Citation Nr: 21022689 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 16-25 935 DATE: April 19, 2021 ORDER Entitlement to a rating in excess of 20 percent for degenerative disc disease, lumbar spine is denied. Entitlement to a rating in excess of 10 percent for left ankle strain is denied. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran’s degenerative disc disease, lumbar spine was manifested by forward flexion of the lumbar spine greater than 30 degrees but not greater than 60 degrees even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, swelling, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without ankylosis, intervertebral disc syndrome, right lower extremity nerve impairment, bowel or bladder impairment. 2. Throughout the appeal period, the Veteran’s left ankle strain is manifested by no more than moderate limited motion of the ankle even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, swelling, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis of the ankle or subastragalar or tarsal joint, malunion of os calcis or astragalus, or an astragalectomy. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for degenerative disc disease, lumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.40, 4.59, 4.71a, Diagnostic Code 5242. 2. The criteria for a rating in excess of 10 percent for left ankle strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.40, 4.45, 4.71a, Diagnostic Code 5271. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1992 to January 2014. These matters come before the Board of Veteran’s Appeals (Board) on appeal from a February 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In a November 2018 rating decision, the RO increased the rating for the left ankle strain from zero percent to 10 percent disabling. In a March 2019 decision, the Board remanded these matters to the RO for further development. More specifically, the Board directed the RO to schedule the Veteran for examinations that included measurements for active and passive motion, weight-bearing and non-weight bearing, and remarks that discussed the Correia v. McDonald, 28 Vet. App. 158, 169-70 (2016) compliance and to obtain relevant treatment records. Such examinations were conducted in December 2019. Updated VA treatment records have been associated with the record and an October 2019 letter requested that the Veteran identify outstanding treatment records related to the instant claims. The Board therefore finds that there has been substantial compliance with its previous remand. Stegall v. West, 11 Vet. App. 268 (1998). In July 2020, the RO issued a rating decision increasing the rating for the degenerative disc disease, lumbar spine from 10 percent to 20 percent disabling but continued the rating for left ankle strain at 10 percent. However, because the increases do not represent a total grant of the benefits sought on appeal, the claims for increase remain on appeal. AB v. Brown, 6 Vet. App. 35 (1993). In Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court of Appeals for Veterans Claims (Court) held that a claim for a total disability rating due to individual unemployability (TDIU) is part of a rating claim when such claim is expressly raised by the Veteran or reasonably raised by the record. In this case, the record does not reflect, and the Veteran does not allege, that he is unemployable due to degenerative disc disease, lumbar spine or his left ankle strain. The Veteran reported that he worked as a budget analyst in a December 2019 VA examination report. Therefore, the Board finds that a TDIU is not raised by the Veteran or reasonably raised by the record in connection with his initial rating claim decided herein and, consequently, no further consideration of such is necessary at this time. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disabilities resulting from all types of diseases and injuries encountered because of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. Separate ratings can be assigned for separate periods based on the facts found, a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The court has instructed that in applying these regulations VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. Mitchell v. Shinseki, 25 Vet. App. 32 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board notes that effective February 7, 2021, the criteria for schedule of ratings for the musculoskeletal system was revised. See 86 Fed. Reg. 8142 (Feb. 4, 2021) (codified at 38 C.F.R. pt. 4). In the instant case, the claims file is absent any medical evidence submitted or associated with the claims file subsequent to the revised rating effective date of February 7, 2021. Therefore, the February 2021 musculoskeletal criteria do not apply to the Veteran’s claims on appeal; and the appropriate criteria is discussed below. The Board also notes that the February 7, 2021 musculoskeletal amendments presented no changes to the rating criteria for Diagnostic Code 5242. In other words, Diagnostic Code 5242 is the same both prior to and after February 7, 2021. Compare 38 C.F.R. § 4.71a (December 29, 2020) with 38 C.F.R. § 4.71a (February 7, 2021). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to a rating in excess of 20 percent for degenerative disc disease, lumbar spine is denied. The Veteran contends that his current degenerative disc disease, lumbar spine is worse than evaluated, causing pain and an inability to sit or walk for prolonged periods of time. See December 2019 VA examination. The Veteran's service-connected degenerative disc disease, lumbar spine is currently evaluated as 20 percent disabling under Diagnostic Code 5242. VA regulations provide that spine disabilities are rated under either the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, under Diagnostic Code 5243, whichever would result in a higher rating. 38 C.F.R. § 4.71a. As Diagnostic Codes 5242 and 5243 contain successive criteria, the criteria for the lower rating must be met before a higher disability rating may be awarded. A higher rating cannot be granted based on a finding that the Veteran's disability picture more nearly approximates the criteria for the next higher rating. However, reasonable doubt regarding the presence of a criterion may be resolved in the Veteran's favor. See Johnson v. Wilkie, 30 Vet. App. 245 (2018). Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent rating is warranted for forward flexion of the thoracic spine greater than 30 degrees, but not greater than 60 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 30 percent rating is warranted for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 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. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided are the maximum that can be used for calculation of the combined range of motion. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 20 percent rating is assigned when intervertebral disc syndrome causes incapacitating episodes with a total duration of at least 2 weeks, but less than 4 weeks, during a 12 month period; a 40 percent rating is assigned when intervertebral disc syndrome causes incapacitating episodes having a total duration of at least 4 weeks, but less than 6 weeks, during a 12 month period; and a 60 percent rating is assigned when intervertebral disc syndrome causes incapacitating episodes having a total duration of at least 6 weeks during a 12 month period. 38 C.F.R. § 4.71a. An incapacitating episode is defined by regulation as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a. In the January 2014 VA examination, the examiner noted the Veteran had flare ups monthly for two to 10 days at a time. His forward flexion was up to 80 degrees, his extension to 20 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degree, right lateral rotation to 20 degrees and left lateral rotation to 20 degrees. There was no objective evidence of painful motion, no localized tenderness and pain on palpation, and no muscle spasm or guarding of the spine resulting in abnormal gait or spinal contour. There also was no ankylosis of the spine that resulted in abnormal gait or spinal contour. There was no intervertebral disc syndrome, but were neurological abnormalities in the form of mild radiculopathy. In the October 2018 VA examination, the examiner noted that the Veteran reported mild to moderate stabbing lower back pain, in which he self-medicated with Motrin or Tylenol. The Veteran’s range of motion measured abnormal. His forward flexion was up to 75 degrees, his extension to 30 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30 degree, right lateral rotation to 30 degrees and left lateral rotation to 30 degrees. There was no pain on weight bearing, but there was mild tenderness with palpation over the center lumbar spine. There was no pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time and no flareups. There was no guarding or muscle spasm of the thoracolumbar spine, no radiculopathy and no ankylosis of the spine. Also, there was no neurologic abnormalities and no intervertebral disc syndrome. The Veteran used an assistive device in the form of a brace occasionally. Pain on passive range of motion was not tested and no evidence of pain on non-weight bearing. It was noted that the Veteran occasionally used a cane for assistance. In the March 2019 decision, the Board found the October 2018 examination inadequate because it did not test for pain on both active and passive motion, in weight-bearing and non-weight bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, supra. Furthermore, since the examination was not conducted during a flare-up, the examiner did not address the Veteran's report of flare-ups and the severity, frequency, duration, precipitating and alleviating factors, and the extent of functional impairment during flare-ups. See Sharp v. Shulkin, 29 Vet. App. 26 (2017), DeLuca v. Brown, 8 Vet. App. 202 (1995). In the December 2019 VA examination, the examiner noted that the Veteran reported his back hurts when he bends over, if he sits for more than 30 to 45 minutes and if he is standing still for more than 10 minutes. His forward flexion was up to 60 degrees, his extension to 18 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degree, right lateral rotation to 25 degrees and left lateral rotation to 25 degrees. There was no evidence of pain with weight bearing and non-weight bearing, as well as, no localized tenderness or pain on palpation of joints. There was guarding or muscle spasms, but not resulting in abnormal gait or abnormal spinal contour. There was no ankylosis, no muscle atrophy, and no intervertebral disc syndrome of the thoracolumbar spine, along with no neurologic abnormalities. However, the examiner noted that pain, weakness, fatigability or incoordination significantly limited the back’s functional ability with flareups. The Veteran’s range of motion reduced to a flexion up to 40 degrees, extension to 15 degrees, right lateral flexion to 15 degrees, left lateral flexion to 15 degree, right lateral rotation to 20 degrees and left lateral rotation to 20 degrees. No further loss of range of motion was noted after three repetitions during the examination. Pain on passive range of motion could not be tested because it could have increased the risk of further injury. Moreover, it was noted that the Veteran occasionally used a cane for assistance. VA treatment records have also been associated with the Veteran’s claims file. In summary, these records reflect the Veteran complained of back pain for which he had ongoing treatment. The Board finds that a rating in excess of 20 percent under the General Rating Formula is not warranted for the Veteran's degenerative disc disease, lumbar spine. In this regard, the record fails to show that forward flexion of the thoracolumbar spine is limited to 30 degrees or less, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. A January 2014 VA examination found forward flexion to be 80 degrees with pain and that there was no additional loss of function on range of motion testing and the December 2019 VA examination found forward flexion to be up to 40 degrees with pain. Here, the VA treatment records and VA examinations do not reveal additional functional impairment, including additional limitation of motion, on account of pain, weakness, etc, that is not already contemplated by the assigned 20 percent rating. 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca, supra. Thus, a higher rating is not warranted for the Veteran's degenerative disc disease, lumbar spine even in consideration of painful motion and other factors such as weakness, fatigability, lack of endurance, and incoordination. Moreover, there was no ankylosis. Therefore, a rating in excess of 20 percent is not warranted. Furthermore, as the evidence fails to show that the Veteran has intervertebral disc syndrome with incapacitating episodes resulting in bed rest ordered by a physician at any point pertinent to the appeals period, a higher or separate rating is not warranted under the intervertebral disc syndrome Rating Formula. In addition to considering the orthopedic manifestations of a back disability, VA regulations also require that consideration be given to any associated objective neurologic abnormalities, which are to be evaluated separately under an appropriate diagnostic code. However, the Veteran has not alleged, and the evidence does not show, that he has bladder impairment, bowel impairment or right lower extremity nerve impairment as a result of his service-connected degenerative disc disease, lumbar spine. Moreover, the Veteran is already in receipt of separate ratings for left lower extremity sciatica. Therefore, the Board finds that, at no time during the appeal period, has the Veteran's service-connected degenerative disc disease, lumbar spine resulted in neurological impairment of the bowel or bladder warranting an additional separate rating. Finally, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court’s holdings in Correia and Sharp. See Correia v. McDonald, supra, and Sharp v. Shulkin, supra. In this case, the January 2014 VA examination was conducted prior to Correia and Sharp and provides only partial information as described above. Pain was noted on examination in the December 2019 VA examination report. The effect of pain on range of motion is described above. Regarding repeated use over time, the Board notes that the January 2014, October 2018 and December 2019 VA examiners conducted repetitive-use testing and concluded that there was no additional limitation in range of motion. Regarding flare-ups, the Board acknowledges that the January 2014 VA examiner did not provide an opinion regarding additional functional impairment during flare-ups and that the Veteran denied that he experienced flare-ups in an October 2018 VA examination. However, the Board finds that all information required for rating purposes was provided. The December 2019 VA examiner indicated that the Veteran lumbar spine condition interfered with his prolonged standing, sitting, walking and bending and the January 2014 VA examiner noted that the Veteran reported monthly flare-ups with a duration of two to 10 days. The December 2019 VA examination reflected measurements for active and passive range of motion as well as range of motion testing in weight-bearing and nonweight-bearing. As both of the Veteran’s spine does not have an opposing joint, it is not possible to measure range of motion in the undamaged joint. The Veteran reported flare-ups and the December 2019 VA examiner estimated the range of motion during such flare-ups. Therefore, the examinations of records are adequate for rating purposes. In reaching its conclusions, the Board acknowledges the Veteran's sincere belief that his degenerative disc disease, lumbar spine is more severe than as reflected by the currently assigned disability ratings. The Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability in light of the rating criteria to be more persuasive than his reports regarding the severity of his degenerative disc disease, lumbar spine. The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran's service-connected degenerative disc disease, lumbar spine; however, the Board finds that his symptomatology has been stable throughout the period on appeal. Therefore, assigning a staged rating for such disability is not warranted. Furthermore, the Veteran has not raised any other issues, nor has any other issues been reasonably raised by the record, with regard to the increased rating claim adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). In reaching the foregoing determinations, the Board has applied the benefit of the doubt doctrine and resolved all doubt in the Veteran's favor. However, insofar as the Board has denied higher or separate ratings, the preponderance of the evidence is against such aspects of the claim. Therefore, the benefit of the doubt doctrine is not applicable and the increased rating claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 2. Entitlement to a rating in excess of 10 percent for left ankle strain is denied. The Veteran contends that his current left ankle strain is worse than evaluated, causing a sensation of weakness. See January 2014 VA examination. The Veteran’s left ankle strain is rated as 10 percent disabling under Diagnostic Code 5271. Ankle disabilities are rated pursuant to Diagnostic Codes 5270 through 5274. A 10 percent rating under Diagnostic Code 5271 requires “moderate” limitation of motion and a 20 percent rating requires “marked” limitation of motion. 38 C.F.R. § 4.71a. Twenty percent is the highest rating available under Diagnostic Code 5271. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. It should also be noted that use of descriptive terminology by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. In the January 2014 VA examination, the Veteran was diagnosed with bilateral ankle sprain. The Veteran reported functional loss as excessive fatigability, but reported no flare-ups that impacted his right and left ankle. Upon physical examination, right ankle plantar flexion was 45 degrees or greater and dorsiflexion at 20 degrees or greater, with no evidence of painful motion. Measurements for the left ankle were the same. The Veteran was able to perform repetitive-use testing, bilaterally, with no additional limitation of range of motion or functional loss/impairment. There was no pain on palpation, muscle strength was normal, joint stability was normal, there was no ankylosis, and there were no additional right or left ankle conditions. The Veteran did not have any bilateral joint replacements or any other right ankle surgical interventions, and did not use an assistive device. In the November 2018 VA examination, the Veteran was diagnosed with left ankle sprain and his right ankle found to be normal. The Veteran described flare-ups as intermittent, moderate, sharp left ankle pain occurring on weight-bearing or prolonged walking. Upon physical examination, left ankle plantar flexion was 30 degrees or greater and dorsiflexion at 20 degrees or greater, with painful motion, but no functional loss. The Veteran was not able to perform repetitive-use testing, however the examination was neither medically consistent or inconsistent with the Veteran's statements describing functional loss with repetitive use over time. The examination was not conducted during a flare-up and it was neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups. As mentioned above, the March 2019 Board decision deemed this examination inadequate because it did not address the Correia and Sharp factors. In the December 2019 VA examination, the Veteran reported no flare-ups, that instead his left ankle hurt all the time. The examiner confirmed a diagnosis of left lateral collateral ligament sprain. The Veteran’s right ankle was normal. The Veteran stated that his left ankle pain was alleviated by medication and described his functional loss as pain during prolonged walks and going down the stairs. Dorsiflexion was zero to 15 degrees, plantar flexion zero to 30 degrees, and the range of motion itself contributed to causing pain on range of motion but not on weight bearing and not causing functional loss. Both dorsiflexion and plantar flexion exhibited pain, and there was objective evidence of localized tenderness or pain on palpation. There was no crepitus, no ankylosis, and no instability. Repeated use with at least three repetitions was tested but there was no additional loss of function or range of motion and no pain, weakness, fatigability or incoordination significantly limiting functional ability with repeated use over a period of time. The examiner found that testing for pain on passive range motion was not medically appropriate because it could increase risk of injury. Also, there was no evidence of pain when the left ankle was tested on non-weight bearing. VA treatment records have also been associated with the Veteran’s claims file. In summary, these records reflect the Veteran complained of right ankle pain for which he had ongoing treatment. Throughout the period on appeal, the Veteran’s left ankle strain manifested as moderate impairment to range of motion without marked impairment to range of motion. The evidence shows that the Veteran’s dorsiflexion was to 15 degrees and plantar flexion to 30 degrees, both at worst during flare-ups in the December 2019 VA examination. Moreover, there was no additional loss of function or range of motion found after repetitive use testing. Although pain was noted on flexion range of motion on VA examination, such did not result in or cause additional functional loss even in contemplation of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca v. Brown, supra. Although pain may cause functional loss, pain itself does not constitute functional loss. Mitchell v. Shinseki, supra. Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id.; see 38 C.F.R. § 4.40. Here, the VA treatment records, and VA examinations do not reveal additional functional impairment, including additional limitation of motion, on account of pain, weakness, etc, that is not already contemplated by the assigned noncompensable rating. 38 C.F.R. § 4.59. Accordingly, higher ratings are not warranted for the Veteran’s residuals of left ankle strain even in consideration of painful motion and other factors such as weakness, fatigability, lack of endurance, and incoordination. Furthermore, as there is no evidence of ankylosis of the ankle or subastragalar or tarsal joint, malunion of os calcis or astragalus, or an astragalectomy, higher or separate ratings under Diagnostic Codes 5270, 5272, 5273, and 5274 are not warranted. Finally, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court of Appeals for Veterans Claims (Court)’s holdings in Correia and Sharp. In this case, the January 2014 VA examination was conducted prior to Correia and Sharp and provides only partial information as described above. The Veteran reported flare-ups of pain with weight-bearing or prolonged walking but did not report additional range of motion restrictions during the January 2014 VA examination. The Veteran reported flare-ups of intermediate sharp ankle pain with weight-bearing or prolonged walking and the examiner found that pain, weakness, fatigability or incoordination significantly limited functional ability during flare-ups in an October 2018 VA examination. In a December 2019 VA examination, the Veteran denied flare-ups related to the right ankle and instead as he was in constant pain. The December 2019 VA examination reflected measurements for active and passive range of motion as well as range of motion testing in weight-bearing and nonweight-bearing. Therefore, this examination is adequate for adjudicative purposes. The Board also acknowledges the Veteran's sincere belief that his left ankle symptoms are more severe than currently contemplated. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology and resulting functional difficulties, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, supra. Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disability. The Board has considered whether further staged ratings under Hart, supra, are appropriate for the Veteran’s service-connected left ankle sprain; however, the Board finds that his symptomatology has been stable throughout this appeal period. Therefore, assigning staged ratings for such disability is not warranted. The Veteran has not raised any other issues, and no other issues have been reasonably raised by the record. See Doucette v. Shulkin, supra. (Continued on the next page)   In sum, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 10 percent for left ankle sprain. As the preponderance of the evidence is against the assignment of a rating in excess of 10 percent, the benefit-of-the-doubt doctrine is not for application, and the appeal must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Adeyemi, 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.