Citation Nr: 21009964 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 12-17 889 DATE: February 23, 2021 ORDER Entitlement to an initial rating in excess of 40 percent for arthritis of the shoulders, hands, and knees prior to April 8, 2015 is denied. Entitlement to a 10 percent rating for sarcoid arthropathy of the thoracolumbar spine is granted from February 15, 2012. Entitlement to a compensable rating for sarcoid arthropathy of the thoracolumbar spine prior to February 15, 2012, and to a rating in excess of 10 percent thereafter, is denied. Entitlement to a higher initial rating for sarcoid arthropathy of the cervical spine, currently rated as noncompensable prior to April 8, 2015, 10 percent disabling from Apri 8, 2015, and 20 percent from November 26, 2019, is denied. Entitlement to a higher initial rating for sarcoid arthropathy of the right shoulder, currently rated as noncompensable prior to April 8, 2015 and 20 percent disabling thereafter, is denied. Entitlement to a higher initial rating for sarcoid arthropathy of the left shoulder, currently rated as noncompensable prior to April 8, 2015 and 20 percent disabling thereafter, is denied. Entitlement to a higher initial rating for sarcoid arthropathy of the right knee, currently rated as noncompensable prior to November 26, 2019 and 10 percent disabling thereafter, is denied. Entitlement to a higher initial rating for sarcoid arthropathy of the left knee, currently rated as noncompensable prior to November 26, 2019 and 10 percent disabling thereafter, is denied. Entitlement to an initial compensable rating for sarcoid arthropathy of the right hand prior to November 26, 2019 is denied. Entitlement to an initial compensable rating for sarcoid arthropathy of the left hand prior to November 26, 2019 is denied. Entitlement to a higher initial rating for sarcoid arthropathy, right thumb, currently rated 10 percent disabling, is denied. Entitlement to a higher initial rating for sarcoid arthropathy, right index finger, currently rated 10 percent disabling, is denied. Entitlement to a higher initial rating for sarcoid arthropathy, right long finger, currently rated 10 percent disabling, is denied. Entitlement to a higher initial rating for sarcoid arthropathy, right ring finger, currently rated noncompensably disabling, is denied. Entitlement to a higher initial rating for sarcoid arthropathy, right little finger, currently rated noncompensably disabling, is denied. Entitlement to a higher initial rating for sarcoid arthropathy, left thumb, currently rated 10 percent disabling, is denied. Entitlement to a higher initial rating for sarcoid arthropathy, left index finger, currently rated 10 percent disabling, is denied. Entitlement to a higher initial rating for sarcoid arthropathy, left long finger, currently rated 10 percent disabling, is denied. Entitlement to a higher initial rating for sarcoid arthropathy, left ring finger, currently rated noncompensably disabling, is granted. Entitlement to a higher initial rating for sarcoid arthropathy, left little finger, currently rated noncompensably disabling, is denied. FINDINGS OF FACT 1. Prior to April 8, 2015, the Veteran’s degenerative arthritis of the shoulders, hands, and knees was manifested by definite impairment of health, as evinced by his use of prescribed narcotic pain medication, and diagnostic imaging revealing joint degeneration throughout the upper and lower body; weight loss and anemia productive of severe impairment of health, or severely incapacitating exacerbations occurring four or more times per year of a lesser number over prolonged periods were not shown. 2. The Veteran’s sarcoid arthropathy of the thoracolumbar spine has been manifested by limitation of flexion between 60 and 85 degrees since February 15, 2012; at no time has it been manifested by muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour; no neurologic abnormalities other than mild radiculopathy of the bilateral lower extremities have been demonstrated. 3. The Veteran’s sarcoid arthropathy of the cervical spine has been manifested by limitation of flexion to 40 degrees since February 15, 2012, and combined range of motion not greater than 170 degrees since November 26, 2019; at no time has it been manifested by cervical flexion limited to 15 degrees or less, favorable ankylosis of the cervical spine, radiculopathy, or other neurologic abnormalities. 4. Prior to April 8, 2015, there was no showing of compensable loss of range of motion, or of pain on motion resulting in functional loss, in the Veteran’s right shoulder. As of April 8, 2015, there is evidence of painful motion; at no time has limitation of motion midway between side and shoulder level been demonstrated or approximated. 5. Prior to April 8, 2015, there was no showing of compensable loss of range of motion, or of pain on motion resulting in functional loss, in the Veteran’s left shoulder. As of April 8, 2015, there is evidence of painful motion; at no time has limitation of motion to 25 degrees from the side been demonstrated or approximated. 6. Prior to November 26, 2019, the evidence did not show compensable loss of range of motion or painful motion in either knee; from November 26, 2019 there is no showing that either knee was manifested by limitation of flexion to 45 degrees, limitation of extension to 10 degrees, or instability. 7. Prior to November 26, 2019, there was no showing of compensable loss of range of motion in any finger of either hand, nor was painful motion shown. 8. From November 26, 2019, limitation of motion of the right thumb is shown; there is no showing of limitation of motion with a gap of more than two inches between the thumb pad and the fingers with the thumb attempting to oppose the fingers. 9. From November 26, 2019, the Veteran’s sarcoid arthropathy of the right index finger manifested by painful motion, with no evidence of ankylosis or functional impairment such that no effective function remains other than that which would be equally well served by an amputation or prosthesis. 10. From November 26, 2019, the Veteran’s sarcoid arthropathy of the right long finger manifested by painful motion, with no evidence of ankylosis or functional impairment such that no effective function remains other than that which would be equally well served by an amputation or prosthesis. 11. From November 26, 2019, the Veteran’s sarcoid arthropathy, right ring finger is assigned a noncompensable rating, which is the maximum rating possible under the diagnostic code that evaluates limitation of motion of the ring finger; there is no evidence of ankylosis or symptoms analogous to amputation. 12. From November 26, 2019, the Veteran’s sarcoid arthropathy, right little finger is assigned a noncompensable rating, which is the maximum rating possible under the diagnostic code that evaluates limitation of motion of the little finger; there is no evidence of ankylosis or symptoms analogous to amputation. 13. From November 26, 2019, painful motion of the left thumb is shown; there is no showing of limitation of motion with a gap of more than two inches between the thumb pad and the fingers with the thumb attempting to oppose the fingers. 14. From November 26, 2019, the Veteran’s sarcoid arthropathy of the left index finger manifested by painful motion, with no evidence of ankylosis or functional impairment such that no effective function remains other than that which would be equally well served by an amputation or prosthesis. 15. From November 26, 2019, the Veteran’s sarcoid arthropathy of the left long finger manifested by painful motion, with no evidence of ankylosis or functional impairment such that no effective function remains other than that which would be equally well served by an amputation or prosthesis. 16. From November 26, 2019, the Veteran’s sarcoid arthropathy, left ring finger is assigned a noncompensable rating, which is the maximum rating possible under the diagnostic code that evaluates limitation of motion of the ring finger; there is no evidence of ankylosis or symptoms analogous to amputation. 17. From November 26, 2019, the Veteran’s sarcoid arthropathy, left little finger is assigned a noncompensable rating, which is the maximum rating possible under the diagnostic code that evaluates limitation of motion of the little finger; there is no evidence of ankylosis or symptoms analogous to amputation. CONCLUSIONS OF LAW 1. The criteria for Entitlement to in excess of 40 percent for arthritis of the shoulders, hands, and knees prior to April 8, 2015 have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5002. 2. The criteria for a 10 percent rating for sarcoid arthropathy of the thoracolumbar spine from February 15, 2012 have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5237. 3. The criteria for entitlement to a compensable rating for sarcoid arthropathy of the thoracolumbar spine prior to February 15, 2012, and for a rating in excess of 10 percent thereafter, have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5237. 4. The criteria for entitlement to a higher initial rating for sarcoid arthropathy of the cervical spine, currently rated as noncompensable prior to April 8, 2015, 10 percent disabling from April 8, 2015, and 20 percent from November 26, 2019, have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5237. 5. The criteria for entitlement to a higher initial rating for sarcoid arthropathy of the right shoulder, currently rated as noncompensable prior to April 8, 2015 and 20 percent disabling thereafter have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5201. 6. The criteria for entitlement to a higher initial rating for sarcoid arthropathy of the left shoulder, currently rated as noncompensable prior to April 8, 2015 and 20 percent disabling thereafter have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5201. 7. The criteria for entitlement to a higher initial rating for sarcoid arthropathy of the right knee, currently rated as noncompensable prior to November 26, 2019 and 10 percent disabling thereafter, have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DCs 5257, 5258, 5259, 5260, 5261. 8. The criteria for entitlement to a higher initial rating for sarcoid arthropathy of the left knee, currently rated as noncompensable prior to November 26, 2019 and 10 percent disabling thereafter, have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DCs 5257, 5258, 5259, 5260, 5261. 9. The criteria for entitlement to an initial compensable rating for sarcoid arthropathy of the right hand prior to November 26, 2019 have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DCs 5228, 5229. 10. The criteria for entitlement to an initial compensable rating for sarcoid arthropathy of the left hand prior to November 26, 2019 have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DCs 5228, 5229. 11. The criteria for entitlement to a higher initial rating for sarcoid arthropathy, right thumb, currently rated 10 percent disabling have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5228. 12. The criteria for entitlement to a higher initial rating for sarcoid arthropathy, right index finger, currently rated 10 percent disabling have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5229. 13. The criteria for entitlement to a higher initial rating for sarcoid arthropathy, right long finger, currently rated 10 percent disabling have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5229. 14. The criteria for entitlement to a higher initial rating for sarcoid arthropathy, right ring finger, currently rated noncompensably disabling, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5230. 15. The criteria for entitlement to a higher initial rating for sarcoid arthropathy, right little finger, currently rated noncompensably disabling, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5230. 16. The criteria for entitlement to a higher initial rating for sarcoid arthropathy, left thumb, currently rated 10 percent disabling have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5228. 17. The criteria for entitlement to a higher initial rating for sarcoid arthropathy, left index finger, currently rated 10 percent disabling have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5229. 18. The criteria for entitlement to a higher initial rating for sarcoid arthropathy, left long finger, currently rated 10 percent disabling have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5229. 19. The criteria for entitlement to a higher initial rating for sarcoid arthropathy, left ring finger, currently rated noncompensably disabling, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5230. 20. The criteria for entitlement to a higher initial rating for sarcoid arthropathy, left little finger, currently rated noncompensably disabling, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5230. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1965 to February 1967. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing held at the Board’s Central Office in Washington, D.C. in April 2013. A transcript of the hearing is included in the claims file. This case was previously before the Board in December 2014 and February 2018. In its February 2018 decision, the Board granted a 40 percent initial rating for degenerative arthritis of the bilateral shoulders, bilateral hands, and bilateral knees prior to April 8, 2015 and denied entitlement to higher initial ratings for the other disabilities on appeal. The Veteran appealed the Board decision to the Court of Appeals for Veterans Claims (CAVC or the Court). In January 2019, the Court granted a Joint Motion for Partial Remand (JMPR) vacating and remanding the February 2018 Board decision to the extent it denied higher initial ratings for the disabilities on appeal. In July 2019, the Board remanded the case for further development pursuant to the JMPR. Increased Ratings Disability ratings are determined by applying a schedule of reductions in earning capacity from specific injuries or a combination of injuries that is based upon the average impairment of earning capacities. 38 U.S.C. § 1155. Each disability must be viewed in relation to its entire history, with emphasis upon the limitations proportionate to the severity of the disabling condition. 38 C.F.R. § 4.1. Where there is a question as to which of the two disability evaluations is applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence of record, any reasonable doubt remaining will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. When the appeal arises from an initial assigned rating, consideration must be given to whether staged ratings should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). When rating the Veteran’s service-connected disability, the entire medical history must be reviewed. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board must also fully consider the lay assertions of record. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). When evaluating musculoskeletal disabilities, VA may, in addition to applying schedular criteria, consider granting a higher rating in cases in which the claimant experiences additional functional loss due to pain, weakness, excess fatigability, or incoordination, to include with repeated use or during flare-ups, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45 (2016); DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996). Residuals of the Veteran’s sarcoidosis, including musculoskeletal symptoms affecting the bilateral shoulders, hands, and knees, and the cervical and thoracolumbar spine, were initially rated by analogy under DC 5002, which deals with rheumatoid arthritis, the evidence indicating the Veteran’s sarcoidosis was responsible for arthritic processes that affected various parts of his musculoskeletal system. DC 5002 contemplates the severity of active arthritic processes; the specific criteria are discussed in detail below. For chronic residuals associated with an underlying arthritic process, DC 5002 provides that they may be rated either under the DC 5002 criteria or based on limitation of motion of the affected area, but not both. A note appended further clarifies that “[t]he ratings for the active [arthritic] process will not be combined with the residual ratings for limitation of motion or ankyloses,” adding the evaluator must “[a]ssign the higher rating.” From April 8, 2015, the Veteran’s chronic residuals of arthritis attributable to sarcoidosis have been rated based on limitation of motion of the various affected areas, the resulting individual ratings exceeding the 40 percent rating previously assigned under DC 5002. The question remains before the Board whether, for each portion of the appeal period, the Veteran would be entitled to a higher evaluation by application of DC 5002, or by assigning separate ratings for the affected areas, including the cervical and thoracolumbar spine, bilateral shoulders, bilateral hands, and bilateral knees. In considering the Veteran’s cervical and lumbar spine disabilities as part of the current claim, the Board notes the Veteran’s September 2012 statement in support of claim, wherein he indicates his “neck and back pain should [not] be separate issues [from the claim for degenerative arthritis,” noting the connection between his upper back, neck, and shoulder symptomatology in describing “pain from [his] neck down to [his] shoulders,” and statements furnished by S.P., M.D., a private provider, who has indicated the Veteran’s sarcoidosis is most likely causative for all of his arthritic symptoms, including those affecting the upper and lower back. 1. Entitlement to in excess of 40 percent for arthritis of the shoulders, hands, and knees prior to April 8, 2015 Prior to April 8, 2015, the Veteran’s systemic arthritis has been rated by analogy under DC 5002, which provides for a 20 percent evaluation for arthritis that results in one or two exacerbations per year; for a 40 percent evaluation in the case of a symptom combination productive of “definite impairment of health” supported by examination findings or incapacitating exacerbations occurring three or more times per year; for a 60 percent rating where arthritis is accompanied by weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring four or more times per year or a lesser number over a longer period; and for a 100 percent rating where constitutional manifestations associated with active joint involvement are totally incapacitating. The Board’s February 2018 decision granted a 40 percent rating under DC 5002 for the period on appeal prior to April 8, 2015; that part of the Board’s decision was left undisturbed in the January 2019 JMPR. As discussed above, a note appended to the DC 5002 criteria provides that “[t]he ratings for the active [arthritic] process will not be combined with the residual ratings for limitation of motion or ankyloses,” directing the evaluator to “[a]ssign the higher evaluation.” The Board observes that with consideration of a benefit granted in this decision, from February 15, 2012, the Veteran is in receipt of a 10 percent rating for sarcoidal arthropathy of the thoracolumbar spine. From April 8, 2015, the Veteran is in receipt of ratings of 10 percent for arthritic residuals of sarcoidosis for the cervical spine, 20 percent for the left shoulder, and 20 percent for the right shoulder. As such, a higher evaluation as contemplated by the note appended to DC 5002 would constitute no less than a 60 percent rating under the DC 5002 criteria, which, as noted above, requires a showing of “weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring four or more times a year or a lesser number over a prolonged period.” Such a showing has not been made here. First, the Veteran’s treatment records do not reflect that he has ever been diagnosed with anemia, or that marked weight loss has been recorded over any portion of the appeal period. Moreover, there is simply no evidence of “severely incapacitating episodes” at any point during the appeal period, including the latter portion. The record does not reflect that the Veteran has been prescribed extended bedrest due to an arthritic flareup, or that his activities have been restricted by a medical professional due to such flareups. Accordingly, the Veteran’s sarcoid-related symptomatology has been evaluated not under the criteria of DC 5002, but under the individual criteria for each affected area for the period dating from April 8, 2015, which approach results in a higher overall rating from that date. However, the record is bare of clinical or examination findings to support compensable evaluations for the individually enumerated manifestations of the Veteran’s sarcoidosis residuals prior to April 8, 2015. As such, DC 5002 remains the most appropriate code under which to evaluate his symptomatology affecting the shoulders, hands, and knees prior to that date. The evidence covering that earlier portion of the appeal period reveals limited treatment sought or received for arthritic residuals of the Veteran’s service-connected sarcoidosis. In fact, an April 2013 private provider note from S.P., M.D., indicates the Veteran’s diagnosis of sarcoid arthritis is not a firm diagnosis, but the most probably one given his overall health picture. The private provider adds that diagnostic imaging is unable to differentiate between sarcoid arthritis and latent onset osteoarthritis. In any event, neither private treatment records nor the examination notes from any VA examination reveal altogether incapacitating episodes at any point. The Veteran has reported that when his symptoms are at their worst, which occurs approximately three to four times per year, he uses prescribed Tramadol to manage symptoms. Again, there is no indication he has been prescribed extended bedrest or significantly curtailed activities for his arthritic symptoms. The Veteran’s consistent complaints of joint pain and documented use of Tramadol, coupled with diagnostic imaging showing degenerative changes over time most likely associated with sarcoid arthropathy, are consistent with the currently assigned 40 percent rating, which requires a showing of symptom combinations “productive of definite impairment of health,” for the earlier portion of the appeal period. The record demonstrates degenerative joint disease of multiple joints bilaterally and in the upper and lower body, which has required periodic treatment with narcotic pain medication. There is no basis in the record for a higher rating. There has never been any showing of weight loss and anemia, or of severely incapacitating exacerbations, during any portion of the appeal period. Nor have arthritic symptoms been “totally incapacitating,” as contemplated by the criteria for a total disability rating, at any time. In sum, the Board finds that entitlement to a rating in excess of 40 percent is not warranted for degenerative arthritis of the shoulders, hands, and knees, secondary to service-connected sarcoidosis prior to April 8, 2015. Because evaluation under separate codes dealing with the individual areas of the body affected results in a higher overall rating from that date, the Board has not assigned a compensable rating under DC 5002 on or after April 8, 2015. 2. Entitlement to a higher initial rating for sarcoid arthropathy of the thoracolumbar spine, currently rated as noncompensable prior to April 8, 2015 and 10 percent disabling thereafter Back disabilities are rated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), specified in 38 C.F.R. § 4.71a. If there is intervertebral disc disease, the rating criteria specified in the Formula for Rating Intervertebral Disk Syndrome Based on Incapacitating Episodes may be applicable. In this case, the Veteran’s back disability has been evaluated under DC 5237, for lumbosacral or cervical strain. The General Rating Formula provides for a 10 percent evaluation when back disability results in forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees, or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees, or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour. Back disability warrants a 20 percent rating where there is forward flexion of the thoracolumbar spine 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 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 evaluation is warranted for favorable ankylosis of the entire thoracolumbar spine or forward flexion of the thoracolumbar spine of 30 degrees or less. The only criterion which warrants an evaluation in excess of 40 percent for limitation of motion of the thoracolumbar spine is where there is unfavorable ankylosis of the thoracic spine. Unfavorable ankylosis of the entire thoracolumbar spine warrants a 50 percent rating, and unfavorable ankyloses of the entire spine warrants a 100 percent rating. The General Formula directs that any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be rated separately, under an appropriate diagnostic code. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The Rating Schedule allows evaluation of intervertebral disc syndrome (IVDS) based on incapacitating episodes. 38 C.F.R. § 4.71a, DC 5243. An incapacitating episode is a period of acute signs and symptoms that requires bed rest and treatment by a physician. 38 C.F.R. § 4.71a, Note (1). As the record does not reflect any episodes of prescribed bed rest and treatment having a total duration of at least two weeks during any twelve month period within the current appeal period, an evaluation higher than 10 percent is unavailable under the formula for rating IVDS based on incapacitating episodes, and will not be discussed further. Back disability is, as noted above, rated on limitation of motion, or may be rated based on subjective complaints of pain, if there is objective confirmation of arthritis on radiologic examination. DCs 5003, 5010. A 10 percent evaluation is the maximum schedular evaluation available for arthritis of one joint or group of joints under DCs 5003 or 5010, so application of these DCs would not result in a more favorable evaluation for the Veteran. No further discussion of those DCs is required. The record reflects limited treatment sought or received for low back pain during the appeal period. September 2004 VA treatment notes show complaints of periodic low back and hip pain associated with sarcoidosis, but diagnostic imaging from that period fails to show acute findings. Complaints and treatment remained sparse until the Veteran’s February 2012 VA back examination. At the February 15, 2012 examination, flexion was limited to 85 degrees. The rest of the range of motion testing was normal, with no loss of range of motion after three repetitions of testing. The examiner’s notes show the Veteran was not tender to palpation of the paraspinal musculature. Moreover, he had no radicular symptoms, his gait was normal, and there was no evidence of muscle atrophy. All neurological testing was normal, and straight leg raise testing was negative bilaterally. The Veteran did report period pain with walking and standing, but examination notes do not reflect any pain behavior observed on examination, or reported with any aspect of testing. A VA examination was conducted in April 2015. There, the Veteran complained of painful flareups every 2-3 months lasting for several days, explaining he used prescribed Tramadol to manage symptoms. Range of motion testing revealed flexion to 80 degrees, extension to 30, left lateral flexion and rotation both to 30 degrees, and right lateral flexion and rotation both to 30 degrees, with no loss of range of motion after three repetitions of testing. There was a degree of tenderness to palpation in the lumbar area, but full muscle strength of the hips and lower extremities bilaterally. There was no evidence of pain with weight bearing. Neurological testing was normal, and straight leg raise testing was negative bilaterally. There was no evidence of ankylosis at any level of the spine, and the Veteran’s gait was normal, albeit with periodic use of a cane by report. On VA examination in November 2019, the Veteran reported that he “can’t bend, can’t turn, constant 5/10 achy pain.” With certain movements his pain would go up to 10/10 pain. He reported that he could not garden and had difficulty standing or sitting for long periods of time. He had started getting back spasms. The Veteran reported numbness and tingling in both feet. He reported that his back condition had worsened since onset. The Veteran reported flare-ups and functional loss associated with gardening once or twice a month that would last for up to two weeks. On examination, initial ranges of motion were flexion to 80 degrees; extension to five degrees; right lateral flexion to 15 degrees; left lateral flexion to 10 degrees; right lateral rotation to 30 degrees; and left lateral rotation to 20 degrees. There was no additional loss of range of motion after three repetitions. Pain was noted with all range of motion testing and it caused functional loss. There was no pain with weight bearing. The examiner stated that pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. The examiner further stated that pain, weakness, fatigability or incoordination did not significantly limit functional ability with flare ups. There was no guarding or muscle spasm noted on examination. Muscle strength testing was normal and there was no muscle atrophy. Reflexes were normal. Straight leg raising test was positive bilaterally. Mild radiculopathy was noted bilaterally. There were no other neurologic abnormalities present. There was no ankylosis of the spine. The Veteran did not have intervertebral disc syndrome. The Veteran demonstrated flexion limited to 85 degrees at the February 15, 2012 VA examination. Thus, a 10 percent rating is warranted from that date. The ranges of motion noted on the April 2015 and November 2019 also noted flexion between 60 and 85 degrees, which is consistent with the 10 percent rating. There is no significant evidence to support assignment of a higher rating for any portion of the period on appeal. Testing has never revealed loss of thoracolumbar range of motion warranting a higher rating; flexion has not been shown to be limited to 60 degrees or less, and the combined range of motion of the thoracolumbar spine has always been more than 120 degrees. Nor has muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour been found on examination. Although there is evidence of functional loss, demonstrated objectively on the April 2015 and November 2019 VA examinations, that functional loss is already contemplated in the 10 percent rating assigned, and there is no indication that such functional loss would cause additional limitation of motion that would be equivalent to that required for a higher, 20 percent, rating. The Board notes that the RO has granted service connection with separate compensable ratings for the mild radiculopathy of the left and right lower extremities. Those ratings are not currently on appeal. No other neurologic findings have been shown, and the Veteran does not have intervertebral disc syndrome that would warrant considering a rating based on incapacitating episodes. Accordingly, the Board finds assignment of a rating in excess of 10 percent unwarranted for any portion of the appeal period. 3. Entitlement to a higher initial rating for sarcoid arthropathy of the cervical spine, currently rated as noncompensable prior to April 8, 2015, 10 percent disabling from Apri 8, 2015, and 20 percent thereafter Under the General Rating Formula for the spine, a 10 percent rating is assigned for forward flexion greater than 30 degrees but not greater than 40 degrees; a 20 percent rating is assigned for forward flexion of 15 degrees but not greater than 30 degrees; or combined range of motion not greater than 170 degrees; a 30 percent rating is assigned for forward flexion of the cervical spine of 15 degrees or less; or favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine. The Veteran is in receipt of an initial noncompensable rating for sarcoid arthropathy of the cervical spine, a 10 percent rating from April 8, 2015, and a 20 percent rating from November 26, 2019. The record reflects periodic complaints of neck and upper back pain throughout the appeal period. Numerous lay statements reflect the Veteran’s ongoing struggle with cervical spine-related symptoms. However, as with his lower back, treatment has been minimal over the course of the appeal period. The Veteran has been afforded several VA cervical spine examinations. At his February 2012 VA examination, the Veteran demonstrated less than normal range of motion of the neck; forward flexion was limited to 40 degrees, right and left lateral flexion to 35 degrees, and right and left lateral rotation to 70 degrees. Critically, there was no evidence of painful motion on testing, and no loss of range of motion after three repetitions of testing. Further, there was no guarding, there were no spasms, and neurological testing was normal. The Veteran denied radicular symptoms. He did complain of periodic flareups. A second VA examination took place in April 2015. At this examination, the Veteran denied flareups, and range of motion testing was all normal, with no loss of range of motion following three repetitions of testing. Forward flexion was to 45 degrees; extension was to 45 degrees; right and left lateral flexion to 45 degrees, and right and left lateral rotation to 80 degrees. There was evidence of pain with forward flexion. Again, there was no guarding and no spasm, and neurological testing was normal, with no signs of radicular symptoms. The examiner concluded the Veteran would not be expected to lose function due to repetitive use over time. On VA examination conducted November 26, 2019, the Veteran reported “constant neck pain 4/10 achy pain.” He reported stiffness, inability to turn his neck, difficulty driving, and difficulty looking up to the sky. He reported flare-ups associated with certain movements and usage of the neck, and possibly the way he sleeps at times. He reported that the flare-ups caused 9/10 achy pain and lasted from three to four days. On examination, forward flexion was limited to 40 degrees; extension was to 20 degrees; right and left lateral flexion to 20 degrees, and right and left lateral rotation to 30 degrees. Pain was noted on examination and it caused functional loss. There was no pain on weight bearing. There was no additional limitation of motion after repetitive motion. The examiner stated that pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. The examiner further stated that pain, weakness, fatigability or incoordination did not significantly limit functional ability with flare ups. There was no localized tenderness, guarding, or muscle spasm. There was no muscle atrophy. Muscle strength was 4/5. Reflex and sensory examination was normal, and there was no cervical radiculopathy present. There was no ankylosis of the cervical spine. The Veteran did not have intervertebral disc syndrome. The Veteran demonstrated flexion limited to 40 degrees at the February 15, 2012 VA examination. Thus, a 10 percent rating is warranted from that date based on limitation of flexion to not greater than 40 degrees. The ranges of motion noted on the April 2015 VA examination were normal and did not provide a basis for a higher rating than 10 percent. The RO assigned a 20 percent rating from November 26, 2019 based on combined range of motion of the cervical spine not greater than 170 degrees as shown on the VA examination of that date. Such limitation of motion was not demonstrated in the record prior to November 26, 2019. There is no significant evidence to support assignment of a rating higher than 20 percent for any portion of the period on appeal. Testing has never revealed cervical spine flexion limited to 15 degrees or less, or favorable ankylosis of the cervical spine. Although there is evidence of functional loss, demonstrated objectively on the November 2019 VA examination, that functional loss is already contemplated in the 20 percent rating assigned, and there is no indication that such functional loss would cause additional limitation of motion that would be equivalent to that required for a higher, 30 percent, rating. No radiculopathy or other neurologic findings have been shown, and the Veteran does not have intervertebral disc syndrome that would warrant considering a rating based on incapacitating episodes. Accordingly, the Board finds assignment of a higher rating than those currently assigned unwarranted for any portion of the appeal period. 4. Entitlement to a higher initial rating for sarcoid arthropathy of the right shoulder, currently rated as noncompensable prior to April 8, 2015 and 20 percent disabling thereafter 5. Entitlement to a higher initial rating for sarcoid arthropathy of the left shoulder, currently rated as noncompensable prior to April 8, 2015 and 20 percent disabling thereafter The diagnostic codes applicable to a rating of the shoulder are between DCs 5200-5203. Ratings vary depending on whether the impairment is to the major or minor arm. In this case, the Veteran is right hand dominant. Normal shoulder flexion and abduction is from 0 to 180 degrees (90 degrees at shoulder level), and normal internal and external rotation is from 0 to 90 degrees. 38 C.F.R. § 4.71, Plate I. Under DC 5200 for ankylosis of the scapulohumeral articulation (the scapula and humerus move as one piece), for the major arm, a 30 percent rating is assigned when the ankylosis is favorable with abduction to 60 degrees such that a person can reach his mouth and head, a 40 percent rating is assigned the arm when the ankylosis is considered to be intermediate that is between favorable and unfavorable, a 50 percent rating is assigned when the ankylosis is considered to be unfavorable, such that abduction is limited to 25 degrees from the side. For the minor arm, a 20 percent rating is assigned when the ankylosis is favorable with abduction to 60 degrees such that a person can reach his mouth and head, a 30 percent rating is assigned the arm when the ankylosis is considered to be intermediate that is between favorable and unfavorable, a 40 percent rating is assigned when the ankylosis is considered to be unfavorable, such that abduction is limited to 25 degrees from the side. Under DC 5201 for limitation of motion of the major arm, a 20 percent rating is assigned when the range of motion is limited to shoulder level. A 30 percent rating is assigned when the maximum range of motion is limited to midway between side and shoulder level, and a 40 percent rating is assigned when range of motion of the arm is limited to 25 degrees from the side. For the minor arm, a 20 percent rating is assigned when the range of motion is limited to shoulder level, or when the maximum range of motion is limited to midway between side and shoulder level, and a 30 percent rating is assigned when range of motion of the arm is limited to 25 degrees from the side. Under DC 5202 for other impairment of the humerus, for the major arm, when there is malunion of the humerus, a 20 percent rating is assigned with moderate deformity and a 30 percent is assigned for marked deformity. A 20 percent rating is also assigned when there is recurrent dislocation of the humerus at the scapulohumeral joint with infrequent episodes, and a 30 percent where there is guarding of movement only at shoulder level, or with frequent episodes and guarding of all arm movements. A 50 percent rating is assigned when there is fibrous union of the arm; a 60 percent rating is assigned when there is nonunion of (false flail joint) the humerus in the arm; and an 80 percent rating is assigned when there is loss of head of (flail shoulder) the humerus in the arm. For the minor arm, when there is malunion of the humerus, a 20 percent rating is assigned with moderate deformity or marked deformity. A 20 percent rating is also assigned when there is recurrent dislocation of the humerus at the scapulohumeral joint, with either infrequent episodes, and guarding of movement only at shoulder level, or with frequent episodes and guarding of all arm movements. A 40 percent rating is assigned when there is fibrous union of the arm; a 50 percent rating is assigned when there is nonunion of (false flail joint) the humerus in the arm; and a 70 percent rating is assigned when there is loss of head of (flail shoulder) the humerus in the arm. Under DC 5203 for impairment of the clavicle or scapula, for both the major and minor arms, a 10 percent rating is assigned for malunion or for nonunion without loose movement. When there is nonunion with loose movement, a 20 percent rating is assigned. A 20 percent rating is also assigned when there is dislocation of the clavicle or scapula. The Board also notes that degenerative arthritis is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200, etc.). 38 C.F.R. § 4.71a, DC 5003. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. As discussed above, when an evaluation of a disability is based upon limitation of motion, the Board must also consider additional functional loss owing to other factors as described in 38 C.F.R. §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). In determining the actual degree of disability with respect to the Veteran’s shoulder disability, contemporaneous medical records and an objective examination by a medical professional are more probative of the degree of the impairment than his lay opinions. This is particularly so where the rating criteria require analysis of the clinical significance of medical symptoms, even if the existence of symptoms is observable by a lay person. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); King v. Shinseki, 700 F.3d 1339, 1344-45 (Fed. Cir. 2012). Treatment records predating the Veteran’s February 2012 VA shoulder examination do not reflect significant shoulder-related pain complaints, or complaints of loss of function or range of motion. At the February 2012 VA examination, range of motion testing was entirely normal, with no evidence of painful motion, and no loss of range of motion after three repetitions of testing. There was no guarding, but there was a degree of localized tenderness to palpation in both shoulders. The Veteran demonstrated full muscle strength in both abduction and forward flexion, and there was no evidence of joint impingement on testing. Further, the Veteran denied any history of mechanical symptoms such as joint clicking or catching, or any history of dislocation. The acromioclavicular joint was nontender. The Veteran’s April 2013 Board hearing testimony reflected difficulty laying on one side and lifting an arm. As this evidence shows, the Veteran did not demonstrate compensable loss of right or left shoulder range of motion at the February 2012 VA examination, and there was no evidence of pain on motion. Nor did the Veteran demonstrate other shoulder-related symptomatology, such as joint instability, or malunion or nonunion about the humeral head. As such, and absent treatment records supplying evidence of loss of range of motion, painful motion, or other symptoms, the Board finds the evidence preponderates against the claim for a compensable rating for a left or right shoulder disability prior to April 8, 2015, even with consideration of the Veteran’s hearing testimony. A second VA examination was conducted in April 2015. Again, range of motion testing was normal for both shoulders, with no evidence of pain on motion or with weight bearing. The Veteran did not lose range of motion after three repetitions of testing, and he reported no flareups. He demonstrated full muscle strength in abduction and forward flexion. Crepitus was noted. The examiner concluded there was no evidence of functional loss with repeated use over time. On VA examination in November 2019, the Veteran reported a decrease in strength in bilateral shoulders. He reported difficulty grabbing clothes or looking through them while they are on a rack, and that he could not lay on his shoulders, especially on the right shoulder. The Veteran reported difficulty with raising his arms. On examination, right shoulder range of motion was flexion to 150 degrees; abduction to 140 degrees; external rotation to 45 degrees; and internal rotation to 60 degrees. Pain was noted on examination and caused functional loss. There was evidence of crepitus but no pain on weight bearing. There was no additional limitation of motion after repetitive motion. The examiner stated that pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. The examiner further stated that pain, weakness, fatigability or incoordination did not significantly limit functional ability with flare ups. Muscle strength was 4/5 and there was no muscle atrophy. There was no ankylosis. A rotator cuff condition was not suspected. No scapula or clavicle condition was present. There was no loss of head, nonunion, or malunion of the humerus. On examination, left shoulder range of motion was flexion to 150 degrees; abduction to 150 degrees; external rotation to 70 degrees; and internal rotation to 45 degrees. Pain was noted on examination and caused functional loss. There was evidence of crepitus but no pain on weight bearing. There was no additional limitation of motion after repetitive motion. The examiner stated that pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. The examiner further stated that pain, weakness, fatigability or incoordination did not significantly limit functional ability with flare ups. Muscle strength was 4/5 and there was no muscle atrophy. There was no ankylosis. A rotator cuff condition was not suspected. No scapula or clavicle condition was present. There was no loss of head, nonunion, or malunion of the humerus. In sum, testing conducted at the April 8, 2015 VA examination did not reveal compensable loss of range of motion, or pain on motion. The November 2019 examination noted loss of range of motion, and painful motion. For the right shoulder, the currently assigned 20 percent rating contemplates painful motion equivalent to limitation of motion at the shoulder level under DC 5201. There is no basis for a higher rating, as limitation of shoulder motion midway between side and shoulder level has not been shown. Nor has ankylosis of scapulohumeral articulation or impairment of the humerus been shown. Any functional loss the Veteran experiences has been compensated by the 20 percent evaluation already assigned from April 8, 2015. The evidence does not support a higher rating for any portion of the appeal period. For the left shoulder, the currently assigned 20 percent rating contemplates painful motion equivalent to limitation of motion at the shoulder level under DC 5201. There is no basis for a higher rating, as limitation of shoulder motion to 25 degrees from the side has not been shown. Nor has ankylosis of scapulohumeral articulation or impairment of the humerus been shown. Any functional loss the Veteran experiences has been compensated by the 20 percent evaluation already assigned from April 8, 2015. The evidence does not support a higher rating for any portion of the appeal period. 6. Entitlement to a higher initial rating for sarcoid arthropathy of the right knee, currently rated as noncompensable prior to November 26, 2019 and 10 percent disabling thereafter 7. Entitlement to a higher initial rating for sarcoid arthropathy of the left knee, currently rated as noncompensable prior to November 26, 2019 and 10 percent disabling thereafter The Veteran is currently in receipt of a noncompensable rating for each knee for the appeal period prior to November 26, 2019, and a 10 percent rating for each knee from November 26, 2019. Knee disability can be rated based on limitation of motion under DCs 5260 and 5261, which address limitation of flexion and extension, respectively. For rating purposes, normal range of motion in a knee joint is from 0 to 140 degrees. 38 C.F.R. § 4.71, Plate II. Flexion of the leg limited to 60 degrees warrants a 0 percent rating, flexion limited to 45 degrees warrants a 10 percent rating, flexion limited to 30 degrees warrants a 20 percent rating, and flexion limited to 15 degrees warrants a 30 percent rating. 38 C.F.R. § 4.71a, DC 5260. Extension limited to 5 degrees warrants a 0 percent rating, extension limited to 10 degrees warrants a 10 percent rating, extension limited to 15 degrees warrants a 20 percent rating, extension limited to 20 degrees warrants a 30 percent rating, extension limited to 30 degrees warrants a 40 percent rating, and extension limited to 45 degrees warrants a 50 percent rating. 38 C.F.R. § 4.71a, DC 5261. VA’s General Counsel has held that separate ratings are available for limitation of flexion and limitation of extension under Diagnostic Codes 5260 and 5261. VAOPGCPREC 9-2004 (2004). Diagnostic Code 5257 provides ratings of 10, 20, and 30 percent for recurrent subluxation or lateral instability of the knee which is slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Diagnostic Code 5258 provides a 20 percent rating may be assigned for dislocated semilunar cartilage (meniscus) with frequent episodes of “locking,” pain, and effusion into the joint. Diagnostic Code 5259 provides for a 10 percent rating for symptomatic removal of the semilunar cartilage. VA’s General Counsel has held that a veteran may be awarded separate ratings for arthritis with limitation of motion under Diagnostic Code 5260 or 5261 and for instability under Diagnostic Code 5257 or 5259. VAOPGCPREC 23-97 (July 1, 1997); VAOPGCPREC 9-98; see also Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991). As the record is bare of evidence of instability or meniscal problems of any kind, these Diagnostic Codes will not be discussed further. Knee disability due to arthritis may also be evaluated under DC 5003, which deals with degenerative arthritis. That code directs the rating agency to refer to the rating scheme for degenerative arthritis, which provides for a 10 percent rating for arthritis where x-ray evidence confirms the involvement of 2 or more major joints or 2 or more minor joint groups, and a 20 percent rating for arthritis where x-ray evidence shows involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. A compensable rating under DC 5003 requires a showing of some degree of limitation of motion, along with painful motion objectively confirmed by findings such as swelling or muscle spasm. In a May 24, 2009, lay statement, the Veteran’s minister noted that the Veteran’s knee problems led to an inability to kneel during altar calls. A June 2, 2009, lay statement from a friend noted difficulty bending down. A June 12, 2009, lay statement from another friend indicated that knee pain prevented the Veteran from walking the halls of a school. The Veteran’s April 2013 Board hearing testimony reflected difficulty sitting with knees bent, getting out of the car, dancing, and sitting on bleachers. On VA examination in February 2012, range of motion testing was normal, with no evidence of painful motion, and no loss of range of motion with repetitive use testing. The Veteran reported no flareups, and there was no tenderness to palpation. The Veteran’s knees were stable in all planes, and there was no evidence of meniscal problems or of subluxation of the joint. The Veteran’s unassisted gait was normal. A second VA examination was conducted in April 2015. The Veteran reported that bending of the knees to take care of a flower bed caused pain and stiffness. Range of motion testing was again normal for both knees, with no pain on motion, and no loss of range of motion after multiple repetitions of testing. There was no evidence of pain with weight bearing, and no tenderness to palpation. No swelling or spasm was noted. The examiner indicated that repetitive use was observed with no functional loss. The knees were again stable in every plane, with no flareups reported, and no history of meniscal conditions noted. The Veteran also demonstrated full lower extremity strength bilaterally. Examination notes indicate the Veteran reported occasional use of a cane; however, treatment records are silent as to any prescription of an ambulatory device, and neither the VA examinations of record nor any treatment notes reveal that a medical professional has identified a need for even occasional use of such a device. On VA examination in November 2019, the Veteran reported that swelling of the knees caused achiness. When his knees would swell, the Veteran used a cane. The Veteran reported a popping sensation and difficulty sitting and standing for long periods of time. the Veteran reported flare-ups of knee pain once per month, lasting for two to three days, and resulting in 7/10 pain. On examination, for each knee, initial range of motion was from zero to 140 degrees, which the examiner characterized as normal. No pain was noted on examination. There was no pain with weight bearing and no crepitus. There was no additional loss of function or range of motion after repetitive testing. The examiner stated that pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. The examiner further stated that pain, weakness, fatigability or incoordination did not significantly limit functional ability with flare ups. Muscle strength testing was 5/5 bilaterally, and there was no muscle atrophy. Ankylosis was not shown. There was no joint instability of either knee. There was no history of recurrent subluxation or instability of either knee. The examiner stated that for both knees there was no objective evidence of pain on passive range of motion testing and no objective evidence of pain when the joint is used in non-weight bearing. The examiner noted that “Veteran claims he has functional lost due to pain and stiffness, but no restrictions or pain noted on day of the examination.” After careful review of the record, the Board finds that the evidence does not support the assignment of a compensable rating for a knee disability at for any portion of the appeal period prior to November 26, 2019, because there was never a showing of a compensable degree of limitation of motion in extension or flexion, nor has there been a showing of painful motion, instability, or any other knee-related symptoms resulting in functional loss. See Deluca, 8 Vet. App. 202. For this period, because there was no showing of limitation of motion in any degree, and no showing of painful motion objectively confirmed by findings such as swelling or muscle spasm, the Board finds that entitlement to a 10 percent rating under DC 5003 is unwarranted. Moreover, the Veteran is not entitled to a 20 percent disability rating during this time period under DC 5003, as X-ray evidence of service-connected arthritis in two or more major joints of either leg, with incapacitating exacerbations, have not been demonstrated. The objective evidence does not demonstrate the Veteran has sought treatment for any incapacitating episodes of knee pain or loss of function during that portion of the appeal period. For the appeal period beginning November 26, 2019, the Veteran has been assigned a 10 percent rating for each knee based on painful motion. There is no basis for a higher rating for either knee, as flexion limited to 45 degrees, or extension limited to 10 degrees, has not been shown. In fact, the November 2019 examiner noted full range of motion, with no pain demonstrated on examination. There is also no basis for a separate rating based on instability, as instability was not shown on examination. The Board has considered the statements of the Veteran as well as the lay statements of record as to the severity of his knee pain during the period of this appeal. The Veteran is certainly competent to report observable symptoms, including worsening of such symptoms. However, in evaluating a claim for an increased schedular disability rating, VA must consider the factors as enumerated in the rating criteria discussed above, which in part involves the examination of clinical data gathered by competent medical professionals. Massey v. Brown, 7 Vet. App. 204, 208 (1994). While the Veteran is competent to report that his symptoms are worse, the training and experience of medical personnel makes the medical findings found in treatment notes and examinations more probative as to the extent of the disability. In sum, the Board finds that entitlement to an initial compensable evaluation for a bilateral knee disability prior to November 26, 2019, and a rating in excess of 10 percent for either knee from that date, is not warranted. 8. Entitlement to an initial compensable rating for sarcoid arthropathy of the right hand prior to November 26, 2019 9. Entitlement to an initial compensable rating for sarcoid arthropathy of the left hand prior to November 26, 2019 Prior to November 26, 2019, the Veteran’s sarcoid arthropathy of the right and left hands was assigned a noncompensable rating. As will be shown below, the RO in August 2020 granted separate ratings for each finger of the hands. Considering the portion of the appeals period prior to November 26, 2019, the Board notes that sarcoid arthropathy of the bilateral hands was evaluated under DC 5228 which deals with limitation of motion of the thumb. A 10 percent rating is assigned when there is a gap of one to two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. A 20 percent rating is assigned when there is a gap of more than two inches between the thumb pad and fingers, with the thumb attempting to oppose the fingers. Limitation of motion in the index or long finger is rated under Diagnostic Code 5229. A maximum 10 percent rating is assigned when there is a gap of one inch or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. Only a noncompensable rating is available for limitation of motion in the ring finger or little finger. The rating criteria under these diagnostic codes is the same for the both the major and minor fingers. Diagnostic Code 5003 states that the severity of degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint or joints involved. When limitation of motion of the specific joint(s) is present, but noncompensable under the appropriate diagnostic codes, a 10 percent rating is for application for each affected major joint or group of minor joints, to be combined, not added. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent evaluation is warranted with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, and a 20 percent evaluation is warranted with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. For the purpose of rating disability from arthritis, multiple involvements of the interphalangeal (IP), metacarpal, and carpal joints of the upper extremities are considered a group of minor joints. 38 C.F.R. § 4.45 (f). There was no evidence of significant treatment sought or received for hand or finger-related symptoms during the appeal period prior to November 26, 2019. The Veteran has been afforded several VA hand and finger examinations. At the first, conducted in February 2012, all range of motion testing was normal, with no evidence of pain on motion, and no loss of range of motion with repetitive use testing. The Veteran reported no flareups. He demonstrated full grip strength bilaterally. There was no evidence of ankylosis of any digit. These findings were mirrored at an April 2015 VA examination. The Veteran again demonstrated no loss of range of motion in any digit, with no loss of range of motion after three repetitions of testing, and no flareups reported. The Veteran also demonstrated full 5/5 grip strength bilaterally. After reviewing the evidence of record, the Board does not find a compensable rating warranted for either hand prior to November 26, 2019. There was no showing of a loss of range of motion in any digit in any degree, nor any showing of painful motion, flareups, weakness, or loss of function with repeated use over time. As the evidence preponderates against the claim, entitlement to an initial compensable rating for sarcoid arthropathy of the bilateral hands prior to November 26, 2019 must be denied. Gilbert v. Derwinski, 2 Vet. App. 49, 53 (1990). 10. Entitlement to a higher initial rating for sarcoid arthropathy, right thumb, currently rated 10 percent disabling On the November 2019 VA examination, the Veteran reported stiffness, swelling and constant 4/10 achy pain of the fingers. He noted difficulty writing and picking up objects. Weather changes caused his symptoms to worsen. On examination, the right thumb demonstrated MCP range of motion from zero to 50 degrees, and PIP range of motion from zero to 45 degrees. There was no gap between the pad of the thumb and the fingers. There was no evidence of pain with use of the hand, and no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The examiner noted pain that did not cause or result in functional loss. Hand grip strength was 5/5 and there was no muscle atrophy. There was no ankylosis. There was no objective evidence of pain on passive range of motion testing. There was objective evidence of pain when the joint is used in non-weight bearing. DC 5228 contemplates a 20 percent evaluation for limitation of thumb motion where there is a gap of more than two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. 38 C.F.R. Part 4, DC 5228. While the November 2019 VA examination showed some limitation of motion of the right thumb, there is no showing of limitation of thumb motion with a gap of more than two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. The examiner found no decreased grip strength. The current 10 percent evaluation for the right thumb is warranted for the painful motion noted on the November 2019 examination. As this is the basis for the current compensable evaluation, the Board finds that no additional disability based on functional loss is appropriate. DeLuca, supra.; 38 C.F.R. §§ 4.40, 4.45, 4.59. Accordingly, the Board concludes that an evaluation in excess of 10 percent for sarcoid arthropathy of the right thumb is not warranted. 11. Entitlement to a higher initial rating for sarcoid arthropathy, right index finger, currently rated 10 percent disabling On the November 2019 VA examination, the Veteran reported stiffness, swelling and constant 4/10 achy pain of the fingers. He noted difficulty writing and picking up objects. Weather changes caused his symptoms to worsen. On examination, the right index finger demonstrated MCP range of motion from zero to 90 degrees, PIP range of motion from zero to 100 degrees, and DIP range of motion from zero to 70 degrees. There was no gap between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible. There was no evidence of pain with use of the hand, and no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The examiner noted pain with finger flexion that did not cause or result in functional loss. Hand grip strength was 5/5 and there was no muscle atrophy. There was no ankylosis. There was no objective evidence of pain on passive range of motion testing. There was objective evidence of pain when the joint is used in non-weight bearing. The Veteran has been assigned a 10 percent rating based on painful motion of the right index finger. Diagnostic Code 5229 provides for a maximum 10 percent rating for any limitation of motion of the index or long finger with a gap of one inch (2.5 cm) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. Based on the foregoing, the Board finds that a disability rating in excess of 10 percent is not warranted in this case. The Veteran is already receiving the maximum rating under Diagnostic Code 5229 that is based on limitation of motion. His current rating is based on painful motion, but there is no showing of any gap between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible. Functional ankylosis is not shown. The Board considered whether an alternative or separate rating are appropriate in this case. Review of the rating schedule, however, indicates that there are no other applicable diagnostic codes that would permit a disability rating in excess of 10 percent. Under Diagnostic Code 5225, a 10 percent disability rating is assigned for unfavorable or favorable ankylosis of the index finger for both the major and minor finger; no higher disability ratings are available. 38 C.F.R. § 4.71a, Diagnostic Code 5225. A note to this diagnostic code instructs to also consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand. Id. In the instant case, the Veteran does not have actual or functional ankylosis. With respect to amputation, under Diagnostic Code 5153, disability ratings are assigned for amputation of the index finger. 38 C.F.R. § 4.71a, Diagnostic Code 5153. However, the VA examination does not show that the functional impairment of his finger was such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. As such a rating under Diagnostic Code 5153 is not warranted. In sum, the evidence does not provide a basis for a rating higher than the 10 percent nor any additional separate rating. The benefit of the doubt doctrine does not apply. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 12. Entitlement to a higher initial rating for sarcoid arthropathy, right long finger, currently rated 10 percent disabling On the November 2019 VA examination, the Veteran reported stiffness, swelling and constant 4/10 achy pain of the fingers. He noted difficulty writing and picking up objects. Weather changes caused his symptoms to worsen. On examination, the right long finger demonstrated MCP range of motion from zero to 90 degrees, PIP range of motion from zero to 100 degrees, and DIP range of motion from zero to 70 degrees. There was no gap between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible. There was no evidence of pain with use of the hand, and no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The examiner noted pain with finger flexion that did not cause or result in functional loss. Hand grip strength was 5/5 and there was no muscle atrophy. There was no ankylosis. There was no objective evidence of pain on passive range of motion testing. There was objective evidence of pain when the joint is used in non-weight bearing. The Veteran has been assigned a 10 percent rating based on painful motion of the right long finger. Diagnostic Code 5229 provides for a maximum 10 percent rating for any limitation of motion of the index or long finger with a gap of one inch (2.5 cm) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. Based on the foregoing, the Board finds that a disability rating in excess of 10 percent is not warranted in this case. The Veteran is already receiving the maximum rating under Diagnostic Code 5229 that is based on limitation of motion. His current rating is based on painful motion, but there is no showing of any gap between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible. Functional ankylosis is not shown. The Board considered whether an alternative or separate rating are appropriate in this case. Review of the rating schedule, however, indicates that there are no other applicable diagnostic codes that would permit a disability rating in excess of 10 percent. Under Diagnostic Code 5226, a 10 percent disability rating is assigned for unfavorable or favorable ankylosis of the long finger for both the major and minor finger; no higher disability ratings are available. 38 C.F.R. § 4.71a, Diagnostic Code 5226. A note to this diagnostic code instructs to also consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand. Id. In the instant case, the Veteran does not have actual or functional ankylosis. With respect to amputation, under Diagnostic Code 5154, disability ratings are assigned for amputation of the long finger. 38 C.F.R. § 4.71a, Diagnostic Code 5154. However, the VA examination does not show that the functional impairment of his finger was such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. As such a rating under Diagnostic Code 5154 is not warranted. In sum, the evidence does not provide a basis for a rating higher than the 10 percent nor any additional separate rating. The benefit of the doubt doctrine does not apply. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 13. Entitlement to a higher initial rating for sarcoid arthropathy, right ring finger, currently rated noncompensably disabling On the November 2019 VA examination, the Veteran reported stiffness, swelling and constant 4/10 achy pain of the fingers. He noted difficulty writing and picking up objects. Weather changes caused his symptoms to worsen. On examination, the right ring finger demonstrated MCP range of motion from zero to 90 degrees, PIP range of motion from zero to 100 degrees, and DIP range of motion from zero to 70 degrees. There was no gap between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible. There was no evidence of pain with use of the hand, and no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The examiner noted pain with finger flexion that did not cause or result in functional loss. Hand grip strength was 5/5 and there was no muscle atrophy. There was no ankylosis. There was no objective evidence of pain on passive range of motion testing. There was objective evidence of pain when the joint is used in non-weight bearing. The Veteran’s disability has been rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5230. Under this provision, a limitation of motion of the ring or little finger is assigned a noncompensable rating. 38 C.F.R. § 4.71a. As set forth above, Diagnostic Code 5230 does not provide for a compensable rating. 38 C.F.R. § 4.71, Diagnostic Code 5230. An initial compensable rating pursuant to 38 C.F.R. § 4.59 is not for application when the applicable Diagnostic Code does not provide a compensable rating. See Sowers v. McDonald, 27 Vet. App. 472, 480 (2016); Petitti v. McDonald, 27 Vet. App. 415, 428-29 (2015) (a compensable rating is warranted for joint pain pursuant to 38 C.F.R. § 4.59 for orthopedic disabilities, but only if they are rated under diagnostic codes containing a compensable rating). Therefore, an initial compensable rating under Diagnostic Code 5230 is not warranted. Under Diagnostic Code 5003, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. 38 C.F.R. § 4.71a, Diagnostic Code 5003. For the purpose of rating disability from arthritis the interphalangeal, metacarpal, and carpal joints are considered a group of minor joints. 38 C.F.R. § 4.45. While the November 2019 VA examiner noted arthritis, the disability does not involve arthritis of more than one minor joint group. Additionally, the evidence does not show degenerative arthritis with involvement of two or more major joints. Accordingly, an increased rating is not warranted under Diagnostic Code 5003. 14. Entitlement to a higher initial rating for sarcoid arthropathy, right little finger, currently rated noncompensably disabling On the November 2019 VA examination, the Veteran reported stiffness, swelling and constant 4/10 achy pain of the fingers. He noted difficulty writing and picking up objects. Weather changes caused his symptoms to worsen. On examination, the right little finger demonstrated MCP range of motion from zero to 90 degrees, PIP range of motion from zero to 100 degrees, and DIP range of motion from zero to 70 degrees. There was no gap between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible. There was no evidence of pain with use of the hand, and no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The examiner noted pain with finger flexion that did not cause or result in functional loss. Hand grip strength was 5/5 and there was no muscle atrophy. There was no ankylosis. There was no objective evidence of pain on passive range of motion testing. There was objective evidence of pain when the joint is used in non-weight bearing. The Veteran’s disability has been rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5230. Under this provision, a limitation of motion of the ring or little finger is assigned a noncompensable rating. 38 C.F.R. § 4.71a. As set forth above, Diagnostic Code 5230 does not provide for a compensable rating. 38 C.F.R. § 4.71, Diagnostic Code 5230. An initial compensable rating pursuant to 38 C.F.R. § 4.59 is not for application when the applicable Diagnostic Code does not provide a compensable rating. See Sowers v. McDonald, 27 Vet. App. 472, 480 (2016); Petitti v. McDonald, 27 Vet. App. 415, 428-29 (2015) (a compensable rating is warranted for joint pain pursuant to 38 C.F.R. § 4.59 for orthopedic disabilities, but only if they are rated under diagnostic codes containing a compensable rating). Therefore, an initial compensable rating under Diagnostic Code 5230 is not warranted. Under Diagnostic Code 5003, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. 38 C.F.R. § 4.71a, Diagnostic Code 5003. For the purpose of rating disability from arthritis the interphalangeal, metacarpal, and carpal joints are considered a group of minor joints. 38 C.F.R. § 4.45. While the November 2019 VA examiner noted arthritis, the disability does not involve arthritis of more than one minor joint group. Additionally, the evidence does not show degenerative arthritis with involvement of two or more major joints. Accordingly, an increased rating is not warranted under Diagnostic Code 5003. 15. Entitlement to a higher initial rating for sarcoid arthropathy, left thumb, currently rated 10 percent disabling On the November 2019 VA examination, the Veteran reported stiffness, swelling and constant 4/10 achy pain of the fingers. He noted difficulty writing and picking up objects. Weather changes caused his symptoms to worsen. On examination, the left thumb demonstrated MCP range of motion from zero to 100 degrees, and PIP range of motion from zero to 90 degrees. There was no gap between the pad of the thumb and the fingers. There was no evidence of pain with use of the hand, and no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The examiner noted pain that did not cause or result in functional loss. Hand grip strength was 5/5 and there was no muscle atrophy. There was no ankylosis. There was no objective evidence of pain on passive range of motion testing. There was objective evidence of pain when the joint is used in non-weight bearing. DC 5228 contemplates a 20 percent evaluation for limitation of thumb motion where there is a gap of more than two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. 38 C.F.R. Part 4, DC 5228. The November 2019 VA examination did not demonstrate any limitation of motion of the left thumb. There is no showing of limitation of thumb motion with a gap of more than two inches between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. The examiner found no decreased grip strength. The current 10 percent evaluation for the left thumb is warranted for the painful motion noted on the November 2019 examination. As this is the basis for the current compensable evaluation, the Board finds that no additional disability based on functional loss is appropriate. DeLuca, supra.; 38 C.F.R. §§ 4.40, 4.45, 4.59. Accordingly, the Board concludes that an evaluation in excess of 10 percent for sarcoid arthropathy of the left thumb is not warranted. 16. Entitlement to a higher initial rating for sarcoid arthropathy, left index finger, currently rated 10 percent disabling On the November 2019 VA examination, the Veteran reported stiffness, swelling and constant 4/10 achy pain of the fingers. He noted difficulty writing and picking up objects. Weather changes caused his symptoms to worsen. On examination, the left index finger demonstrated MCP range of motion from zero to 90 degrees, PIP range of motion from zero to 100 degrees, and DIP range of motion from zero to 70 degrees. There was no gap between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible. There was no evidence of pain with use of the hand, and no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The examiner noted pain with finger flexion that did not cause or result in functional loss. Hand grip strength was 5/5 and there was no muscle atrophy. There was no ankylosis. There was no objective evidence of pain on passive range of motion testing. There was objective evidence of pain when the joint is used in non-weight bearing. The Veteran has been assigned a 10 percent rating based on painful motion of the left index finger. Diagnostic Code 5229 provides for a maximum 10 percent rating for any limitation of motion of the index or long finger with a gap of one inch (2.5 cm) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. Based on the foregoing, the Board finds that a disability rating in excess of 10 percent is not warranted in this case. The Veteran is already receiving the maximum rating under Diagnostic Code 5229 that is based on limitation of motion. His current rating is based on painful motion, but there is no showing of any gap between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible. Functional ankylosis is not shown. The Board considered whether an alternative or separate rating are appropriate in this case. Review of the rating schedule, however, indicates that there are no other applicable diagnostic codes that would permit a disability rating in excess of 10 percent. Under Diagnostic Code 5225, a 10 percent disability rating is assigned for unfavorable or favorable ankylosis of the index finger for both the major and minor finger; no higher disability ratings are available. 38 C.F.R. § 4.71a, Diagnostic Code 5225. A note to this diagnostic code instructs to also consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand. Id. In the instant case, the Veteran does not have actual or functional ankylosis. With respect to amputation, under Diagnostic Code 5153, disability ratings are assigned for amputation of the index finger. 38 C.F.R. § 4.71a, Diagnostic Code 5153. However, the VA examination does not show that the functional impairment of his finger was such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. As such a rating under Diagnostic Code 5153 is not warranted. In sum, the evidence does not provide a basis for a rating higher than the 10 percent nor any additional separate rating. The benefit of the doubt doctrine does not apply. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 17. Entitlement to a higher initial rating for sarcoid arthropathy, left long finger, currently rated 10 percent disabling On the November 2019 VA examination, the Veteran reported stiffness, swelling and constant 4/10 achy pain of the fingers. He noted difficulty writing and picking up objects. Weather changes caused his symptoms to worsen. On examination, the left long finger demonstrated MCP range of motion from zero to 90 degrees, PIP range of motion from zero to 100 degrees, and DIP range of motion from zero to 70 degrees. There was no gap between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible. There was no evidence of pain with use of the hand, and no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The examiner noted pain with finger flexion that did not cause or result in functional loss. Hand grip strength was 5/5 and there was no muscle atrophy. There was no ankylosis. There was no objective evidence of pain on passive range of motion testing. There was objective evidence of pain when the joint is used in non-weight bearing. The Veteran has been assigned a 10 percent rating based on painful motion of the left long finger. Diagnostic Code 5229 provides for a maximum 10 percent rating for any limitation of motion of the index or long finger with a gap of one inch (2.5 cm) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. Based on the foregoing, the Board finds that a disability rating in excess of 10 percent is not warranted in this case. The Veteran is already receiving the maximum rating under Diagnostic Code 5229 that is based on limitation of motion. His current rating is based on painful motion, but there is no showing of any gap between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible. Functional ankylosis is not shown. The Board considered whether an alternative or separate rating are appropriate in this case. Review of the rating schedule, however, indicates that there are no other applicable diagnostic codes that would permit a disability rating in excess of 10 percent. Under Diagnostic Code 5226, a 10 percent disability rating is assigned for unfavorable or favorable ankylosis of the long finger for both the major and minor finger; no higher disability ratings are available. 38 C.F.R. § 4.71a, Diagnostic Code 5226. A note to this diagnostic code instructs to also consider whether evaluation as amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand. Id. In the instant case, the Veteran does not have actual or functional ankylosis. With respect to amputation, under Diagnostic Code 5154, disability ratings are assigned for amputation of the long finger. 38 C.F.R. § 4.71a, Diagnostic Code 5154. However, the VA examination does not show that the functional impairment of his finger was such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. As such a rating under Diagnostic Code 5154 is not warranted. In sum, the evidence does not provide a basis for a rating higher than the 10 percent nor any additional separate rating. The benefit of the doubt doctrine does not apply. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 18. Entitlement to a higher initial rating for sarcoid arthropathy, left ring finger, currently rated noncompensably disabling On the November 2019 VA examination, the Veteran reported stiffness, swelling and constant 4/10 achy pain of the fingers. He noted difficulty writing and picking up objects. Weather changes caused his symptoms to worsen. On examination, the left ring finger demonstrated MCP range of motion from zero to 90 degrees, PIP range of motion from zero to 100 degrees, and DIP range of motion from zero to 70 degrees. There was no gap between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible. There was no evidence of pain with use of the hand, and no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The examiner noted pain with finger flexion that did not cause or result in functional loss. Hand grip strength was 5/5 and there was no muscle atrophy. There was no ankylosis. There was no objective evidence of pain on passive range of motion testing. There was objective evidence of pain when the joint is used in non-weight bearing. The Veteran’s disability has been rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5230. Under this provision, a limitation of motion of the ring or little finger is assigned a noncompensable rating. 38 C.F.R. § 4.71a. As set forth above, Diagnostic Code 5230 does not provide for a compensable rating. 38 C.F.R. § 4.71, Diagnostic Code 5230. An initial compensable rating pursuant to 38 C.F.R. § 4.59 is not for application when the applicable Diagnostic Code does not provide a compensable rating. See Sowers v. McDonald, 27 Vet. App. 472, 480 (2016); Petitti v. McDonald, 27 Vet. App. 415, 428-29 (2015) (a compensable rating is warranted for joint pain pursuant to 38 C.F.R. § 4.59 for orthopedic disabilities, but only if they are rated under diagnostic codes containing a compensable rating). Therefore, an initial compensable rating under Diagnostic Code 5230 is not warranted. Under Diagnostic Code 5003, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. 38 C.F.R. § 4.71a, Diagnostic Code 5003. For the purpose of rating disability from arthritis the interphalangeal, metacarpal, and carpal joints are considered a group of minor joints. 38 C.F.R. § 4.45. While the November 2019 VA examiner noted arthritis, the disability does not involve arthritis of more than one minor joint group. Additionally, the evidence does not show degenerative arthritis with involvement of two or more major joints. Accordingly, an increased rating is not warranted under Diagnostic Code 5003. 19. Entitlement to a higher initial rating for sarcoid arthropathy, left little finger, currently rated noncompensably disabling On the November 2019 VA examination, the Veteran reported stiffness, swelling and constant 4/10 achy pain of the fingers. He noted difficulty writing and picking up objects. Weather changes caused his symptoms to worsen. On examination, the left little finger demonstrated MCP range of motion from zero to 90 degrees, PIP range of motion from zero to 100 degrees, and DIP range of motion from zero to 70 degrees. There was no gap between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible. There was no evidence of pain with use of the hand, and no evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The examiner noted pain with finger flexion that did not cause or result in functional loss. Hand grip strength was 5/5 and there was no muscle atrophy. There was no ankylosis. There was no objective evidence of pain on passive range of motion testing. There was objective evidence of pain when the joint is used in non-weight bearing. The Veteran’s disability has been rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5230. Under this provision, a limitation of motion of the ring or little finger is assigned a noncompensable rating. 38 C.F.R. § 4.71a. As set forth above, Diagnostic Code 5230 does not provide for a compensable rating. 38 C.F.R. § 4.71, Diagnostic Code 5230. An initial compensable rating pursuant to 38 C.F.R. § 4.59 is not for application when the applicable Diagnostic Code does not provide a compensable rating. See Sowers v. McDonald, 27 Vet. App. 472, 480 (2016); Petitti v. McDonald, 27 Vet. App. 415, 428-29 (2015) (a compensable rating is warranted for joint pain pursuant to 38 C.F.R. § 4.59 for orthopedic disabilities, but only if they are rated under diagnostic codes containing a compensable rating). Therefore, an initial compensable rating under Diagnostic Code 5230 is not warranted. Under Diagnostic Code 5003, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. 38 C.F.R. § 4.71a, Diagnostic Code 5003. For the purpose of rating disability from arthritis the interphalangeal, metacarpal, and carpal joints are considered a group of minor joints. 38 C.F.R. § 4.45. While the November 2019 VA examiner noted arthritis, the disability does not involve arthritis of more than one minor joint group. Additionally, the evidence does not show degenerative arthritis with involvement of two or more major joints. Accordingly, an increased rating is not warranted under Diagnostic Code 5003. ROBERT C. SCHARNBERGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Mazzucchelli, 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.