Citation Nr: 21015530 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 15-36 799 DATE: March 17, 2021 ORDER Entitlement to a rating higher than 20 percent for lumbar spine degenerative arthritis is denied. Entitlement to a 20 percent rating, but no higher, from July 21, 2010, to December 28, 2014, for right leg compartment syndrome, status-post fasciotomy, muscle Groups XI and XII, is granted. Entitlement to a 20 percent rating, but no higher, from July 21, 2010, to December 28, 2014, for left leg compartment syndrome, status-post fasciotomy, muscle Groups XI and XII, is granted. Entitlement to a rating higher than 30 percent since December 29, 2014, for right leg compartment syndrome, status-post fasciotomy, muscle Group XII, is denied. Entitlement to a rating higher than 30 percent since December 29, 2014, for right leg compartment syndrome, status-post fasciotomy, muscle Group XII, is denied. The reduction of the Veteran’s evaluation for right leg compartment syndrome, status-post fasciotomy, from 30 percent to 0 percent, effective June 25, 2020, was improper, and the rating is restored. The reduction of the Veteran’s evaluation for left leg compartment syndrome, status-post fasciotomy, from 30 percent to 0 percent, effective June 25, 2020, was improper, and the rating is restored. From February 7, 2021, a separate 10 percent rating, but no higher, for right leg compartment syndrome, status-post fasciotomy, muscle Group XI, is granted. From February 7, 2021, a separate 10 percent rating, but no higher, for left leg compartment syndrome, status-post fasciotomy, muscle Group XI, is granted. FINDINGS OF FACT 1. The Veteran’s lumbar spine degenerative arthritis has not manifested by forward flexion of 30 degrees of less, and he does not have favorable ankylosis of the entire thoracolumbar spine. 2. From July 21, 2010, to August 28, 2013, the Veteran’s right and left leg compartment syndrome, status-post fasciotomy, manifested with moderate Group XII muscle injury symptoms. 3. From July 21, 2010, to December 28, 2014, the Veteran’s right and left leg compartment syndrome, status-post fasciotomy, did not manifest with moderately severe Group XII muscle injury symptoms. 4. From July 21, 2010, to December 28, 2014, the Veteran’s right and left leg compartment syndrome, status-post fasciotomy, also manifested with moderate, but not moderately severe, Group XI muscle injury symptoms. 5. Since December 29, 2014, the Veteran has been assigned a 30 percent rating for right and left leg compartment syndrome, status-post fasciotomy, which is the maximum rating for Group XII muscle injuries. 6. The July 2020 rating decision reduced the Veteran’s evaluations for right and left leg compartment syndrome, status-post fasciotomy, to 0 percent, effective June 25, 2020. It failed to apply the correct statutory and regulatory provisions for reduced ratings. 7. Effective February 7, 2021, VA regulations provide that when rating compartment syndrome, each affected muscle group should be rated separately. CONCLUSIONS OF LAW 1. The criteria for a rating higher than 20 percent for lumbar spine degenerative arthritis have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 2. From July 21, 2010 to December 28, 2014, the criteria for a 20 percent rating, but no higher, for right leg compartment syndrome, status-post fasciotomy, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.55, 4.56, 4.59, 4.73, Diagnostic Codes 5311, 5312. 3. From July 21, 2010 to December 28, 2014, the criteria for a 20 percent rating, but no higher, for left leg compartment syndrome, status-post fasciotomy, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.55, 4.56, 4.59, 4.73, Diagnostic Codes, 5311, 5312. 4. Since December 29, 2014, the Veteran has been assigned the maximum 30 percent schedular rating for Group XII muscle injuries for right leg compartment syndrome, status-post fasciotomy. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.55, 4.56, 4.59, 4.73, Diagnostic Codes 5311, 5312, 5331. 5. Since December 29, 2014, the Veteran has been assigned the maximum 30 percent schedular rating for Group XII muscle injuries for left leg compartment syndrome, status-post fasciotomy. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.55, 4.56, 4.59, 4.73, Diagnostic Codes 5311, 5312, 5331. 6. The reduction of the rating for right leg compartment syndrome, status-post fasciotomy, from 30 percent to 0 percent, was improper; the 30 percent rating is restored, effective June 25, 2020. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.105, 3.321, 3.344, 4.73, Diagnostic Code 5312. 7. The reduction of the rating for left leg compartment syndrome, status-post fasciotomy, from 30 percent to 0 percent, was improper; the 30 percent rating is restored, effective June 25, 2020. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.105, 3.321, 3.344, 4.73, Diagnostic Code 5312. 8. Since February 7, 2021, the criteria for a separate 10 percent rating, but no higher, for Group XI muscle injuries for right leg compartment syndrome, status-post fasciotomy, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.55, 4.56, 4.59, 4.73, Diagnostic Codes 5311, 5331. 9. Since February 7, 2021, the criteria for a separate 10 percent rating, but no higher, for Group XI muscle injuries for left leg compartment syndrome, status-post fasciotomy, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.55, 4.56, 4.59, 4.73, Diagnostic Codes 5311, 5331. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1981 to May 2001. This case comes to the Board of Veterans’ Appeals (Board) from a July 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office. In November 2019, these issues were remanded by the Board for further development. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, 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. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran’s lumbar spine disability is rated under Diagnostic Code 5242, for degenerative arthritis of the spine. Disabilities of the lumbar spine are evaluated under the General Rating Formula for Diseases and Injuries of the Spine, or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. These criteria apply with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. 38 C.F.R. § 4.71a, 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. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. A 40 percent evaluation is warranted when (1) forward flexion of the thoracolumbar spine is 30 degrees or less, or (2) there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted when there is unfavorable ankylosis of the entire thoracolumbar spine. Id. The Board notes that effective February 7, 2021, the regulations pertaining to the musculoskeletal system was revised, but these revisions did not substantively affect the rating criteria for the General Rating Formula for Diseases and Injuries of the Spine. Disabilities of the spine can also be rated under Diagnostic Code 5243 when intervertebral disc syndrome is present. A 40 percent evaluation is warranted when the veteran has incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. For purposes of evaluations under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Note (1). Under the revised criteria for Diagnostic Code 5243, this diagnostic code can only be assigned when there is disc herniation with compression and/or irritation of the adjacent nerve root. In this case, however, the Veteran has not been diagnosed with intervertebral disc disorder or disc herniation. While the Veteran has written that he believes he has had a pinched nerve, and he has expressed concern about having a herniated disc to his treatment providers, the Veteran has never been found to have these conditions, and there is no evidence that he has ever been prescribed bed rest by a physician. These criteria therefore do not apply and will therefore not be further discussed. 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). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016). The Veteran’s compartment syndrome has been rated under Diagnostic Code 5312, for impairment of the Group XII muscles affecting the function of dorsiflexion, extension of toes, stabilization of arch, anterior muscles of the leg, tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius. Group XI muscles are rated under Diagnostic Code 5311. Both of these muscle groups are assigned a 0 percent disabling when the disability is slight, 10 percent disabling when it is moderate, 20 percent disabling when it is moderately severe, and 30 percent disabling when it is severe. 38 C.F.R. § 4.73, Diagnostic Code 5312. Effective February 7, 2021, a separative diagnostic code has been added for compartment syndrome under 38 C.F.R. § 4.73, Diagnostic Code 5331, which states that each affected muscle group should be rated separately and combined in accordance with 38 C.F.R. § 4.25. When evaluating muscle injuries, open comminuted fracture with muscle or tendon damage will generally be rated as severe, and a through-and-through injury with muscle damage will be evaluated as no less than moderate. 38 C.F.R. § 4.56(a),(b). In this case, the Veteran has not been found to have an open comminuted fracture or through-and-through injury at any time, and these provisions do not apply. Disabilities resulting from muscle injuries shall be classified as slight, moderate, moderately severe, or severe. Slight disability of muscles occurs where there are simple wounds of muscle without debridement or infection. The history and complaint of symptoms should include: service department records show superficial wound with brief treatment and return to duty; healing with good functional results; and no cardinal signs or symptoms of muscle disability such as loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement. Objective findings should include minimal scar; no evidence of fascial defect, atrophy, or impaired tonus; and no impairment of function or metallic fragments retained in muscle tissue. 38 C.F.R. § 4.56. Moderate disability of muscles is where there are through-and-through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. History and complaints should include service department record or other evidence of in-service treatment for the wound; record of consistent complaint of one or more of the cardinal signs and symptoms (loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement); and particularly lowered threshold of fatigue after average use, affecting the particular functions controlled by the injured muscles. Objective findings should include entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue. Some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. Id. Moderately severe disability of muscles is where there are through-and-through or deep penetrating wound by small high velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. History and complaints include: service department record or other evidence showing hospitalization for a prolonged period for treatment of wound; record of consistent complaint of cardinal signs and symptoms (loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement); and, if present, evidence of inability to keep up with work requirements. Objective findings should include entrance and (if present) exit scars indicating track of missile through one or more muscle groups. Indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side demonstrate positive evidence of impairment. Id. Severe disability of muscles includes through-and-through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. History and complaints include: service department record or other evidence showing hospitalization for a prolonged period for treatment of wound. Record of consistent complaint of cardinal signs and symptoms (loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement) worse than those shown for moderately severe muscle injuries; and, if present, evidence of inability to keep up with work requirements. Objective findings should include ragged, depressed, and adherent scars indicating wide damage to muscle groups in missile track. Palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area. Muscles swell and harden abnormally in contraction. Tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, the following are also signs of severe muscle disability include scattered foreign bodies; adhesion of scar to the bone; diminished muscle excitability to pulsed electrical current in electrodiagnostic tests; visible or measurable atrophy; adaptive contraction of an opposing group of muscles. Id. Lumbar Spine Degenerative Arthritis The Veteran contends that a rating higher than 20 percent is warranted for his service-connected lumbar spine degenerative arthritis. He wrote in May 2012 that his back pain prevents him from performing tasks such as yard work, heavy lifting, and driving for too long. He wrote that he has daily pain and numbness in his back, legs, and buttocks. He wrote that every 4 or 5 months or so, he gets a pinched nerve that causes him to be bed-ridden for two to three days. The Veteran’s wife has submitted written statements describing how her husband has constantly present back pain that limits his ability to participate in physical activities. She wrote in December 2010 that everyday chores, such as mowing the grass, had become harder for him, because his ability to use his back had decreased. In July 2013, she wrote that the Veteran’s back pain had become increasingly intense, and that at least three days a week, he lies on the floor and stretches to gain relief from the soreness. She wrote that he could not walk for long distances, mow the yard, or pick up his grandchildren because of pain. She also wrote in February 2017 about how his pain has prevented him from participating in the sports he used to love. In an August 2001 rating decision, the Veteran was granted service connection for lumbar strain, and assigned a 20 percent rating, effective June 1, 2001. In July 2010, the Veteran submitted a claim for an increased rating for his lumbar spine disability. The Veteran attended a VA examination in December 2010. He reported experiencing worsening back pain since around 2005-2006, and that he now had daily pain, including pain radiating to his right buttock. The Veteran reported having flare ups that limited his ability to move around comfortable, and that they might discourage him from going out or doing household chores. The Veteran had a normal gait and was able to walk 1-3 miles. There was no abnormal spinal curvature, spasm, or ankylosis. Range of motion testing found forward flexion to 100 degrees. The examiner wrote that the Veteran’s back disorder did cause decreased mobility, problems with lifting and carrying, decreased strength, and limited recreational activities. The Veteran next attended a VA examination in August 2013. He reported having flare ups from sitting for long periods of time, and that he takes hydrocodone and a TENS unit for the pain. The Veteran had forward flexion to 70 degrees, with pain at 40 degrees. There was no change after repetitive use testing. The examiner wrote that the range of motion lost during a flare up could not be determined without an examination during a flare ups. There was no localized tenderness, muscle spasms, or muscle atrophy. The Veteran also attended a VA examination in December 2014. He reported that exertion and long road trips worsened his pain, and that he can’t stay in one position for too long. He reported having flare ups that occurred with sitting for long periods of time, and that are treated with medication and his TENS unit. When flare ups occurred, he was unable to bend over, unable to lift heavy objects, and could not mow the law. Range of motion testing found forward flexion to 70 degrees, and there was pain with motion. There was no additional loss of function after three repetitions, and the examiner was unable to say without resort to speculation how much range of motion would be reduced with repeated use over time or flare ups. There was no guarding or muscle spasm, muscle atrophy, or ankylosis. At a November 2017 VA examination, the Veteran reported having chronic lumbar pain that continually worsened, and that he was treated with epidural injections which had not really helped. He reported having flare ups that caused increased pain, and that he was limited in his ability to sit, stand, or walk for prolonged periods of time. The Veteran had forward flexion to 40 degrees, with pain. Passive range of motion testing could not be performed or was not medically appropriate. After repetitive motion, the Veteran had flexion to 35 degrees. The examiner found that pain, weakness, fatigability, and incoordination would not significantly limit functional ability with flare ups. The Veteran did have muscle spasm/guarding, but it did not result in abnormal gait or spinal contour. The Veteran did not have intervertebral disc syndrome, and he did not require an assistive device for walking. The Veteran most recently attended a VA examination in December 2019. He reported having an aching in his back even with rest, and that prolonged walking sitting, or laying down will aggravate his back. He reported having flare ups of his lower back about 2 times a year, and that he needs to go to Urgent Care for medication when this happens. He reported that his back range of motion with a flare up decreased about 50 percent in all directions. Range of motion testing found forward flexion to 80 degrees. The Veteran was able to perform repetitive motion with no further loss of function. The examiner found that the examination was medically consistent with the Veteran’s statements about flare ups, and that during a flare up, he would have forward flexion to 40 degrees. The Veteran’s VA treatment records and records from the Military Health System show regular complaints of pain in his lower back. In June 2010, he was treated for lower leg and back pain. His lumbosacral spine exhibited to tenderness on palpation or muscle spasm, and the motion was normal, with no pain with motion. The Veteran was found to have mild, ongoing, functional back pain. In December 2010, the Veteran reported low back pain that was worse with activity in the morning. He had no bowel or bladder problems. At a February 2011 orthopedic surgery evaluation, the Veteran reported that he had been taking medication and attending physical therapy, and had great improvement. His radicular symptoms had disappeared, and his low back pain had improved greatly. In November 2011, the Veteran reported that for the last 3 days, he had exacerbation of his lower back pain, with increased numbness and tingling. At an evaluation in December 2011, he was recommended to try a TENS unit to help with back pain. He was found to have a moderate decrease in range of motion, and motor strength was 4/5. He was given steroid injections. In March 2012, he reported that he had back pain exacerbated by a car trip. He reported having more frequent flares, 4 to 5 years per year, that were more severe. He had no bowel or bladder dysfunction. In September 2012, he reported that his pain was aggravated by sitting and heavy lifting. He had flexion to 45 degrees, and there was no localized tenderness or muscle spasm. In October 2012, he reported that his back pain was a constant dull throbbing, worse with sitting. He had a normal gait and full range of motion. In February 2015, the Veteran reported low back pain that radiated down the right. At a September 2017 orthopedic evaluation, the Veteran discussed his worsening pain, and denied any bowel or bladder symptoms. In October 2017, he reported that his injections provided little relief, and he had great discomfort with sitting and driving. He denied any bowel or bladder symptoms. He had a normal gait and normal range of motion. In October 2018, he reported ongoing low back pian, including flare ups one or 2 times a year. His range of motion was stiff, but within full limits, and he had normal gait and used no assistive device. In January 2019, the Veteran reported back pain with radiation down the right leg. He could run 100 yards, but extended walking really bothered him. He was occasionally able to walk his dog for at least an hour. He had full range of motion with back flexion and extension. In April 2019, the Veteran reported having a back flare up caused by working out at the gym. In June 2019, the Veteran reported that his back pain was not too bad, and he had full range of motion with flexion and extension. In September 2019, the Veteran reported doing fairly well, but he had aching in his low back that was worse with prolonged sitting and forward flexion. He stated that it still occasionally interfered with his daily activities, but was much improved. He had normal gait and full range of motion with back flexion and extension. His back was tender to palpation. In November 2019, the Veteran had a right sacroiliac steroid injection, and he reported having significant alleviation of his right low back pain after undergoing the injection. In March 2020, he reported that his back pain was about the same. The Board has reviewed all of the evidence of record, but finds that a rating higher than 20 percent is not warranted. A higher, 40 percent evaluation requires evidence showing that forward flexion of the thoracolumbar spine is limited to 30 degrees or less, or evidence showing favorable ankylosis of the entire thoracolumbar spine. In this respect, there is no competent medical evidence demonstrating that the Veteran had ankylosis or demonstrating forward thoracolumbar flexion to 30 degrees or less at any time. All of the Veteran’s VA examinations and treatment records show forward flexion of greater than 30 degrees, even when flare ups, pain, and repetitive motion are taken into account. While the Veteran reported in December 2019 that flare ups caused him to lose approximately 50 percent of his range of motion, the Veteran had flexion to 80 degrees, and half of this would only result in forward flexion of 40 degrees. The Veteran has never been found to have ankylosis. VA regulations allow for consideration of a Veteran’s pain and its impact on his functional mobility when assigning evaluations. Actually painful joints are entitled to at least the minimum compensable rating. 38 C.F.R. § 4.59; Petitti v. McDonald, 27 Vet. App. 415 (2015). The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. In this case, the Veteran has already been assigned more than the minimum compensable rating for his lumbar spine degenerative arthritis, and there is no evidence that painful motion reduces his forward flexion to 30 degrees or less, even when considering repetitive use or flare ups. The Board also notes that any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note 1. In this case, the Veteran has already been assigned separate service connection for radiculopathy in the right and left leg associated with his lumbar spine disability since March 2017. The Veteran has not disagreed with the ratings or effective dates assigned for his lower leg radiculopathy, and these issues are not currently on appeal before the Board. The December 2010 VA examiner noted that the Veteran had urinary frequency, but she did not indicate that this was due to the Veteran’s service-connected lumbar spine disorder. The Veteran’s VA treatment records show on multiple occasions that no bowel or bladder complications related to the Veteran’s back disorder were found. The medical evidence does not demonstrate that the Veteran has any other neurological disorders related to his lumbar strain, and he has not asserted that he has had any such symptoms. In sum, the Board finds that the most probative evidence is against the Veteran’s claim for a rating in excess of 20 percent for his service-connected lumbar spine degenerative arthritis. In reaching this decision the Board considered the doctrine of reasonable doubt; however, the preponderance of the evidence is against the claim. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Right and Left Leg Compartment Syndrome and Status-Post Fasciotomy The Veteran has also requested higher ratings for his service connection right and left leg compartment syndrome, status-post fasciotomy. The Veteran has specifically requested separate evaluations for the injuries to both muscle groups XI and XII. The Veteran has written that he has pain and discomfort in his legs if he has to stand or walk for long periods of time. He has also written that he is no longer able to run like he used to and that it limits his ability to do outdoor activities. The Veteran’s spouse has written statements describing how the Veteran has to take pain medication in order to do extensive walking or standing, and that he can no longer run or do cardiovascular exercise. The Veteran was initially granted service connection for right and left leg shin splints, and assigned 0 percent ratings, effective June 1, 2001. In July 2010, the Veteran submitted a claim for service connection for chronic compartment syndrome. After an April 2011 VA examination that found that the previous diagnosis of shin splints had been in error, in a July 2011 rating decision, the Veteran’s leg disabilities were recharacterized as right leg status-post fasciotomy, anterior and posterior compartment, and left leg status-post fasciotomy. The noncompensable ratings were continued. In a September 2015 rating decision, it was found that the September 2015 Statement of the Case had contained clear and unmistakable error by failing to consider all medical evidence. The Veteran’s evaluations were increased to 10 percent, effective August 29, 2013, and 30 percent, effective December 29, 2014. In a July 2020 rating decision, the Veteran’s evaluations for right and left leg compartment syndrome were reduced to 0 percent, effective June 25, 2020. The Veteran has attended numerous VA examinations during the course of this claim. The Veteran attended a VA examination in April 2011. The examiner wrote that the Veteran was initially diagnosed with shin splints, but this was incorrect, and he was later correctly diagnosed with bilateral compartment syndrome. The Veteran had been treated with fasciotomy surgery, and now continued with anti-inflammatory medication. The Veteran reported that walking greater than 15 minutes caused pain in both legs, and he had to take a break and take pain medication. The Veteran had pain, flare ups, and increased fatigability, but no weakness or decreased coordination. There was no evidence of impairment of muscular strength or function on physical examination. At an August 2013 VA examination, the Veteran reported having pain in both legs with running, even after his fasciotomy. The examiner found that the Veteran had bilateral damage to Group XI muscles and to Group XII muscles. The examiner found there was some loss of deep fascia, but the injuries did not affect muscle substance or function. The muscle injury caused occasional lowered threshold of fatigue in muscle groups XI and XII. Muscle strength testing was normal, and there was no muscle atrophy. The Veteran did not use any assistive device with locomotion. The examiner found it did not cause any impact on his ability to work. At a December 2014 VA examination, the Veteran reported leg pain that caused limited standing and walking and that prevented running. He was again found to have bilateral damage to Group XI muscles and to Group XII muscles. Palpation showed loss of deep fascia, and there was herniation of muscles due to the gap from the fasciotomy. He was found to have consistent fatigue and pain in both muscle Groups XI and XII. Muscle strength was 4/5. There was no muscle atrophy. At a November 2017 VA examination, the Veteran reported that his compartment syndrome symptoms had been asymptomatic and that he had been doing well, but he had pain on his left leg scars that did not affect the function of his left leg. The examiner found that the Veteran had injury to muscle Group XI in both legs, but not to Group XII. Muscle strength was normal, and the examiner did not find that the Veteran’s muscle injury impacted his ability to work. The examiner wrote that the condition was “currently resolved,” and that the Veteran denied a functional loss or limitation as a result of this condition. At a December 2019 VA examination, the Veteran reported that he had flare ups in his knees and legs with too much walking. He reported soreness, achiness, and stiffness at the incision sites on his lower legs. He stated that with the flare ups at the fasciotomy sites, he did not lose any range of motion of the lower leg, but it hurt more to move them. The examiner explained that fasciotomy surgery to the anterior compartment of the leg refers to the Group XII muscles, and fasciotomy surgery to the posterior compartment refers to the Group XI muscles. At this time, he found normal flexion and extension of both lower legs, and no deficit in either muscle group. The Veteran reported having some flare ups of the fasciotomy sites about 2 times a month, with some stiffness and aching after much walking, and this lasted for 2 hours and improved with rest. There was no change in the range of motion with these flare ups. The Veteran did not have pain with active or passive motion, or with weight-bearing. The Veteran had full muscle strength. The Veteran most recently attended a VA examination in June 2020. The Veteran reported occasional burning and aching in his shins, and that he has been told not to run anymore. The examiner found that Group XII was affected bilaterally. The muscle injury did not affect muscle substance or function, and no other signs or symptoms attributable to muscle injury were found. The Veteran had full muscle strength and no muscle atrophy. The injury did not affect his ability to work. VA treatment records and records from the Military Health System show occasional complaints of leg pain related to compartment syndrome. In June 2010, he reported pain in his legs with prolonged walking. On July 27, 2010, he reported that he recently went to an amusement park, and his leg started hurting after 4 hours, and that he could not run or walk for more than 2 hours at the mall due to leg pain. He was noted to have compartment syndrome with worsening leg pain. The Board has reviewed all of the evidence and finds that revision of the current evaluations is warranted. For the first stage on appeal, July 21, 2010 to August 28, 2013, the Board affords the Veteran the benefit of the doubt and finds that 10 percent ratings are warranted for injury to muscle Group XII and Group XI in both the right leg and left leg. These ratings, when combined, pursuant to 38 C.F.R. § 4.55, result in a 20 percent rating for each leg from July 21, 2010, to December 28, 2014. At the April 2011 VA examination, the Veteran reported pain, flare ups, and increased fatigability. By the time of the August 2013 VA examination, the Veteran was also found to have loss of deep fascia of the muscles. This is the type of symptom that likely existed well before the August 2013 VA examination, and together with the Veteran’s credible lay assertions of having pain, weakness, and fatigue in his legs, the Board concludes that from July 21, 2010 to August 28, 2013, the Veteran’s right and left leg compartment syndrome residuals caused moderate impairment to muscle Group XII, and 10 percent ratings under Diagnostic Code 5312 can be assigned. See Swain v. McDonald, 27 Vet. App. 219, 224 (2015) (Effective dates should not be mechanically assigned based solely on the date of the VA examination, but should include consideration of all of the facts to determine the date that the increase in disability was ascertainable.). The Board has also considered the Veteran’s contention that a separate rating should be assigned for injury to muscle Group XI, which the evidence shows has also undergone damage and fasciotomy surgery. While there has been some disagreement among VA examiners as to whether just muscle Group XII, or both Group XII and Group XI have been affected, the Board finds the explanation of the December 2019 VA examiner highly persuasive, as he explained that the Veteran’s anterior and posterior fasciotomies affected both of these groups. The Board also notes that the findings of the VA examiners that there was palpable loss of deep fascia was not indicated to be limited to Group XII. In the absence of a statement otherwise, the Board must assume that this tissue loss applies to both Group XII and Group XI, and therefore both muscle groups have moderate damage. When there is more than one compensable muscle group injury in the same anatomical region, but that does not act on the same joint, the evaluation for the most severely injured muscle group will be increased by one level and used as the combined evaluation for the affected muscle group. 38 C.F.R. § 4.55(e). Here, both muscle groups are in the Veteran’s lower leg, but they affect different joints. The Board therefore finds that this disability is most appropriately rated under the criteria for muscle Group XII, but because muscle Group XI is also affected, he is entitled to have his rating increased by one level, and a 20 percent rating for both right and left leg compartment syndrome, status-post fasciotomy, is granted for the period from July 21, 2010 to December 28, 2014. The Board also finds that the effective date of July 21, 2010, is appropriate for the date of the increased rating. The Veteran submitted a claim for service connection on July 21, 2010, and this was accepted as a claim for an increased rating for what had been characterized as shin splints. While a rating up for one year earlier can be assigned if the medical evidence demonstrates that the condition underwent an increase in severity during that time, there is no such indication in the medical evidence that the Veteran’s leg disabilities had worsened during that period. See 38 C.F.R. § 3.400(o)(2). The Veteran reported to his treatment provider that his leg pain had worsened on July 27, 2010, but this is after the Veteran submitted the claim. To the extent that the Veteran has argued that his symptoms have been severe enough to warrant a higher rating ever since his fasciotomy surgeries, the Board is unable to assign an effective date outside out this one year period, and any worsening which occurred well before July 21, 2009 would not be encompassed by the current appeal period. From July 21, 2010 to December 28, 2014, the evidence does not show that ratings higher than 10 percent for are warranted for either muscle Group XII or XI, as the Veteran’s disabilities were never shown to be more than “moderate.” See 38 C.F.R. § 4.56. The Veteran did not have a through-and-through or deep penetrating wound. While he was found to have weakness, pain, lowered threshold of fatigue, his muscle strength testing was normal, and there was no muscle atrophy. The Veteran’s compartment symptom residuals did not cause any impairment in his ability to keep up with work requirements. While the Veteran was found to have some loss of deep fascia, the injuries did not affect muscle substance or function. The Board finds that the Veteran’s disability picture overall indicates no more than “moderate” impairment caused by compartment symptom residuals, and the Board finds that no rating higher than 10 percent for each leg is warranted for this period for impairment of muscle Group XII or muscle Group XI. Effective December 29, 2014, the Veteran’s was granted increased ratings of 30 percent for each leg. The Regional Office assigned this increased rating based on a finding of palpation showing loss of deep fascia in the wound area. A 30 percent rating is assigned only when a Group XII muscle injury is “severe.” 38 C.F.R. § 4.73, Diagnostic Code 5312. It is unclear to the Board why this symptom alone would warrant an increase in the Veteran’s rating to 30 percent, as a finding of some loss of deep fascia is also specifically listed in the types of symptoms that can be associated with “moderate” disability or “moderately severe” disability. In the absence of any other symptoms indicating that a severe disability was present, it appears to the Board that this evaluation may have been assigned in error. Nevertheless, the Board will not challenge this assignment, and accepts that from December 29, 2014, the Veteran was assigned a 30 percent rating for both right and left leg compartment syndrome, and this is the highest rating that can be assigned for this disorder. In a July 2020 rating decision, the Regional Office reduced the Veteran’s evaluations to 0 percent, effective June 25, 2020, based on the findings of the June 2020 VA examination. The Board finds that this reduction was improper. To properly reduce a rating, VA must meet both procedural and substantive benchmarks. In this case, the reduction did not reduce the Veteran’s overall compensation payments, and a rating decision proposing the reduction was not required. See 38 C.F.R. § 3.105(e). When a disability rating has been in effect for 5 years of more, there is a heightened standard of review that must be applied when reducing that rating. See 38 C.F.R. § 3.344(c). The entire record of examinations and medical history must be full and complete, and any reduction must be based on a conclusion that material improvement has occurred which is reasonably certain to be maintained under the ordinary conditions of life. 38 C.F.R. § 3.344(a). In this case, the July 2020 rating decision did not consider whether actual improvement had occurred, and it does not appear that the June 2020 VA examination did actually consider whether any improvement shown would be maintained under the ordinary conditions of life. The Board finds that the July 2020 rating decision failed to apply the correct statutory and regulatory provisions when reducing the Veteran’s ratings. The failure to properly apply the provisions of 38 C.F.R. § 3.344 renders a rating reduction void ab initio. See Kitchens v. Brown, 7 Vet. App. 320, 325 (1995). The Veteran’s 30 percent ratings for both right and leg compartment syndrome, status-post fasciotomy, from June 25, 2020, are restored. The Veteran therefore retains a 30 percent rating for the entire period from December 29, 2014, to the present. The Board also again considers whether a separate rating can be assigned for Group XI muscle injuries, but from December 29, 2014, the Veteran was assigned the maximum rating for either Group XI or Group XII muscle injuries, and therefore there is no “higher level” that the rating can be increased by. 38 C.F.R. § 4.56(e). Effective February 7, 2021, VA regulations included a new diagnostic code which specifically pertained to compartment syndrome. It states that each affected muscle group should be rated separately. 38 C.F.R. § 4.73, Diagnostic Code 5331. The Board therefore finds that as of this date, it is no longer appropriate to apply 38 C.F.R. § 4.55(e), but instead, each muscle group should have its own rating. The Board therefore finds that a separate rating of 10 percent, but no higher, should be assigned for Group XI muscle injury for both the right and left leg compartment syndrome. The evidence of record does not indicate that the Veteran’s Group XI muscle injury has been any worse than “moderate” at any time. 38 C.F.R. § 4.73, Diagnostic Code 5311. As was discussed above, the Veteran does not have a through-and-through or deep penetrating wound. His symptoms have been found to be some loss of deep fascia, pain, and fatigue, but his muscle strength has generally been found to be normal, and his compartment syndrome does not impair his ability to keep up with work requirements. He continues to be able to walk and exercise, although he has expressed that long periods of walking are painful and tiring. The Board finds that this disability picture overall does not more nearly approximate a disability that is “moderately severe.” The Board has considered the Veteran’s competent lay statements regarding the functional impact of his disabilities. He is competent to report his own observations with regard to the severity of his disability, including reports of pain and difficulty standing or walking for long periods. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Veteran’s statements are credible and consistent with the ratings now assigned. The occurrence of pain and difficulty while performing physical activities is specifically contemplated in the rating criteria for muscle injuries, and they are encompassed by the ratings assigned. The Board notes that the Veteran has also been found to have scars related to his left leg compartment syndrome. The Veteran has already been granted separate service connection for left leg scars, rated as 10 percent disabling from March 14, 2017 and 0 percent disabling from December 24, 2019. The Veteran has not disagreed with these evaluations or their effective dates, and they are not currently considered part of the appeal before the Board. In sum, the Board finds that the Veteran’s right and left leg compartment syndrome, status-post fasciotomy, warrant ratings of 20 percent, but no higher, from July 21, 2010 to December 28, 2014. From December 29, 2014, they have been assigned the maximum schedular rating, and no higher rating can be assigned. Effective February 7, 2021, new VA regulations went into effect, and the Veteran may be assigned separate 10 percent ratings, but no higher, for Group XI injuries for both the right and left legs. In reaching this conclusion, the Board has again considered the applicability of the benefit of the doubt doctrine, but the preponderance of the evidence is against assignment of any higher ratings than those now assigned. See 38 U.S.C. § 5107(b). DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mary E. Rude, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.