Citation Nr: 21032504 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 14-40 560 DATE: May 27, 2021 ORDER A 20 percent rating, but not higher, for the service-connected cervical strain from July 1, 2011, to October 4, 2019, is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to a rating in excess of 20 percent for the service-connected cervical spine strain from October 4, 2019, to February 16, 2021, is denied. Entitlement to a rating in excess of 30 percent for the service-connected cervical spine strain from beginning February 16, 2021, is denied. Entitlement to a rating in excess of 40 percent for cervical spine strain, prior to May 11, 2011, on an extraschedular basis, is denied. FINDINGS OF FACT 1. Resolving all doubt in his favor, from July 1, 2011, to October 4, 2019, the Veteran's cervical strain was characterized by forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees. 2. From October 4, 2019, to February 16, 2021, the Veteran's cervical strain did not result in limitation of forward flexion to 15 degrees or less, or ankylosis of the cervical spine. 3. Beginning February 16, 2021, the Veteran's cervical strain did not result in ankylosis of the cervical spine. 4. Prior to May 11, 2011, the Veteran's cervical strain did not have symptoms or cause functional impairment not contemplated by the schedular rating criteria. CONCLUSIONS OF LAW 1. The criteria for a 20 percent evaluation, but not higher, for service-connected cervical strain from July 1, 2011, to October 4, 2019, have been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237 (2019). 2. The criteria for a rating in excess of 20 percent from October 4, 2019, to February 16, 2021, for service-connected cervical strain have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. § 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.21, 4.71a, Diagnostic Code 5237 (2019). 3. The criteria for a rating in excess of 30 percent beginning February 16, 2021, for service-connected cervical strain have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. § 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.21, 4.71a, Diagnostic Code 5237-5243 (2021). 4. The criteria for a rating in excess of 40 percent for cervical spine strain, prior to May 11, 2011, on an extraschedular basis, have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 3.321 (b)(1), 4.71a, Diagnostic Code 5237 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 2002 to February 2006. This case is before the Board of Veterans' Appeals (Board) on appeal from a May 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. This claim was previously before the Board in February 2020, at which time it was remanded for additional development. In February 2021, the RO increased the Veteran's evaluation for his cervical spine strain to 30 percent disabling, effective February 16, 2021. As a result, the Board has amended the Veteran's claims on appeal to reflect this increase. Increased Rating Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degrees of disability specified by the schedule are considered adequate to compensate veterans for considerable loss of working time from exacerbation or the illness proportionate to the severity of the several grades of disability. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 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. In general, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, staged ratings are also appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in this decision is, therefore, undertaken with consideration of the possibility that different ratings may be warranted for different time periods. The Veteran is presumed to be seeking the maximum possible evaluation. AB v. Brown, 6 Vet. App. 35 (1993). When a question arises as to which of two ratings applies under a particular code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. At the time of an initial rating, separate ratings can be assigned for separate periods of time based on the facts found-a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Cervical Spine Strain The Veteran's cervical spine disability has been rated as 10 percent disabling from July 1, 2011, to October 4, 2019, under Diagnostic Code 5237, as 20 percent disabling from October 4, 2019 to February 16, 2021, under Diagnostic Code 5237, and as 30 percent disabling from February 16, 2021, under Diagnostic Codes 5237-5243. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27 (2019). Diagnostic Code 5237 pertains to cervical strain, whereas Diagnostic Code 5243 pertains to intervertebral disc syndrome (IVDS). When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not considered to be contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The United States Court of Appeals for Veterans Claims (Court) clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, and less or more movement than is considered normal, weakened movement, excess fatigability, and pain on movement (with swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The Court has held that the provisions of 38 C.F.R. § 4.59 are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011). Significantly, regulations pertaining to musculoskeletal disabilities were recently amended and new criteria for rating musculoskeletal disabilities became effective on February 7, 2021. When 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. VAOPGCPREC 3- 2000; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The recently revised musculoskeletal regulations do not provide for retroactive application; thus, the amendments may be applied as of, but not prior to, February 7, 2021. Hence, for the period beginning February 7, 2021, the version more favorable to the veteran will apply. Prior to February 7, 2021 Disabilities that fell under Diagnostic Code 5237 required application of a General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitation Episodes, as follows: A 10 percent rating was warranted for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height; A 20 percent rating was warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis; A 30 percent rating was warranted for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. Unfavorable ankylosis of the entire cervical spine warranted a 40 percent rating. Unfavorable ankylosis of the entire spine warranted a 100 percent rating. 38 C.F.R. § 4.71. There are several notes set out after the applicable diagnostic criteria. First, associated objective neurologic abnormalities are to be rated separately under an appropriate Diagnostic Code. Second, for purposes of VA compensation, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees. Third, in exceptional cases, an examiner may state that, because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that particular individual, even though it does not conform to the normal range of motion stated in the regulation. Fourth, each range of motion should be rounded to the nearest 5 degrees. Finally, for VA purposes, unfavorable ankylosis is a condition in which the entire cervical spine, entire thoracolumbar spine, or entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficult walking because of a limited line of vision, restricted opening of the veteran's mouth and chewing, breathing limited to diaphragmatic respiration, gastrointestinal symptoms due to pressure of the costal margin on the abdomen, dyspnea or the existence of dysphagia, atlantoaxial or cervical subluxation or dislocation, or neurologic symptoms due to nerve root stretching. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. Under the IVDS Rating Formula, a 20 percent rating is warranted for incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating is warranted for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating requires incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. An incapacitating episode is defined as a period of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a. Beginning February 7, 2021 As of February 7, 2021, changes have been implemented to the musculoskeletal rating criteria. There were, however, no changes to Diagnostic Code 5237. There were changes to Diagnostic Code 5243, effective February 7, 2021. The name title of the code remained the same, but specified that the evaluator is to assign this diagnostic code only when there is disc herniation with compression and/or irritation of the adjacent nerve root; the evaluator is to assign diagnostic code 5242 for all other diagnoses. 1. Entitlement to a rating in excess of 10 percent for the service-connected cervical spine strain for the period from July 1, 2011, to October 4, 2019 The Veteran received a VA examination in February 2012 and did not report flare-ups of the cervical spine. He stated that he had lost range of motion and his neck stiffened on a cold, windy day. Upon examination, forward flexion, extension, right lateral flexion, and left lateral flexion were 45 degrees or greater. Right lateral rotation and left lateral rotation were to 80 degrees or better. There was no additional limitation in range of motion following repetitive use and no functional loss of the cervical spine. There was also no localized tenderness or pain to palpation for joints/soft tissue, no guarding or muscle spasm, and no muscle atrophy. Finally, the examiner noted that there was no IVDS. Pursuant to the June 2020 Board remand, a VA medical addendum was submitted in February 2021 opining whether the Veteran's range of motion results from the February 2012 VA examination would have been reduced if tested in both active and passive motion and in weight-bearing and nonweight-bearing. If possible, the examiner was asked to describe the additional range of motion loss in degrees. The examiner noted the results of the February 2021 VA examination and concluded that, compared to those results, the Veteran's range of motion from the February 2012 VA examination would have been reduced if tested in both active and passive motion and in weight-bearing and nonweight-bearing. In February 2021, the initial range of motion results found forward flexion to 20 degrees, extension to 5 degrees, right lateral flexion to 0 degrees, left lateral flexion to 30 degrees, right lateral rotation to 20 degrees and left lateral rotation to 50 degrees. Passive range of motion results found forward flexion to 20 degrees, extension to 10 degrees, right lateral flexion to 0 degrees, left lateral flexion to 30 degrees, right lateral rotation to 20 degrees and left lateral rotation to 50 degrees. Repeated use over time results found forward flexion to 15 degrees, extension to 10 degrees, right lateral flexion to 0 degrees, left lateral flexion to 25 degrees, right lateral rotation to 15 degrees and left lateral rotation to 45 degrees. During flare-ups, forward flexion to 15 degrees, extension to 5 degrees, right lateral flexion to 0 degrees, left lateral flexion to 20 degrees, right lateral rotation to 15 degrees and left lateral rotation to 40 degrees. The Board will resolve reasonable doubt in the Veteran's favor and find that a 20 percent evaluation is warranted for the period from July 1, 2011, to October 4, 2019. The February 2021 addendum found that the Veteran's range of motion results from February 2012 would have been reduced but did not offer estimates for the reduction. The examiner, however, noted the range of motion results from the February 2021 VA examination and compared them to the February 2012 VA examination to reach his conclusion. Therefore, reading the evidence in the light most favorable to the Veteran, the Board will conclude that the passive range of motion in February 2021, which found forward flexion to 20 degrees, would be similar to the passive range of motion in February 2012. A 30 percent evaluation is not warranted for this time period because there is no evidence that forward flexion of the cervical spine was 15 degrees or less. There is also no evidence of favorable ankylosis of the entire cervical spine A 40 percent evaluation is not warranted because there is no evidence of unfavorable ankylosis of the entire cervical spine. Finally, a 100 percent evaluation is not warranted because there is no evidence of unfavorable ankylosis of the entire spine. 2. Entitlement to a rating in excess of 20 percent for the service-connected cervical spine strain from October 4, 2019, to February 16, 2021 The Veteran received a VA examination in October 2019 and did not report flare-ups of the cervical spine. Upon examination, forward flexion and extension were to 30 degrees, right and left lateral flexion were to 25 degrees, and right and left lateral rotation were to 50 degrees. There was pain that caused functional loss, but no evidence of pain with weight bearing or objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the cervical spine. The Veteran was able to perform repetitive use testing but there was no additional loss of function or range of motion after three repetitions. Pain, weakness, fatigability, or incoordination also did not significantly limit functional ability with repeated use over time. There were no muscle spasms, but the Veteran had guarding that did not result in abnormal spinal contour. The sensory examination was considered normal and there was no radiculopathy present. There was also no ankylosis of the spine. Finally, the examiner noted that there was IVDS of the cervical spine, but the Veteran had no episodes of acute signs and symptoms due to the condition that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The medical evidence of record shows that the Veteran had not exhibited a forward flexion of the cervical spine to 15 degrees or less or ankyloses of the spine from October 4, 2019, to February 16, 2021. There was also no pain or functional loss which would limit his range of flexion to more than what is already contemplated by his 20 percent rating. Therefore, the Board finds that the preponderance of evidence is against a rating in excess of 20 percent for the period from October 4, 2019, to February 16, 2021. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Code 5243; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to a rating in excess of 30 percent for the service-connected cervical spine strain from beginning February 16, 2021, is denied. Pursuant to the June 2020 Board remand, the Veteran received a VA examination in February 2021 and reported flare-ups of the cervical spine. There was also functional loss, including decreased range of motion, having a hard time "looking up and down," a crooked axis of the head that progressed more to the left as time passed, tremors in the right upper extremities, headaches, and missed time at work and time away from his family. Upon examination, initial range of motion results found forward flexion to 20 degrees, extension to 5 degrees, right lateral flexion to 0 degrees, left lateral flexion to 30 degrees, right lateral rotation to 20 degrees and left lateral rotation to 50 degrees. The range of motion contributed to functional loss including impairment with driving for long periods and impairment during exercising and sports requiring repeated turning of the head and neck. Passive range of motion results found forward flexion to 20 degrees, extension to 10 degrees, right lateral flexion to 0 degrees, left lateral flexion to 30 degrees, right lateral rotation to 20 degrees and left lateral rotation to 50 degrees. Repeated use over time results found forward flexion to 15 degrees, extension to 10 degrees, right lateral flexion to 0 degrees, left lateral flexion to 25 degrees, right lateral rotation to 15 degrees and left lateral rotation to 45 degrees. The examiner was not being examined during a flare-up, but pain, weakness, and lack of endurance caused functional loss. Estimated range of motion during flare-ups found forward flexion to 15 degrees, extension to 5 degrees, right lateral flexion to 0 degrees, left lateral flexion to 20 degrees, right lateral rotation to 15 degrees and left lateral rotation to 40 degrees. The Veteran did not have localized tenderness, guarding, or muscle spasm. Additional factors contributing to the cervical spine disability included left neck torticollis, severe limited mobility, stiffness, and mild weak movements. There was no muscle atrophy but there were signs and symptoms due to radiculopathy. There was also no ankylosis. Finally, the examiner noted that there was IVDS of the cervical spine, but the Veteran had no episodes of acute signs and symptoms due to the condition that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The clinical records do not show evidence of spinal ankylosis. The February 2021 VA examiner specifically opined that there was no ankylosis of the spine and this opinion is not contradicted by another medical opinion of record. Colvin v. Derwinski, 1 Vet. App. 171 (1991). Therefore, the Board finds that a rating in excess of 30 percent is not warranted for the Veteran's cervical spine disability due to ankylosis. 38 C.F.R. § 4.71a. The Board also notes that the Veteran has been diagnosed with IVDS, but the examiner opined that the Veteran had not had any episodes of acute signs and symptoms attributable to the condition that required bed rest prescribed by a physician and treatment by a physician in the last 12 months. Therefore, a higher rating for IVDS is not warranted. The Board further notes that radiculopathy of the right upper extremity was granted with an evaluation of 20 percent, effective February 16, 2021. There is no indication that the Veteran has expressed disagreement with this rating, and it is not subject for current appellate review. Furthermore, the provisions of 38 C.F.R. §§ 4.40, 4.45 are not for consideration where the Veteran is in receipt of the highest rating based on limitation of motion and a higher rating requires ankylosis, as is the scenario in the present case. Johnston v. Brown, 10 Vet. App. 80 (1997). Therefore, a higher rating based on functional impairment is not warranted. Finally, as the revisions implemented to the musculoskeletal rating criteria, effective February 7, 2021, do not change the substantive criteria for Diagnostic Codes 5237 or 5243, they do not offer an option for an increased rating. Accordingly, the Board finds that a rating in excess of 30 percent beginning February 16, 2021 for the Veteran's cervical spine disability is not warranted. 4. Entitlement to a rating in excess of 40 percent for cervical spine strain, prior to May 11, 2011, on an extraschedular basis The Veteran's claim was referred to the Director of Compensation Services in June 2020 to determine whether the Veteran's cervical spine disability warranted a rating higher than 40 percent prior to May 11, 2011, on an extraschedular basis under the special provisions of 38 C.F.R. § 3.321(b)(1). In response to that June 2020 referral, the Director rendered a December 2020 advisory opinion concluding that an extraschedular rating was not warranted for the Veteran's cervical spine disability. The Director concluded that the totality of evidence on record and RO submission indicated no support for the notion that the Veteran's cervical spine disability constituted such an unusual or exceptional disability pattern to render application of the regular rating criteria as impractical. However, the Director's opinion is not a final determination on the matter. Rather, the Board must review all the evidence in rendering a final determination regarding whether the appellant is entitled to an extra-schedular rating. As the issue of extraschedular consideration for the Veteran's cervical spine disability was adjudicated in the first instance by the Director in December 2020, the Board is now free to review these matters de novo. Floyd v. Brown, 9 Vet. App. 94 (1996). There is no restriction on the Board's ability to review the adjudication of an extraschedular rating once the Director determines that an extraschedular rating is not warranted. Anderson v. Shinseki, 22 Vet. App. 423, 427 (2009). See also Wages v. McDonald, 27 Vet. App. 233, 239 (2015) ("[T]he Director's decision is in essence the de facto decision of the agency of original jurisdiction and, as such, is not evidence". The Board conducts a de novo review of the Director's decision.) More recently, however, on March 14, 2019, the Veterans Court (CAVC) also issued Ray v. Wilkie, 31 Vet. App. 58 (2019) which, in part, addressed the effect of the Board's referral of a case for extraschedular consideration when the Board later reviews the Director's decision not to award an extraschedular disability rating. The Court held that the Board's determination to refer a case for extraschedular consideration is a factual finding that does not bind the Board or require the Board to award an extraschedular rating; however, if the Board denies the claim after referral, the Board "must provide adequate reasons or bases for deviating from its earlier referral decision." Even more recently, on May 28, 2020, the CAVC issued Smiddy v. Wilkie, 32 Vet. App. 350 (2020). In Smiddy, the Court extended its holding in Ray regarding the initial decision of whether to refer the issue of an extraschedular TDIU under 38 C.F.R. § 4.16 (b) to the Director of Compensation Services to the initial decision of whether to refer the issue of an extraschedular rating decision under 38 C.F.R. § 3.321 (b)(1) to the Director. In other words, when the Board denies entitlement to an extraschedular rating under 38 C.F.R. § 3.321 (b), it must provide adequate reasons and bases for any factual determination that deviates from its earlier decision to remand the claim for referral to the Director of Compensation Service. Here, the Board made factual findings in its February 2020 remand that the Veteran's 40 percent rating for his cervical spine strain may not contemplate the impairment in earning capacity related to the inability to turn his neck. Furthermore, the impact on his employment may be marked, based on his statements that he worked as a telephone lineman but was unable to work or lift some objects. Consideration of an extraschedular rating, after a determination by the Director in the first instance, requires consideration of whether the schedular rating criteria adequately contemplate the Veteran's disability picture. If the schedular evaluation is not found to contemplate the level of disability and symptomatology shown and is found inadequate, then the second inquiry is whether the exceptional disability picture exhibits other related factors, such as marked interference with employment or frequent periods of hospitalization. See Thun v. Peake, 22 Vet. App. 111 (2008). The first Thun element compares a claimant's symptoms to the rating criteria, while the second addresses the resulting effects of those symptoms. Thus, the first and second Thun elements, although interrelated, involve separate and distinct analyses. Yancy v. McDonald, 27 Vet. App. 484, 495 (2016). Concerning the first element, comparison of the Veteran's symptoms and associated functional impairment does not show that the rating criteria were inadequate to describe his disability picture prior to May 11, 2011. The record shows that he had complaints and findings of pain, stiffness, and limitation of motion. Specifically, the Veteran complained of an inability to turn his neck during flare-ups at his September 2009 VA examination. Although Diagnostic Code 5237 does not specifically list his symptoms other than limitation of motion, ratings under the General Formula for Diseases and Injuries of the spine are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. In other words, the rating criteria considers the symptoms of which the Veteran has complained. Additionally, for all musculoskeletal disabilities, the Rating Schedule contemplates functional loss, which may be manifested by, for example, decreased or abnormal excursion, strength, speed, coordination, or endurance. 38 C.F.R. § 4.40; see also Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). For disabilities of the joints, particularly, the Rating Schedule specifically contemplates factors such as weakened movement, premature or excess fatigability, pain on movement, disturbance of the Veteran's locomotion, and interference with sitting, standing, and weight-bearing. 38 C.F.R. §§ 4.45, 4.59; Mitchell, 25 Vet. App. at 37. See also DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). The Veteran also submitted a statement in March 2020 and complained of excruciating headaches that would not go away and nerve pain prior to 2011. The Board notes that the Veteran is currently service connected for migraine headaches, effective April 27, 2009. He is also service connected for right upper extremity radiculopathy, effective February 16, 2021. While the Veteran complained of nerve pain, the medical evidence reflects that there were no neurological diagnoses made prior to May 11, 2011. Specifically, the September 2009 VA examination found that the cranial nerves were grossly intact, and the sensory examination was normal in all four extremities. The Board has considered the statements made by the Veteran relating his nerve pain to his service-connected cervical strain. However, lay evidence can be considered competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007)). In this case, however, the Veteran is not competent to provide testimony regarding a diagnosis of a nerve disorder prior to May 11, 2011. Because these types of disorders are not diagnosed by unique and readily identifiable features, they do not involve a simple identification that a layperson is considered competent to make. The most probative medical evidence of record reflects that the Veteran did not have a diagnosis of a neurological disability prior to May 11, 2011. In summary, the schedular criteria for musculoskeletal disabilities contemplate a wide variety of manifestations of functional loss. The Veteran's stated symptoms, namely, limitation of motion, pain, and stiffness, are all contemplated by the schedular rating criteria. Because the Rating Schedule was purposely designed to compensate for such functional effects of his disability in all spheres of his daily life, including at work and at home, and given the variety of ways in which the Rating Schedule contemplates functional loss for musculoskeletal disabilities, the Board concludes that the schedular rating criteria reasonably describe his disability picture and that an extraschedular rating is not warranted. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Daniels, 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.