Citation Nr: 21027815 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 15-44 083 DATE: May 6, 2021 ORDER Entitlement to an initial rating in excess of 20 percent prior to December 30, 2015 for left shoulder osteoarthritis is denied. Entitlement to a rating of 30 percent, but no higher from December 30, 2015 for left shoulder osteoarthritis is granted. Entitlement to a temporary 100 percent rating for total left shoulder replacement from August 3, 2017 is granted. Entitlement to a rating of 50 percent, but no higher, from October 1, 2018 for status post total left shoulder replacement is granted. Entitlement to an initial evaluation in excess of 30 percent for left shoulder muscle atrophy is denied. Entitlement to an initial compensable evaluation for left shoulder scar is denied. FINDINGS OF FACT 1. For the period prior to December 30, 2015, the Veteran's left (minor) shoulder disability was manifested by pain and limitation of motion no worse than flexion and abduction to 85 degrees. 2. Resolving reasonable doubt in favor of the Veteran, for the period from December 30, 2015, his left (minor) shoulder disability was manifested by limitation of motion of the left arm to 25 degrees or less. 3. The Veteran underwent a total left shoulder replacement on August 3, 2017. 4. Resolving reasonable doubt in favor of the Veteran, for the period from October 1, 2018, he experienced chronic residuals consisting of severe, painful motion or weakness in the affected minor extremity. 5. Throughout the period on appeal, the Veteran is in receipt of the highest schedular rating available for his left (minor) shoulder atrophy. 6. Throughout the period on appeal, the Veteran's left shoulder scar was neither painful or unstable and the approximate total area was no more than 5.25 square centimeters. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 20 percent prior to December 30, 2015 for left shoulder osteoarthritis have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.71a, Diagnostic Code 5003-5201. 2. The criteria for a disability rating of 30 percent, but no higher, from December 30, 2015 for left shoulder osteoarthritis have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.71a, Diagnostic Code 5003-5201. 3. The criteria for a disability rating of 100 percent from August 3, 2017 for a total left shoulder replacement have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.71a, Diagnostic Code 5051. 4. The criteria for a disability rating of 50 percent, but no higher, from October 1, 2018 for status post total left shoulder replacement have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.71a, Diagnostic Code 5051. 5. The criteria for a rating in excess of 30 percent for left shoulder muscle atrophy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.71a Diagnostic Code 5303. 6. The criteria for an initial compensable rating for a left shoulder scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.118, Diagnostic Code 7802. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1983 to November 2012. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In November 2018, the Veteran appeared at a hearing before the undersigned. A transcript of the hearing is of record. An April 2020 Board decision remanded the issue related to an increased rating for the Veteran's left shoulder disability, indicating that the Veteran had undergone a surgical procedure for his left arm disability with a private provider, the records of which had not been obtained. Therefore, the Board found that remand was necessary to obtain outstanding treatment records and to obtain an updated VA examination addressing his post-surgery condition and level of functioning. The Veteran's private treatment records were obtained and associated with the claims file. The Veteran was additionally afforded the requested VA examination in June 2020. Thus, the Board finds that there has been substantial compliance with the April 2020 remand. Stegall v. West, 11 Vet. App. 268 (1998). Following the requested development, in an October 2020 rating decision, the RO increased the Veteran's left shoulder disability rating to 50 percent, effective August 3, 2017, and awarded separate disability ratings for residuals of his left shoulder disability, including a 30 percent rating for muscle atrophy, effective October 21, 2016, and a noncompensable evaluation for a left shoulder scar, effective December 1, 2012. Subsequently, a December 2020 rating decision, finding clear and unmistakable error (CUE) with the prior October 2020 rating decision, awarded the following staged ratings for his service-connected left shoulder disability: a 30 percent evaluation from October 21, 2016, a 100 percent evaluation from August 28, 2017, a 20 percent evaluation from October 1, 2018, and a 50 percent evaluation from June 23, 2020. The RO additionally awarded special monthly compensation from August 28, 2017 through September 30, 2018, the period in which a temporary total rating was in effect for convalescence, and proposed to sever service connection for muscle atrophy. Notably, as service connection for muscle atrophy currently remains in effect, as this issue is part of the Veteran's increased rating claim on appeal, the Board will address whether a higher rating is warranted for his left should muscle atrophy. Additionally, the Board will address whether higher ratings are warranted for the Veteran's left shoulder disability for the period prior to August 28, 2017 and the period from October 1, 2018; however, the total 100 percent rating for the period between August 28, 2017 and September 30, 2018 constitutes a full award of the benefits sought on appeal, as no higher rating is available. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). Increased Ratings 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. When rating musculoskeletal disabilities on the basis of limited motion of a joint, VA must consider functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. §§ 4.40 and 4.45 are to be considered only in conjunction with diagnostic codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). Painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Where functional loss is alleged due to pain upon motion, the function of the musculoskeletal system and movements of joints must still be analyzed. DeLuca v. Brown, 8 Vet. App. 202 (1995). A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80 (1997). Similarly, painful motion alone does not constitute limited motion for the purposes of rating under diagnostic codes pertaining to limitation of motion. However, pain may result in functional loss if it limits the ability to perform normal movements with normal excursion, strength, speed, coordination, or endurance. Functional loss due to pain is to be rated at the same level as functional loss caused by some other factor that actually limited motion. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Left Shoulder Disability The Veteran is currently in receipt of the following disability ratings for his left shoulder disability: a 20 percent disability rating from December 1, 2012 pursuant to Diagnostic Code 5003-5201; a 30 percent disability rating from October 21, 2016 pursuant to Diagnostic Code 5003-5201; a 100 percent disability rating from August 28, 2017; a 20 percent disability rating from October 1, 2018 pursuant to Diagnostic Code 5051; and a 50 percent disability rating from June 23, 2020 pursuant to Diagnostic Code 5051. He is additionally in receipt of a 30 percent disability rating effective October 21, 2016 for left shoulder atrophy under Diagnostic Code 5303. The Veteran is right hand dominant and his left shoulder is considered the "minor" shoulder for rating purposes. Prior to August 3, 2017 Under Diagnostic Code 5003, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate codes for the specific joint or joints involved. If the limitation of motion is non-compensable, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added, under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a. Diagnostic Code 5201 provides, in pertinent part, that a 20 percent rating is warranted for limitation of motion of the minor shoulder midway between the side and shoulder level, and a 30 percent rating for the minor shoulder is warranted for limitation of motion of the arm to 25 degrees. 38 C.F.R. § 4.71a. Additionally, Diagnostic Code 5303 provides ratings for muscle injuries in Group III, intrinsic muscles of the shoulder girdle. 38 C.F.R. § 4.73. A noncompensable rating is assigned for slight impairment of the nondominant shoulder. A 20 percent rating is assigned for moderate or moderately severe impairment of the shoulder. A 30 percent rating is warranted for severe impairment of the nondominant shoulder. 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. See 38 C.F.R. § 4.71, Plate I. The record reflects that the Veteran underwent a left shoulder resurfacing arthroplasty during his active service in October 2011. A November 2013 medical treatment record notes that, since his surgery, he continued to have pain, sometimes a 9/10, and treatment by a chiropractor to try to loosen up some of the muscles around the shoulder girdle. On physical examination of the left shoulder, he had about 85-degree abduction and forward flexion but no further motion, and the motion that he had was painful. X-rays of the shoulder show a hemiarthroplasty and essentially no significant glenoid articular cartilage and even inferior spurs. The physician recommended a revision of the left shoulder to a formal total shoulder with replacement of the glenoid and a new stemmed humeral prosthesis; however, the Veteran indicated that he wished to delay surgery. An October 2014 treatment record notes that the Veteran had markedly limited motion above 90 degrees and he preferred to hold his shoulder in internal rotation to relieve the pain in the shoulder. Current x-rays of the shoulder show some arthroplasty with metal on bone in the glenoid of that left shoulder with some arthritic changes around the glenoid. He indicated that he still wanted to delay surgery. A December 30, 2015 VA examination notes a diagnosis of left shoulder joint replacement (total shoulder arthroplasty/hemiarthroplasty). The Veteran reported that he had chronic incapacitating pain in "right" shoulder with movement having to hold his "left" arm against his body, restricting any shoulder motion, to reduce the pain. He indicated that he had virtually no use of left arm except when his hand was at waist level with the upper arm held against his side. The Veteran reported experiencing flare-ups with any motion involving the left shoulder or left upper arm. He described his functional loss as marked restriction in the use of the left arm due to shoulder pain; he had to keep his left arm immobile as much as possible. Upon range of motion testing, the Veteran had left shoulder flexion to 60 degrees, abduction to 50 degrees, external rotation to 20 degrees, and internal rotation to 20 degrees. The examiner indicated that the Veteran's limited range of motion was due to the Veteran keeping his arm pressed against his body to immobilize the shoulder due to the pain. He had pain with all forms of shoulder motion; there was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue, but there was no pain noted with weightbearing. The Veteran was unable to perform repetitive use testing because he was unable to move his left shoulder due to the severe pain. The examiner indicated that pain and weakness significantly limited functional ability with repeated use over a period of time and with flare-ups, but the examiner was unable to describe this in terms of range of motion because the Veteran kept his shoulder immobile to avoid the pain. Muscle strength testing was not performed. No other pertinent physical findings, complications, conditions, signs or symptoms were noted. The examiner indicated that the Veteran had significant arthropathy in both shoulders, with the left being almost totally incapacitating. A January 2016 treatment record notes that the Veteran held his arm flexed to his side due to his pain, and even vibrations riding in the car bother his left shoulder. The physician indicated that he had "such severe arthritis in the glenoid" that surgery was again recommended, indicating that the Veteran had "essentially no motion at this time." He was issued a TENS unit later in January 2016 for pain management. A June 2016 treatment record notes that the Veteran had chronic problems with a failed hemiarthroplasty of the left shoulder. He experienced chronic pain and "basically cannot use the left arm at all." At this time, the Veteran indicated that he was interested in a referral to an upper extremity specialist for consideration of conversion to a left total shoulder arthroplasty. An October 2016 VA examination notes diagnoses of left shoulder impingement syndrome, left shoulder joint replacement, and left shoulder degenerative arthritis. The Veteran reported developing a bone spur in his left shoulder that progressed to the point of causing constant severe pain. He underwent a partial shoulder replacement in 2011 with continued, but less severe, pain. Currently, a total shoulder replacement has been recommended to improve his range of motion and lessen the pain. The Veteran reported flare-ups with increased use of the left upper extremity. He reported functional loss or functional impairment described as the inability to lift, reach, or use the left shoulder much; he could type with his left hand but has lost essentially 90 percent or more of his left shoulder range of motion. Upon range of motion testing of the left shoulder, flexion was limited to 20 degrees, abduction was limited to 20 degrees, and internal and external rotation were limited to 20 degrees. The examination notes that the Veteran had marked decrease in range of motion of approximately 75 to 80 percent with severe pain on examination. There was evidence of pain with weightbearing and objective evidence of tenderness to palpation over the entire shoulder; there was objective evidence of crepitus. The Veteran was unable to perform repetitive use testing due to severe pain, and the examiner noted the inability to determine whether pain, weakness, fatigability or incoordination significantly limit functional ability with repeated use over a period of time or during flare-ups without resorting to speculation because the Veteran was not examined with repeated use over time and his left shoulder was not flared. Left shoulder muscle strength was noted as 1 out of 5 and muscle atrophy was noted. His left side circumference was measured as 25 centimeters; his right-side circumference was measured as 28 centimeters. The examiner indicated that the Veteran did not have functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis. Finally, the examination notes that the Veteran had practically no use of his left shoulder without severe pain; he needed assistance with dressing. The Veteran testified during his November 2018 Board hearing that from approximately 2012 to 2017, he essentially had "zero use" of his left arm due to his pain; it just hung at his side. After a review of the evidence, the Board finds that a rating of 30 percent is warranted from December 30, 2015. In this regard, the Board notes that, although the December 2015 VA examination reflects that the Veteran had left shoulder flexion to 60 degrees and abduction to 50 degrees, internal and external rotation were limited to 20 degrees, the VA examiner indicated that the Veteran's left shoulder was almost totally incapacitated. Furthermore, the January 2016 medical record notes that the Veteran's left arm had "essentially no motion at this time," and the June 2016 medical record further echoed this, indicating that he "basically cannot use the left arm at all." The Board finds that this evidence supports a finding that the Veteran's left shoulder disability more closely approximates the maximum 30 percent disability rating from December 30, 2015. A 30 percent rating is not warranted prior to December 30, 2015, however. In this regard, although the Veteran has reported that his left arm was essentially useless since 2012, the evidence during this period reflects that the Veteran had left shoulder flexion and abduction to 85 or 90 degrees, although it was painful. There is no medical evidence prior to December 30, 2015 to suggest that his disability picture more closely approximates limitation of motion of the arm to 25 degrees. Additionally, a rating higher than 30 percent is not warranted at any time for the period from December 30, 2015. The highest schedular rating provided under the code is 30 percent for limitation of motion of the nondominant arm to 25 degrees from the side. 38 C.F.R. § 4.71a. The rating contemplates pain on motion and is consistent with limitation of motion of the minor arm to 25 degrees or less. Even considering functional loss due to pain and other factors, more than the maximum 30 percent assignable under Diagnostic Code 5201 for limited motion of the minor arm simply is not assignable. See Johnston v. Brown, 10 Vet. App. 80, 84-85 (1997). Furthermore, the Board finds that a higher rating is not warranted at any time prior to August 3, 2017 under any other Diagnostic Code. In this regard, the Board notes that, effective October 21, 2016, the Veteran has been awarded a 30 percent rating for muscle atrophy. This is the highest schedular rating provided for severe limitation of the nondominant arm. There is no medical evidence of record indicating that the Veteran had muscle atrophy prior to October 21, 2016, and the Veteran does not contend otherwise. Nevertheless, the Board notes that providing a separate disability rating based on left shoulder impairment, including weakness, symptoms which are already contemplated under his currently assigned ratings, would be tantamount to impermissible pyramiding. See 38 C.F.R. § 4.14. Diagnostic Code 5003 does not provide a higher rating as the Veteran's left shoulder is a single major joint. Additionally, Diagnostic Code 5200 is inapplicable as no ankylosis of the left shoulder had been shown at any time during the period on appeal. Furthermore, Diagnostic Codes 5202 and 5203 are inapplicable as there is no malunion or other impairment of the humerus or impairment of the clavicle or scapula shown during this period. Finally, although the Veteran had surgery on the left shoulder in October 2011, it was a resurfacing arthroplasty/hemiarthroplasty and not a shoulder replacement surgery as required for rating the shoulder under Diagnostic Code 5051. See 80 Federal Register 42040 (July 16, 2015). The Board has also considered whether the Veteran has loss of use of his left upper extremity but finds that he does not. The term "loss of use" of a hand or foot is defined by 38 C.F.R. § 3.350(a)(2), which is also appliable to loss of use of an extremity, as a condition where no effective function remains other than that which would be equally well served by an amputation stump at the site of election below elbow or knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function, whether the acts of grasping, manipulation, etc. in the case of the hand, or balance, propulsion, etc., in the case of a foot, could be accomplished equally well by an amputation stump with prosthesis. The evidence reflects that he has significant limitation of the extremity but that he still retains use. Although the December 2015 VA examiner indicated that the Veteran's left shoulder was almost totally incapacitated, the Veteran himself reported at that time that he was still able to use his extremity so long as he immobilized his shoulder to the extent possible. Additionally, the October 2016 VA examiner, also noting that the Veteran had "practically" no use of his left shoulder without severe pain, found that the Veteran did not have functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis. While the Board acknowledges the notations in the medical treatment records indicating that the Veteran had "essentially" no motion and that he was "basically" unable to use his left arm, none of these clinicians provided an opinion suggesting that this rises to the level of loss of use of his extremity where no effective function remains other than that which would be equally well served by an amputation. Nevertheless, the Board finds that these descriptions are similar to those of the October 2016 VA examiner, who, while noting that the Veteran had "practically" no use of his left shoulder without severe pain, nevertheless found that the Veteran did not have functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis. The Board finds the opinion of the VA examiner to be the most probative evidence with regard to the severity of the Veteran's left shoulder functional impairment. Thus, while the Board recognizes that the Veteran experienced severe pain and limitations due to his left shoulder disability and avoided using his left shoulder and arm due to pain, the Board does not find that that the Veteran's left shoulder function more closely approximates loss of use of his left upper extremity. Finally, to the extent that there are deficiencies in the December 2015 or October 2016 VA examinations of record, the Board notes that, effective December 30, 2015, the Veteran is now in receipt of the maximum rating for his left shoulder that is allowed for limitation of motion without demonstrating amputation or the functional equivalent of amputation; therefore, the Board finds that any such errors in these VA examinations are harmless. See Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). Based on the above, the Board finds that the Veteran's disability did not meet or more nearly approximate the criteria for a 30 percent rating prior to December 30, 2015 or a rating in excess of 30 percent at any time during the period prior to August 3, 2017. Even considering the actual degree of functional impairment imposed by pain, incoordination, weakness, fatigue, and lack of endurance in accordance with 38 C.F.R. sections 4.40, 4.45, and 4.59, a higher evaluation is not available under the applicable diagnostic codes. From August 3, 2017 The Veteran's left shoulder disability has been rated under Diagnostic Code 5051 since August 28, 2017. Under Diagnostic Code 5051, with respect to the minor extremity, a 100 percent rating is warranted for one year following implantation of the prosthesis. Following this one-year period, a minimum 20 percent rating is assigned for intermediate degrees of residual weakness, pain, or limitation of motion of the minor extremity. A maximum 50 percent evaluation is assigned for chronic residuals consisting of severe, painful motion or weakness in the affected minor extremity. See 38 C.F.R. § 4.71a, Diagnostic Code 5051. As previously indicated, during the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). Notably, however, Diagnostic Code 5051 was unaffected by these recent amendments. The evidence reflects that the Veteran underwent a total left shoulder replacement on August 3, 2017. Specifically, a private treatment record dated August 11, 2017 notes that the Veteran was seen for postoperative follow-up for a left total shoulder arthroplasty performed on August 3, 2017. At his November 2018 Board hearing, the Veteran testified that he had regained about 70 percent usage of his left arm since his total left shoulder replacement and he was attending physical therapy to prevent the reformation of scar tissue. He testified that he was currently able to raise his left arm slightly above shoulder level before the pain started, which he described as an "ice pick stabbing pain." He also reported that he currently had less strength in that extremity than he did prior to the total replacement. A June 2020 VA examination notes a diagnosis of total left shoulder replacement. The Veteran reported experiencing a stiff and aching left shoulder pain every morning, which became sharp with overhead reaching, holding his arm at the level of the shoulder for 30 to 40 minutes (driving), or lifting more than 15 to 20 pounds with the left arm. The Veteran indicated that he did not experience flare-ups, but he had functional impairment described as the inability to lift more than 15 to 20 pounds with his left arm without experiencing a sharp left shoulder pain. Upon range of motion testing, his left shoulder flexion was limited to 75 degrees, abduction was limited to 60 degrees, external rotation was limited to 45 degrees, and internal rotation was limited to 40 degrees. There was no additional functional loss after three repetitions. Pain significantly limited functional ability with repeated use over a period of time; however, the examiner indicated that there was no additional limitation in his left shoulder range of motion as a result. Muscle strength testing was normal, and the Veteran did not have atrophy. The examiner indicated that the Veteran did not have functional impairment of an extremity such that no effective function remains other than that which would be equally well served by an amputation with prosthesis. Due to his left shoulder disability, the examiner indicated that the Veteran was poorly suited to work in a vocation which required repetitive usage of left arm. As an initial matter, the Board notes that the RO initially awarded the Veteran a 100 percent rating for his left shoulder replacement effective August 3, 2017; however, finding CUE with this rating decision, in December 2020, the RO, finding that the Veteran did not undergo his total left shoulder replacement until August 28, 2017, awarded a 100 percent evaluation effective August 28, 2017. A review of the Veteran's private medical records reflects that he did indeed have his complete shoulder replacement on August 3, 2017. Thus, the Board finds that the Veteran's temporary 100 percent rating is warranted from August 3, 2017. Turning to the period following his period of convalescence, resolving reasonable doubt in favor of the Veteran, the Board finds that a 50 percent evaluation is warranted for the entire period from October 1, 2018. In this regard, the Board notes that, during this period, the Veteran experienced continued left shoulder decreased range of motion, feelings of weakness and sharp pain, and corresponding functional loss. Furthermore, the only medical evidence of record addressing the Veteran's functional impairment of the left shoulder during this period is the June 2020 VA examination, which provided the basis for the 50 percent rating for the Veteran's total left shoulder replacement residuals. As such, the Board does not find that the available evidence during this period supports the assignment of staged ratings. Accordingly, affording the Veteran the benefit of the doubt, the Board finds that a 50 percent evaluation is warranted for the entire period beginning October 1, 2018, following his period of convalescence. A rating higher than 50 percent is not warranted at any time during the period from October 1, 2018, however. There is no evidence that the Veteran underwent any further surgical repair of his left shoulder to warrant further extension of his 100 percent rating, and a 50 percent rating is the schedular maximum under Diagnostic Code 5051, which contemplates chronic, severe residuals of a shoulder replacement surgery on the minor upper extremity. Even considering functional loss and 38 C.F.R. sections 4.40, 4.45, and 4.59, a rating in excess of 50 percent under Diagnostic Code 5051 is not possible. Furthermore, rating the Veteran's left shoulder under any other applicable diagnostic code would not result in a higher rating. Only Diagnostic Code 5202 provides for a rating higher than 50 percent for impairment of a minor upper extremity. To warrant a 70 percent rating under 5202, the Veteran would have to have a loss of the head of the humerus, i.e. a flail joint, which the medical evidence does not demonstrate. Finally, separate ratings for the left shoulder under Diagnostic Codes 5200 through 5203 would constitute impermissible pyramiding. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259 (1994). The currently assigned 50 percent evaluation under Diagnostic Code 5051 contemplates all residuals of the Veteran's left shoulder replacement, including but not limited to pain, limited motion, and weakness. Based on the above, the Board concludes that the criteria for a rating of 50 percent, but no higher, is warranted from October 1, 2018 for the Veteran's left shoulder disability. Left Shoulder Scar The Veteran is currently in receipt of a noncompensable evaluation for a left shoulder scar effective December 1, 2012 under Diagnostic Code 7802. In evaluating skin and scar residuals, the Board notes that during the appeal period, changes were made to certain Diagnostic Codes under 38 C.F.R. § 4.118. Effective August 13, 2018, VA amended its regulations governing skin disabilities. VA's intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. 83 Fed. Reg. 32592 (July 13, 2018). As the Veteran filed his claim before the August 13, 2018 effective date, the Board will consider whether either the old or new rating criteria is more favorable to the Veteran. The pre-amended Diagnostic Code 7801 provided disability ratings for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear. 38 C.F.R. § 4.118, Diagnostic Code 7801 (2017). In contrast, the amended Diagnostic Code 7801 contemplates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7801 (August 13, 2018). Both the old and new criteria provide that a 10 percent rating is awarded when the area of the scar(s) covers at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters). A 20 percent rating is warranted when the area of the scar(s) covers at least 12 square inches (77 square centimeters) but less than 72 square inches (456 square centimeters). A 30 percent rating is warranted when the area of the scar(s) covers at least 72 square inches (456 square centimeters) but less than 144 square inches (929 square centimeters). A 40 percent rating is assigned when the area of the scar(s) covers at least 144 square inches (929 square centimeters) or greater. 38 C.F.R. § 4.118, Diagnostic 7801. Note (1) to the pre-amended Diagnostic Code 7801 stated that a deep scar is one associated with underlying soft tissue damage. Prior to August 13, 2018, Diagnostic Code 7802 provided rating criteria for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear. 38 C.F.R. § 4.118, Diagnostic 7802 (2017). The amended version is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7802 (August 13, 2018). Both versions state that a 10 percent disability rating is warranted when the area of the scar covers 144 square inches (929 square centimeters) or greater. Under both the old and new rating criteria, Diagnostic Code 7804 provides disability ratings for scars that are unstable or painful. A 10 percent rating is warranted for one or two scars that are unstable or painful. A 20 percent rating is warranted for three or four scars that are unstable or painful. A 30 percent rating is warranted for five or more scars that are unstable or painful. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, an additional 10 percent should be added to the evaluation based on the total number of unstable or painful scars. Note (3) states that scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable. 38 C.F.R. § 4.118, Diagnostic 7804. Under the old rating criteria, Diagnostic Code 7805 provided that other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-7804 under an appropriate Diagnostic Code. 38 C.F.R. § 4.118, Diagnostic Code 7805 (2017). The Board notes that this diagnostic code is largely unchanged under the new amendments apart from the replacement of the phrase "(including linear scars)" with "and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804." 38 C.F.R. § 4.118, Diagnostic Code 7805 (August 13, 2018).). Medical treatment records are silent for any complaints related to his left shoulder scar. The December 2015 VA examination indicates that the Veteran had one left shoulder scar measuring 8 centimeters, which was not painful or unstable. The October 2016 VA examination notes that the Veteran had a left shoulder scar, measuring 10 centimeters by .5 centimeters as a result of his 2011 partial shoulder replacement, which was neither painful nor unstable. The June 2020 VA examination indicates that the Veteran had a left shoulder scar that measured 10.5 centimeters by .3 centimeters, which was neither painful nor unstable. After a review of the evidence, the Board finds that a compensable rating is not warranted for the period on appeal. The evidence does not reflect that the Veteran's left shoulder scar covers 144 square inches (929 square centimeters) or greater, as required for a 10 percent rating under both the pre-and post-amended rating criteria. 38 C.F.R. § 4.118, DC 7802. Rather, the VA examinations indicate that the Veteran had one left shoulder scar measuring approximately 8 to 10.5 centimeters by .3 to .5 centimeters, which is no more than 5.25 square centimeters. Therefore, the Board finds that a compensable evaluation is not warranted for the Veteran's left shoulder scar under DC 7802. The Board has considered whether other ratings are applicable to the Veteran's left shoulder scar. A disability rating under Diagnostic Codes 7801 is not warranted because the Veteran's scar was not at least 6 square inches, as noted for a 10 percent rating under DC 7801 under both the pre- and post-amended criteria. Nor is a compensable rating warranted under DC 7804 because the Veteran's left shoulder scar was neither painful nor unstable, as required for a compensable rating under both the old and new rating criteria. Furthermore, there is no basis to assign a compensable rating for the Veteran's left shoulder scar pursuant to DC 7805. There are no additional symptoms noted at any time during the period on appeal, which have not already been considered under DC 7802, nor has the Veteran contended otherwise. Accordingly, the Board finds that the Veteran's impairment due to his left shoulder scar is more consistent with a noncompensable disability rating and that the level of disability necessary to support the assignment of a compensable rating under DC 7805 is absent. The Board additionally notes that DC 7800 is not applicable as it relates specifically to scars of the head, face, or neck. 38 C.F.R. § 4.118. Accordingly, the Board finds that a rating in excess of zero percent is not warranted for the period on appeal for the Veteran's left shoulder scar. As the preponderance of the evidence is against the claim for a higher rating, the benefit of the doubt doctrine is not for application, and the Veteran's claim for an increased rating for his left shoulder scar is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102; 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Hite, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.