Citation Nr: 21021618 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 17-64 864 DATE: April 13, 2021 ORDER For the period on appeal prior to January 17, 2017, an increased evaluation of 20 percent, but no greater, for the Veteran’s service-connected right shoulder disability, to include painful motion from a right shoulder strain, is granted. For the period on appeal from January 17, 2017, an increased evaluation in excess of 20 percent for the Veteran’s service-connected right shoulder disability, to include painful motion from a right shoulder strain, is denied. For the entire period on appeal, an increased evaluation in excess of 10 percent for the Veteran’s service-connected right hip disability, based upon limitation of extension under Diagnostic Code 5251, is denied. For the entire period on appeal, an increased compensable evaluation for the Veteran’s service-connected right hip disability, based upon limitation of flexion under Diagnostic Code 5252, is denied. For the entire period on appeal, an increased compensable evaluation for the Veteran’s service-connected right hip disability, based upon impairment of thigh under Diagnostic Code 5253, is denied. FINDINGS OF FACT 1. The Veteran is right hand dominant. 2. For the period on appeal prior to January 17, 2017, the Veteran’s service-connected right shoulder disability, to include a right shoulder strain, manifested painful motion, flexion limited to 180 degrees, and abduction limited to 180 degrees. 3. For the period on appeal from January 17, 2017, the Veteran’s service-connected right shoulder disability, to include a right shoulder strain, manifested painful motion, flexion limited to 90 degrees, and abduction limited to 90 degrees. 4. For the entire period on appeal, the Veteran’s service-connected right hip disability, to include right hip strain/piriformis syndrome, manifested painful motion with flareups and limited range of motion estimated as follows: flexion limited to 85 degrees; extension limited to 15 degrees; abduction limited to 25 degrees; adduction limited to 20 degrees; external rotation limited to 45 degrees; and internal rotation limited to 30 degrees. CONCLUSIONS OF LAW 1. For the period on appeal prior to January 17, 2017, the criteria for the assignment of an increased evaluation of 20 percent for the Veteran’s service-connected right shoulder disability, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.69, 4.71, 4.71a, Diagnostic Code 5201. 2. For the period on appeal from January 17, 2017, the criteria for the assignment of an increased evaluation in excess of 20 percent for the Veteran’s service-connected right shoulder disability, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.69, 4.71, 4.71a, Diagnostic Code 5201. 3. For the entire period on appeal, the criteria for an increased evaluation in excess of 10 percent for the Veteran’s service-connected right hip disability, to include right hip strain/piriformis syndrome, with limitation of extension under Diagnostic Code 5251, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.69, 4.71, 4.71a, Diagnostic Code 5251. 4. For the entire period on appeal, the criteria for an increased compensable evaluation for the Veteran’s service-connected right hip disability, to include right hip strain/piriformis syndrome, with limitation of flexion under Diagnostic Code 5252, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.69, 4.71, 4.71a, Diagnostic Code 5252. 5. For the entire period on appeal, the criteria for an increased compensable evaluation for the Veteran’s service-connected right hip disability, to include right hip strain/piriformis syndrome, impairment of thigh under Diagnostic Code 5253, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.69, 4.71, 4.71a, Diagnostic Code 5253. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the U.S. Army from February 2010 to June 2012, as well as service in the Army Reserves and Active Duty for Training (ACDUTRA). This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2017 rating decision issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran’s Form 9 indicates that she did not request a Board hearing. In November 2018, the Board remanded this appeal for further development, including procuring the Veteran’s VA vocational rehabilitation records and an additional VA examination to assess the Veteran’s service-connected right shoulder disability. To the extent that the directed development has been completed, the Board finds that substantial compliance with its remand directives has been accomplished. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.902 (2016). See 38 U.S.C. § 7107(b) (2020). Increased Rating Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. See 38 U.S.C. § 1115; 38 C.F.R. §§ 3.321(a), 4.1, 4.21. Disability evaluations are based upon the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. See 38 C.F.R. § 4.10. Separate diagnostic codes identify the various disabilities. See 38 C.F.R. § 4.27. VA has a duty to acknowledge and to consider all regulations that are potentially applicable to issues raised in the record and to explain the reasons and bases for its conclusions. See Schafrath v. Derwinski, 1 Vet. App. 589, 592-93 (1991). It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. See 38 C.F.R. §§ 3.321(a), 4.1, 4.21. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. §§ 4.7, 4.21. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. See 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is the primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether they were raised by the Veteran, as well as the entire history of the Veteran’s disability. See 38 C.F.R. § 4.1, 4.2; Schafrath,1 Vet. App. at 595. Separate evaluations may be assigned for separate periods of time, or staged, where factual findings show distinct time periods during which the Veteran’s disability exhibits symptoms that warrant the application of different ratings. See Fenderson v. West, 12 Vet. App. 119, 126-28 (1999); see also Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Additionally, the evaluation of the same disability under several Diagnostic Codes, known as pyramiding, must be avoided. See 38 C.F.R. § 4.14. Separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Effective dates for disability ratings may be established up to one year prior to the date of claim if, based upon all the evidence of record, it can be factually ascertained that an increase in the Veteran’s service-connected disability occurred during that year preceding the claim. See 38 U.S.C. § 5110(b)(3); C.F.R. § 3.400(o)(2). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. See 38 C.F.R. § 4.40. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all of these elements. See id. The functional loss may be due to absence of part, or all, of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the veteran undertaking the motion. See id. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. See id. The factors involved in evaluating and rating disabilities of the joints include the following: less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.); more movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.); weakened movement (due to muscle injury, disease, or injury of peripheral nerves, divided or lengthened tendons, etc.); excess fatigability; incoordination and impaired ability to execute skilled movements smoothly; or pain on movement, swelling, deformity, or atrophy of disuse. See 38 C.F.R. § 4.45. Functional loss caused by pain must be rated at the same level as if that functional loss were caused by some other factor that actually limited motion, such as deformity, atrophy, adhesions, or any of the other factors cited above. See Schafrath, 1 Vet. App. at 592. Consequently, in rating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. See id. Where the veteran is diagnosed with any form of arthritis, painful motion is an important factor of disability, and facial expressions such as wincing exhibited in the presence of pressure on or manipulation of the affected joints, should be carefully noted and related to the affected joints. See 38 C.F.R. § 4.59. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. See id. 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. See id. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. See id. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weightbearing and, if possible, with the range of the opposite undamaged joint. See id. When adjudicating disabilities evaluated based upon limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40 and 4.45 pertaining to functional impairment. See DeLuca v. Brown, 8 Vet. App. 202, 205-07 (1995). In applying these regulations, VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, or incoordination. See id. Such inquiry should not be limited to muscles or nerves, and, if feasible, these determinations should be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, or incoordination. See id. Consideration of 38 C.F.R. § 4.59 is not limited to cases involving arthritis; thus, a rating based on painful motion of a joint may be appropriate regardless of whether the painful motion stemmed from joint or periarticular pathology. See Burton v. Shinseki, 25 Vet. App. 1, 4-5 (2011). However, pain must affect some aspect of the normal working movements of the body such as excursion, strength, speed, coordination and endurance to constitute functional loss. See Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). Although pain may cause functional loss, pain itself does not constitute functional loss and is merely one factor to be considered when evaluating functional impairment; see id.; however, 38 C.F.R. § 4.40 does not require a separate rating for pain, but rather provides guidance for determining ratings under other diagnostic codes assessing musculoskeletal function. See Spurgeon v. Brown, 10 Vet. App. 194, 196 (1997). Once the evidence has been assembled in the record, it is the Board’s responsibility to consider all lay and medical evidence of record, analyze the credibility and probative value of the evidence, and provide reasons for rejecting any material evidence favorable to the claimant. See 38 U.S.C. § 7104(a); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996). In addressing lay evidence and determining its probative value, the Board must assess both its competency, a legal concept determining whether testimony may be heard and considered, and credibility, a factual determination regarding the probative value of the evidence. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall afford the claimant the benefit of the doubt. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. Where the evidence is in relative equipoise, the claimant shall prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). The preponderance of the evidence must weigh against the Veteran’s claim in order for it to be denied. See Alemany v. Brown, 9 Vet. App. 518, 519-20 (1996). 1. For the period on appeal prior to January 17, 2017, an increased evaluation of 20 percent, but no greater, for the Veteran’s service-connected right shoulder disability, to include painful motion from a right shoulder strain, is granted. 2. For the period on appeal from January 17, 2017, an increased evaluation in excess of 20 percent for the Veteran’s service-connected right shoulder disability, to include painful motion from a right shoulder strain, is denied. Disabilities of the shoulder and arm are rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5200 to 5203. For rating purposes, a distinction is made between major (dominant) and minor (non-dominant) musculoskeletal groups, and the determination of dominance shall be based upon the evidence of record or by testing on VA examination. See 38 C.F.R. § 4.69. Only one hand shall be considered dominant, and the injured hand, or the most severely injured hand, of an ambidextrous individual will be considered the dominant hand for rating purposes. See id. Hyphenated diagnostic codes may be used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. See 38 C.F.R. § 4.27. Diagnostic Code 5200 provides ratings for ankylosis of scapulohumeral articulation as follows: (1) a 20 percent rating for favorable ankylosis of the minor arm, to include abduction to 60 degrees, and the ability to reach the mouth and head; (2) a 30 percent rating for intermediate ankylosis of the minor arm, between favorable and unfavorable, or favorable ankylosis of the major arm, to include abduction to 60 degrees, and the ability to reach the mouth and head; (3) a 40 percent rating for unfavorable ankylosis, to include abduction of the minor arm limited to 25 degrees from the side or intermediate ankylosis of the major arm, between favorable and unfavorable; and (4) a 50 percent rating for unfavorable ankylosis, to include abduction of the major arm limited to 25 degrees from the side. See 38 C.F.R. § 4.71a, Diagnostic Code 5200. Diagnostic Code 5201 provides ratings for limitation of motion of the arm as follows: (1) a 20 percent rating for limitation of motion of the major or minor arm to the shoulder level, or for limitation of motion of the minor arm to midway between the side and shoulder level; (2) a 30 percent rating for limitation of motion of the major arm to midway between the side and shoulder level, or for limitation of motion of the minor arm to 25 degrees from the side; and (3) a schedular maximum of 40 percent for limitation of motion of the major arm to 25 degrees from the side. See 38 C.F.R. § 4.71a, Diagnostic Code 5201. Standard range of motion of the shoulder is forward elevation (flexion) to 180 degrees and abduction to 180 degrees. See 38 C.F.R. § 4.71, Plate I. Forward flexion and abduction to 90 degrees constitutes the ability to raise an arm to shoulder level. See id. Diagnostic Code 5202 provides ratings for other impairment of the humerus (shoulder) as follows: (1) a 20 percent rating contemplates malunion of the major or minor humerus with a moderate deformity; malunion of the minor humerus with a marked deformity; recurrent dislocation of the major or minor humerus at the scapulohumeral joint, with infrequent episodes, and guarding of major or minor arm movement only at shoulder level; or recurrent dislocation of the minor humerus at the scapulohumeral joint, with frequent episodes and guarding of all minor arm movements; (2) a 30 percent rating contemplates malunion of the major humerus with a marked deformity; or recurrent dislocation of the major humerus at the scapulohumeral joint, with frequent episodes and guarding of all major arm movements; (3) a 40 percent rating contemplates fibrous union of the minor humerus; (4) a 50 percent rating contemplates fibrous union of the major humerus; or nonunion (false flail joint) of the minor humerus; (5) a 60 percent rating contemplates nonunion (false flail joint) of the major humerus; (6) a 70 percent rating contemplates loss of head (flail shoulder) of the minor humerus; and (7) an 80 percent rating contemplates loss of head (flail shoulder) of the major humerus. See 38 C.F.R. § 4.71a, Diagnostic Code 5202. Diagnostic Code 5203 provides ratings for impairment of the clavicle or scapula as follows: (1) a 10 percent rating contemplates malunion of either the major or minor arm, or nonunion of the clavicle or scapula without loose movement of either the major or minor arm; and (2) a 20 percent rating contemplates dislocation of the clavicle or scapula or nonunion of the clavicle or scapula with loose movement of either the major or minor arm. See 38 C.F.R. § 4.71a, Diagnostic Code 5203. The impairment may also be evaluated as the impairment of function of contiguous joint. See id. Degenerative arthritis established by X-ray findings must be evaluated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. See 38 C.F.R. § 4.71a, Diagnostic Code 5003. However, when the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent may be applied to each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. See id. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. See id. In the absence of limitation of motion, X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations, will warrant a 20 percent rating. See id. X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups will warrant a 10 percent rating. See id. The 10 percent and 20 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. See 38 C.F.R. § 4.71a, Diagnostic Code 5003, Note 1. The assignment of a particular diagnostic code depends upon the facts of each particular case, and the Board is authorized to choose an appropriate diagnostic code that is supported by both the evidence of record and a sufficiently articulated rationale. See Butts v. Brown, 5 Vet. App. 532, 538-39 (1993). Moreover, service connection for a disability is not severed when the diagnostic code assigned to that disability is revised in order to more accurately reflect the veteran’s relevant medical history, diagnoses, and demonstrated symptomatology. See Read v. Shinseki, 651 F.3d 1296, 1302 (Fed. Cir. 2011). The effective date for the grant of service connection, in conjunction with a grant of entitlement to service connection, shall generally be the day following separation from active service or the date entitlement arose if the claim is received within one year of separation from service; otherwise, the effective date shall be the date of receipt of the claim, or the date the entitlement arose, whichever is later. See 38 U.S.C. § 5110; 38 C.F.R. §§ 3.400(b)(2)(i); (o)(2). When determining when the entitlement arose, an effective date for benefits can be no earlier than the date the disability at issue first manifested. See DeLisio v. Shinseki, 25 Vet. App. 45, 52 (2011). In this case, the Veteran filed an increased rating claim for her right shoulder disability on January 1, 2017; therefore, the Board has considered whether it was factually ascertainable that the Veteran’s service-connected right shoulder disability was entitled to any increased evaluations as early as January 1, 2016. The Veteran contends that she is entitled to increased evaluations in excess of those currently awarded as follows: (1) for the period on appeal prior to January 17, 2017, an evaluation of 10 percent under Diagnostic Code 5201-5019; and (2) for the period on appeal from January 17, 2017, an evaluation of 20 percent under Diagnostic Code 5201. After careful review, and for the reasons set forth below, the Board finds that for the entire period on appeal, the Veteran’s right shoulder disability warrants an evaluation of 20 percent under Diagnostic Code 5201 for painful motion of the right arm (dominant upper extremity). In June 2017, the Veteran was afforded a VA examination which culminated in a report diagnosing a right shoulder strain and finding as follows: (1) the Veteran is right hand dominant; (2) the Veteran reported right shoulder flareups, described as a sharp cramp which may happen suddenly; (3) the Veteran reported functional loss, to include the intermittent inability to lift her small child or to pick up an item without triggering a sharp pain in the right shoulder; (4) initial range of motion was measured as normal, and unchanged after three repetitions, as follows: (a) unlimited flexion (180 degrees); (b) unlimited abduction (180 degrees); (c) unlimited external rotation (90 degrees); and (d) unlimited internal rotation (90 degrees); (5) pain was noted upon examination to cause functional loss with flexion; (6) objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue was noted upon examination, to include moderate tenderness of AC joint; (7) evidence was noted of pain with weight-bearing; (8) objective evidence of pain was noted on passive range of motion testing; (9) objective evidence of pain was noted on non-weight bearing testing; (10) pain, fatigue, and lack of endurance significantly limit functional ability with repeated use over a period of time and with flareups; (11) an acromioclavicular (AC) joint condition was suspected, to include AC joint dislocation or separation which does not affect range of motion of the shoulder (glenohumeral joint); (12) tenderness on palpation of the AC joint was noted; (13) a cross-body adduction test was positive; and (14) the Veteran’s right shoulder condition functionally impairs her employment, to include rendering her unable to lift heavy objects. The June 2017 VA examination report further notes no evidence of the following: (1) no objective evidence of crepitus; (2) no reduction in muscle strength; (3) no muscle atrophy; (4) no ankylosis; (5) negative tests for rotator cuff conditions; (6) no suspicion of instability, dislocation, or labral pathology; (7) no loss of head; (8) no malunion of humerus; (9) no arthritis; (10) no evidence of pain on passive range of motion testing of the left shoulder; and (11) no evidence of pain on non-weight bearing testing of the left shoulder. In October 2019, the Veteran was afforded a second VA examination which culminated in a report diagnosing both a right shoulder strain and rotator cuff tendonitis and further finding as follows: (1) the Veteran reported increased pain with decreased range of motion treated with daily naproxen; (2) the Veteran reported no flareups; (3) the Veteran reported functional loss to include the inability to perform any heavy lifting or overhead activities; (4) initial range of motion was measured as follows: (a) flexion limited to 90 degrees; (b) abduction limited to 90 degrees; (c) external rotation limited to 50 degrees; and (d) internal rotation limited to 50 degrees; (5) range of motion itself does not contribute to functional loss; (6) pain noted on examination causes functional loss; (7) pain was exhibited upon all ranges of motion (flexion; abduction; external rotation; and internal rotation); (8) objective evidence was noted of localized tenderness or pain on palpation of the joint or associated soft tissue; (9) moderate, anterior tenderness directly related to shoulder strain was noted; (10) evidence of pain was noted with weight bearing; (11) objective evidence of pain was noted on passive range of motion; (12) objective evidence of pain was noted when the joint is used in non-weight bearing; (13) pain was noted to significantly limit functional ability with repeated use over a period of time; (14) reduction in muscle strength is entirely due to the Veteran’s right shoulder condition and was measured as 4/5 for forward flexion and abduction; (15) rotator cuff condition was suspected as evidenced by the following (a) a positive Hawkins’ impingement test; (b) a positive empty can test; (c) a negative external rotation infraspinatus strength test; and (d) the inability to perform a lift-off subscapularis test; and (16) the Veteran’s right shoulder condition caused her to miss less than one weeks’ work time in the prior 12 months, which was caused by her inability to lift heavy objects or to perform overhead activities. The October 2019 VA examination report further notes no evidence of the following: (1) no objective evidence of crepitus; (2) no additional loss of function or range of motion after three repetitions; (3) no muscle atrophy; (4) no ankylosis; (5) no suspicion of a clavicle, scapula, AC joint or sternoclavicular joint condition; (6) no suspicion of instability, dislocation, or labral pathology; (7) no loss of head; (8) no malunion of humerus; (9) no arthritis; (10) no evidence of pain on passive range of motion testing of the left shoulder; and (11) no evidence of pain on non-weight bearing testing of the left shoulder. Based upon the foregoing evidence, the Board finds that during the entire period on appeal, the evidence of record indicates that the Veteran’s service-connected right shoulder disability manifested symptoms that more closely approximate the criteria for a disability rating of 20 percent under Diagnostic Code 5201, but do not more closely approximate the criteria for a disability rating of 30 percent under any relevant diagnostic code. As an initial matter, the Board finds that the preponderance of the evidence of record establishes that the Veteran is right-hand dominant; accordingly, the Veteran’s right shoulder shall be considered dominant, or major, and shall therefore be evaluated as a major extremity. See 38 C.F.R. § 4.69. After careful review, and in consideration of the foregoing evidence the Board hereby finds that, for the entire period on appeal, the competent evidence of record warrants a 20 percent evaluation for the Veteran’s right shoulder disability under Diagnostic Code 5201 for painful motion, as the record contains the Veteran’s report of painful motion and functional impairment during the entire period on appeal, and Diagnostic Code 5201 provides a minimum schedular evaluation of 20 percent for the major extremity. See 38 C.F.R. § 4.71a; Burton, 25 Vet. App. at 4-5 (2011). As stated above, a higher evaluation based on functional loss due to pain or weakness, fatigability, incoordination, or pain on movement of a joint must be considered, and the record contains consistent lay statements from the Veteran describing the painful motion of her right shoulder, to include her statements to the June 2017 and October 2019 VA examiners. See 38 C.F.R. § 4.59. Moreover, the Board finds that the Veteran is competent to describe the observable, non-medical symptoms of her right shoulder disability, such as the nature, severity, and location of her pain, stiffness, and limited range of motion, see Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007), and that the Veteran’s lay statements regarding her right shoulder symptoms are credible because such statements have been consistent with each other and throughout the evidence of record. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996) (citations omitted). In so finding, the Board further finds that an evaluation in excess of 20 percent is not warranted in this case, as neither VA examination report indicates that the Veteran’s right shoulder more nearly approximates limitation of motion to midway between the Veteran’s side and shoulder level (i.e., flexion and/or abduction limited to 45 degrees), as required for the 30 percent rating for the major arm. See 38 C.F.R. § 4.71a, Diagnostic Code 5201. Accordingly, the Board concludes that the preponderance of evidence weighs against the Veteran’s claims of entitlement to a disability evaluation under Diagnostic Code 5201 in excess of 20 percent, because 20 percent is the minimum rating afforded to a major extremity exhibiting range of motion limited to shoulder level absence evidence of limitation to 45 degrees. See 38 C.F.R. § 4.71a, Diagnostic Code 5201. Moreover, although the Veteran’s right shoulder disability does cause pain, painful motion does not result in the degree of functional loss required for a rating in excess of 20 percent. Consideration has also been given to the potential application of the other diagnostic codes for disabilities of the shoulder and arm. See 38 C.F.R. § 4.71a. However, the Board finds no basis upon which to assign increased or additional ratings for the Veteran’s right shoulder disability at any point during any period of appeal, as the Veteran has never been found to have ankylosis of the scapulohumeral articulation (Diagnostic Code 5200), impairment of the humerus (Diagnostic Code 5202), impairment of the clavicle or scapula (Diagnostic Code 5203), or arthritis (Diagnostic Code 5003). Therefore, no additional separate evaluations of the Veteran’s service-connected right shoulder disability are warranted in this case. The Veteran has not specifically raised any other issues, nor have any other issues been reasonably raised by the evidence of record. See Doucette v. Shulkin, 28 Vet. App. 366, 370 (2017). Accordingly, because the Board concludes that, for the entire period on appeal, the Veteran’s right shoulder disability warrants an evaluation of 20 percent under Diagnostic Code 5201 for painful motion of the right arm, the Board further finds as follows: (1) resolving all reasonable doubt in favor of the Veteran, for the period on appeal prior to January 17, 2017, an evaluation of 20 percent under Diagnostic Code 5201 for painful motion is granted; and (2) for the period on appeal from January 17, 2017, a preponderance of the evidence of record weighs against an increased evaluation in excess of 20 percent; therefore, the benefit of the doubt doctrine does not apply, and the Veteran’s claim for an increased evaluation in excess of 20 percent must be denied. See Gilbert, 1 Vet. App. at 53-54. 3. For the entire period on appeal, an increased evaluation in excess of 10 percent for the Veteran’s service-connected right hip disability, based upon limitation of extension under Diagnostic Code 5251, is denied. 4. For the entire period on appeal, an increased compensable evaluation for the Veteran’s service-connected right hip disability, based upon limitation of flexion under Diagnostic Code 5252, is denied. 5. For the entire period on appeal, an increased compensable evaluation for the Veteran’s service-connected right hip disability, based upon impairment of thigh under Diagnostic Code 5253, is denied. The Veteran contends that she is entitled to increased evaluations for her service-connected right hip disability, in excess of the following current awards: (1) a 10 percent evaluation based upon limitation of extension under Diagnostic Code 5251, effective June 6, 2012; (2) a noncompensable evaluation based upon limitation of flexion under Diagnostic Code 5252, effective June 6, 2012; and (3) a noncompensable evaluation based upon impairment of thigh under Diagnostic Code 5253, effective January 17, 2017. However, for the reasons set forth below, the Board disagrees and finds as follows: (1) for the entire period on appeal, a preponderance of the evidence of record weighs against an increased evaluation in excess of 10 percent based upon limitation of extension under Diagnostic Code 5251; (2) for the entire period on appeal, a preponderance of the evidence of record weighs against an increased compensable evaluation based upon limitation of flexion under Diagnostic Code 5252; and (3) for the period on appeal from January 17, 2017, a preponderance of the evidence of record weighs against an increased compensable evaluation based upon impairment of thigh under Diagnostic Code 5253. Diagnostic Codes 5250 through 5255 pertain to disabilities of the hip and thigh. See 38 C.F.R. § 4.71a. The VA Rating Schedule provides that the normal range of motion of the hip includes from zero degrees to 125 degrees of flexion and from zero degrees to 45 degrees of abduction. See 38 C.F.R. § 4.71, Plate II. Diagnostic Code 5250 governs ankylosis of the hip and provides as follows: (1) a 90 percent rating evaluation is warranted where there is evidence of extremely unfavorable ankylosis, the foot not reaching the ground, crutches necessary; (2) a 70 percent evaluation is warranted where there is evidence of intermediate unfavorable ankylosis; and (3) a 60 percent evaluation is warranted where there is evidence of favorable ankylosis, in flexion at an angle between 20 degrees and 40 degrees, and in slight adduction or abduction. See 38 C.F.R. § 4.71a. Diagnostic Code 5251 governs limitation of thigh extension and provides a sole 10 percent rating for extension limited to 5 degrees. See id. Diagnostic Code 5252 governs limitation of thigh flexion and provides as follows: (1) a 40 percent evaluation is warranted where there is evidence of flexion limited to 10 degrees; (2) a 30 percent evaluation is warranted where there is evidence of flexion limited to 20 degrees; (3) a 20 percent evaluation is warranted where there is evidence of flexion limited to 30 degrees; and (4) a 10 percent evaluation is warranted where there is evidence of flexion limited to 45 degrees. See 38 C.F.R. § 4.71a. Diagnostic Code 5253 governs impairment of the thigh and provides as follows: (1) a 20 percent evaluation is warranted where there is evidence of limitation of abduction of the thigh, motion lost beyond 10 degrees; (2) a 10 percent evaluation is warranted where there is evidence of limitation of adduction of the thigh, cannot cross leg; and (3) a 10 percent evaluation is warranted where there is evidence of limitation of rotation of the thigh, cannot toe-out more than 15 degrees on affected leg. See id. Diagnostic Code 5254 provides an 80 percent evaluation for flail hip joint. See id. Diagnostic Code 5255 governs impairment of the femur and provides as follows: (1) an 80 percent evaluation is warranted where there is evidence of fracture of the shaft or anatomical neck of femur with nonunion and loose motion (spiral or oblique fracture); (2) a 60 percent evaluation is warranted where there is (a) evidence of a fracture of the surgical neck of the femur, with false joint, or (b) evidence of a fracture of the shaft or anatomical neck of the femur with nonunion, without loose motion, and weightbearing preserved with aid of brace or evidence; (3) a 30 percent evaluation is warranted where there is evidence of malunion of the femur with marked knee or hip disability; (4) a 20 percent evaluation is warranted where there is evidence of malunion of the femur with moderate knee or hip disability; and (5) a 10 percent evaluation is warranted where there is evidence of malunion of the femur with a slight knee or hip disability. See id. The assignment of a particular diagnostic code depends upon the facts of each particular case, and the Board is authorized to choose an appropriate diagnostic code that is supported by both the evidence of record and a sufficiently articulated rationale. See Butts v. Brown, 5 Vet. App. 532, 538-39 (1993). Moreover, service connection for a disability is not severed when the diagnostic code assigned to that disability is revised in order to more accurately reflect the veteran’s relevant medical history, diagnoses, and demonstrated symptomatology. See Read v. Shinseki, 651 F.3d 1296, 1302 (Fed. Cir. 2011). The effective date for the grant of service connection, in conjunction with a grant of entitlement to service connection, shall generally be the day following separation from active service or the date entitlement arose if the claim is received within one year of separation from service; otherwise, the effective date shall be the date of receipt of the claim, or the date the entitlement arose, whichever is later. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2)(i); (o)(2). When determining when the entitlement arose, an effective date for benefits can be no earlier than the date the disability at issue first manifested. See DeLisio v. Shinseki, 25 Vet. App. 45, 52 (2011). In this case, the Veteran filed an increased rating claim for her right hip disability on January 1, 2017; therefore, the Board has considered whether it was factually ascertainable that the Veteran’s service-connected right hip disability was entitled to any increased evaluations as early as January 1, 2016. After careful review, the Board finds that for the entire period on appeal, the preponderance of the evidence of record demonstrates that the Veteran’s service-connected right hip disability has manifested painful motion with flareups and range of motion estimated during flareups as follows: (a) flexion limited to 85 degrees; (b) extension limited to 15 degrees; (c) abduction limited to 25 degrees; (d) adduction limited to 20 degrees; (e) external rotation limited to 45 degrees; and (f) internal rotation limited to 30 degrees. Accordingly, based upon the competent evidence of record as set forth below, the Board finds that the Veteran’s service-connected right hip disability does not warrant any increased evaluations for any portion of the period on appeal. In June 2017, the Veteran was afforded a VA examination to evaluate her service-connected right hip disability, which culminated in a report diagnosing a right hip strain with piriformis syndrome and further finding as follows: (1) the Veteran reported right hip flareups, described as sudden pain when walking or needing to pop the right hip back into place; (2) the Veteran reported functional loss, to include the inability to run, stand, or to walk for long periods of time; (3) range of motion during flareups was estimated as follows: (a) flexion limited to 85 degrees; (b) extension limited to 15 degrees; (c) abduction limited to 25 degrees; (d) adduction limited to 20 degrees; (e) external rotation limited to 45 degrees; and (f) internal rotation limited to 30 degrees; (4) adduction is not so limited that the Veteran cannot cross her legs; (5) abnormal range of motion itself contributes to functional loss, to include the inability to walk for extended periods of time; (6) pain, fatigue, and lack of endurance significantly limit functional ability with repeated use over a period of time and with flare ups; (7) pain was noted upon examination on all ranges of motion; (8) evidence of pain with weight bearing; (9) additional contributing factors of disability were also noted, to include less movement than normal and disturbance of locomotion; and (10) objective evidence of pain was on passive range of motion and on non-weight bearing testing. The June 2017 VA examination report further notes no evidence of any of the following: (1) no objective evidence of crepitus; (2) no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue; (3) no additional loss of function or range of motion after three repetitions; (4) no reduction in muscle strength; (5) no muscle atrophy; (6) no ankylosis; (7) no malunion or nonunion of femur, flail hip joint, or leg length discrepancy; (8) no evidence of pain on passive range of motion testing of the left hip; (9) no evidence of pain on non-weight bearing testing of the left hip; and (10) no arthritis. As stated above, where a veteran’s claim involves rating the severity of a joint disability based upon limitation of motion, functional impairment must be assessed in order to determine whether the disability at issue manifested weakened movement, excess fatigability, or incoordination. See 38 C.F.R. §§ 4.40, 4.45; DeLuca, 8 Vet. App. at 205-07. Accordingly, the Veteran has been awarded a 10 percent evaluation under in consideration of her functional loss due to painful motion, which is the maximum rating available under Diagnostic Codes 5250 through 5255 without further evidence of ankylosis, limitation of flexion of 30 degrees of less, limitation of extension of five degrees of less, flail joint, or malunion or fracture of the femur. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016). As noted above, repetitive testing conducted during the June 2017 VA examination failed to elicit additional limitation of motion, and the Veteran’s painful motion during flareups was found to cause limitation of flexion limited to 85 degrees. Therefore, as all requested testing has been completed, and the record contains no evidence indicating additional symptoms of disability, the Veteran’s right hip pain cannot be found to more nearly approximate an evaluation in excess of 10 percent under Diagnostic Code 5252. See 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5252. Accordingly, the Board finds that the Veteran has been appropriately compensated for her reported painful motion of the right hip. Similarly, with respect to the Veteran’s award of a separate noncompensable evaluation for limitation of extension under Diagnostic Code 5251, the Board also finds that the preponderance of the evidence of record does not support a compensable evaluation, as the June 2017 VA examination report contains no evidence warranting a compensable rating, such as the Veteran’s right leg extension is not limited to 5 degrees. See 38 C.F.R. § 4.71a, Diagnostic Code 5251. Moreover, regarding the Veteran’s award of a separate noncompensable evaluation for impairment of the right thigh under Diagnostic Code 5253, the Board also finds that the preponderance of the evidence of record does not support a compensable evaluation, as the June 2017 VA examination report contains no evidence warranting such an evaluation, such as the Veteran’s inability to cross her legs or to toe-out more than 15 degrees on her right leg. In every instance where the Rating Schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. See 38 C.F.R. § 4.3. Accordingly, as all requested testing has been completed, and the record contains no evidence warranting a compensable evaluation under Diagnostic Code 5253, such as the Veteran’s inability to cross her legs or to toe-out more than 15 degrees on her right leg, the Board finds that the Veteran has been appropriately compensated for the impairment of her right thigh, and the preponderance of the evidence of record weighs against the assignment of a compensable evaluation under Diagnostic Code 5253. See 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a. The Board has also considered whether, in the light of the assignment of separate evaluations under Diagnostic Codes 5252 and 5253, the Veteran’s compensation for her right hip disability has resulted in impermissible pyramiding, see 38 C.F.R. § 4.14, but finds no improper pyramiding in this case as none of the symptomatology under Diagnostic Code 5252 for limitation of flexion or Diagnostic Code 5152 for extension duplicates or overlaps with the symptomatology of Diagnostic Code 5253 for limitation of abduction, adduction, or rotation. See Esteban, 6 Vet. App. at 261-62. As limitation of extension, flexion, abduction, adduction, and rotation involve excursions of movements in different planes, these limitations therefore constitute different bases for evaluation the Veteran’s right hip. See 38 C.F.R. § 4.45. Additionally, as the Veteran’s right hip disability has been assigned a noncompensable evaluation under Diagnostic Code 5253, she is not receiving compensation for duplicative or overlapping symptomatology; therefore, the noncompensable ratings do not constitute impermissible pyramiding. See 38 C.F.R. § 4.14. The Board has also considered whether the Veteran’s service-connected right hip disability warrants the assignment of an additional or a higher rating under other applicable diagnostic codes at any point during the period on appeal. See Schafrath, 1 Vet. App. at 595. However, because the record contains no evidence of arthritis, ankylosis, limitation of extension of 30 degrees of less, flail joint, or malunion or fracture of the femur, the Board finds that no additional disability ratings are warranted in this case. The Veteran has not specifically raised any other issues, nor have any other issues been reasonably raised by the evidence of record. See Doucette v. Shulkin, 28 Vet. App. 366, 370 (2017). Accordingly, in consideration of the foregoing, the Board finds as follows: (1) for the entire period on appeal, a preponderance of the evidence of record weighs against an increased evaluation in excess of 10 percent based upon limitation of extension under Diagnostic Code 5251; (2) for the entire period on appeal, a preponderance of the evidence of record weighs against an increased compensable evaluation based upon limitation of flexion under Diagnostic Code 5252; and (3) for the entire period on appeal from January 17, 2017, a preponderance of the evidence of record weighs against an increased compensable evaluation based upon impairment of thigh under Diagnostic Code 5253. Therefore, the benefit of the doubt doctrine does not apply, and the Veteran’s claim for an increased evaluation in excess of 20 percent for her service-connected right hip disability must be denied. See Gilbert, 1 Vet. App. at 53-54. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Marsdale 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.