Citation Nr: 21022473 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 13-00 300A DATE: April 15, 2021 ORDER An extension of the total rating for convalescence beyond March 31, 2015 for a right knee disability is denied. An initial rating higher than 50 percent for posttraumatic stress disorder (PTSD) is denied. An initial rating for lumbar spine degenerative disc disease (DDD) higher than 10 percent prior to September 23, 2020, and higher than 40 percent, thereafter, is denied. An initial 10 percent rating for left lower extremity (LLE) sciatic nerve radiculopathy prior to July 25, 2019 is granted. An initial 40 percent rating for LLE sciatic nerve radiculopathy from September 23, 2020 is granted. An initial 10 percent rating for right lower extremity (RLE) sciatic nerve radiculopathy prior to January 13, 2017 is granted. An initial rating for right knee degenerative joint disease (DJD), status post total knee replacement, higher than 10 percent prior to February 20, 2014, and higher than 30 percent from April 1, 2015 is denied. An initial 10 percent rating for right knee instability prior to February 20, 2014, and from April 1, 2015 to February 6, 2021 is granted. An initial rating higher than 10 percent for left knee DJD is denied. An initial rating higher than 10 percent for left shoulder DJD is denied. An initial rating higher than 10 percent for left ankle DJD is denied. An initial rating higher than 10 percent for right ankle DJD is denied. An initial rating higher than 10 percent for right elbow tendonitis is denied. An initial rating higher than 10 percent for left plantar fasciitis is denied. FINDINGS OF FACT 1. As of April 1, 2015, the Veteran’s right knee replacement surgery did not result in severe postoperative residuals, immobilization of the knee joint, or use of crutches or a wheelchair. 2. The severity, frequency, and duration of the Veteran’s PTSD symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas. 3. Prior to September 23, 2020, lumbar spine DDD was not manifested by forward flexion of 60 degrees or less, combined range of motion of 120 degrees or less, or spasm or guarding. 4. Prior to July 25, 2019, the Veteran had mild incomplete paralysis of the left sciatic nerve. 5. From September 23, 2020, the Veteran had moderately severe incomplete paralysis of the left sciatic nerve. 6. Prior to January 13, 2017, the Veteran had mild incomplete paralysis of the RLE sciatic nerve. 7. Prior to February 20, 2014, the Veteran’s right knee disability was manifested by full extension and 130 degrees of flexion; from April 1, 2015, residuals of his total knee replacement did not include severe painful motion or weakness. 8. Prior to February 20, 2014, and from April 1, 2015 to February 6, 2021, the Veteran had mild right knee instability. 9. From February 7, 2021, the Veteran had patellar instability requiring a knee brace. 10. The Veteran’s left knee DJD is manifested by full extension and at least 120 degrees of flexion. 11. Left shoulder DJD is manifested by at least 130 degrees of flexion and abduction. 12. Left ankle DJD is not manifested by marked limitation of motion. 13. Right ankle DJD is not manifested by marked limitation of motion. 14. Right elbow tendonitis is manifested by full extension and at least 124 degrees of flexion. 15. The Veteran’s left foot plantar fasciitis is manifested by no more than moderate symptoms and has not undergone surgical treatment. CONCLUSIONS OF LAW 1. The criteria for a temporary total rating for convalescence for a right knee disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.30. 2. The criteria for a disability rating higher than 50 percent for PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 3. The criteria for a rating higher than 10 percent for lumbar spine DDD prior to September 23, 2020, and higher than 40 percent, thereafter, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5243. 4. The criteria for an initial 10 percent rating for LLE sciatic nerve radiculopathy prior to July 25, 2019 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520. 5. The criteria for an initial 40 percent rating for LLE sciatic nerve radiculopathy from September 23, 2020 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520. 6. Prior to January 13, 2017, the criteria for a 10 percent rating for RLE sciatic nerve radiculopathy are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520. 7. The criteria for an initial rating for right knee DJD, status post total knee replacement, higher than 10 percent prior to February 20, 2014, and higher than 30 percent from April 1, 2015 are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.71a, DCs 5055, 5260. 8. The criteria for a separate 10 percent rating for right knee instability prior to February 20, 2014, and from April 1, 2015 to February 6, 2021 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.71a, DC 5257. 9. The criteria for a separate 20 percent rating for right knee instability from February 7, 2021 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.71a, DC 5257. 10. The criteria for an initial rating higher than 10 percent for left knee DJD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.40, 4.45, 4.71a, DC 5260. 11. The criteria for a rating higher than 20 percent for left shoulder DJD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5201. 12. The criteria for a rating higher than 10 percent for left ankle DJD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5271. 13. The criteria for a rating higher than 10 percent for right ankle DJD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5271. 14. The criteria for a rating higher than 10 percent for right elbow tendonitis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5206. 15. The criteria for a rating higher than 10 percent for left foot plantar fasciitis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DCs 5284, 5285. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the U.S. Marine Corps from December 1983 to August 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from March 2011 and July 2015 rating decisions. It was previously remanded by the Board for additional development in December 2016 and November 2017. Extension of the temporary total rating for a right knee disability The Veteran was assigned a 100 percent rating for his right knee disability from February 20, 2014, through March 31, 2015, based on the rating criteria of 38 C.F.R. § 4.71a, DC 5055, which provides for a 100 percent rating for one year following a knee replacement procedure. Notably, effective February 7, 2021, that provision was amended to reduce the 100 percent rating from a period of one year to just four months. In a March 2015 statement, he stated that he had experienced recent problem with the knee, including bruising, numbness, pain and swelling. He reported having a bone scan that same month which showed significant growth, and stated that his doctor recommended several more months of recovery. In a March 2016 statement, he indicated that the total recovery time was over 18 months. Because the 100 percent rating was assigned based on the schedular criteria, the Board has construed his request for an extension as a request for a temporary total rating for convalescence. Such ratings are governed by 38 C.F.R. § 4.30. This regulation provides such ratings when treatment of a service-connected disability requires 1) surgery necessitating at least one month of convalescence; 2) surgery with severe postoperative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited); or 3) immobilization by cast, without surgery, of one major joint or more. A review of the evidence, including the Veteran’s outpatient records, does not show that, as of April 1, 2015, he experienced any of the above-listed manifestations. Although he continued to experience symptoms in his right knee, these did not include any severe postoperative residuals, immobilization of the knee joint, or use of crutches or a wheelchair. Therefore, a rating based on convalescence is not appropriate in this case. PTSD The Veteran is currently assigned a 50 percent rating for his PTSD under 38 C.F.R. § 4.130, DC 9411, which is part of the General Formula for Mental Disorders (General Formula). Under this formula, the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran’s associated symptoms caused the level of impairment required for a disability rating of 70 percent or higher. A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. The Board concludes that the Veteran’s symptoms did not cause the level of impairment required for a disability rating of 70 percent or higher. The Veteran’s symptoms more closely approximated the symptoms associated with a 50 percent rating and resulted in a level of impairment that most closely approximated the level of impairment associated with a 50 percent rating. In making this determination, the Board acknowledges that the Veteran experiences various symptoms associated with this PTSD. However, the analysis of his claim will be limited only to those symptoms which could indicate that a higher rating is warranted. Specifically, the Veteran reported suicidal ideation in February 2017, December 2018 and February 2020. While this is associated with the higher 70 percent rating, the evidence clearly shows that the December 2018 and February 2020 instances occurred when the Veteran reported a friend’s suicide and the death of his niece, respectively. There is no indication that this ideation persisted for any significant time, and outside of those events, suicidal ideation was only reported in February 2017. Under these circumstances, the Board concludes that suicidal ideation did not manifest with sufficient frequency or duration to warrant a 70 percent rating. In addition, a June 2010 VA examination noted obsessive behavior related to physical fitness. However, there is no indication that this obsessive behavior interfered with routine activities as contemplated by the 70 percent rating criteria. Finally, lay statements from the Veteran and others, as well as VA treatment records, document angry outbursts in which the Veteran broke objects. This indicates unprovoked irritability with periods of violence. However, that manifestation, either alone or viewed alongside the suicidal ideation discussed above, is not sufficient to warrant an overall 70 percent disability rating. This determination is consistent with the August 2010 and November 2020 VA examinations, in which both examiners concluded that the Veteran had an overall level of impairment less than that contemplated by the 70 percent rating, i.e., occupational, and social impairment with deficiencies in most areas. For these reasons, an initial rating higher than 50 percent is not warranted in this case. Lumbar spine DDD The Veteran’s lumbar spine disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5243, which is part of the General Rating Formula for Diseases and Injuries of the Spine. Prior to September 23, 2020, he is assigned a 10 percent rating. From that date, he has a 40 percent rating. Under the rating formula, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 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 warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. The Board finds that the preponderance of the evidence is against a rating higher than 10 percent prior to September 23, 2020. As noted, a higher 20 percent rating requires forward flexion not greater than 60 degrees or a combined range of motion not greater than 120 degrees. An August 2010 VA examination documented 90 degrees of forward flexion and 240 degrees of combined range of motion. Pain was present, but range of motion was unchanged following repetitive testing. An additional VA examination from July 2019 documented forward flexion of 70 degrees and combined range of motion of 170 degrees. There was no change with repetitive testing, and while the Veteran reported flare-ups, the July 2019 VA examiner stated that the examination was conducted during a flare-up. In addition to the range of motion findings, both VA examiners stated that no guarding or spasm was present. A March 2016 disability benefits questionnaire submitted (DBQ) by the Veteran did not include any range of motion measurements, but it also indicated the absence of any spasm or guarding. From September 23, 2020, a rating higher than 40 percent is not warranted. The VA examination conducted on that date did not document any ankylosis, let alone the unfavorable ankylosis necessary for the higher 50 percent rating. Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Under the rating formula, any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1. Here, there is no bowel or bladder impairment. However, the Veteran does have bilateral lower extremity radiculopathy, which is discussed below. LLE sciatic nerve radiculopathy As of July 25, 2019, the Veteran is assigned a 20 percent rating for left leg sciatic nerve radiculopathy. The Board finds that a 10 percent rating should be granted prior to that date, and that a rating higher than 20 percent is not warranted as of that date. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. Prior to July 25, 2019, a 10 percent rating is warranted. Outpatient records from September 2011 diagnosed sciatica, but objective findings for strength, sensation and reflexes were normal. VA treatment records from October 2017 documented diminished reflexes (1+), with otherwise normal findings. Additional records from August 2018 showed normal objective findings. While the Board acknowledges the Veteran’s subjective reports of pain and numbness, the minimal objective impairment during this period indicates no more than mild incomplete paralysis. From July 25, 2019, to September 22, 2020, a rating higher than the current 20 percent is not appropriate. The VA examination conducted on that date documented diminished ankle reflexes (1+), with otherwise normal strength, sensation, and knee reflexes. The examiner noted severe paresthesias only, with no constant pain, intermittent pain, or numbness. The overall severity of the Veteran’s radiculopathy was characterized as mild. These findings are consistent with no more than the moderate incomplete paralysis contemplated by the assigned 20 percent rating. An additional VA examination was performed on September 23, 2020. That examination documented slightly diminished strength (4/5), diminished knee reflexes, absent ankle reflexes, diminished sensation in the thigh and knee, and absent sensation in the lower leg and foot. The examiner noted symptoms of moderate intermittent pain, severe paresthesias and severe numbness. Although he characterized the overall severity of the Veteran’s condition as moderate, the Board concludes that it is moderately severe and warrants a 40 percent rating. A higher 60 percent rating is not warranted because there is no marked muscle atrophy present. RLE sciatic nerve radiculopathy prior to January 13, 2017 Initially, the Board notes that, effective from January 13, 2017, the Veteran is service-connected for a RLE neurological disability associated with his right knee replacement. Because this disability is associated with the knee and not the spine, it is not currently on appeal as part and parcel of the rating for the spine. However, the evidence also shows that, prior to January 13, 2017, the Veteran was diagnosed with RLE radiculopathy of the sciatic nerve associated with his lumbar spine disability. However, beyond his subjective reports of pain and numbness, the strength, sensation, and reflexes of the right leg were normal as documented in an August 2010 VA examination and September 2011 outpatient treatment records. A March 2016 DBQ submitted by the Veteran indicated an overall moderate level of severity, but strength was normal. The sensation section of the DBQ is unclear, as the physician who completed it checked multiple contradictory boxes. Ultimately, the Board finds that only mild incomplete paralysis of the sciatic nerve was present, and therefore a 10 percent rating is granted prior to January 13, 2017. Right knee DJD Prior to February 20, 2014, the Veteran is assigned a 10 percent rating under 38 C.F.R. § 4.71a, DC 5260. From April 1, 2015, he is assigned a 30 percent rating under DC 5055. He had a temporary total rating for convalescence during the intervening period. Under DC 5260, a 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. Here, an August 2010 VA examination documented 130 degrees of flexion. No pain was present, and range of motion was unchanged following repetitive testing. This is the only specific measurement of flexion prior to February 20, 2014, and therefore a higher rating under DC 5260 is not warranted for that period. The Board has also considered a separate rating for limitation of extension. Under DC 5261, a 10 percent rating is warranted for extension limited to 10 degrees. However, the August 2010 VA examination documented full extension (0 degrees) without pain. VA treatment records from January 2014 also show full extension. Therefore, a separate rating under DC 5261 is not appropriate prior to February 20, 2014. From April 1, 2015, the Veteran is rated under DC 5055 for his knee replacement. That code provides a minimum 30 percent rating, which is what the Veteran is currently assigned. Intermediate degrees of impairment are to be rated by analogy to DCs 5256, 5261 or 5262. Chronic residuals of severe painful motion or weakness warrant a 60 percent rating. The Board finds that a rating higher than 30 percent is not warranted. First, as discussed above, any weakness in the leg is already rated under the 10 percent rating for right leg radiculopathy. In addition, VA treatment records from June 2019 documented 120 degrees of flexion. A July 2019 VA examination documented full range of motion of the knee, albeit with the presence of pain. However, the examiner specifically noted that only pain, and not “severe painful motion,” was present at the time. In January 2020, VA treatment records documented full extension and 118 degrees of flexion. In sum, the evidence does not establish “severe” painful motion as a residual of the Veteran’s right knee replacement, and the range of motion findings do not correspond to any ratings higher than the current 30 percent. Right knee instability Separate from the Veteran’s range of motion and knee replacement residuals discussed above, the Board finds that a 10 percent rating for right knee instability is warranted prior to February 20, 2014, and from April 1, 2015. Under DC 5257, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability. A 20 percent rating is warranted for moderate recurrent subluxation or lateral instability. A 30 percent rating is warranted for severe recurrent subluxation or lateral instability. According to MERRIAM WEBSTER’S COLLEGIATE DICTIONARY 999 (11th Ed. 2007), “slight” means small in amount. “Moderate” means limited in scope or effect. “Severe” means very painful or harmful or of a great degree. Objective medical evidence is not required to establish lateral knee instability under DC 5257, so objective medical evidence cannot be categorically found more probative than lay evidence with respect to this DC. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). The August 2010 VA examination and September 2012 VA treatment records show the Veteran reported a history of his knee “giving out.” Objective testing at the time noted normal ligament stability. However, in VA records dated January 2020, physical examination noted a “jog” of medial and lateral instability alongside the Veteran’s own report of feeling less stable. The Board finds that the preponderance of the evidence supports a finding of “mild” instability, but no greater. The Board has carefully considered the Veteran’s reports in that regard. English, 30 Vet. App. 347, 352-53. However, overall, the lay and medical evidence indicates that instability symptoms varied and do not suggest the presence of symptoms more nearly approximating moderate severity. Effective February 7, 2021, the rating criteria for DC 5257 were amended. They provide for a higher 20 percent rating for patellar instability when there is a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription for a brace, cane, or walker. In this case, the Board finds that the Veteran’s total knee replacement is a diagnosed condition involving the patellofemoral complex. Moreover, he was prescribed a brace prior to his February 2014 total knee replacement, and subsequent examination reports and treatment records dated through 2019 shown he continued to use it regularly afterwards. Therefore, the revised criteria for a 20 percent rating have been met. A higher 30 percent rating under the revised criteria requires a prescription for a brace and either a cane or walker, but the Veteran was not prescribed these additional ambulatory aids. Left knee DJD The Veteran is currently assigned a 10 percent rating for his left knee under DC 5260. VA examinations and treatment records document flexion of 140 degrees without pain in August 2010, 120 degrees in December 2017, and 140 degrees with pain in July 2019. The most recent finding was obtained during a flare-up of the Veteran’s condition. These findings do not correspond to a higher rating under DC 5260. The same records also all document full extension (0 degrees), which does not correspond to a separate compensable rating under DC 5261. There is no report of left knee instability from the Veteran, and objective testing from August 2010, December 2017 and July 2019 showed normal ligament stability. Therefore, a rating under DC 5257 is not warranted. Left shoulder DJD The Veteran’s left shoulder disability is rated under 38 C.F.R. § 4.71a, DC 5201, for limitation of motion of the arm. He is right-handed, and therefore his left arm is his “minor” arm for rating purposes Under DC 5201, for the minor extremity, limitation of motion of the arm midway between side and shoulder warrants a 20 percent rating, and limitation of motion of the arm to 25 degrees from side warrants a maximum 30 percent rating. 38 C.F.R. § 4.71a, DC 5201. Diagnostic Code 5201 “does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of the arm.” Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013). A rating higher than 20 percent is not warranted in this case. VA examinations from August 2010 and July 2019 documented at least 170 degrees of flexion and abduction, and while the Veteran reported experiencing flare-ups, the July 2019 examiner indicated that the examination was conducted during a flare-up. In addition, outpatient records from September 2010 and December 2015 documented at least 130 degrees of flexion and abduction. Collectively, these measurements greatly exceed the 25 degrees or less of motion required for the higher 30 percent rating. Left ankle DJD Right ankle DJD Because the analysis of the Veteran’s left and right ankle disabilities is identical, they will be discussed together. The Veteran is currently assigned a 10 percent rating for each ankle under 38 C.F.R. § 4.71, DC 5271. Under that code, a 10 percent rating is assigned for “moderate” limitation of motion, and a 20 percent rating is assigned for “marked” limitation of motion. The terms “moderate” and “marked” were not previously defined. However, the rating criteria were recently amended. Effective February 7, 2021, moderate is defined as less than 15 degrees of dorsiflexion or less than 30 degrees of plantar flexion and marked is defined as less than 5 degrees of dorsiflexion or less than 10 degrees of plantar flexion. Normal range of motion of the ankle is 20 degrees of dorsiflexion and 45 degrees of plantar flexion. 38 C.F.R. § 4.71, Plate II. In this case, VA examinations were conducted in August 2020 and July 2019. In each ankle, both examinations documented 20 degrees of dorsiflexion and 45 degrees of plantar flexion, albeit with the presence of pain. However, there was no additional limitation following repetitive testing. While the Veteran reported flare-ups, the July 2019 examiner stated that the examination was being conducted during a flare-up. Right elbow tendonitis The Veteran is currently assigned a 10 percent rating for his right elbow under 38 C.F.R. § 4.71a, DC 5206. That code addresses limitation of flexion of the forearm. A higher 20 percent rating requires flexion limited to 90 degrees. Normal range of motion of the forearm is 0 degrees extension to 145 degrees of flexion. 38 C.F.R. § 4.71, Plate I. However, an August 2010 VA examination documented 124 degrees of flexion, and a July 2019 VA examination documented normal flexion (145 degrees). These measurements were unchanged with repetitive testing, and while the Veteran reported flare-ups, the July 2019 VA examiner indicated that the examination occurred during a flare-up. Therefore, a higher rating under DC 5206 is not warranted. DC 5207 addresses limitation of extension. A 10 percent rating requires extension limited to 45 degrees. The two VA examinations both documented full extension (0 degrees). Therefore, a separate rating under DC 5207 is not warranted. Left plantar fasciitis The Veteran is currently assigned a 10 percent rating under DC 5299-5284. DC 5284 addresses other foot injuries not listed under other codes. Ratings of 10, 20 and 30 percent are assigned for moderate, moderately severe, and severe foot injuries. As noted, descriptive terms such as moderate or severe are not defined in the rating schedule. Nevertheless, the Board finds that a higher rating is not warranted. Outpatient records from August 2010 noted left heel pain which moderately limited activities, and tenderness and swelling were present on examination. An August 2010 VA examination noted a history of pain and lack of endurance while standing, and tenderness on examination. The Veteran received orthotic inserts in November 2017, and additional VA treatment records noted pain on palpation in December 2018 and February 2019. A July 2019 VA examination documented constant pain which was accentuated on use, and that orthotics provided relief. Because the evidence documents pain and tenderness with moderate limitations on activity, the Board finds that the Veteran’s left foot disability is no more than moderate in severity. Effective February 7, 2021, the rating criteria were amended to include DC 5285, which specifically addresses plantar fasciitis. It provides a 20 percent rating for unilateral plantar fasciitis not relieved by non-surgical and surgical treatment. Otherwise, a 10 percent rating is assigned. Note (2) of the code states that this 20 percent rating can be satisfied if surgery is recommended but a claimant is not a surgical candidate. Under these revised criteria, a higher rating is not warranted because the Veteran has not undergone surgery, or otherwise been recommended for surgery, for his left foot. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shamil Patel, 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.