Citation Nr: 21012956 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 10-02 326 DATE: March 8, 2021 ORDER Entitlement to an initial rating of 10 percent is granted for patellofemoral syndrome of the left knee (left knee condition) effective September 1, 2007; however, a rating in excess of 10 percent is denied. Entitlement to an initial rating in excess of 10 percent; a rating in excess of 20 percent since January 7, 2014; and a rating in excess of 40 percent for lumbar degenerative disc disease, also claimed as lumbar strain (back condition) since December 17, 2019 is denied. FINDINGS OF FACT 1. Since September 1, 2007, the probative evidence of record establishes that the Veteran had pain during range of motion. 2. Prior to January 7, 2014, the Veteran had painful motion of his lumbar spine. 3. Between January 7, 2014 and December 17, 2019, the Veteran’s lumbar forward flexion was limited to 60 degrees, but not 30 degrees or less, and without ankylosis of the spine. 4. Since December 17, 2019, the Veteran’s lumbar flexion has been limited to 30 degrees or less, but the probative evidence does not demonstrate ankylosis of the spine. CONCLUSIONS OF LAW 1. The criteria for a rating of 10 percent, but no higher, for a left knee condition since September 1, 2007 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5003, 5260. 2. The criteria for an initial rating in excess of 10 percent; a rating in excess of 20 percent since January 7, 2014; and a rating in excess of 40 percent since December 17, 2019 for a back condition have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237, 5242. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from May 1979 to August 2007. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a February 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The RO, in pertinent part, granted service connection for left knee strain and lumbar strain, evaluated as zero (0) and 10 percent disabling, respectively, effective September 1, 2007. In January 2014, while the Veteran’s appeal was pending, the agency of original jurisdiction (AOJ) increased the rating for lumbar strain to 20 percent, effective January 7, 2014. In November 2016, the AOJ, in pertinent part, increased the rating for left knee strain to 10 percent, effective April 8, 2009. In August 2016 and October 2017, the Board remanded the issues currently on appeal for additional development. The Veteran’s claims were most recently before the Board in May 2019 wherein they were again remanded for additional development. The AOJ performed this development, to include informing the Veteran of the need to complete releases for private physical therapy records. The Veteran did not return any releases and did not provide any other records in support of his claims. Through a June 2020 rating decision, the Veteran was awarded a 40 percent rating for his back condition. The claims have now returned to the Board for adjudication. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, 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. Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings would be necessary. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In other words, where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings would be necessary. Separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999); see also AB v. Brown, 6 Vet. App. 35 (1993) (a claim for an original or an increased rating remains in controversy when less than the maximum available benefit is awarded). Reasonable doubt as to the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In this case, separate evaluations are warranted as explained below. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). Diagnostic Code 5003 provides that degenerative arthritis that is 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 there is limitation of motion of the specific joint or joints that is compensable (10 percent or higher) under the appropriate diagnostic codes, the compensable limitation of motion should be rated under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a. Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In addition to the general criteria for increased ratings claims, when assessing the severity of musculoskeletal disabilities that are at least partly rated on the basis of limitation of motion, VA must also consider the extent that the Veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent (“flare-ups”) due to the extent of his pain (and painful motion), weakness, premature or excess fatigability, and incoordination-assuming these factors are not already contemplated by the governing rating criteria. DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. Further, the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158 (2016). In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107(b). 1. Left knee condition The Veteran contends that he should be awarded an increased initial rating for his left knee condition. Through a November 2016 rating decision, the AOJ assigned a 10 percent rating for the Veteran’s left knee effective April 8, 2009. Prior to this, the Veteran’s left knee was rated as noncompensable effective September 1, 2007. As explained in the February 2008 rating decision that assigned the initial rating, the reason a non-compensable rating was assigned was that the Veteran did not have painful motion and therefore a 10 percent rating under Diagnostic Code 5003 was not warranted. The November 2016 rating decision assigned a 10 percent rating due to the diagnosis the of patellofemoral syndrome (PFS) with pain upon motion. Knee disabilities are unique in the rating code, as they are one of a few orthopedic disabilities in which a Veteran may receive multiple ratings based on separate symptoms in the same joint. While the law generally prevents considering the same symptoms under various diagnoses to support separate ratings, some of the relevant Diagnostic Codes for the knee have been interpreted to apply to different functions of the knee, therefore warranting separate consideration. Specifically, the evidence may warrant separate ratings for limitation of flexion of the knee, limitation of extension of the knee, lateral instability and recurrent subluxation of the knee, and meniscal disabilities. The Board will explore all possibilities in this case. Standard range of knee motion is from zero degrees (on extension) to 140 degrees (on flexion). See 38 C.F.R. § 4.71, Plate II. When the limitation of motion is non-compensable under the appropriate diagnostic codes, a rating of 10 percent may be applied to each such major joint (such as the knee) or group of minor joints affected by limitation of motion. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a. Under Diagnostic Code 5260, a 0 percent (noncompensable) disability rating is assigned for flexion limited to 60 degrees, a 10 percent disability rating is assigned for flexion limited to 45 degrees, a 20 percent disability rating is assigned for flexion limited to 30 degrees, and a 30 percent disability rating is assigned for flexion limited to 15 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5261, a 0 percent (noncompensable) disability rating is assigned for extension limited to 5 degrees, a 10 percent disability rating is assigned for extension limited to 10 degrees, a 20 percent disability rating is assigned for extension limited to 15 degrees, a 30 percent disability rating is assigned for extension limited to 20 degrees; a 40 percent disability rating is assigned for extension limited to 30 degrees; a 50 percent disability rating is assigned for extension limited to 45 degrees. 38 C.F.R. § 4.71a. Diagnostic Code 5257 provides for a 10 percent rating for slight recurrent subluxation or lateral instability. A 20 percent rating is warranted for moderate subluxation or lateral instability. A maximum 30 percent rating is warranted for severe recurrent subluxation or lateral instability. Under Diagnostic Code 5259, a 10 percent rating is available for removal of the semilunar cartilage (meniscus) that is symptomatic. Under Diagnostic Code 5258, a symptomatic meniscus is described as “locking,” pain, and effusion into the joint. During the pendency of this appeal, VA amended the Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Codes 5257, 5262), effective from February 7, 2021. As is relevant to this appeal, the following changes were made with respect to Diagnostic Code5257 and 5262. Regarding Diagnostic Code 5257, the regulations in effect from February 7, 2021, now provide the following: Recurrent subluxation or instability: Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation………………………………30 One of the following………………………………..20 Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s),crutch(es), walker) for ambulation, Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g, cane(s), crutch(es), or a walker) or bracing for ambulation. Sprain, incomplete ligament tear, or complete ligament tear (repaired, repaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation…………10 Patellar instability: A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or walker……………………..30 A diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker…………….20 A diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker…………………………………………………10 Note (1): For patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note (2): A surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). Id. Diagnostic Code 5262 now provides for the following: Nonunion of, with loose motion, requiring brace……..40 Malunion of: Evaluate under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or medial tibial stress syndrome (MTSS), or shin splints: Requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities……………………………………30 Requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, one lower extremity ………………20 Requiring treatment for no less than 12 consecutive months, and unresponsive to either shoe orthotics or other conservative treatment, one or both lower extremities ……………………..10 Treatment less than 12 consecutive months, one or both lower extremities………………………….0 Id. a. Rating as of September 1, 2007 At the August 2007 VA examination, the Veteran reported pain in his knees, at the top of both kneecaps, that occurred every day. He took Motrin for the pain. He reported flare-ups when he would run and avoided kneeling or bending his knees that day. He also reported difficulty squatting, using a ladder, or other activities that put stress on his knee. His left knee range of motion was within normal limits and the examiner did not find pain on range of motion testing. The Veteran had crepitus over his patella. The examiner assessed a diagnosis of knee strain. Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). VA must also consider the extent that the Veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent (“flare-ups”) due to the extent of his pain (and painful motion), weakness, premature or excess fatigability, and incoordination-assuming these factors are not already contemplated by the governing rating criteria. DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. The Board finds that while the Veteran’s range of motion itself was not painful, he reported pain and other functional impairment related to his left knee. Given this, the Board finds that the criteria for painful motion under 38 C.F.R. § 4.59 are met. Thus, an initial, compensable, 10 percent rating, is warranted for the Veteran’s left knee since September 1, 2007. b. Entitlement to a rating in excess of 10 percent since September 1, 2007 The Board finds the VA examinations to be the most probative evidence of record related to the Veteran’s knees. While there are treatment records noting knee pain, there are no VA or private treatment records that provide a numerical equivalent to range of motion (versus a percent a range of motion lost). Of those that do discuss range of motion, it is noted as full or within normal limits. In order to warrant a higher initial rating, the Veteran’s left knee limited motion would need to manifest in symptomology approximating a limitation of 30 degrees flexion or 15 degrees extension. Here, the Board does not so find. The Veteran had VA examinations in August 2007, January 2014, September 2016, and December 2019. The range of motion measurements in the VA examinations in August 2007 and January 2014 (0-140 degrees); and September 2016 (0-110 degrees) do not approximate those required for higher or separate ratings. The September 2016 noted that the examiner was unable to measure range of motion during weight bearing due to an “unsteady gait and pain with this range of motion.” If the Veteran had an unsteady gait due to his knees, it would have been discussed in his symptoms, flare-ups, or functional loss. Here, the Board finds that the examination discussion and the contemporaneous medical record do not indicate an unsteady gait due to the Veteran’s knee. The neurological and stability testing were all within normal limits. Therefore, even the amended regulations with respect to Diagnostic Code 5257 are not for application as there is simply no evidence of instability or subluxation in any respect, as indicated in the VA examinations. While the prior VA examinations did not provide an estimate of range of motion lost during flare-ups or functional loss, the December 2019 examination did. After an initial range of motion measurement of 0-70 degrees, the examiner considered the Veteran’s complaints of flare-ups (moderate to severe pain with activity) and functional loss (limited range of motion) and found that during these, the Veteran’s range of motion would fall as low as 0-40 degrees. Thus, even considering this limitation, the Veteran’s left knee would still not meet the criteria for a higher 20 percent rating for limitation of flexion (30 degrees) or a separate compensable evaluation for limitation of extension (10 degrees). In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The Board has considered the Veteran’s complaint of more severe symptomology during flare-ups and additional functional loss. However, the December 2019 examiner considered these complaints and estimated a range of motion lost. While the Veteran reported pain, flareups must be quantifiable and must result in limitation of motion of function beyond that contemplated by the already provided evaluation. Additionally, because there is a regulation addressing the stabilization of ratings, flareups must be of such length as to establish that the overall impairment is more severe than currently evaluated. In this instance, the Veteran’s statements made in this case do not show that any flareups or repeated use over time have additionally limited function in a quantifiable way, nor do they show that they are of such length or duration that a higher rating would be warranted The specific clinical measures of ranges of motion, including examiners’ findings and opinions regarding additional limitations of motion due to such factors, have been weighed and considered by the Board. Such specific measures and findings are of more probative value in determining specific ranges of motion than are general histories or general descriptions of symptoms of pain or limitations, such as this Veteran’s report of pain and limitation of function. Despite the Veteran’s contention of a greater degree of limitation on his knee condition, the disability rating assigned herein indicates a significant impact on his functional ability. Such disability evaluations assigned by VA recognizes his painful motion. The critical question in this case, however, is whether the problems he has cited meet an even higher level under the rating criteria. For reasons cited above, the Board finds they do not. For the foregoing reasons, the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 10 percent for a left knee condition. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Back condition The Veteran contends that he should be awarded higher ratings for his back condition. He is in receipt of a 10 percent rating effective September 1, 2007; a 20 percent rating, effective January 7, 2014; and a 40 percent rating effective December 23, 2019. The Veteran is currently rated under Diagnostic Code 5242 for degenerative arthritis of the spine and was previously rated under Diagnostic Code 5237 for lumbar strain. Both Diagnostic Codes are considered under General Rating Formula for Diseases and Injuries of the Spine. Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent rating is warranted for 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 not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion limited to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. To warrant a rating higher than 40 percent, the evidence must show unfavorable ankylosis. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Ankylosis is defined as “immobility and consolidation of a joint due to disease, injury, or surgical procedure.” Dorland’s Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id., at Note 5. No medical evidence indicates that ankylosis occurred during the period on appeal. As noted, VA amended the Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020), effective from February 7, 2021. With respect to the present disability, no changes were made to the applicable diagnostic codes. Therefore, further discussion is not warranted. The following sections discuss the periods when the ratings for the Veteran’s back condition increased. A separate section discusses entitlement to a separate rating for radiculopathy. a. Period from September 1, 2007 to January 7, 2014 The Veteran’s first VA examination was in August 2007. He reported that he had back pain that was worse when he was more active, such as yard work, and took over-the-counter medication when this happened. After flares, he avoided bending for long periods of because of the pain. He reported that he had a “shooting” pain down the back of his thigh. Upon range of motion testing, the Veteran’s lumbar movements were limited as follows: lumbar flexion, to 95 degrees; lumbar extension to 35 degrees; bilateral lateral flexion 40 degrees; and bilateral rotation 35 degrees. Thus, the total range of motion was 280 degrees. No diagnosis of radiculopathy was rendered. The remainder of the medical evidence between September 1, 2007 and January 7, 2014 does not reveal greater limitations that would warrant a higher rating. The Veteran’s medical records note pain and tenderness, but do not provide a measurement of range of motion lost. Therefore, these records warrant less probative weight than the measurements taken by the VA examiner. Given the above, the criteria for painful motion were met and an initial 10 percent rating was assigned. However, a greater degree of range of motion lost or its functional equivalent was not met prior to January 7, 2014. b. Period from January 7, 2014 to December 23, 2019 The Veteran attended a VA examination on January 7, 2014. He reported daily pain 2-4/10 and took pain medication for his back. He did not report flare-ups of back pain. Upon range of motion testing, the Veteran’s lumbar movements were limited as follows: lumbar flexion, to 60 degrees (but painful motion at 30 degrees); lumbar extension to 30 degrees (but painful motion at 15 degrees); bilateral lateral flexion 30 degrees (but painful motion on the right at 20 degrees); and bilateral rotation 35 degrees. Thus, the total range of motion was 220 degrees (with painful motion it was 165 degrees total). Upon repetitive use, the Veteran’s forward flexion was reduced to 50 degrees. The examiner opined that the Veteran would have the following functional impairment of his back: less movement than normal; incoordination, impaired ability to execute skilled movements smoothly; and pain on movement. But the examiner did not provide an estimate of additional range of motion lost. The Veteran had tenderness of his back, but without abnormal gait or abnormal spinal contour. It was based on this examination that the AOJ granted a 20 percent rating effective January 7, 2014 based on forward flexion of the back of 60 degrees, but not less than 30 degrees. The Veteran attended an examination in September 2016. He reported increased pain and muscle spasms. He had constant pain at 4/10; early morning was 6/10; and during severe flare-ups, it was 8-9/10. He reported “nerve” pain at least once a week and that lasted a couple of minutes but would go away with repositioning. The Veteran reported flare-ups and functional impairment as follows: “twisting and turning, reaching out in front to pick-up something, bending to tie shoes, squatting, reaching out in front, standing and sitting.” Upon range of motion testing, the Veteran’s forward flexion was limited to 60 degrees and all other ranges of motion were limited to 30 degrees. The Veteran had pain in all motions. The Veteran had tenderness, but without abnormal gait or abnormal spinal contour. The examiner did not find additional range of motion lost after repetitive use and did not provide an opinion on range of motion lost during flares. The remainder of the examination was within normal limits. The remainder of the medical record does not reveal greater limitations that would warrant a higher rating. The Veteran’s medical records note pain and tenderness, but do not provide a measurement of range of motion lost. Therefore, these records warrant less probative weight than the measurements taken by the VA examiners. Given the above, the Board finds that the criteria for a rating in excess of 20 percent for the Veteran’s back condition has not been met for the period from January 7, 2014 to December 23, 2019. At most, the Veteran’s forward flexion was limited to 60 degrees. While the January 2014 VA examiner found that painful forward flexion of the Veteran’s back started at 30 degrees, the Board finds that the contemporaneous medical evidence does not support that range of motion was limited to 30 degrees or less. The September 2016 examiner did not find a similar limitation of motion and the medical evidence does not indicate such a severe limitation of motion. As for flare-ups and functional loss, the Board does not find that a greater degree of limitations would result. The Veteran reported no flare-ups in January 2014 and reported the following in September 2016: “twisting and turning, reaching out in front to pick-up something, bending to tie shoes, squatting, reaching out in front, standing and sitting.” While these limitations would result in some additional range of motion lost, the Board finds that they would not equate to the equivalent of 30 degrees of lost flexion (from 60 degrees to 30 degrees) such that a higher rating would result. c. Period since December 23, 2019 The Veteran was afforded a VA examination on December 23, 2019. It is from this date that the Veteran was awarded a 40 percent rating based on forward flexion of his back at 30 degrees or less. In order to warrant a higher rating, the evidence would have to show either favorable or unfavorable ankylosis. The evidence does not so indicate. Thus, a rating in excess of 40 percent since December 23, 2019 is denied. d. Radiculopathy At various points in the record, it appears that the Veteran may be referencing symptomology consistent with radiculopathy. See August 2007 VA examination (pain shooting into the leg); VA record January 2011 (pain radiating down right leg); September 2016 (positive straight leg raise (SLR) on the right); and August 2017 (pain radiating to right groin). In July 2019, a VA medical record even renders a diagnosis of radiculopathy. However, at other points in the record, the Veteran’s SLR testing is negative and no VA examiner, to include the December 2019 examiner, assessed a diagnosis of radiculopathy. The VA examinations do not include complaints of radiculopathy. Given this, the Board affords more probative weight to the VA examiners because the had an opportunity to review the medical evidence and personally examine the Veteran. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Thus, a separate compensable rating for radiculopathy is not warranted. e. Summary In summary, the Board finds that the criteria for higher ratings than those currently assigned have not been met or approximated. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The Board has considered the Veteran’s complaint of more severe symptomology during flare-ups and additional functional loss. The December 2019 examiner considered these complaints and estimated a range of motion lost. Prior to this, the Board does not find that reported flare-ups would approximate the range of motion lost which is required for the next higher rating. While the Veteran reported pain, flareups must be quantifiable and must result in limitation of motion of function beyond that contemplated by the already provided evaluation. Additionally, because there is a regulation addressing the stabilization of ratings, flareups must be of such length as to establish that the overall impairment is more severe than currently evaluated. In this instance, the Veteran’s statements made in this case do not show that any flareups or repeated use over time have additionally limited function in a quantifiable way, nor do they show that they are of such length or duration that a higher rating would be warranted The specific clinical measures of ranges of motion, including examiners’ findings and opinions regarding additional limitations of motion due to such factors, have been weighed and considered by the Board. Such specific measures and findings are of more probative value in determining specific ranges of motion than are general histories or general descriptions of symptoms of pain or limitations, such as this Veteran’s report of pain and limitation of function. Despite the Veteran’s contention of a greater degree of limitation on his back condition, the disability rating assigned herein indicates a significant impact on his functional ability. Such disability evaluations assigned by VA recognizes his painful motion. The critical question in this case, however, is whether the problems he has cited meet an even higher level under the rating criteria. For reasons cited above, the Board finds they do not. For the foregoing reasons, the preponderance of the evidence is against the Veteran’s claim for an initial rating in excess of 10 percent; a rating in excess of 20 percent since January 7, 2014; and a rating in excess of 40 percent for his back condition since December 17, 2019. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. T. Berry Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board I. M. Hitchcock 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.