Citation Nr: 21008927 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 18-02 674 DATE: February 18, 2021 ORDER Entitlement to a 20 percent rating, but no higher, for service-connected lumbosacral strain with degenerative arthritis is granted effective December 11, 2017 to October 6, 2020. Entitlement to ratings for service-connected lumbosacral strain with degenerative arthritis in excess of 10 percent prior to December 11, 2017, in excess of 20 percent prior to October 7, 2020, and in excess of 40 percent thereafter is denied. Entitlement to a 40 percent rating, but no higher, for limitation of extension of the right knee is granted effective October 7, 2020. Entitlement to a rating in excess of 10 percent for osteoarthritis of the right knee (hereinafter “limitation of flexion of the right knee”) is denied for the entire period on appeal. Entitlement to a 20 percent rating, but no higher, for service-connected residuals of a right ankle strain is granted effective October 7, 2020. Entitlement to ratings for residuals of a right ankle strain in excess of 10 percent prior to October 7, 2020 and in excess of 20 percent thereafter is denied. FINDINGS OF FACT 1. Resolving all reasonable doubt in the Veteran’s favor, from December 11, 2017 to October 6, 2020, the evidence of record is at least evenly balanced to suggest that the Veteran’s service-connected lumbosacral strain with degenerative arthritis manifested in forward flexion limited to 60 degrees or less upon repeated use over time. 2. Prior to December 11, 2017, there is no competent or credible evidence of record to suggest that the Veteran’s service-connected lumbosacral strain with degenerative arthritis manifested in forward flexion limited to 60 degrees or less, a combined range of motion limited to 120 degrees or less, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 3. There is no competent or credible evidence of record to suggest that the Veteran’s service-connected lumbosacral strain with degenerative arthritis manifested in forward flexion limited to 30 degrees or less at any point prior to October 7, 2020; moreover, there is no competent or credible evidence of record to suggest that the Veteran’s lumbar spine disorder has ever manifested in ankylosis of any kind. 4. The evidence of record demonstrates that as of October 7, 2020, the Veteran’s right knee extension is limited to 35 degrees following repeated use over time, but there is no evidence of record to suggest limitation of extension to 45 degrees or more severe at any time during the period on appeal. 5. Throughout the rating period on appeal, the Veteran’s right knee has not manifested incapacitating episodes, ankylosis, subluxation, lateral instability, impairment of the semilunar cartilage, flexion limited to 60 degrees or worse, malunion or nonunion of the tibia and fibula, shin splints, or genu recurvatum. 6. Resolving all reasonable doubt in the Veteran’s favor, the evidence of record is at least evenly balanced to suggest that as of October 7, 2020, the Veteran’s right ankle disorder has manifested in a marked limitation of range of motion and is entitled to a maximum rating accordingly; however, there is no evidence to suggest that same ever manifested in more than moderate limitation of range of motion prior to October 7, 2020. CONCLUSIONS OF LAW 1. The criteria for a 20 percent rating for service-connected lumbosacral strain with degenerative arthritis have been met effective December 11, 2017 to October 6, 2020, but no higher or earlier. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.27, 4.40, 4.59, 4.71a, Diagnostic Codes 5237, 5242 (1997, 2020). 2. The criteria for ratings for service-connected lumbosacral strain with degenerative arthritis in excess of 10 percent prior to December 11, 2017, in excess of 20 percent prior to October 7, 2020, and in excess of 40 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.27, 4.40, 4.59, 4.71a, Diagnostic Codes 5237, 5242 (1997, 2020). 3. The criteria for a 40 percent rating for limitation of extension of the right knee have been met effective October 7, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.27, 4.40, 4.59, 4.71a, Diagnostic Codes 5003, 5261 (1997, 2020). 4. The criteria for a rating in excess of 10 percent for limitation of flexion of the right knee have not been met for any part of the period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.27, 4.40, 4.59, 4.71a, Diagnostic Codes 5003, 5260 (1997, 2020). 5. The criteria for a 20 percent rating for service-connected residuals of a right ankle strain have been met effective October 7, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.27, 4.40, 4.59, 4.71a, Diagnostic Codes 5003, 5271 (1997, 2020). 6. The criteria for ratings for residuals of a right ankle strain in excess of 10 percent prior to October 7, 2020 and in excess of 20 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.27, 4.40, 4.59, 4.71a, Diagnostic Codes 5003, 5271 (1997, 2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from January 1987 to January 1993, and then in the United States Army from October 2003 to February 13, 2005 and again from February 11, 2009 to March 30, 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of an October 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, the Veteran’s claims for increased ratings herein, as well as other claims, were received by the Agency of Original Jurisdiction on June 22, 2015. The Board accordingly does not have jurisdiction to adjudicate the propriety of any rating prior to June 22, 2015. The Veteran testified before the undersigned Acting Veterans Law Judge at a hearing that was conducted on February 4, 2020. A transcript of the hearing has been associated with the claims file. To the extent that any claims other than those that are listed on the title page may have ever been in appellate status, the Veteran testified that all other claims (including one for a rating of total disability based on individual unemployability due to service-connected disorders [TDIU]) should be dismissed. After the hearing, the Veteran’s claims were partially dismissed and partially remanded in April 2020. See BVA Remand (Apr. 14, 2020). To the extent that a claim for a TDIU can sometimes be inferred as part and parcel of a claim for increased ratings, see Rice v. Shinseki, 22 Vet. App. 447 (2009), the Board concludes that Rice does not apply, because the Veteran’s claim for a TDIU was dismissed upon the Veteran’s informed testimony. Subsequent to the Board’s April 2020 remand, the Veteran was afforded a staged 40 percent rating for the lumbar spine disorder, effective October 7, 2020, as well as a separate noncompensable disability rating for right knee limitation of extension, effective from October 7, 2020. See Rating Decision (Oct. 27, 2020). That rating decision continued the right knee limitation of flexion and right ankle disorder ratings at 10 percent each. Because higher ratings are available throughout the rest of the appellate period, the claims remain on appeal accordingly. See AB v. Brown, 6 Vet. App. 35 (1993). The Veteran was issued a Supplemental Statement of the Case (SSOC) as to all of the above on October 27, 2020. The Board concludes that the Veteran has been afforded substantial compliance with all previous remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Correia v. McDonald, 28 Vet. App. 158 (2016) (instructing that VA orthopedic examinations should include testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing (if applicable) and, if possible, with the range of the opposite undamaged joint); Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017) (outlining VA examiners’ obligation to elicit information regarding flare-ups of a musculoskeletal disability if the examination is not conducted during such a flare-up, and to use this information to characterize additional functional loss during flare-ups). Accordingly, the case is now appropriate for appellate review. In short, and to be discussed more fully in relevant parts below, the Board grants an interim 20 percent staged rating for the Veteran’s back disorder from December 11, 2017 until prior to October 7, 2020. Otherwise, the Veteran’s claim for higher ratings for a back disorder (in excess of 10 percent earlier than December 11, 2017, in excess of 20 percent thereafter until prior to October 7, 2020, and in excess of 40 percent thereafter) is denied. The Board grants a 40 percent rating for the Veteran’s right knee limitation of extension effective October 7, 2020, but otherwise denies the claim for any higher rating for the knee (in excess of 10 percent for limitation of flexion). The Board grants a 20 percent rating for the Veteran’s right ankle disorder effective October 7, 2020, but otherwise denies the claim for any higher rating for the ankle (in excess of 10 percent earlier than October 7, 2020, or in excess of 20 percent thereafter). Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating many accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a questions as to which of two evaluations apply, assigning a higher of the two where the disability pictures more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person’s ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Separate evaluations may be assigned for separate periods of time based on the facts found, a practice known as “staged ratings.” Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). A disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40; see also 38 C.F.R. §§ 4.45, 4.59. Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). 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. 1. Entitlement to a 20 percent rating, but no higher, for service-connected lumbosacral strain with degenerative arthritis is granted effective December 11, 2017 until prior to October 7, 2020. 2. Entitlement to ratings for service-connected lumbosacral strain with degenerative arthritis in excess of 10 percent prior to December 11, 2017, in excess of 20 percent prior to October 7, 2020, or in excess of 40 percent thereafter is denied. The Veteran generally contends that higher ratings are warranted for his lumbar spine disorder. Specific argument in support of his appeal has not been presented. The Board is in receipt of the Veteran’s VA examination history and VA treatment records throughout the period on appeal. The Veteran’s lumbosacral strain with degenerative arthritis was previously evaluated as 10 percent disabling prior to October 7, 2020, and 40 percent disabling thereafter, under Diagnostic Code 5242-5237. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. The hyphenated diagnostic code in this case indicates that the service-connected disability of degenerative arthritis of the spine (Diagnostic Code 5242) is rated based on a lumbosacral strain (Diagnostic Code 5237). The assignment of a particular diagnostic code is “completely dependent on the facts of a particular case.” Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the current diagnosis, and demonstrated symptomatology. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Thus, the Board has considered the propriety of assigning a higher, or separate, rating under another diagnostic code. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). Therefore, the Board will evaluate the Veteran’s spine disability under the diagnostic code that will provide the most favorable rating, mindful not to pyramid and overly compensate him for the same symptom. See, e.g., Esteban v. Brown, 6 Vet. App. 259, 261 (1994). VA regulations provide that spine disabilities are rated under either the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome Based (IVDS) on Incapacitating Episodes, under Diagnostic Code 5243, whichever would result in a higher rating. 38 C.F.R. § 4.71a. There is no evidence to suggest that the Veteran has ever been diagnosed with IVDS at any time on appeal; therefore, Diagnostic Code 5243 does not apply, and the Formula for Rating IVDS Based on Incapacitating Episodes is not for application either. As Diagnostic Codes 5237 and 5242 contain successive criteria, the criteria for the lower rating must be met before a higher disability rating may be awarded. A higher rating cannot be granted based on a finding that the Veteran’s disability picture more nearly approximates the criteria for the next higher rating. However, reasonable doubt regarding the presence of a criterion may be resolved in the Veteran’s favor. Johnson v. Wilkie, 30 Vet. App. 245 (2018). The General Rating Formula for Diseases and Injuries of the Spine, 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, provides the following: A 10 percent rating is assigned when forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine is greater than 120 degrees but not greater than 235 degrees; or, there is evidence of muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is assigned when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or, there is evidence 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. A 40 percent rating is assigned for forward flexion of the thoracolumbar spine of 30 degrees or less; or, unfavorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a. The current spine rating criteria instructs the Board to evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. See 38 C.F.R. § 4.71a, Note (1). The current spine rating criteria provide specific values for range of motion of the cervical and thoracolumbar (thoracic and lumbar) spine. For the thoracolumbar spine, normal range of motion on forward flexion is zero to 90 degrees; backwards extension, zero to 30 degrees; left and right lateral flexion, zero to 30 degrees; and, left and right lateral rotation, zero to 30 degrees. See 38 C.F.R. § 4.71a, Note (2) (see also Plate V). The Board is in receipt of three separate examination reports, as pertaining to the Veteran’s thoracolumbar spine: October 9, 2015; December 11, 2017; and October 27, 2020. By way of background, in initially developing his claim for increased ratings at any time after June 22, 2015, the Veteran was first afforded a VA examination for his spine on October 9, 2015. See C&P Exam (Oct. 9, 2015). The Veteran generally stated that his back pain had gotten progressively worse since last examination, and that it is subject to flare-ups that “feels like someone is stabbing him in his back,” and can force him to sleep in a chair instead of lying down. See id. at Question No. 2b. Unfortunately, the examiner deemed that he was unable to estimate the effects of flare-ups in terms of additional range of motion lost, see Sharp v. Shulkin, supra; however, the examiner measured the Veteran’s thoracolumbar spinal range of motion on repetitive use as 80 degrees in forward flexion and 225 combined. See C&P Exam (Oct. 9, 2015), at Questions No. 3 et seq. Furthermore, the examiner indicated that the Veteran does not have guarding or muscle spasm. The Veteran then submitted to another VA examination on December 11, 2017. See C&P Exam (Dec. 11, 2017). The Veteran generally stated that his back pain had gotten progressively worse, and there is also evidence that the Veteran suffered from a fall on but not before November 21, 2016. See, e.g.: VA Treatment Record (Nov. 21, 2016) (memorializing a prior fall); (July 14, 2017) (“Patient states that their pain is not new. Location: Lower back, R-knee, R-ankle. How long have you had this pain: chronic. Has it changed or gotten worse: worse.”) Meanwhile, at the examination, the Veteran denied flare-ups, see C&P Exam (Dec. 11, 2017), at Question No. 2b, and his initial range of motion was measured as 65 degrees forward flexion and 135 degrees combined. The Veteran underwent repetitive use testing, but no change in range of motion was notated. However, the examiner did not attempt repetitive use over time. See id. at Question No. 3 et seq. Based upon these two earliest examinations of record, the Board resolves all reasonable doubt to conclude that if the December 11, 2017 examiner would have performed repetitive use testing over time, it is at least 50 percent likely that forward flexion would have been “not greater than 60 degrees” as of the date of that examination. As a result, the Board grants a staged rating of 20 percent effective from December 11, 2017, accordingly. The Board acknowledges that despite the October 2015 examiner’s purported inability to estimate the effects of flare-ups, the preponderance of the evidence of record precludes a finding of entitlement to any rating in excess of 10 percent until December 11, 2017. The Veteran had never articulated that flare-ups limited his forward flexion from 80 degrees (at most restricted as measured) to 60 degrees (which would be a 25 percent reduction from that). The Board ultimately concludes that any remand to elicit further information about flare-ups prior to December 2017 would be purely speculative, and remands that are not reasonably likely to yield further benefit to the Veteran are to be avoided. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). The Veteran was afforded another examination on October 7, 2020. Here, the Veteran was afforded a 40 percent rating, in light of forward flexion of the thoracolumbar spine limited to 30 degrees. Meanwhile, the examiner of record indicated that the Veteran does not have ankylosis of the spine, and there is no competent or credible evidence of record to suggest that the Veteran may suffer from ankylosis. A 40 percent rating is the highest available rating based upon limitation of motion; all higher ratings require ankylosis, which is not present or alleged in this case. Therefore, Sharp v. Shulkin is of no concern as of October 7, 2020. Meanwhile, while the Board is sympathetic to the Veteran’s general claims of worsening pain, there is simply no credible evidence to suggest that his back pain ever became more than 20 percent disabling at any point prior to the October 7, 2020 examination. In awarding a 10 percent rating prior to December 11, 2017, then a 20 percent rating thereafter until prior to October 7, 2020, and then a 40 percent rating thereafter, the Board finds that his symptomatology is specifically contemplated by the respective staged ratings to which he is entitled. In addition to considering the orthopedic manifestations of a back disability, VA regulations also require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. However, the Veteran has not alleged, and the evidence does not show, that he has bladder impairment or bowel impairment as a result of his service-connected lumbosacral strain with degenerative arthritis. Moreover, the Veteran's radiculopathy in the right lower extremity has been separately rated. Therefore, the Board finds that, at no time during the appeal period, has the Veteran's lumbosacral strain with degenerative arthritis resulted in additional neurological impairment. In reaching its conclusions, the Board acknowledges the Veteran’s belief that his lumbosacral strain with degenerative arthritis is more severe than is reflected by the currently assigned disability ratings. 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 most persuasive regarding the severity of his lumbosacral spine disorder. The Board has also considered whether further staged ratings under Hart, supra, are appropriate for the Veteran’s service-connected lumbar spinal stenosis with degenerative arthritis; however, the Board finds that his symptomatology is now adequately compensated throughout each period on appeal, and the Veteran has never suffered from ankylosis. Therefore, assigning further staged ratings for such disability is not warranted. Further, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claim adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). As a result of the above, the Board concludes that the Veteran is entitled to a rating of 20 percent for his lumbosacral spine disorder effective December 11, 2017 until prior to October 7, 2020, but no higher and no earlier. There is no evidence of record to suggest that the Veteran is entitled to a rating in excess of 10 percent for his lumbosacral strain with degenerative arthritis at any time prior to December 11, 2017, nor in excess of 40 percent at any time on appeal. 38 C.F.R. § 4.71a, Diagnostic Codes 5237, 5242, contra id. at Diagnostic Code 5243. There is no more reasonable doubt to be resolved. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 5356 (1990). 3. Entitlement to a 40 percent rating, but no higher, for limitation of extension of the right knee is granted effective October 7, 2020. 4. Entitlement to a rating in excess of 10 percent for limitation of flexion of the right knee is denied for the entire period on appeal. The Veteran generally contends that higher ratings are warranted for his right knee disorder. Specific argument in support of his appeal has not been presented. The Board is in receipt of the Veteran’s VA examination history and VA treatment records throughout the period on appeal. Disabilities of the knee are rated under Diagnostic Codes 5256 to 5263. 38 C.F.R. § 4.71a. Diagnostic Code 5260 provides that flexion of the leg limited to 15 degrees warrants a 30 percent rating; flexion limited to 30 degrees warrants a 20 percent rating; flexion limited to 45 degrees warrants a 10 percent rating; and flexion limited to 60 degrees warrants a zero percent (noncompensable) rating. 38 C.F.R. § 4.71a. Diagnostic Code 5261 provides that extension of the leg limited to 45 degrees warrants a 50 percent rating; extension limited to 30 degrees warrants a 40 percent rating; extension limited to 20 degrees warrants a 30 percent rating; extension limited to 15 degrees warrants a 20 percent rating; extension limited to 10 degrees warrants a 10 percent rating; extension limited to 5 degrees warrants a zero percent (noncompensable) rating. 38 C.F.R. § 4.71a. For comparison, normal range of motion of the knee is from zero degrees of extension to 140 degrees of flexion. See 38 C.F.R. § 4.71, Plate II. 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. When the knee disability affects the meniscus, a 20 percent rating is warranted when there is dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint. 38 C.F.R. § 4.71a, Diagnostic Code 5258. A 10 percent rating is warranted when there has been removal of semilunar cartilage (e.g., meniscectomy) and current residual symptoms. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Separate ratings can be assigned for the above knee disabilities (Diagnostic Codes 5257, 5258, 5259, 5260, and 5261) when none of the symptomatology overlaps and the separate rating is based on additional disabling symptomatology. 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). Ratings can also be assigned for impairment of the tibia or fibula, removal of semilunar cartilage, genu recurvatum, or ankylosis of the knee. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5259, 5262, 5263. As noted above, the Veteran is in receipt of a 10 percent disability rating for right knee limitation of flexion throughout the period on appeal. During the course of this appeal, the RO granted a separate noncompensable disability rating for right knee limitation of extension, effective from October 7, 2020. By way of background, in initially developing his claim for increased ratings at any time after June 22, 2015, the Veteran was first afforded a VA examination for his knee on October 9, 2015. See C&P Exam (Oct. 9, 2015). The Veteran generally stated that his knee pain had gotten progressively worse since last examination, and that it is subject to flare-ups that “has a stabbing, tingling sensation in the center of his knee,” and can force him to apply topical analgesic, stretch his leg, and massage his knee. See id. at Question No. 2b. Unfortunately, the examiner deemed that he was unable to estimate the effects of flare-ups in terms of additional range of motion lost, see Sharp v. Shulkin, supra; however, the examiner measured the Veteran’s right knee range of motion on initial and repetitive use from 0 to 130 degrees in flexion and 130 to 0 degrees in extension combined. See C&P Exam (Oct. 9, 2015), at Questions No. 3 et seq. Furthermore, the examiner indicated that the Veteran does not have ankylosis, subluxation, lateral instability, tibial/fibular impairment, shin splints, or meniscal conditions. See id. at Questions Nos. 5-8. The Veteran was then afforded another VA examination for his knee on December 11, 2017. See C&P Exam (Dec. 11, 2017). The Board notes that the Veteran generally stated that his knee pain had gotten progressively worse throughout his subsequent medical history, see, e.g.: VA Treatment Record (Nov. 21, 2016) (memorializing a prior fall); (July 14, 2017) (“Patient states that their pain is not new. Location: Lower back, R-knee, R-ankle. How long have you had this pain: chronic. Has it changed or gotten worse: worse.”); however, the Veteran specifically denied flare-ups of the knee. See C&P Exam (Dec. 11, 2017) at Question No. 2b; Sharp v. Shulkin, supra. The examiner measured the Veteran’s right knee range of motion on initial and repetitive use from 0 to 90 degrees in flexion and 90 to 0 degrees in extension combined. See C&P Exam (Oct. 9, 2015), at Questions No. 3 et seq. Furthermore, the examiner indicated that the Veteran does not have ankylosis, subluxation, lateral instability, tibial/fibular impairment, shin splints, or meniscal conditions. See id. at Questions Nos. 5-8. Ultimately, the Board validates the Veteran’s statements that his symptomatology progressed with increasingly severity; however, the evidence of record up to this point indicates that a 10 percent rating adequately compensated the Veteran for his right knee disorder. Finally, the Veteran’s right knee was most recently examined on October 7, 2020. See C&P Exam (Oct. 7, 2020). Here, once again, the Veteran denied flare-ups. See id. at Question No. 2b. On the other hand, in testing repeated use over time, the Veteran’s right knee range of motion was measured as flexion from 35 to 100 degrees, and extension from 100 to 35 degrees. See id. at Question No. 3c. Once more, the examiner indicated that the Veteran does not have ankylosis, subluxation, lateral instability, tibial/fibular impairment, shin splints, or meniscal conditions. See id. at Questions Nos. 5-8. Based upon these examination results, the Board awards a 40 percent rating for right knee limitation of extension effective October 7, 2020, but no higher and no earlier. This award is based upon the finding of extension limited to 35 degrees, but never limited to 45 degrees or more severe. 38 C.F.R. § 4.71a, DC 5261. Prior to October 7, 2020, the Veteran’s right knee extension was unlimited. The remainder of the Veteran’s claim – entitlement to a disability rating in excess of 10 percent for right knee limitation of flexion, is denied, as flexion, at worst, has been limited to 90 degrees, taking into account pain and additional limitation during flare-ups and following repetitive use; such limitation in flexion does not even meet the criteria for a noncompensable disability rating under DC 5260. 38 C.F.R. § 4.71a. The Board acknowledges that despite the October 2015 examiner’s purported inability to estimate the effects of flare-ups, the preponderance of the evidence of record precludes a finding of entitlement to any rating in excess of 10 percent for right knee limitation of flexion at any time, or to a separate rating for limitation of extension prior to October 7, 2020, especially since the Veteran denied flare-ups in two subsequent VA examinations. When the Veteran indicated flare-ups upon the first 2015 VA examination, he never articulated that flare-ups limited flexion to 60 degrees (more than half than what was measured) or limited extension to worse than 0 degrees. There is no competent or credible evidence of record to substantiate such a claim. The Board ultimately concludes that any remand to elicit further information about flare-ups prior to October 2020 would be purely speculative, and remands that are not reasonably likely to yield further benefit to the Veteran are to be avoided. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). The Board has considered the applicability of other potential diagnostic codes. As the evidence of record fails to ankylosis, impairment of the tibia or fibula, a meniscus impairment, or genu recurvatum, the Veteran is not entitled to a higher or separate rating under 5256, 5258, 5259, 5262, or 5263, respectively, for his residuals of a torn meniscus of the right knee. The Board has considered whether there is any other schedular basis for further granting the above claim but has found none. The Board recognizes that it is the intent of the rating schedule 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 this case, the Veteran is already assigned a 10 percent rating for his right knee under Diagnostic Code 5003-5260 for the entire period on appeal, which is the minimum compensable rating for the knee joint. In addition, the 40 percent rating for right limitation of extension assigned from October 7, 2020, herein, reflects the limitation of extension shown as of that date, but not prior. The rating criteria reasonably describe the Veteran’s disability and his symptomatology. For all musculoskeletal disabilities, the rating schedule contemplates functional loss, which may be manifested by, for example, decreased or abnormal excursion, strength, speed, coordination, or endurance. 38 C.F.R. § 4.40; Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). The Veteran’s knee disability has been manifested by symptoms of painful motion and limitation of flexion and extension. The schedular rating criteria specifically provides ratings for painful arthritis (Diagnostic Codes 5003, 5257, 5258, 38 C.F.R. § 4.59) and limitation of motion (Diagnostic Codes 5260 and 5261), including motion limited to orthopedic factors such as pain, incoordination, weakness, and instability of station (38 C.F.R. §§ 4.40, 4.45, 4.59, DeLuca), which are incorporated into the schedular rating criteria. The Board acknowledges the Veteran’s regular use of a cane, and that its use is not specifically noted in the rating criteria. However, the symptoms alleviated by the use of these devices are addressed. The medical record, particularly the VA examinations, describe the level of his disability when these devices are not in use and, as noted above, those symptoms are contemplated under the rating criteria. Cf. Jones v. Shinseki, 26 Vet. App. 56 (2012) (holding that the Board may not deny entitlement to a higher rating on the basis of relief provided by medication when the rating criteria does not specifically contemplate those effects). To the extent that the Veteran and contends that his right knee disorder is more severe than currently evaluated during any period on appeal, the Board observes that the Veteran, while competent to report symptoms, is not competent to report that his knee disabilities are of sufficient severity to warrant higher evaluations under VA’s rating schedule because such an opinion requires medical expertise (training in evaluating musculoskeletal impairment), which he has not been shown to possess. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Woehlaert, 21 Vet. App. 456 (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). The Board has considered whether a staged rating under Hart, supra is appropriate; however, the Board finds that after awarding a 40 percent rating for limitation of extension effective October 7, 2020, the remainder of his symptomatology has been stable throughout the appeal, to the extent that his limitation of flexion has never been more severe than 10 percent disabling. Therefore, assigning staged ratings is not warranted. Further, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to such claim. Doucette, 28 Vet. App. 366 (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). For all the foregoing reasons, the Board grants the Veteran’s claim for a 40 percent rating for his right knee limitation of extension effective October 7, 2020; however, the remainder of the claim, for further entitlement to a rating in excess of 10 percent for right knee limitation of flexion, is denied. As the preponderance of the evidence is against a higher or separate rating, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. 5. Entitlement to a 20 percent rating, but no higher, for service-connected residuals of a right ankle strain is granted effective October 7, 2020. 6. Entitlement to ratings for residuals of a right ankle strain in excess of 10 percent prior to October 7, 2020 and in excess of 20 percent thereafter is denied. The Veteran generally contends that a higher rating is warranted for his right ankle disorder. Specific argument in support of this appeal has not been presented. The Veteran’s right ankle disorder is rated by analogy under Diagnostic Code 5271-5003 (residuals of a strained right ankle, resulting in arthritis). This “built-up” Diagnostic Code reflects the rater’s attempt to arrive at the best criteria for rating a disability which does not specifically appear in the rating schedule. 38 C.F.R. § 4.27. Diagnostic Code 5003 refers to degenerative arthritis and is rated based upon limitation of motion of the affected part (in this case, for the Veteran’s right ankle; more specifically, either due to impairment of range of motion of the ankle [Diagnostic Code 5271]). The Veteran’s residuals of strained right ankle are rated under Diagnostic Code 5271-5003. 38 C.F.R. § 4.71a. A 10 percent rating is awarded for “moderate” limitation of motion; a 20 percent for “marked.” 38 C.F.R. § 4.71a, Diagnostic Code 5271. The normal range of motion in the ankle is 20 degrees of dorsiflexion and 45 degrees of plantar flexion. See 38 C.F.R. § 4.71, Plate II. Notably, the terms "moderate" and "marked" are not defined under VA regulations. Those terms also do not appear to have a generally accepted medical definition. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. It should also be noted that use of terminology such as "moderate" by VA examiners and others, although evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Under the revised diagnostic code, marked limitation of ankle motion constitutes less than five degrees of dorsiflexion or less than 10 degrees of plantar flexion while moderate limitation of ankle motion constitutes less than 15 degrees of dorsiflexion or less than 30 degrees of plantar flexion. Also included within 38 C.F.R. § 4.71a are multiple Diagnostic Codes that evaluate ankle disabilities based on other manifestations, including Diagnostic Code 5270 (ankylosis of the ankle), Diagnostic Code 5272 (ankylosis of the subastragalar or tarsal joint), Diagnostic Code 5273 (malunion of the os calcis or astragalus), and Diagnostic Code 5274 (astragalectomy). Diagnostic Code 5003 directs a rating as traumatic arthritis. In Diagnostic Code 5003, a 10 percent rating is awarded with X-ray evidence of involvement of two or more major joints or two or more minor joint groups; a 20 percent rating is awarded when the disorder manifests in occasional incapacitating episodes. Under the amended diagnostic code, post-traumatic arthritis is to be rated as limitation of motion, dislocation or other specified instability under the affected joint—namely, in this case, Diagnostic Code 5271 as discussed above. By way of background, in initially developing his claim for increased ratings at any time after June 22, 2015, the Veteran was first afforded a VA examination for his ankle on October 9, 2015. See C&P Exam (Oct. 9, 2015). The Veteran denied flare-ups of his right ankle. See id. at Question No. 2b. Range of motion after three repetitions was measured from 0 to 20 degrees on dorsiflexion and on plantar flexion. See id. at Question No. 3b. The Board concludes that this more closely approximates “moderate” loss of range of motion—not “marked.” Furthermore, there is no evidence of occasionally incapacitating exacerbations. See Sharp, supra. The Veteran then presented before a private physician on November 14, 2017. See C&P Exam (Nov. 14, 2017) (rec’d Dec. 11, 2017 ). The physician concluded that the right ankle was negative for fracture, dislocation, any other significant bone or soft tissue abnormality, and arthritis. Id. The Board concludes that despite the Veteran’s occasional statements throughout his VA medical treatment history of some occasionally worsening symptoms of his right ankle, the preponderance of the evidence of record precludes a finding that his right ankle has ever manifested in marked limitation of range of motion or occasionally incapacitating episodes of arthritis. In other words, a rating in excess of 10 percent does not yet appear to be warranted. The Veteran was most recently afforded another examination on October 7, 2020. At this examination, upon repetitive use, plantar flexion was measured from 0 to 15 degrees; dorsiflexion, from 0 to 5 degrees. To the extent that the Veteran endorsed flare-ups of the right ankle here but never previously, see Sharp v. Shulkin, supra, the Board resolves all reasonable doubt in the Veteran’s favor and grants a maximum schedular rating of 20 percent effective October 7, 2020. There is simply no evidence of record suggesting a similar marked loss of range of motion any earlier than October 7, 2020. Effective October 7, 2020, this yields a maximum schedular rating for this diagnostic code throughout the appellate period. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). To the extent that any portion of this claim may remain, the Board now dismisses it. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (where the law, not the evidence, is dispositive, the appeal should be terminated for lack of legal merit or entitlement). In addition, the Board has considered whether a higher or separate rating could be awarded under an alternative diagnostic code for the Veteran’s residuals of a right ankle strain. 38 C.F.R. § 4.71a, Diagnostic Codes 5270-74. In the October 2020 VA examination, the examiner found that the Veteran does not exhibit ankylosis in either ankle. See C&P Examination (Oct. 2020) at Question No. 5. As such, Diagnostic Code 5270 does not appear to apply. Similarly, the Veteran stated that he does not have, and has never been diagnosed with, either os calcis or astragalus, nor has he ever undergone an astragalectomy. See id. at Question No. 7. These findings preclude consideration of Diagnostic Codes 5272, 5273, and 5274, respectively. Under 38 C.F.R. § 4.71a, there are no other diagnostic codes available to evaluate disabilities of the ankle. The Board also acknowledges the Veteran’s sincerely held belief that his right ankle symptoms are more severe than currently contemplated. 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 his symptomatology and resulting functional difficulties, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert, supra. Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disability. The Board has also considered whether further staged ratings under Fenderson, supra, are appropriate for the Veteran’s residuals of a right ankle strain; however, the Board has awarded a maximum 20 percent disability rating effective October 7, 2020 (the first available evidence of record to suggest such an entitlement) and is continuing a minimum 10 percent rating for arthritis of the ankle for the former period in appellate status; therefore, staged ratings have been fully considered, but assigning further staged ratings for such disability is not warranted. Further, neither the Veteran nor his attorney have raised any other issues nor have any other issues been reasonably raised by the record, in regard to the increased rating claim adjudicated herein. See Doucette, supra. Based on the foregoing, the Board finds that a rating of 20 percent for the Veteran’s residuals of a right ankle strain since October 7, 2020, but no higher and no earlier, is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Prior to October 7, 2020, the Veteran’s claim for a rating in excess of 10 percent is denied. Id. There is no more reasonable doubt to be resolved. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert. T. SHERRARD Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael B. Engle, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.