Citation Nr: 21031233 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 16-42 774 DATE: May 21, 2021 ORDER Entitlement to a disability rating in excess of 10 percent for a left ankle disability prior to October 3, 2019, is denied. Entitlement to a disability rating of 20 percent, but no higher, for a left ankle disability since October 3, 2019, is granted. Entitlement to a disability rating in excess of 20 percent for a left shoulder disability is denied. Entitlement to a disability rating in excess of 20 percent prior to October 3, 2019, for a right shoulder disability is denied. Entitlement to a disability rating of 30 percent, but no higher, for a right shoulder disability since October 3, 2019, is granted. FINDINGS OF FACT 1. Prior to October 3, 2019, the Veteran's left ankle disability was manifested by no worse than moderate limitation of motion of the ankle. 2. Since October 3, 2019, the Veteran's left ankle disability is manifested by marked limitation of motion, with consideration of pain and associated functional impairment; there is no ankylosis or deformity of the ankle. 3. The Veteran's left shoulder disability is manifested by pain with flexion limited to 70 degrees. 4. Prior to October 3, 2019, the Veteran's right shoulder disability was manifested by pain with flexion limited to 140 degrees. 5. Since October 3, 2019, the Veteran's right shoulder is manifested by pain, pain on motion, and weakness of motion. The right shoulder disability most closely approximated by limitation of motion of the arm midway between the side and shoulder level. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 10 percent for a left ankle disability prior to October 3, 2019, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.21, 4.40, 4.44, 4.45, 4.59, 4.71a, Diagnostic Code 5271. 2. The criteria for entitlement to a disability rating of 20 percent, but no higher, for a left ankle disability since October 3, 2019 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.21, 4.40, 4.44, 4.45, 4.59, 4.71a, Diagnostic Code 5271. 3. The criteria for entitlement to a disability rating in excess of 20 percent for a left shoulder disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. 4. The criteria for entitlement to a disability rating in excess of 20 percent prior to October 3, 2019, for a right shoulder disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. 5. The criteria for entitlement to a disability rating of 30 percent, but no higher, for a right shoulder disability since October 3, 2019 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service with the U.S. Air Force from March 1970 to March 1994. This case comes before the Board of Veteran's Appeals (Board) on appeal from a September 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). When this matter was previously before the Board in December 2018, the issues were remanded for further development. During the processing of the remand, service connection for a bilateral foot disability was granted; this fully satisfied the claim with regard to that issue, and it is no longer on appeal. AB v. Brown, 6 Vet. App. 35 (1993). The remaining issues have now been returned to the Board for adjudication. Duty to Notify and Assist VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). These duties have been satisfied in this case. Appropriate notice was provided in November 2012. The RO associated the Veteran's service and VA and private outpatient treatment records with the claims file. All released or submitted private treatment records have been associated with the claims file. No other relevant records have been identified and are outstanding. Appropriate and necessary examinations were afforded the Veteran, and are adequate for evaluation, as they include needed findings to permit application of the rating schedule and identification of current disability. Such includes the examinations ordered in the December 2018 Board remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). As such, VA has satisfied its duty to assist. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Increased Rating Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and, above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be staged. Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A Veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Left Ankle The Board notes that the rating criteria for the Musculoskeletal System was amended on February 7, 2021. See 85 Fed. Reg. 76453 (Nov. 30, 2020). Under the prior criteria of Diagnostic Code (Code) 5271, a 20 percent rating is warranted for marked limitation of motion, and a 10 percent rating is warranted for moderate limitation of motion. See 38 C.F.R. § 4.71a, Code 5271. Under the current criteria of Code 5271, a 20 percent rating is warranted for marked limitation of motion (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion), and a 10 percent rating is warranted for moderate limitation of motion (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion). See 38 C.F.R. § 4.71a, Code 5271 (Effective February 7, 2020.) The proposed rule stated that the regulatory change was intended as a clarification of current policy. See 82 Fed. Reg. 35719, 35723 (Aug. 1, 2017). Prior to the amendment, the words "slight," "moderate," and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence for "equitable and just decisions." 38 C.F.R. § 4.6. In December 2012, the Veteran was afforded a VA ankle examination. He was diagnosed with left ankle fracture with loss of motion. The Veteran did not report any flare-ups that impacted the function of his ankle. Initial range of motion (ROM) for left ankle plantar flexion ended at 45 degrees or greater with no objective evidence of painful motion and dorsiflexion ended at 20 degrees or greater with no objective evidence of painful motion. He was able to perform repetitive-use testing; ROM was unchanged. He did not have additional limitation or a functional loss impairment after repetitive-use testing. There was no localized tenderness or pain on palpation of the joints/soft tissue of the ankle. He had a normal muscle strength testing and joint stability testing. He did not have ankylosis. He did not have shin splints. He did not have a total ankle joint replacement. He did not use an assistive device for his condition. A March 2014 private treatment note documented complaints of ankle pain. The examiner felt that an elastic bracing would be beneficial for the Veteran. The examiner noted that the Veteran had marked swelling. An August 2015 private treatment note documented the Veteran was seen for treatment for his ankle. The Veteran reported that sometimes he woke up at night because of pain. He described the pain as cramping in his ankle. A November 2015 private treatment note documented that the Veteran sought treatment for his ankle. The Veteran had 5/5 ankle plantar flexion, 5/5 ankle dorsiflexion, normal sensation to light touch, and negative straight leg raising test. In March 2016, the Veteran was afforded a VA ankle examination. The Veteran was diagnosed with residuals of left ankle fracture with loss of motion. The Veteran described his flare-ups as swelling, burning, stiffness, and inability to bear weight in the ankle. He noted that his ankle had popping and shooting pain up his leg. He had a sharp pain doing lateral motion or long-distance walking. He had numbness and tingling in his ankle. The Veteran indicated that he had a functional loss/impairment with weight-bearing, limitation of motion, prolong walking, standing, climbing, less movement that weakened movement, and excess inability to pain on movement. He indicated that his ankle interfered with his sitting, standing, weight-bearing, limitation standing, walking, weakness of motion and painful motion. His initial ROM for left ankle plantar flexion ended at 30 degrees and dorsiflexion ended at 15 degrees. There was pain noted in dorsiflexion that did not result or cause functional loss. There was evidence of pain with weight bearing. There was lateral and medial tenderness to the ankle. There was no objective evidence of crepitus. The examiner noted that the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time or with flare-ups. He had a normal muscle strength testing; he did not have muscle atrophy. He did not have ankylosis. He did not have shin splints. The Veteran did not use an assistive device for his condition. The Veteran would not be equally well served by an amputation with prosthesis. The examiner opined that the Veteran's ankle disability did not impact his ability to perform any type of occupational task. In April 2018, the Veteran was afforded a VA ankle examination. The Veteran was diagnosed with bilateral chronic ankle sprain. The Veteran described his flare-ups as chronic bilateral ankle pain with limitation with standing and ambulating. His functional loss/impairment was described as the same as his flare-ups. His initial ROM for left ankle plantar flexion ended at 45 degrees and dorsiflexion ended at 20 degrees. There was pain noted on the examination that did not result or cause a functional loss. There was evidence of pain with weight-bearing. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was no objective evidence of crepitus. The Veteran was able to perform repetitive use testing without any additional loss of function or ROM. The Veteran was tested immediately after repetitive use over time. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time. The examination was not conducted during a flare-up. The examiner noted that the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss during flare-ups. Pain caused a functional loss during flare-ups. The examiner noted that he was not able to describe in the terms of ROM. He explained that the Veteran was not in a current flare-up status. Additional contributing factors of his disability was disturbance of locomotion and interference with standing. He had a normal muscle strength testing. He did not have muscle atrophy. He did not have ankylosis. There was no ankle instability or dislocation suspected. He did not have shin splints or use an assistive device for his condition. The examiner opined that the Veteran's ankle condition impacted his ability to perform occupational tasks such as standing or walking for extended time. In October 2019, the Veteran was afforded a VA ankle examination. The Veteran was diagnosed with left fibular fracture. The Veteran did not report any flare-ups. He described a functional loss/impairment as chronic pain that got worse after only 5-minutes of walking. His initial ROM for left ankle plantar flexion ended at 30 degrees and dorsiflexion ended at 5 degrees. The Veteran's ROM itself did not contribute to a functional loss. There was pain noted on the examination that caused a functional loss. There was evidence of pain with weight-bearing. There was evidence of moderate tenderness to the lateral ankle. There was evidence of crepitus. The Veteran was able to perform repetitive use testing without any additional loss of function or ROM. The Veteran was not examined immediately after repetitive use over time. The examiner noted that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. Pain significantly limited his functional ability with repeated use over time. Described in terms of ROM was 25 degrees for plantar flexion and 5 degrees for dorsiflexion. He had a normal muscle strength testing. He did not have muscle atrophy. He did not have ankylosis. There was no ankle instability or dislocation suspected. He did not have shin splints. He did not use an assistive device for his condition. There was objective evidence of pain on passive ROM and non-weight bearing. The examiner opined that the Veteran's ankle condition impacted his ability to perform any type of occupational task. The examiner noted that the Veteran's pain got worse after only 5-minutes of walking. Prior to October 2019 The Board has carefully considered all the evidence and potentially applicable diagnostic codes, including the DeLuca factors, and finds that the disability picture of the Veteran's left ankle condition does not more nearly approximate the rating criteria for a rating in excess of 10 percent prior to October 2019. The evidence does not show that the Veteran's symptoms meet the criteria for a 10 percent rating pursuant to Code 5271 because the Veteran does not have marked limitation of motion of the left ankle. The Board notes that the VA examinations addressed DeLuca factors, to include symptoms described by the Veteran in competent and credible statements, and that even with consideration of the DeLuca factors, the Veteran's limitation of motion of the left ankle is not marked. VA examination reports cannot be described as marked limitation of motion in the ankle, nor are they descriptive of ankylosis of the joint, as motion is possible. There is likewise no evidence of weakness or incoordination in the joint that contributes to any functional loss during this period. The December 2012 examination showed ROM for plantar flexion ended at 45 degrees and dorsiflexion ended at 20 degrees or greater. The November 2015 private treatment note documented his plantar flexion 5/5 and dorsiflexion 5/5. March 2016 examination demonstrated ROM as plantar flexion ended at 30 degrees and dorsiflexion ended at 15 degrees. April 2018 examination demonstrated ROM as plantar flexion ended at 45 degrees and dorsiflexion ended at 20 degrees. The Veteran's pain of the left ankle during this period is adequately contemplated by the currently assigned 10 percent ratings. The Board has considered the Veteran's lay statements and assertions. To the extent that the Veteran's statements at the December 2012, March 2016, and April 2018 VA examination reflect symptoms not contemplated by the rating criteria, the Board notes that the evidence, to include the VA examiner's opinion and the Veteran's reported limitations with exertional activities, does not show marked interference with employment or frequent hospitalization. The Board further notes that the Veteran has not made any assertions identifying why a higher rating for left ankle strain is warranted. From October 2019 The Board finds that the Veteran's left ankle condition more nearly approximates a 20 percent rating effective October 3, 2019. The October 2019 examination demonstrated that ROM for left ankle plantar flexion ended at 30 degrees and dorsiflexion ended at 5 degrees. The examiner noted that pain caused a functional loss. There was evidence of pain on weight-bearing and non-weight bearing. Furthermore, pain significantly limited his functional ability with repeated use over time. The examiner noted that that the Veteran's pain got worse after only 5 minutes of walking. Resolving all doubt in favor of the Veteran, the Board finds that the Veteran's left ankle condition more nearly approximates the criteria of a 20 percent rating when considering these reports of pain with activity, functional loss/impairment, and the lay and medical evidence of record. The symptomatology associated with the left ankle is more indicative of marked limitation of motion. This is the highest rating available under Diagnostic Code 5271, and the reported functional impairment has already been considered in the 20 percent rating being assigned. The Board has considered whether a higher or separate rating is warranted under another diagnostic code, but there has been no ankylosis shown in this case (Diagnostic Code 5270). Therefore, a rating in excess of 20 percent is not warranted. Bilateral Shoulder The applicable rating criteria for musculoskeletal disorders, in particular shoulder disabilities, under 38 C.F.R. § 4.71a were amended, effective February 7, 2021 [Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453-69 (November 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5201)]. Diagnostic Code 5201, applicable here, was amended to note that shoulder level is 90 degrees and midway is 45 degrees. Code 5201 provides, for the minor arm, a minimum compensable rating of 20 percent for limitation of motion to shoulder level (e.g., 90 degrees). The same 20 percent rating is also provided for limitation of motion midway between the side and shoulder level (30 percent for major). A 30 percent rating is provided for limitation of motion to 25 degrees from the side (40 percent for major). For rating purposes, a distinction is made between major (dominant) and minor groups. Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. 38 C.F.R. § 4.69. The Veteran has reported being right-handed and left-handed; for rating purposes, the Veteran is considered right-hand dominant. The right is the more impaired limb, and by regulation is considered the dominant limb. 38 C.F.R. § 4.69. Thus, his service-connected right shoulder will be considered his major extremity and left shoulder his minor extremity. In December 2012, the Veteran was afforded a VA shoulder examination. The Veteran was diagnosed with left and right shoulder crepitus. The Veteran did not report any flare-ups that impacted the function of the shoulder. The Veteran was right hand dominant. His initial ROM for the right shoulder for flexion was 180 degrees with no objective evidence of painful motion, abduction was 180 degrees with no objective evidence of painful motion, external rotation ended at 90 degrees with no objective evidence of painful motion, and internal rotation ended at 90 degrees with no objective evidence painful motion. Initial ROM for the left shoulder flexion was 180 degrees with no objective evidence of painful motion, abduction was 180 degrees with no objective evidence of painful motion, external rotation ended at 90 degrees with no objective evidence of painful motion, and internal rotation ended at 90 degrees with no objective evidence painful motion. The Veteran was able to perform repetitive-use testing with 3 repetitions. Post-test ROM was the same as the initial ROM. The Veteran did not have additional limitation in ROM of the shoulder following repetitive-use testing. He did not have any functional loss and/or functional impairment of the shoulder. There was no localized tenderness or pain on palpation of joints/soft tissue/biceps tendon of either shoulder. He did not have guarding of the shoulders. He had a normal muscle strength testing. He did not have ankylosis. He had a negative Hawkins' impingement test, empty-can test, external rotation/infraspinatus strength test, and lift-off subscapularis test. He did not have any mechanical symptoms. He had a negative crank apprehension and relocation test. He did not have an AC joint condition or any other impairment of the clavicle or scapula. He had a negative cross-body adduction test. He has not had a total shoulder joint replacement. He has not had any arthroscopic or other shoulder. There was no documented degenerative or traumatic arthritis documented. The examiner opined that the Veteran's shoulder condition did not impact his ability to work. In March 2016, the Veteran was afforded a VA shoulder examination. The Veteran was diagnosed with bilateral shoulder impingement syndrome. The Veteran indicated that he was left hand dominant. The Veteran described flare-ups in the right shoulder as sharp pain when raising his arm. He had locking, popping, clicking, and burning pain in the right shoulder. He described flare-ups in the left shoulder as sharp pain with all motion. He had locking, popping, clicking, and burning pain in the left shoulder. He had a functional impairment/loss in both shoulders described as limitation of motion and painful motion. He was not able to lift or pick up heavy objects and he had weakness in motion in both arms. His initial ROM for the right shoulder for flexion was 140 degrees, abduction was 120 degrees, external rotation was 90 degrees, and internal rotation was 90 degrees. His initial ROM for the left shoulder for flexion was 120, abduction was 100 degrees, external rotation was 80 degrees, and internal rotation was 90 degrees. Pain was noted on the examination but did not result in or cause functional loss. There was pain on flexion, abduction, and external rotation. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was no evidence of pain with weight-bearing. There was objective evidence of crepitus in both shoulders. The Veteran was able to perform repetitive-use testing in both arms. There was no additional loss of function or ROM after three repetitions in both arms. The examiner noted that the examination was neither medically consistent or inconsistent with the Veteran's statements describing functional loss with repetitive use over time or flare-ups in both arms. Pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time or flare-ups in both arms. The Veteran had additional factors contributing to his disability described less movement than normal in both arms. He had a normal muscle strength testing. He did not have muscle atrophy. He did not have ankylosis. He had a positive Hawkins' impingement test and lift-off subscapularis test. He had a negative empty-can test, and external rotation/infraspinatus strength test. He did not have any shoulder instability, dislocation, or labral pathology suspected. He did not have any clavicle, scapula, acromioclavicular joint, or sternoclavicular joint condition suspected. He did not have any condition or impairment of the humerus. The Veteran did not use an assistive device for his condition. The examiner opined that the Veteran's shoulder condition did not impact his ability to perform any type of occupational task. In October 2019, the Veteran was afforded a VA shoulder examination. The Veteran was diagnosed with bilateral shoulder impingement syndrome. The Veteran indicated that he was right hand dominant. He reported right shoulder flare-ups with activity, such reaching overhead or lifting heavy objects. He described sharp pain and weakness in the shoulder that limited motion to shoulder level. His left shoulder flare-ups occurred about 3 to 4 times a month and were severe. The Veteran had a functional loss/impairment described as limitation in lifting above his head. He was not able to lift or pick up heavy object. He had pain, limitation of ROM, weakness of motion and limitation of the arm at shoulder level. His initial ROM for the right shoulder for flexion was 80 degrees, abduction was 80 degrees, external rotation was 40 degrees, and 90 degrees for internal rotation. His initial ROM for the left shoulder for flexion was 80 degrees, abduction was 80 degrees, external rotation was 40 degrees, and 90 degrees for internal rotation. Pain was noted on the examination that caused a functional loss. ROM itself contributed to a functional loss. The Veteran was not able to perform overhead activities. There was no objective evidence of crepitus. There was evidence of pain with weight-bearing. The Veteran was able to perform repetitive use testing with no additional loss of function or ROM. The examiner noted that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time and flare-ups. Pain significantly limited his functional ability with repeated use over time. Described in terms of ROM for flexion was 70 degrees, abduction was 70 degrees, external rotation 30 degrees, and 90 degrees for internal rotation for both shoulders. There were no additional factors contributing to his disability. He had a normal muscle strength testing. He did not have muscle atrophy. He did not have ankylosis. There was a rotator cuff condition suspected. He had a positive Hawkins impingement test. The examiner marked N/A for the empty can test, external rotation/ infraspinatus strength test, and lift-off subscapularis test. He did not have any shoulder instability. He did not have any clavicle, scapula, acromioclavicular joint, or sternoclavicular joint condition suspected. He did not have a condition or impairment of the humerus. He did not use an assistive device for his condition. There was objective evidence of pain on passive ROM testing of the bilateral shoulder. There was evidence of pain on non-weight bearing testing of the bilateral shoulder. The examiner opined that the Veteran's condition impacted his ability to perform any type of occupational task. The examiner noted that he could not perform overhead activities due to limitation of ROM. Left Shoulder The Board has carefully considered all the evidence and potentially applicable diagnostic codes, including the DeLuca factors, and finds that the disability picture of the Veteran's left shoulder disability does not more nearly approximate the rating criteria at a higher disability level. The evidence does not show that the Veteran's symptoms meet the criteria for a 30 percent disability rating under Code 5201 because the Veteran's left shoulder disability does not limit the range of motion of his left arm to 25 degrees from his side in any plane, even upon consideration of the impact of pain at flare-ups. Additionally, there is no ankylosis of the joint or impairment of the humerus (Codes 5200 or 5202) which could warrant application of a rating in excess of 20 percent. An increased rating is not warranted. Right Shoulder Prior to October 2019 The Board has carefully considered all the evidence and potentially applicable diagnostic codes, including the DeLuca factors, and finds that the disability picture of the Veteran's right shoulder disability does not more nearly approximate the rating criteria at a higher disability level prior to October 2019. The evidence does not show that the Veteran's symptoms meet the criteria for a 30 percent disability rating under Code 5201 because the Veteran's right shoulder disability does not limit the range of motion of his left arm to 25 degrees from his side in any plane, even upon consideration of the impact of pain at flare-ups. VA examination reports demonstrated the Veteran was able to lift his arm above his head. He noted that he had popping and sharp pain in the right shoulder. Additionally, there is no ankylosis of the joint or impairment of the humerus (Codes 5200 or 5202) which could warrant application of a rating in excess of 20 percent. An increased rating is not warranted prior to October 3, 2019. From October 2019 After reviewing the relevant medical and lay evidence and applying the above laws and regulations, the Board finds that a rating of 30 percent is warranted for the Veteran's right shoulder disability exclusive of the period from October 3, 2019. However, the preponderance of the evidence is against right shoulder disability being rated in excess of 30 percent. Viewing the record from October 2019, the Veteran's limitations due to pain, limitation of ROM, weakness of motion and limitation of the arm at shoulder level. Although at most 70-degree limitation of abduction is noted, which is to greater than midway between the side and shoulder level, the examiner found weakened movement and pain on movement. The examiner noted that the Veteran was unable to put his arm above his head. Additionally, considering the Veteran's reports and findings of functional limitations of his right shoulder in his daily activities, the Board finds that the criteria for a 30 percent rating are approximated. The Board is also tasked with considering whether other diagnostic codes apply to the Veterans disability. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). The Board has also considered the application of Diagnostic Codes 5200 and 5203 in this appeal, but both codes are inapplicable. The October 2019 examination results, as well as VA treatment records demonstrate no ankylosis, favorable or unfavorable of the right shoulder, precluding a rating under Diagnostic Code 5200. A rating under Code 5203 would not be applicable as there is no available schedular rating that is greater than the currently assigned 30 percent under Code 5201. Additionally, separate ratings for the right shoulder under Code 5201 and Code 5203 would constitute pyramiding. 38 C.F.R. § 4.14. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Baxter 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.