Citation Nr: 21023076 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 15-39 577 DATE: April 20, 2021 ORDER Entitlement to a rating in excess of 30 percent for service-connected uterine fibroids, status post hysterectomy, is denied. Entitlement to a rating in excess of 10 percent for service-connected total right knee replacement prior to March 15, 2010, and in excess of 30 percent from May 1, 2011 (excluding period of temporary total rating) is denied. Entitlement to a rating in excess of 10 percent for service-connected scars of the right knee and abdomen is denied. Entitlement to a rating in excess of 20 percent for service-connected lumbar spine disability is denied. Entitlement to a rating in excess of 20 percent for service-connected left lower extremity radiculopathy of the lumbar spine is denied. Entitlement to a rating in excess of 20 percent for service-connected cervical spine disability prior to July 25, 2018, and in excess of 30 percent on and thereafter, is denied. Entitlement to a rating in excess of 10 percent for service-connected cervical radiculopathy of the left upper extremity prior to July 25, 2018, and in excess of 30 percent on and thereafter, is denied. Entitlement to a compensable rating for service-connected biopsy scars of the left breast is denied. Entitlement to a rating in excess of 10 percent for service-connected Kienbach’s disease with arthritis of the right wrist is denied. Entitlement to a rating in excess of 10 percent for service-connected Kienbach’s disease with arthritis of the left wrist is denied. FINDINGS OF FACT 1. The removal of the Veteran’s uterus has been assigned the maximum allowable evaluation of 30 percent. 2. Prior to March 15, 2010, the Veteran’s right knee disability was manifested by pain and symptomatic removal of cartilage. 3. From May 1, 2011, the residuals of a total right knee replacement surgery have been manifested by an intermediate degree of weakness, pain, and limitation of motion limited to 10 degrees for extension and to at least 115 degrees for flexion. 4. For the entire appeal period, the Veteran’s residual scars are painful, stable, and do not result in functional impairment. 5. For the entire appeal period, the Veteran’s lumbar spine disability is manifested, at worst, by forward flexion to 45 degrees, without ankylosis of the spine, intervertebral disc syndrome (IVDS), or incapacitating episodes. 6. For the entire appeal period, the Veteran’s left lower extremity lumbar radiculopathy more nearly approximates moderate incomplete paralysis. 7. Prior to July 25, 2018, the Veteran’s degenerative joint disease of the cervical spine was not manifested by forward flexion to 15 degrees or less, or ankylosis. 8. Since July 25, 2018, the Veteran’s degenerative joint disease of the cervical spine has not been manifested by unfavorable ankylosis of the entire cervical spine or the entire spine. 9. Prior to July 25, 2018, the Veteran had no more than mild incomplete left upper extremity radiculopathy (minor) of the cervical spine. 10. Since July 25, 2018, the Veteran has had no more than moderate incomplete left upper extremity radiculopathy (minor)of the cervical spine. 11. For the entire appeal period, the Veteran’s residuals of left breast biopsy are not manifested by significant alteration of size or form of one breast. 12. For the entire appeal period, the Veteran is in receipt of the maximum available rating for limitation of motion in her right wrist; ankylosis of the right wrist has not been shown. 13. For the entire appeal period, the Veteran is in receipt of the maximum available rating for limitation of motion in her left wrist; ankylosis of the left wrist has not been shown. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 30 percent for service-connected uterine fibroids, status post hysterectomy, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.116, Diagnostic Code 7618. 2. The criteria for a rating in excess of 10 percent for a right knee disability prior to March 15, 2010 are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5259. 3. The criteria for a rating in excess of 30 percent from May 1, 2011 for residuals of a total right knee replacement surgery are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5055. 4. The criteria for a rating in excess of 10 percent for scars of the right knee and abdomen are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.118, Diagnostic Code 7804. 5. The criteria for a rating in excess of 20 percent for a lumbar spine disability are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5237, 5243. 6. For the entire appeal period, the criteria for the assignment of a rating in excess of 20 percent for lumbar radiculopathy of the left lower extremity are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.7, 4.124a, Diagnostic Code 8720. 7. Prior to July 25, 2018, the criteria for a rating in excess of 20 percent for degenerative joint disease of the cervical spine are not met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237-5243. 8. From July 25, 2018, the criteria for a rating in excess of 30 percent for degenerative joint disease of the cervical spine have not been met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5237-5243. 9. Prior to July 25, 2018, the criteria for a rating in excess of 10 percent for radiculopathy of the left upper extremity of the cervical spine have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.1, 4.2, 4.7, 4.40, 4.59, 4.124a, Diagnostic Code 8715. 10. From July 25, 2018, the criteria for a rating in excess of 30 percent for radiculopathy of the left upper extremity of the cervical spine have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.1, 4.2, 4.7, 4.40, 4.59, 4.124a, Diagnostic Code 8513. 11. For the entire appeal period, the criteria for a compensable rating for residuals of biopsy scars are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.2, 4.3, 4.7; 4.116, Diagnostic Code 7626. 12. For the entire appeal period, the criteria for a rating in excess of 10 percent for a right wrist disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.71a Diagnostic Code 5003-5215. 13. For the entire appeal period, the criteria for a rating in excess of 10 percent for a left wrist disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.71a Diagnostic Code 5003-5215. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty from December 1974 to May 2001. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a January 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In February 2019 and December 2020, the Board remanded these matters for further evidentiary development. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result 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. Separate ratings can be assigned for separate periods of time based on facts found, a practice known as staged ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). 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). Where service connection has already been established and an increase in the disability rating is at issue, it is a present level of disability that is of primary concern. Francisco v. Brown,7 Vet. App. 55 (1994). Therefore, the Board will only consider evidence submitted one year prior to the filing of the claim for an increased rating, rather than from the initial assigment. The Veteran filed her increased rating claims in February 2009. Therefore, the appeal period for consideration begins February 2010. The Board has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all the evidence of record submitted by the Veteran or on his behalf. See Gonzales v. West,218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, on the claims. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant). Finally, the Board notes that neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Uterine fibroids, status post hysterectomy The Veteran’s service-connected hysterectomy is rated 30 percent disabling under Diagnostic Code 7618. Service connection is also in effect for a surgical scar (rated as 10 percent disabling) secondary to the service-connected hysterectomy. The Veteran was also granted entitlement to a special monthly compensation under 38 U.S.C. § 1114, subsection (k) and 38 C.F.R. § 3.350 (a) on account of anatomical loss of a creative organ from July 15, 2003. Under Diagnostic Code 7618, a 100 percent evaluation is warranted for three months following the removal of the uterus. Thereafter, a maximum 30 percent evaluation is assigned. Here, the evidence reveals that the Veteran underwent a hysterectomy in July 2003. She was assigned a 100 percent rating from July 15, 2003 to October 31, 2003, after which she was assigned a 30 percent rating, effective November 1, 2003. As 30 percent is the maximum rating allowed, as a matter of law, the Veteran is not entitled to a rating in excess of 30 percent. A December 2019 VA gynecological examination indicated that the Veteran’s ovaries had also been removed. However, in a June 2020 addendum opinion, the examiner explained that this was not the case, that the relevant recent history was based on the Veteran’s reports, and that available treatment records contradict the Veteran’s reports. The examiner noted that this is frequently the case since people often do not remember the exact details of their surgeries and what parts may or may not be remaining. The examiner reiterated that a surgical pathology report and a post-surgical ultrasound both indicate that the Veteran’s ovaries remain intact, and that additional records were not found to indicate additional surgery with oophorectomy. The examiner concluded that the Veteran’s records indicate a hysterectomy without oophorectomy. (Based on the results of the December 2019 VA examination, the Veteran was service-connected for a female sexual arousal disorder associated with her uterine fibroids, status post hysterectomy, and was assigned a noncompensable rating.) The Board concludes that a higher rating is not warranted for the Veteran’s service-connected uterine fibroids, status post hysterectomy. She is assigned the maximum 30 percent rating under Diagnostic Code 7618, and a higher rating is not warranted under any other diagnostic code. Right knee disability The Veteran contends that she is entitled to a rating higher than 10 percent for her right knee disability for the period prior to March 15, 2010. Review of the record shows that a November 2002 rating decision increased her rating from noncompensable to 10 percent disabling for right knee status post ACL repair and medial meniscectomy disability under Diagnostic Code 5259. The Veteran submitted her claim for an increased rating in 2010 and appealed the January 2012 rating decision that confirmed and continued the 10 percent rating assigned for her right knee under Diagnostic Code 5259. The rating remained in effect until the Veteran underwent total knee replacement surgery on March 15, 2010. At that time, a temporary total rating was assigned, followed by a 100 percent rating under the criteria set forth under Diagnostic Code 5055. The rating was reduced to 30 percent in accordance with that criteria. See January 2012 rating decision. This aspect of the Veteran’s right knee disability rating will be addressed in the next section. The evidence of record indicates the Veteran has undergone right surgeries for the removal of cartilage, warranting a 10 percent rating under Diagnostic Code 5259. In January 2010, prior to her right knee surgery, the Veteran was examined at a Health Clinic in Germany, where range of motion (ROM) were provided. ROM in the right knee was zero to 100 degrees in flexion and zero degrees in extension. Repetitive testing was not provided. There were no other findings concerning limitation of motion. The record shows that the Veteran was admitted to the same clinic for total right knee endoprosthesis on March 15, 2010. Based on findings prior to the March 15, 2010 total knee replacement surgery, the Board finds that a rating in excess of 10 percent is not warranted prior to March 15, 2010. Specifically, the Veteran is entitled to the maximum allowable 10 percent rating under Diagnostic Code 5259 for symptomatic removal of cartilage. As range of motion measurements were normal, zero to 100 degrees in flexion and zero degrees in extension; and as there was no evidence of impairment of tibia and fibula, frequent episodes of locking of the knee, ankylosis, or other evidence of impairment of the knee prior to March 15, 2010; a higher rating is not warranted under any other diagnostic code applicable to the knee. Thus, a rating in excess of 10 percent is not warranted for the Veteran’s right knee disability prior to March 15, 2010. In denying a higher rating, the Board finds that the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. As previously noted herein, the Veteran underwent a total right knee replacement surgery on March 15, 2010. In a January 2012 rating decision, the RO granted a temporary 100 percent rating for the Veteran’s right knee disability for convalescence from March 15, 2010 through April 30, 2011, and a 30 percent rating was assigned from May 1, 2011. Pursuant to Diagnostic Code 5055, prosthetic replacement of a knee joint is rated 100 percent for one year following implantation of the prosthesis. The one-year total rating commences after a one-month convalescent rating under 38 C.F.R. § 4.30. Thus, chronic residuals consisting of severe painful motion or weakness in the affected extremity warrant a 60 percent rating. Intermediate degrees of residual weakness, pain, or limitation of motion are rated by analogy to Diagnostic Codes 5256, 5260, 5261, or 5262. The minimum rating following replacement of a knee joint is 30 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5055. At a November 2010 VA examination, the Veteran reported symptoms of pain, weakness, stiffness, permanent swelling, heat and redness, instability or giving way, locking, fatigability, and lack of endurance. It was noted that the Veteran walked with two crutches because of chronic right knee pain as well as a recent left ankle fracture fixated with a left lower leg cast. The Veteran reported that she was forced to put more pressure on the right leg due to the left ankle fracture. On examination, range of motion measurements in the right knee were zero to 118 degrees in flexion, with pain; and zero degrees in extension. Repetitive testing showed range of motion measurements limited to 96 degrees in flexion, with pain; and zero degrees in extension. Painful motion was on flexion only. There was no edema, effusion, or instability; and there was no noted significant quadriceps atrophy or true muscular weakness of the right knee. On pressure, there was tenderness on right patella. There was no redness or abnormal movement. It was noted that McMurray’s sign was not completed as the menisci was removed during the replacement surgery. The Veteran’s gait was asymmetrical on even ground, with a double-sided limp and slowed gait pattern. Under weight-bearing, the Veteran presented with a normal right knee alignment. Ankylosis was not present. The Veteran provided the examiner with X-ray films of the right knee from March 2010. The examiner indicated that no previous films were available for comparative views. It was noted that the Veteran’s right knee presented with a cemented total knee replacement. The examiner indicated that the Veteran’s disability impacted her ability to work due to limitations when lifting more than five kilograms or when walking more than two kilometers at a time. He remarked that the Veteran was not limited when sitting or standing. At a July 2014 VA examination, the Veteran reported constant pain in the right knee, depending on use or when the weather changes. She did not report any flare-ups of the knee. Range of motion measurements revealed flexion to 115 degrees, with pain; and extension to zero degrees. Repetitive-use testing did not reveal additional limitation in range of motion measurements after three repetitions. Functional loss or functional impairment was reported as less movement than normal and pain on movement. There was no pain on palpation. Muscle strength testing results were normal. Joint stability test results were also normal. There was no evidence or history of recurrent patellar subluxation or dislocation, and no tibial or fibular impairment. Her total right knee replacement caused residuals of intermediate degrees of residual weakness, pain, or limitation of motion. At a December 2019 VA examination, the Veteran reported long-standing right knee pain and stiffness which improved somewhat with the knee replacement, but that she had some continued issues of popping and pain that became stable over time since the surgery. She described occasional flare-ups with more intense burning pain, stiffness, and swelling—and functional loss or impairment of her right knee joint with difficulty walking, squatting, or climbing stairs. On examination, range of motion measurements revealed flexion from 5 to 110 degrees, with pain; and extension from 110 to 5 degrees. It was noted that range of motion contributed to functional loss, described as a slower walking pace and interference with squatting and stair climbing. There was no objective evidence of localized tenderness or pain on palpation and no evidence of pain with weight bearing. She was able to perform repetitive-use testing with at least three repetitions, with no additional loss of function or range of motion. She was not examined immediately after repetitive use over time. The examiner indicated that the examination was medically consistent with the Veteran’s statements describing functional loss with repetitive use over time. Pain, weakness, fatigability, and incoordination significantly limit functional ability with repeated use over a period of time, and pain resulted in functional loss. Although no additional range of motion loss was indicated, pain with prolonged use limited the ability to continue. The examination was not conducted during a flare-up as the examination was noted to be medically consistent with the Veteran’s statements describing functional loss during flare-ups. It was also indicated that pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups. The examiner noted that pain caused this functional loss, described in terms of range of motion as 10 to 100 degrees for flexion, and 100 to 10 degrees for extension. Muscle strength testing results were noted as 4/5 (active movement against some resistance) each for flexion and extension. There was no ankylosis, and no history of recurrent subluxation or lateral instability. Joint stability testing revealed no joint instability of the right knee. The Veteran’s total right knee replacement was shown to cause residuals of intermediate degrees of residual weakness, pain, or limitation of motion. There was no objective evidence of pain on nonweight-bearing. The examiner noted that the Veteran’s disability impacted her ability to work due to difficulty with walking, squatting, or climbing stairs. Based on the evidence of record, the Board finds that the Veteran has an intermediate degree of residual weakness, pain, or limitation of motion. As such, a rating in excess of 30 percent is not warranted. Any evaluation in excess of the currently assigned 30 percent would have to meet the criteria for Diagnostic Codes 5256, 5260. 5261, or 5262. In this regard, there is no evidence of ankylosis, so Diagnostic Code 5256 is not applicable. Neither is there evidence of tibia and fibula impairment, so Diagnostic Code 5262 is also not for application. Regarding limitation of extension or flexion, the record shows that the Veteran is able to move the right knee from at least 10 degrees extension to at least 115 degrees flexion after her knee replacement surgery. As such, the Board finds no basis for a rating in excess of 30 percent. For these stated reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim for a rating in excess of 30 percent for residuals of the Veteran’s total right knee replacement since May 1, 2011, and the claim must be denied. As the preponderance of the evidence is against the claim, the benefit-of-the- doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Scars of the right knee and abdomen The Veteran contends that she is entitled to a higher rating for her residual scars, which are currently assigned a 10 percent rating under Diagnostic Code 7804. This Diagnostic Code provides for a 10 percent rating for one or two scars that are unstable or painful. Note (1): An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2): If one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3): Scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable. 38 C.F.R. § 4.118, Diagnostic Code 7804. The Board finds that a rating in excess of 10 percent is not warranted at any point during the appeal period. As previously discussed, the Veteran underwent right knee replacement surgery in March 2010, for which there is a residual scar. There is also a scar associated with her July 2003 hysterectomy. At a November 2010 VA examination, the Veteran reported that the scar on her right knee was still tender. The examiner noted that the scar was straight but wrinkled, measuring 16 cm by 0.4 cm. It was noted that there was tenderness at the prepatellar part of the scar on pressure, and that the lower 7.5 cm of the scar was adherent. There was no ulceration or breakdown of the skin; no elevation or depression of the scar; no underlying tissue loss; and no inflammation, edema, or keloid formation. The color of the scar compared to normal areas of the skin was slightly livid, with no disfigurement. The examiner diagnosed the Veteran with partially tender and partially adherent scar in status post total right knee replacement with recurrent pain in the prepatellar area. At the examination, the Veteran also reported pain in the middle of her scar on her abdomen. The examiner noted that the scar was unusually long, arched with irregular texture but was smooth, and measured 43.5 cm by 0.1 - 1 cm. It was noted that there was tenderness in the middle of the scar, over a distance of 12 cm in length, and the tender part was adherent. There was no ulceration or breakdown of the skin; no elevation or depression of the scar; no underlying tissue loss; and no inflammation, edema, or keloid formation. The examiner noted that the greatest part of the scar was paler than the surrounding skin, and that only the adherent mid-part in a length of 12 cm was darker than the surrounding skin. The examiner indicated that there was no disfigurement; and that the scar was covered by clothing. The examiner diagnosed the Veteran with tender and adherent scar in status post abdominal hysterectomy with uterine fibroids, with recurrent pain in the middle of the scar, over 12 cm in length. At the July 2014 VA examination, the Veteran was noted to have scars on the trunk or extremities other than the head, face, or neck (right knee and abdomen scars). It was noted that the scars were not neither painful nor unstable. The examiner noted that the Veteran had six linear scars on the right knee, with measurements of 16 cm by 0.6 cm, 1.5 cm by 0.5 cm, 2 cm by 0.5 cm, 1 cm by 0.5 cm, 1 cm by 0.3 cm, and 1 cm by 0.2 cm. The Veteran was also noted to have one scar on the abdomen, measuring 35 cm by 0.3 cm. The examiner indicated that the scars did not result in limitation of function. The Board notes that in July 2020, the Veteran submitted photographs of her right knee, which shows only one continuous, linear scar, as opposed to six different scars. This corroborates the November 2010 VA examiner’s report of just one linear scar on the right knee. At a December 2019 VA examination, the Veteran reported that she experienced itchy, annoying, and sometimes burning scar pain, for which she used coconut oil and Vitamin C. The examiner noted one painful scar—the hysterectomy scar on the Veteran’s abdomen. None of the scars were noted as unstable. The examiner indicated that there was one right knee scar (which measured 18 cm by 0.4 cm) and one scar on the abdomen (which measured 30 cm by 0.3 cm). It was noted that the scar on the abdomen was tender to palpation. The approximate total area of the right knee scar was noted as 7.2 square cm, and the scar on the Veteran’s abdomen had a total area of 13.5 square cm. The Board finds that the weight of the evidence is against an evaluation in excess of 10 percent for the Veteran’s right knee and abdomen scars under Diagnostic Code 7804. A rating higher than 10 percent is only warranted for three or more unstable or painful scars or for scars that are both painful and unstable. In this case, the Veteran has been noted to have two painful scars, with no evidence of any of those scars being unstable at any point during the appeal period. Although the July 2014 examiner indicated that there were six scars on the Veteran’s right knee, as previously explained, the Veteran submitted photographs of the right knee in 2020, which show just one linear scar on the right knee, which corroborates what was reported on the November 2010 and the December 2019 VA examination reports. In evaluating the diagnostic codes potentially applicable to the Veteran’s scars, the Board notes that Diagnostic Code 7800 does not apply because neither of the two scars of the head, face, or neck. Diagnostic Code 7801 does not apply because neither of the scars are burn scars, nor are they deep. Diagnostic Code 7802 does not apply because these two scars do not cover an area of 144 square inches or more. Diagnostic Code 7805 does not apply because the scars are not noted to cause any functional impairment (such as limitation of motion). The Board has considered all potentially applicable provisions of 38 C.F.R. Parts 3 and 4, as required by Schafrath, whether or not they have been raised by the Veteran. The Board finds no provision upon which to assign a greater or separate rating. In reaching this decision, the Board notes that the Veteran is separately service-connected for scars of her wrists and breast, under different diagnostic codes. The issue of whether a higher rating is warranted for a biopsy scar of the Veteran’s left breast will be addressed herein. Lumbar spine disability The Veteran contends that the service-connected degenerative disc disease and osteochondrosis L4-L5 of her lumbar spine thoracolumbar spine disability is worse than is currently rated at 20 percent. However, a higher rating is not warranted. Disabilities of the spine, such as the Veteran’s lumbar spine disability, can be rated according to the General Rating Formula for Diseases and Injuries of the Spine, which allows for separate ratings for neurologic disabilities, or under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, depending on whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 3.25. Under the formula for rating spine disorders (Diagnostic Codes 5235-5242), the next highest disability rating, a 40 percent rating is warranted where forward thoracolumbar flexion is limited to 30 degrees or less, or there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine, while a 100 percent evaluation contemplates unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula of Disease and Injuries of the Spine. Unfavorable ankylosis is a condition where the entire thoracolumbar spine is held in flexion or extension and the condition results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. 38 C.F.R. § 4.71a, General Rating Formula of Disease and Injuries of the Spine, Note (5). Under the formula for IVDS based on incapacitating episodes, 38 C.F.R. § 4.71a, Diagnostic Code 5243, the next highest disability rating, a 40 percent disability rating contemplates incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past twelve months. A 60 percent rating, contemplates incapacitating episodes having a total duration of at least six weeks during the past twelve months. These criteria are an alternative to rating on the basis of orthopedic and neurologic manifestations under the General Formula for Diseases and Injuries of the Spine, and a rating is assigned on the basis of whichever method results in the higher rating. 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (2). 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, flare-ups, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, to 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. DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § 4.59. The Court has recently held that “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Rather, to support an increased rating, pain must result in functional loss in terms of limitations in the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination [, or] endurance.” Id., quoting 38 C.F.R. § 4.40. In order to be awarded a disability rating in excess of 20 percent, the evidence must demonstrate forward flexion of the thoracolumbar spine limited to 30 degrees or less, ankylosis of some kind in the entire thoracolumbar spine, or IVDS with doctor prescribed bed rest for incapacitating episodes having a total duration of at least four weeks during the past twelve months. At a November 2010 VA examination, the Veteran reported daily pain to the left side of her lower back, accompanied by constant stiffness and weakness. She indicated that she had no weight loss, fevers, malaise, bladder complaints, bowel complaints, or visual disturbance. It was noted that the Veteran’s gait was very short-stepped, somewhat straddle-legged, aided and limited to 1000 yards at a very slow pace. There was no antalgic scoliosis, anterior pelvic tilt, lumbar bulging or protruding of the ribs seen when bending over, and no leg length discrepancy. The examiner noted that the Veteran’s thoracolumbar spine presented with a slight oblique deviation to the left side. There was flattened thoracic kyphosis and maintained lumbar lordosis. Examination findings showed range of motion measurements for forward flexion at zero to 72 degrees, with pain; extension was zero to 13 degrees, with pain; right lateral flexion was zero to 24 degrees, with pain; left lateral flexion was zero to 28 degrees, with pain; right lateral rotation was zero to 45 degrees, with pain; and left lateral rotation was zero to 48 degrees, with pain. After repetitive testing, forward flexion was 56 degrees, with severe pain; backward extension was 10 degrees, with severe pain; right lateral flexion was 20 degrees, with severe pain; left lateral flexion was 22 degrees, with severe pain; right lateral rotation was 40 degrees, with severe pain; and left lateral rotation was 46 degrees, with severe pain. It was noted that the Veteran’s paraspinal muscles were tight, hard, and painful between T12 and L3 level, bilaterally, and there was a distinct paravertebral muscle spasm palpable. It was also noted that the Veteran was very slow and careful with her motions, but guarding did not result in an abnormal gait. Ankylosis was not present. Localized tenderness with preserved spinal contour was noted from L3 through S1. It was noted that atrophy, tone, and strength of the musculature was non-assessable because of a casted left lower leg due to a left ankle fracture. Imaging studies revealed advanced osteochondrosis at L4-L5. At a July 2014 VA examination, the Veteran reported pain in the lower back, which radiated to her left leg. She did not report any flare-ups. On examination, range of motion measurements showed forward flexion to 85 degrees, with pain; extension to 10 degrees, with pain; right lateral flexion to 10 degrees, with pain; left lateral flexion to 15 degrees, with pain; right lateral rotation to 10 degrees, with pain; and left lateral rotation to 10 degrees, with pain. The Veteran was able to perform repetitive-use testing after three repetitions, with no additional limitation in range of motion measurements. It was noted that functional loss or functional impairment resulted in less movement than normal and pain on movement. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability. There was localized tenderness or pain to palpation. Guarding and/or muscle spasm was present but did not result in abnormal gait or spinal contour. Muscle strength testing results were all normal. There was no muscle atrophy. Reflex and sensory examination results were normal. Ankylosis was not present. Straight leg testing results were negative. Mild radiculopathy was noted for the left lower extremity, affecting the sciatic nerve roots. No other neurologic abnormalities were noted. IVDS was not present. The examiner noted that the Veteran’s lumbar spine disability impacted her ability to work when lifting more than five pounds. At a December 2019 VA examination, the Veteran reported long-standing low back pain and stiffness, with difficulty sleeping. She described flare-ups as occasional episodes of more intense low back pain and stiffness. The Veteran reported functional loss or functional impairment of the lumbar spine as difficulty with driving, twisting, or lifting. On examination, range of motion measurements showed forward flexion to 60 degrees; and extension, right lateral flexion, left lateral flexion, right lateral rotation, and left lateral rotation, each limited to 20 degrees. It was noted that range of motion contributed to functional loss by inhibiting the ability to bend, twist, and lift. It was also noted that pain resulted in functional loss. The Veteran was able to perform repetitive-use testing after three repetitions, with no additional limitation in range of motion measurements. It was noted that functional loss or functional impairment resulted in less movement than normal and pain on movement. The examiner noted that pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over a period of time. The examination was not conducted during a flare-up, with the examiner indicating that the examination was medically consistent with the Veteran’s statements describing functional loss during flare-up. It was noted that pain significantly limited functional ability with flare-ups. Described in terms of range of motion, forward flexion was limited to 45 degrees; and extension, right lateral flexion, left lateral flexion, right lateral rotation, and left lateral rotation, each limited to 15 degrees. There was no localized tenderness or pain to palpation, and no evidence of pain with weight bearing. There was no guarding or muscle spasm. Muscle strength testing results were all normal. There was no muscle atrophy. Reflex examination results were hypoactive for bilateral knees and ankles. There was some decreased sensation. Ankylosis was not present. Straight leg testing results were negative for the left side and positive for the right side. Moderate radiculopathy was noted for the right and left lower extremities, affecting the sciatic and femoral nerve roots. No other neurologic abnormalities were noted. IVDS was not present. The examiner noted that the Veteran’s lumbar spine disability impacted her ability to work due to limited capacity for lifting or twisting, and limited tolerance for prolonged walking, standing, or driving. The Board notes that, throughout numerous pages of service, VA, and private treatment records, as well as the VA examination reports, forward flexion has been limited, at most, to 45 degrees, including during flare-ups, or following repetitive use. Use after three repetitions and factors such as pain, flare-ups, fatigue, weakness, and incoordination have not been shown to result in additional limitation of motion or compensable loss of function beyond that which what was estimated by the VA examiners. As such, a higher disability rating based upon limitation of motion is not warranted. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32 (2011). The Board further notes that ankylosis has not been demonstrated. The evidence, including the lay evidence, shows no indication that the spine has been fixed in extension or flexion at any time during the appeal period, thus demonstrating the absence of ankylosis. Therefore, a rating in excess of 20 percent is not warranted under Diagnostic Code 5237. Similarly, the evidence does not demonstrate that the Veteran has IVDS or has ever been prescribed bed rest by a physician. The VA examiners specifically found that she did not have IVDS and the Veteran has not described any period of such bed rest due to her lumbar spine disability. As such, a disability rating in excess of 20 percent is not warranted under the rating criteria for IVDS. All diagnostic codes relevant to the thoracolumbar spine disability have been considered, but finds that no other codes are applicable. All current neurologic findings are rated separately and considered herein. Accordingly, the Board finds that a disability rating in excess of 20 percent for the Veteran’s lumbar spine disability is not warranted. See 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). In reaching this decision, the Board notes that neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Left lower extremity lumbar radiculopathy The Veteran seeks a higher rating for her left lower extremity lumbar radiculopathy. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a , Diagnostic Code 8520. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8620 and 8720). 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. 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. 38 C.F.R. § 4.124a; Miller v. Shulkin, 28 Vet. App. 376 (2017). The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. Viewing the evidence as a whole, the Board finds that, for the entire period of appeal, the Veteran’s left lower extremity lumbar radiculopathy most closely approximates moderate incomplete paralysis and not moderately severe incomplete paralysis. At a November 2010 VA examination, the Veteran reported numbness and/or sciatic nerve pain radiating from the lower back to her left leg and foot. Examination findings indicate that her sciatic radiculopathy of the lumbar spine was moderate in severity. Findings also show neuritis and neuralgia of the spinal nerve root and spinal nerve L5 on the left (left sciatic nerve). Sensory examination results showed no segmental sensory disturbances but constant pain down the dorsolateral thigh traveling down the front lateral left lower leg into the upper left foot and in all left-sided toes. The examiner diagnosed vertebragen radiculopathy of the left spinal nerve L5, resulting in daily recurring left-sided sciatic nerve pain and recurring numbness involving the left leg and left foot. During the July 2014 VA examination, the Veteran reported pain in the lower back, which radiated to her left leg. Muscle strength testing results were all normal. There was no muscle atrophy. Reflex and sensory examination results were normal. Ankylosis was not present. Straight leg testing results were negative. The examiner noted mild radiculopathy for the left lower extremity, affecting the sciatic nerve roots. The examiner also noted mild intermittent pain and mild paresthesias and/or dysesthesias. At a December 2019 VA examination, the Veteran reported long-standing low back pain and stiffness, with difficulty sleeping. She described flare-ups as occasional episodes of more intense low back pain and stiffness. Muscle strength testing results were all normal. There was no muscle atrophy. Reflex examination results were hypoactive for bilateral knees and ankles. There was some decreased sensation. Ankylosis was not present. Straight leg testing results were negative for the left side. Moderate radiculopathy was noted for the left lower extremity, affecting the sciatic and femoral nerve roots. The examiner noted mild intermittent pain, moderate paresthesias and/or dysesthesias, and mild numbness for the left lower extremity. No other neurologic abnormalities were noted. Considering the evidence as a whole, the Veteran’s left lower extremity lumbar radiculopathy is most analogous to moderate incomplete paralysis. The November 2010 examiner noted radiating pain but no motor or sensory deficits. The July 2014 VA examiner noted radicular symptoms of mild intermittent pain and mild paresthesias or dysesthesias but no numbness. Reflex and sensory testing were normal. Muscle strength testing results were normal, and the examiner noted that the severity was mild. The December 2019 examiner evaluated the severity as moderate. The examiner noted mild intermittent pain, moderate paresthesias and/or dysesthesias, and mild numbness. Sensory examination showed some decreased sensation and hypoactive left knee and ankle, but muscle strength testing results were normal. None of the examinations show muscle atrophy. The Board thus finds that the Veteran’s level of impairment is most analogous to moderate incomplete paralysis, warranting the current 20 percent rating. Consideration has also been given to the potential application of the other diagnostic codes for disabilities of the peripheral nerves. See 38 C.F.R. § 4.124a, Diagnostic Codes 8510-8540. However, the Board finds no basis upon which to assign an evaluation in excess of 20 percent for the Veteran’s left lower extremity lumbar radiculopathy at any point during the appeal period. Because the preponderance of the evidence weighs against the claim for a rating in excess of 20 percent, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7. Cervical spine disability The Veteran is currently assigned a 20 percent disability rating prior to July 25, 2018, and a rating of 30 percent disabling from July 25, 2018, for the degenerative joint disease (DJD) of her cervical spine. See 38 C.F.R. § 4.71a, Diagnostic Codes 5237-5243. As the Veteran contends that the severity of her disability warrants higher ratings, the Board will consider whether a rating in excess of 20 percent is warranted prior to July 25, 2018, and whether a rating in excess of 30 percent is warranted from July 25, 2018. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. Diagnostic Code 5237 is applicable to the cervical spine, and Diagnostic Code 5243 is applicable to IVDS. Under the General Rating Formula for Disease and Injuries of the Spine (Diagnostic Codes 5235-5242), a 20 percent rating is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is warranted for forward flexion of the cervical spine to 15 degrees or less; or favorable ankylosis of the entire cervical spine. A 40 percent disability rating is warranted for unfavorable ankylosis of the entire cervical spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. These ratings are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. Id. For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees. See 38 C.F.R. § 4.71a, Plate V. For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. See 38 C.F.R. § 4.71a, Note (5). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, intervertebral disc syndrome with incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months warrants the assignment of a 20 percent rating. Intervertebral disc syndrome with incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months is assigned a 40 percent rating. A 60 percent rating is warranted for incapacitating episodes having a total duration of at least six weeks during the past 12 months. Note (1): For purposes of evaluations 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. Note (2): If intervertebral disc syndrome is present in more than one spinal segment provided that the effects in each spinal segment are clearly distinct evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. 38 C.F.R. § 4.71a, Diagnostic Code 5243. At a November 2010 VA examination, the Veteran reported constant stiffness and weakness in her neck and that she experienced pain radiating to her left shoulder and down to her lower back. The Veteran also reported daily flare-ups which do not decrease in pain until her medicine takes effect. A physical examination at that time revealed forward flexion to 29 degrees, with flexion to 30 degrees after repetitive motion. No ankylosis or IVDS was indicated. At a July 2014 VA examination, the Veteran reported nightly pain in the neck, sometimes accompanied by shooting pain in the right arm. She did not report flare-ups. Range of motion testing revealed forward flexion to 45 degrees or greater, with no objective evidence of painful motion. Following repetitive testing, the Veteran was still able to demonstrate 45 degrees or greater of forward flexion. The VA examiner noted that the Veteran did not have additional limitation of range of motion of the cervical spine following repetitive-use testing. No ankylosis was indicated. The VA examiner noted that the Veteran did not have IVDS of the cervical spine. With regard to the appeal period prior to July 25, 2018, the Veteran’s cervical spine disability picture is not more closely approximated by an increased rating based on the presence of additional functional loss based on the criteria set forth in 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). During this portion of the appeal period, after a review of the evidence, including VA treatment records and VA examinations, the Board finds that the Veteran’s service-connected DJD of the cervical spine was not manifested by forward flexion limited to 15 degrees. Additionally, the medical evidence of record, as discussed above, documents active range of motion findings of the Veteran’s cervical spine; as such, there are no documented findings of ankylosis of the Veteran’s spine. Moreover, there was no finding of IVDS. The Veteran’s reported symptomatology does not, when viewed in conjunction with the medical evidence, tend to establish additional limitation of motion to the degree that would warrant a rating in excess of 20 percent for the service-connected DJD of the cervical spine under 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. Additionally, as stated in Correia v. McDonald, 28 Vet. App. 158 (2016), the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. A retroactive range of motion testing cannot be performed because it would be a matter of mere speculation for the examiner. Therefore, the Board finds that the November 2010 and July 2014 VA examinations are adequate. Symptoms noted during this portion of the period on appeal include forward flexion limited, at worst, to 29 degrees, with pain. Nevertheless, such symptoms are contemplated in the currently assigned 20 percent disability rating. As a result, a rating in excess of 20 percent is denied prior to July 25, 2018, for the service-connected DJD of the cervical spine. See 38 C.F.R. § 4.71a, DCs 5237-5243. At a July 2018 VA examination, the Veteran reported flare-ups up the cervical spine, described as sharp pain and stiffness. She described having overall functional impairment in decreased range of motion. Range of motion testing reflected 20 degrees of forward flexion. Pain was noted on the examination. Following repetitive testing, forward flexion was limited to 15 degrees. It was noted that pain and a lack of endurance significantly limit functional ability with repeated use over time and during flare-ups, causing functional loss described as forward flexion limited to 10 degrees, and 5 degrees, respectively. The examination was not conducted during a flare-up; the examiner indicated that the examination was medically consistent with the Veteran’s statements describing functional loss during a flare-up. There was no muscle atrophy. Ankylosis was not present. IVDS was also not present. The examiner noted the functional impact of the Veteran’s cervical spine disability as neck pain, stiffness, and difficulty with prolonged bending or heavy lifting. With regard to the appeal period from July 25, 2018, after a review of the evidence, including VA examination and treatment records, the Board finds that the service-connected DJD of the Veteran’s cervical spine has not been manifested by unfavorable ankylosis of the entire cervical spine or the entire spine. The current symptomatology includes pain, and limited forward flexion, at worst, to 5 degrees. As such, a rating in excess of 30 percent is denied. As the Veteran is already in receipt of the schedular maximum for limitation of motion of the cervical spine since July 25, 2018, inquiry into the DeLuca factors is moot for that appeal period. DeLuca v. Brown, 8 Vet. App. 202, 206 (1995); Johnston v. Brown, 10 Vet. App. 80, 87 (1997). Moreover, as IVDS was not demonstrated, an increased rating under DC 5243 for IVDS based on incapacitating episodes is not warranted. Cervical radiculopathy of the left upper extremity The Veteran was assigned a 10 percent rating prior to July 25, 2018 for cervical radiculopathy of the left upper extremity under Diagnostic Code 8715. See Rating Codesheet; October 2, 2018; 38 C.F.R. § 4.124a, Diagnostic Code 8513. She is currently assigned a 30 percent rating since July 25, 2018 for cervical radiculopathy of the left upper extremity under Diagnostic Code 8513. See Rating Codesheet, May 1, 2020; 38 C.F.R. § 4.124a, Diagnostic Code 8513. She asserts that higher ratings are warranted for each appeal period. The record reflects that the Veteran is right-handed. As such, the service-connected cervical radiculopathy of the left upper extremity affects her minor extremity. 38 C.F.R. § 4.69. Under DC 8715, a 10 percent rating is assigned for mild incomplete paralysis of the median nerve for the major and minor extremity. A 30 percent rating is assigned for moderate incomplete paralysis of the median nerve for the major extremity and a 20 percent rating is assigned for moderate incomplete paralysis of the median nerve for the minor extremity. Higher ratings are assigned for severe incomplete paralysis and complete paralysis. 38 C.F.R. § 4.124a. At a November 2010 VA examination, the Veteran reported radiating pain in her left arm, radiating predominantly to the middle, ring, and little finger of her left hand. She reported daily flare-ups of radiating pain and neurological symptoms of variable duration which aggravate how she sits. She stated that she has weakness and daily fatigue with functional loss which interrupts all daily activities because of the neurological symptoms. Examination findings revealed spinal nerve C8 on the left, causing left arm and left middle finger, ring finger, and little finger hand numbness and pain. Sensory examination showed no segmental sensory disturbances along the distal vertebragen cervical dermatomes in the Veteran’s arms and hands. There was no evidence of hypoesthesias, paresthesias, dysaesthesias or other sensory disturbances in both upper extremities and in the shoulder girdle region. It was noted that daily recurring numbness and/or pain along the cervical dermatome C8 involved the left middle finger, ring finger, and little finger. Motor examination showed normal tone and strength of the musculature. The examiner diagnosed vertebragen chronic radiculopathy of the spinal nerve C8 on the left, resulting in daily recurring lift arm and hand pain, and daily recurring numbness involving the left-sided outer three fingers. At a July 2014 VA examination for the Veteran’s cervical spine, muscle strength testing of the left elbow, wrist, and fingers reflected normal strength. No muscle atrophy was noted. A reflex examination revealed normal results. Sensation to light touch testing results were also normal for the Veteran’s left upper extremity. The VA examiner noted mild intermittent pain and mild paresthesias and/or dysesthesias of the left upper extremity. The VA examiner noted that the nerve roots involved were the C5/C6 and C7. It was indicated that the Veteran’s radiculopathy was mild in severity. No other neurological abnormalities related to her cervical spine, such as bowel or bladder problems, were noted. Based on the evidence above, the Board finds that, prior to July 25, 2018, the Veteran’s disability picture for cervical radiculopathy of the left upper extremity did not more nearly approximate moderate incomplete paralysis under Diagnostic Code 8715, to warrant the next-higher 20 percent rating. Specifically, the evidence, including VA treatment records, private treatment records, and VA examination results, reveals that her disability was mild in severity. For instance, the July 2014 examiner noted mild intermittent pain and mild paresthesias or dysesthesias. He concluded that the Veteran’s radiculopathy was mild. There were no other neurological abnormalities related to the Veteran’s cervical spine during this period, to warrant a higher rating. In sum, the Board finds that, for the appeal period prior to July 25, 2018, the Veteran’s left upper extremity radiculopathy of the cervical spine disability picture more nearly approximated mild incomplete paralysis. As such, the Board concludes that a rating in excess of 10 percent rating was not warranted for this appeal period. 38 C.F.R. § 4.124a, Diagnostic Code 8715. For the rating period on appeal from July 25, 2018, the left upper extremity cervical radiculopathy has been rated 30 percent disabling under Diagnostic Code 8513. Diagnostic Code 8513 provides ratings for paralysis of the median nerve. The schedular rating criteria under Diagnostic Code 8513 provide for disability ratings based on the severity of incomplete paralysis of all radicular groups as well as ratings for neuritis and neuralgia, which manifest by symptoms of pain, sensory disturbances, and loss of reflex. Disability ratings of 20, 30, and 60 percent are warranted, respectively, for mild, moderate, and severe incomplete paralysis of all radicular groups for the minor (or non-dominant) extremity. A maximum 80 percent rating is warranted for complete paralysis. 38 C.F.R. § 4.124a. The Veteran underwent another VA examination in July 2018. Muscle strength testing of her left elbow, wrist, and fingers was normal. No muscle atrophy was noted. Additionally, reflex examinations of her biceps, triceps, and brachioradialis revealed normal results, as did sensory testing of her left shoulder, inner/outer forearm, and hand/fingers. It was noted that the Veteran had moderate intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness of the left upper extremity. The VA examiner stated that the Veteran had moderate radiculopathy. Relevant evidence of record does not meet the criteria for a rating in excess of 30 percent since July 25, 2018. A disability rating of 60 percent or higher for all radicular groups of the left (minor) extremity would only be warranted for severe incomplete paralysis and/or complete paralysis, none of which are present here. The July 2018 VA examination report reflects moderate pain and a normal sensory examination. The examination report reflects radiculopathy in the left upper extremity that was moderate in severity. Additionally, the Board has considered whether any other diagnostic code under the criteria for diseases of the peripheral nerves would allow for a higher disability rating for the service-connected left upper extremity nerve disability. A rating under Diagnostic Codes 8512 is not warranted as the Veteran has not been diagnosed with severe incomplete paralysis of the left (minor) lower radicular group or severe incomplete paralysis of the middle radicular group (Diagnostic Code 8611). Therefore, a disability rating under any of these diagnostic codes is not warranted. 38 C.F.R. § 4.124a. Despite the Veteran’s complaints, the examiners of record did not find any clinically observable symptoms to be more than moderate in nature. In the absence of any clinical evidence of severe incomplete paralysis due to cervical radiculopathy of the left upper extremity, no higher rating than 30 percent can be assigned. 38 C.F.R. § 4.124a, Diagnostic Code 8513. Left breast biopsy scars Initially, the Board notes that the biopsy scars of the Veteran’s left breast are currently rated as noncompensable under Diagnostic Code 7626. She contends that a higher rating is warranted. Under Diagnostic Code 7626, which addresses surgery of the breast, a noncompensable rating is provided following wide local excision without significant alteration of size or form of one breast. A 30 percent rating is warranted following a simple mastectomy or wide local excision with significant alteration of size or form of one breast, and a 40 percent rating is provided following modified radical mastectomy of one breast. A 50 percent rating is provided following radical mastectomy of one breast. Thus, to warrant a higher rating in the instant case, the evidence must demonstrate significant alteration of size or form of one breast. In this regard, neither the Veteran nor the evidence indicates significant alteration of size or form of the breast. During a November 2010 VA examination, the Veteran reported that the deformity bothers her, but no pain was noted. The examiner noted that the needle biopsy scar was no longer visible, and that the Veteran’s status post lumpectomy scar measured 3 cm by 0.1 cm. The status post lymph node removal scar was noted to measure 5.5 cm by 0.1 cm. Both scars were straight in shape and had a smooth texture. Neither scar was tender or disfigured. The examiner noted that the unremarkable, status post lumpectomy, left breast scar had underlying soft tissue loss measuring 1 inch by 0.5 inches, with no further symptoms. The unremarkable status post lymph node removal, left breast scar was asymptomatic. No other medical evidence was provided regarding the Veteran’s left breast scars. There was no indication that the wide local excision is a significant alteration of the size or form of the Veteran’s left breast. During a July 2014 VA examination, it was noted that the Veteran has two linear scars on the left breast. The first scar measured 4.3 cm by 0.2 cm, and the second scar measured 2 cm by 0.2 cm. Neither scars were noted to be painful or unstable. A December 2019 VA examination report documents a left breast scar measuring 3 cm by 1.5 cm. The scar was reported to have underlying soft tissue damage but was not noted to be painful or unstable. The approximate combined total area of the scar was noted as 4.5 square centimeters. The VA examiners found no pertinent physical findings, complications, conditions, signs and/or symptoms related to the Veteran’s fibrocystic disease of the breast. Further, none of the VA examiners determined that the Veteran’s breast condition or scars impacted her ability to work. As previously stated, a compensable rating under Diagnostic Code 7626 requires mastectomy or wide local excision with significant alternation of size or form. The evidence of record does not show mastectomy and the VA examinations have not found current, significant alteration of size or form following the Veteran’s biopsy. The November 2010 VA examiner found that the biopsy scar was no longer visible, and that neither scar was disfigured. Subsequent VA examinations did not indicate current alteration of size or form. As such, the Board finds that a compensable rating is not warranted for the service-connected biopsy scars of the left breast. While the Board acknowledges the Veteran’s beliefs regarding the alteration of her left breast due to the biopsy, the Board finds the medical evidence is most probative as it considers her reported symptoms and provides clinical evaluation of the disability. Here, the medical evidence does not reflect significant alteration of size or form of one breast to meet the criteria for a higher rating at any time during the pendency of the appeal. Thus, even considering the Veteran’s self-reported symptomatology, the Board finds that a compensable rating for biopsy scars of her left breast is not warranted at any time. 38 C.F.R. § 4.116, Diagnostic Code 7626. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt-rule does not apply. Gilbert, supra. A compensable disability rating for biopsy scars of the left breast is denied for the entirety of the appeal period. Kienbach’s disease with arthritis of each wrist The Veteran contends that her right and left wrist disabilities are more disabling than reflected by the ratings currently assigned. Her right and left wrist disabilities are rated as 10 percent disabling under Diagnostic Codes 5215-5003 for limitation of motion of the wrist (Code 5215) and degenerative arthritis (Code 5003). Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. The injured hand, or the most severely injured hand, of an ambidextrous individual will be considered the dominant hand for rating purposes. 38 C.F.R. § 4.69. In this case, the Veteran is right-hand dominant; thus, her service-connected right wrist disability involves her major upper extremity, while her left wrist disability involves her minor upper extremity, as shown below by the evidence of record. Diagnostic Code 5215 provides a 10 percent rating each for the major and minor extremities where there is limitation of motion of the wrist manifested by dorsiflexion limited to less than 15 degrees and palmar flexion limited in line with the forearm. This is the maximum possible schedular rating under Diagnostic Code 5215. 38 C.F.R. § 4.71a, Diagnostic Code 5215. Diagnostic Code 5214 provides ratings in excess of 10 percent where the wrist is ankylosed. Favorable ankylosis of the wrist in 20 degrees to 30 degrees dorsiflexion is rated 30 percent disabling for the major wrist and 20 percent for the minor wrist; ankylosis of the wrist in any other position except favorable is rated 40 percent disabling for the major wrist and 30 percent for the minor wrist; and unfavorable ankylosis of the wrist in any degree of palmar flexion, or with ulnar or radial deviation, is rated 50 percent disabling for the major wrist and 40 percent for the minor wrist. Id. As noted above, the Veteran is currently assigned the maximum 10 percent rating under Diagnostic Code 5215 for each of her right and left wrist degenerative joint disease based on limitation of motion of the wrist. 38 C.F.R. § 4.71a. Once a particular joint is evaluated at the maximum level in terms of limitation of motion, there can be no additional disability due to pain. See Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Thus, to warrant a higher rating, the evidence would need to show that the Veteran has ankylosis of her wrists that further impacts her range of motion. This has not been shown to be the case. Turning to the evidence of record, the Board reflects that the Veteran’s wrists were shown to have at least some range of motion during the November 2010, July 2014, and December 2019 VA examinations; the examiners all noted that there was no ankylosis of the Veteran’s right or left wrist during those examinations. At the November 2010 examination, range of motion results for the right wrist revealed dorsiflexion to zero degrees, palmar flexion to 40 degrees, radial deviation to 2 degrees, and ulnar deviation to 22 degrees. Repetitive range of motion testing did not cause additional pain, weakness, fatigue, or lack of coordination. Ankylosis was not present. Range of motion for the Veteran’s left wrist revealed dorsiflexion to 6 degrees, palmar flexion 20 degrees, radial deviation to 4 degrees, and ulnar deviation to 10 degrees. Repetitive range of motion testing did not cause additional pain, weakness, fatigue, or lack of coordination. At a July 2014 VA examination, range of motion results for the right wrist showed dorsiflexion to zero degrees, palmar flexion to 30 degrees, radial deviation to 5 degrees, and ulnar deviation to 5 degrees. Range of motion for the Veteran’s left wrist revealed dorsiflexion to 5 degrees, palmar flexion 35 degrees, radial deviation to 4 degrees, and ulnar deviation to 10 degrees. Repetitive range of motion testing did not cause additional limitation in range of motion. Ankylosis was not present for either wrist joint. At a December 2019 VA examination, range of motion results for the right wrist showed dorsiflexion to 20 degrees, palmar flexion to 20 degrees, radial deviation to 20 degrees, and ulnar deviation to -10 degrees. Range of motion for the left wrist revealed dorsiflexion to 20 degrees, palmar flexion 20 degrees, radial deviation to 20 degrees, and ulnar deviation to -10 degrees. Repetitive range of motion testing did not cause additional limitation in range of motion. Pain was noted for the right wrist but not for the left. Ankylosis was not present for either wrist joint. The Board has additionally reviewed the Veteran’s VA and non-VA treatment records, but no ankylosis of her right or left wrist is shown in any of those records. After a careful review of the evidentiary record, the Board finds that the weight of the evidence is against the assignment of a disability rating in excess of 10 percent for the Veteran’s right and left wrist disabilities throughout the period on appeal. In this regard, even considering the Veteran’s complaints of pain and other symptoms affecting her range of motion, she is currently in receipt of the maximum available rating on the basis of limitation of motion under Diagnostic Code 5215, for each wrist. A higher rating is also not available pursuant to Diagnostic Code 5214, the only other diagnostic code pertaining to the wrist, which requires ankylosis of the wrist. At no time has the Veteran been shown to have ankylosis, even when considering the impact of flare-ups, and no neurological impairment of the right or left wrist has been identified. In this regard, the Board affords more probative value to the findings of the VA examiners that the Veteran has mostly had normal strength in her wrists. Therefore, a rating higher than 10 percent is not warranted. As 10 percent is the maximum rating for limitation of motion, as opposed to ankylosis, the regulatory provisions pertaining to functional loss are not applicable. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202; Spencer v. West, 13 Vet. App. 376, 382 (2000); Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Consideration has been given to assigning staged ratings. However, at no time during the period in question has the Veteran’s disabilities warranted higher schedular ratings than those assigned, and the disabilities have been stable throughout the appeal period. Hart v. Mansfield, supra. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claims adjudicated herein. Doucette v. Shulkin, supra. Therefore, the Board finds that a rating in excess of 10 percent for each of the Veteran’s wrist disabilities is not warranted and the appeal must be denied. There is no reasonable doubt to be resolved as to these issues. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Trowers, Associate 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.