Citation Nr: 21024769 Decision Date: 04/26/21 Archive Date: 04/26/21 DOCKET NO. 14-10 890A DATE: April 26, 2021 ORDER A rating in excess of 20 percent for a lumbar spine disability prior to January 21, 2016 is denied. A 40 percent for a lumbar spine disability, from January 21, 2016, forward, is granted, subject to the laws and regulations governing the award of monetary benefits. A rating in excess of 40 percent for a lumbar spine disability is denied. A rating in excess of 10 percent for a left ankle disability, prior to December 12, 2019, and in excess of 20 percent, from December 12, 2019, forward, is denied. A 20 percent rating for a left wrist disability is granted, subject to the laws and regulations governing the award of monetary benefits. FINDINGS OF FACT 1. From September 16, 2009 to January 21, 2016, the Veteran’s lumbar disability was not shown to result in forward flexion functionally limited to 30 degrees or less. 2. On January 21, 2016, the Veteran’s lumbar spine disability was shown to result in forward flexion functionally limited to 30 degrees. 3. At no time has the Veteran’s lumbar spine disability been shown to result in unfavorable ankylosis of the thoracolumbar spine, or the entire spine; nor has bed rest been shown to have been prescribed to treat incapacitating episodes of intervertebral disc syndrome. 4. Prior to December 12, 2019, the Veteran’s left ankle was not shown to have been productive of “marked” limitation of motion, to have caused malunion of the os calcis or astragalus, or to have resulted in ankylosis of the ankle. 5. From December 12, 2019, forward, the Veteran’s left ankle disability has been shown to cause “marked” limitation of motion; however, the Veteran’s left ankle has not been shown to have malunion of the os calcis or astragalus; and has not been shown to have ankylosis of the ankle. 6. The Veteran’s left wrist disability has not shown a formal diagnosis for ankylosis, but the evidence of record supports finding that his severe limitation of motion is consistent with a finding of favorable ankylosis. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for a lumbar spine disability, from September 16, 2009 to January 21, 2016, have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242-5238. 2. The criteria for a 40 percent rating for a lumbar spine disability, from January 21, 2016, forward, have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242-5238. 3. The criteria for a rating in excess of 40 percent for a lumbar spine disability, from January 21, 2016, forward, have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242-5238. 4. The criteria for a rating in excess of 10 percent for a left ankle disability, prior to December 12, 2019 have not been met. 38 U.S.C. §§ 1155, 5107; 38C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5270-74. 5. The criteria for a rating in excess of 20 percent for a left ankle disability, from December 12, 2019, forward, have not been met. 38 U.S.C. §§ 1155, 5107; 38C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5270-74. 6. The criteria for a 20 percent rating for a left wrist disability have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.124a, Diagnostic Codes 5214, 5215, and 5125. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1988 to December 1988 and from February 1990 to June 1993. The Veteran provided testimony at a September 2018 Board hearing before the undersigned Veterans Law Judge (VLJ). A complete transcript is of record. This appeal was previously before the Board in April 2019. The Board remanded the Veteran’s service connection claims for a bilateral knee condition and sleep apnea and his claim for a total disability rating based on individual unemployability (TDIU) for further development. The Veteran was provided VA examinations for his knees and sleep apnea in December 2019. A subsequent June 2020 rating decision granted the Veteran service connection for a bilateral knee disability, and for sleep apnea, and granted a TDIU. The Board notes that the Veteran has not shown any disagreement with the assigned effective date for a TDIU. As such, the Board finds that the June 2020 rating decision is considered a full grant of benefits sought on appeal, as to the service connection claims for a bilateral knee disability and sleep apnea and his claim for a TDIU; and these issues are no longer before the Board. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997). The April 2019 Board decision also remanded the Veteran’s increased rating claims for his low back, left ankle, and a left wrist disabilities because the Veteran testified that the conditions had worsened over the years and the Board found that new VA examinations were necessary. The Veteran was afforded VA examinations for his service-connected low back, left ankle, and left wrist in December 2019 that assessed the current severity of the respective disabilities. As such, the Board finds that the April 2019 Board remand directives have been substantially complied with. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating A rating in excess of 20 percent for a lumbar spine disability, from September 16, 2009 to January 21, 2016, is denied. The Veteran asserts that his low back condition has been judged unfairly and inaccurately because his injury has been deteriorating consistently. VA received the Veteran’s increased rating claim for his lumbar spine disability on September 16, 2009. A December 2009 rating decision denied his claim. The Veteran disagreed with that decision and this appeal ensued. Back disabilities are currently rated under either the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome (IVDS) based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. § 4.71a. Under the current Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 10 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least one week but less than two weeks during a 12-month period on appeal. A 20 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least two weeks but less than four weeks during a 12-month period on appeal. A 40 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least four weeks but less than six weeks during a 12-month period on appeal. A 60 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least six weeks during a 12-month period on appeal. 38 C.F.R. § 4.71a, Diagnostic Code 5243. An incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note (1). The evidence of record does not show that the Veteran has experienced any IVDS. The December 2009 VA examiner did not indicate the presence of IVDS and the January 2016 and December 2019 VA examiner’s both indicated that the Veteran did not have IVDS. Moreover, there is no evidence showing that the Veteran has ever been prescribed bed rest to treat his lumbar spine disability. Because the prescription of bed rest is a foundational requirement of a rating under this section of the rating schedule, the absence of any prescribed bed rest precludes a rating from being assigned under it. As such, a rating based on IVDS is not appropriate, and it is therefore more beneficial to evaluate the Veteran’s lumbar spine disability under the General Rating Formula for Diseases and Injuries of the Spine. Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent evaluation is warranted if forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or if there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent evaluation is warranted if forward flexion of the thoracolumbar spine is 30 degrees or less or there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. It is noted that on February 7, 2021, during the course of this appeal, revisions to the Schedule for Rating Disabilities that addresses the musculoskeletal system went into effect. The Supreme Court has held that statutes generally may not be construed to have retroactive effect unless their language requires that result. See Landgraf v. USI Film Products, 511 U.S. 244 (1994). In Karnas, the Federal Circuit held that the more favorable regulations should apply to the Veteran. See Karnas v. Derwinski, 1 Vet. App. 308 (1991). However, the Federal Circuit overruled Karnas to the extent that it allowed for retroactive application and conflicted with U.S. Supreme Court and Federal Circuit precedents. Specifically, in Kuzma, the Federal Circuit held that the Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Thus, Karnas allows the old criteria to be applied before and after the effective date of the amendment, if such is more favorable to the Veteran. But, in light of Kuzma, the amended regulation cannot be applied prior to the effective date unless it explicitly provides otherwise. In other words, the old and new regulations are for consideration with regard to rating the Veteran’s disability, and he is entitled to the more favorable regulation; however, if the revised criteria are more favorable to the Veteran and provide for an increased rating, that award may not be made effective before the effective date of the change. See 38 U.S.C. § 5110 (g); VAOPGCPREC 3-00. Here, the amendments to the rating schedule do not have any retroactive application. In this case, the revisions to the regulations have a limited effect because they do not change how the lumbar spine is rated. Rather, the revisions revised Diagnostic Codes 5242 and 5243, which states that Diagnostic Code 5243 is assigned when there is disc herniation with compression and or irritation of the adjacent nerve root; and to assign Diagnostic Code 5242 for all other diagnoses. Diagnostic Code 5244 also adds a new diagnostic code for traumatic paralysis. Here, the Veteran has not been diagnosed, nor does he assert that he has IVDS or traumatic paralysis and the revisions do not impact the Veteran’s lumbar spine rating. The Veteran was afforded a VA examination in December 2009 at which he reported experiencing back pain in his lower lumbosacral region, which radiated over the left side. He reported flare-ups of his back disability, which he described as a sharp pain, that could last from five to thirty minutes. On examination, he showed forward flexion to 70 degrees, extension to 20 degrees, left lateral bending to 20 degrees, right lateral bending to 20 degrees, left rotation to 20 degrees, and right rotation to 20 degrees. The examiner reported that they observed the Veteran rise up out of the chair he was sitting in, in the waiting room, and was able to walk into the examination room without a limp. However, once in the examination room, he rose out of the seated position slowly. The examiner indicated that the Veteran restricted his range of motion subjectively with back pain. The Veteran testified that that his back pain has gotten worse over the years. He reported that he had been prescribed a back brace and a cane for his back. However, he did not state when he was prescribed such devices. The Veteran’s post-service treatment records show treatment for his low back pain. The treatment records describe limitation of motion in his lumbar spine. For example, in July 2010, he showed forward flexion to 45 degrees, extension to 10 degrees, and right and left lateral rotation to 20 degrees. See VA Treatment record dated July 2, 2010. A rehabilitation consultation note reported that his active range of motion was modestly reduced in flexion and extension. See VA Treatment Record dated August 14, 2013. Regarding the Veteran’s use of assistive devices, there is no evidence that indicates he used a back brace or cane for his back during this period on appeal. The contemporaneous evidence of record shows that he was prescribed a back brace in July 2016 and the record shows that he was prescribed a cane, but it is unclear as to when. Here, during this period on appeal, the Veteran has not demonstrated limitation of motion for forward flexion of the thoracolumbar spine, limited to 30 degrees or less, which is consistent with a 40 percent rating. The Board acknowledges that the Veteran reported having flare-ups at the December 2009 VA examination; however, on examination, he showed forward flexion to 70 degrees and there was no indication that his limitation of motion would be so limited during a flare-up, that it would cause his forward flexion limited to 30 degrees or less. At worst, during this period on appeal, he showed forward flexion to 45 degrees, well in excess of the criteria for a 40 percent rating. There has been no indication that he has ankylosis of the spine. Further, during an August 2013 rehabilitation session, he was reported to only have “modestly” reduced flexion and extension; there was no indication that he had a severe limitation of motion that would have otherwise limited his forward flexion to 30 degrees or less, during this period on appeal. The Board acknowledges the Veteran’s assertion that his lumbar spine disability has been judged unfairly and inaccurately and that he experiences pain. However, the Board is bound by the regulations and cannot award disability ratings that are not consistent with the rating criteria. A rating in excess of 20 percent for a lumbar spine disability requires forward flexion of the thoracolumbar spine to be limited to 30 degrees or less; favorable ankylosis of the entire thoracolumbar spine; or unfavorable ankylosis of the entire lumbar spine. Here, none of those criteria have been met during the period on appeal. Further, the Board acknowledges the Veteran’s use of assistive devices; however, the use of a back brace and a cane does not appear to have started during this period on appeal. For example, the Veteran was prescribed a back brace in July 2016. Here, the Veteran’s assertions and subjective complaints does not result in symptoms more nearly approximating a limitation of forward flexion to 30 degrees or less, or ankylosis of the spine. Accordingly, a rating in excess of 20 percent for a lumbar spine disability, from September 16, 2009 to January 21, 2016, is denied. A rating of 40 percent for a lumbar spine disability, from January 21, 2016, forward, is granted. The Veteran was afforded a VA examination in January 2016 at which he reported that his low back condition had worsened and that on some days, he could not even get out of bed due to the pain. He did not report experiencing any flare-ups of his lumbar spine disability. On examination, he showed forward flexion from 5 degrees to 35 degrees, extension to negative 7 degrees, right lateral flexion to 5 degrees, left lateral flexion to 25 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 15 degrees. The examiner noted pain on examination, in all planes of motion, which caused functional loss, but did not have pain with weight bearing. The Veteran was able to perform repetitive use testing with no loss of range of motion. The examiner indicated that the Veteran was examined immediately after repetitive use over time and pain, weakness, fatigability, or incoordination did not significantly limit functional ability. The examiner reported that the Veteran did not have muscle spasms or guarding, but did have localized tenderness, which did not result in abnormal gait or abnormal spinal contour. The Veteran showed normal strength in all planes of motion. The examiner reported that the Veteran did not have IVDS of the lumbar spine, did not use assistive devices, and did not have ankylosis of the spine. The Veteran was afforded a VA examination in December 2019. The Veteran reported that he had been living with pain over the years and that he used a brace for stability and pain relief. He stated that his current symptoms were pain and weakness. He did not report having flare-ups but reported that he could not sit or stand for long periods of time. On examination, his forward flexion was limited to 30 degrees, his extension was limited to 10 degrees, right lateral flexion was limited to 10 degrees, left lateral flexion was limited to 15 degrees, right lateral rotation was limited to 15 degrees, and left lateral rotation was limited to 5 degrees. There was pain noted on examination, in all planes of motion. There was also evidence of pain with weight bearing. The Veteran was able to perform repetitive use testing with no additional loss in terms of range of motion. The examiner indicated that the examination did not take place after repetitive use over time, but opined that it would cause the Veteran’s range of motion to be limited to approximately 20 degrees of forward flexion. The examiner reported that the Veteran had muscle spasms resulting in abnormal gait or abnormal spinal contour. Muscle strength testing showed 3/5 strength in all planes of motion. There was no evidence of ankylosis of IVDS. The examiner reported that the Veteran used a brace and crutches on a constant basis for his back. The Board notes that a June 2020 rating decision increased the Veteran’s disability rating from 20 percent to 40 percent for his lumbar spine disability based on the findings of the December 2019 VA examination, and assigned the effective date for the 40 percent rating, as December 12, 2019. However, the Board finds that the criteria for a 40 percent rating were met on January 21, 2016. The Board acknowledges that the Veteran’s forward flexion was found to be limited to 35 degrees at the January 2016 VA examination, but also notes that the examiner indicated that forward flexion began at 5 degrees. Given that his forward flexion was shown to be from 5 degrees to 35 degrees, the Board finds that his forward flexion was limited to 30 degrees or less, from January 21, 2016, forward. Accordingly, the criteria for a 40 percent rating for a lumbar spine disability have been met, from January 21, 2016, forward. A rating in excess of 40 percent for a lumbar spine disability is denied. However, the Board also finds that the weight of the evidence does not support a rating in excess of 40 percent for a lumbar spine disability, at any time. The Board acknowledges the Veteran’s assertion that his low back disability has been judged unfairly and inaccurately, although the Board also notes that the Veteran has not specified as to why he believes this. To the extent that the rating has been inaccurate, the Board believes that the assignment of a 40 percent rating from January 21, 2016, forward, has rectified any inaccuracy in the rating of his lumbar spine disability. The Board also acknowledges the Veteran’s complaints of worsening symptoms over time, to include pain and weakness and recognizes his use of assistive devices. However, such complaints of pain and weakness, even in conjunction with the use of a back brace and a cane does not result in symptoms more nearly approximating unfavorable ankylosis of the entire thoracolumbar spine. The criteria for a rating in excess of 40 percent for a lumbar spine disability requires the Veteran to show a diagnosis for ankylosis of the lumbar spine, or the entire spine. Given the Veteran’s complaints of worsening symptoms at the September 2018 Board hearing, he was afforded a new VA examination. Fortunately, there was no evidence of ankylosis in his spine. Additionally, the Veteran’s treatment records do not show any diagnosis for ankylosis of the spine. Further, the Veteran has not reported the signs or symptoms of ankylosis of the spine. Ultimately, the evidence does not show that the range of motion is so functionally limited in the back to approximate even favorable ankylosis. Accordingly, a rating in excess of 40 percent for a lumbar spine disability is denied. A rating in excess of 10 percent for a left ankle disability, prior to December 12, 2019, and in excess of 20 percent, from December 12, 2019, forward, is denied. The Veteran asserts that his left ankle condition has been judged unfairly and inaccurately because his injury has been deteriorating consistently, as well as aggressively. VA received the Veteran’s increased rating claim for his left ankle disability on September 16, 2009. A December 2009 rating decision denied his claim. The Veteran disagreed with that decision and this appeal ensued. As such, the period on appeal begins on September 16, 2009. The Veteran’s left ankle disability is currently rated at 20 percent under Diagnostic Code 5271, effective January 12, 2019. His 20 percent rating is based on a marked limitation of motion. From September 16, 2009 to January 12, 2019, the Veteran’s left ankle disability is rated at 10 percent based on a moderate limitation of motion. Diagnostic Code 5270 evaluates ankylosis of the ankle. No VA examiner has diagnosed ankylosis of the left ankle, and VA treatment records do not suggest the presence of ankylosis. Therefore, this Diagnostic Code is not applicable and will not be discussed further. Diagnostic Code 5272 concerns ankylosis of the subastragalar or tarsal joint of the ankle. No VA examiner has diagnosed ankylosis of the subastragalar or tarsal joint, and VA treatment records do not suggest the presence of ankylosis of the subastragalar or tarsal joint. Therefore, this Diagnostic Code is not applicable and will not be discussed further. Diagnostic Code 5273 addresses malunion of the os calcis or astragalus. The medical record does not document malunion of the os calcis or astragalus of the left ankle. Therefore, this Diagnostic Code is not applicable and will not be discussed further. Diagnostic Code 5274 evaluates astragalectomy, or removal of the talus bone. The medical record does not document removal of the talus bone of the left ankle. Therefore, this Diagnostic Code is not applicable and will not be discussed further. Diagnostic Code 5271 evaluates range of motion in the ankle. A 10 percent rating is assigned for moderate limitation of motion. A 20 percent rating is assigned for marked limitation of motion. Ankle dorsiflexion is measured from 0 degrees to 20 degrees; plantar flexion is measured from 0 degrees to 45 degrees. 38 C.F.R. § 4.71a, Plate II. As previously mentioned, there have been revisions to the regulations regarding the musculoskeletal system. Here, the revisions to the regulations have a limited impact because they do not substantively change how the ankle is rated. Rather, the revisions define marked and moderate limitation of motion as it applies to the ankles. Under the revised regulations, marked limitation of motion of the ankle means less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion and is rated at 20 percent. Moderate limitation of motion means less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion and is rated at 10 percent. In applying the appropriate Diagnostic Codes in this case, the Board notes that it must explain what is meant by mild and moderate. Here, the Board adopts the definitions contained in the revised regulations and they appear reasonable. The Veteran was afforded a VA examination in December 2009 at which he reported that on long walks, he would usually take a break for a short while to quiet any aggravation of ankle pain. The Veteran reported that he did not wear any orthopedic devices, but the examiner indicated that he wore a supportive boot to the examination. He reported that his ankle pain was a 7/10 on an ongoing basis; however, the examiner noted that he was able to walk without a limp. On examination, he showed dorsiflexion to 8 degrees and plantar flexion to 40 degrees. The examiner reported that repeated testing did not limit range of motion. The Veteran was afforded a VA examination in January 2016 at which he reported experiencing swelling in his left ankle, but was most affected by pain after being on his feet for a while. He reported having flare-ups of the left ankle that resulted predominantly in pain, but mostly in swelling. He also described his functional loss as less movement. On examination, the examiner indicated that the Veteran’s dorsiflexion began at negative 5 degrees, but did not indicate an end of the range. He showed plantar flexion from 5 degrees to 20 degrees. The Veteran was able to perform repetitive use testing and it did not result in additional loss in terms of range of motion. The examiner reported that the examination was not conducted during a flare-up and declined to opine as to whether pain, weakness, fatigability, or incoordination significantly limited functional ability because it would result in mere speculation. Muscle strength testing showed normal strength in all planes of motion. The examiner reported that there was no ankylosis of the left ankle. There was no evidence of ankle instability or dislocation. A careful review of the Veteran’s post-service medical records, to include VA treatment records, show that he complained of left ankle pain and swelling, but do not reveal any range of motion testing and do not reveal any findings that would otherwise warrant a rating in excess of 10 percent. Here, prior to December 12, 2019, the Veteran is in receipt of a 10 percent rating for his left ankle, for moderate limitation of motion. The next higher rating at 20 percent requires a more significant, “marked” limitation. At the December 2009 VA examination, he showed dorsiflexion to 8 degrees and plantar flexion to 40 degrees and the examiner reported that repeated testing did not limit range of motion. On examination, the Veteran was shown to retain about 74 percent of his total ankle range of motion and the Board finds that such range of motion is not best characterized by “marked” limitation of motion. The Board acknowledges that the Veteran’s dorsiflexion was found to start at negative 5 degrees, with no end point at the January 2016 VA examination. However, the examiner also specifically reported that the Veteran did not have ankylosis of the left ankle. Here, the Board interprets this range of motion measurement to mean that the Veteran had five degrees of range motion for dorsiflexion. He also showed that plantar flexion from 5 to 20 degrees, or 15 degrees of range of motion. Here, the Veteran showed that he retained about 30 percent of his total ankle range of motion. The Board recognizes that the Veteran does have a limitation of range of motion, but does not find that it is best characterized by “marked” limitation of motion. Further, the Veteran’s chief complaint throughout this period on appeal was not that his ankle was limited in terms of range of motion, but that it was painful. The Board notes that although the revised regulations have defined “marked” and “moderate” limitation of motion, they do not have retroactive application; but they are informative. Here, the Veteran does not meet the criteria for a finding of marked limitation of motion, under the new rating criteria, when considering both VA examinations during this period on appeal; he did not show less than five degrees dorsiflexion or less than 10 degrees plantar flexion. As such, the Board finds that at worst, the Veteran was shown to retain about 30 percent of his total ankle range of motion, during this period on appeal. As discussed, the Board does not find that the Veteran’s limitation of motion in his left ankle, during this period on appeal, is best characterized as “marked.” Further, there was no showing of ankylosis in the left ankle or malunion of the os calcis or astragalus. Accordingly, a rating in excess of 10 percent for a left ankle disability, prior to December 12, 2019, is denied. The Board notes that in reaching this conclusion, consideration has been given to the impact of factors such as weakness, pain, fatigability, etc. However, the use of terms such as moderate and marked has allowed such symptoms to be considered within the framework of evaluating the ankle disability. As such, a higher rating is not warranted based on the DeLuca factors. The Veteran was afforded a VA examination in December 2019 at which he reported that he had lived with pain in his ankle over the years and that he wore a brace on his left ankle. He reported a popping with movement in his ankle. He indicated that he had swelling, pain, instability, and weakness of the left ankle. He reported that he did not have flare-ups of the left ankle. On examination, he showed dorsiflexion to 5 degrees and plantar flexion to 5 degrees. There was pain noted on examination, in all planes of motion. The Veteran was able to perform repetitive use testing, with no additional loss in terms of range of motion. Muscle strength testing showed 3/5 strength for all planes of motion. There was no evidence of ankylosis. A review of the Veteran’s VA treatment records does not reveal any range of motion testing and does not reveal any findings that would otherwise warrant a rating in excess of 20 percent for a left ankle disability. Here, the Veteran has shown severe limitation of motion in his left ankle at the December 2019 VA examination; he showed only 5 degrees of range of motion for both plantar flexion and dorsiflexion, retaining only about 15 percent of normal ranges of motion. The Board acknowledges that the Veteran has been shown to have severe limitation of range of motion; however, the highest rating under Diagnostic Code 5271 is 20 percent, for which his is already in receipt of. The Board is sympathetic to the Veteran’s increased rating claim for his left ankle and does not doubt that it causes him significant impairment. However, the Board is bound by the rating criteria and there is no higher rating available for limitation of motion that the Veteran may receive because he already receives the maximum schedular rating for limitation of motion. Here, the Veteran has not been shown to have ankylosis; malunion of the os calcis or astragalus; or did he undergo an astraglectomy. Accordingly, a rating in excess of 20 percent for a left ankle disability is denied. A 20 percent rating for a left wrist disability is granted. The Veteran asserts that there is evidence of severe pain and weakness in his left wrist and is entitled to a 40 percent disability rating. VA received the Veteran’s increased rating claim for his service-connected left wrist disability on January 23, 2015. A July 2015 rating decision granted an increased rating, to 10 percent, effective January 23, 2015, the date of claim. The Veteran’s left wrist disability is currently rated at 10 percent under Diagnostic Code 5215, effective January 23, 2015, the date of claim. His 10 percent rating is based on painful motion. See 38 C.F.R. § 4.59. Disability ratings for the wrist are assigned pursuant to Diagnostic Codes 5214 (ankylosis of the wrist), 5215 (limitation of motion of the wrist), and 5125 (loss of use of hand). 38 C.F.R. § 4.71a. The schedular rating criteria provide different disability ratings for wrist disorders depending on whether the wrist disorder impacts the dominant or nondominant wrist. Id. VA examinations indicate that the Veteran’s left wrist is his nondominant wrist. Under Diagnostic Code 5215, a disability rating of 10 percent is assigned when dorsiflexion of the nondominant wrist is less than 15 degrees or when palmar flexion is limited in line with the forearm. 38 C.F.R. § 4.71a, Diagnostic Code 5215. Under Diagnostic Code 5214, a disability rating of 20 percent is assigned when the nondominant wrist manifests favorable ankylosis with a dorsiflexion between 20 and 30 degrees, and a disability rating of 30 percent is assigned when the nondominant wrist manifests ankylosis in any position except favorable. A disability rating of 40 percent is assigned when the Veteran’s nondominant wrist manifests unfavorable ankylosis in any degree of palmar flexion or with ulnar or radial deviation. Under Diagnostic Code 5125, a disability rating of 60 percent is assigned for the loss of use of the nondominant hand. 38 C.F.R. § 4.71a, Diagnostic Code 5125. As previously mentioned, there have been revisions to the regulations regarding the musculoskeletal system. Here, the revisions to the regulations have no impact on this issue because there were no changes made as to how the wrist is rated. The Veteran was afforded a VA examination in January 2016 at which he reported consistent pain and weakness in his left wrist and stated that he could not push his weight up on it. He did not report having flare-ups, but described his functional loss as less movement. On examination, he showed palmar flexion to 10 degrees, dorsiflexion to 35 degrees, ulnar deviation to 5 degrees, and radial deviation to 15 degrees. The examiner noted that there was pain on examination, in all planes of motion. There was also evidence of pain with weight bearing. The examiner indicated that the examination took place after repetitive use over time but did not limit functional ability. Muscle strength testing showed normal strength in all planes of motion. There was no evidence of ankylosis. The examiner reported that the Veteran used a brace on a regular basis. The Veteran was afforded a VA examination in December 2019. The Veteran reported that he has lived with pain throughout the years and that he wore a brace for stability and pain relief. He noted that his current symptoms were pain and weakness. He did not report having flare-ups in his left wrist. On examination, he showed no range of motion for plantar flexion, ulnar deviation, and radial deviation; and dorsiflexion to 5 degrees. The examiner indicated that there was evidence of pain on examination and there was evidence of pain with weight bearing. The Veteran was able to perform repetitive use testing with no additional loss in terms of range of motion. The examiner opined that after repetitive use over time, the Veteran would not have any range of motion in any of the planes of motion. In the additional factors contributing to disability section, the examiner reported that the Veteran could not move his wrist due to a very limited range of motion. Muscle strength testing showed 3/5 strength for flexion and 2/5 strength for extension. There was no evidence of ankylosis. The examiner indicated that the Veteran used a brace on a constant basis. The examiner reported that the Veteran’s left wrist disability would not be equally well served by an amputation. A review of the Veteran’s VA treatment records does not reveal any findings that would otherwise warrant a rating in excess of 20 percent for a left wrist disability. Here, the Veteran is in receipt of the maximum 10 percent rating under Diagnostic Code 5215. His rating is based on painful motion of the left wrist; however, the Board acknowledges that the range of motion testing at the December 2019 VA examination also warrants a 10 percent rating under Diagnostic Code 5215. However, the Board finds that the Veteran’s severe limitation of motion in his left wrist, is consistent with a finding of favorable ankylosis, under Diagnostic Code 5214. The Board acknowledges that there has been no formal finding that the Veteran is diagnosed with ankylosis. However, the initial range of motion testing at the December 2019 VA examination shows that he did not have any rage motion for palmar flexion and only showed dorsiflexion to 5 degrees. The examiner further reported that after repetitive use over time, the Veteran would not have any range of motion in any of the planes of motion; and in the additional factors contributing to disability section, the examiner reported that the Veteran could not move his wrist due to a very limited range of motion. Here, the Board finds that the December 2019 VA examiner’s report is consistent with a finding of favorable ankylosis of the nondominant wrist because he was found to essentially have an immobile left wrist. The Board notes that the December 2019 VA examiner reported that the Veteran’s left wrist disability would not be equally well served by an amputation. As such, the Board finds that a rating under Diagnostic Code 5215 is not applicable. Further, a 40 percent rating is not warranted because there has been no evidence of unfavorable ankylosis. Accordingly, a 20 percent rating, but no higher, for a left wrist disability is granted. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Fu, 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.