Citation Nr: 21015115 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 15-09 611 DATE: March 16, 2021 ORDER A rating in excess of 10 percent prior to October 27, 2014, and in excess of 20 percent thereafter, for degenerative arthritis of the cervical spine is denied. A rating in excess of 20 percent for tendonitis, left shoulder, is denied. A rating in excess of 20 percent for tendonitis, right shoulder, is denied. FINDINGS OF FACT 1. Prior to October 27, 2014, the Veteran’s degenerative arthritis of the cervical spine was manifest by subjective complaints of pain and forward flexion of no worse than 35 degrees; but no ankylosis was shown and there was no muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 2. From October 27, 2014 onward, the Veteran’s degenerative arthritis of the cervical spine was manifest by subjective complaints of pain and forward flexion of no worse than 25 degrees; but no ankylosis was shown. 3. The Veteran’s tendonitis, left shoulder, was manifested by subjective complaints of pain, left shoulder flexion to no worse than 75 degrees, and abduction to no worse than 85 degrees. 4. The Veteran’s tendonitis, right shoulder, was manifested by subjective complaints of pain, left shoulder flexion to no worse than 80 degrees, and abduction to no worse than 90 degrees. CONCLUSIONS OF LAW 1. Prior to October 27, 2014, the criteria for a rating in excess of 10 percent for degenerative arthritis of the cervical spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237. 2. From October 27, 2014, onward, the criteria for a rating in excess of 20 percent for degenerative arthritis of the cervical spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237. 3. The criteria for a rating in excess of 20 percent for tendonitis, left shoulder, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5201. 4. The criteria for a rating in excess of 20 percent for tendonitis, right shoulder, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5201. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1988 to July 1992. On appeal is an August 2012 rating decision issues by the Department of Veteran Affairs (VA) Regional Office (RO) that: (1) denied a rating in excess of 10 percent for the Veteran’s service-connected degenerative arthritis of the cervical spine; (2) denied a rating in excess of 10 percent rating for the Veteran’s service-connected tendonitis, left shoulder; and, (3) denied a rating in excess of 10 percent for the Veteran’s service-connected tendonitis, right shoulder. During the pendency of the appeal, the ratings were increased in a January 2015 Decisional Review Officer (DRO) rating decision as follows: (1) a 20 percent rating was assigned for the Veteran’s service-connected degenerative arthritis of the cervical spine effective October 27, 2014; (2) a 20 percent rating was assigned for the Veteran’s service-connected tendonitis, left shoulder, effective October 27, 2014; and, (3) a 20 percent rating was assigned for the Veteran’s service-connected tendonitis, right shoulder, effective October 27, 2014. As the disability rating assigned did not represent a total grant of benefits sought on appeal, the claim for an increase remained before the Board. AB v Brown, 6 Vet. App. 35, 39 (1993). When the matters initially came before the Board of Veterans Appeals (Board) in June 2018 and August 2020, the Board remanded for additional development, to include new VA examinations. In July 2020, the DRO issued another rating decision that granted earlier effective dates as follows: (1) the 10 percent rating assigned for the first part of the staged rating for degenerative arthritis of the cervical spine is now effective March 24, 2006; (2) the 20 percent rating assigned for tendonitis, left shoulder, is now effective March 27, 2012; and, (3) the 20 percent rating assigned for tendonitis, right shoulder, is now effective March 27, 2012. The requested development has been completed and the matters returned to the Board for appellate adjudication. Duty to Notify and Assist The Veteran has not raised any issues with the duty to notify. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board”). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained. Also of record are VA examinations conducted in July 2012, October 2014, and September 2020. The Veteran has not referred to any additional, unobtained, relevant, available evidence. Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA’s duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41 (2018). Consideration of the whole recorded history is necessary so that a rating may accurately compensate the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31 (1999). 1. Entitlement to a rating in excess of 10 percent prior to October 27, 2014, and in excess of 20 percent thereafter, for degenerative arthritis of the cervical spine. The Veteran’s degenerative arthritis of the cervical spine is currently rated under Diagnostic Code 5237. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, this diagnostic code was not changed. Under Diagnostic Code 5237, a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine. A 30 percent rating is warranted for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 20 percent rating is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 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. 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. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Here, in January 2009, the Veteran was granted service connection for a “sprain, cervical spine” and assigned a 10 percent rating that is now effective March 24, 2006. In March 2012, the Veteran filed an increased rating claim, and the August 2012 rating decision that denied this claim is on appeal. Currently, the Veteran has a staged rating of 10 percent prior to October 27, 2014; and 20 percent thereafter. Each of the ratings will be addressed in turn. Prior to October 27, 2014 A VA examination of the Veteran’s cervical spine was conducted in July 2012. The Veteran reported a history of being deployed to Iraq and being in a military truck on a bumpy road when the driver lost control and the vehicle rolled. The Veteran reported she hit her head and was told she had whiplash. The Veteran states she now has flare ups of neck/shoulder pain 1-2 times a month. She stated the flare ups are aggravated by unsure activity; alleviated by time; and, not undergoing any treatment. Upon examination, the examiner noted the Veteran had no guarding or muscle spasms; no abnormal gait or abnormal spinal contour; no pain to palpation; no muscle atrophy; no intervertebral disc syndrome (IVDS); no neurological abnormalities; and, no other pertinent physical findings. Forward flexion of the cervical spine was 40 degrees, and after repetitive use testing, was 35 degrees. The examiner noted a diagnosis of neck pain/sprain. In a lay statement received from the Veteran in July 2012, the Veteran complained of chronic pain in neck and shoulders. Post service VA treatment records from the Spokane VAMC are associated with the Veteran’s claims file. In summary, these records reflect the Veteran’s complaints, diagnosis, and treatment of her neck pain. For example, a March 2012 record reflects a complaint of chronic pain in neck and shoulders. Upon review of the relevant medical and lay evidence prior to October 27, 2014, the Board finds that the Veteran’s symptoms are consistent with the 10 percent rating currently assigned, based on the degree of forward flexion and the lack of ankylosis. To obtain a higher rating for the Veteran’s spine disability, it is necessary to show forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; abnormal gait; or, ankylosis. For this period, however, the Veteran’s forward flexion was no worse than 35 degrees; and no abnormal gait or ankylosis was noted. Even considering the functional loss due to pain, the Veteran’s symptoms did not approximate limitation of motion to 30 degrees, or ankylosis. Additionally, there is no evidence that the Veteran experienced incapacitating episodes of at least 2 weeks duration due to IVDS during this period on appeal. Thus, the Board finds that a rating in excess of 10 percent is not warranted for the Veteran’s cervical spine disability at any point prior to October 27, 2014. After October 27, 2014 On October 27, 2014, the Veteran underwent another VA examination of her cervical spine. The examiner indicated the Veteran reported a history of a motor vehicle accident and the worsening of her condition over time. Forward flexion of the cervical spine was measured at 25 degrees with no additional loss after repetitive use testing. The examiner noted guarding or muscle spasm was present but did not result in abnormal gait or spinal contour. The examiner also noted less movement than normal and pain on movement. There was no ankylosis; no muscle atrophy; no IVDS; no neurologic abnormalities; and, no radiculopathy. The examiner opined that the Veteran’s cervical spine disability has progressed. In September 2020, the Veteran underwent another VA examination of her cervical spine. The examiner noted a diagnosis of “degenerative arthritis of the cervical spine.” Forward flexion of the cervical spine was measured at 45 degrees with no additional loss after repetitive use testing. Pain was noted on examination and causes functional loss. Pain was exhibited on examination on forward flexion, extension, right and left lateral flexion, and right and left lateral rotation. The examiner noted that pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over time. The Veteran reported having flare ups described as “When I have to move my neck around a lot it gets weak and I have more pain.” The examiner described the flare up in terms of range of motion as forward flexion to 45 degrees. Radiculopathy was noted in the right upper extremity. There was no guarding or muscle spasm; no ankylosis; no IVDS; and, no other neurologic abnormalities. Finally, the examiner noted the degenerative arthritis and right upper extremity radiculopathy are a progression of the cervical spine sprain. Post service VA treatment records from the Spokane VAMC and American Lake VAMC are associated with the Veteran’s claims file. In summary, these records reflect the Veteran’s complaints, diagnosis, and treatment of her neck pain. An August 2013 record reflects a complaint of neck and bilateral shoulder pain since motor vehicle accident in Iraq. A May 2014 record reflects a complaint of chronic neck/shoulder pain with pain worse in morning or upon heavy lifting; massage relieves stress. A February 2015 record reflects a complaint of neck pain. A February 2020 record reflects the Veteran reported that she is just out of a chiropractic appointment where he identified some serious issues with her neck, and she was angry because she’s been complaining about her neck, shoulder, and arm pain for some time now. She reports that her chiropractor is going to start with making adjustments 3 times a week for several weeks, then move on to the recommendation of massage treatments, and finally additional exercises that she could do at home. She is hopeful that this will improve her discomfort. Upon review of the relevant medical evidence from October 27, 2014, and thereafter, the Board finds that the Veteran’s symptoms are consistent with the 20 percent rating currently assigned for her cervical spine disability, based on the degree of forward flexion and the lack of ankylosis. To obtain a higher rating for the Veteran’s spine disability, it is necessary to show forward flexion of the cervical spine 15 degrees or less; or, ankylosis. For this period however, the Veteran’s forward flexion was no worse than 25 degrees; and no ankylosis was noted. Even considering functional loss due to pain, the Veteran’s symptoms did not approximate forward flexion limited to 15 degrees or less or ankylosis. Thus, the Board finds that a rating in excess of 20 percent is not warranted at any point after October 27, 2014. Further, with regard to the radiculopathy, right upper extremity that was associated with the Veteran’s cervical spine disability, the Board notes that the Veteran is separately service connected for radiculopathy of the right upper extremity. No other neurological disorders have been diagnosed. Accordingly, a separate rating based on objective neurological abnormalities is not warranted at any time during the period on appeal. 2. Entitlement to a rating in excess of 20 percent for tendonitis, left shoulder. The Veteran’s tendonitis, left shoulder, is currently rated under Diagnostic Code 5201 which governs limitation of motion. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes “to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities.” Id. Here, Diagnostic Code 5201 was revised by provide additional measurements for flexion and abduction to the existing rating criteria. The revisions are highlighted here in red. Different ratings are available for the dominant (major) and non-dominant (minor) side. Here, the Board notes the Veteran is right-hand dominant, and therefore the ratings for the minor side must be considered when considering impairment of her left shoulder. Under Diagnostic Code 5201, for the minor side, a 20 percent rating is warranted for limitation of motion to shoulder level (flexion and/or abduction limited to 90 degrees) or for motion limited midway between the side and shoulder level (flexion and/or abduction limited to 45 degrees); and, a maximum 30 percent rating is warranted for flexion and/or abduction limited to 25 degrees from the side. Here, the Veteran was granted service connection for tendonitis, left shoulder, in a January 2009 rating decision. In March 2012, the Veteran filed an increased rating claim, and the August 2012 rating decision that denied this claim is on appeal. Currently, the Veteran has had a rating of 20 percent for tendonitis, left shoulder, for the entire period on appeal. After review of the medical and lay evidence in this case, the Board finds that a disability rating in excess of 20 percent is not warranted for the Veteran’s tendonitis, left shoulder. The Veteran underwent a VA examination of her left shoulder in July 2012. The examiner noted the Veteran reported a history of being deployed to Iraq and being in a military truck on a bumpy road when the driver lost control and the vehicle rolled. The Veteran reported she hit her head and was told she had whiplash. The Veteran states she has flare ups of shoulder pain 1-2 times a month. She stated the flare ups are aggravated by unsure activity; alleviated by time; and, not undergoing any treatments. Upon physical examination, the examiner noted the Veteran’s left shoulder forward flexion to be to 165 degrees; and her abduction to be to 175 degrees. The examiner noted a diagnosis of shoulder pain in both her left and right shoulder. The Veteran underwent another VA examination in October 2014. The examiner noted the Veteran reported her condition had gotten worse. Upon physical examination, the examiner noted the Veteran’s left shoulder forward flexion to be to 90 degrees; and her abduction to be to 100 degrees. The examiner noted a diagnosis of “tendonitis of both shoulders.” The Veteran underwent a final VA examination in September 2020. The examiner noted the Veteran reported her condition has worsened and she has been treated with steroid injections, chiropractor, and acupuncture. Upon physical examination, the examiner noted the Veteran’s left shoulder forward flexion to be to 75 degrees; and her abduction to be to 85 degrees. The examiner noted a diagnosis of left shoulder tendonitis. The examination report noted that the Veteran reported flare-ups described as “when I carry anything heavy my shoulders hurt.” The Veteran also reported functional loss, saying she could not lift overhead. The examination report noted that the range of motion itself contributed to a functional loss by causing difficulty lifting the arm out to the side and overhead. The Veteran exhibited pain on flexion, abduction, and external and internal rotation. VA treatment records from the Spokane VAMC and American Lake VAMC are associated with the Veteran’s claims file. In summary, these records reflect the Veteran’s complaints, diagnosis, and treatment of her shoulder pain over the years. An August 2013 record reflects a complaint of neck and bilateral shoulder pain since motor vehicle accident in Iraq. A May 2014 record reflects a complaint of chronic neck/shoulder pain with pain worse in morning or upon heavy lifting; massage relieves stress. A February 2020 record reflects the Veteran was angry because she’s been complaining about her neck, shoulder, and arm pain for some time now. Upon review of the relevant medical evidence, the Board finds that the Veteran’s symptoms are consistent with the 20 percent rating currently assigned for the Veteran’s left shoulder, based on the degree of flexion which was reported as no worse than 75 degrees when measured during the September 2020 VA examination, and the degree of abduction which was reported as no worse than 85 degrees when measured during the September 2020 examination. Here, to warrant a higher, 30 percent evaluation, the Veteran’s motion of the left shoulder would have to be limited to 25 degrees or less of flexion and/or abduction from the side. However, that level of limitation of motion of the left shoulder is simply not shown during the appellate period. Even considering the functional loss due to pain, the Veteran’s symptoms did not approximate limitation of motion of the arm to 25 degrees from the side. The Board has also considered whether a higher evaluation would be warranted under another potentially applicable diagnostic code. However, there is no medical evidence of ankylosis of the scapulohumeral articulation resulting in abduction to 60 degrees (Diagnostic Code 5200); or, impairment of the humerus (Diagnostic Code 5202). Thus, separate or higher ratings are not warranted under those Diagnostic Codes. Further, the Board finds that while the Veteran is competent to attest to the fact that she experiences pain in her shoulders, she is not competent to offer diagnoses of specific conditions or objective degrees of limitation of motion regarding her shoulders. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, the Board finds that the medical evidence of record is the most probative evidence of the Veteran’s left shoulder disability. The preponderance of evidence weighs against the finding that a rating in excess of 20 percent is warranted for her tendonitis, left shoulder, for the period on appeal. As such, the Veteran’s claim for a higher rating must be denied. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.71(a), Diagnostic Code 5201. 3. Entitlement to a rating in excess of 20 percent for tendonitis, right shoulder. The Veteran’s tendonitis, right shoulder, is currently rated under Diagnostic Code 5201 which governs limitation of motion. As noted above, during the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes “to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities.” Id. Here, Diagnostic Code 5201 was revised by provide additional measurements for flexion and abduction to the existing rating criteria. The revisions are highlighted here in red. Different ratings are available for the dominant (major) and non-dominant (minor) side. Here, the Board notes the Veteran is right-hand dominant, and therefore the ratings for the major side must be considered when considering impairment of her right shoulder. Under Diagnostic Code 5201, for the major side, a 20 percent rating is warranted for limitation of motion to shoulder level (flexion and/or abduction limited to 90 degrees). A 30 percent rating is warranted for motion limited midway between the side and shoulder level (flexion and/or abduction limited to 45 degrees); and, a maximum 40 percent rating is warranted for flexion and/or abduction limited to 25 degrees from the side. Here, the Veteran was granted service connection for tendonitis, right shoulder, in a January 2009 rating decision. In March 2012, the Veteran filed an increased rating claim, and the August 2012 rating decision that denied this claim is on appeal. Currently, the Veteran had a rating of 20 percent for the entire period on appeal. After review of the medical and lay evidence in this case, the Board finds that a disability rating in excess of 20 percent is not warranted for the Veteran’s tendonitis, right shoulder. The Veteran underwent a VA examination of her left shoulder in July 2012. The examiner noted the Veteran reported a history of being deployed to Iraq and being in a military truck on a bumpy road when the driver lost control and the vehicle rolled. The Veteran reported she hit her head and was told she had whiplash. The Veteran states she has flare ups of shoulder pain 1-2 times a month. She stated the flare ups are aggravated by unsure activity; alleviated by time; and, not undergoing any treatments. Upon physical examination, the examiner noted the Veteran’s right shoulder forward flexion to be to 180 degrees; and her abduction to be to 180 degrees. The examiner noted a diagnosis of shoulder pain in both her left and right shoulder. The Veteran underwent another VA examination in October 2014. The examiner noted the Veteran reported her condition had gotten worse. Upon physical examination, the examiner noted the Veteran’s right shoulder forward flexion to be to 90 degrees; and her abduction to be to 100 degrees. The examiner noted a diagnosis of “tendonitis of both shoulders.” The Veteran underwent a final VA examination in September 2020. The examiner noted the Veteran reported her condition has worsened and she has been treated with steroid injections, chiropractor, and acupuncture. Upon physical examination, the examiner noted the Veteran’s right shoulder forward flexion to be to 80 degrees; and her abduction to be to 90 degrees. The examiner noted a 2005 diagnosis of right shoulder tendonitis and a 2012 diagnosis of acromioclavicular joint osteoarthritis, right shoulder. The VA examination report noted that the Veteran had functional loss due to pain. The examiner stated that the range of motion contributed to a functional loss by causing difficulty lifting the arm out to the side and overhead. The Veteran exhibited pain in the right shoulder on flexion, abduction, and external and internal rotation. VA treatment records from the Spokane VAMC and American Lake VAMC are associated with the Veteran’s claims file. In summary, these records reflect the Veteran’s complaints, diagnosis, and treatment of her shoulder pain over the years. An August 2013 record reflects a complaint of neck and bilateral shoulder pain since motor vehicle accident in Iraq. A May 2014 record reflects a complaint of chronic neck/shoulder pain with pain worse in morning or upon heavy lifting; massage relieves stress. A February 2020 record reflects the Veteran was angry because she’s been complaining about her neck, shoulder, and arm pain for some time now. Upon review of the relevant medical evidence, the Board finds that the Veteran’s symptoms are consistent with the 20 percent rating currently assigned for the Veteran’s right shoulder, based on the degree of flexion which was reported as no worse than 80 degrees when measured during the September 2020 VA examination, and the degree of abduction which was reported as no worse than 90 degrees when measured during the September 2020 examination. Here, to warrant a higher, 30 percent evaluation, the Veteran’s motion of the right shoulder would have to be limited to 45 degrees or less of flexion and/or abduction midway between side and shoulder. However, that level of limitation of motion of the right shoulder is simply not shown during the appellate period. Even considering the functional loss due to pain, the Veteran’s symptoms did not approximate limitation of motion of the arm to midway between side and shoulder level in the right shoulder. The Board has also considered whether a higher evaluation would be warranted under another potentially applicable diagnostic code. However, there is no medical evidence of ankylosis of the scapulohumeral articulation resulting in abduction to 60 degrees (Diagnostic Code 5200); or, impairment of the humerus (Diagnostic Code 5202). Thus, separate or higher ratings are not warranted under those Diagnostic Codes. Further, the Board finds that while the Veteran is competent to attest to the fact that she experiences pain in her shoulders, she is not competent to offer diagnoses of specific conditions or objective degrees of limitation of motion regarding her shoulders. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, the Board finds that the medical evidence of record is the most probative evidence of the Veteran’s left shoulder disability. The preponderance of evidence weighs against the finding that a rating in excess of 20 percent is warranted for her tendonitis, right shoulder, for the period on appeal. As such, the Veteran’s claim for a higher rating must be denied. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.71(a), Diagnostic Code 5201. K. MARENNA Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Jiggetts 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.