Citation Nr: 21026700 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 17-27 751 DATE: May 3, 2021 ORDER Entitlement to a disability rating in excess of 20 percent prior to December 6, 2019, and a rating in excess of 30 percent on and after December 6, 2019, for left (minor) shoulder degenerative joint disease (DJD) is denied. Entitlement to an initial disability rating in excess of 20 percent for left (minor) recurrent shoulder dislocation is denied. FINDINGS OF FACT 1. The Veteran is right hand dominant. 2. For the period prior to December 6, 2019, the service-connected left shoulder DJD (minor), is manifested by pain, painful motion, less movement than normal, and range of motion of the left shoulder functionally capable of more than 25 degrees from side. 3. For the period from December 6, 2019, the Veteran is in receipt of the maximum schedular rating available for his service-connected left shoulder DJD (minor) for limitation of motion; the Veteran does not have ankylosis, impairment of the humerus, or impairment of the clavicle or scapula involving dislocation, nonunion or malunion of the joint. 4. During the entire period on appeal, the Veteran's recurrent dislocation of the left shoulder was not manifested by fibrous union of the humerus, nonunion of the humerus, or loss of head of humerus; and the right shoulder disability is not manifested by impairment of the humerus. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent prior to December 6, 2019, and in excess of 30 percent thereafter, for DJD of the left shoulder (minor) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.71(a), Diagnostic Code 5201. 2. The criteria for an initial disability rating in excess of 20 percent for left and right shoulder disabilities have not been met at all times during the pendency of the appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5202. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January 1951 to October 1954. This matter was previously remanded by the Board for additional development in February 2020. The requested development has been completed and this matter is returned to the Board for further consideration. See Stegall v. West, 11 Vet. App. 268 (1998). The issue of entitlement to a total disability rating based on individual unemployability (TDIU) was also remanded in February 2020. Following the remand, the August 2020 rating decision granted TDIU and the Veteran has not objected to the assigned effective date of July 13, 2015. Since this grant constituted a full grant of the benefits sought on appeal, this claim is no longer in appellate status. AB v. Brown, 6 Vet. App. 35, 39 (1993). Increased Rating 1. Entitlement to a disability rating in excess of 20 percent prior to December 6, 2019, and a rating in excess of 30 percent on and after December 6, 2019, for left (minor) shoulder DJD is denied. 2. Entitlement to a disability rating in excess of 20 percent for left (minor) recurrent shoulder dislocation is denied. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. During the pendency of the appeal, the Veteran's left shoulder DJD has been rated under Diagnostic Code 5003-5201. A hyphenated diagnostic code is used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. The additional code is shown after the hyphen. The hyphenated diagnostic code in this case indicates that degenerative arthritis, under Diagnostic Code 5003, is the service-connected disability, and the residual condition to which the arthritis is rated by analogy is limitation of motion of the shoulder, which is rated under Diagnostic Code 5201. 38 C.F.R. § 4.71a (2018). Diagnostic Code 5003 provides that degenerative arthritis is rated based on limitation of motion under the appropriate codes for the specific joint involved. 38 C.F.R. § 4.71a. In the absence of a compensable limitation of motion, Diagnostic Code 5003 allows for a rating of 10 percent for each major joint or group of minor joints affected. Id. For VA rating purposes, a shoulder is a major joint. 38 C.F.R. § 4.45(f). Under Diagnostic Code 5201, a 20 percent rating contemplates limitation of motion of the arm at shoulder level (for both major and minor extremity) and midway between side and shoulder level (minor extremity). A rating of 30 percent rating requires limitation of motion of the arm midway between side and shoulder level (major extremity) and to 25 degrees from side (minor extremity). A 40 percent rating is assigned for limitation of motion of the arm to 25 degrees from the side (major extremity). 38 C.F.R. § 4.71a, Diagnostic Code 5201. Normal ranges of motion of the shoulder are forward flexion and abduction from 0 to 180 degrees and internal and external rotation from 0 to 90 degrees. 38 C.F.R. § 4.71, Plate I. 38 C.F.R. § 4.71a, Diagnostic Code 5202 provides that malunion of the humerus with moderate deformity warrants a 20 percent evaluation. Malunion of the humerus with marked deformity warrants a 20 percent evaluation (minor) and 30 percent evaluation (major). Recurrent dislocation of the humerus at the scapulohumeral joint with infrequent episodes, and guarding of movement only at shoulder level, warrants a 20 percent evaluation. Recurrent dislocation of the humerus at the scapulohumeral joint with frequent episodes and guarding of all arm movements warrants a 20 percent evaluation (minor) and 30 percent evaluation (major). Fibrous union of the humerus warrants a 40 percent evaluation (minor) and 50 percent evaluation (major). Nonunion of the humerus (false flail joint) warrants a 50 percent evaluation (minor) and 60 percent evaluation (major). Loss of head of humerus (flail shoulder) warrants a 70 percent evaluation (minor) and 80 percent evaluation (major). 38 C.F.R. § 4.71a, Diagnostic Code 5203 provides that malunion of the clavicle or scapula warrants a 10 percent evaluation. Nonunion of the clavicle or scapula without loose movement warrants a 10 percent evaluation. Nonunion of the clavicle or scapula with loose movement warrants a 20 percent evaluation. Dislocation of the clavicle or scapula warrants a 20 percent evaluation. When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Thus, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011). Initially, the Board notes that under the laws administered by VA, disabilities of the shoulder, arm, wrist and hand are rated under 38 C.F.R. § 4.71a. For rating purposes, a distinction is made between major (dominant) and minor musculoskeletal groups. 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. See 38 C.F.R. § 4.69. Here, as the evidence shows that the Veteran is right-hand dominant, the Board finds that his right upper extremity is his dominant extremity for rating purposes. Turning to the evidence of record, according to the VA treatment records, x-rays of the left shoulder in September 2014 showed severe degenerative changes in the left acromioclavicular and glenohumeral joint. An October 2014 VA treatment record indicated the Veteran "had been doing well until the last year or so when he feels like his shoulder could 'drop'." The Veteran's shoulder pain was described as a 4 out of 10. Active range of motion was forward flexion at 110 degrees and abduction at 90 degrees. Passive range of motion of the left shoulder was forward flexion at 120 degrees and abduction at 110 degrees. He had full strength in the upper left extremity. Imaging revealed worsening of the left shoulder osteoarthritis. A January 2015 private treatment record from Select Physical Therapy where the Veteran experienced pain when he picked up any weights with the left upper extremity. He felt pain in the morning and was unable to perform reaching behind his back for bathing and toileting activities with the left upper extremity. He had stiffness and pain with overhead reaching. According to treatment record, the range of motion testing on November 2014 revealed left shoulder flexion was at 95 degrees and abduction at 73 degrees. In January 2015, the flexion was at 110 and 112 degrees and abduction was at 90 and 95 degrees. In June 2015, the Veteran underwent a VA examination where range of motion testing of the left shoulder revealed flexion at 120 degrees and abduction at 90 degrees. Pain was noted on examination but did not result in or cause functional loss. There was pain with weight hearing and objective evidence of localized tenderness or pain on palpation at the superior aspect. There was no objective evidence of crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions and without additional functional loss or range of motion after three repetitions. The Veteran was not being conducted during a flare up and the VA examined noted that that the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss during the flare ups. The Veteran was examined immediately after repetitive use over time and the VA examiner was unable to say without speculation whether pain, weakness, fatigability, or incoordination could significantly limit the functional ability during a flare up or when the joint was being used repeatedly over time as the Veteran is not in the stated condition at the time of the examination. The Veteran's muscle strength testing was normal and there was no evidence of ankylosis. There was no evidence of shoulder instability, dislocation, labral pathology, or clavicle, scapula, acromioclavicular joint or sternoclavicular joint condition. The Veteran did not have loss of head, nonunion, fibrous union of the humerus, or malunion of the humerus with moderate or marked deformity. The VA examiner noted the Veteran would have difficulty performing repetitive use or lifting. The Veteran underwent another VA examination in October 2015 where a diagnosis of glenohumeral joint osteoarthritis and acromioclavicular joint osteoarthritis of the left shoulder was confirmed. The Veteran reported that the left shoulder condition had worsened and reported decreased mobility. The pain was described as a 7 out of 10 on a daily basis. He reported flared ups of the left shoulder pain at least once a month. Lifting up bags greater than 10 lbs. and mopping caused pain. He was unable to do any activities requiring lifting above 50 degrees. The pain was sharp and woke him up in the middle of the night. Range of motion testing revealed flexion at 65 degrees and abduction at 40 degrees. There was decreased mobility due to the abnormal range of motion. Pain noted on examination did not result in functional loss. There was tenderness to palpation over supraspinatus, subscapularis, teres minors, AC joint, and bicipital tendon. There was objective evidence of crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions and without additional functional loss or range of motion after three repetitions. The Veteran was not examined immediately after repetitive use over time and the VA examiner noted the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. The VA examiner was unable to say without mere speculation whether pain, weakness, fatigability, or incoordination could significantly limit the functional ability during a flare up or when the joint was used repeatedly over time as the Veteran was not in the stated condition at the time of the examination. Muscle strength testing revealed forward flexion at active movement against some resistance, and abduction at active movement against gravity. There was no evidence of muscle atrophy or ankylosis in the left shoulder. The Hawkins' Impingement test, Empty-can test, and External Rotation/Infraspinatus Strength test were positive. The Veteran was unable to perform the Lift-off Subscapularis test. The Veteran had symptoms of mechanical symptoms and a history of recurrent dislocation (subluxation) of the glenohumeral (scapulohumeral) joint with frequent episodes and guarding of movement only at the shoulder level. There was tenderness on palpation of the AC joint but the Veteran did not have an AC joint condition or any other impairment of the clavicle or scapula. The cross-body adduction test was positive. There was no loss of head (flail shoulder), nonunion (false flail shoulder), or fibrous union of the humerus. The Veteran did not have malunion of the humerus with moderate or marked deformity. A scar on the left shoulder was also noted. The VA examiner determined that while the Veteran's shoulder condition impacted his ability to perform any type of occupational task, it did not preclude limited duty or sedentary employment. A May 2016 private treatment record from Jewett Orthopedic Clinic revealed the Veteran's left shoulder had no swelling or deformity. He had crepitation and tenderness with motion and with restricted abduction and external rotation. It was stable to stressing. There was some weakness with resisted abduction but light touch sensation was intact. The Veteran was afforded another VA examination in December 2017 where the Veteran reported flare ups of the shoulder 4 to 5 times a month, lasting two days. He had limitation of motion with pain. Range of motion in the left shoulder was flexion of 55 degrees and abduction of 50 degrees. The pain was noted examination on flexion and abduction which caused functional loss. There was no evidence of pain with weight bearing or objective evidence of localized tenderness or pain on palpation of the joint of associated soft tissue. There was also no objective evidence of crepitus. The Veteran was not able to perform repetitive use testing with at least three repetitions due to pain. The Veteran was not examined immediately after repetitive use over time or flare ups and the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time or flare ups. Pain and lack of endurance caused limitation of functional ability with repeated use over a period of time and flare ups. Further, the VA examiner noted the Veteran was unable to lift. Muscle strength testing revealed full strength and without atrophy. There was no evidence of ankylosis or a rotator cuff condition. There was no indication of shoulder instability, dislocation, or labral pathology. There was no clavicle, scapula, acromioclavicular joint or sternoclavicular joint condition suspected. The Veteran did not have a loss of head (flail shoulder), nonunion (false flail joint), or fibrous union of the humerus. The did not have malunion of the humerus with moderate or marked deformity. A left shoulder scar was noted. The VA examiners stated his shoulder condition would impact his ability to perform occupational tasks as he is unable to lift with either arm. Furthermore, the VA examiner stated there was no evidence of pain on passive range of motion testing or when the joint was used in non-weight bearing. A March 2018 VA imaging of the left shoulder revealed severe DJD of the left shoulder. An October 2018 VA treatment record indicated the Veteran had pain at the front of his shoulder described as intermittent aching, stabbing pain at an 8 on a 10 scale. Activity at and above the shoulder height caused most discomfort. He denied constant numbness or tingling in the left upper extremity. In June 2018, the VA treatment record of the left shoulder noted the rotator cuff was weak to stressing and without swelling. There was "very little" active range of motion below shoulder height and none at or above shoulder height. The passive range of motion at and above shoulder height was painful but without tenderness on palpation of the bicep tendon. There was tenderness on palpation of the glenohumeral joint. No gross instability was noted, external rotation was at 20 degrees and the skin was intact. A December 2018 letter from a private acupuncturist stated that the Veteran had severe left shoulder pain and weakness. It was noted that the Veteran had limited range of motion in the left shoulder with associated pain with active and passive range of motion. In a July 2019 VA examination report, the Veteran complained of fear of dislocation when he slept on his left side and daily flare ups. Range of motion testing revealed flexion at 50 degrees and abduction at 60 degrees. The abnormal range of motion led to limited overhead reach and lifting. Although the VA examiner conducted range of motion testing, the report did not note where pain began or attribute reported measurements to active or passive motion. Although the issue of a higher rating for recurrent left shoulder dislocation is currently on appeal, the VA physician's assistant indicated that "shoulder instability, dislocation or labral pathology was not suspected." The VA examiner also reported that one of the additional factors contributing to the Veteran's left shoulder disability was less movement than normal due to ankylosis. However, the examiner indicated that there was no ankylosis in the left shoulder. Therefore, in October 2019 the Board found that the examination was incomplete and contradictory. The Veteran was afforded another VA examination in October 2019 where he stated his current symptoms were pronounced and severe pain in the left shoulder, frequently bone on bone contact, and was very painful when lifting and not able to do overhead use. He lost muscle mass in the left upper arm. Imaging studies showed DJD in both shoulders. Flare ups in the left shoulder occurred six times a day and more at night when sleeping "wanting to get out of place." The left shoulder flare ups were severe, lasted 30 minutes to 3 hours, were precipitated by daily use and sleeping, and alleviated by resting, non-use, ice, heat, and medication. Range of motion testing revealed 60 degrees flexion and 60 degrees abduction. Pain noted on examination and caused functional loss. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was evidence of pain with weight bearing and crepitus. There was objective evidence of pain on passive range of motion and non-weight bearing testing. The Veteran became tired easily and moved his shoulders slowly during the physical examination and range of motion maneuvers. The Veteran was able to perform repetitive-use testing with at least three repetition and there was no additional loss of function or range of motion after three repetitions. The Veteran was not examined immediate after repetitive use over time or flare ups as the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time or flare ups. Pain caused functional loss where flexion and abduction were at 40 degrees. Muscle strength was described as active movement against some resistance in the left shoulder. There was reduction in muscle strength due to DJD of the left shoulder. There was evidence of muscle atrophy where the circumference of the right "more normal side" was 33 cm and the circumference of the atrophied side was 30 cm. There was no evidence of ankylosis or rotator cuff conditions. There was instability with mechanical symptoms. There was a history of recurrent dislocation of the glenohumeral joint described as frequent. There was no evidence of a clavicle, scapula, acromioclavicular joint or sternoclavicular joint condition. The Veteran did not have loss of head, nonunion, fibrous union of the humerus, or malunion of the humerus with moderate or marked deformity. The Veteran underwent another VA examination in January 2020 where range of motion testing revealed flexion at 30 degrees and abduction at 15 degrees which inhibited any lifting. Pain was noted on examination and caused functional loss. There was pain with weight bearing and there was objective evidence of localized tenderness or pain on palpation of the left superior shoulder. There was no evidence of crepitus. The Veteran was able to perform repetitive use testing with at least three repetition but without additional functional loss or range of motion after three repetitions. The Veteran was examined immediately after repetitive use over time but pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time. Muscle strength testing revealed active movement against some resistance in the left shoulder. There was no evidence of muscle atrophy or ankylosis. The Hawkins' Impingement test, Empty-can test, External Rotation/Infraspinatus Strength, and Lift-off Subscapularis test was positive. Shoulder instability, dislocation or labral pathology was not suspected. The clavicle, scapula, acromioclavicular joint and sternoclavicular joint conditions were not suspected. The Veteran did not have loss of head, nonunion, fibrous union of the humerus, or malunion of the humerus with moderate or marked deformity. The VA examiner noted that the Veteran's condition would limit his ability to perform any physical lifting with his arms and sedentary activity would be less affected. The Board remanded this issue again in February 2020. The VA examination report stated that the Veteran exhibited left shoulder limitation of motion due to pain. The Board determined that the VA examiner did not indicate the degree at which the left shoulder pain began. The report of a January 2020 VA shoulder examination relates that the Veteran again exhibited left shoulder limitation of motion due to pain which causes functional loss. The examining VA physician's assistant did not indicate the degree at which the left shoulder pain began. Therefore, a new VA examination was warranted. Pursuant to the Board's remand, the Veteran underwent a VA examination in August 2020. The Veteran's current symptoms included severe pain with movement of the left shoulder and needed some assistance dressing but was able to arise from sitting using both arms for strength. He reported "[p]ain flares across the left shoulder and neck with activity." The stated he could not raise his left arm due to pain and did no repeated movements because of flare ups in pain. Range of motion testing revealed left arm flexion at 60 degrees and abduction at 50 degrees with pain. The VA examiner noted there was objective evidence of pain when the left shoulder was used in non-weight bearing and was unable to perform the passive range of motion. The severe loss of range of motion in the left arm was only used for stability. There was objective evidence of localized tenderness or pain on palpation at the anterior posterior shoulder described as severe. There was pain with weight bearing and crepitus. The Veteran was unable to perform repetitive use testing with at least three repetitions due to severe pain. The Veteran was not examined immediate after repetitive use over time or during a flare up as the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time or flare up. Pain significantly limited his functional ability with repeated use over a period of time or flare up. It was constant and severe. The precipitating factors was slight elevation of the arm. He had minimal strength to lift "perhaps" 5 lbs. and he could not reach to a horizonal plane. The Veteran was unable to reach behind his head or back, and there was no pushing or pulling attempted with the left arm. The VA examiner noted that the Veteran reported severe pain with more than minimal range of motion and when testing, he severely guarded and resisted range of motion due to pain. Due to his advanced osteoarthritis in the left shoulder and age, an attempt was not made to attempt to challenge his limited range of motion with passive stretching past the point he complains of pain. Therefore, evaluating the rotator cuff was incomplete. Muscle strength testing revealed active movement against some resistance in the left shoulder without muscle atrophy or ankylosis. He was unable to perform the Hawkins' Impingement test, Empty-can test, and Lift-off Subscapularis test but the External Rotation/Infraspinatus Strength test was positive. There was a history of mechanical symptoms, recurrent but infrequent episodes of dislocation of the glenohumeral joint and guarding of all arm movement. There was acromioclavicular joint degeneration which affected the range of motion. There was tenderness of palpation of the acromioclavicular joint. There was no loss of head, nonunion, or fibrous union of the humerus, or malunion of the humerus with moderate or marked deformity. As an initial matter, the Board is cognizant of Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), however, notes that the examinations indicate that additional limitation was described as increased pain, thus sufficiently addressing the functional loss experienced by the Veteran during flare-ups. In addition, the Court, in Correia v. McDonald, 28 Vet. App. 158, 168-70 (2016), held that 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. However, retroactive motion testing cannot be performed to determine the range of motion in the manner now required by Correia. An examiner's assessment of the range of motion findings required by that case would, at this point, amount to pure speculation on the part of any examiner. As previously indicated, the evidence of record reflects that the Veteran is right hand dominant. Accordingly, his left shoulder is classified as a minor, rather than a major, extremity. After a review of the evidence, the Board finds that the weight of the competent and probative evidence is against finding that the Veteran's disability picture more closely approximates a rating in excess of 20 percent for the period prior to December 6, 2019, or in excess of 30 percent thereafter for left shoulder DJD under Diagnostic Code 5201. For the period prior to December 6, 2019, the record does not show that the left arm's range of motion was limited to 25 degrees from the side. At worse, left arm flexion was to 50 degrees and abduction was to 40 degrees at this time and the Veteran was unable to lift his arms above his head, indicating range of motion greater than 25 degrees from the side. Therefore, the Board finds that a rating in excess of 20 percent during this period for limitation of motion is not warranted. 38 C.F.R. § 4.71a; Diagnostic Code 5201. Regarding the period from December 6, 2019, the Veteran is in receipt of the maximum rating for his limitation of motion of the minor shoulder. Id. Thus, no higher disability rating is available under Diagnostic Code 5201. The Board has considered the Veteran's left shoulder disability under other analogous criteria; however, there is no evidence of ankylosis of the scapulohumeral articulation at any time during the period on appeal. 38 C.F.R. § 4.71a, Diagnostic Code 5200. In addition, the evidence of record does not indicate that the Veteran's left shoulder disability manifests any of the symptoms warranting a rating higher than 20 percent under Diagnostic Code 5202 such as loss of head (flail shoulder), nonunion (false flail joint), fibrous union, or malunion of the humerus during the entire period on appeal. See 38 C.F.R. § 4.71a. The Board notes that the VA examinations indicate that the Veteran had an impairment of the clavicle or scapula; however, the medical evidence does not indicate any dislocation, nonunion or malunion of the joint. Moreover, the maximum rating under Diagnostic Code 5203 is 20 percent; thus, a higher rating is not available under this Diagnostic Code. Id. Furthermore, under Diagnostic Code 5003, a 10 percent evaluation is the highest possible evaluation for the Veteran's left shoulder disability because the shoulder is a single major joint. The Board acknowledges that the evidence reflects that the Veteran has reported of pain. However, the evidence of record does not reflect that the Veteran experienced additional functional limitation due to left shoulder pain. The Board notes that the VA examinations indicate that the Veteran reported difficulty performing activities of daily living and lifting. Even with consideration of pain on motion, the Board finds that any additional limitation of motion or functional loss caused by pain or weakness is not significant enough to conclude that the symptoms more nearly approximate a higher disability rating prior to, and following, December 6, 2019. DeLuca, 8 Vet. App. at 204-07; 38 C.F.R. §§ 4.40 and 4.45. The medical evidence of record shows that for the period prior to December 6, 2019, the Veteran was able to move the left arm beyond 25 degrees on flexion and abduction, including when functional loss with repeated use and pain are considered. Therefore, the Board concludes that his left shoulder DJD was not so disabling as to approximate the level of impairment required for assignment of a higher rating under the limitation of motion criteria during the period prior to December 6, 2019. Moreover, the evidence does not reflect left shoulder motion that more nearly approximates favorable or unfavorable ankylosis at any time during the period on appeal, and the Veteran is already in receipt of the maximum 30 percent rating under Diagnostic Code 5201 for the period from December 6, 2019. See 38 C.F.R. §§ 4.40, 4.45, 4.59, DeLuca v. Brown, 8 Vet. App. 202 (1995). Therefore, the Board thus finds that the current ratings assigned for the left shoulder during the period on appeal sufficiently compensate the Veteran for the extent of his functional loss due to limited movement and pain. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board notes that the Veteran has a scar on his left shoulder due to the surgery, and he is separately service-connected for the scar and the rating of the scar is not on appeal. Accordingly, the Board finds that a rating in excess of 20 percent is not warranted for the period prior to December 6, 2019, and a rating no higher than 30 percent is warranted for the period from December 6, 2019, for the Veteran's left shoulder DJD and in excess of 20 percent for left recurrent shoulder dislocation is denied. 38 C.F.R. § 4.71a; Diagnostic Codes 5201, 5202. Z. SAHRAIE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Yoo, 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.