Citation Nr: 21022485 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 16-09 005 DATE: April 15, 2021 ORDER Service connection for right ear hearing loss is granted. A compensable rating for left ear hearing loss is denied. A rating higher than 20 percent prior to November 13, 2014, for lumbar spine disability is denied. A 60 percent rating, but no higher, for the period beginning November 13, 2014, for lumbar spine disability is granted. Service connection for bladder dysfunction is granted. Service connection for bowel dysfunction is granted. A 10 percent rating prior to July 2, 2020, for right hip limitation of extension is granted. A 10 percent rating prior to July 2, 2020, for left hip limitation of extension is granted. A compensable rating for right hip limitation of flexion is denied. A 20 percent rating for left hip limitation of flexion is granted. A rating higher than 10 percent prior to July 2, 2020, and higher than 20 percent thereafter for right hip impairment is denied. A 10 percent rating, but no higher, prior to July 2, 2020, for left hip impairment is granted. A 20 percent rating as of July 2, 2020, for right ankle strain is granted. A 20 percent rating as of July 2, 2020, for left ankle strain is granted. A compensable rating for bilateral flat feet is denied. A rating higher than 10 percent for right knee limitation of flexion is denied. A rating higher than 10 percent for left knee limitation of flexion is denied. A rating higher than 20 percent for a right shoulder disability is denied. A rating higher than 10 percent for a right elbow bursitis/limitation of flexion is denied. A rating higher than 10 percent for tension headaches is denied. FINDINGS OF FACT 1. Resolving reasonable doubt in favor of the Veteran, his right ear hearing loss is related to his active duty service. 2. The weight of the probative evidence shows that the Veteran's left ear hearing loss is manifested by no worse than Level I hearing acuity in the left ear. 3. Prior to November 13, 2014, the Veteran’s lumbar spine showed flexion, at worst, to 65 degrees; as of November 13, 2014, the Veteran’s lumbar spine caused incapacitating episodes over the prior 12 months which required bed rest for a period of at least 6 weeks; at no time was ankylosis shown. 4. The Veteran’s bladder and bowel dysfunction are related to his service connected lumbar spine disability. 5. Resolving all reasonable doubt in favor of the Veteran, prior to July 2, 2020, his right and left hip limitation of extension more closely approximates a limitation to 5 degrees. 6. The preponderance of the evidence is against finding that Veteran's right hip had limited flexion to 45 degrees or less. 7. Resolving all reasonable doubt in favor of the Veteran, his left hip limitation of flexion more closely approximated a limitation to 30 degrees. 8. For the period prior to July 2, 2020, the Veteran’s right hip was not shown to have motion lost beyond 10 degrees. 9. Prior to July 2, 2020, the Veteran’s left hip more closely approximated being unable to toe out more than 15 degrees; has motion lost beyond 10 degrees was not shown. 10. As of July 2, 2020, the Veteran’s right and left ankle strain more closely approximated a marked limitation of motion. 11. The Veteran's bilateral flatfeet have not approximated a moderate, severe, or pronounced disability. 12. Throughout the appeal, the Veteran's right knee had flexion at worst to 110 degrees. 13. Throughout the appeal, the Veteran's left knee had flexion at worst to 110 degrees. 14. Throughout the appeal, the Veteran's right shoulder was not limited to midway between his side and shoulder level or 25 degrees from his side. 15. Prior to July 2, 2020, the Veteran’s right elbow demonstrated flexion to 120 degrees and flexion to 100 degrees thereafter. 16. Throughout the appeal, the Veteran’s prostrating headaches did not average once a month or more frequently over the prior several months. CONCLUSIONS OF LAW 1. The criteria for service connection for right ear hearing loss are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.385. 2. The criteria for a compensable rating for left ear hearing loss are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code (DC) 6100. 3. The criteria for a rating higher than 20 percent prior November 13, 2014, for a lumbar spine disability 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 5242-5243. 4. The criteria for a 60 percent rating, but no higher, as of November 13, 2014, for a lumbar spine disability are 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 5242-5243. 5. The criteria for service connection for bowel and bladder dysfunction are 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 5242, Note 1. 6. The criteria for a 10 percent rating for right and left hip limitation of extension prior to July 2, 2020, are 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 5251. 7. The criteria for a compensable rating for right hip limitation of flexion 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 5252. 8. The criteria for 20 percent rating, but no higher, for left hip limitation of flexion are 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 5252. 9. The criteria for a rating higher than 10 percent prior to July 2, 2020, and higher than 20 percent thereafter for a right hip 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 5253. 10. The criteria for a 10 percent rating prior to July 2, 2020, for a left hip impairment are 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 5253. 11. The criteria for a 20 percent rating as of July 2, 2020, for the Veteran's right and left ankle strain are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DCs 5271. 12. The criteria for a compensable rating for bilateral flatfeet are not met. 38 C.F.R. §§ 4.1, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5276. 13. The criteria for a rating higher than 10 percent for limitation of flexion of the right and/or left knee are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5260. 14. The criteria for a rating higher than 20 percent for a right shoulder disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5201. 15. The criteria for a compensable rating prior to July 2, 2020, and higher than 10 percent thereafter for right elbow bursitis/limitation of flexion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DCs 5019-5206. 16. The criteria for a rating higher than 10 percent for tension headaches are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 2008 to September 2012. These matters have previously been remanded by the Board. The regulations pertaining to rating musculoskeletal disabilities were revised, effective February 7, 2021. Claims, such as this, pending prior to the effective date will be considered under both old and new rating criteria from that date, and whichever criteria is more favorable to the Veteran will be applied from that date. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that it was incurred in service. 38 C.F.R. § 3.303 (d). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102, Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Right Ear Hearing Loss For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. At the outset, the Board notes that the Veteran is service connected for left ear hearing loss and bilateral tinnitus. He is a combat veteran, who was exposed to combat related noise and also has a parachutist badge, indicating he was exposed to helicopter and plane noise while in-service. Historically, the Veteran’s right ear hearing loss claim was denied based on his right ear not meeting the statutory definition of hearing loss for VA purposes as defined by 38 C.F.R. § 3.385. See November 2012 rating decision. VA examinations in 2015 and 2020 indicate that the Veteran’s right ear now meets the criteria set forth by § 3.385 for hearing loss for VA purposes. The Veteran has been totally disabled since his 2012 discharge from service and has no noise exposure after his discharge from service. However, VA examiners have not found a link between the Veteran’s right ear hearing loss and his service. A prior Board remand found the 2015 VA examiner’s opinion inadequate for adjudication purposes. Based on the Veteran’s credible reports of diminished hearing since service, a lack of other noise exposure since service, and the established link between the Veteran’s left ear hearing loss and tinnitus to his service, the Board finds that service connection for the Veteran’s right ear hearing loss is warranted. The July 2020 examination based its negative opinion on the Veteran’s normal hearing at separation, which is an impermissible conclusion, and did not address the lack of other noise exposure or other causation for the Veteran’s current hearing loss. See Hensley v. Brown, 5 Vet. App. 155, 157 (1993). The examiner also did not discuss the differentiation between the Veteran’s service connected left ear hearing loss and his right ear hearing loss. As such, the Board does not afford the opinion any probative weight. Furthermore, continuing to seek examinations and opinions regarding the Veteran’s right ear hearing loss runs afoul of the prohibition against seeking to obtain negative evidence. See Mariano v. Principi, 17 Vet. App. 305, 312 (2003). Thus, resolving all reasonable doubt in favor of the Veteran, the Board finds that service connection for the Veteran’s right ear hearing loss is warranted. Increased Ratings Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 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. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a ; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Left Ear Hearing Loss The Veteran’s left ear hearing loss is assigned a noncompensable (0%) rating as of his September 2012 grant of service connection under DC 6100. Evaluations of defective hearing range from 0 percent to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, DC 6100. To evaluate the degree of disability from bilateral hearing loss, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII. As the Veteran was service connected for right ear hearing loss, above, the Board will consider the hearing levels in both of the Veteran’s ears for purposes of his left ear hearing loss.   A VA examination in December 2015 recorded the Veteran’s hearing loss pure tone thresholds, in decibels, as: HERTZ 500 1000 2000 3000 4000 RIGHT 10 10 20 40 55 LEFT 5 10 25 60 65 His speech discrimination score at that time was 92 percent for the both ears. Under Table VI, this corresponds to a hearing level of I in both of his ears, which under Table VII, corresponds to a non-compensable rating. The examination in June 2020 documented the Veteran’s hearing levels. At that time, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 RIGHT 15 30 35 50 65 LEFT 20 15 35 65 70 His speech discrimination score at that time was 100 percent for the right ear and 92 percent for the left ear. Under Table VI, this corresponds to a hearing level of I in both of his ears, which, under Table VII, corresponds to a non-compensable rating. There are no other medical records of evidence which address the severity of the Veteran’s hearing loss. In sum, the objective testing of record does not show that a compensable rating is warranted for the Veteran’s left ear hearing loss. During his VA examinations, the Veteran reported functional impairment such as difficulty hearing conversations. However, these impairments are inherently part of the rating assigned to his hearing loss disability. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). There is no indication that his hearing loss results in any symptoms or functional impairment not contemplated by the rating schedule, and therefore there is no basis upon which a higher rating can be assigned. Based on the foregoing, a compensable rating for left ear hearing loss is denied. Lumbar spine The Veteran's lumbar spine disability was assigned a 20 percent rating prior to November 13, 2014, under DC 5243, for intervertebral disc syndrome (IVDS), and a 40 percent rating under DC 5242, limitation of flexion, as of November 13, 2014. DC 5243 provides that IVDS is to be rated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. The 2021 revisions mandate that the IVDS DC only be assigned when there is disc herniation with compression and/or irritation of the adjacent nerve root. As the criteria prior to the 2021 revisions are more favorable to the Veteran, those criteria will be applied. The Formula for Rating IVDS Based on Incapacitating Episodes provides that a 40 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes. Note 1 to Diagnostic Code 5243 provides that, for purposes of ratings under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. DC 5242 assigns a 40 percent rating 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 rating is warranted for unfavorable ankylosis of the entire spine. See 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to bowel or bladder impairment, are to be evaluated separately under an appropriate DC. Id. at Note 1. Prior to the Veteran’s November 13, 2014, VA examination, there is no evidence that his lumbar spine either caused incapacitating episodes having a total duration of 4 weeks or more or that his forward flexion was limited to 30 degrees or less – either of which is required for a rating higher than 20 percent. The Veteran’s VA examination showed that his forward flexion was to 65 degrees. See 2011 VA examination. His private medical records document pain and flare-ups, as does his 2011 examination, but there is no indication that the Veteran’s range of motion was further limited to an approximation of 65 degrees or less of forward flexion or that he had periods of doctor prescribed bed rest of 4 weeks or more. However, as of his 2014 VA examination, the Veteran’s IVDS was noted to have caused 6 weeks or more of bed rest in the 12 months prior – which warrants a 60 percent rating. Thus, as of November 13, 2014, the Veteran’s lumbar spine is granted a 60 percent rating. The only higher available rating is a 100 percent rating for ankylosis of the entire spine – which has not been documented. The Board has considered the lay statements of evidence regarding the Veteran’s lumbar spine disability prior to November 13, 2014, and has concluded that the medical evidence, prepared by skilled professionals, is more probative regarding the Veteran’s degree of disability. Furthermore, the Board notes that the Veteran consistently reported that he suffered from bladder and bowel problems as a result of his lumbar spine disability. Multiple private medical records and his VA examinations of his lumbar spine have documented these associated complications. As such, the Board finds that service connection for bladder dysfunction and bowel dysfunction as due to the Veteran’s lumbar spine disability is warranted. Bilateral Hips The Veteran is in receipt of multiple ratings for his bilateral hip disabilities pursuant to DCs 5251-5253. The average normal range of motion of the hip is flexion from 0 to 125 degrees and abduction from 0 to 45 degrees. 38 C.F.R. § 4.71, Plate II. At the outset, as to other potentially applicable diagnostic codes pertaining to the hip, the record does not contain evidence of ankylosis, femur fracture or flail joint; therefore, ratings under DCs 5250, 5254, or 5255 are not appropriate at any time during the rating period. 38 C.F.R. § 4.71a. Additionally, the rating criteria addressing the Veteran’s bilateral hip disabilities (i.e. DCs 5251-5253) were not subject to the 2021 revisions. Hip Limitation of Extension DC 5251 provides a sole 10 percent rating for extension of the thigh limited to 5 degrees. The Veteran’s right and left hip limitation of extension under DC 5251 are assigned noncompensable ratings as of his September 16, 2012, grant of service connection and 10 percent ratings as of July 2, 2020. After review of the evidence the Board finds that a 10 percent rating prior to July 2, 2020, is warranted. The Veteran’s pre-discharge examination noted that his hip extension was limited to 15 degrees; however, the examiner noted the Veteran reported flare-ups which were severe, occurred multiple times a day, and reduced his range of motion a significant degree. See August 2011 VA examination. The examination did not provide an estimate on the additional limitation of motion of the Veteran’s hip extension during a flare-up. Based on the Veteran’s credible reports of pain and flare-ups, the Board finds it reasonable to assume the Veteran’s extension range of motion of the right and left hip would be restricted to 5 degrees. Thus, the Veteran’s right and left hip limitation of extension each warrant a 10 percent rating as of his September 2012 grant of service connection. As the 10 percent is the maximum allowed, there is no legal basis upon which to award a higher rating for limitation of extension of the right or left hip. See Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006); Sabonis v. Brown, 6 Vet. App. 426 (1994). Hip Limitation of Flexion DC 5252 provides for a 10, 20, 30, or 40 percent rating for flexion of the thigh limited to 45, 30, 20, or 10 degrees, respectively. The Veteran’s right hip is assigned a non-compensable rating under DC 5252 and his left hip is assigned a 10 percent rating as of his September 2012 grant of service connection. After review of the record, the Board does not find that any evidence supports a compensable rating for the Veteran’s right hip limitation of flexion. Throughout the appeal period the Veteran’s at-worst limitation of flexion was recorded as 55 degrees, which was his limitation during a flare-up. See July 2020 VA examination. The Veteran’s at worst range of motion which approximated his credible reports of pain and additional limitation during flare-ups was outside the 45 degree limitation of flexion required by the rating criteria to assign a compensable rating. There are no records of evidence which indicate that the Veteran’s right hip limitation of flexion was more severe than evidence in the July 2020 VA examination or that showed his flexion was limited to 45 degrees or less. Thus, there is no basis upon which a compensable rating for limitation of flexion can be granted. A compensable rating for right hip limitation of flexion is denied. As to the Veteran’s left hip, his pre-discharge VA examination found that his flexion was limited to 35 degrees. See August 2011 VA examination. Again, the Veteran reported flare-ups which were described as severe, occurring multiple times a day, and interfered with his range of motion. Based on the Veteran’s credible reports of pain flare-ups, the Board finds it reasonable to assume the Veteran’s flexion range of motion of the left hip would be restricted to 30 degrees, which warrants a 20 percent rating as of his September 2012 grant of service connection. Other medical evidence of record does not show that the Veteran’s left hip limitation of flexion was such that a rating higher than 20 percent is warranted. His August 2011 examination was his at-worst limitation of flexion and his reports of pain and flare-ups, while credible, do not show a more close approximation of a limitation of flexion to 20 degrees or less, which the rating criteria mandates for a rating higher than 20 percent. Hip Impairment of the Thigh DC 5253 provides for a 10 percent rating where there is impairment of the thigh, resulting in limitation of rotation of the affected leg, such that he cannot toe-out more than 15 degrees, or there is a limitation of abduction such that the Veteran cannot cross his legs. A 20 percent rating is warranted where impairment of the thigh causes limitation of abduction of motion lost beyond 10 degrees. 38 C.F.R. § 4.71a. The Veteran’s right hip is assigned a 10 percent rating as of his September 2012 grant of service connection and a 20 percent rating as of his July 2020 VA examination under DC 5253. The Veteran’s left hip is assigned a 20 percent rating as of his July 2020 VA examination. As with the limitation of extension, a 20 percent rating under DC 5253 is the maximum rating allowed. Thus, ratings higher than 20 percent as of July 2, 2020, have no legal basis. For the period prior to July 2, 2020, the Board finds that the Veteran’s right hip was not shown to have motion lost beyond 10 degrees. The Veteran’s VA examinations prior to July 2, 2020, show his at worst abduction to be 40 or 45 degrees. See August 2011 and December 2015 VA examinations. Even considering the Veteran’s reports of pain and flare-ups, his range of motion was well outside the range for a rating higher than 10 percent. There are no records of evidence prior to the July 2020 VA examination which indicate the Veteran’s right hip had limitation of abduction motion lost beyond 10 degrees, which is required by the rating criteria. As such a rating higher than 10 percent prior to July 2, 2020, is denied. As to the Veteran’s left hip, the Board does find that a 10 percent rating prior to July 2, 2020, is warranted. An April 2013 VA medical record showed the Veteran was not able to frog leg out. The Board finds that this approximates that the Veteran was unable to toe out more than 15 degrees. Thus, resolving all doubt in the Veteran’s favor, a 10 percent rating as of his September 2012 grant of service connection is warranted. As with the Veteran’s right hip, however, there is no evidence which shows that the Veteran’s left hip prior to July 2, 2020, had motion lost beyond 10 degrees. His 2011 and 2015 VA examinations show his abduction to 35 and 45 degrees, respectively. Thus, a rating higher than 10 percent prior to July 2, 2020, is denied. Bilateral Ankle Strain The Veteran’s bilateral ankles are each assigned a 10 percent rating as of his September 12, 2012, grant of service connection pursuant to DC 5271. Under DC 5271, a maximum rating of 20 percent is warranted where the limitation of motion in the ankle is marked. Normal ankle motion is dorsiflexion to 20 degrees, and plantar flexion to 45 degrees. 38 C.F.R. § 4.71a, Plate II. The 2021 revisions defined a marked limitation of motion to be less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. After review of the record, the Board does not find that the evidence of record supports a rating higher than 10 percent for the Veteran’s right or left ankle strain prior to July 2, 2020. Prior to the July 2020 VA examination, the Veteran’s at worst range of motion was found to be normal. See August 2011 and December 2015 VA examinations. In his August 2011 pre-discharge examination, the Veteran denied pain and flare-ups in either ankle and his range of motion was normal in both ankles. Though he did report pain and flare-ups in his December 2015 examination, the Veteran’s report of his functional loss during a flare-up was a lack of endurance. Additionally, the December 2015 examination did not note any reduction in the Veteran’s range of motion with repeated use. The rating criteria require a marked limitation of motion to support a rating higher than 10 percent. The Board does not find that such a limitation of the Veteran’s bilateral ankle motions is documented in the record prior to July 2, 2020, even considering the Veteran’s credible reports of pain and flare-ups. However, as of the July 2, 2020, VA examination, the Board does find that the Veteran’s right and left ankles more closely approximated a marked limitation of motion. At that time, the Veteran’s dorsiflexion was found to be 5 degrees during a flare-up. The Board finds that this limitation of motion though not the requirement under the 2021 revisions, does satisfy the marked limitation of motion prior to the 2021 revisions. As such, a 20 percent rating for the Veteran’s right and left ankles as of July 2, 2020, is warranted. Flatfeet The Veteran's bilateral flatfeet is assigned a noncompensable rating as of his September 12, 2012, grant of service connection pursuant to DC 5276. 38 C.F.R. § 4.71a. The rating criteria addressing the Veteran’s bilateral flatfeet (DC 5276) was not subject to the 2021 revisions. DC 5276 provides for a non-compensable evaluation for pes planus with mild symptoms such that are relieved by a built-up shoe or arch support. A 10 percent evaluation is warranted for moderate symptoms such as the weight-bearing line over or medial to the great toe, inward bowing of the tendo Achilles, or pain on manipulation and use of the feet, either bilateral or unilateral. A 30 percent evaluation is warranted for bilateral severe symptoms such as objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, or characteristic callosities. The maximum schedular evaluation of 50 percent is warranted for bilateral pronounced symptoms such as marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achilles on manipulation, or symptoms not improved by orthopedic shoes or appliances. After review of the evidence, the Board does not find that the Veteran’s flatfeet meet the criteria for a compensable rating. His July 2020 VA examination noted the most severe symptoms of the Veteran’s flatfeet as: extreme tenderness of plantar surfaces, decreased longitudinal arch height, marked pronation, and weight bearing line falling over or medial to great toe. The Veteran did not exhibit swelling on use, calluses, lower extremity deformity, inward bowing, or marked inward displacement and severe spasm of the achilles tendon. See July 2020 VA examination. The Veteran’s August 2011 and December 2015 VA examination also did not show that the Veteran’s feet had swelling on use, calluses, lower extremity deformity, inward bowing, or marked inward displacement and severe spasm of the achilles tendons. Thus, the Veteran’s bilateral flatfeet has not met the rating criteria for a compensable rating at any time during the course of the appeal. The criteria mandate at least one of the symptoms of swelling on use, calluses, lower extremity deformity, inward bowing, or marked inward displacement and severe spasm of the achilles tendon to warrant a compensable rating and without evidence of any such of these symptoms there is no basis upon which the Board can grant a compensable rating at any time. The Board has considered the lay statements of evidence and has concluded that the medical evidence, prepared by skilled professionals, is more probative regarding the Veteran’s degree of disability. As such, a compensable rating for bilateral flatfeet is denied. Bilateral Knees The Veteran's right and left knee are assigned 10 percent ratings under DC 5260 since his September 12, 2012, grand of service connection. DC 5260 provides for a 20 percent rating with flexion limited to 30 degrees; and the highest available 30 percent rating with flexion limited to 15 degrees. DC 5260 was not subject to the 2021 revisions. Normal extension of the knee is to 0 degrees and normal flexion of the knee is to 140 degrees. 38 C.F.R. § 4.71a, Plate II. After review of the record, the Board does not find that the evidence supports a rating higher than 10 percent for either the Veteran’s right or left knee disabilities. A rating higher than 10 percent is only available to the Veteran if his right knee shows limitation of flexion to 30 degrees or less. Throughout the period on appeal, the Veteran’s range of motion has been either normal or at worst 0-110 degrees of extension to flexion. See July 2020 VA examination. Thus, even considering the Veteran’s documented and credible reports of flare-ups and functional loss, his range of motion is outside of the range provided for a rating higher than 10 percent. There are no records which support a finding that the Veteran’s bilateral knee ranges of motion were limited to flexion of 30 degrees or less or that any pain or flare-up more closely approximated such a limitation. The Board has considered the lay statements of evidence and has concluded that the medical evidence, prepared by skilled professionals, is more probative regarding the Veteran’s degree of disability. As such, ratings higher than 10 percent for the Veteran’s right and left knee limitation of flexion are denied. There is no doubt or reasonable doubt to resolve to the Veteran's benefit or in his favor as the evidence of record does not support a higher rating. Separate evaluations under other potentially applicable diagnostic codes have been considered. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). The evidence of record does not show that the Veteran has other such impairments that additional ratings pursuant to DCs 5256-5259 and 5261-5263 are warranted. Right shoulder The Veteran's right shoulder is assigned a 20 percent rating under DC 5201 since his grant of service connection. DC 5201 provides that limitation of motion of the arm from midway between the side and shoulder level warrants a 30 percent rating for a major extremity. Limitation of motion to 25 degrees from the side warrants a 40 percent rating for a major extremity. 38 C.F.R. § 4.71a. The 2021 revisions stated that a limitation midway between the side and the shoulder approximated flexion and/or abduction limited to 45 degrees. The Veteran's right shoulder is his major extremity. Normal range of motion of the shoulder is flexion and abduction from 0 to 180 degrees, and internal and external rotation each to 90 degrees. 38 C.F.R. § 4.71, Plate I. Abduction is the motion of lifting the arm from the side, with 0 degrees representing the arm at the side and 90 degrees representing the arm at the shoulder level. 38 C.F.R. § 4.71a, Plate I. 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). In order for the Veteran to merit a rating higher than 20 percent, his right shoulder must show limitation of motion of the arm from midway between the side and shoulder level or limitation of motion to 25 degrees from the side, or under the revisions flexion and/or abduction limited to a minimum of 45 degrees. After review of the record, the Board does not find that the evidence of record supports a rating higher than 20 percent for the Veteran's right shoulder disability. The Veteran's documented range of motion throughout the appeal and his own statements indicated that his pain prevented him from working above his shoulder; the records do not show and the Veteran has not reported that pain or limitations prevent him from motion of the right shoulder midway between his side and shoulder level or to 25 degrees from his side. His at worst range of motion, as documented in his January 2018 VA examination, found flexion to 110 degrees and abduction to 88 degrees. Thus, the Veteran was not shown to have a limitation of his shoulder mobility to his side – which is mandated for a rating higher than 20 percent. Additionally, his flexion and abduction ranges of motion were well outside the provided limitations necessary to mandate a rating higher than 20 percent. The Board has considered the lay statements of evidence and has concluded that the medical evidence, prepared by skilled professionals, is more probative regarding the Veteran’s degree of disability. There is no doubt or reasonable doubt to resolve to the Veteran's benefit or in his favor as the evidence of record does not support a higher rating. Increased evaluations under other potentially applicable diagnostic codes have been considered. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). The evidence of record does not show that the Veteran has other such impairments that additional ratings pursuant to DCs 5208-5213 are warranted. 38 C.F.R. §§ 4.7, 4.71a. Right Elbow The Veteran’s right elbow is assigned multiple ratings since his September 16, 2012, grant of service connection. Under DCs 5019-5206, the Veteran was assigned a 10 percent rating as of his July 2, 2020, VA examination and a noncompensable rating (0%) prior to that. Under DC 5213, the Veteran was assigned a 10 percent rating as of his grant of service connection. The Veteran's right elbow is his major extremity. DC 5019 directs bursitis to be rated under the limitation of motion of the affected part. Pursuant to DC 5206, limitation of forearm flexion, for the dominant (major) arm, a noncompensable rating is assigned for flexion limited to 110 degrees, a 10 percent rating is assigned for either arm with flexion limited to 100 degrees, and a 20 percent rating is assigned for either arm with flexion limited to 90 degrees. DCs 5019 and 5206 were not subject to the 2021 revisions. Normal range of motion of the elbow is from 0 degrees of extension to 145 degrees of flexion. Normal pronation of the forearm is to 80 degrees of pronation and 85 degrees of supination. 38 C.F.R. § 4.71, Plate I. As to the Veteran’s limitation of flexion, the Board does not find that compensable rating prior to July 2, 2020, or a rating higher than 10 percent thereafter is supported by the record. The Veteran’s elbow demonstrated normal range of motion in his 2011 VA examination and flexion to 120 degrees in his December 2015 VA examination. Thus, though the Veteran did report flare-ups, his documented ranges of motion were not estimated to be flexion limited to 100 degrees or less, which was required for a compensable rating. Even considering the Veteran’s flare-ups, an approximation of flexion limited to 100 degrees or less was not shown by the record. Thus, a compensable rating prior to July 2, 2020, is not supported by the record. As of the July 2, 2020, VA examination, the Veteran’s limitation of flexion was noted to be, at worst after repeated use over time to be flexion to 100 degrees. A higher rating, then, is not warranted. The Veteran denied flare-ups, so further consideration of reduction of flexion is not documented by the record. Thus, the 10 percent rating assigned to the Veteran takes into consideration his functional limitations and any pain, fatigability or incoordination the Veteran's flexion limitation may cause. There are no records of evidence which document that the Veteran’s right elbow range of motion was limited to flexion less than 100 degrees, which is necessary for a rating higher than his currently assigned 10 percent as of July 2, 2020. The Board has considered the lay statements of evidence and has concluded that the medical evidence, prepared by skilled professionals, is more probative regarding the Veteran’s degree of disability. There is no doubt or reasonable doubt to resolve to the Veteran's benefit or in his favor as the evidence of record does not support a higher rating. Headaches The Veteran’s headaches are assigned a 10 percent rating under DCs 8199-8100 as of the September 2012 date of service connection. DC 8100 assigns a 30 percent rating for characteristic prostrating attacks averaging once a month over the last several months; and a 50 percent rating for very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. The rating criteria of DC 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). The phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under DC 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as "extreme exhaustion or powerlessness." Thus, the phrase "characteristic prostrating attacks" is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness. There is no evidence of record which established that the Veteran’s headaches approximated characteristic prostrating attacks averaging one or more a month or that were productive of severe economic inadaptability. The Board notes that the Veteran reported 30 headaches per month, with 9 noted as prostrating in his August 2011 VA examination. However, there are no clinical findings which support that the Veteran was experiencing 9 prostrating headaches per month. Additionally, the 2011 examination found that the Veteran’s headaches had no effect on occupation. Indeed, in May and July 2013, October 2014, and May 2015, the Veteran denied having headaches. See May and July 2013, October 2014, and May 2015 VA medical records. A June 2014 VA medical record showed the Veteran reported headaches 3 times a week which was described as a heart pounding sensation. The Veteran’s December 2015 and September 2019 VA examinations found the Veteran did not have characteristic prostrating attacks of migraine pain. Thus, though the Veteran might have opined that his headaches were prostrating, there is no objective clinical evidence which indicated that the Veteran was suffering from such attacks with such frequency to support a rating higher than 10 percent throughout the period on appeal. The Board has considered the lay statements of evidence and has concluded that the medical evidence, prepared by skilled professionals, is more probative regarding the Veteran’s degree of disability. There is no doubt or reasonable doubt to resolve to the Veteran's benefit or in his favor as the evidence of record does not support a higher rating. A rating higher than 10 percent for the Veteran’s headaches is denied. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Parrish, 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.