Citation Nr: 21026861 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 14-41 212A DATE: May 4, 2021 ORDER An initial disability rating of 10 percent, and no higher, for headaches prior to June 14, 2015 is granted. A disability rating in excess of 30 percent for headaches beginning June 14, 2015 is denied. A 20 percent disability rating, and no higher, for residuals of right shoulder injury diagnosed as chronic impingement/tendonitis, status post rotator cuff repair beginning December 7, 2011 is granted. A 70 percent disability rating, and no higher, for an acquired psychiatric disorder, to include major depressive disorder, alcohol abuse disorder, and gambling addiction beginning December 7, 2011 is granted. A disability rating in excess of 10 percent prior to October 1, 2014, and in excess of 20 percent thereafter, for residuals, cervical spine injury with cervical strain, degenerative arthritis and C3/4 disc herniation is denied. FINDINGS OF FACT 1. Prior to June 24, 2015, the Veteran experienced headaches with significant frequency requiring medication but the most probative evidence of record does not show that these headaches included characteristic prostrating attacks. 2. Beginning June 24, 2015, the Veteran experienced headaches characterized by frequent prostrating attacks occurring on average at least once per month; however, there is no indication that these attacks were productive of severe economic inadaptability at any point during the appeal period. 3. It is factually ascertainable that the Veteran has been experiencing chronic right shoulder pain since December 7, 2011 and, since that time, the Veteran's right shoulder disorder has been manifested by limitation of motion of the right arm to no less than 120 degrees and symptoms of pain and stiffness. 4. For the entire period on the appeal, the Veteran's psychiatric disorder has been shown to be productive of a disability picture that equates to occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to symptoms such as suicidal ideation; difficulty in adapting to stressful circumstances, sleep disturbances; disturbances of motivation and mood; impulse control, self-harm, and difficulty in establishing and maintaining effective relationships. 5. Prior to October 1, 2014, the Veteran's cervical spine disorder was manifested by chronic neck pain resulting in no loss of range of motion other than left lateral flexion reduced to 35 degrees. Beginning October 1, 2014, the cervical spine disorder has been manifested by forward flexion reduced to no more than 30 degrees. CONCLUSIONS OF LAW 1. Prior to June 24, 2015, the criteria for an initial 10 percent disability rating, but no more, for headaches were met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.321, 4.124a, Diagnostic Code 8100. 2. Beginning June 24, 2015, the criteria for a disability rating in excess of 30 percent for headaches have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.321, 4.124a, Diagnostic Code 8100. 3. The criteria for a 20 percent disability rating, and no higher, for the Veteran's right shoulder disorder have been met since December 7, 2011. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5201. 4. The criteria for a disability rating of 70 percent, and no higher, for the Veteran's psychiatric disorder have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.14, 4.40, 4.59, 4.130, Diagnostic Codes 9435. 5. The criteria for a disability rating in excess of 10 percent prior to October 1, 2014, and in excess of 20 percent thereafter, for the Veteran's cervical spine disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5243. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1986 to September 1991. These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) which granted service connection for headaches, assigning a noncompensable disability rating effective January 31, 2013, continued a 30 percent disability rating for the Veteran's psychiatric disability, continued a 10 percent disability rating for the Veteran's cervical spine disability, and continued a 10 percent disability rating for the Veteran's right shoulder disability. The Veteran disagreed with this decision and perfected this appeal. This case was previously before the Board in May 2018, at which time it was remanded for further development. Subsequently, by rating decision dated in June 2019 rating decision, the RO increased the Veteran's disability rating for his psychiatric disability from 30 to 50 percent disabling effective December 19, 2014, increased the Veteran's disability rating for his right shoulder disability from 10 to 20 percent disabling effective December 7, 2012, increased the Veteran's disability rating for his cervical spine disability from 10 to 20 percent disabling effective October 1, 2014, and increased the Veteran's disability rating for his headaches from noncompensable to 30 percent disabling effective June 14, 2015. The Board has considered whether a claim for a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) has been raised by the Veteran during the pendency of this appeal. In Rice v. Shinseki, 22 Vet. App. 447 (2009), the United States Court of Appeals for Veterans Claims (Court) held that VA must address the issue of entitlement to TDIU in increased-rating claims when the issue of unemployability either is raised expressly or by the record. While not dispositive, the Board must note that the Veteran has continued to hold a full-time position at his local VA medical center and appears to be highly functioning in carrying out his duties per self-report. A review of available VA treatment records does not reflect that the Veteran ever asserted that the symptomatology associated with his various service-connected disabilities precluded him from securing and following substantially gainful employment. Moreover, the VA examiners of record who have evaluated the severity of the various disabilities on appeal did not find that they together had such a severe impact on the Veteran's occupational functioning during the appeal period that he was precluded from securing and following substantially gainful employment. Accordingly, a claim for TDIU has not been raised by the record. General Legal Criteria Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity resulting from disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. A veteran's entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 38 C.F.R. § 4.40 notes that disability of the musculoskeletal system is primarily the inability, due to damage or infection of parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Functional loss may be due to the absence of part or all of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. 38 C.F.R. § 4.40. 38 C.F.R. § 4.45 provides that factors of disability involving a joint reside in reductions of its normal excursion of movements in different planes of motion and therefore, inquiry will be directed to such considerations as weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.); excess fatigability; and incoordination (impaired ability to execute skilled movements smoothly). 38 C.F.R. § 4.45. The United States Court of Appeals for Veterans Claims (Court) has held that when a diagnostic code provides for compensation based upon limitation of motion, the provisions of 38 C.F.R. §§ 4.40 and 4.45 must also be considered, and that examinations upon which the rating decisions are based must adequately portray the extent of functional loss due to pain "on use or due to flare-ups." DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Also, the Court has held that "to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of" 38 C.F.R. § 4.59. See Correia v. McDonald, 28 Vet. App. 158 (2016). 38 C.F.R. § 4.59 states that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." As such, pursuant to Correia, an adequate VA joints examination must, wherever possible, include range of motion testing on active and passive motion and in weight-bearing and nonweight-bearing conditions. Effective February 7, 2021, several changes to the diagnostic codes used for rating musculoskeletal disabilities were made. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020). When a law or regulation changes after a claim has been filed or reopened, but before the administrative or judicial appeals process has been concluded, the version of the law or regulation most favorable to the appellant generally applies. Only the former criteria can be applied for the period prior to the effective date of the new criteria. However, both the old and new criteria can be applied as of that date. See VAOPGCPREC 7-2003 (Nov. 19, 2003); see also 38 U.S.C. § 5110 (g); 38 C.F.R. § 3.114. While the Veteran has not yet been notified of all applicable regulatory changes and considered his claim under such regulations, the Board notes that the rating criteria prior to February 7, 2021 pertaining to the shoulders and cervical spine are significantly more favorable to the Veteran. As such, there is no prejudice to the Veteran in the Board considering the claims at this time. 1. Headaches By way of history, the Veteran's service treatment records (STRs) show that he was involved in a motor vehicle accident in June 1991, injuring his right shoulder and neck, and began complaining of chronic headaches approximately three months later. He submitted an initial claim for service connection for headaches in January 2013 and, as above, by rating decision dated in October 2013, the RO granted service connection for headaches, assigning a noncompensable disability rating effective January 31, 2013. The Veteran disagreed with this decision and perfected this appeal. Subsequently, by rating decision dated in June 2019, the RO increased the Veteran's disability rating for his headaches from noncompensable to 30 percent disabling effective June 14, 2015. He seeks a rating in excess of those assigned for the entirety of the appeal period, which extends back to January 31, 2013, the date of the original claim of service connection for the disability. The ratings at issue were assigned pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100. Under Diagnostic Code 8100, a 10 percent disability rating is warranted for headaches with characteristic prostrating attacks occurring on an average of once every two months over the last several months, while a 30 percent disability rating is warranted for prostrating attacks occurring once every month. 38 C.F.R. § 4.124a, Diagnostic Code 8100. Headaches manifested by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability warrant a 50 percent disability rating. 38 C.F.R. § 4.124a, Diagnostic Code 8100. VA regulations do not define "prostrating," nor has the United States Court of Appeals for Veterans Claims (Court). Cf. Fenderson v. West, 12 Vet. App. 119 (1999) (in which the Court quotes Diagnostic Code 8100 verbatim but does not specifically address the matter of what is a prostrating attack). However, the Board notes that according to MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 999 (11th Ed. 2007), "prostration" is defined as "complete physical or mental exhaustion." A similar definition is found in DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1554 (31st Ed. 2007), in which "prostration" is defined as "extreme exhaustion or powerlessness." VA regulations also do not define "economic inadaptability." However, the Court has noted that nothing in Diagnostic Code 8100 requires the Veteran to be completely unable to work in order to qualify for a 50 percent rating. See Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004). Evidence relevant to the current level of severity of the Veteran's headaches includes VA examination reports dated in October 2013, October 2014, and November 2018. Also of record are statements from the Veteran as well as VA and private treatment records dated through November 2020. During the October 2013 VA headache examination, the Veteran reported experiencing daily headaches with pain on both sides of his head that he was able to ignore while at work. According to the Veteran, he experienced some light sensitivity, but no nausea or vomiting. The examiner did not note that the Veteran had characteristics prostrating attacks. After an in-person evaluation, the examiner found that the headaches did not contribute to any impairment of occupational functioning. During the October 2014 VA headache examination, the Veteran reported experiencing chronic headache pain of moderate intensity which waxed and waned with activities. According to the Veteran, while working he could ignore the symptoms but that he noticed them when he was resting. He specifically denied experiencing phonophobia, nausea, vomiting or other migraine symptoms, although he did endorse some sensitivity to light. The examiner did not note that the Veteran had characteristics prostrating attacks. After an in-person evaluation, the examiner found that the headaches did not contribute to any impairment of occupational functioning. In a June 2015 correspondence, the Veteran detailed that he experienced headaches every day with intensity ranging from mild to severe lasting from two to six hours at a time. According to the Veteran he had to retreat to a dark room to alleviate his symptoms at least once a week. He also reported that he had to leave work early at least a couple of times per month due to his headaches pain. During an attack of increased headache pain he experienced nausea, lethargy, and light sensitivity. During the November 2018 VA headache examination, the Veteran, again, reported experiencing daily headache pain. However, he also endorsed experiencing migraine headaches with more severe symptomatology two or three times per week that required him to leave work early. Treatments included pain medication, chiropractic visits and Botox injections. Additional symptoms included nausea and sensitivity to light. The examiner further noted that the Veteran experienced characteristic prostrating attacks of migraine headaches more frequently than once per month; however, the examiner did not find that the prostrating attacks contributed to severe economic inadaptability. In summation, the examiner found that the headaches contributed to impairment of occupational functioning as the Veteran had to leave work early two days per weeks due to migraine headaches. A review of available VA medical records shows that the Veteran has received treatment for chronic headaches for the entirety of the appeal period. A January 2013 outpatient record shows that the Veteran reported chronic headache pain without additional symptomatology; the impression was tension type headaches. A February 2014 outpatient record reflects that the Veteran had attempted several interventions to help alleviate his symptoms but that nothing had worked to date, to include gabapentin as well as facet injections. During a March 2014 neurology consultation he reported that his pain was a five or six out of ten and that he experienced both light and sound sensitivity. A May 2015 outpatient record reflects that the Veteran was still reporting that his pain was constant but that he was still functional while experiencing this pain; the evaluation was maintained as tension type headaches. Thereafter, during a November 2015 evaluation the Veteran reported that he experienced daily headaches and light sensitivity relieved by lying in the dark. A January 2019 neurology consultation report shows that the Veteran again reported experiencing daily headache pain with light sensitivity, with attacks of more severe pain once or twice a day lasting 15 minutes to an hour at a time. Upon consideration of the record, the Board finds that a 10 percent rating, but no more, is warranted for the Veteran's headaches prior to June 14, 2015; from that date, the Board does not find that a rating in excess of 30 percent is warranted. Regarding the period prior to June 14, 2015, the Board acknowledges that there is no evidence that the Veteran was experiencing prostrating attacks of headache pain, as he never reported that he would have to stop working or doing activities while experiencing a headache; indeed, he stated during both the October 2013 and October 2014 VA examinations that his symptoms would become more manageable when he was working. That being said, the Board does find that the combination of frequent headaches and the medications used for such headaches results in symptomatology that, while not prostrating in nature, is certainly commensurate to characteristic prostrating attacks averaging one in two months over the last several months, and thus warrants a 10 percent initial evaluation. 38 C.F.R. § 4.20. In the total absence of headaches with characteristic prostrating attacks occurring on an average once a month over the last several months, there exists no basis for an even higher rating prior to June 14, 2015. Beginning June 14, 2015, the Board notes that the Veteran has consistently reported that his headaches required him to lie down in a dark room once or twice a week for a few hours at a time; furthermore, he has detailed that he had to leave work a few hours early at least once a week due to his headache pain. During the November 2018 examination, the examiner estimated that the Veteran experienced characteristic prostrating attacks of migraine headache pain more frequently than once per month; however, the examiner did not find that the prostrating attacks contributed to severe economic inadaptability. As stated previously, the Veteran need not demonstrate that he is wholly unable to work as due to his headaches to warrant the 50 percent rating. That being said, there is no indication from the record that the Veteran's headaches have contributed to more than a few hours of missed work per month, and the Veteran himself has not contended that he experiences severe economic inadaptability as due to his headaches. Accordingly, the preponderance of the evidence weighs against a determination that an increased 50 percent rating is warranted for the headaches at any point during the appeal period. 2. Right Shoulder By way of history, the Veteran's STRs show that he was involved in a motor vehicle accident in June 1991, injuring his right shoulder. He submitted an initial claim for service connection for a right shoulder disorder in October 1991 and, by rating decision dated in September 1992, the RO granted service connection for residuals right shoulder injury with painful shoulder motion, assigning a 10 percent disability rating effective September 21, 1991. Thereafter, the Veteran underwent surgery on his right shoulder on January 19, 2007, and the RO granted a temporary 100 percent disability rating for the Veteran's right shoulder disability effective January 19, 2007, assigned a 20 percent rating effective March 1, 2007, and continued a 10 percent disability rating effective May 17, 2007. The Veteran underwent surgery on his right shoulder again on April 27, 2011, and the RO granted another temporary 100 percent disability rating for the Veteran's right shoulder disability effective April 27, 2011 and continued a 10 percent disability rating effective July 1, 2011. The Veteran submitted the current claim for an increased rating in December 2012 and, as above, by rating decision dated in October 2013, the RO continued a 10 percent disability rating for the Veteran's right shoulder disability. The Veteran disagreed with this decision and perfected this appeal. Subsequently, by rating decision dated in June 2019 rating decision, the RO increased the Veteran's disability rating for his right shoulder disability from 10 to 20 percent disabling effective December 7, 2012. He seeks a rating in excess of those assigned for the entirety of the appeal period, which extends back to December 7, 2011, the date of the original increased rating claim plus the one-year look back period. See Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010). Disabilities of the shoulder and arm are evaluated under rating criteria that contemplate ankylosis of scapulohumeral articulation (Diagnostic Code 5200), limitation of motion of the arm (Diagnostic Code 5201), other impairment of the humerus (Diagnostic Code 5202), or impairment of the clavicle or scapula (Diagnostic Code 5203). Under the laws administered by VA, disabilities of the shoulder and arm are rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5200 through 5203. 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. 38 C.F.R. § 4.69. Here, as the evidence shows that the Veteran is right-hand dominant, his right shoulder is his major shoulder for rating purposes. A rating under Diagnostic Code 5201 is warranted when the evidence demonstrates limitation of motion of either arm at shoulder level, or midway between side and shoulder level of the minor arm (20 percent); limited to midway between side and shoulder level for the major arm, or to 25 degrees from the side for the minor arm (30 percent); or limitation of motion to 25 degrees from the side for the major arm. (40 percent schedular maximum) 38 C.F.R. § 4.71a, Diagnostic Code 5201. Normal ranges of motion of the shoulder are flexion (forward elevation) from 0 degrees to 180 degrees, abduction from 0 degrees to 180 degrees, external rotation from 0 degrees to 90 degrees, and internal rotation from 0 degrees to 90 degrees. 38 C.F.R. § 4.71, Plate I. The amendments to 38 C.F.R. § 4.71a, effective February 7, 2021, clarify that limitation of motion of the arm under Diagnostic Code 5201 includes either flexion or abduction. 85 Fed. Reg. 76453 (Nov. 30, 2020). The revised regulations also clarify that "shoulder level" equates to flexion and/or abduction limited to 90 degrees, "midway between side and shoulder level" equates to flexion and/or abduction limited to 45 degrees, and "To 25 degrees from side" equates to flexion and/or abduction limited to 25 degrees from side. Prior to February 7, 2021, the Board will consider the old version of the diagnostic codes only; however, for the period beginning February 7, 2021 the Board will consider both the old and amended version (amended code) of the diagnostic code and rate based on whichever is most favorable to the Veteran. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Evidence relevant to the current level of severity of the Veteran's right shoulder disability includes VA examination reports dated in February 2013, October 2014, and November 2018. Also of record are statements from the Veteran as well as VA and private treatment records dated through November 2020. During the February 2013 VA shoulder examination, the Veteran reported experiencing chronic right shoulder pain. He also endorsed experiencing flare-ups of additional pain radiating into his right arm precipitated by use of his shoulder. Range of motion testing revealed no loss of through any range, and there was also no additional range of motion loss after repetitive use testing. The examiner did not estimate whether the Veteran would experience any additional impairment during a flare-up. Pain to palpation was noted throughout the shoulder, although no ankylosis or instability were documented. In summation, the examiner found that the right shoulder disability did not contribute to impairment of occupational functioning. During the October 2014 VA shoulder examination, the Veteran reported chronic right shoulder pain that radiated into his neck. According to the Veteran, he was unable to perform overhead activities with his right shoulder and did not move patients at work; otherwise he was not restricted in his ability to carry out his duties at work. He did not endorse experiencing flare-ups of additional symptomatology. Range of motion testing revealed flexion limited to 160 degrees, abduction limited to 160 degrees, and no limitation of external or internal rotation. Pain was noted throughout flexion and abduction, with anterior shoulder joint tenderness to palpation. It was also noted that the Veteran had difficulty reaching above shoulder level. After repetitive use testing flexion and abduction were further reduced to 150 degrees; similarly, the examiner estimated that during a flare-up of pain right shoulder flexion and abduction would be reduced to 150 degrees. The examiner found no evidence of ankylosis or instability. In summation, the examiner found that the right shoulder disability contributed to impairment of occupational functioning in the form of precluding overhead activity as well as the moving of patients at the Veteran's work. During the November 2018 VA shoulder examination, the Veteran reported experiencing chronic achy pain in his right shoulder as well as right shoulder fatigue after lifting. Range of motion testing revealed flexion limited to 120 degrees, abduction limited to 140 degrees, no limitation of external rotation, and internal rotation limited to 50 degrees. Pain was noted throughout abduction and internal rotation, with sharp pain to palpation of the lateral shoulder. It was also noted that the Veteran had difficulty reaching above shoulder level. The examiner further noted evidence of pain with weight bearing as well as evidence of crepitus. There was no additional loss of range of motion after repetitive use testing. Rotator cuff impairment testing was negative, but muscle strength testing did reveal a slight loss of right shoulder abduction strength. The examiner found no evidence of ankylosis or instability. In summation, the examiner found that the right shoulder disability contributed to impairment of occupational functioning in the form of precluding overhead activity with the right shoulder. A review of available VA medical records reflects that the Veteran has been receiving treatment for chronic right shoulder pain for the entirety of the appeal period. A November 2012 outpatient record shows that he reported experiencing chronic right shoulder pain that radiated into his neck; he was given a lidocaine injection with offered some pain relief. A May 2015 outpatient note indicates that the Veteran reported experiencing difficulty with doing activity above his head. The Veteran then reported experiencing increasing right shoulder pain during a March 2018 primary care consultation. During the evaluation he specified that the pain existed posteriorly as well as at the lateral aspect of the right shoulder with abduction; he also detailed experiencing some crepitus. On examination the right shoulder showed decreased range of motion, with decreased internal rotation as well as mild localized tenderness at the superior right deltoid. The claims file contains copies of evaluations dated in August and September 2018 from the Billings Clinic. The Veteran reported experiencing severe chronic right shoulder pain that he described as "electrical" in nature. An examination revealed no loss of range of motion except some limited internal rotation at the side. Upon consideration of the evidence of record, the Board finds that a minimum rating of 20 percent is warranted for the entirety of the appeal period, that is, from December 7, 2011, as it was factually ascertainable that the Veteran was experiencing chronic right shoulder pain from that date and thus is entitled to the minimal compensable rating for the shoulder. U.S.C. 5110(b)(2); 38 C.F.R. § 3.400 (o); see also 38 C.F.R. § 4.59. Specifically, the Board refers to VA medical records documenting that the Veteran repeatedly reported experiencing chronic right shoulder pain for several years prior to the first available VA medical records. However, at no point during the appeal period has the right shoulder exhibited range of motion limited to below shoulder level, which would be necessary to warrant a rating in excess of the 20 percent currently assigned. The Board has also considered whether a higher disability rating is warranted for the right shoulder disability based on impairment of the clavicle or scapula pursuant to Diagnostic Code 5203. However, there is no evidence that the Veteran experiences any impairment of the clavicle or scapula in the right shoulder. There is similarly no evidence of ankylosis of scapulohumeral articulation (Diagnostic Code 5200) or impairment of the humerus (Diagnostic Code 5202). Furthermore, as noted above, while the recent amendments to the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a clarify that limitation of motion includes either flexion or abduction, this does not impact the Veteran's claim as, effective February 7, 2021, there is no evidence of any limitation of flexion or abduction to 25 degrees. Id. Similarly, the clarification that Diagnostic Codes 5201 and 5202 provide that shoulder level is 90 degrees and midway is 45 degrees does not impact the Veteran's claim as he is already rated on the basis of limitation to motion of the arm at shoulder level, which warrants a 20 percent rating for both the major and minor extremity under Diagnostic Code 5201. Id. The Board has reviewed the Veteran's lay testimony and the VA treatment records in the claims file, but this evidence does not tend to show that the symptoms of his right shoulder disability warrants a rating in excess of the 20 percent currently assigned. The 20 percent rating was granted with consideration of the additional functional loss stemming from the Veteran's pain symptomatology. The VA examiners of record specifically evaluated whether the Veteran would experience additional loss of range of motion after repetitive use and/or during a flare-up, but none of those examiners found that any additional limitation of motion would equate to limitation below shoulder level, which would be necessary to warranted a higher rating. Moreover, the 20 percent rating was assigned in recognition that it is the lowest available rating for the evaluation of right shoulder limitation of motion. See 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59; DeLuca, supra. Accordingly, the Board concludes that it has not been shown that any functional loss the Veteran exhibits in the right shoulder rises to the level of the more restricted flexion necessary for entitlement to the next degree of disability. The assigned rating adequately contemplates the functional impairment resulting from the Veteran's right shoulder disability. 3. Psychiatric Disorder By way of history, the Veteran submitted an initial claim for service connection for a psychiatric disorder in January 2008, contending that such was secondary to his service-connected right shoulder disorder, and, by rating decision dated in May 2008, the RO granted service connection for acquired psychiatric disorder to include depressive disorder, assigning a 10 percent disability rating effective January 24, 2008. Subsequently, by rating decision dated in July 2010, the RO increased the Veteran's disability rating for his psychiatric disorder from 10 to 30 percent disabling effective March 16, 2010. The Veteran submitted the current claim for an increased rating in December 2012 and, as above, by rating decision dated in October 2013, the RO continued a 30 percent disability rating for the Veteran's psychiatric disability. The Veteran disagreed with this decision and perfected this appeal. Subsequently, by rating decision dated in June 2019 rating decision, the RO increased the Veteran's disability rating for his psychiatric disability from 30 to 50 percent disabling effective December 19, 2014. He seeks ratings in excess of those assigned for the entirety of the appeal period, which extends back to December 7, 2011, the date of the original increased rating claim plus the one-year look back period. See Gaston, supra. The ratings at issue were assigned under Diagnostic Code 9435 pursuant to the General Rating Formula for Mental Disorders as outlined in 38 C.F.R. § 4.130, Diagnostic Code 9411. Under the General Rating Formula, a rating of 30 percent is warranted if there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and an inability to establish and maintain effective relationships. Id. A 100 percent evaluation is warranted for total occupational and social impairment due to gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living; disorientation to time or place; memory loss for names of close relatives, own occupation or own name. Id. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign a rating based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign a rating solely on the basis of social impairment. See 38 C.F.R. § 4.126. Ratings are assigned according to the manifestation of particular symptoms. The use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. VA must consider all symptoms of a claimant's condition that affect the level of occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994) (DSM-IV). When determining the appropriate disability evaluation to assign for psychiatric disabilities, however, the Board's "primary consideration" is the Veteran's symptoms. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013.) Evidence relevant to the current level of severity of the Veteran's psychiatric disability includes VA examination reports dated in February 2013, October 2014, and November 2018. Also of record are statements from the Veteran as well as VA and private treatment records dated through November 2020. During the February 2013 VA psychiatric examination, the Veteran reported that he lived alone and did not socialize with others. It was noted that he had divorced from his former spouse three years prior and had two adult children from that marriage that he maintained contact with. At the time of the examination he reported working as EMT/patient care technician at a local hospital for 60+ hours per week. According to the Veteran he had been attending regular sessions with a clinical doctor and was prescribed a variety of psychiatric medications for alleviation of his symptoms. He also acknowledged a history of alcohol abuse as well as a gambling addiction. After a thorough evaluation, the examiner set forth a diagnosis of depressive disorder, not otherwise specified, with symptoms of depression, anxiety, decreased energy, self-harm and decreased appetite. The examiner noted that the Veteran reported cutting himself beginning a few years prior but would not specify how often he did this. It was the February 2013 examiner's impression that the acquired psychiatric disorder would contribute to occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily with normal routine behavior, self-care and conversation. The examiner further noted that the Veteran was able to manage his grooming and hygiene as well as his housekeeping chores. The examiner highlighted that the Veteran was able to work 60 hours a week in a high-stress environment with some slight adaptations; the examiner also detailed that the Veteran reported getting into some arguments with coworkers but not to the extent that it interfered with his work. The Veteran submitted a psychiatric questionnaire dated in April 2014 and prepared by his treating physician, a Dr. J.S., wherein she reported that she had been treating the Veteran since November 2007. She set forth diagnoses of major depressive disorder, borderline personality disorder, and alcohol use disorder. She also noted the following symptoms: deficiencies in family relations, obsessional rituals with interfere with routine activities, persistent danger of hurting self or others, deficiencies in work or school, depression affecting the ability to function independently, appropriately and effectively, neglect of personal appearance and hygiene, deficiencies in mood, difficulty in adapting to stressful circumstances, intrusive recollections of a traumatic experience, unprovoked hostility and irritability, inability to establish and maintain effective relationships, deficiencies in judgment, and suicidal ideation. It was Dr. J.S.'s impression that the psychiatric disorder would contribute to the Veteran missing work more than three times a month. During the October 2014 VA psychiatric examination, the Veteran reported that he self-isolated and only socialized with his adult children and extended family. He detailed that he still worked about 60 hours a week, but that his responsibilities had shifted to do more clerical work to help accommodate his other disabilities. He again noted that he was still attending regular treatment sessions and maintained a regimen of psychiatric medications. He also reiterated his history of alcohol abuse and his gambling addiction, which contributed to financial difficulties. After a thorough evaluation, the October 2014 examiner set forth a diagnosis of an unspecified depressive disorder with symptoms of depression and anxiety. The examiner also noted that the Veteran reported some occasional suicidal thoughts without any specific plan. It was the examiner's impression that the acquired psychiatric disorder would contribute to occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily with normal routine behavior, self-care and conversation. This represented a lack of change in symptomatology to the examiner, which was further supported by the Veteran's reported continued high functioning in his work environment. During the November 2018 VA psychiatric examination, the Veteran reported that he continued to self-isolate. He also noted that his duties at work had changed again but that he still worked regularly as a phlebotomist. According to the Veteran, he attended treatment sessions at his local VA medical center and was prescribed a regimen of psychotropic medication. After a thorough evaluation, the November 2018 examiner set forth a diagnosis of major depressive disorder with psychotic features as well as an alcohol abuse disorder and a moderate tobacco use disorder. The examiner listed the following symptoms: depression, anxiety, suspiciousness, near-continuous depression impacting the ability to function independently, chronic sleep impairment, flattened affect, difficulty in understanding complex commands, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a work-like setting, inability to establish and maintain effective relationships, suicidal ideation, and persistent danger of hurting self or others. The examiner also noted that the Veteran reported some occasional suicidal ideation without any specific plan. Furthermore, the examiner noted that the Veteran's attention, concentration, abstract thinking, judgment, decision-making and impulse control were all adversely effected by his psychiatric disorder. Ultimately, it was the examiner's impression that the acquired psychiatric disorder would contribute to occupational and social impairment with reduced reliability and productivity; however, the examiner acknowledged that the mental disorders were comorbid and could not be differentiated into which impairment was caused by each mental disorder for the indicated level of occupational and social impairment. A review of available VA medical records shows that the Veteran has been receiving treatment for his psychiatric disorder for the entirety of the appeal period. A February 2012 mental health note reflects that the Veteran had recently resumed gambling and drinking after a series of intensive inpatient treatment sessions following a 2010 psychiatric hospitalization. At the time of the evaluation it was noted that the Veteran was expressing some hopelessness but was evaluated as being a low risk for suicide. An April 2012 suicide risk assessment note indicates that the Veteran reported cutting himself with a scalpel a month prior after a breakup with his then-girlfriend; the assessment was that the Veteran did not intend to kill himself through this behavior. Thereafter, during an October 2012 mental health encounter, he discussed suicidal intent extensively with his treatment provider, and detailed an incident that occurred where he was swimming in deep water and considered letting himself drown. The treatment provider recommended hospitalization but did not insist upon it in light of several supports that were in place to help ensure the Veteran's safety. A December 2012 mental health consult shows that the Veteran was involved in a legal issue in November related to his alcohol use. Following that incident he was equipped with monitoring devices that prevented him from gambling or using alcohol; this improved his mood but as these were his coping mechanisms for his other physical disabilities, he began to seek self-harm as a way to manage his pain. He denied suicidal ideation during this encounter. After several months of reports showing that his symptoms were well-managed, a September 2013 consultation note reflects that the Veteran engaged in self-harm after a disturbing incident at work with a fellow veteran. Thereafter, the available records indicate that the Veteran attended regular treatment sessions for several years without any discernible escalation of symptomatology. An August 2017 mental health note again shows that the Veteran reported occasional suicidal ideation and self-harm and an increasingly uncontrolled gambling addiction. Subsequent treatment records dating through November 2020 reflect that the Veteran ceased attending regular psychiatric treatment sessions but more recently expressed interest in resumption of said treatment with his previous provider, Dr. J.S. Upon review of the evidence, and resolving all reasonable doubt in favor of the Veteran, the Board finds that the criteria for a 70 percent rating, but no more, have been met for the entirety of the appeal period, to include the one year period prior to date of the Veteran's increased rating claim (that is, from December 7, 2011 to December 7, 2012). VA medical records show that suicidal ideation was listed as an active problem for this entire period, and while the Veteran has not consistently endorsed experiencing suicidal ideation with every treatment encounter he has a noted history of two suicide attempts that has necessitated continuous evaluations to monitor his suicide risk. Furthermore, the Veteran has a demonstrated history of self-harm and has repeatedly cut himself on numerous occasions, reportedly as a coping mechanism for various stressors he encounters in his everyday life. This is further corroborated by the April 2014 report of his primary treating physician, Dr. J.S., who noted his history of passive suicidal ideation and self-harm. In addition, the Board notes that the Veteran while appearing to be highly functioning at work has also demonstrated a lack of care for his own well-being and hygiene. There is also copious documentation of his lack of socialization, alcohol and gambling addictions, and lack of impulse control. Ultimately, the Board finds that the preponderance of the record reflects symptomatology commensurate with the 70 percent rating criteria. Although all three of the VA examiners who have evaluated the severity of the acquired psychiatric disorder found that the symptoms of the disability contributed to no more than moderate impairment in social and occupational functioning, the Board has highlighted above those symptoms inherent in the 70 percent rating that were seemingly overlooked by the VA examiners, to include suicidal ideation, self-harm, difficulty in adapting to stressful circumstances, and an inability to establish and maintain effective relationships. Taken together with those symptoms already encompassed in the 30 and 50 percent ratings, these newly recognized symptoms resulted in occupational and social impairment, with deficiencies in most areas, such as work, family relations, judgment, thinking, or mood. Resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran is entitled to an evaluation of 70 percent for the entirety of the appeal. However, the Veteran's symptomatology does not meet the criteria for a 100 percent rating at any time during the appeal period. While the evidence does show that the Veteran recently reported experiencing hallucinations on the November 2018 VA examination, there is no evidence that he has ever acted on those hallucinations or that they have resulted in spatial or temporal disorientation. Furthermore, the record does not show that he has exhibited the gross impairment in thought process or communication or grossly inappropriate behavior necessary for a 100 percent evaluation. Indeed, he has maintained employment throughout the entirety of the appeal period and every indication is that he is highly functioning in the work environment. Moreover, while the Veteran has reported experiencing memory issues, there is no suggestion that he experiences memory loss for his own name or names of close relatives. He has also endorsed having a good relationship with his three adult children. Most significantly, there is no indication that he experiences total occupational and social impairment as due to his service-connected acquired psychiatric disorder. Accordingly, a 100 percent evaluation is not warranted. 4. Cervical Spine By way of history, the Veteran's STRs show that he was involved in a motor vehicle accident in June 1991, injuring his neck. He submitted an initial claim for service connection for a cervical spine disorder in October 1991 and, by rating decision dated in September 1992, the RO granted service connection for residuals cervical spine injury with painful shoulder motion, assigning a 10 percent disability rating effective September 21, 1991. This 10 percent rating was temporarily decreased to noncompensable effective May 1, 1995 but increased back to 10 percent effective April 28, 1998. The Veteran submitted the current claim for an increased rating in December 2012 and, as above, by rating decision dated in October 2013, the RO continued a 10 percent disability rating for the Veteran's cervical spine disability. The Veteran disagreed with this decision and perfected this appeal. Subsequently, by rating decision dated in June 2019 rating decision, the RO increased the Veteran's disability rating for his cervical spine disability from 10 to 20 percent disabling effective October 1, 2014. He seeks a rating in excess of those assigned for the entirety of the appeal period, which extends back to December 7, 2011, the date of the original increased rating claim plus the one-year look back period. See Gaston, supra. Disabilities of the spine are to be evaluated under the General Rating Formula for Diseases and Injuries of the Spine (outlined below). 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5242. Intervertebral disc syndrome (IVDS) will be evaluated under the general formula for rating diseases and injuries of the spine or under the formula for rating intervertebral disc syndrome based on incapacitating episodes (outlined below), whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5242. Under the General Rating Formula for Diseases or Injuries of the Spine, a 10 percent evaluation is warranted with forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees, muscle spasm, guarding, localized tenderness not resulting in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis is present, or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent evaluation is warranted with forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees, combined range of motion of the cervical spine is not greater than 170 degrees, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis is present. A 30 percent evaluation is warranted if forward flexion of the cervical spine is 15 degrees or less or there is favorable ankylosis of the entire cervical spine. A 40 percent evaluation is warranted if there is unfavorable ankylosis of the entire cervical spine. A 100 percent rating is warranted if there is unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Disease and Injuries of the Spine. Normal ranges of motion of the cervical spine are flexion from 0 to 45 degrees, extension from 0 to 45 degrees, lateral flexion from 0 to 45 degrees, and lateral rotation from 0 to 80 degrees. 38 C.F.R. § 4.71, Plate V. Ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5. Under the Formula for Rating IVDS Based on Incapacitating Episodes, a 20 percent rating is warranted for incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past twelve months; a 40 percent rating requires evidence of incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a 60 percent rating requires evidence of incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Formula for Rating IVDS. An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Id. at Note (1). If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, each segment will be evaluated on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. Id. at Note (2). Beginning February 7, 2021, Diagnostic Code 5243 (pertaining to IVDS) is only used when there is disc herniation with compression and/or irritation of the adjacent nerve root. Diagnostic Code 5242 is used for all other disc diagnoses. Evidence relevant to the current level of severity of the Veteran's cervical spine disability includes VA examination reports dated in February 2013, October 2014, and November 2018. Also of record are statements from the Veteran as well as VA and private treatment records dated through November 2020. During the February 2013 VA cervical spine examination, the Veteran reported experiencing chronic neck pack with flare-ups of sharp pains when turning his head that occurred every few weeks. Range of motion testing revealed no limitation of forward flexion, extension, right lateral flexion, right lateral rotation, and left lateral rotation; the only range of motion that exhibited any loss was left lateral flexion, which was reduced to 35 degrees. After repetitive use testing, the only additional loss of range of motion was in forward flexion, which was reduced to 40 degrees. Further testing revealed localized tenderness and guarding of the cervical spine; however, the examiner did not find that this resulted in abnormal gait or spinal contour. There was no loss of muscle strength or reflexes as well as no IVDS, ankylosis, or any neurological abnormalities. In summation, it was the examiner's impression that the cervical spine disability did not contribute to any impairment of occupational functioning. During the October 2014 VA neck examination, the Veteran reported experiencing chronic, daily neck pain of moderate to severe intensity that radiated into his right shoulder. According to the Veteran his neck pain did not interfere with his ability to complete his work duties. He did not endorse experiencing any flare-ups of additional symptomatology. Range of motion testing revealed forward flexion restricted to 30 degrees, extension restricted to 35 degrees, right and lateral flexion both restricted to 15 degrees, and right and left lateral rotation restricted to 50 degrees, with painful motion beginning at 40 degrees. There was no additional loss of range of motion after repetitive use testing. The examiner noted that the Veteran exhibited functional loss in the form of less movement than normal as well as pain on movement. Furthermore, the examiner found evidence of localized tenderness as well as muscle spasm; however, the examiner did not find that this contributed to any additional functional loss. There was no loss of muscle strength or reflexes as well as no IVDS, ankylosis, or any neurological abnormalities; the examiner did note, however, a decrease in right hand sensation. In summation, it was the examiner's impression that the cervical spine disability did not contribute to any impairment of occupational functioning. The Veteran submitted a cervical spine impairment questionnaire dated in May 2015 and prepared by his treating physician, a Dr. R.V., wherein he reported that he had been treating the Veteran since November 2012 for neck and shoulder pain. He set forth diagnoses of chronic neck pain, facet arthropathy, and a bulging cervical disc at C3-4. He indicated that the Veteran first experienced pain when testing forward flexion between 15 and 30 degrees, although Dr. R.V. acknowledged that this pain did not contribute to any functional loss. Dr. R.V. also noted tingling in the fingers, tenderness of the neck into the right trapezius, muscle spasms on the right side of the neck, and crepitus at the back of the neck. Dr. R.V. denied any evidence of ankylosis, reflex changes, swelling, muscle atrophy or weakness, radiculopathy, or impairment of ambulation. According to Dr. R.V., the Veteran's symptoms required doctor-prescribed bed rest totalling between one and two weeks in the prior 12-month period. Dr. R.V. then noted that the Veteran exhibited minimal impairment of grasping/turning objects, moderate impairment of using fingers for fine manipulation, and marked impairment of using arms for reaching. In summation, Dr. R.V. found that although the Veteran would be able to secure and maintain gainful employment despite the symptoms and limitations stemming from his cervical spine disability, the disability would contribute to the Veteran missing about one day of work per month due to symptoms of pain making his work difficult. During the November 2018 VA cervical spine examination, the Veteran reported experiencing chronic, daily neck pain with tightness and popping; he related that it felt like a "bowling ball" on his shoulders. Although the Veteran did not endorse experiencing any flare-ups of additional pain, he did detail that he had to turn his body to look in a new direction (rather than his neck), and provided the example of having to do this while driving his vehicle. Range of motion testing revealed forward flexion restricted to 40 degrees, extension restricted to 30 degrees, right and lateral flexion both restricted to 30 degrees, and right and left lateral rotation restricted to 40 degrees. While the examiner acknowledged that repeated use of the neck would contribute to increased pain, the examiner did not estimate that this pain would result in any additional loss of range of motion after repetitive use testing. Furthermore, the examiner found evidence of localized tenderness as well as muscle spasm and guarding. The examiner commented that the muscle spasms resulted in the loss of normal lordosis and moderate trapezius. There was no loss of muscle strength or reflexes as well as no IVDS, ankylosis, or any neurological abnormalities; the examiner did note, however, objective evidence of pain when the neck was used in non-weight bearing. In summation, it was the examiner's impression that the cervical spine disability did not contribute to any impairment of occupational functioning other than restricting the Veteran's ability to turn his head, such as while driving a vehicle. A review of available VA medical records reflects that the Veteran has been complaining of and seeking treatment for neck pain for the entirety of the appeal period. An October 2012 outpatient note shows that he was hit from behind while driving and reported experiencing additional neck and shoulder pain. Thereafter, a May 2015 outpatient note shows that the Veteran exhibited full range of motion throughout his cervical spine, although it was acknowledged that the Veteran experienced pain in all ranges of motion. During a June 2017 chiropractic consultation, the Veteran exhibited reduced rotation and extension, although exact measurements were not provided. Subsequent medical records show continued treatment for neck pain to include physical therapy and recurrent injections to relieve pain. Upon review of the record, the Board finds that a rating in excess of 10 percent is not warranted for the cervical spine disability prior to October 1, 2014. Range of motion testing on the prior February 2013 examination did not reflect impairment sufficient to warrant the greater 20 percent rating under the applicable criteria. Furthermore, there was no evidence of IVDS or ankylosis. Available VA medical records corresponding to this time period also do not show any impairment of range of motion; instead, the only consistently reported symptom of the cervical spine disability was chronic neck pain. Accordingly, the Board will not disturb the currently awarded 10 percent rating for the period prior to October 1, 2014 as this represents the compensation due to the Veteran for his actually painful cervical spine disability. Similarly, the Board also finds that a rating in excess of 20 percent is not warranted for the cervical spine disability at any point from October 1, 2014. That increased rating was awarded on the basis of the finding on the October 2014 VA examination that the Veteran exhibited forward flexion limited to 30 degrees, thus corresponding to the currently assigned 20 percent rating pursuant to Diagnostic Code 5242. The evidence of record, to include the rest of the October 2014 VA examination report as well as the November 2018 VA examination and the available VA and private treatment records, does not demonstrate that the Veteran experienced symptomatology of a sufficient severity to warrant an increased rating. Indeed, while Dr. R.V. in the April 2015 correspondence noted evidence of IVDS, he acknowledged that the IVDS would only contribute to incapacitating episodes necessitating doctor-prescribed bed rest for a total of one week in the prior 12-month period, which is not of a sufficient severity to warrant an increased under the criteria pursuant to Diagnostic Code 5243. The Board also reiterates that at no point during the appeal period has the Veteran exhibited any ankylosis of the cervical spine. The Board has reviewed the Veteran's lay testimony and the VA treatment records in the claims file, but this evidence does not tend to show that the symptoms of his cervical spine disability warrants a rating in excess of 10 percent prior to October 1, 2014 or a rating in excess of 20 percent thereafter. The 10 percent rating was awarded in recognition of the Veteran's consistent complaints of neck pain, despite the fact that the February 2013 examination did not reveal any symptomatology that would warrant a 10 percent rating on a schedular basis. Similarly, the Veteran's neck pain is contemplated within the 20 percent rating assigned from October 1, 2014. Therefore, the Board finds that the assigned ratings adequately contemplates the functional impairment resulting from the Veteran's cervical spine disability. See 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. at 208. The evidence of record does not show objective neurologic abnormalities associated with the Veteran's cervical spine disability. There is accordingly no basis for separate evaluations for any such disorders. 38 C.F.R. § 4.71a, General Rating Formula, Note (1). In summation, a disability rating in excess of 10 percent prior to October 1, 2014, and in excess of 20 percent thereafter is not warranted for the Veteran's cervical spine disability. As the preponderance of the evidence is against disability ratings in excess of those assigned, the benefit of the doubt doctrine is inapplicable. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). APRIL MADDOX Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher M. Collins, 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.