Citation Nr: 21021951 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 15-45 807 DATE: April 14, 2021 ORDER An increased rating in excess of 10 percent for cervical strain with parascapular muscle spasm is denied. An increased rating in excess of 10 percent for shin splint, right lower extremity with knee impairment, is denied. An increased rating in excess of 10 percent for shin splint, left lower extremity with knee impairment, is denied. FINDINGS OF FACT 1. The Veteran’s service-connected cervical strain with parascapular muscle spasm (cervical spine disability) more nearly approximated forward flexion limited to 45 degrees, and muscle tightness not severe enough to cause abnormal spinal contour, but not forward flexion limited to 30 degrees or less, combined range of motion of 170 degrees or less, muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour, or symptoms of comparable severity, to include consideration of flare-ups and functional impairment/loss. 2. The Veteran’s right leg shin splints symptomatology does not more nearly approximate malunion with at least moderate knee or ankle disability, and the evidence does not show that the Veteran has undergone surgery for his right leg shin splints. 3. The Veteran’s left leg shin splints symptomatology does not more nearly approximate malunion with at least moderate knee or ankle disability, and the evidence does not show that the Veteran has undergone surgery for his left leg shin splints. CONCLUSIONS OF LAW 1. The criteria for an increased disability rating in excess of 10 percent for the Veteran’s cervical spine disability have not been met for the entire appeal period. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 2. The criteria for an increased rating in excess of 10 percent for right leg shin splints have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5262. 3. The criteria for an increased rating in excess of 10 percent for left leg shin splints have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5262. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1993 to February 1998. This matter came before the Board of Veterans Appeals (Board) on appeal from a January 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). A February 2015 rating decision increased the Veteran’s rating for the cervical spine disability to 10 percent effective August 21, 2014. Additionally, a June 2020 rating decision increased the Veteran’s rating for shin splints, right and left lower extremity with knee impairment, to 10 percent effective June 30, 2014. Because higher ratings for this disability are assignable during the relevant period and the Veteran is presumed to seek the maximum available benefit, the issue remains on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). In September 2018, the Board remanded the claims for further development. Increased Rating Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. 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 rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3 1. Entitlement to an increased rating in excess of 10 percent for the service-connected cervical spine disability. The Veteran generally contends that the symptoms of his cervical spine disability warrant an increased disability rating. The Veteran has been in receipt of a 10 percent rating for cervical strain with parascapular muscle spasm under 38 C.F.R. § 4.71a, DC 5237, previously rated as 5290. During the pendency of the Veteran’s increased rating claim on appeal, the rating criteria for evaluating arthritis and certain musculoskeletal disabilities were amended in November 2020, December 2020, and February 2021. See 85 Fed. Reg. 76,453-76,469 (Nov. 30, 2020); 85 Fed. Reg. 85,523-85,524 (Dec. 29, 2020); 86 Fed. Reg. 8,142-8,144 (Feb. 4, 2021). The change, effective February 7, 2021, added certain diagnostic codes and amended the rating criteria for several diagnostic codes listed under 38 C.F.R. § 4.71a. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the Board may not apply a current regulation prior to its effective date, unless the regulation specifically provides otherwise. See VAOPGCPREC 7-2003 (Nov. 19, 2003); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003) (overruling Karnas v. Derwinski, 1 Vet. App. 307 (1991) to the extent that it conflicts with the precedents of the United States Supreme Court and the Federal Circuit). However, the Board is not precluded from applying prior versions of the applicable regulations to the period on or after the effective date of the new regulation if the prior versions were in effect during the pendency of the appeal. See VAOPGCPREC 3-2000, 65 Fed. Reg. 33,422 (2000); see also DeSousa v. Gober, 10 Vet. App. 461, 467 (1997).” As there is no indication that the above amendments were intended to be applied retroactively, the changes do not apply before the date they became effective. See Kuzma, 341 F.3d at 1329. For the entire appeal period, the criteria for rating disabilities of the spine are listed under DCs 5235 to 5243. See 38 C.F.R. § 4.71a. The General Rating Formula provides that with or without symptom such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings are assigned: A 10 percent rating is assigned for forward flexion of the cervical spine greater than 30 degrees, but not greater than 40 degrees; or, combined range of motion of the cervical spine greater than 170 degrees, but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is assigned for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 30 percent rating is assigned for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. Id. A 40 percent rating is assigned for unfavorable ankylosis of the entire cervical spine. Id. The highest rating, 100 percent rating, is assigned for unfavorable ankylosis of entire spine. Id. Note (2) provides that normal forward flexion, extension, and left and right lateral flexion of the cervical spine are all zero to 45 degrees and left and right lateral rotation of the cervical spine are both zero to 80 degrees. The regulations applicable to rating musculoskeletal disabilities require that VA must also consider the extent that a veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent (‘flare-ups’) due to the extent of his pain (and painful motion), weakness, premature or excess fatigability, and incoordination. DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995); see also 38 C.F.R. §§ 4.40, 4.45. For VA purposes, unfavorable ankylosis is a condition in which the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. 38 C.F.R. § 4.71a, Diagnostic Code 5242, Note (5). A February 2015 Disability Benefits Questionnaire (DBQ) report reflects that the Veteran has a diagnosis of cervical strain with muscle spasm. He reported recurrent episodes of neck pain and muscle spasms. The Veteran reported flare-ups of the cervical spine described as pain and stiffness that occurred every two to three months that lasted three to four day. He reported that flare-ups limited his movement—he could not move his neck around. He reported that this makes driving the fork lift at work difficult to see behind. Initial range of motion (ROM) testing revealed forward flexion to 45 degrees or greater with painful motion beginning at 40 degrees. Extension was to 30 degrees with painful motion beginning at 30 degrees. The examiner noted that his cervical spine condition impacted his ability to work. He could lift 20 to 25 pounds infrequently. He could sit one to two hours. In an April 2016 statement from the Veteran’s mother, she reported that the Veteran is always in pain, including his neck. In an April 2016 statement, the Veteran reported suffering from cervical strain and he had constant neck and shoulder pain. He reported that his quality of life is suffering. A December 2016 DBQ report reflects that the Veteran complained of pain in the posterior cervical spine at the midline. He described his pain as a 5 to 6 out of 10 (10 indicating the greatest amount of pain) to 9 out of 10. There was no radiation of pain. He reported that he gets intermittent tingling in his fingertips bilaterally especially when he is active. There is no locking and stiffness. He reported that he will self-manipulate his neck causing it to pop and this will give some mild relief. He reported that his activities of daily living are not limited, and his job is not limited; however, he will take breaks as needed. He reported that there are no flare ups causing incapacitation or medical attention. Additionally, he did not report functional impairment/loss. Initial ROM testing revealed forward flexion to 45 degrees and extension to 35 degrees. Right and left lateral flexion was to 40 degrees; right lateral rotation was to 45 degrees and left lateral rotation was to 60 degrees. Range of motion itself did not contribute to a functional loss. Pain was noted on examination (forward flexion and extension) and did not result in/cause functional loss. There was no evidence of pain with weight-bearing. There was no objective evidence of localized tenderness or pain on palpation. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or ROM after three repetitions. The Veteran was examined immediately after repetitive use over time. The examiner was unable to say without mere speculation whether pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time. The Veteran did not have guarding or muscle spasm. There was less movement than normal. The Veteran did not have muscle atrophy. There was no radicular pain or any other signs or symptoms due to radiculopathy. There was no ankylosis of the spine. There was no IVDS. His gait was normal, and his sensation was intact distally to both upper extremities. There were no palpable spasms. The Veteran described his pain with ROM testing as tight. There was no arthritis. A June 2019 DBQ report reflects that the Veteran reported increased tingling in his trapezoids all the way down to his forearms that is present all the time. He reported headaches from the posterior aspect of his skull forward. He reported that it hurts to turn his neck to the right. He reported difficulty finding a comfortable position in which to sleep at night. He reported flare-ups described as looking at a monitor for an extended part of time and his head will start to hurt and his vision is blurred. He reported that he had no neck pain increase. He reported that movement increased his pain, especially looking to the right while driving. He reported that his neck is stiff in the morning and when it gets cold. He reported that during flare-ups, the pain is like tightness. He reported average pain was 8 out of 10. Initial ROM testing revealed forward flexion to 40 degrees and extension to 45 degrees. Right and left lateral flexion was to 20 degrees, and right and left lateral rotation was to 70 degrees. Range of motion itself did not contribute to a functional loss. Pain was noted on extension and caused functional loss. There was no evidence of pain with weight bearing. There was no objective evidence of localized tenderness or pain on palpation. The Veteran was able to perform repetitive use testing with no additional loss of function or ROM. Pain significantly limited functional ability with repeated use over a period of time. The examiner was unable to describe this in terms of ROM and reported that a review of the history and objective evaluation make it greater than 50 percent as likely as not that the pain is mild. He reported that the same logic and result applies to flare-ups. There was no guarding and muscle spasm. There was no muscle atrophy. There was no radicular pain or any other signs or symptoms due to radiculopathy. There was no ankylosis and neurologic abnormalities. There was no IVDS. The Veteran’s cervical spine condition impacted his ability to work due to certain ranges of motion and fixation on monitors for 20 minutes. In a March 2020 VA addendum, opinion, the examiner reported that after reviewing the medical records available, it is greater than 50 percent as likely as not that the Veteran’s functional ability over time due to a) pain, weakness, fatigability and incoordination as well as in, b) flare-ups in the neck comports to a 5 o 10 percent loss of motion in all ranges. He clarified that this is only an estimate and not based on actual objective clinical evaluation at the specific times of occurrence. He concluded that it is medically impossible to give this answer as anything other than a range of loss of motion and an estimate only. Additionally, the examiner noted that the Veteran does not have cervical spine related radiculopathy. He has no pain on compression (weight bearing) of the cervical spine and no pain on palpation of the facets, but pain when the facets are stressed. He has no motor or sensory abnormalities to examination and his reflects are symmetrical and equal, even the biceps of reflex. He concluded that he has no diagnostic elements necessary to make a diagnosis of radiculopathy. He clarified that the tingling he feels is intermittent and likely related to trapezial spasm and possibly to acute flare-ing in the cervical spine facets. He stated that these are not by nature and complaints/symptoms of a true radiculopathy and in conjunction with the examination do not comport a diagnosis. Finally, the examiner also reported that it is less than 50 percent as likely as not that any mild degenerative changes in the cervical spine are the result of progression of the Veteran’s service-connected cervical strain with parascapular spasm. He stated that the latter is soft tissue in nature and does not progress to degenerative change. Additionally, in reviewing the Veteran’s initial statement regarding the injury mechanism, it is of insufficient trauma to cause traumatic arthritis. VA treatment records were reviewed in connection with the claim and revealed symptoms as noted in the examination reports. Upon review of the evidence of record, the Board finds that a disability rating in excess of 10 percent for the Veteran’s cervical spine disability is not warranted. Throughout the entire period on appeal, the Veteran’s ROM testing for his cervical spine revealed flexion from 40 to 45 degrees and, the combined range of motion was consistently well above 170 degrees. The Veteran’s flare-ups in 2015 were described as pain with stiffness and limitation where he reported he could not turn his neck all the way around. In 2016, he did not have any complaint of flare-ups. His flare-ups were noted again in 2019 described again as stiffness. The examiner estimated a 5 to 10 percent loss in ROM during flare-ups which would make his estimated forward flexion to about 36 degrees and his extension to about 40 degrees, giving the Veteran the benefit of the doubt. The Veteran’s competent reports of pain resulting in functional impairment has been considered, and under the General Formula, the Veteran is in receipt of a 10 percent rating as the minimum evaluation available for a joint with painful motion per 38 C.F.R. § 4.59. However, a rating higher than 10 percent is not warranted at any time during the period on appeal. As previously discussed, the Veteran’s range of motion in flexion ranged from 40 degrees to 45 degrees during the period on appeal. The evidence of record, including the Veteran’s DBQs and VA treatment records, do not at any time note symptomatology that more nearly approximated forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees, combined range of motion of the cervical spine not greater than 170 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. In fact, the Veteran’s June 2019 DBQ specifically reflects that the Veteran’s neck disability did not include guarding or muscle spasms, and at no time does the Veteran otherwise report suffering from neck disability symptomatology that more nearly approximates that contemplated by a higher than 10 percent rating under DC 5237 at any time during the period on appeal. The Veteran self-reported that his neck pain has not worsened during that examination. The Board has also considered whether a higher rating is warranted under an alternate diagnostic code. However, as indicated by the DBQs, the Veteran does not have IVDS, thus, a higher evaluation under DC 5243 is not available. The Board has considered whether a separate evaluation for neurological disability is warranted. See 38 C.F.R. § 4.71a, Note 1. However, there were no neurologic abnormalities noted at the time of the either DBQ, thus the Board finds that a separate evaluation for additional neurological disability is not warranted. Notably, in the 2020 addendum opinion, the examiner provided reasoning for why the Veteran does not have a neurological disability, despite his complaint of tingling. The examiner noted that the Veteran does not have motor or sensory abnormalities on examination and his reflects are symmetrical and equal, even the biceps of reflex. He concluded that he has no diagnostic elements necessary to make a diagnosis of radiculopathy. He clarified that the tingling he feels is intermittent and likely related to trapezial spasm and possibly to acute flare-ing in the cervical spine facets. Finally, the amended criteria under 38 C.F.R. § 4.71a for musculoskeletal disabilities effective February 7, 2021 do not have any impact on the rating assigned for the cervical spine disability in this case, as the general rating formula for diseases and injuries of the spine was not changed. For the foregoing reasons, an increased rating in excess of 10 percent for the Veteran’s cervical spine disability is not warranted. As the preponderance of the evidence is against higher ratings, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. 2. Entitlement to a disability rating in excess of 10 percent for the service-connected right leg shin splints with knee impairment. 3. Entitlement to a disability rating in excess of 10 percent for the service-connected left leg shin splints with knee impairment. The Veteran generally contends that the symptoms of his bilateral shin splint disability warrant increased disability ratings. The Veteran’s right and left leg shin splints are each rated 10 percent disabling under 38 C.F.R. § 4.71a, 5262. Prior to the February 7, 2021 regulatory amendment to the rating criteria for musculoskeletal disabilities, there is no diagnostic code specifically applicable to “shin splints,” so these disabilities were rated by analogy to DC 5262, applicable to impairment of the tibia and fibula. Under DC 5262, a 10 percent rating is warranted for malunion with slight knee or ankle disability. A 20 percent rating is warranted for malunion with moderate knee or ankle disability. A 30 percent rating is warranted for malunion with marked knee or ankle disability. A maximum, 40 percent rating is warranted for nonunion with loose motion requiring brace. The terms “marked,” “moderate” and “slight” are not defined in DC 5262, and the question of whether a particular degree of disability is slight, moderate or marked is ultimately a legal rather than a medical one. 38 C.F.R. § 3.100 (a) (2017) (delegating the Secretary’s authority “to make findings and decisions... as to the entitlement of claimants to benefits” to, inter alia, VA “adjudicative personnel”); 38 C.F.R. § 4.2 (“It is the responsibility of the rating specialist to interpret reports of examination... so that the current rating may accurately reflect the elements of disability present.”). Effective February 7, 2021, additional criteria specific to medial tibial stress syndrome (MTSS), or shin splints was added under Diagnostic Code 5262. A noncompensable rating is assigned for shin splints requiring treatment of less than 12 consecutive months for one, or both, lower extremities. A 10 percent rating is assigned for shin splints of one, or both lower extremities, requiring treatment for no less than 12 consecutive months, and when the shin splints (unilateral or bilateral) are unresponsive to either shoe orthotics or other conservative treatment. A 20 percent rating is assigned for unilateral lower extremity shin splints (affecting either lower extremity) that require treatment for no less than 12 consecutive months; and, that are unresponsive to surgical intervention, and unresponsive to either shoe orthotics or other conservative treatment. A maximum 30 percent rating is assigned for bilateral shin splints that require treatment for no less than 12 consecutive months; and, that are unresponsive to surgical intervention and unresponsive to either shoe orthotics or other conservative treatment. The December 2015 DBQ report reflects that the Veteran has a diagnosis of bilateral shin splints. The Veteran reported that he began to have pain of shin splints about one to two years after joining the military. He reported that he has continued to have this pain intermittently over the years since leaving the military. He reported the symptoms have worsened over the past year, increasing in frequency and duration. The Veteran reported flare-ups described as pain related to increased activities of walking that occurred four to five times a year and would last for three to four days. He stated that pain interfered with walking and driving forklift at work. He reported that when it flares, he is “hobbling” around, and it is hard to get around. Range of motion testing for the right and left knee was normal with no objective evidence of pain. The Veteran did not have additional limitation in ROM of the knee and lower leg following repetitive-use testing. The Veteran had functional loss/impairment described as weakened movement bilaterally and pain to both shins with walking and driving the forklift at work. Pain could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. The examiner specified that there was no loss of ROM, but has pain with walking or driving forklift at work. Joint stability testing was normal. There was no evidence or history of recurrent patellar subluxation/dislocation. The Veteran experienced shin splint pain four to five times a year, which lasts three to four days. Pain was exacerbated by walking and interferes with driving forklift at work. The Veteran’s condition impacted his ability to work. Due to his condition, he can lift 20 to 25 pounds infrequently. He can walk approximately 0.5 miles before pain starts. He can walk 6 out of 8 hours with frequent breaks. Sitting is unlimited and standing was limited to one hour then has pain. The Veteran worked at a post office dock and had to do extensive walking. He also drove a forklift at work occasionally. When he has a flare-up, he reported that he is not able to drive the forklift. A May 2016 DBQ report reflects that the Veteran reported intermittent pain since his in-service injury. He stated that since the beginning of the year, he has had constant knee pain in both knees. The Veteran reported flare-ups described as difficulty putting pressure on his knees and a bad limp. He reported functional loss/impairment described as constant pain. Initial ROM testing of the right and left knee revealed flexion to 110 degrees and extension to 0 degrees. Range of motion itself did not contribute to functional loss. Pain was noted on examination of flexion and caused functional loss. There was no evidence of pain with weight-bearing. There was objective evidence of crepitus. The Veteran was able to perform repetitive-use testing with at least three repetitions with no additional loss of function or range of motion after three repetitions. Pain significantly limited functional ability with repeated use over a period of time. However, the examiner was unable to describe this in terms of ROM as the Veteran was not observed after prolonged repetitive use. Additionally, pain significantly limited functional ability with flare ups. However, the examiner was unable to describe this in terms of ROM because the Veteran was not experiencing a flare at time of the examination. The Veteran had disturbance of locomotion, bilaterally. He did not have any muscle atrophy and there was no ankylosis. The examiner noted that the shin splints did not affect ROM of the knee or ankle. He reported that the Veteran’s shin splint symptoms were asymptomatic. A June 2019 DBQ report reflects that the Veteran has bilateral shin splints that he reported has increased in pain. He reported that he ran 1.5 miles and then he has to stop due to anterior medial and lateral tightness followed by 10 minutes of pain in the legs if he does not stop. He reported that he is able to walk for 30 minutes and then experiences the same tightness/pain. The Veteran also reported flare-ups and functional impairment. The pain is shooting in nature and is described as “sharp.” He reported that his pain was a 4 to 5 out of 10 but reaches 7 to 8 out of 10. He reported that he wore calf compression braces regularly. Initial ROM testing of the right and left knee revealed flexion to 130 degrees and extension to 0 degrees. Range of motion itself did not contribute to functional loss. There was no pain noted on examination and there was no evidence of pain with weight bearing. There was objective evidence of localized tenderness or pain on palpation described as anterolateral leg tightness and deep anteromedial pain. There was no objective evidence of crepitus. The Veteran was able to perform repetitive-use testing with at least three repetitions with no additional functional loss or range of motion after three repetitions, bilaterally. There was no evidence of pain with weight bearing. Pain significantly limited functional ability with repeated use over a period of time and with flare-ups. The examiner was unable to describe this in terms of ROM but explained that the history and examination, as well as a review of the records, make it greater than 50 percent as likely as not that the Veteran experiences mild to moderate pain as a result of repetitive motion bilaterally. There was no muscle atrophy and ankylosis. There was no recurrent effusion and joint instability. He reported that the Veteran has not and does not have recurrent patellar dislocation, shin splints. There was no meniscus condition. The Veteran reported using braces regularly. In a March 2020 addendum, the examiner reported that there are additional conditions and they are shin splints, bilaterally as noted on the examination of the knees and the legs. However, in reviewing his notes, he reported that there are no abnormalities in the ankle ROMs and no other joints are affected. He stated that these shin splints likely evoke compartment syndrome symptoms as noted in the medical history after walking and running that cease after rest. He stated that the Veteran’s knee ROM would not be affected per se by shin splints alone, but the pain generated in the superior anterior and medical compartments would comport to a 10 percent loss of motion in flexion and extension. VA treatment records were reviewed in connection with the claim and reflect similar complaints of pain as noted in the DBQ reports. Upon review of the evidence of record, the Board finds that an increased disability rating in excess of 10 percent is not warranted for the Veteran’s bilateral shin splints. There is no evidence at any time during the pendency of the appeal that the Veteran’s shin splints symptomatology more nearly approximate malunion with at least moderate knee or ankle disability. The DBQ examination notes do not reflect evidence of fracture or malalignment of the left femur, tibia and fibula, and no joint effusion, or radio-opaque foreign bodies. The Veteran’s ROM of the right and left knee were only limited to 110 degrees on flexion with extension to 0 degrees. The Veteran reported flare-ups; however, this was estimated to be mild to moderate pain as a result of repetitive motion. The Veteran’s bilateral shin splints evoke compartment syndrome symptoms as noted in the medical history after walking and running that cease after rest. The Board finds the Veteran’s right and left shin splints symptomatology does not more nearly approximate malunion with at least moderate knee or ankle disability as contemplated by a 20 percent rating under DC 5262, or limitation of motion contemplated by at least a 20 percent rating under DC 5260. Moreover, as the evidence of record does not show that the Veteran’s shin splints were unresponsive to surgical intervention; or, that the Veteran has undergone surgery of his shin splints, a rating in excess of 10 percent may not be assigned under the revised regulations in effective from February 7, 2021. In fact, a 10 percent rating for each lower extremity would not be assignable under the revised criteria because that criteria only allow for a single 10 percent rating for bilateral shin splints that do not require surgical treatment. As the rating criteria in effect prior to February 7, 2021 are more favorable to the Veteran, they will be applied for the entire period covered by the claim. Therefore, an increased rating higher than 10 percent for both right and left shin splints is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. The Veteran has not contended, and the evidence does not reflect, that he has experienced symptoms outside of those listed in the rating criteria. Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017). L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Laroche, N. 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.