Citation Nr: 21011832 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 15-10 118 DATE: March 2, 2021 ORDER Entitlement to a disability rating in excess of 20 percent prior to July 27, 2015 for left shoulder biceps tendonitis and status post subacromial decompression with mild acromial joint arthritis is denied. Entitlement to a disability rating of 30 percent, but not more, as of September 1, 2015 for left shoulder biceps tendonitis and status post subacromial decompression with mild acromial joint arthritis is granted. Entitlement to a disability rating in excess of 20 percent prior to January 7, 2019 for lumbar spine myofascial pain syndrome is denied. Entitlement to a disability rating in excess of 40 percent as of January 7, 2019 for lumbar spine myofascial pain syndrome is denied. FINDINGS OF FACT 1. Prior to July 27, 2015, the Veteran’s left shoulder biceps tendonitis and status post subacromial decompression with mild acromial joint arthritis was characterized by pain, flare-ups, and functional limitation of motion with flexion and/or abduction of the arm midway between side and shoulder level; functional limitation of motion to 25 degrees from his side, ankylosis of the left shoulder, and impairment of the humerus were not shown. 2. As of September 1, 2015, the Veteran’s left shoulder biceps tendonitis and status post subacromial decompression with mild acromial joint arthritis has been characterized by shoulder pain, flare-ups, and limitation of motion of flexion and/or abduction that is functionally limited to 25 degrees from his side; ankylosis and impairment of the humerus have not been shown. 3. Prior to January 7, 2019, the Veteran’s lumbar spine myofascial pain syndrome was characterized by forward flexion greater than 30 degrees and a combined range of motion not greater than 120 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or coordination, or as a result of repetitive motion and/or flare-ups, without muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, ankylosis, incapacitating episodes due to intervertebral disc syndrome (IVDS), or associated objective neurological abnormalities; forward flexion of the thoracolumbar spine of 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine were not shown. 4. As of January 7, 2019, the Veteran’s lumbar spine myofascial pain syndrome has been characterized by forward flexion of the thoracolumbar spine of 30 degrees or less, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or coordination, or as a result of repetitive motion and/or flare-ups, without muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, ankylosis, incapacitating episodes due to IVDS, or associated objective neurological abnormalities; favorable ankylosis of the entire thoracolumbar spine has not been shown. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 20 percent prior to July 27, 2015 for left shoulder biceps tendonitis and status post subacromial decompression with mild acromial joint arthritis have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.59, 4.71, 4.71a, Diagnostic Code (DC) 5201. 2. The criteria for entitlement to a disability rating of 30 percent, but not more, as of September 1, 2015 for left shoulder biceps tendonitis and status post subacromial decompression with mild acromial joint arthritis have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.59, 4.71, 4.71a, DC 5201. 3. Prior to January 7, 2019, the criteria for entitlement to a disability rating in excess of 20 percent for lumbar spine myofascial pain syndrome have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.59, 4.71a, DC 5237. 4. As of January 7, 2019, the criteria for entitlement to a disability rating in excess of 40 percent for lumbar spine myofascial pain syndrome have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.59, 4.71a, DC 5237. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from March 2010 to February 2014. The Board of Veteran’s Appeals (Board) remanded the matter in June 2018 to obtain outstanding new and addendum medical opinions. The Board is now satisfied that there was substantial compliance with the remand. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-147 (1999). Increased Rating Disability evaluations are determined by applying a schedule of ratings which is based on average impairment of earning capacity based on the specific diagnostic codes identifying the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. 38 C.F.R. § 4.7. While the Board typically considers only those factors contained wholly in the rating criteria, it is appropriate to consider factors outside the specific rating criteria when appropriate in order to best determine the level of occupational and social impairment. See Mauerhan v. Principi, 16 Vet. App. 436 (2002); Massey v. Brown, 7 Vet. App. 204, 208 (1994). Separate ratings can be assigned for separate periods based on the facts found – a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one condition is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation is the ability of the body, as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidence by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the U.S. Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. 1. Entitlement to an increased rating for left shoulder biceps tendonitis and status post subacromial decompression with mild acromial joint arthritis From March 1, 2014 through July 26, 2015 and from September 1, 2015 through January 6, 2019, the Veteran had been in receipt of a 20 percent rating for left shoulder biceps tendonitis and status post subacromial decompression with mild acromial joint arthritis under 38 C.F.R. § 4.71a, DC 5201. As of January 7, 2019, the Veteran has been in receipt of a 30 percent rating for his left shoulder disability. Id. From July 27, 2015 until August 31, 2015, the Veteran had a 100 percent rating and, therefore, that period is not at issue. The Veteran contends that the symptoms of his left shoulder disability merit increased ratings, and he has continuously experienced symptoms that include limited range of motion, pain with range of motion, flare-ups, and pain while driving or performing activities of daily living. Of note, the Veteran’s left upper extremity is his nondominant extremity. It should be noted that, during the course of this appeal, the schedular criteria for evaluating left shoulder disability have been amended. Specifically, the criteria pertaining to limitation of motion of the arm under 38 C.F.R. § 4.71a, DC 5201, were amended effective February 7, 2021. See 85 Fed. Reg. 76, 453 (November 30, 2020). Where a law or regulation changes during the pendency of a claim for increased rating, the Board should first determine whether application of the revised version would produce retroactive results. In particular, a new rule may not extinguish any rights or benefits the claimant had prior to the enactment of the new rule. VAOPGCPREC 07-03 (November 19, 2003). However, if the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991), overruled in part, Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). As the Veteran’s claim was received prior to the effective date of the regulation changes, the Board must consider the Veteran’s shoulder disability under both the old and new revised rating criteria and must apply the old rating criteria if the result is more favorable to the Veteran. Id. Under the pre-amended criteria, in order to warrant a 30 percent rating for a nondominant shoulder disability based on limitation of motion, the evidence must show: • Intermediate ankylosis between favorable and unfavorable (30 percent under DC 5200); or • Arm limitation of motion to 25 degrees from side (30 percent under DC 5201). 38 C.F.R. § 4.71a. Under the amended criteria, the next higher 30 percent rating is warranted when the evidence shows either: • Intermediate ankylosis between favorable and unfavorable (30 percent under DC 5200); or • Limitation of motion of the arm with flexion and/or abduction limited to 25 degrees from side (30 percent under DC 5201). 38 C.F.R. § 4.71a. In order to warrant a rating in excess of 30 percent for a nondominant shoulder disability under both the pre-amended and the amended criteria, the evidence must show: • Unfavorable ankylosis of the scapulohumeral articulation, abduction limited to 25 degrees from side (40 percent under DC 5200); or • Fibrous union of the humerus (40 percent under DC 5202); or • Nonunion of (false flail joint) the humerus (50 percent under DC 5205); or • Loss of head of (flail shoulder) the humerus (70 percent under DC 5202). 38 C.F.R. § 4.71a. Prior to July 27, 2015 Based on the evidence of record, the Board finds that a rating in excess of 20 percent for the Veteran’s left shoulder disability prior to July 27, 2015 based on limitation of motion is not warranted under either the amended or pre-amended criteria. As an initial matter, a rating in excess of 20 percent based on ankylosis of the left shoulder is not warranted because ankylosis has not been shown at any point in this period. Moreover, examinations show that there was no impairment of the humerus during the appeal period. Therefore, neither a 30 percent rating under DC 5200 nor a 40 percent rating DC 5202 under either the pre-amended or the amended criteria are for application. The only way the Veteran can receive a rating in excess of 20 percent prior to July 27, 2015 under either the amended or pre-amended criteria is by demonstrating limitation of motion of the arm to 25 degrees from the side (30 percent under DC 5201). See 38 C.F.R. § 4.71a. Here, however, the evidence does not show the required limitation of range of motion for an increased rating. During a March 2014 VA examination, the Veteran reported that he experiences pain and flare-ups. When describing the flare-ups, he noted that “every time [he] uses it, (left arm), it hurts, like when [he is] driving or lifting.” He noted that the pain was primarily in his shoulder, but it radiated down his left arm toward his hand. His left shoulder flexion was measured at 145 degrees with objective evidence of pain occurring at 110 degrees and left shoulder abduction was 145 degrees with pain beginning at 110 degrees. The examiner noted no additional limitations after repetitive-use testing and noted that functional limitations were caused by pain on movement and less movement than normal. Tenderness to palpation was noted below the AC area, but there was no loss of muscle strength, no ankylosis, no instability, and no deformity. However, while the examiner noted that the Veteran had flare-ups, they indicated that there was insufficient evidence or objective exam findings to provide a reliable prediction of decreased functional ability during flare-ups without resorting to speculation. The Veteran underwent a second VA examination in October 2014 where he reported that physical therapy improved his range of motion and pain but did not resolve it. He reported that the shoulder joint pain was intermittent and occurred approximately 50 percent of the time with elevation of the arm. He noted that if he did not move the left shoulder, he did not experience pain. He described the pain as sharp and deep inside the joint, but he did not miss time in school due to the left shoulder and was able to lift objects that weighed five pounds or less, but nothing heavier. He also reported that he was able to perform his activities of daily living. Lastly, the Veteran indicated that during flare-ups he was not able to work overhead and was limited in lifting. Upon examination, his flexion and abduction in the left shoulder were both limited to 170 degrees, and the examiner indicated that the range of motion itself did not contribute to functional loss, but that functional loss was caused by pain. The examiner indicated that the Veteran did not demonstrate pain with weight bearing but he had tenderness or pain on palpation over the anterior shoulder at biceps insertion. The examiner noted that he was unable to say whether weakness, fatigability, or incoordination significantly limited the Veteran’s functional ability with repeated use over time or during flare-ups without resorting to mere speculation, but that there was no additional loss of range of motion after the Veteran performed repetitive use testing with at least three repetitions. Again, there was no ankylosis, instability, deformity, or issues with the humerus noted. A July 2014 MRI was reviewed and it indicated that the Veteran had no degenerative arthritis. The examiner noted that the Veteran would not likely be able to perform any job requiring repetitive lifting or elevation of the arm over shoulder level. Because the March and October 2014 VA opinions did not comply with the requirements of Correia v. McDonald, 28 Vet. App. 158 (2016) and Sharp v. Shulkin, 29 Vet. App. 26 (2017), an addendum retrospective opinion was provided by a VA examiner in April 2020. After reviewing the evidence of record, the examiner opined that the Veteran’s initial range of motion during that period was 170 degrees for both flexion and abduction, 90 degrees for external rotation, and 60 degrees for internal rotation. The examiner opined that after repetitive use over time or during flare-ups, the Veteran’s flexion and abduction was limited to only 110 degrees each, external rotation was limited to 70 degrees, and internal rotation was limited to 40 degrees. Because the April 2020 VA examiner reviewed the record, considered the Veteran’s contentions, and estimated the Veteran’s range of motion limitations in accordance with the proper diagnostic criteria in forming their opinion, the Board finds it highly probative. There is no other medical evidence prior to July 27, 2015 that indicates greater range of motion limitations. Although the VA examinations noted pain and range of motion limitations that worsened during flare-ups and after repetitive use over time, there is no evidence that the Veteran’s range of motion was diminished enough prior to July 27, 2015 to limit the motion of the arm to 25 degrees from the side. As such, this level of impairment is consistent with the 20 percent rating he was assigned for this period. Accordingly, under DC 5201, a rating in excess of 20 percent for a minor joint is not warranted for the period prior to July 27, 2015. As of September 1, 2015 After reviewing the evidence of record, the Board determines that a 30 percent rating, but not more, as of September 1, 2015, is warranted under either the pre-amended or amended criteria. The Veteran underwent arthroscopic surgery with biceps tendinosis and subacromial decompression in July 2015, and he underwent a VA examination afterward in December 2015. He reported that he has constant left shoulder pain which increases with activity. He also reported that he is able to perform all of his indoor chores but is only able to perform light duty outdoor chores. Furthermore, he reported that he experiences flare-ups that cause left shoulder pain when he attempts any manual labor. Upon examination, his left shoulder flexion and abduction were both 140 degrees, and it was noted that he exhibited mild pain and stiffness. However, the examiner also noted that his pain on abduction did not result in functional loss. Despite mild anterior left shoulder tenderness, there was no crepitus or pain with weight bearing. He was able to perform repetitive use testing with at least three repetitions with no additional functional loss, but the examiner indicated that they were not able to determine the degree of additional functional loss on flare-ups or after repeated use over time without resorting to mere speculation. Muscle strength was normal, and it was indicated that the Veteran had no ankylosis or impairment of the humerus. The examiner also indicated that there was no history of mechanical symptoms or recurrent dislocation of the glenohumeral joint. The examiner noted that a November 2014 MRI revealed degenerative or traumatic arthritis of the left shoulder and indicated that the Veteran should have been considered to still be post-operative at the time of the exam. Although the December 2015 VA examiner did not opine additional functional loss after repetitive use over time, the Veteran underwent another VA examination in January 2019. The Veteran reported that the condition has worsened, the pain has increased, he has loss of range of motion, and he is unable to pick things up without experiencing pain. He noted that he experiences flare-ups that he describes as a sharp pain that intensifies when lifting up or with use. Upon examination, the Veteran’s left shoulder flexion was 120 degrees, abduction was 110 degrees, external rotation was 75 degrees, and internal rotation was 30 degrees. There was moderate pain observed on all range of motion testing and there was objective evidence of crepitus, but there was no evidence of pain with weight bearing. It was noted that the Veteran experienced pain, fatigue, weakness, and lack of endurance after repetitive-use testing with at least three repetitions, and his flexion was limited to 105 degrees, abduction was limited to 105 degrees, external rotation was limited to 60 degrees, and internal rotation was limited to 20 degrees. The examiner notes that upon flare-ups and after repetitive use over time, the Veteran’s range of motion is limited to 5 degrees for flexion, abduction, external rotation, and internal rotation, and he experiences pain, fatigue, weakness, and lack of endurance. However, it was also noted that there is no evidence of ankylosis, instability, dislocation, labral pathology, or impairment of the humerus. Despite the lack of estimated functional loss with flare-ups or after repetitive use over time during the December 2015 VA examination, the Board determines that the January 2019 VA examination adequately represents the Veteran’s range of motion limitations in those situations at that time status post arthroscopic surgery because initial range of motion testing was similar during both examinations, and the Veteran reported in January 2019 that his condition had worsened since his last examination, indicating that his condition could not have been worse in 2015 than it was in 2019. Giving the Veteran the benefit of the doubt, the Board determines that a 30 percent rating for limitation of motion is warranted beginning September 1, 2015 for limitation of motion of a minor joint, which is the highest rating awarded for such impairment. However, a rating in excess of 30 percent is not warranted under either the pre-amended or amended rating criteria as of September 1, 2015. Specifically, there is no evidence in the record demonstrating either ankylosis or an impairment of the humerus as required under DC 5200 or DC 5202. As such, a rating of 30 percent, but not more, is warranted for limitation of motion of the non-dominant arm to 25 degrees. The Board considered the Veteran’s statements in determining the appropriate disability ratings. Specifically, the Veteran reported that he experiences worsening and constant pain and range of motion limitations that limit his ability to lift anything or perform activities of daily living, and that it is much worse during flare-ups. However, the Board finds these statements of limited probative value. While the Veteran, as a lay person, is competent to report observable symptomatology, once basic competency is met, the Board must consider credibility of testimony. In this case, the Veteran’s reports are not generally consistent with VA examinations and medical records demonstrating range of motion midway between side and shoulder level prior to July 27, 2015, and there is no evidence in the record of ankylosis or humerus impairments throughout the entire period at issue. As such, not all of the Veteran’s assertions are supported by the evidence of record. See Caluza v. Brown, 7 Vet. App. 498 (1995). Additionally, although the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his left nondominant shoulder disability according to the appropriate DCs. Rucker, 10 Vet. App. at 74; Layno, 6 Vet. App. at 469; see also Cartwright, 2 Vet. App. at 25. On the other hand, such competent evidence concerning the nature and extent of the Veteran’s left shoulder disability have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with their evaluations. The medical findings of the physicians who performed the VA examinations directly address the criteria under which this disability is evaluated. Because the examiners were able to review the medical file and examine the Veteran, the Board finds the examiners’ assessments of greater probative weight. As such, a rating in excess of 20 percent prior to July 27, 2015 is denied, and a rating of 30 percent, but not more, as of September 1, 2015 is granted. There is no doubt to be otherwise resolved. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 2. Entitlement to an increased rating for lumbar spine myofascial pain syndrome Prior to January 7, 2019, the Veteran has been in receipt of a 20 percent rating for lumbar spine myofascial syndrome under 38 C.F.R. § 4.71, DC 5237, and a rating of 40 percent thereafter. The Veteran contends that the symptoms of his lumbar spine myofascial pain syndrome merit increased ratings, and he has continuously experienced symptoms that include limited range of motion, pain with range of motion, flare-ups, and tingling and burning sensations into his lower extremities. During the course of this appeal, the schedular criteria for evaluating the spine have been also been amended. Specifically, the criteria pertaining to degenerative arthritis of the spine or degenerative disc disease under 38 C.F.R. § 4.71a, DC 5242, and intervertebral disc syndrome under 38 C.F.R. § 4.71a, DC 5243, were amended effective February 7, 2021. See 85 Fed. Reg. 76, 453 (November 30, 2020). As the Veteran’s claim was received prior to the effective date of the regulation changes, the Board must consider the Veteran’s spine disability under both the old and new revised rating criteria and must apply the old rating criteria if the result is more favorable to the Veteran. 38 U.S.C. § 5110; Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991), overruled in part, Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Under the pre-amended criteria, in order to warrant a rating in excess of 20 percent for a disability of the spine based on lumbosacral strain, the evidence must show: • Forward flexion of the thoracolumbar spine to 30 degrees or less (40 percent under DC 5237); • Favorable ankylosis of the entire thoracolumbar spine (40 percent under DC 5237); or • Intervertebral disc syndrome with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months (40 percent under DC 5243). 38 C.F.R. § 4.71a. Under the amended criteria, in order to warrant a rating in excess of 20 percent for a disability of the spine based on lumbosacral strain, the evidence must show: • Forward flexion of the thoracolumbar spine to 30 degrees or less (40 percent under DC 5237); • Favorable ankylosis of the entire thoracolumbar spine (40 percent under DC 5237); • Intervertebral disc syndrome (IVDS) with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months, but only if there is disc herniation with compression and/or irritation of the adjacent nerve root (40 percent under DC 5243). 38 C.F.R. § 4.71a. In order to warrant a rating in excess of 40 percent for a lumbar spine disability under the pre-amended criteria, the evidence must show: • Unfavorable ankylosis of the entire thoracolumbar spine (50 percent under DC 5237); or • IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months (60 percent under DC 5243). 38 C.F.R. § 4.71a. In order to warrant a rating in excess of 40 percent for a lumbar spine disability under the amended criteria, the evidence must show: • Unfavorable ankylosis of the entire thoracolumbar spine (50 percent under DC 5237); or • IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months, but only if there is disc herniation with compression and/or irritation of the adjacent nerve root (60 percent under DC 5243). 38 C.F.R. § 4.71a. Prior to January 7, 2019 Based on the evidence of record, the Board finds that a rating in excess of 20 percent for the Veteran’s lumbar spine disability prior to January 7, 2019 is not warranted under either the amended or pre-amended criteria. First, the Veteran underwent a VA examination in March 2014 where he reported that he continued to experience low back pain despite treatment with physical therapy, injections, muscle relaxers, and topical anesthetics. He reported that his pain was worse during the day and he would experience flare-ups with prolonged standing, sitting, or holding one position for 15 minutes or longer. Upon examination, the Veteran’s forward flexion was 90 degrees or greater with no objective evidence of painful motion. Forward flexion was also noted at 90 degrees with repetitive-use testing with 3 repetitions, but functional limitations of less movement than normal and pain on movement were noted. It was also noted that the Veteran had minimal tenderness lateral to the spine bilaterally in the lumbar area, but no spasms were noted, and he did not exhibit abnormal gait or abnormal spinal contour as a result of symptoms. Additionally, there was no evidence of radiculopathy, ankylosis of the spine, other neurologic abnormalities, or IVDS and incapacitating episodes. A lumbar CT showed spondylolysis, but no spondylolisthesis, no disc abnormalities, and no arthritis. In April 2014, the VA examiner reported in an addendum opinion that they could not opine as to decreased functional ability during flare-ups or after repeated use over time without resorting to mere speculation. As a result of this inadequate opinion, a September 2020 addendum retrospective opinion was obtained. The VA examiner reviewed the evidence of record and estimated that the Veteran’s range of motion during the March 2014 examination after repeated use over time and during flare-ups would have been limited to 60 degrees for forward flexion. They also estimated that the Veteran would have had larger decreases in motion when bending as this is usually the case for individuals with back pain. A VA examination was obtained in May 2018 to determine whether the Veteran’s right lower extremity neuropathy symptoms were proximately due to or the result of his service-connected lumbar spine disorder. A CT scan of the Veteran’s lumbar spine from April 2017 demonstrated L-5 lumbar spondylosis without spondylolisthesis. However, the examiner noted that a September 2017 EMG study did not demonstrate evidence of peripheral neuropathy. Furthermore, as will be discussed in further detail below, L-5 lumbar spondylosis without spondylolisthesis is a separate and unrelated condition to lumbar spine myofascial pain syndrome. As such, the evidence does not support that the Veteran’s service-connected disorder caused him any neurological abnormalities. In addition to the VA examinations, there is no evidence of forward flexion of the thoracolumbar spine 30 degrees or less, ankylosis, IVDS, or associated objective neurological abnormalities. In August 2014, physical therapy records noted 100 percent range of motion at the lumbar spine, although the Veteran had pain at the L4-5 vertebrate with extension. Physical therapy records from January 2017 noted the Veteran had limited range of motion and wore a back brace, and in April 2017 it was noted that the Veteran had severely restricted range of motion of the lumbar spine with extension, but only moderately restricted range of motion with flexion. There are no measurements of limitation in degrees of range of motion provided in the physical therapy records, but the Veteran had a symmetric gait, could perform heel/toe/tandem gait, had normal appearing posture, had a negative straight leg raise test, and there were no trigger points with palpation. He also had normal sensation throughout the lower extremities. Additionally, x-rays of the lumbar spine from January 2017 showed no significant degenerative changes, no compressed joints, unremarkable SI joints, and satisfactory alignment. Furthermore, an August 2018 VA examination for medical conditions related to the Gulf War stated that the Veteran showed a sitting tolerance within normal limits, he was able to transition from sitting to standing normally, he had a normal gait with equal weight bearing on the right and left, he was able to walk on heels and toes with normal posture, and he had normal coordination and reflexes. While the Veteran reported symptoms that included pain with sitting, standing, or walking for long or performing activities of daily living, and he required treatment with physical therapy, TENS unit, acupuncture, medication, topical treatments, and a home lumbar traction device, the records do not contain evidence of forward flexion of the thoracolumbar spine 30 degrees or less, ankylosis, IVDS, or associated objective neurological abnormalities prior to January 7, 2019. As such, a rating in excess of 20 percent is not warranted. As of January 7, 2019 After reviewing the evidence of record, the Board determines that a rating in excess of 40 percent under either the pre-amended or amended criteria is not warranted. The Veteran reported that his lumbar spine symptoms have continued to worsen. As a result, he underwent a VA examination in January 2019 where he detailed his worsening pain and noted that he experiences tingling that radiates down his legs. He also noted that he has flare-ups that can be described as a burning sensation that feels like pins and needles, and he cannot bend down without pain or discomfort or lift objects. Upon examination, his range of motion was measured at 50 degrees of flexion, 10 degrees of extension, 20 degrees right and left lateral flexion, and 20 degrees right and left lateral rotation. He exhibited pain on both forward flexion and extension, there was evidence of pain with weight bearing, and there was moderately severe pain or tenderness in the low back. After 3 repetitions, his forward flexion was reduced to 40 degrees, extension was reduced to 5, and lateral flexion and rotation bilaterally was 15 degrees. It was estimated that during flare-ups or after repeated use over time, the Veteran’s range of motion was limited in all directions to 5 degrees. The examiner also noted positive straight leg raising tests bilaterally. However, the examination also noted that the Veteran has no ankylosis, muscle spasms do not cause gait abnormalities, there is no muscle atrophy, he has normal strength and sensation, and he does not have IVDS. Furthermore, there was no evidence of pain on passive range of motion testing or pain on non-weight bearing. Although the Veteran complained of numbness and tingling that radiated into the bilateral lower extremities, February 2020 and April 2020 VA examiners opined that the Veteran’s L-5 spondylosis without spondylolisthesis with accompanying bilateral radiculopathy was a new and separate condition due to compression or impingement of spinal nerve roots, and myofascial pain syndrome is unrelated to the pathophysiology of L-5 bilateral spondylosis. The February 2020 examiner stated that myofascial pain syndrome is a disorder in which pressure or sensitive points in the muscles cause pain in seemingly unrelated body parts, and that this does not cause degenerative changes of the spine and nerve compression that results in L-5 lateral spondylosis with accompanying bilateral radiculopathy, to which the April 2020 VA examiner concurred. The April 2020 VA examiner opined that it is at least as likely as not that the Veteran’s radiating pain, numbness, and tingling are due to his L-5 lateral spondylosis without spondylolisthesis with accompanying radiculopathy, which is not service-connected. As such, the weight of the evidence supports that the Veteran’s reported neurological symptoms are not likely due to his service-connected lumbar spine disorder. There is no other evidence in the record to indicate the Veteran has ever been diagnosed with ankylosis or IVDS or that his neurological abnormalities are related to his myofascial pain syndrome of the lumbar spine. As such, a rating in excess of 40 percent for lumbar spine myofascial pain syndrome as of January 7, 2019 is not warranted. The Board considered the Veteran’s statements in determining the appropriate disability ratings. Specifically, the Veteran reported that he experiences worsening and constant pain and range of motion limitations that limit his ability to sit, stand, or walk for prolonged periods, bend, or perform activities of daily living, and that his symptoms are much worse during flare-ups. Although the Board finds the Veteran’s statements credible, it also finds these statements to be of limited probative value. While the Veteran, as a lay person, is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his lumbar spine according to the appropriate DCs. Rucker, 10 Vet. App. at 74; Layno, 6 Vet. App. at 469; see also Cartwright, 2 Vet. App. at 25. On the other hand, such competent evidence concerning the nature and extent of the Veteran’s lumbar spine myofascial pain syndrome have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with their evaluations. The medical findings of the physicians who performed the VA examinations directly address the criteria under which this disability is evaluated. Because the examiners were able to review the medical file and examine the Veteran, the Board finds the examiners’ assessments of greater probative weight. As such, the weight of the evidence does not support increased ratings for lumbar spine myofascial pain syndrome, and there is no doubt to be otherwise resolved. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). The appeal is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Veltri, Associate Counsel