Citation Nr: 21008931 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 14-34 345 DATE: February 18, 2021 ORDER New and material evidence having been received, the application to reopen the claim of entitlement to service connection for right knee disorder is granted. Prior to March 5, 2019, a 20 percent rating, but no higher, for left foot fasciitis is granted, subject to the laws and regulations governing the payment of monetary benefits. Prior to March 5, 2019, a rating in excess of 20 percent for residual of post calcaneal spurs of the right foot is denied. As of March 5, 2019, a rating in excess of 30 percent for bilateral plantar fasciitis with residual post calcaneal spurs of the right foot is denied. A 20 percent rating, but no higher for right lateral collateral ligament sprain is granted, subject to the laws and regulations governing the payment of monetary awards. An initial compensable rating for scar, residual to post calcaneal spurs of the right foot, is denied. As of December 5, 2014, a 10 percent rating, but no higher, for painful scar of the right medial heal is granted, subject to the laws and regulations governing the payment of monetary benefits. REMANDED Entitlement to service connection for right knee disorder, claimed as secondary to service-connected right ankle and bilateral foot disabilities, is remanded. FINDINGS OF FACT 1. In a final decision issued in February 2012, the Agency of Original Jurisdiction (AOJ) found that new and material evidence had not been received to reopen a claim of entitlement to service connection for a right knee disorder. 2. Evidence associated with the record since the final February 2012 denial is not cumulative or redundant of the evidence of record at the time of the decision and raises a reasonable possibility of substantiating the claim of entitlement to service connection for right knee disorder. 3. Prior to March 5, 2019, the Veteran’s left foot fasciitis resulted in a moderately severe foot injury as demonstrated by constant pain and an altered gait, without more severe symptomatology more nearly approximately a severe foot injury or actual loss of use of the foot. 4. Prior to March 5, 2019, the Veteran’s residual of post calcaneal spurs of the right foot resulted in a moderately severe foot injury as demonstrated by constant pain and an altered gait, without more severe symptomatology more nearly approximately a severe foot injury or actual loss of use of the foot. 5. As of March 5, 2019, the Veteran’s bilateral plantar fasciitis was manifested by pain on use, pain accentuated on use, and pain on manipulation, not improved by orthopedic shoes or appliances, without manifestations that more nearly approximate pronounced bilateral flatfoot, with marked pronation, extreme tenderness of plantar surfaces, and marked inward displacement and severe spasm of the tendo achillis on manipulation. 6. For the entire appeal period, the Veteran’s right lateral collateral ligament sprain resulted in marked limitation of motion, but no ankylosis. 7. For the entire appeal period, the Veteran’s scar, residual to post calcaneal spurs of the right foot, is manifested by a single scar measuring approximately 2 centimeters by 0.2 centimeters, which did not result in any disabling effects and is not painful or unstable prior to December 5, 2014. 8. As of December 5, 2014, the Veteran’s scar, residual to post calcaneal spurs of the right foot, is painful, but not unstable, at the right medial heal. CONCLUSIONS OF LAW 1. The February 2012 rating decision that found that new and material evidence had not been received to reopen a claim of entitlement to service connection for a right knee disorder is final. 38 U.S.C. § 7105(c) (West 2012); 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103 (2011). 2. New and material evidence has been received to reopen the claim of entitlement to service connection for right knee disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. Prior to March 5, 2019, the criteria for a rating of 20 percent, but no higher, for left foot fasciitis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5299-5284. 4. Prior to March 5, 2019, the criteria for a rating in excess of 20 percent residual of post calcaneal spurs of the right foot have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5003-5284. 5. As of March 5, 2019, the criteria for a rating in excess of 30 percent for bilateral plantar fasciitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5276. 6. The criteria for a rating of 10 percent, but no higher, for right lateral collateral ligament sprain have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271. 7. The criteria for an initial compensable rating for scar, residual to post calcaneal spurs of the right foot, has not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, Diagnostic Code 7805. 8. As of December 5, 2014, the criteria for a 10 percent rating, but no higher, for painful scar of the right medial heal have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, Diagnostic Code 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1992 to September 2000. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in May 2013 by a Department of Veterans Affairs (VA) Regional Office. In December 2014, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In July 2018, the Board remanded the issues on appeal for additional development and, in a rating decision issued in May 2020, the AOJ granted increased ratings for the Veteran’s bilateral plantar fasciitis and right ankle disability, and a separate 10 percent rating for painful scar of the right medial heal, as of March 5, 2019. Inasmuch as higher ratings are available for such disabilities, and the Veteran is presumed to be seeking the maximum available benefit for a disability, his claims for higher ratings remain on appeal. AB v. Brown, 6 Vet. App. 35, 38 (1993). The case now returns for further appellate review, with the Board herein characterizing the issues accordingly. The Board notes that, since the issuance of the May 2020 supplemental statement of the case, additional evidence, to include updated VA treatment records, has been associated with the record. While the Veteran has not waived AOJ consideration of such evidence, the Board finds that no prejudice results to him in proceeding with a decision at the present time as such is irrelevant to the instant claims or contain findings duplicative to those previously considered by the AOJ. 38 C.F.R. § 20.1305(c). 1. Whether new and material evidence has been received in order to reopen the claim of entitlement to service connection for a right knee disorder. By way of background, VA received the Veteran’s original claim for service connection for a right knee disorder in July 2009, which the AOJ denied in a rating decision issued in November 2009. In pertinent part, the AOJ noted that his service treatment records were negative for complaints of a right knee condition, and there was no evidence that such a disability currently existed. Thus, the AOJ denied service connection for a right knee disorder, to include as secondary to the Veteran’s service-connected right ankle disability. Later that month, the Veteran was advised of the decision and of his appellate rights, but he did not enter a notice of disagreement with such decision. Additionally, no new and material evidence was physically or constructively associated with the record within one year of the issuance of such decision, and no relevant service department records have since been received. Therefore, the November 2009 rating decision is final. 38 U.S.C. § 7105(c) (West 2002); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2009). VA received the Veteran’s application to reopen the claim of entitlement to service connection for a right knee disorder in July 2011. In a January 2012 rating decision, the AOJ again considered the Veteran’s service treatment records as well as post-service VA treatment records, but found that, as such did not reflect evidence of a current right knee disability, new and material evidence had not been received to reopen a claim of entitlement to service connection for a right knee disorder, to include as secondary to the Veteran’s service-connected right foot and/or ankle disabilities. In February 2012, the Veteran was advised of the decision and his appellate rights; however, he did not file a timely notice of disagreement with the denial. Furthermore, no new and material evidence was physically or constructively received within the year following the issuance of the rating decision, and no relevant service department records have since been received. Therefore, the February 2012 rating decision is final. 38 U.S.C. § 7105(c) (West 2012); 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103 (2011). Generally, a claim which has been denied in an unappealed Board decision or an unappealed AOJ decision may not thereafter be reopened and allowed. 38 U.S.C. §§ 7104(b), 7105(c). The exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). New evidence would raise a reasonable possibility of substantiating the claim if, when considered with the old evidence, it would at least trigger the Secretary’s duty to assist by providing a medical opinion. Shade v. Shinseki, 24 Vet. App. 110 (2010). For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). Since the issuance of the January 2012 rating decision, additional evidence consisting of VA examination reports, VA treatment records, and lay statements, to include the Veteran’s testimony at his December 2014 Board hearing, has been received. In pertinent part, VA examiners in March 2014 and March 2020 provided diagnoses of right knee strain and right knee osteoarthritis, respectively. As such newly received evidence speaks to one of the bases of the prior denials, namely, the absence of a clinical diagnosis of a chronic right knee disability, the Board finds that the evidence associated with the record since the final January 2012 denial is not cumulative or redundant of the evidence of record at the time of the decision and raises a reasonable possibility of substantiating the claim of entitlement to service connection for right knee disorder. Therefore, new and material evidence has been received, and such claim is reopened. Increased Ratings Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the U.S. Court of Appeals for Veterans Claims held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). For the service-connected disabilities on appeal, the appeal period before the Board begins on February 15, 2012, the date VA received the Veteran’s informal claim for increased ratings, plus the one-year look back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). 2. Entitlement to a rating in excess of 10 percent for left foot fasciitis prior to March 5, 2019. 3. Entitlement to a rating in excess of 20 percent for residual of post calcaneal spurs of the right foot prior to March 5, 2019. Prior to March 15, 2019, the Veteran’s service-connected left foot plantar fasciitis and residual of post calcaneal spurs of the right foot were assigned ratings of 10 percent and 20 percent pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5299-5284 and 5003-5284, respectively. In this regard, the assignment of Diagnostic Code 5299 reflects that the Veteran’s service-connected left foot plantar fasciitis was not listed in the Rating Schedule and, thus, was rated by analogy to Diagnostic Code 5284. Furthermore, while the Veteran’s service-connected residual of post calcaneal spurs of the right foot is rated pursuant to Diagnostic Code 5003, which pertains to degenerative arthritis, which, in turn, provides that such is rated based on limitation of motion, the evidence does not show that the Veteran has arthritis of the right foot. Nonetheless, based on such criteria, his residual of post calcaneal spurs of the right foot is rated pursuant to Diagnostic Code 5284. Under Diagnostic Code 5284, a 10 percent rating is provided for a moderate foot injury. A 20 percent rating is provided for a moderately severe foot injury, and a 30 percent evaluation is provided for a severe foot injury. The Note to Diagnostic Code 5284 indicates that a maximum 40 percent rating will be assigned for actual loss of use of the foot. 38 C.F.R. § 4.71a. The words “slight,” “moderate,” and “severe” as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. 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. Turning to the evidence of record, an October 2011 Podiatry Progress Note shows the Veteran reported painful bilateral heels and arches, with increasing pain on the left side, and wore a soft cast on his right foot to reduce some of the pain. The Veteran had normal muscle strength, but pain on palpation at the medial calcaneal tubercle and distally along the arch of both feet and with stress of the bilateral plantar fascia. Letters dated in October 2011 and November 2011 indicated the Veteran was limited to light duty, with limited amount of standing and weight-bearing, at work due to bilateral foot pain. A March 2012 magnetic resonance imaging scan showed only small bilateral calcaneal spurs, and VA treatment records dated in February 2012 and May 2012 reflect the Veteran’s reports of pain. On VA examination in February 2013, the Veteran reported daily, constant bilateral foot pain on the bottom of the heels and to the forefoot. He used custom orthotics without much relief. Physical examination revealed pain on palpation of the soles of the feet towards the forefoot; however, both motor and sensory examination were normal, and no foot conditions other than bilateral plantar fasciitis and small calcaneal spurs were noted on examination. On VA examination in July 2014, the Veteran reported daily bilateral plantar fasciitis pain, which was sharp with standing and walking, and flare-ups of pain that caused him to call out sick from work. The Veteran also had excess fatigability, pain on weight-bearing, pain on nonweight-bearing, interference with standing, and lack of endurance with both feet. With respect to work, the Veteran reported reduced endurance with walking, climbing on ladders, and climbing stairs due to his bilateral foot pain. The VA examiner found the Veteran had “mild to moderate impairment,” and no foot conditions other than bilateral plantar fasciitis were noted on examination. At the December 2014 Board hearing, the Veteran testified that he had daily, constant, severe left foot pain and daily, constant, excruciating right foot pain. He reported that he was unable to stand for long periods due to severe pain, and his bilateral foot disabilities affected his balance. He also stated that he had shooting pain through his toes on his right foot, with numbness in his toes and back of the heel. According to a January 2016 VA treatment record, the Veteran was limited to walking 200 yards before he developed bilateral foot pain. He had tenderness over the plantar fascia and the tendon to the flexor hallucis longus on the right side. The Veteran was also noted to have a slow, labored, antalgic gait with decreased step and stride. A May 2016 VA treatment record indicates the Veteran could not walk on his toes or heels due to his plantar fasciitis. Upon review, the Board finds the medical evidence and the Veteran’s lay statements show his service-connected left and right foot disabilities most nearly approximated a moderately severe foot injury prior to March 5, 2019. Here, the Board has paid particular attention to the Veteran’s reports of daily, constant pain and functional impairment related to walking, standing, and climbing. However, the July 2014 VA examiner found only “mild to moderate impairment,” and the medical evidence does not reflect additional symptomatology beyond pain and an altered gait, such as swelling and/or stiffness, associated with the Veteran’s bilateral foot disabilities. Further, although the Veteran reports missing some work due to flare-ups and an associated change in duties, the record, to include his lay statements, show that he has continued to work full-time. Consequently, as the evidence does not show that the Veteran’s bilateral foot disabilities more nearly approximated a severe foot injury or actual loss of use of either foot, the Board finds the criteria for a 20 percent rating, but no higher, have been met for each service-connected foot disability prior to March 5, 2019. Diagnostic Code 5284. The Board has considered whether higher and/or separate ratings are warranted under any other potentially applicable diagnostic codes. However, as the medical evidence does not reflect flat foot, weak foot, claw foot, anterior metatarsalgia, hallux valgus, hammer toe, or malunion of tarsal or metatarsal bones, or neurological impairment associated with the Veteran’s service-connected left and right foot disabilities, such are not applicable in this case. In regard to the latter matter, the Board notes that the Veteran is separately service-connected for right tarsal tunnel syndrome associated with his right ankle disability. 38 C.F.R. § 4.71a, 4.124a, Diagnostic Codes 5276-5283, 8520-8530. 4. Entitlement to a rating in excess of 30 percent for bilateral plantar fasciitis with residual of post calcaneal spurs of the right foot as of March 5, 2019. As of March 5, 2019, the Veteran was awarded service connection for right foot plantar fasciitis, and his service-connected bilateral foot disabilities were rated as a combined 30 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5276. In this regard, it was determined that, as of such date, the nature of the functions affected, anatomical location, and symptomatology of the service-connected disability most nearly approximated flat foot, rather than a generic foot injury. Thus, the Veteran’s left and right foot disabilities were rated together pursuant to Diagnostic Code 5276, as opposed to separately under Diagnostic Code 5284. Under Diagnostic Code 5276, a 30 percent rating is assigned for severe bilateral flatfoot with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities. For pronounced bilateral flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, and marked inward displacement and severe spasm of the tendo Achilles on manipulation, not improved by orthopedic shoes or appliance, a 50 percent rating is assigned. 38 C.F.R. § 4.71a, Diagnostic Code 5276. On VA examination on March 5, 2019, the Veteran reported mild bilateral foot pain that became worse after standing, walking long distances, and running. The Veteran wore orthotics, but did not use ambulatory aids and was able to perform his indoor and outdoor chores. While the Veteran had pain accentuated on use and pain on manipulation of both feet, he did not have swelling on use or characteristic callouses. He also did not have extreme tenderness of plantar surfaces, decreased longitudinal arch height on weight-bearing, marked deformity, or marked pronation. Moreover, the weight-bearing line did not fall over or medial to the great toe on either foot, and the Veteran did not have inward bowing of the Achilles tendon or marked inward displacement and severe spasm of the Achilles tendon. Although there was objective evidence of pain on weight-bearing and non-weight-bearing, the Veteran did not report pain, weakness, fatigability, or incoordination that significantly limited functional ability during flare-ups or with repeated use, and he did not describe any other functional loss during flare-ups or with repeated use. The VA examiner described the functional impact of the Veteran’s disability as possibly resulting in difficulty playing sports and performing heavy manual labor. The remaining medical evidence of record does not provide additional information pertinent to the Veteran’s bilateral plantar fasciitis subsequent to the date of the VA examination report. As such, the record does not reflect objective evidence of marked pronation, extreme tenderness of plantar surfaces of the feet, and marked inward displacement and severe spasm of the tendo Achilles on manipulation. While the Board acknowledges the Veteran’s competent reports of his symptomatology, the Board finds the medical evidence is most probative as it considers the Veteran’s reported symptoms and provides clinical evaluation of the disability, to include the functional impairment caused thereby. Consequently, even considering the Veteran’s self-reported symptomatology, the Board finds a rating in excess of 30 percent for bilateral plantar fasciitis is not warranted at any time as of March 5, 2019 pursuant to Diagnostic Code 5276. The Board further observes that, as of February 7, 2021, VA has amended the Rating Schedule to include plantar fasciitis. Specifically, as of such date, plantar fasciitis is rated pursuant to Diagnostic Code 5269, which provides for a 30 percent rating where there is bilateral plantar fasciitis with no relief from both non-surgical and surgical treatment. A 20 percent rating is warranted where there is unilateral plantar fasciitis with no relief from both non-surgical and surgical treatment. Otherwise, a 10 percent rating is assigned for unilateral or bilateral plantar fasciitis. Note (1) indicates that, with actual loss of use of the foot, a 40 percent is assigned. Note (2) reports that, if a veteran has been recommended for surgical intervention, but is not a surgical candidate, his or her plantar fasciitis is evaluated under the 20 percent or 30 percent criteria, whichever is applicable. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020), 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5269). Thus, as the Veteran is already in receipt of a 30 percent rating for bilateral plantar fasciitis, which is the maximum schedular rating for such disability under Diagnostic Code 5269 and fully contemplates his symptomatology, a higher or separate rating under such diagnostic code is not warranted. The Board has further considered whether higher and/or separate ratings are warranted under any other potentially applicable diagnostic codes. However, as the medical evidence does not reflect weak foot, claw foot, anterior metatarsalgia, hallux valgus, hammer toe, or malunion of tarsal or metatarsal bones, or neurological impairment associated with the Veteran’s service-connected left and right foot disabilities, such are not applicable in this case. In regard to the latter matter, the Board again notes that the Veteran is separately service-connected for right tarsal tunnel syndrome associated with his right ankle disability. 38 C.F.R. § 4.71a, 4.124a, Diagnostic Codes 5277-5283, 8520-8530. 5. Entitlement to a rating of in excess of 10 percent prior to March 5, 2019, and in excess of 20 percent thereafter for right lateral collateral ligament sprain. The Veteran’s right lateral collateral ligament sprain is evaluated as 10 percent disabling prior to March 5, 2019, and 20 percent disabling thereafter under Diagnostic Code 5271, which, prior to February 7, 2021, provides a 10 percent rating for moderate limited motion of the ankle and a 20 percent rating for marked limitation of motion of the ankle. 38 C.F.R. § 4.71a. As of February 7, 2021, Diagnostic Code 5271 provides for a 10 percent rating for moderate limitation motion of the ankle, defined as less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion, and a 20 percent rating for marked limitation motion of the ankle, defined as less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5271). Normal plantar flexion ranges from zero to 45 degrees and normal dorsiflexion ranges from zero to 20 degrees. Turning to the evidence of record, an October 2011 VA Podiatry Progress Note shows the Veteran had decreased range of motion of the ankle and was unable to perform double heel raise testing. A February 2012 VA treatment record also reflects decreased range of motion of the right ankle and chronic heel pain. The Veteran was unable to undergo a complete VA examination in November 2011 as he was wearing a soft cast on his right foot. On VA examination in February 2013, the Veteran reported ongoing medial right ankle pain that sometimes shot up the medial aspect of his ankle into his leg and occasional instances when he felt like his ankle gave out. The Veteran had normal plantar flexion to 45 degrees, however, with objective evidence of painful motion at 30 degrees, and dorsiflexion was limited to five degrees, with objective evidence of pain beginning at zero degrees. There was no additional loss following repetitive-use testing. Moreover, he did not have ankylosis of the ankle, subtalar, and/or tarsal joint. An April 2013 VA treatment record also shows the Veteran’s right ankle range of motion was only “slightly reduced”. In July 2014, VA examination revealed plantar flexion limited to 30 degrees and dorsiflexion limited to 10 degrees. However, the Veteran was unable to perform repetitive-use testing due to pain, and functional loss included less movement than normal, excess fatigability, pain on movement, and interference with sitting, standing, and weight-bearing. The Veteran also had pain on palpation and decreased strength with both plantar flexion and dorsiflexion. He did not present with ankylosis of the ankle. In May 2015, September 2015, and November 2015, the Veteran notably had full plantar flexion to 45 degrees with dorsiflexion only limited to 10 degrees. At the Board hearing in December 2014, the Veteran reported problems with instability and giving way, in addition to continuous pain. On VA examination on March 5, 2019, the date where a 20 percent rating for marked limitation of right ankle motion was assigned, the Veteran reported ankle joint pain that became worse with prolonged standing and cold weather, but he denied flare-ups. In pertinent part, while the Veteran had full plantar flexion, dorsiflexion was limited to zero degrees. The examiner noted there was no objective evidence of pain on examination or crepitus, although the Veteran did have mild medial, lateral, and anterior ankle joint tenderness. There was no additional loss of function or range of motion after repetitive-use testing, or ankylosis. Based on the foregoing, to include the fact that the Veteran had limitation of dorsiflexion of the right ankle limited to 5 degrees at the February 2013 VA examination, the Board resolves all doubt in favor of the Veteran and finds that his right ankle disability more nearly approximates marked limitation of motion for the entire appeal period. Thus, a 20 percent rating, the schedular maximum, under Diagnostic Code 5271 is warranted for the entire appeal period. In this case, the only applicable diagnostic code that provides for a rating greater than 20 percent is Diagnostic Code 5270, which evaluates ankylosis of the ankle. Here, however, the evidence does not demonstrate any findings of ankylosis at any time during the appeal period. Rather, as described above, the pertinent medical evidence shows the Veteran has had the ability to move his right ankle throughout the appeal period. As a result, a higher rating under Diagnostic Code 5270 is not warranted for the Veteran’s service-connected right ankle disability. 6. Entitlement to an initial compensable rating for scar, residual to post calcaneal spurs of the right foot. 7. Propriety of the separately assigned rating for painful scar of the right medial heal, evaluated as 10 percent rating as of March 5, 2019. Throughout the pendency of the appeal, the Veteran is in receipt of a noncompensable rating for his right foot scar pursuant to Diagnostic Code 7805. Diagnostic Code 7805, which specifically provides that other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804 that require the evaluation of any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-7804 should be rated under an appropriate diagnostic code. 38 C.F.R. § 4.118. As noted above, the AOJ also awarded a separate 10 percent rating, effective March 5, 2019, for the Veteran’s right foot scar under Diagnostic Code 7804. Diagnostic Code 7800 pertains to burn scars of the head, face, or neck; scars of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck. 38 C.F.R. § 4.118. As the Veteran’s service-connected scar is located on his right foot, this Diagnostic Code is not for application. Diagnostic Code 7801 pertains to burn scars or scars due to other causes, not of the head, face, or neck, that are, prior to August 13, 2018, deep and nonlinear and, after such date, associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Under this Diagnostic Code, a 10 percent rating is assigned when the scar(s) cover an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.), and a 20 percent rating is warranted when the scar(s) cover an area or areas of at least 12 square inches (77 sq. cm.) but less than 72 square inches (465 sq. cm.). A 30 percent rating is assigned when the scar(s) cover an area or areas of at least 72 square inches (465 sq. cm.) but less than 144 square inches (929 sq. cm.), and a 40 percent rating is warranted when the scar(s) cover an area or areas of 144 square inches (929 sq. cm.) or greater. Diagnostic Code 7802 pertains to burn scars or scars due to other causes not of the head, face, or neck that are, prior to August 13, 2018, superficial and nonlinear and, after such date, not associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Under this Diagnostic Code, a 10 percent rating is assigned when the scar(s) cover an area or areas of 144 square inches (929 sq. cm) or greater. As the medical evidence shows the Veteran’s scar measures approximately two centimeters by 0.2 centimeters, a higher evaluation is not warranted under either Diagnostic Code 7801 or 7802. However, as noted in the May 2020 rating decision, scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under Diagnostic Code 7804, when applicable. Note (3). In this regard, Diagnostic Code 7804 provides that one or two scars that are unstable or painful warrant a 10 percent evaluation. 38 C.F.R. § 4.118. Three or four scars that are unstable or painful warrant a 20 percent rating, while five or more scars that are unstable or painful warrant a 30 percent evaluation. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) states that if one or more scars are both unstable and painful, the rater is to add 10 percent to the evaluation that is based on the total number of unstable or painful scars. As described above, the Veteran has only one service-connected scar, and the medical evidence does not reflect findings of any additional scars. Additionally, a VA examiner found in February 2013 that the Veteran’s scar was not painful and/or unstable, and an April 2013 VA treatment record shows the Veteran’s surgical scar on the plantar medical right foot was well-healed without edema or erythema. However, at the December 5, 2014, Board hearing, the Veteran testified that the scar was very sensitive and tender and, if touched, sent a sensation of pain shooting up his leg. Likewise, the March 2019 VA examination report reflects his reports of mild pain in the area of his right medial heel scar with minor trauma and/or palpation, and the scar was noted as tender to palpation on physical examination. Based on this evidence, the Board finds a separate 10 percent rating, but no higher, is warranted for the Veteran’s right foot scar as of December 5, 2014, pursuant to Diagnostic Code 7804. 38 C.F.R. § 4.118. However, the medical evidence does not indicate the existence of other disabling effects for which a higher or separate rating is warranted at any time during the appeal period. Other Considerations In reaching its conclusions in the instant case, the Board acknowledges the Veteran’s belief that his bilateral foot, right ankle, and scar disabilities are more severe than as reflected by the current assigned disability ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disabilities. The Board has also considered whether additional staged ratings under Fenderson, supra, and Hart, supra, are appropriate for the Veteran’s service-connected disabilities; however, the Board finds that his symptomatology has been stable throughout each period on appeal. Thus, assigning additional staged ratings for such disabilities is not warranted. Furthermore, 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 increased rating claims adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). In reaching such determinations, the Board has considered the applicability of the benefit of the doubt doctrine, which has resulted in partial awards of increased ratings for the Veteran’s left foot, right ankle, and scar disabilities. However, insofar as the Board has denied higher or separate ratings for the disabilities on appeal, the preponderance of the evidence is against such aspects of the Veteran’s claims. Thus, the benefit of the doubt doctrine is not applicable in such regard and his increased rating claims must otherwise be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 8. Entitlement to service connection for right knee disorder, claimed as secondary to service-connected right ankle and bilateral foot disabilities. The Veteran contends he has a current right knee disorder that is caused or aggravated by his right ankle and bilateral foot disabilities. As noted previously, VA examiners in March 2014 and March 2020 provided diagnoses of right knee strain and right knee osteoarthritis, respectively. However, the March 2014 VA examiner opined that the Veteran’s bilateral knee pain was as likely as not the result of his near 60-pound weight gain since service. Furthermore, the March 2020 VA examiner opined it is less likely as not that the Veteran’s right knee disorder is secondary to his service-connected right ankle disability. In this regard, she found there was no evidence in the chart or according to the Veteran’s own reports that he had a chronically altered gait secondary to right ankle pain or a leg length discrepancy. Additionally, the VA examiner noted the Veteran’s right knee complaints began after a twisting injury in 2015. As a result, she found there was insufficient objective evidence to suggest a link between the Veteran’s service-connected right ankle injury and his current diagnosis of right knee osteoarthritis. Upon review, the Board finds the VA examiners’ opinions insufficient for the purpose of determining entitlement to service connection. Here, although the March 2014 VA examiner provided an opinion as to the etiology of the Veteran’s right knee pain, she did not address whether the Veteran’s current right knee disorder is aggravated by a service-connected disability. Likewise, the March 2020 VA examiner did not address whether the Veteran’s current right knee disorder is aggravated beyond its natural progression by his service-connected right ankle disability, or whether such is caused or aggravated by his service-connected bilateral foot disability. Consequently, a remand is necessary in order to obtain an addendum opinion addressing such matters. The matter is REMANDED for the following action: Forward the record, to include a copy of this Remand, to the VA examiner who conducted the March 2020 VA examination, or an appropriate clinician if unavailable, for an addendum opinion as to the etiology of the Veteran’s right knee disorder. After review of all the evidence, the clinician should provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s current right knee disorder, diagnosed as right knee strain and right knee osteoarthritis, is aggravated by his service-connected right lateral collateral ligament sprain and/or right tarsal tunnel syndrome (right ankle disabilities). The clinician should also provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s current right knee disorder is caused or aggravated by his service-connected bilateral plantar fasciitis with residual of post calcaneal spurs of the right foot. For any aggravation found, the examiner should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. M. Celli, 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.