Citation Nr: 21040145 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 06-38 454 DATE: July 2, 2021 ORDER Entitlement to a rating in excess of 10 percent for limitation of extension due to myositis ossificans of the right hip is denied. Entitlement to a compensable initial rating for limitation of flexion due to myositis ossificans of the right hip is denied. Entitlement to a 10 percent initial rating for limitation of adduction due to myositis ossificans of the right hip is granted. Entitlement to an initial rating in excess of 10 percent for limitation of abduction, adduction, or rotation due to myositis ossificans of the right hip is denied. Entitlement to a rating in excess of 10 percent for degenerative joint disease of the right knee and arthroscopic residuals prior to December 9, 2020, is denied. Entitlement to a rating in excess of 20 percent for degenerative joint disease of the right knee and arthroscopic residuals for the period beginning December 9, 2020, is denied. Entitlement to a rating in excess of 10 percent for chronic tendonitis of the left Achilles prior to December 9, 2020, is denied. Entitlement to a rating in excess of 10 percent for chronic tendonitis of the right Achilles prior to December 9, 2020, is denied. Entitlement to a 20 percent rating for chronic tendonitis of the left Achilles for the period beginning December 9, 2020, is granted. Entitlement to 20 percent rating for chronic tendonitis of the right Achilles for the period beginning December 9, 2020, is granted. Entitlement to a rating in excess of 20 percent rating for chronic tendonitis of the left Achilles for the period beginning December 9, 2020, is denied. Entitlement to a rating in excess of 20 percent crating for chronic tendonitis of the right Achilles for the period beginning December 9, 2020, is denied. Entitlement to a compensable rating for left fourth (ring) metacarpal fracture residuals with open reduction and internal fixation is denied. REMANDED The claim for a total disability rating for compensation based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The 10 percent rating currently assigned for limitation of extension due to myositis ossificans of the right hip is the highest assignable rating for such limitation of extension of the thigh under the VA Schedule for Rating Disabilities, 38 C.F.R. Part 4 (Ratings Schedule). 2. Flexion of the right hip is not limited to 45 degrees. 3. The positive and negative clinical evidence as to whether there is a loss of adduction in the right hip such that it is not possible for the Veteran to cross his legs is in relative balance. 4. Abduction in the right thigh is not lost beyond 10 degrees. 5. Prior to December 9, 2020, motion in the right knee was not limited to 30 degrees of flexion or 15 degrees of extension; recurrent subluxation or lateral instability is not shown prior to December 9, 2020. 6. For the period beginning December 9, 2020, recurrent subluxation or lateral instability is not shown in the right knee and motion in the right knee is not limited to 15 degrees of flexion or 20 degrees of extension. 7. Marked limitation of motion in each ankle is shown from December 9, 2020, but no earlier. 8. The highest assignable rating for limitation of ankle motion under the Ratings Schedule is 20 percent and there are no other manifestations associated with the service-connected tendonitis of the left or right Achilles which would warrant increased compensation under the Ratings Schedule. 9. In the absence of the involvement of any other fingers, the service-connected left fourth metacarpal fracture residuals with open reduction and internal fixation do not warrant a compensable rating under the Ratings Schedule. CONCLUSIONS OF LAW 1. The criteria for rating in excess of 10 percent for limitation of extension due to myositis ossificans of the right hip are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.7, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5003, 5251 (2020). 2. The criteria for a compensable rating for limitation of flexion due to myositis ossificans of the right hip are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.7, 4.27, 4.40, 4.45, 4.59, 4.71a, DCs 5003, 5252 (2020). 3. Resolving all reasonable doubt in favor of the Veteran, the criteria for an initial 10 percent rating for limitation of adduction due to myositis ossificans are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.7, 4.27, 4.40, 4.45, 4.59, 4.71a, DCs 5003, 5253 (2020). 4. The criteria for an initial rating in excess of 10 percent rating for limitation of abduction, adduction, or rotation due to myositis ossificans are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.7, 4.27, 4.40, 4.45, 4.59, 4.71a, DCs 5003, 5253 (2020). 5. The criteria for a rating in excess of 10 percent for degenerative joint disease of the right knee and arthroscopic residuals prior to December 9, 2020, are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107, 5110(a) (2012); 38 C.F.R. §§ 3.400, 4.7, 4.27, 4.40, 4.45, 4.59, 4.71a, DCs 5260, 5261, 5257 (2020). 6. The criteria for a rating in excess of 20 percent for degenerative joint disease of the right knee and arthroscopic residuals for the period beginning December 9, 2020, are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.7, 4.27, 4.40, 4.45, 4.59, 4.71a, DCs 5260, 5261 (2020), DC 5257 (to include under revisions effective from February 7, 2021, and the criteria in effect prior to that time). 7. The criteria for a rating in excess of 10 percent for chronic tendonitis of the left or right Achilles prior to December 9, 2020, are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107, 5110(a) (2012); 38 C.F.R. §§ 3.400, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5271 (2020). 8. The criteria for a 20 percent for chronic tendonitis of the left and right Achilles are met from December 9, 2020. 38 U.S.C. §§ 1155, 5103, 5103A, 5107, 5110(a) (2012); 38 C.F.R. §§ 3.400, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5271 (to include under revisions effective from February 7, 2021, and the criteria in effect prior to that time). 9. The criteria for a rating in excess of 20 percent for chronic tendonitis of the left or right Achilles for the period beginning December 9, 2020, are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5271 (to include under revisions effective from February 7, 2021, and the criteria in effect prior to that time). 10. The criteria for a compensable rating for a left fourth metacarpal fracture residuals with open reduction and internal fixation are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.7, 4.20, 4.40, 4.45, 4.59, 4.71a, DC 5227 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1974 to March1994. I. Procedural History In July 2017, the Board of Veterans' Appeals (Board) denied service connection for a right shoulder disability; increased ratings for service-connected right hip, right knee, right Achilles tendon, left Achilles tendon, and left fourth metacarpal disabilities; and entitlement to TDIU. These denials were all based on the Veteran's failure to report to VA examinations to address these claims under the provisions of 38 C.F.R. § 3.655 (2020). The Veteran subsequently appealed this decision to the United States Court of Appeals for Veterans Claims (Court). In September 2018, the Court granted the Parties' August 2018 Joint Motion to Remand (JMR); vacated the July 2017 Board decision; and remanded the Veteran's appeal to the Board for additional action in compliance with the JMR. The JMR found that as the record did not adequately document that the Veteran had been informed of the time and place of the examinations in question, the denial of the Veteran's claims pursuant to the provisions of 38 C.F.R. § 3.655 in the July 2017 Board decision was not appropriate. As such, the Board issued a remand in March 2019 directing that the Veteran again be scheduled for examinations to address the claims on appeal. Pursuant to this development, a March 2021 rating decision granted service connection for right shoulder strain; as such, the claim for service connection for a right shoulder disability is no longer in appellate status. This rating decision also granted service connection for the additional right hip disabilities of limitation of flexion due to myositis ossificans of the right hip under DC 5252 and "impairment" of the right hip under DC 5253 (which provides ratings for hip impairment on the basis of limitation of limitation of abduction, adduction, or rotation of the hip). As the undersigned finds the propriety of the initial ratings for these additional disabilities to be inextricably intertwined with the claim for an increased rating for limitation of extension due to myositis ossificans of the right hip previously on appeal, these claims have been added to the appeal for review by the Board. II. Legal Criteria/Analysis A. General Legal Criteria When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court of Appeals for Veterans Claims (Court) held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail. The Court has also stated, "It is clear that to deny a claim on its merits, the evidence must preponderate against the claim." Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert. Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. While the Veteran's entire history is reviewed when assigning a disability evaluation, where service connection has already been established and 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 (1994). However, the Court has since held that in determining the present level of a disability for any increased evaluation claim, the Board must consider the application of staged ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In other words, where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings would be necessary. 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The Court has instructed that in applying these regulations VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § 4.59 (2006). In Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court) held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 38 C.F.R. § 4.40. Degenerative arthritis established by X-ray findings is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a, DC 5003. DC 5003 provides that when limitation of motion due to arthritis is noncompensable under the appropriate diagnostic code, 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. Traumatic arthritis is rated as for degenerative arthritis. DC 5010. The effective date of an increased rating will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. B. Right Hip 1. Rating Criteria Full motion of the hip is to 125 degrees of flexion, 0 degrees of extension, and 45 degrees of abduction. 38 C.F.R. § 4.71, Plate II. A 10 percent rating is warranted when extension of the thigh is limited to 5 degrees. C.F.R. § 4.71a, DC 5251. This is the only rating provided for limitation of thigh extension under DC 5251. Flexion of the hip limited to 45 degrees warrants a 10 percent disability rating and flexion of the hip limited to 30 degrees warrants a 20 percent disability rating. 38 C.F.R. § 4.71a, DC 5252. A 30 percent rating is warranted for flexion of the hip limited to 20 degrees. Id. Thigh impairment manifested by the loss of adduction such that the it is not possible to cross one's legs or limitation of rotation such that one cannot toe-out more than 15 degrees warrants a 10 percent rating. 38 C.F.R. § 4.71a , DC 5253. A 20 percent under DC 5253 requires there to be the loss of abduction of the hip beyond 10 degrees. 2. Application of the Rating Criteria A December 2019 Hip and Thigh Conditions Disability Benefits Questionnaire (DBQ) revealed the following right hip motion: 90 degrees of flexion, 15 degrees of extension, 23 degrees of abduction, 21 degrees of adduction, 50 degrees of external rotation, and 20 degrees of internal rotation. Adduction was limited such that the Veteran could not cross his legs. Pain was noted on all motion and loss of motion was said to contribute to functional loss to the extent that the Veteran was unable to stoop down. Repetitive motion resulted in no additional loss of motion in the right hip. Pain, weakness, fatigability, or incoordination were said to significantly limit functional ability with repeated use over a period of time and pain, fatigue, weakness, and lack of endurance were said to cause functional loss. There was no ankylosis in the right hip and no malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. The Veteran denied having flare-ups. Right hip disability was said to impact the Veteran's ability to perform occupational tasks to the extent it prevented him from being able to walk, stand, stoop, or sit for periods of time. As for the findings required by Correia v. McDonald, 28 Vet. App. 158 (2016), the December 2019 DBQ noted that there was objective evidence of pain on passive motion and weight bearing and non-weight bearing of the right hip. The Veteran was also afforded a VA DBQ of the right hip in December 2020. This examination revealed the following right hip motion: 75 degrees of flexion, 20 degrees of extension, 30 degrees of abduction, 20 degrees of adduction, 35 degrees of external rotation, and 25 degrees of internal rotation. Adduction was said to not be limited such that the Veteran could not cross his legs. Pain was noted on all ranges of motion. Repetitive motion resulted in additional loss of motion as follows: 70 degrees of flexion, 15 degrees of extension, 25 degrees of abduction, 15 degrees of adduction, 30 degrees of external rotation, and 20 degrees of internal rotation. Pain, weakness, fatigability, or incoordination were said to significantly limit functional ability with repeated use over a period of time and pain and lack of endurance were said to cause functional loss measured as additional loss of motion as follows; 60 degrees of flexion, 10 degrees of extension, 20 degrees of abduction, and 30 degrees of adduction. There was no ankylosis in the right hip and no malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. Concerning the findings with respect to flare-ups required by Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Veteran reported flare-ups of in the right hip in his own words on the December 2020 DBQ that occur daily to a moderate to severe degree that last most of the day. He said the flare-ups are precipitated by prolonged sitting, walking, and bending and that they were relieved by medication. The examination was said to be medically consistent with the Veteran's statements describing functional loss during flare-ups. Right hip disability was said to impact the Veteran's ability to perform occupational tasks to the extent there is right hip pain, stiffness, and limited range of motion and that the Veteran would have difficulty with heavy lifting over 10 pounds, prolonged standing, walking/jogging over a quarter mile, or climbing stairs more than 2 flights. The examiner stated that Veteran was unable to maintain employment that required the above mentioned functions. As for the findings required by Correia, the December 2020 DBQ again noted that there was objective evidence of pain on passive motion and weight bearing and non-weight bearing of the right hip. VA outpatient treatment records of record, dated at the time of this writing through April 2021, do not reveal clinical findings associated with the right hip that differ in significant degree from those obtained at the VA examinations as set forth above as pertinent to the applicable criteria under the Ratings Schedule. Appling the pertinent rating criteria to the facts set forth above, as the only assignable rating for loss of hip extension under DC 5251 is 10 percent, no compensation in addition to the 10 percent rating currently assigned for loss of extension due to myositis ossificans of the right hip may be assigned under the Ratings Schedule. With respect to a compensable rating on the basis of limitation of flexion of the thigh hip under DC 5252, such would require flexion to be limited to 45 degrees. Flexion in the right hip was measured to well beyond 45 degrees at the VA examinations set forth above, to include after repetitive use and with consideration of pain and lack of endurance. As there is otherwise no clinical evidence indicating that flexion in the right hip is limited to 45 degrees, a compensable initial rating for loss of flexion due to myositis ossificans of the right hip may not be assigned. 38 C.F.R. § 4.71a, DC 5252. As set forth above, the December 2019 DBQ noted that adduction was limited in the right hip such that the Veteran could not cross his legs. While such was not found to be the case with range of adduction testing on the December 2020 DBQ, given the conflict in the evidence as to this matter, the Board will resolve all reasonable doubt in the Veteran's favor and conclude that that adduction is limited in the right hip such that the Veteran cannot not cross his legs, thus warranting a 10 percent initial rating for loss of functioning due to myositis ossificans of the right hip under DC 5253. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert. As for a rating in excess of 10 percent under DC 5253, such would require there to be the loss of abduction of the hip beyond 10 degrees. Abduction in the right hip was measured to well beyond 10 degrees at the VA examinations set forth above, to include after repetitive use and with consideration of pain and lack of endurance. As there is otherwise no clinical evidence indicating that there is the loss of abduction of the right hip beyond 10 degrees, an initial rating for loss of functioning due to myositis ossificans of the right hip in excess of 10 percent may not be assigned under 38 C.F.R. § 4.71a, DC 5253. C. Degenerative Joint disease of the Right Knee 1. Rating Criteria Prior to revisions which became effective February 7, 2021, slight recurrent subluxation or lateral instability of a knee warranted a 10 percent rating under DC 5257. A 20 percent rating required moderate recurrent subluxation or lateral instability, and a 30 percent rating was warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, DC 5257 (as in effect prior to February 7, 2021). The revisions to DC 5257 effective from February 7, 2021, provide for a 20 percent rating for a sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s),crutch(es), walker) for ambulation; and unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), or a walker) or bracing for ambulation; or if there is a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker. 85 FR 76464, Nov. 30, 2020. A 30 percent rating is warranted under the revision to DC 5257 for an unrepaired or failed repair of a complete ligament tear that causes persistent instability and requires a medical provider prescription of both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. Id. These revisions to DC 5257 also provide for a 30 percent rating for patellar instability resulting in a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Id. Note (1) under the revisions to DC 5257 states that with respect to patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Id. Note (2) under these revisions provides that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as "surgical repair" for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). Id. Under DC 5260, a 10 percent is warranted where flexion is limited to 45 degrees. A rating of 20 percent is warranted where flexion is limited to 30 degrees and a rating of 30 percent is warranted were flexion is limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. The maximum assignable rating for limitation of knee flexion under DC 5260 is 30 percent. Id. Under DC 5261, a 10 percent rating is warranted where extension is limited to 10 degrees and a 20 percent rating is warranted where extension is limited to 15 degrees. A rating of 30 percent is warranted where extension is limited to 20 degrees while a 40 percent rating is warranted where extension is limited to 30 degrees. 38 C.F.R. § 4.71a, DC 5261. A 50 percent is warranted where extension is limited to 45 degrees. Id. A 30 percent is warranted for moderate recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, DC 5257. VA's General Counsel has held that a claimant who has arthritis and instability of the knee may be rated separately under DCs 5003/5010 and 5257, respectively. VAOPGCPREC 23-97; 62 Fed. Reg. 63,604 (1997). In VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998), VA's General Counsel further explained that, to warrant a separate rating, the limitation of motion need not be compensable under DC 5260 or 5261; rather, such limited motion must at least meet the criteria for a zero (0) percent rating. The VA General Counsel has also held that separate ratings under 38 C.F.R. § 4.71a, DCs 5260 and 5261 may be assigned for limitation of flexion and extension of the same joint. See VAOPGCPREC 9-2004; 69 Fed. Reg. 59,990 (2004). 2. Application of the Rating Criteria A December 2019 Knee and Lower Leg Conditions DBQ recorded range of motion in the right knee from 80 degrees of flexion to 5 degrees of extension. Pain was noted on flexion and extension and loss of motion was said to contribute to functional loss to the extent that the Veteran was unable stoop down. Repetitive motion resulted in no additional loss of motion in the right knee. Pain, weakness, fatigability, and incoordination were said to significantly limit functional ability with repeated use over a period of time and pain, fatigue, weakness, and lack of endurance were said to cause functional loss. There was no ankylosis in the right knee and it was noted that there was no history of recurrent subluxation or lateral instability in the right knee. Joint stability testing conducted upon the examination was normal. The right knee hip disability was said to impact the Veteran's ability to perform occupational tasks to the extent it prevented him from being able to walk, stand, stoop, or sit for periods of time. As for the findings required by Correia, the December 2019 DBQ noted that there was objective evidence of pain on passive motion and weight bearing and non-weight bearing of the right knee. The Veteran was also afforded a VA DBQ of the right knee in December 2020 and this examination revealed 60 degrees of flexion and full extension in the right knee. Pain was noted on flexion and extension all ranges of motion. Repetitive motion resulted in the additional loss of flexion to 50 degrees. Pain and lack of endurance were said to cause functional loss after repetitive motion. The Veteran reported flare-ups of in the right knee in his own words that occur daily to a severe degree that last all day. Such flare-ups were said to result in an additional loss of flexion to 30 degrees; to be precipitated by standing and walking; and to be relieved by the Veteran going to bed. The examination was said to be medically consistent with the Veteran's statements describing functional loss during flare-ups. There was again no ankylosis noted in the right knee and it was also noted again that there was no history of recurrent subluxation or lateral instability in the right knee. Joint stability testing conducted upon the examination was again normal. The right knee disability was said to impact the Veteran's ability to perform occupational tasks to the extent there is right knee pain, stiffness, and limited range of motion and that the Veteran would have difficulty with heavy, prolonged standing, walking over 2 miles, or climbing even 1 flight of stairs. The examiner stated that Veteran was unable to maintain employment that required the above mentioned functions. As for the findings required by Correia, the December 2020 DBQ again noted that there was objective evidence of pain on passive motion and non-weight bearing of the right knee. The previously referenced VA outpatient treatment records of record also do not reveal clinical findings associated with the right knee that differ in significant degree from those obtained on the VA examinations as set forth above as pertinent to the applicable criteria under the Ratings Schedule. Based on the findings from the December 2020 DBQ, the aforementioned March 2021 rating decision increased the rating for the service connected degenerative joint disease of the right knee and arthroscopic residuals from 10 to 20 percent under DCs 5003-5260 effective from December 9, 2020, the day the December 2020 DBQ was conducted (Hyphenated Diagnostic Code numbers reflect the assignment of a rating under the first diagnostic Code number using the criteria of the second Diagnostic Code. See 38 C.F.R. § 4.27 (2020)). This increase was based on the fact that flexion was limited to 30 degrees with flare-ups as set forth on the December 2020 DBQ. As such, the matters for consideration are whether a rating in excess 10 percent for the service connected right knee disability may be assigned prior to December 9, 2020, and whether a rating in excess of 20 percent for this disability may be assigned for the period beginning December 9, 2020. AB v. Brown, 6 Vet. App. 35 (1993). A rating in excess of 10 percent for the service connected right knee disability prior to December 9, 2020, would require evidence prior to that date during the appeal period that there was moderate recurrent subluxation or lateral instability in the right knee, flexion in the right knee was limited to 30 degrees, or extension in the right knee was limited to 15 degrees so as to warrant increased compensation under DCs 5257, 5360, or 5261, respectively. No history of instability in the right knee was reported on the December 2019 DBQ and the physical examination revealed no instability. The range of motion findings in the right knee on the December 2019 DBQ were recorded at 80 degrees of flexion and 5 degrees of extension. There is otherwise no evidence dated prior to December 9, 2020, indicating that increased compensation for the service connected right knee disability would be warranted under DCs 5257, 5360, or 5261 or any other diagnostic code pertaining to the rating of knee disabilities codified at 38 C.F.R. § 4.71a, DCs 5256-5263. As such, a rating in excess of 10 percent for this disability prior to December 9, 2020, cannot be assigned. 38 U.S.C. § 5110(a); 38 C.F.R. §§ 3.400, 4.71a, DCs 5256-5263. As for a rating in excess of 20 percent for the service connected right knee disability for the period beginning December 9, 2020, on the basis of limitation of motion, such would require limitation of flexion to 15 degrees or limitation of extension to 20 degrees to warrant a 30 percent under DCs 5260 or 5261, respectively. Right knee flexion on the December 2020 DBQ was measured to 30 degrees at worst during flare-ups and there was full extension. There is otherwise no clinical evidence for the period beginning December 9, 2020, of the range of motions required for ratings in excess of 10 percent under DCs 5260, 5261. As for increased compensation for recurrent subluxation in either knee for the period beginning December 9, 2020, under the criteria codified at DC 5257 in effect prior to the recent regulatory revisions, severe recurrent subluxation or lateral instability would be required for an increased rating of 30 percent. The December 2020 DBQ reflected no history or recurrent subluxation or lateral instability in the right knee and normal right knee joint stability upon testing. There is otherwise no clinical evidence dated on or after December 9, 2020, of any, much less severe, recurrent subluxation or lateral instability in the right knee. With respect to a rating in excess of 20 percent under the revisions to DC 5257 effective from February 7, 2021, such would, at a minimum, require a disability manifested as recurrent subluxation or lateral instability that resulted in an unrepaired or failed repair of a complete ligament tear or patellar instability manifested as a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair. Such manifestations are not shown on the reports from the December 2020 DBQ or any other clinical evidence, nor is it claimed that such manifestations have occurred. In short therefore, a rating in excess of 20 percent for recurrent subluxation in the right kneeor a separate rating on such a basiscannot be assigned. 38 C.F.R. § 4.71a, DC 5257 (as in effect prior to and from February 7, 2021). D. Tendonitis of the Left and Right Achilles 1. Rating Criteria Full motion in the ankle is from 20 degrees of ankle dorsiflexion and 45 degrees of plantar flexion. 38 C.F.R. § 4.71, Plate II. Moderate limitation of ankle motion warrants a 10 percent rating and marked limitation of ankle motion warrants a 20 percent rating. 38 C.F.R. § 4.71a, DC 5271. The highest rating assignable for loss of ankle motion under DC 5271 is 20 percent. Regulatory revisions effective from February 7, 2021, specify that marked limitation of ankle motion is less than 5 degrees of dorsiflexion or less than 10 degrees of plantar flexion. 2. Application of the Rating Criteria A December 2019 Ankle Conditions DBQ recorded motion to 10 degrees of dorsiflexion in each ankle and 15 degrees of plantar flexion in the right ankle and 20 degrees of plantar flexion in the right ankle. There was pain with such motion in each ankle and the loss of motion was said to contribute to functional loss to the extent that the Veteran was unable to stoop down. Repetitive motion resulted in no additional loss of motion. The Veteran denied having flare-ups and there was no ankylosis in either ankle. The bilateral ankle disability was said to impact the Veteran's ability to perform occupational tasks to the extent that due to stiffness and pain, he would have difficulty with prolonged walking over a quarter mile or climbing more than 2 flights of stairs. As for the findings required by Correia, the December 2019 DBQ noted that there was objective evidence of pain on passive motion and weight bearing and non-eight bearing of each ankle. The Veteran was also afforded a VA DBQ of the ankles in December 2020 that revealed motion in each ankle to 10 degrees of dorsiflexion and 30 degrees of plantar flexion. There was pain on such motion in each ankle. Repetitive motion resulted in the additional loss of motion in each ankle measured to 5 degrees of dorsiflexion and 20 degrees of plantar flexion. Pain and lack of endurance were said to cause functional loss with repetitive motion. Repeated use over time was said to result in the additional loss of motion in each ankle measured to 5 degrees of dorsiflexion and 20 degrees of plantar flexion. The Veteran in his own words described flare-ups in each ankle that occur daily, are mild, last for hours, are precipitated by prolonged standing and/or walking, and are relieved by rest. Flare-ups were said to result in the additional loss of motion in each ankle to 5 degrees of dorsiflexion and 15 degrees of plantar flexion. The examination was said to be medically consistent with the Veteran's statements describing functional loss during flare-ups. No ankylosis was shown in either ankle. The bilateral ankle disability was again said to impact the Veteran's ability to perform occupational tasks to the extent that due to stiffness and pain, he would have difficulty with prolonged walking over a quarter mile or climbing more than 2 flights of stairs. The examiner stated that Veteran was unable to maintain employment that required the above-mentioned functions. As for the findings required by Correia, the December 2020 DBQ again noted that there was objective evidence of pain on passive motion and weight bearing and non-weight bearing of each ankle. The previously referenced VA outpatient treatment records of record also do not reveal clinical findings associated with either ankle that differ in significant degree from those obtained at the VA examinations as set forth above as pertinent to the applicable criteria under the Ratings Schedule. Applying the pertinent legal criteria to the evidence set forth above, given the significant loss of dorsiflexion to 5 degrees noted in each ankle with repetitive motion, prolonged motion, and flare-ups shown on the December 2020 DBQ, the Board finds that such represents "marked" limitation of motion so as to warrant a 20 percent rating for tendonitis of the left and right achilles effective from the date of the December 2020 DBQ, December 9, 2020. 38 U.S.C.§ 5110(a); 38 C.F.R. §§ 3.400, 4.71a, DC 5271. The Board makes this determination mindful of the regulatory revisions made effective from February 7, 2021, that specifically define "less than" 5 degrees of dorsiflexion as representing marked limitation of motion and finds that the loss of dorsiflexion noted above obtained in December 2020 to, at a minimum, so approximate what may reasonably described as "marked" limitation of ankle motion under the criteria set forth in DC 5271 in effect prior to and after the regulatory changes so as to warrant a 20 percent rating. All reasonable doubt in this regard has been resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert. As for a rating in excess 10 percent for tendonitis of the left and right achilles prior to December 9, 2020, the range of motion demonstrated at the December 2019 DBQ of 10 degrees of dorsiflexion in each ankle and 15 degrees of plantar flexion in ankle cannot reasonably described as "marked," and the additional loss of motion with repetitive motion, prolonged motion, and flare-ups shown on the December 2020 DBQ was not shown on the December 2019 DBQ or any other clinical evidence of record dated during the appeal period prior to December 9, 2020. The record during such period does not otherwise reflect "marked" limitation of motion in ether ankle so as to warrant a rating in excess of 10 percent under DC 5271. The clinical record during the appeal period and prior to December 9, 2020, also does not reflect findings that would warrant a rating in excess of 10 percent under any other potentially applicable diagnostic code pertaining to the rating of ankle disabilities codified at 38 C.F.R. § 4.71a, DCs 5270-5274. As such, a rating in excess of 10 percent for tendonitis of the left or right achilles may not be assigned prior to December 9, 2020. Id; 38 U.S.C.§ 5110(a); 38 C.F.R. §§ 3.400. With respect whether ratings in excess of 20 percent may be assigned for tendonitis of the left or right achilles for the period beginning December 9, 2020, as set forth above, the highest assignable rating for limitation of motion of the ankle under DC 5271 is 20 percent. As such, increased compensation on the basis of limitation of motion in either ankle may not be assigned. As the evidence for the period beginning December 9, 2020, also does reflect findings that would warrant a rating in excess of 20 percent under any other potentially applicable diagnostic code pertaining to the rating of ankle disabilities codified at 38 C.F.R. § 4.71a, DCs 5270-5274, ratings in excess of 20 percent may not be assigned for tendonitis of the left or right achilles for the period beginning December 9, 2020. Id. E. Left Fourth (Ring) Metacarpal Fracture 1. Rating Criteria 38 C.F.R. § 4.7a, DC 5227 provides for a noncompensable rating for unfavorable or favorable ankylosis of the ring or little finger. This is the only assignable rating for unfavorable or favorable ankylosis of the ring or little finger under DC 5227. In rating a disability that is not listed in the Ratings Schedule, it is permissible to rate that disability under a closely related disease or injury in which not only the functions affected, but the anatomical location and symptomatology are closely analogous. 38 C.F.R. § 4.20. When choosing which diagnostic code to apply to an unlisted condition, codes for similar disorders or that provide general descriptions that encompass many ailments should be considered. Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). In deciding which diagnostic code is "closely related" to the unlisted condition, the following three factors may be taken into consideration: (1) whether the functions affected by the condition are analogous; (2) whether the anatomical location of the condition is analogous; and (3) whether the symptomatology of the condition is analogous. Lendenmann v. Principi, 3 Vet. App. 345, 350-51 (1992). 2. Application of the Rating Criteria Service connection is in effect for left ring finger metacarpal fracture residuals with open reduction and internal fixation. A noncompensable rating has been assigned for the disability by analogy to DC 5227. Given the functions (holding and grasping objects, etc.) affected by this condition, location of this condition on the ring finger, and symptomatology associated with this condition (pain, stiffness, restricted motion, etc.), the Board finds the selection of DC 5227 to rate the finger disabitly at issue to be appropriate. Lendenmann, supra. As set forth above, DC 5227 only provides a noncompensable rating for disabitly due to ankylosis of the ring finger. A compensable rating for disability of the fingers under 38 C.F.R. § 4.7a, DCs 5216-5230 would require involvement of digits in addition to the ring finger. Review of the clinical evidence of record, to include Hand and Finger Condition DBQs dated in December 2019 and December 2020 and the VA outpatient treatment reports, do not reflect that the service-connected left finger disability involves any other digit of the left hand. As such, a compensable rating for left ring finger metacarpal fracture residuals with open reduction and internal fixation cannot be assigned. 38 C.F.R. § 4.7a, DCs 5216-5230. F. Final Considerations In making the rating determinations above, the Board has considered the provisions of Correia and Sharpand reported clinical findings as required by these decisionsbut finds that no additional compensation for the disabilities in question other than that to which entitlement has been to have been warranted in the analysis above is warranted with consideration of the holdings in Correia or Sharp. Also considered in making the rating determinations above were the effects of pain in assigning a disability rating, as well as the provisions of 38 C.F.R. §§ 4.40; 4.45 and the holdings in DeLuca and Mitchell, and the VA examination reports discussed above document consideration of these principles, to include repetitive motion and flare-ups. In particular, increased compensation for the service-connected chronic tendonitis of the left and right Achilles was found to be warranted on the basis of loss of motion with repetitive use. The evidence otherwise preponderates against a conclusion that any further increased compensation would be warranted for the service connected disabilities at issue with consideration of the effects of pain in assigning a disability rating, as well as the provisions of 38 C.F.R. §§ 4.40, 4.45 and the holdings in DeLuca and Mitchell. Also in making the above rating determinations, the undersigned observes that she has carefully considered the Veteran's contentions with respect to the nature of the service-connected disabilities at issue and notes that his lay testimony is competent to describe certain symptoms associated with these manifestations. However, the competent medical evidence offering detailed specific findings pertinent to the rating criteria is the most probative evidence with regard to evaluating the pertinent symptoms of the service-connected manifestations at issue. As such, while the undersigned accepts the Veteran's testimony with regard to the matters he is competent to address, she places more probative weight upon the competent medical evidence with regard to the specialized evaluation of functional impairment; namely, the assessments of the severity of disability due to the service connected disabilities addressed above. Finally, in making the negative rating determinations above, the undersigned has considered the doctrine of reasonable doubt but finds that the preponderance of the evidence is against the assignment of any additional compensation for the disabilities at issue other than that to which entitlement has been to have been warranted in the analysis above. As such, increased ratings for these disabilitiesaside from those to which the Veteran has been found to entitled to in the analysis abovemay not be granted. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert. REASONS FOR REMAND The schedular criteria for TDIU under 38 C.F.R. § 4.16(a) (2020) are not currently met. The authority to grant TDIU on an extraschedular basis in the first instance has been specifically delegated to the Under Secretary for Benefits and the Director of the Compensation and Pension Service (Director) and not the Board. Bowling v. Principi, 15 Vet. App. 1 (2001); 38 C.F.R. § 4.16(b). As such, and in light of the evidence of the significant impact service connected disability has on occupational functioning set forth in the discussion above, the matter of entitlement to TDIU on an extraschedular basis must be referred to the Director pursuant to 38 C.F.R. § 4.16(b). For the reasons stated above, this case is REMANDED for the following action: 1. Ask the Veteran to provide IRS tax returns for the years he asserts entitlement to TDIU and a statement that the copy is an exact duplicate of the return filed with the IRS. Provide the Veteran with an IRS Form 4506-T "Request for Transcript of Tax Return" which may also be found at https://www.irs.gov/pub/irs-pdf/f4506t.pdf so that the Veteran may request tax returns and submit them to VA. Tell the Veteran that if he does not have copies of his tax returns for the requested years, he may use the IRS form cited to above. 2. Submit to the Director the matter of entitlement to TDIU on an extraschedular basis in accordance with the provisions of 38 C.F.R. § 4.16(b). MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Andrew Ahlberg, 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.