Citation Nr: 21008428 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 15-21 408 DATE: February 17, 2021 ORDER Entitlement to a rating in excess of 10 percent for a right ankle lateral collateral ligament strain is dismissed. Entitlement to a rating in excess of 10 percent for a left knee degenerative joint disease prior to March 20, 2012 is denied. Entitlement to a rating in excess of 40 percent for a left knee degenerative joint disease from March 20, 2012 to September 16, 2019 is dismissed. Entitlement to a rating in excess of 50 percent for a left knee degenerative joint disease beginning on September 16, 2019 is dismissed. Entitlement to a separate rating of 10 percent, but no higher, for left knee instability is granted. Entitlement to an initial rating in excess of 10 percent for a lumbosacral strain prior to September 16, 2019, is denied. Entitlement to a rating in excess of 20 percent for a lumbosacral strain beginning September 16, 2019, is dismissed. Entitlement to an initial rating of 10 percent, but no higher, for a left hamstring strain prior to September 16, 2019, is granted. Entitlement to a rating in excess of 10 percent for a left hamstring strain beginning September 16, 2019 is dismissed. REMANDED Entitlement to a separate compensable rating for left upper extremity radiculopathy associated with service-connected lumbosacral strain is remanded. Entitlement to a separate compensable rating for left lower extremity radiculopathy associated with service-connected lumbosacral strain is remanded. FINDINGS OF FACT 1. By letter dated January 2021, prior to the promulgation of a decision in the appeal, the Veteran withdrew his claims of entitlement to a rating in excess of 10 percent for a right ankle lateral collateral ligament strain; a rating in excess of 20 percent for a lumbosacral strain beginning September 16, 2019; a rating in excess of 40 percent for a left knee degenerative joint disease from March 20, 2012 to September 16, 2019; a rating in excess of 50 percent for a left knee degenerative joint disease beginning September 16, 2019; and a rating in excess of 10 percent for a left hamstring strain beginning September 16, 2019. 2. Prior to March 20, 2012, the Veteran’s left knee degenerative joint disease was manifested by painful motion, flexion that was limited to, at worst, 110 degrees and normal 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 recurrent subluxation, effusion, ankylosis, impairment of the tibia and fibula, or genu recurvatum. 3. For the entire period on appeal, the Veteran’s left knee degenerative joint disease manifested as mild subjective instability without objective evidence of instability. 4. For the period on appeal prior to September 16, 2019, the Veteran’s lumbosacral strain was not manifested by forward flexion of 60 degrees or less, 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, incapacitating episodes due to intervertebral disc syndrome or associated objective neurological abnormalities such as bowel or bladder impairments. 5. Prior to September 16, 2019, the Veteran’s left hamstring strain was manifested by, at worst, moderate muscle impairment of the left hamstring. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the issue of entitlement to a rating in excess of 10 percent for a right ankle lateral collateral ligament strain have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 19.55. 2. The criteria for a rating in excess of 10 percent for a left knee degenerative joint disease prior to March 20, 2012, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5260. 3. The criteria for withdrawal of the issue of entitlement to a rating in excess of 40 percent for a left knee degenerative joint disease from March 20, 2012 to September 16, 2019, have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 19.55. 4. The criteria for withdrawal of the issue of entitlement to a rating in excess of 50 percent for a left knee degenerative joint disease beginning September 16, 2019, have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 19.55. 5. The criteria for a separate rating of 10 percent for left knee instability have been met for the entire period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.71a, Diagnostic Code 5257. 6. The criteria for a rating in excess rating in excess of 10 percent for a lumbosacral strain prior to September 16, 2019, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.40, 4.59, 4.71a, Diagnostic Code 5243. 7. The criteria for withdrawal of the issue of entitlement to a rating in excess of 20 percent for a lumbosacral strain beginning September 16, 2019, have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 19.55. 8. The criteria for an initial rating of 10 percent, but no higher, for a left hamstring strain prior to September 16, 2019, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.56, 4.73, Diagnostic Code 5313. 9. The criteria for withdrawal of the issue of entitlement to a rating in excess of 10 percent for a left hamstring strain beginning September 16, 2019, have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 19.55. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from September 1980 to September 1983. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in August 2018, at which time the issues currently on appeal were remanded for additional development. The case has now been returned to the Board for further appellate action. In the June 2020 rating decision, the Veteran was also assigned increased ratings for his service-connected left knee degenerative joint disease from 40 percent to 50 percent, effective September 16, 2019; lumbosacral strain from 10 percent to 20 percent, effective September 16, 2019; and left hamstring strain from noncompensable to 10 percent, effective September 16, 2019. As the Veteran is presumed to seek the maximum available benefits, these issues remain on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). In the June 2020 rating decision, the Veteran was also granted entitlement to service connection for a left ankle lateral collateral ligament sprain with osteochondroma and assigned a 10 percent rating, effective May 24, 2010; entitlement to service connection for a left knee degenerative joint disease based on limitation of flexion, and assigned a noncompensable rating, effective September 16, 2019; as well as well as entitlement to a TDIU, effective August 29, 2014, representing full grants of the matters previously on appeal. Accordingly, those matters are no longer before the Board. In September 2020, the Veteran’s attorney requested a 90 extension of time to submit additional evidence and argument in support of this appeal. The Board granted this Motion for Extension of Time in November 2020. The time period associated with this requested extension of time has expired. At the outset, the Board acknowledges that the Veteran is in receipt of a separate, noncompensable rating for left knee degenerative joint disease (limitation of flexion), effective January 16, 2019. This disability is not currently before the Board on appeal. Therefore, that rating will not be discussed in this decision. Withdrawals The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 19.55. Withdrawal may be made by the Veteran or by his or her authorized representative. 38 C.F.R. § 19.55. By letter dated January 2021, the Veteran submitted a statement stating that he wished to withdraw his claims of entitlement to a rating in excess of 10 percent for a right ankle disorder; a rating in excess of 40 percent for a left knee disorder from March 20, 2012 to September 16, 2019; a rating in excess of 50 percent for a left knee disorder beginning September 16, 2019; a rating in excess of 20 percent for a lumbosacral strain beginning September 16, 2019; and a rating in excess of 10 percent for a left hamstring strain beginning September 16, 2019. The statement indicated that the Veteran believed these claims were properly rated. This statement was signed and submitted by the Veteran’s attorney and the Veteran was included as a carbon copy. The withdrawal was effective immediately upon receipt by VA. 38 C.F.R. § 19.55. The Veteran has withdrawn the appeal on the issues of entitlement to a rating in excess of 10 percent for a right ankle disorder; a rating in excess of 40 percent for a left knee disorder from March 20, 2012 to September 16, 2019; a rating in excess of 50 percent for a left knee disorder beginning September 16, 2019; a rating in excess of 20 percent for a lumbosacral strain beginning September 16, 2019; and a rating in excess of 10 percent for a left hamstring strain beginning September 16, 2019. This withdraw was in writing, included the name of the Veteran, the file number and a specific statement as to which appeals are withdrawn. Hembree v. Wilkie, 33 Vet. App 1 (2020). Thus, as there remains no allegation of error of fact or law for appellate consideration, the Board does not have jurisdiction to review the appeals as to those issues, and they are dismissed. Increased Rating Claims Disability ratings are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. Separate evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as “staged” ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). VA’s determination of the present level of a disability may result in a conclusion that the disability has undergone varying and distinct levels of severity throughout the entire time period the increased-rating claim has been pending. Hart v. Nicholson, 21 Vet. App. 505, 509 (2007). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria.”).] The Board is also cognizant of the ruling of the Court in Rice v. Shinseki, 22 Vet. App. 447 (2009). In Rice, the Court held that a claim for a total rating based on unemployability due to service-connected disability (TDIU), either expressly raised by the Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. In this case, the Veteran is in receipt of a TDIU as of August 29, 2014 based on the combined effects of his disabilities. The Veteran has reported that he stopped working in August 2014. As such, Rice is inapplicable in this case When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Left Knee The Veteran generally asserts that he should have a higher rating for his left knee degenerative joint disease prior to March 20, 2012, as it is worse than contemplated by the currently assigned rating. This appeal stems from a claim dated in March 2010. During the period on appeal, the Veteran’s left knee degenerative joint disease is rated at 10 percent from March 23, 2010 to March 20, 2012; 40 percent from March 20, 2012 to September 16, 2019; and 50 percent thereafter under 38 C.F.R. § 4.71a, Diagnostic Code 5261. The Veteran is also assigned a separate rating for left knee degenerative joint disease (limitation of flexion) rated at noncompensable, effective September 16, 2019, pursuant to Diagnostic Code 5260. Separate ratings can be assigned for knee disabilities when none of the symptomatology overlaps and the separate rating is based on additional disabling symptomatology; this includes separate ratings based on limitation of flexion (Diagnostic Code 5260), limitation of extension (Diagnostic Code 5261), lateral instability or recurrent subluxation (Diagnostic Code 5257), and meniscal conditions (Diagnostic Codes 5258, 5259). See VAOPGCPREC 23-97, 62 Fed. Reg. 63,603 (1997); VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998); VAOPGCPREC 9-2004; 69 Fed. Reg. 59,988 (2004); Lyles v. Shulkin, 29 Vet. App. 107 (2017). The normal range of motion of the knee is from zero degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71, Plate II. Limitation of flexion warrants 10, 20, and 30 percent ratings when limitation is to 45 degrees, 30 degrees, and 15 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Limitation of extension warrants 10, 20, 30, 40, and 50 percent ratings when limitation is to 10 degrees, 15 degrees, 20 degrees, 30 degrees, and 45 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5261. A 10 percent rating can also be assigned for the knee joint if there is painful motion without compensable limitation of motion. 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Code 5003; see also Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that the applicability of 38 C.F.R. § 4.59 is not limited to arthritis claims). Recurrent subluxation and lateral instability of the knee warrants a 10, 20, or 30 percent rating if slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Ratings can also be assigned when the knee disability affects the meniscus, with a 20 percent rating for dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint and a 10 percent rating for removal of semilunar cartilage (e.g., meniscectomy) and current residual symptoms. 38 C.F.R. § 4.71a, Diagnostic Codes 5258, 5259. Ratings can also be assigned for impairment of the tibia or fibula, genu recurvatum, or ankylosis of the knee. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5262, 5263. Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). Ankylosis is also defined as “immobility and consolidation of a joint due to disease, injury, or surgical procedure.” Dorland’s Illustrated Medical Dictionary 93 (30th ed. 2003). In this case the evidence does not reflect, and the Veteran does not allege, that he has tibia or fibula impairment, genu recurvatum, or ankylosis of either knee. As such, those diagnostic codes are not for application. VA amended the criteria for rating musculoskeletal disabilities effective from February 7, 2021. These new regulations apply to all applications for benefits received by VA or that are pending before the Agency of Original Jurisdiction (AOJ) on or after February 7, 2021. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. A February 2010 private treatment note is the first post-service medical evidence of record with regard to the Veteran’s left knee. At that time, the Veteran reported left knee pain and swelling. On range of motion testing, the Veteran demonstrated left knee flexion to 120 degrees and zero degrees of extension. There was evidence of crepitus, and no evidence of instability. At a May 2010 VA examination, the Veteran reported left knee pain, stiffness and swelling. The Veteran indicated that he experienced flare-ups that typically lasted several days in duration and caused difficulty running. On examination, there was evidence of tenderness and crepitus, and no evidence of ankylosis. On range of motion testing, the Veteran demonstrated left knee flexion to 110 degrees and zero degrees of extension. There was no evidence that the Veteran experienced additional functional loss following repetitive-use or during flare-ups. No other pertinent findings were noted. A May 2010 private treatment note indicates that the Veteran experienced occasional left knee giving way and severe pain. A March 2011 private treatment report notes left knee pain, tenderness, and swelling. On range of motion testing performed at that time, the Veteran demonstrated left knee flexion to 120 degrees and zero degrees of extension. There was evidence of crepitus, and no evidence of instability. A November 2011 VA orthopedic note reveals that the Veteran was issued a left knee brace with assistance with ambulation. At a December 2011 VA examination, the Veteran reported that he did not experience left knee flare-ups. On range of motion testing, the Veteran demonstrated left knee flexion to 140 degrees and zero degrees of extension. There was no evidence of painful motion on flexion or extension. There was no evidence that the Veteran experienced additional functional loss following repetitive-use or during flare-ups. There was evidence of tenderness to palpation of the joint line. Muscle strength testing was normal. The medial/lateral collateral ligaments stability test, anterior/posterior cruciate ligaments stability test, and the medial/lateral meniscus stability test were all within normal limits. The examiner reported that the Veteran did not have ankylosis, and there was no objective evidence of subluxation or lateral instability, or a semilunar cartilage condition or recurrent patellar dislocation. The examiner noted that the Veteran did not use any devices to assist with ambulation. The examiner reported that the Veteran’s left knee degenerative joint disease did not impact his ability to work. At a December 2012 VA examination, the Veteran reported that he experienced left knee flare-ups that were productive of increased pain. On range of motion testing, the Veteran demonstrated left knee flexion to 135 degrees and 40 degrees of extension. There was evidence of painful motion on flexion or extension. There was no evidence that the Veteran experienced additional functional loss following repetitive use. There was no evidence of localized tenderness or pain on palpation, or crepitus. Muscle strength testing was normal and there was evidence of atrophy or effusion. The medial/lateral collateral ligaments stability test, anterior/posterior cruciate ligaments stability test, and the medial/lateral meniscus stability test were all within normal limits. The examiner reported that the Veteran did not have ankylosis, and there was no objective evidence of subluxation or lateral instability. There was no evidence that the Veteran experienced a semilunar cartilage condition or recurrent patellar dislocation. The examiner noted that the Veteran did not use any devices to assist with ambulation. The examiner reported that the Veteran’s left knee degenerative joint disease did not impact his ability to work. As noted above, range of motion testing was performed during VA examinations in May 2010 and December 2011 and by private treatment providers and the Veteran was shown to have, at worst, 120 degrees of flexion and zero degrees of extension with regard to his left knee. The reports do not suggest that the specific findings on examination and throughout the period on appeal, in terms of range of motion, would change to the degree required for a higher rating during a flare-up, after repetitive use, due to pain, or with weight bearing, nor does any other evidence of record to include the Veteran’s lay statements. In this regard, the May 2010 examiner commented that although the Veteran experienced flare-ups that resulted in increased pain, the Veteran did not experience additional functional loss following repetitive use or during flare-ups. Moreover, the Veteran denied left knee flare-ups at that time the December 2011 examiner noted that the Veteran did not experience additional functional loss following repetitive use or during flare-ups, and the Veteran denied left knee flare-ups at that time. Therefore, Board finds that such factors do not result in functional loss more nearly approximating flexion limited to 30 degrees or extension limited to 15 degrees in the left knee. See DeLuca v. Brown, supra; Mitchell v. Shinseki, supra. While the Veteran has essentially stated that he has reduced motion in his left knee, he has not described a range of motion less than that found of record. In this regard, he reported that he experienced chronic daily pain, swelling and tenderness. The Veteran’s statements do not show the requisite limitation of motion necessary for higher or additional separate ratings. Treatment records do not show greater limitations of motion than the above examination findings. Given the above, even when considering the left knee pain’s impact on physical activities, higher or separate ratings are not warranted based on limitation of motion. 38 C.F.R. § 4.71a, Diagnostic Code 5260, 5261. Turning to the Veteran’s left knee instability, the Veteran’s treatment records show multiple reports of instability and falls. The Board notes that no objective evidence of lateral instability was found on by the December 2011, December 2012 or September 2019 VA examiners. However, in light of the above, the Board finds that the Veteran does, in fact, experience left knee instability, and that the Veteran’s left knee instability warrants a separate 10 percent rating under Diagnostic Code 5257. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The Board has considered the applicability of other potential diagnostic codes. As the evidence of record fails to demonstrate a meniscus injury, ankylosis, impairment of the tibia or fibula, or genu recurvatum, the Veteran is not entitled to a higher or additional separate rating under 5258, 5259, 5256, 5262, or 5263, respectively, for his left knee degenerative joint disease. The Board acknowledges the Veteran’s statement that his left knee disability is more severe than evaluated. The Veteran is competent to report his symptoms and has presented credible statements in this regard. Layno, 6 Vet. App. 465, 469. The Board finds, however, that neither the Veteran’s statements nor medical evidence demonstrates that the criteria for a rating in excess of 10 percent have been met. The Board also acknowledges that the Veteran’s VA treatment records note complaints of and treatment for his left knee disability. However, these records do not address the specific rating criteria necessary to determine severity. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. The Board also acknowledges that the symptoms reported at the December 2012 VA examination meet the criteria for a higher rating. However, the date of the VA examination is the earliest date from which it is factually ascertainable that the Veteran experienced left knee extension limited to 15 degrees or more. In this regard, there is no evidence prior to the date of that examination showing that the Veteran’s left knee degenerative joint disease was productive of criteria associated with a 20 percent rating. To that end, at the December 2011 VA examination, the examiner noted that the Veteran demonstrated extension to zero degrees, and flexion has not been shown greater than 120 degrees. Thus, the Board finds that a higher rating for a left knee disability based on limitation of flexion or extension is not warranted for the period on appeal. 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261. The Board has considered whether a staged rating under Hart, supra, are warranted, however, the Board finds that his symptomatology has been stable throughout the period on appeal. Therefore, assigning staged ratings is not warranted. Further, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). As noted above, a separate 10 percent rating, but no higher, is warranted for left knee instability. However, insofar as the Board has denied a higher rating, the preponderance of the evidence is against such aspects of the Veteran’s claim. Therefore, the benefit of the doubt doctrine is not applicable and entitlement to a rating in excess of 10 percent for a left knee degenerative joint disease prior to March 20, 2012, must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. Lumbosacral Strain The Veteran generally asserts that he should have a higher rating for his lumbosacral strain prior to September 16, 2019, as it is worse than contemplated by the currently assigned rating. In this case, the Veteran’s lumbosacral strain is rated 10 percent prior to September 16, 2019, and 20 percent disabling thereafter under the provisions of 38 C.F.R. § 4.71, Diagnostic Code 5237. Regulations specify that disabilities of the spine should be evaluated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. When intervertebral disc syndrome (IVDS) is present, it is to be evaluated under the Spinal Formula unless it is more favorable to rate under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula). Ratings under the Spinal Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. As relevant to the thoracolumbar spine, the General Rating Formula provides for a 10 percent rating when forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees, when the combined range of motion of the thoracolumbar spine is greater than 120 degrees but not greater than 235 degrees, or when muscle spasm, guarding or localized tenderness is not severe enough to result in an abnormal gait or abnormal spinal contour. A 20 percent rating when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, when the combined range of motion of the thoracolumbar spine is not greater than 120 degrees, or when muscle spasm or guarding is severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine to 30 degrees or less, or with favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine and a 100 percent rating is assigned with unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is to 90 degrees and the normal combined range of motion is 240 degrees. Id., Note (2). Associated objective neurologic abnormalities should be rated separately under an appropriate diagnostic code. Id., Note (1). Alternatively, the IVDS Formula provides for rating based on the total duration of incapacitating episodes. 38 C.F.R. § 4.71a, IVDS Formula. Incapacitating episodes are defined as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id., Note (1). There is no evidence that the Veteran experiences incapacitating episodes. In this regard, the VA examiners reported that the Veteran did not experience IVDS of the thoracolumbar spine and the Veteran does not contend otherwise. The Veteran was afforded a VA examination in December 2011. At that time, the Veteran reported that he experienced back pain, and denied flare-ups. On range of motion testing, the Veteran demonstrated forward flexion to 90 degrees; extension to 30 degrees; right lateral flexion to 30 degrees; left lateral flexion to 30 degrees; right lateral rotation to 30 degrees; and left lateral rotation to 30 degrees. Pain was noted with forward flexion and extension, and there was evidence of pain with weight-bearing and on palpation. The examiner indicated that range of motion did not contribute to functional loss, and there was no evidence of additional loss of function or range of motion following repetitive-use or during flare-ups. The examiner reported that the Veteran experienced muscle spasms and guarding that did not result in abnormal gait or abnormal spinal contour. Muscle strength testing was normal, and there was no evidence of atrophy or ankylosis. Reflex and sensory examination was normal. There was no evidence of radiculopathy or other neurological abnormalities, nor was there evidence that the Veteran experienced IVDS. The Veteran reported that he did not use any devices for assistance with ambulation. The examiner reported that the Veteran’s lumbar spine disability did not impact his ability to work. A June 2014 VA treatment note shows that Veteran reported that he experienced intermittent lower back pain following prolonged walking that he treated with prescription pain medication. On examination, his gait was within normal limits and there was no evidence of tenderness on the spine. On range of motion testing, the Veteran demonstrated forward flexion to 90 degrees; extension to 30 degrees; right lateral flexion to 30 degrees; left lateral flexion to 30 degrees; right lateral rotation to 30 degrees; and left lateral rotation to 30 degrees. At an October 2014 private orthopedic appointment, the Veteran reported that he experienced stiffness, as well as intermittent back pain. On a 1-10 scale, with 10 being the most severe, the Veteran described the symptoms during a flare-up resulted in a severity level of 4. The Veteran reported that he experienced hand tingling and numbness, as well as decreased strength. A review of the record shows that the Veteran receives treatment at the VA Medical Center for various disabilities. However, there is no indication from the record that his lumbar spine symptoms are manifestly different than those reported above. Upon review, the Board finds that a rating in excess of 10 percent is not warranted for the Veteran’s lumbosacral strain disability for the period on appeal prior to September 16, 2019. In that regard, a review of the record does not contain objective evidence that the Veteran experienced forward flexion worse than 90 degrees. Moreover, the combined range of motion has been shown to be, at worst, 240 degrees. Further, there were no signs that the Veteran’s lumbosacral sprain was productive of muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis, and no incapacitating episodes were noted. The currently assigned 10 percent rating accurately reflects the Veteran’s pain on movement of his lumbar spine, to include during flare-ups and after repetitive use over time. To that end, the December 2011 examiner indicated that range of motion did not contribute to functional loss, and there was no evidence of additional loss of function or range of motion following repetitive-use or during flare-ups. Moreover, treatment notes reflect increased pain during flare-ups but there is no evidence that such pain was severe enough to result in forward flexion to worse than 90 degrees or a combined range of motion to 120 degrees or less. The Board also acknowledges that the symptoms reported at the September 2019 VA examination meet the criteria for a higher rating. However, the date of the VA examination is the earliest date from which it is factually ascertainable that the Veteran experienced lumbar spine forward flexion of 60 degrees or less. To that end, at the September 2019 VA examination, the examiner noted that the Veteran demonstrated forward flexion to 50 degrees. Prior to the date of that examination, the record does not contain lumbar spine range of motion testing showing 60 degrees of forward flexion or less. Therefore, a higher rating is not warranted prior to September 16, 2019. See 38 C.F.R. § 4.71, Diagnostic Code 5237. As noted above, during the appeal period range of motion testing was performed and showed, at worst, forward flexion to 90 degrees and a combined range of motion no less than 240 degrees. During the December 2011 examination the Veteran was asked about pain, flare-ups, and functional limitations, and relevant testing was performed, to include testing for pain and testing to reveal any additional functional limitations in certain circumstances, such as after repetitive use. No report suggests that the specific findings on examination, in terms of range of motion, would change to the degree required for a higher rating during a flare-up, after repetitive use, due to pain, or with weight bearing, nor does any other evidence of record to include the Veteran’s lay statements. While the Veteran has essentially stated that he has reduced motion in his spine, he has not described a range of motion which would warrant a higher rating. In this regard, throughout the period on appeal, the Veteran reported flare-ups but described the flare-ups as consisting of increased pain. The Veteran’s statements do not show the requisite limitation of motion necessary for a higher rating. Treatment records do not show greater limitation of motion than the examination findings. Given the above, a higher rating is not warranted based on limitation of motion. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, supra. The Board has considered a higher rating based on incapacitating episodes. However, there is no indication from the record that the Veteran has experienced incapacitating episodes requiring medically prescribed bed rest. As such, the Veteran is appropriately rated based on pain, limitation of motion, and limitation of function. 38 C.F.R. § 4.71a, Diagnostic Code 5243. Additionally, ankylosis of the spine is not shown by the medical evidence or alleged by the Veteran, and there is no evidence that the Veteran’s muscle spasms resulted in abnormal gait or spinal contour. With regard to disabilities of the spine, VA is to evaluate any associated objective neurologic abnormalities under appropriate diagnostic criteria. See Note (1) of the General Rating Formula. In this regard, the Board acknowledges that the Veteran has reported left upper and lower extremity pain and numbness. However, these symptoms will be addressed separately and are remanded herein. Further, the Board finds that his lumbosacral strain does not result in any additional associated objective neurologic abnormalities, to include bladder or bowel incontinence. Neurologic abnormalities or findings related to the thoracolumbar spine condition such as bowel or bladder problems were not found on objective examination in December 2011 or September 2019. Therefore, absent evidence of objective neurologic abnormalities of bladder or bowel incontinence associated with the lumbar spine disorder, the Board finds that separate ratings for such conditions are not warranted. In reaching its conclusions, the Board acknowledges the Veteran’s belief that his lumbosacral strain is more severe than as reflected by the currently assigned disability rating. 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 his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability in light of the rating criteria to be more persuasive than his reports regarding the severity of his lumbar spine disability Consideration has also been given to assigning further staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). Further, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the rating claim adjudicated herein. See Doucette v. Shulkin, supra. In this case, the preponderance of the evidence is against a rating in excess of 10 percent rating prior to September 16, 2019, and the claim must, accordingly, be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Left Hamstring Strain The Veteran generally asserts that he should have higher ratings for his left hamstring strain as it is worse than contemplated by the currently assigned ratings. Here, the Veteran’s left hamstring strain is rated as noncompensable prior to September 16, 2019, and 10 percent disabling thereafter under the provisions of Diagnostic Code 5313, which pertains to injuries affecting Muscle Group XIII (the posterior thigh group). 38 C.F.R. § 4.73. Diagnostic Code 5313 provides evaluations for a disability of Muscle Group XIII (posterior thigh/hamstring muscles). The functions of these muscles are as follows: extension of hip and flexion of knee; outward and inward rotation of flexed knee; and acting with rectus femoris and sartorius (see XIV, 1, 2) synchronizing simultaneous flexion of hip and knee and extension of hip and knee by belt-over-pulley action at knee joint. The muscle group includes the posterior thigh group, hamstring complex of 2-joint muscles: (1) biceps femoris; (2) semimembranosus; and (3) semitendinosus. Under Diagnostic Code 5313, a slight injury warrants a 0 percent rating, a moderate injury warrants a 10 percent rating, a moderately severe injury warrants a 30 percent rating, and a severe injury warrants a 40 percent rating. 38 C.F.R. § 4.73, Diagnostic Code 5313. The factors to be considered in evaluating disabilities residual to healed wounds involving muscle groups are set forth in 38 C.F.R. §§ 4.55 and 4.56. A through-and-through injury with muscle damage shall be evaluated as no less than a moderate injury for each group of muscles damaged. 38 C.F.R. § 4.56(b). For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement. 38 C.F.R. § 4.56(c). Under Diagnostic Codes 5301 to 5323, disabilities resulting from muscle injuries shall be classified as slight, moderate, moderately severe, and severe. The type of disability associated with a slight muscle disability is a simple wound of muscle without debridement or infection. A history with regard to this type of injury should include service department record of superficial wound with brief treatment and return to duty, healing with good functional results, and no cardinal signs or symptoms of muscle disability. Objective findings should include minimal scar, no evidence of fascial defect, atrophy, or impaired tonus, no impairment of function or metallic fragments retained in muscle tissue. 38 C.F.R. § 4.56(d)(1). The type of injury associated with a moderate muscle disability is a through-and-through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. A history with regard to this type of injury should include service department record or other evidence of in-service treatment for the wound and record of consistent complaints of one or more of the cardinal signs and symptoms of muscle disability, particularly lowered threshold of fatigue after average use affecting the particular functions controlled by the injured muscles. Objective findings should include entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue and some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56(d)(2). The type of injury associated with a moderately severe muscle disability is a through-and-through or deep penetrating wound by a small high-velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. A history with regard to this type of injury should include service medical record or other evidence showing prolonged hospitalization for treatment of wound, record of consistent complaints of cardinal signs and symptoms of muscle disability, and, if present, evidence of inability to keep up with work requirements. Objective findings should include entrance and (if present) exit scars indicating the track of the missile through one or more muscle groups, and indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with the sound side. Tests of strength and endurance compared with sound side should demonstrate positive evidence of impairment. 38 C.F.R. § 4.56(d)(3). The type of injury associated with a severe disability of muscles is a through-and-through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. A history consistent with this type of injury would include service department record or other evidence showing hospitalization for a prolonged period for treatment of wound, record of consistent complaint of cardinal signs and symptoms of muscle disability, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. Objective findings of a severe disability would include ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track; palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area; muscles swell and harden abnormally in contraction; tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, a severe injury would also show x-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile; adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle; diminished muscle excitability to pulsed electrical current in electrodiagnostic tests; visible or measurable atrophy; adaptive contraction of an opposing group of muscles; atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle; or induration or atrophy of an entire muscle following simple piercing by a projectile. 38 C.F.R. § 4.56(d)(4). Here, the record reflects that the Veteran injured his hamstring during active duty as a result of sprinting. The Veteran was afforded a VA examination in December 2011, and the examiner diagnosed a left hamstring strain. On examination, the examiner reported that the Veteran’s left hamstring strain was productive of occasional loss of power, weakness, fatigue and pain. The examiner noted that the Veteran’s left hamstring strain did not affect muscle substance or function. Muscle strength testing of the hip and knee were normal and there was no evidence of atrophy. The Veteran reported that he did not use any devices for assistance with ambulation related to his left hamstring strain. The examiner indicated that the Veteran’s left hamstring strain did not impact his ability to work. A review of the record shows that the Veteran receives treatment at the VA Medical Center for various disabilities. However, there is no indication from the record that his left leg hamstring strain symptoms are manifestly different than those reported at above-mentioned VA examination. Resolving reasonably doubt in the Veteran’s favor, the Board finds that the Veteran is entitled to a rating of 10 percent, but no higher, throughout the entire period on appeal. In this regard, there had been consistent complaint of one or more of the cardinal signs and symptoms of muscle disability as defined in 38 C.F.R. § 4.56(c), particularly lowered threshold of fatigue after average use. Specifically, there is evidence of complaint of occasional loss of power, fatigue, pain and weakness noted in the December 2011 VA examination report, as well as in treatment reports throughout the period on appeal. However, the Board finds that the preponderance of the evidence is against a rating in excess of 10 percent. To that end, following a review of the evidence, medical and lay, the Board finds there is no indication that the Veteran has a moderately severe muscle injury within the meaning of VA regulations governing muscle disabilities. In this regard, the Veteran’s service treatment records do not document hospitalization. Moreover, the evidence does not show impairment analogous to some loss of muscle substance or tonus, nor the loss of deep fascia, etc., consistent with more than moderate muscle injury. Rather, at the December 2011 examination, muscle strength testing was normal, and there was no evidence of muscle atrophy. Additionally, the examiner provided that the functional impact of the hamstring strain would not impact employment. Further, the Veteran’s description of his hamstring injuries during service and his service treatment records are not indicative of the types of injuries that the regulation recognizes as supporting a moderately severe muscle injury. The Board acknowledges the Veteran’s statement that his left hamstring disability is more severe than evaluated. The Veteran is competent to report his symptoms and has presented credible statements in this regard. Layno, 6 Vet. App. 465, 469. The Board finds, however, that neither the Veteran’s statements nor medical evidence demonstrates that the criteria for a rating in excess of 10 percent have been met. The Board also acknowledges that the Veteran’s VA treatment records note complaints of and treatment for his hamstring pain and cramping. However, these records do not address the specific rating criteria necessary to determine severity. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. The Board has considered whether a staged rating under Hart, supra, are warranted, however, the Board finds that her symptomatology has been stable throughout the period on appeal. Therefore, assigning staged ratings is not warranted. Further, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, supra. In reaching the foregoing determinations, the Board has applied the benefit of the doubt doctrine and resolved all doubt in the Veteran’s favor in awarding a 10 percent rating prior to September 16, 2019. However, insofar as the Board has denied higher or separate ratings, the preponderance of the evidence is against such aspects of the Veteran’s claim. Therefore, the benefit of the doubt doctrine is not applicable and such higher rating claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. REASONS FOR REMAND The Board finds that additional development is required before the remaining claim on appeal is decided. Left Upper and Lower Extremity Radiculopathy The Veteran contends that he has left lower extremity radiculopathy associated with his service-connected lumbar spine disability. Although a September 2019 VA examiner determined that there was no clinical objective evidence of radiculopathy on examination, the report does not reflect that electromyography (EMG) or nerve conduction studies were conducted to rule out radiculopathy. There is some evidence in the VA and private medical records that the Veteran may have a nerve impairment in the upper and lower left extremities, and the Veteran has reported that his low back pain radiates to his left extremities. Therefore, the Board concludes that a new VA examination should be conducted, and that EMG and nerve conduction studies should be performed to conclusively determine whether the claimed disabilities exists. The matter is REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of any currently present left upper and/or lower extremity radiculopathy. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to the following: (A) Is at least as likely as not (50 percent or better probability) that any currently present left upper extremity radiculopathy, had its onset during his active service or is otherwise etiologically related to such service? (B) Is at least as likely as not (50 percent or better probability) that any currently present left upper extremity radiculopathy was caused OR aggravated by his service-connected lumbosacral strain? (C) Is at least as likely as not (50 percent or better probability) that any currently present left lower extremity radiculopathy, had its onset during his active service or is otherwise etiologically related to such service? (D) Is at least as likely as not (50 percent or better probability) that any currently present left lower extremity radiculopathy was caused OR aggravated by his service-connected lumbosacral strain? (Continued on the next page)   If the answer to any of the above is yes, the examiner should address the current level of severity of all impairment resulting from any currently present left upper and lower extremity radiculopathy. The examiner must consider the Veteran’s lay statements regarding the onset and continuity of his symptoms. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher O'Donnell, 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.