Citation Nr: 21025327 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 16-29 414 DATE: April 27, 2021 ORDER A disability rating in excess of 10 percent for chronic shin splints of the right lower extremity is denied. A disability rating in excess of 10 percent for chronic shin splints of the left lower extremity is denied. REMANDED A compensable disability rating for peripheral neuropathy of the right lower extremity is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s chronic shin splints of the right lower extremity have not manifested with a moderate right knee or right ankle disability. 2. The Veteran’s chronic shin splints of the left lower extremity have not manifested with a moderate left knee or left ankle disability. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for chronic shin splints of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5262. 2. The criteria for a rating in excess of 10 percent for chronic shin splints of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5262. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1996 until his honorable discharge in August 1997. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision by the St. Paul, Minnesota, Regional Office (RO) of the United States Department of Veterans Affairs (VA). The Veteran did not choose to have a hearing before the Board. In October 2019, the Board remanded the case to the RO for further development. Specifically, the Board directed the RO to obtain new VA examinations to assess the severity of the Veteran’s disabilities, which the RO accomplished. The case now returns to the Board for adjudication. Evidentiary Standards In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. VA is required to give due consideration to all pertinent medical and lay evidence when rating disabilities. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 C.F.R. § 4.3. To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). A claim for an increased rating is a new, distinct claim. See Suttman v. Brown, 5 Vet. App. 127, 136 (1993) (a claim for an increase is “based upon facts different from the prior claim”). An increased disability rating is generally assigned based on a showing that a service-connected disability has worsened. The Board is to consider each disability in relation to the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999); 38 C.F.R. § 4.1. Separate ratings can be assigned for separate periods of time based on the facts found—a practice known as “staged” ratings. Id. at 126. The law requires the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 128‒29 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claims. Disability Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4. The 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. Diagnostic Codes (DCs) are assigned to individual disabilities. Diagnostic Codes provide rating criteria specific to a particular disability. If two DCs are applicable to the same disability, the DC that allows for the higher disability rating applies. 38 C.F.R. § 4.7. When a question arises as to which of two ratings apply under a particular DC, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. Id. Rating Criteria – Shin Splints The Veteran’s bilateral shin splints are rated under 38 C.F.R. § 4.71a, DC 5262 (“Tibia and fibula, impairment of”). Prior to February 7, 2021, DC 5262 provided: Rating (%) Tibia and fibula, impairment of: Nonunion of, with loose motion, requiring brace 40 Malunion of: With marked knee or ankle disability 30 With moderate knee or ankle disability 20 With slight knee or ankle disability 10 VA regulations do not define the terms “slight,” “moderate,” or “marked.” Absent an express definition, it is presumed that VA regulations employ words using their ordinary dictionary meanings at the time the regulations were promulgated. See Nielson v. Shinseki, 607 F.3d 802, 805–06 (Fed. Cir. 2010). “Slight,” as an adjective, is defined as “small of its kind or in amount.” Slight, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/slight, Definition 2, (last visited Apr. 15, 2021). “Moderate,” as an adjective, is defined as “not violent, severe, or intense”; “limited in scope or effect.” Moderate, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/moderate, Definitions 3 and 5 (last visited Apr. 15, 2021). “Marked,” as an adjective, is defined as “having a distinctive or emphasized character.” Severe, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/marked, Definition 2 (last visited Apr. 15, 2021). Using the above definitions as guidance, the Board must arrive at an equitable and just decision based on an evaluation of all relevant evidence. 38 C.F.R. §§ 4.2, 4.6. The Board keeps in mind that the terms “slight,” “moderate,” and “marked” are used in relation to a knee or ankle disability. It should also be noted that use of terminology such as “slight,” “moderate,” and “marked” by VA examiners or other physicians, although an element of evidence to be considered by the Board, is not dispositive of an issue. In addition, objective evidence is not necessarily required to assign a disability rating under DC 5262. Cf. Petitti v. McDonald, 27 Vet. App. 415, 427 (2015). VA amended numerous DCs, including DC 5262, as of February 7, 2021. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76,460 (Nov. 30, 2020), as amended 85 Fed. Reg. 85,523 (Dec. 29, 2020), as amended 86 Fed. Reg. 8,142 (Feb. 4, 2021). Because the Veteran’s appeal was pending prior to these amendments, the Board is required to analyze his claim under both versions of 38 C.F.R. § 4.71a, DC 5262, and whatever criteria is more favorable to the Veteran will be applied as of February 7, 2021. See Ervin v. Shinseki, 24 Vet. App. 318 (2011) (discussing retroactivity and effects of changes in law or regulation during the pendency of an appeal), opinion corrected, 25 Vet. App. 178 (2012). In relevant part, DC 5262 now provides: Rating (%) Tibia and fibula, impairment of: Medial tibial stress syndrome (MTSS), or shin splints: Requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities 30 Requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, one lower extremity 20 Requiring treatment for no less than 12 consecutive months, and unresponsive to either shoe orthotics or other conservative treatment, one or both lower extremities 10 Treatment less than 12 consecutive months, one or both lower extremities 0 Notably, “shin splints” are now specifically listed as a disability with defined criteria. When VA evaluates musculoskeletal disabilities under the Rating Schedule, it must determine whether or not the factors listed in 38 C.F.R. §§ 4.40, 4.45, and 4.59 are properly accounted for within the applicable DC criteria. Notably, sections 4.40 and 4.45 are only applicable in cases where a DC’s rating criteria are based on limitation of motion. As of February 7, 2021, DC 5262 does not contemplate limitation of motion as a rating basis. As such, sections 4.40 and 4.45 are not applicable to the new rating criteria of DC 5262. Under section 4.40, VA must consider whether there is evidence of functional loss due to pain on movement and diminished excursion, strength, speed, coordination, and endurance, to include during flare-ups or after repetitive use. 38 C.F.R. § 4.40; Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2001). Pain on movement, standing alone, is not sufficient to warrant a higher rating under section 4.40. Id. (reaffirming that pain must affect some aspect of “the normal working movements of the body... in order to constitute functional loss”). Section 4.45 expands upon the concept of functional loss, noting six factors that VA must consider when evaluating a disability, namely: (1) less or (2) more movement than is normal; (3) weakened movement; (4) excess fatigability; (5) incoordination; and (6) pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing, to include during flare-ups or after repetitive use. 38 C.F.R. § 4.45. Noticeably, the aspects of functional loss listed in section 4.40 closely parallel the factors listed in section 4.45. Section 4.45 applies to muscles, nerves, as well as the entire musculoskeletal system. DeLuca v. Brown, 8 Vet. App. 202, 207 (1995). Under section 4.59, a veteran may be awarded the minimum compensable evaluation available under a given musculoskeletal DC, even if application of that DC would not support a compensable evaluation, where there is evidence of “actually painful, unstable, or malaligned joints.” 38 C.F.R. § 4.59; Petitti v., 27 Vet. App. at 427. Section 4.59 does not require medical evidence; it may be satisfied with lay and other non-medical evidence. Id. at 428. Thus, pain alone is compensable under section 4.59 for joint disabilities in general. Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). Analysis As applied to the Veteran’s right and left shin splints, the Board finds the new rating criteria of DC 5262 does not benefit the Veteran. In order to obtain either a 20 percent or 30 percent disability rating, the Veteran’s bilateral shin splints had to be “unresponsive to surgery,” among other things. There is no evidence in the record that the Veteran underwent surgery on his bilateral shin splints. Nor is there evidence that any of the medical professionals who evaluated or treated the Veteran, in any manner, indicated, or reasonably suggested, that if the Veteran were to have surgery on his bilateral shin splints that his bilateral shin splints would be “unresponsive to surgery.” Therefore, as the Veteran would not benefit from application of the new rating criteria, the Board will analyze the Veteran’s claims for an increased rating for his bilateral shin splints under the version of DC 5262 in effect prior to February 7, 2021, for the entire appeal period. 1. A disability rating in excess of 10 percent for chronic shin splints of the right lower extremity The Veteran informed the RO of his intent to seek an increased rating for his right shin splints in January 2012. Thus, the relevant appeal period is from January 2011 through the present. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). Throughout the appeal period, the Board finds a lack of evidence that indicates, or reasonably suggests, the Veteran’s right shin splints manifested with a moderate right knee or right ankle disability. Therefore, an increased rating in excess of 10 percent is not warranted, and the factors found within 38 C.F.R. §§ 4.40, 4.45, and 4.59 are adequately encompassed within his 10 percent disability rating. The Veteran’s VA medical records document that he experienced pain in his right shin in 2012, which traveled to his right foot, right knee, right thigh, and lower back. May 2012 VA Pain Clinic Note; July 2012 VA Pain Clinic Note; August 2012 VA Psychology Progress Note. A May 2012 VA clinician documented “slightly” weaker right knee flexion and extension “likely due to pain.” A July 2012 VA physician recorded that the Veteran experienced sharp, numbing, throbbing, and burning pain. The intensity was 8 out 10 on average. He experienced the pain daily. Standing, most movements, and sitting for extended periods of time aggravated the pain. He was on medications. The Veteran reported symptoms of swelling, right leg instability, and some numbness in the tailbone four to five times per month. The VA physician was unable to complete a motor examination due to the Veteran’s pain. The Board finds the Veteran was competent to report his symptoms associated with his right shin splints. Jandreau v. Nicholson, 493 F.3d 1372, 1377 (Fed. Cir. 2007) (noting general competence of laypersons to testify as to symptoms). His statements are also credible and probative. From May 2012 to August 2012, the Veteran’s reported pain is best characterized as intense. But his right knee disability, which manifested as weakness, instability, and loss of range of motion, is best characterized as “slight” in 2012. His right knee disability was not severe, intense, or distinct. He still retained motor functions and range of motion. There is a lack of evidence that his daily life was impaired based on a right knee or right ankle disability around that time. In July 2013, the Veteran appeared for a VA examination to assess his right shin splints. At the time he experienced pain in his right shin. The Veteran reported experiencing flare-ups with occasional pain. His right knee flexion was 0 to 120 degrees (0 to 140 degrees being normal) and his extension was to 0 degrees (normal). The examiner did not find objective evidence of painful motion. There was no loss of range of motion following repetitive testing. He had normal right knee muscle strength. There was no right knee joint instability. The Veteran was not using an assistive device. The examiner opined that the Veteran’s disability did not impact his ability to work. Absent evidence to the contrary, the Board finds the July 2013 VA examiner was competent to exam and assess the severity of the Veteran’s right shin splint. Cox v. Nicholson, 20 Vet. App. 563, 569 (2007) (the competence of VA examiners is presumed absent evidence to the contrary). The Board finds the examiner’s overall examination, medical findings, and medical opinion credible and probative. The examiner conducted a thorough in-person examination, relied on accurate facts, considered the Veteran’s relevant medical records, medical history, and lay statements. The Board recognizes the examiner did not provide an estimation of additional loss of range of motion due to flare-ups or repetitive use over time. Nonetheless, the Board finds the examiner’s examination is still probative in the other respects addressed above. Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (“[E]ven if a medical opinion is inadequate to decide a claim, it does not necessarily follow that the opinion is entitled to absolutely no probative weight.”). Between 2013 and 2015, the Veteran submitted several statements addressing the severity of his right shin splints. He stated that his right leg was in constant pain. He experienced a burning sensation and numbness. His right leg swelled to touch. He stated he was unable to stand for more than five minutes at a time. When walking, his right leg would give out on occasion. He had difficulty sitting with his right foot flat on the floor because he experienced sharp pain from his foot to his thigh. Due to his pain and the medication he was taking, he reported he was unable to work and drive. He had general difficulty running, jumping, squatting, or doing any strenuous activity. The Board finds the Veteran’s reports of his symptoms credible and probative. Based on his statements of worsening of his right shin splints, the RO provided the Veteran a VA examination in April 2015. The Veteran told the examiner he was unable to run and was only able to walk for about seven minutes. He reported his leg would give way. He did not report experiencing flare-ups. Nor did he report having functional loss or functional impairment. The Veteran’s right knee flexion was 0 to 140 degrees and his extension was 140 to 0 degrees. The examiner did not observe painful motion but did observe tenderness along the right shin. The Veteran was examined immediately following repetitive use over time, and the examiner did not find additional loss of range of motion in the right knee. The examiner documented reduced right knee muscle strength, 4 out of 5, which indicated active movement against some resistance. No right knee ankylosis, atrophy, or instability was found. The examiner specifically opined that the Veteran’s right shin splints did not affect his right knee or right ankle’s range of motion. Overall, the examiner opined that the Veteran’s right shin splints were mild in severity. Absent evidence to the contrary, the Board finds the April 2015 VA examiner was competent to exam and assess the severity of the Veteran’s right shin splints. The Board finds the examiner’s overall examination, medical findings, and medical opinion credible and probative. The examiner conducted a thorough in-person examination, relied on accurate facts, considered the Veteran’s relevant medical records, medical history, and lay statements. Between April 2015 and February 2018, the Veteran submitted various statements describing the worsening of his right shin/leg. He stated that he continued to experience pain constantly, which he rated as “7.” He continued to experience trouble standing, walking, and sitting. In his June 2016 VA Form 9, he reported his right leg gave out “every day.” In February 2018, the RO provided the Veteran another VA examination. The focus of the exam was on the Veteran’s left leg. Nonetheless, the medical findings associated with the Veteran’s right knee within the examination are relevant. The examiner documented right knee flexion of 0 to 140 degrees and extension of 140 to 0 degrees. The examiner observed pain during flexion but opined it did not result in additional functional loss. There was no evidence of pain on weightbearing, evidence of tenderness, or crepitus. Following repetitive-use testing, no additional functional loss resulted. The examiner opined that during flare-ups and following repetitive use over time the Veteran’s resulting pain, fatiguability, or incoordination would not significantly limit his functional ability. The Veteran’s right knee muscle strength was normal, 5 out of 5 on flexion and extension. There was no finding of ankylosis or instability in the right knee. The Veteran reported regular use of a cane. Absent evidence to the contrary, the Board finds the February 2018 VA examiner was competent to exam and assess the severity of the Veteran’s right shin splint. The Board finds the examiner’s overall examination, medical findings, and medical opinion credible and probative. The examiner conducted a thorough in-person examination, relied on accurate facts, considered the Veteran’s relevant medical records, medical history, and lay statements. The Veteran’s VA medical records continued to document constant pain and numbness in the Veteran’s right leg. In the Veteran’s May 2018 appellate brief, he continued to assert worsening of his right shin splints. Consequently, the Veteran was provided another VA examination in January 2020. During the examination, the Veteran did not report flare-ups, but he did report decreased flexion of the right knee, numbness, and paresthesias. The examiner found the Veteran’s right knee flexion was 0 to 100 degrees and extension was 100 to 0 degrees, which resulted in an impaired gait an inability to kneel. The examiner observed pain on both flexion and extension that resulted in functional loss. The examiner opined that following repetitive use over time, the Veteran would likely suffer from additional pain. The examiner was unable to describe additional functional loss in terms of range of motion because the Veteran appeared “to resist motion on exam.” The examiner also believed the Veteran suffered from reduced right knee muscle strength, but he resisted testing of strength. The examiner did not find muscle atrophy, ankylosis, or instability of the right knee. The Veteran reported constantly using a cane because his leg would give way sometimes. Overall, the examiner determined the Veteran’s right shin splint symptoms were mild but that a sedentary work environment would be desirable for the Veteran. Absent evidence to the contrary, the Board finds the January 2020 VA examiner was competent to exam and assess the severity of the Veteran’s right shin splints. The Board finds the examiner’s overall examination, medical findings, and medical opinion credible and probative. The examiner conducted a thorough in-person examination, relied on accurate facts, considered the Veteran’s relevant medical records, medical history, and lay statements. Based on all relevant evidence of record, the Board concludes the weight of the evidence is against finding that the Veteran’s right shin splints manifested with a moderate right knee or right ankle disability. The Board finds the Veteran’s statements about his symptomatology credible and probative. He has repeatedly and consistently stated that he has constant pain, numbness, and burning in his right leg. His pain travels from his right up to his lower back. He has trouble doing daily physical activities, such as walking, standing, kneeling, and climbing. His treating VA medical professionals and the VA examiners have documented all of these symptoms. Importantly, rather than remand for a new VA examination, the Board is affording the Veteran the benefit of the doubt that the pain and other symptoms the experiences are due to his right shin splints rather than his right peripheral neuropathy. 38 U.S.C. § 5107(b). Of significance to the Board is the objective evidence of the Veteran’s right knee range of motion. As cited above, between 2013 and 2020, the Veteran’s right knee flexion ranged from 0 to 100 degrees and 0 to 140 degrees (normal). His extension was never limited, reaching 0 degrees during each VA examination. These ranges of motion would not be compensable for VA rating purposes. See 38 C.F.R. § 4.71a, DCs 5260 (limitation of flexion) and 5261 (limitation of extension). Nevertheless, the Board finds the limitations did cause the Veteran functional loss based on the medical and lay evidence of record. The Veteran has credibly stated he is limited in his ambulation, using a cane constantly now. The VA medical examiners also documented limited physical mobility, with the January 2020 VA examiner stating that the Veteran would only be capable of sedentary work. Thus, the Board concludes that the Veteran’s right shin splints manifested with a knee disability. The Veteran’s knee disability, however, is only slight, not moderate or marked. While not dispositive, the April 2015 and January 2020 VA examiners’ independent opinions that the Veteran’s right shin splints symptoms were “mild” is probative. More significant is the Veteran’s object right knee range-of-motion results discussed above. As noted, at no point did he have a compensable limitation of flexion or extension, thus suggesting he retained substantial functionality in his right knee. In addition, no VA examiner, nor other medical professional, documented objective evidence of instability in the Veteran’s right knee. The Veteran has generally described experiencing his right leg “giving way.” He did not state his right knee gave way. The Board finds the objective medical evidence indicating a lack of instability, subluxation, and dislocation of his right knee is more probative that the Veteran’s own generalized statements. If the Veteran’s right leg gave way “every day” as he stated in his June 2016 VA Form 9, the Board would reasonably expect some medical evidence or documentation relating to such significant instability. Yet, there is none that the Board can find. Maxson v Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (“evidence of a prolonged period without medical complaint can be considered along with other factors concerning the veteran’s health and medical treatment”). Also important is the lack of evidence of general atrophy and weakness in the Veteran’s right knee. Only in the April 2015 VA examination was decreased right knee muscle strength documented, and it was only 4 out of 5, which is consistent with a slight right knee disability. As a whole, the evidence weighs against finding that the Veteran’s right shin splints manifested with a moderate right knee or right ankle disability. The Veteran maintained the ability to function on a daily basis, albeit to a lesser degree. The objective medical evidence outweighs the Veteran’s subjective assertions of right knee instability on a daily basis. There is a lack of evidence indicating right knee muscle atrophy, ankylosis, significant weakness, and a loss of range of motion that moderately impairs his functionality. Finally, the only evidence as to a right ankle disability is the Veteran’s lay assertions that he experiences pain and an inability to put his foot flat on the ground when sitting. The Veteran has not offered evidence about the severity, duration, or frequency of any right ankle pain, other than that just stated. The Board concludes his right ankle disability is not a moderate disability. At most, it is a slight right ankle disability manifested by general pain and limited motion only when sitting. Accordingly, the Veteran is not entitled to an increased disability rating in excess of 10 percent throughout the appeal period for his right shin splints. 2. A disability rating in excess of 10 percent for chronic shin splints of the left lower extremity The Veteran informed the RO of his intent to seek an increased rating for his left shin splints in January 2012. Thus, the relevant appeal period is from January 2011 through the present. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). Throughout the appeal period, the Board finds a lack of evidence that indicates, or reasonably suggests, the Veteran’s left shin splints manifested with a moderate left knee or left ankle disability. Therefore, an increased rating in excess of 10 percent is not warranted, and the factors found within 38 C.F.R. §§ 4.40, 4.45, and 4.59 are adequately encompassed within his 10 percent disability rating. The Board has already discussed that the Veteran appeared for four VA examinations, in July 2013, Apri 2015, February 2018, and January 2020. In each examination, the respective examiners evaluated the Veteran’s right leg and left leg. For the same reasons already discussed, the Board finds these examiners were competent, and their respective findings and conclusions are credible and probative. The Board now addresses each examiner’s evaluation of the Veteran’s left leg. During the July 2013 VA examination, the Veteran reported experiencing flare-ups with occasional pain. His left knee flexion was 0 to 120 degrees (0 to 140 degrees being normal) and his extension was to 0 degrees (normal). The examiner did not find objective evidence of painful motion. There was no loss of range of motion following repetitive testing. He had normal left knee muscle strength. There was no left knee joint instability. The Veteran was not using an assistive device. The examiner opined that the Veteran’s left shing splints did not impact his ability to work. During the April 2015 VA examination, the Veteran told the examiner he was unable to run and was only able to walk for about seven minutes. He reported his leg would give way. He did not report experiencing flare-ups. Nor did he report having functional loss or functional impairment. The Veteran’s left knee flexion was 0 to 140 degrees and his extension was 140 to 0 degrees. The examiner did not observe painful motion but did observe pain on weightbearing. The Veteran was examined immediately following repetitive use over time, and the examiner did not find additional loss of range of motion in the left knee. The examiner documented normal left knee muscle strength, 5 out of 5. No left knee ankylosis, atrophy, or instability was found. The examiner specifically opined that the Veteran’s left shin splints did not affect his left knee or left ankle’s range of motion. Overall, the examiner opined that the Veteran’s left shin splints were mild in severity. During the February 2018 VA examination, the Veteran reported experiencing flare-ups. He denied functional loss or functional impairment. The examiner documented left knee flexion of 0 to 140 degrees and extension of 140 to 0 degrees. The examiner observed pain during flexion but opined it did not result in additional functional loss. There was no evidence of pain on weightbearing, evidence of tenderness, or crepitus. Following repetitive-use testing, no additional functional loss resulted. The examiner opined that during flare-ups and following repetitive use over time the Veteran’s resulting pain, fatiguability, or incoordination would not significantly limit his functional ability. The Veteran’s left knee muscle strength was normal, 5 out of 5 on flexion and extension. There was no finding of ankylosis, atrophy, or instability in the left knee. The Veteran reported regular use of a cane. During the January 2020 VA examination, the Veteran did not report flare-ups, but he did report decreased flexion of the left knee, numbness, and paresthesias. The examiner found the Veteran’s left knee flexion was 0 to 100 degrees and extension was 100 to 0 degrees, which resulted in an impaired gait an inability to kneel. The examiner observed pain on both flexion and extension that resulted in functional loss. The examiner opined that following repetitive use over time, the Veteran would likely suffer from additional pain. The examiner was unable to describe additional functional loss in terms of range of motion because the Veteran appeared “to resist motion on exam.” The examiner also believe the Veteran suffered from reduced left knee muscle strength, but he resisted testing of strength. The examiner did not find muscle atrophy, ankylosis, or instability of the left knee. The Veteran reported constantly using a cane for balance. Overall, the examiner determined the Veteran’s left shin splint symptoms were mild but that a sedentary work environment would be desirable for the Veteran. The Veterans statements made to VA through various correspondences have primarily focused on the symptomatology and severity of his right shin splints. In general, however, the Veteran does experience pain in his left leg. He shifts his weight to his left leg to compensate for the pain in his right leg. See December 2017 Statement in Support of Claim. He also asserts his left leg gives way just as his right leg. See September 2020 Statement in Support of Claim. He reports constant flare-ups that cause swelling in his left leg and a stabbing pain. Id. He states he is unable to fully bend to squat, and he is unable to run, crawl, sit, and jump. Id. The Board finds the Veteran’s statements about his left leg symptomatology credible and probative. Based on all relevant evidence of record, the Board concludes the weight of the evidence is against finding that the Veteran’s left shin splints manifested with a moderate left knee or left ankle disability. Of significance to the Board is the objective evidence of the Veteran’s left knee range of motion. As cited above, between 2013 and 2020, the Veteran’s left knee flexion ranged from 0 to 100 degrees and 0 to 140 degrees (normal). His extension was never limited, reaching 0 degrees during each VA examination. These ranges of motion would not be compensable for VA rating purposes. See 38 C.F.R. § 4.71a, DCs 5260 (limitation of flexion) and 5261 (limitation of extension). Nevertheless, the Board finds the limitations did cause the Veteran functional loss based on the medical and lay evidence of record. The Veteran has credibly stated his ambulation I limited, using a cane constantly now. The VA medical examiners also documented limited physical mobility, with the January 2020 VA examiner stating that the Veteran would ideally be capable of sedentary work. Thus, the Board concludes that the Veteran’s left shin splints manifested with a knee disability. To note, there is no evidence, medical or lay, that the Veteran suffered from a left ankle disability. The Veteran’s left knee disability, however, is only slight, not moderate or marked. While not dispositive, the April 2015 and January 2020 VA examiners’ independent opinions that the Veteran’s left shin splints symptoms were “mild” is probative. More significant is the Veteran’s object left knee range-of-motion results discussed above. As noted, at no point did he have a compensable limitation of flexion or extension, thus suggesting he retained substantial functionality in his left knee. In addition, no VA examiner, nor other medical professional, documented objective evidence of instability in the Veteran’s left knee. The Veteran has generally described experiencing his left leg “giving way.” The Board finds the objective medical evidence indicating a lack of left knee instability, subluxation, and dislocation is more probative than the Veteran’s own generalized statements. Given the extent that the Veteran describes the weakness and instability of his left knee, the Board would reasonably expect some medical evidence or documentation relating to such significant instability. Yet, there is none that the Board can find. Maxson, 230 F.3d at 1333 (“evidence of a prolonged period without medical complaint can be considered along with other factors concerning the veteran’s health and medical treatment”). Also important is the lack of evidence of general atrophy and weakness in the Veteran’s left knee. As a whole, the evidence weighs against finding that the Veteran’s left shin splints manifested with a moderate left knee or left ankle disability. The Veteran maintained the ability to function on a daily basis, albeit to a lesser degree. The objective medical evidence outweighs the Veteran’s subjective assertions of his left knee instability. There is a lack of evidence indicating left knee muscle atrophy, ankylosis, significant weakness, and a loss of range of motion that moderately impairs his functionality. Accordingly, the Veteran is not entitled to an increased disability rating in excess of 10 percent throughout the appeal period for his left shin splints. REASONS FOR REMAND 1. A compensable disability rating for peripheral neuropathy of the right lower extremity is remanded. The RO issued a supplemental statement of the case (SSOC) on August 12, 2020, denying entitlement to a compensable disability rating for peripheral neuropathy. On August 19, 2020, VA associated with the Veteran’s claims file a July 2020 VA-contracted examination addressing the severity of the Veteran’s peripheral neuropathy. The RO did not consider this examination in the SSOC. Of significance is the examiner’s findings that the Veteran suffered from mild, incomplete paralysis of the following right lower extremity nerves: (1) sciatic nerve, (2) external popliteal, and (3) musculocutaneous nerve. Previously, the only nerve affected was the internal saphenous nerve, which was deemed moderate, incomplete paralysis. See January 2020 VA Examination. That nerve was not identified as disabling in the July 2020 examination. The Rating Schedule for neurological conditions and convulsive disorders, 38 C.F.R. § 4.124a, has multiple DCs for the various nerves. Relevant here are DCs 8520, 8521, and 8522. DC 8520 provides a 10 percent rating for mild, incomplete paralysis of the sciatic nerve. DC 8521 provides a 10 percent rating for mild, incomplete paralysis of the external popliteal nerve. And DC 8522 provides a noncompensable rating for mild, incomplete paralysis of the musculocutaneous nerve. The January 2020 VA-contracted examiner did not discuss whether the Veteran’s mild, incomplete paralysis of these nerves was due to similar, or separate and distinct symptomatology. This is important because the Veteran may or may not be entitled to separate disability ratings for these nerve disabilities. See 38 C.F.R. § 4.14 ([d]isability from injuries to the . . . nerves may overlap to a great extent, so that special rules are included in the appropriate bodily system for evaluation.”) (Emphasis added); Shuttlesworth v. Wilkie, No. 19-1734, 2020 U.S. App. Vet. Claims LEXIS 1456, at *9 (Vet. App. July 31, 2020) (“Given multiple regulations that expressly forbid separate evaluations, the absence of instructions in [38 C.F.R.] § 4.124a suggests that separate ratings are not prohibited.”) (remanding for a medical examiner to address whether the symptoms were separate and distinct or were attributable to a specific nerve). Accordingly, remand for an addendum opinion is necessary for the examiner to explain whether the Veteran’s nerve disabilities stem from separate and distinct symptomatology or not. 2. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. In the August 12, 2020, SSOC, the RO denied entitlement to TDIU based on the fact that the Veteran did not meet the schedular rating criteria of 38 C.F.R. § 4.16(a) and a finding that he could secure and maintain substantially gainful employment. Nine days later, the RO granted the Veteran an increased disability rating of 70 percent for his major depressive disorder in an August 21, 2020, rating decision. His combined disability rating increased to 80 percent as of December 9, 2019. Therefore, the Veteran now appears to meet the schedular criteria for TDIU. Id. Nonetheless, the Board finds it is unable to address the Veteran’s claim for TDIU on the merits because the Veteran’s peripheral nerve disabilities are inextricably intertwined with his TDIU claim and proper development has yet to occur on his peripheral nerve disabilities. Therefore, remand is necessary. Roebuck v. Nicholson, 20 Vet. App. 307, 313 (2006) (claims are inextricably intertwined where they are “so closely connected that it is necessary that they be adjudicated together” because that could have a significant impact on each other). Accordingly, the matters are REMANDED for the following actions: 1. Obtain any of the Veteran’s outstanding VA medical records and associate them with the claims file. 2. After any additional records are associated with the claims file, obtain an addendum opinion from the July 2020 VA-contracted examiner, or another appropriately qualified clinician if the examiner is unavailable, to address the Veteran’s peripheral neuropathy. The entire claims file must be made available to and be reviewed by the examiner, including a copy of this REMAND order. If the examiner deems an examination is necessary, then one shall be provided. The examiner is asked to address the following: (a.) The examiner is asked to address whether or not the Veteran’s symptoms associated with his peripheral neuropathy are attributable to specifically identified nerves, as identified within the July 2020 VA-contracted examination. The examiner is asked to provide a detailed description as to the severity and symptoms specifically attributable to each nerve involved, if able to do so. (b.) The examiner is also asked to fully describe the functional effects of the Veteran’s right lower extremity peripheral neuropathy on his occupational functioning, daily life, and ordinary activities. The examiner is reminded to consider the Veteran’s lay statements. The examiner must not opine on the credibility of the Veteran. The examiner may, however, discuss whether there is any medical reason to accept or reject the Veteran’s assertion(s). See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). A clear and detailed rationale for the opinion(s), including a discussion of the facts and medical principles involved, should be provided as it will be of considerable assistance to the Board. Please do not simply list the facts on which you relied. If the examiner relies on medical treatises, the examiner should identify the treatises. (Continued on the next page)   If a requested opinion cannot be provided without resorting to speculation, the examiner should so state and explain why an opinion cannot be provided without resorting to speculation. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to the particular question(s). 3. Following completion of all reasonable and necessary development, the RO must readjudicate the Veteran’s claims. The RO should pursue development of all information to its logical conclusion. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. F. Sawka, 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.