, a 10 percent rating is warranted for moderate acquired flat foot; weight-bearing line over or medial to great toe, inward bowing of the Tendo Achillis, pain on manipulation and use of the feet, bilateral or unilateral. A 20 percent rating is assigned for severe unilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is warranted for severe bilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is also warranted for pronounced unilateral acquired flatfoot; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the Tendo Achillis on manipulation, not improved by orthopedic shoes or appliances. A maximum 50 percent rating is warranted for bilateral acquired flatfoot; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the Tendo Achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276. 1. Entitlement to an increased evaluation in excess of 10 percent prior to December 29, 2014 and in excess of 20 percent thereafter for varicose veins of RLE 2. Entitlement to an increased evaluation in excess of 10 percent prior to December 29, 2014 and in excess of 20 percent thereafter for varicose veins of the LLE As indicated in a January 2020 VA artery and vein examination, the clinical records in this case establish that the Veteran has had ongoing varicose veins of her LLE and RLE. The Veteran's contention in an October 2021 Appellate Brief is that her symptoms prior to December 29, 2014 warrant an evaluation in excess of 10 percent and in excess of 20 percent thereafter. Specifically, the Veteran asserts that she is entitled to an evaluation of 20 percent since August 18, 2010. The Veteran also asserts that she is entitled to a separate evaluation for restless leg syndrome of the lower extremities. In an April 2010 VA Veins examination, the Veteran reported that her varicose veins have increased in aching and swelling since she was last examined. She reported that her legs feel tired and restless with prolonged standing. The examiner diagnosed the Veteran as negative for sores or ulcers in her legs. The examiner also noted that the Veteran did not have any palpable varicose veins although she did have superficial varicose veins sparingly and bilaterally of the lower extremities. The examiner noted no evidence of inflammation, swelling edema, or increased pigmentation. The Veteran also reported that her symptoms have improved with the wearing of prescribed compression socks. In a July 2012 VA Vein examination, the examiner diagnosed the Veteran with bilateral lower extremity varicose veins. The Veteran reported intermittent pain prolonged when walking or standing. Aching, fatigue, and restlessness bilaterally of the legs was noted. The examiner noted in the negative for edema. Regarding functional and occupational limitations, the examiner noted that the Veteran's vascular disorder does not impact her ability to work. After a thorough review of the record, the Board concludes that the current evidence does not provide a basis for granting a higher 20 percent evaluation for the Veteran's varicose vein disorder bilaterally of the lower extremities prior to December 29, 2014. As determined by VA examiners, there is no evidence of persistent edema, incompletely relieved by elevation of the extremity, with or without beginning stasis pigmentation or eczema. Although palpable varicose veins of the lower extremities bilaterally were noted with intermittent pain, aching, and fatigue during periods of prolonged standing was noted, there were no findings of persistent edema, or ulceration, to warrant the assignment of a 20 percent evaluation. As such, the preponderance of the evidence does not warrant the assignment of an evaluation in excess of 10 percent as there is no evidence in the record to support a diagnosis for persistent edema, incompletely relieved by elevation of the extremity, with or without beginning stasis pigmentation or eczema to warrant the assignment of a 20 percent evaluation under Diagnostic Code 7120 prior to December 29, 2014. On/after December 29, 2014, in a January 2020 VA vein examination, the examiner diagnosed the Veteran with varicose veins of the lower extremities bilaterally. The Veteran reported the use of prescribed medication for her restless legs. Post-phlebitic syndrome bilaterally was noted with aching leg pain diagnosed during periods of prolonged standing or walking. The examiner noted that the Veteran's symptoms were relieved by elevation of the extremity. Intermittent edema of the extremity and persistent edema was noted bilaterally. Vascular ultrasound findings were negative for deep veins thrombosis. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). After a thorough review of the record, the Board concludes that the current evidence does not provide a basis for granting a higher 40 percent evaluation for the Veteran's varicose vein disorder bilaterally of the lower extremities on/after December 29, 2014. As determined by the VA examiner, there is no evidence of persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. Although there was evidence of persistent edema bilaterally of the lower extremities relieved by elevation, there was no findings of persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration to warrant the assignment of a 40 percent evaluation under Diagnostic Code 7120 on/after December 29, 2014. As such, the Board finds that the preponderance of the evidence does not warrant the assignment of an evaluation in excess of 20 percent as there is no evidence in the record to support a diagnosis for persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. As such, the preponderance of the evidence does not warrant the assignment of an evaluation in excess of 10 percent prior to December 29, 2014 or in excess of 20 percent thereafter. The Board also considered the assignment of a separate evaluation for restless leg syndrome under Mittleider as indicated in the Veteran's October 2021 informal hearing presentation. The Board notes that the findings of restless leg syndrome were noted in various VA examinations and are already encompassed by the assignment 10 percent rating in the schedule prior to December 29, 2014 and the 20 percent rating thereafter as the DC 7120 refers to "symptoms." The Board finds that based on the evidence of the claims file, the assigned 10 percent evaluation prior to December 29, 2014 and the 20 percent evaluation currently assigned better approximates the trajectory of the Veteran's varicose vein disorder. As the Board reviewed the Veteran's records and determined that they do not support an increased disability rating in excess of 20 percent for this disorder, the evidence for this period preponderates against an increase so reasonable doubt provisions are inapplicable. 38 C.F.R. § 3.102 3. Entitlement to an increased evaluation in excess of 20 percent for a left foot disorder As indicated in a January 2020 VA foot examination, the clinical records in this case establish that the Veteran has had ongoing degenerative arthritis and degenerative joint disease of her left foot since her initial February 2008 diagnosis. The Veteran's contention in an October 2021 Appellate Brief is that her left foot symptoms since August 18, 2010 warrants an evaluation in excess of 20 percent; specifically, to 30 percent disabling. The Veteran also contends that she is entitled to a separate evaluation for hallux valgus. In an April 2010 VA Feet examination, the examiner diagnosed the Veteran with a Lisfranc fracture of the left foot and post-traumatic arthritis of the left foot. The Veteran reported weight-bearing pain during activities, but denied flare-ups, weakness, heat, or redness. During the examination, the examiner noted normal gait with arthritis midfoot and spurring. Tenderness to palpitation of the midfoot with spurring was noted. The examiner also noted 10 degrees hallux valgus in the left foot with no tenderness to palpitation at the first MTP point. Regarding functional and occupational limitations, the Veteran reported that she has not missed any work in the past twelve months due to her left foot problems April 2010 MRI findings reveal degenerative changes of the hindfoot and the talonavicular joint. In a July 2012 VA foot examination, the examiner diagnosed the Veteran with a Lisfranc left foot fracture. The examiner diagnosed hallux valgus of the left foot with no evidence of pes cavus or malunion of nonunion of the tarsal or metatarsal bones. Evidence of weak foot was noted with the Veteran favoring her left foot with walking as evidence by a mild limp. Diagnostic imaging findings reveal abnormal findings with degenerative or traumatic arthritis. Regarding functional and occupational limitations, the examiner noted that the Veteran's left foot disorder does not impact her ability to work. A May 2015 podiatry note showed deep tendon reflexes intact and somatosensory sensations were normal in the left foot, along with palpable pulses. Palpation of all bones, joints and ligaments were within normal limits. Although, pain was noted around the left mid-foot, muscle strength and tone were described as normal. In a January 2020 VA foot disorder examination, the examiner diagnosed the Veteran with degenerative arthritis and degenerative joint disease with the residuals of a left foot fracture. The Veteran reported left foot pain and flare-ups of her left foot with prolonged walking or weather changes. The examiner diagnosed the Veteran with left foot pain with the manipulation of her feet with no evidence of swelling on use. Characteristic callouses were also diagnosed with no evidence of tenderness of plantar surfaces or objective evidence of marked deformity. Pain on weight-bearing was noted with excess fatigability. Imaging findings revealed degenerative arthritis of the left foot. Regarding functional and occupational limitations, the examiner noted that the Veteran's left foot disorder impacts her ability to work. The examiner noted that the Veteran is unable to walk or stand for prolonged periods of time. As noted in the 2020 VA vein and artery examination report, the Veteran worked in a job dealing with mortgages where she noted she had to "change positions and move around." She did not note she had a job where she had to be on her feet consistently. After a thorough review of the record, the Board concludes that the current evidence does not provide a basis for granting a higher 30 percent evaluation for the Veteran's left foot disorder. As determined by VA examiners, there is no evidence of a severe foot injury. Although there is a history of a left foot fracture with residual post-traumatic arthritis, and weight bearing pain, there is no evidence of a pronounced unilateral acquired flatfoot (DC 5276), weak foot (DC 5277), claw foot (DC 5278), metatarsalgia (DC 5279), hallux rigidus (DC 5281), hammer toe (DC 5282), or mal- or nonunion of bones (DC 5283). The Board also considered the assignment of a separate evaluation under Diagnostic Code 5280 for hallux valgus under Mittleider as requested in the Veteran's October 2021 informal hearing presentation. A review of the record reveals no findings that the Veteran underwent a left foot operation for the resection of the metatarsal head or that the Veteran has experienced the equivalent of an amputation of the great big toe to warrant the assignment of a separate evaluation under Diagnostic Code 5280. This rating on its own does not provide for an increase. The United States Court of Veterans Claims (the Court) has held that when a when a condition is specifically listed in the Schedule, it may not be rated by analogy under DC 5284. Copeland v. McDonald, 27 Vet. App. 333, 337 (2015). Also, the critical element in permitting the assignment of several ratings under various DCs is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. at 261-62; 38 C.F.R. § 4.14 (precluding the assignment of separate ratings for the same manifestations of a disability under different diagnoses). While the IHP stated the VA 2012 examination report was inadequate, the Board reviewed subsequent reports and finds those reports were fully adequate and allows the disability to be rated as the symptoms and findings were fully on point and address the severity of the foot symptoms. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). The Board finds that based on the evidence of the claims file, the 20 percent evaluation currently assigned better approximates the trajectory of the Veteran's left foot disorder. As the Board reviewed the Veteran's records and determined that they do not support an increased disability rating in excess of 20 percent for this disorder, the evidence for this period preponderates against an increase so reasonable doubt provisions are inapplicable. 38 C.F.R. § 3.102. 4. Entitlement to an increased evaluation in excess of 10 percent for a left ankle disorder As indicated in a January 2020 VA ankle examination, the clinical records in this case establish that the Veteran has had ongoing post-traumatic osteoarthritis of the left ankle since her initial October 2009 diagnosis. The Veteran's contention in an October 2021 Appellate Brief is that her symptoms since August 2010 warrant an evaluation in excess of 10 percent; specifically, a 20 percent rating back to August 2010. In an April 2010 VA Feet examination, the examiner diagnosed the Veteran with an ankle dislocation. The Veteran reported weight-bearing pain during activities, but denied flare-ups, weakness, heat, or redness. The Veteran complained of fatigability, stiffness, and swelling and reported that her ankle occasionally gives out. During the examination, the examiner noted a normal gait. The examiner noted evidence of ankle tenderness midfoot at the tarsometatarsal joints. The examiner also noted tenderness along the peroneal tendons in the lateral ankle with no evidence of ankle instability. Ankle dorsiflexion was noted at 10 degrees with pain noted at the end range of motion. Plantar flexion was noted at 40 degrees without pain. Regarding functional and occupational limitations, the Veteran reported that she has not missed any work in the past twelve months due to her left ankle problems. In an April 2010 VA physical therapy consultation, the Veteran was prescribed a left ankle brace. April 2010 MRI findings reveal degenerative changes of the ankle. In a July 2012 VA ankle examination, the examiner diagnosed the Veteran with a left ankle strain. The Veteran reported in the negative for flare-ups. Plantar flexion was noted at 40 degrees with objective evidence of pain noted at 35 degrees. Dorsiflexion was noted 20 degrees or greater. Excess fatigability was noted with disturbance of locomotion and weight bearing pain diagnosed. The examiner also diagnosed pain on palpitation with no evidence of laxity or ankylosis. Regarding functional and occupational limitations, the examiner noted that the Veteran's ankle disorder did not impact her ability to work. In a January 2020 VA ankle examination, the examiner diagnosed the Veteran with post-traumatic osteoarthritis of the left ankle. The Veteran reported ankle flare-ups with swelling, aches, and functional impairment. Dorsiflexion was noted at 20 degrees with plantar flexion noted at 40 degrees with no evidence of weight-bearing pain. Objective evidence of localized tenderness or pain on palpitation was noted with no evidence of crepitus, atrophy, joint instability, or ankylosis. Regarding functional and occupational limitations, the examiner noted that the Veteran's ankle disorder impacts her ability to work, stand for long periods of time, or walk. After a thorough review of the record, the Board concludes that the current evidence does not provide a basis for granting a higher 20 percent evaluation for the Veteran's left ankle disorder. Prior to the regulation change in February 2021, the Veteran denied missing work in the 2010 VA examination report. In January 2020 varicose veins examination report, she noted she worked in mortgages and the January 2020 ankle VA examination report noted impact on ability to work but that was related to prolonged standing, which as the other examination notes, she does not have to do for her current position. As a result, note that in terms of functional impairment, the Board finds the impact is moderate. As determined by the VA examiners, for after February 2021, there was no evidence of functional impairment resulting in marked limitation of motion less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion to warrant the assignment of a 20 percent evaluation. The Board also considered the assignment of a higher evaluation under Diagnostic Code 5270; however, although weight bearing and localized tenderness was noted, there were no findings of crepitus, ankylosis, joint instability, or laxity to warrant the assignment of a 20 percent evaluation under Diagnostic Code 5270. The other DCs regarding ankylosis of the subastragalar or tarsal joint (DC 5272), malunion (DC 5273) or astragalectomy (DC 5274) are not found and are not for application. As such, the Board finds that the preponderance of the evidence does not warrant the assignment of an evaluation in excess of 10 percent as there is no evidence in the record to support a diagnosis for marked limitation of ankle motion less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion to warrant a 20 percent evaluation during the rating period on appeal. The Board finds that the functional impairment of the Veteran's left ankle is moderate. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). The Board finds that based on the evidence of the claims file, the 10 percent evaluation currently assigned better approximates the trajectory of the Veteran's left ankle disorder. As the Board reviewed the Veteran's records and determined that they do not support an increased disability rating in excess of 10 percent for this disorder, the evidence for this period preponderates against an increase so reasonable doubt provisions are inapplicable. 38 C.F.R. § 3.102. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Elliot Harris 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.