Citation Nr: 21041281 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 16-58 416A DATE: July 8, 2021 ORDER Entitlement to a compensable rating prior to June 27, 2014, and in excess of 10 percent from June 27, 2014, for degenerative joint changes of the left knee with patellofemoral pain syndrome and chondromalacia is denied. Entitlement to an increased rating in excess of 10 percent for bilateral pes planus with plantar fasciitis and bilateral heel spurs prior to March 29, 2017, is denied. Entitlement to an increased rating of 50 percent for bilateral pes planus with plantar fasciitis and bilateral heel spurs from March 29, 2017, but no higher, is granted, subject to the regulations governing the payment of monetary awards. Entitlement to an increased rating in excess of 50 percent for bilateral pes planus with plantar fasciitis and bilateral heel spurs from December 16, 2019, is denied. Entitlement to an initial rating of 30 percent for bursitis of the right shoulder but no higher is granted, subject to the regulations governing the payment of monetary awards. FINDINGS OF FACT 1. Prior to June 27, 2014, the Veteran's degenerative joint changes of the left knee with patellofemoral pain syndrome and chondromalacia showed a normal range of motion with pain. 2. From June 27, 2014, the Veteran's degenerative joint changes of the left knee with patellofemoral pain syndrome and chondromalacia showed flexion limited to no less than 100 degrees, with additional factors including pain on movement, pain on palpation of the knees, disturbance of locomotion, pain on weight-bearing, and that the knee sometimes gives out. 3. Prior to March 29, 2017, the Veteran's bilateral pes planus with plantar fasciitis and bilateral heel spurs resulted in pain on movement and manipulation of the feet. 4. From March 29, 2017, the Veteran's bilateral pes planus with plantar fasciitis and bilateral heel spurs resulted in accentuated pain on manipulation, extreme tenderness of the plantar surfaces was not improved by orthopedic shoes or appliances, and pain on weight-bearing and non-weight-bearing. 5. From December 16, 2019, the Veteran's bilateral pes planus with plantar fasciitis and bilateral heel spurs resulted in accentuated pain on manipulation, extreme tenderness of the plantar surfaces was not improved by orthopedic shoes or appliances, and pain on weight-bearing and non-weight-bearing. 6. The Veteran's bursitis of the right shoulder manifests as limitation of motion that more nearly approximates being midway between the side and shoulder level, when considering functional impairment from pain on movement, tenderness to palpation, and reduced internal and external rotation of the arm. CONCLUSIONS OF LAW 1. The criteria for a compensable rating prior to June 27, 2014, and to a rating in excess of 10 percent from June 27, 2014, for degenerative joint changes of the left knee with patellofemoral pain syndrome and chondromalacia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5256, 5257, 5258, 5259, 5260, 5261, 5262, 5263. 2. The criteria for an increased rating of 50 percent, but no higher, from March 29, 2017, for bilateral pes planus with plantar fasciitis and bilateral heel spurs have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5269, 5276. 3. The criteria for an increased rating in excess of 10 percent prior to March 29, 2017, and in excess of 50 percent from December 16, 2019, for bilateral pes planus with plantar fasciitis and bilateral heel spurs have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5269, 5276. 4. The criteria for an initial rating of 30 percent, but no higher, for bursitis of the right shoulder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5201. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1989 to August 2009. These matters initially came before the Board of Veterans' Appeals (Board) on appeal from rating decisions by a Department of Veterans Affairs (VA) regional office (RO) dated December 2014 (which increased the evaluation of the left knee to 10 percent effective June 27, 2014 and denied an increase for the bilateral pes planus) and November 2015 (which granted service connection for bursitis of the right shoulder at a 20 percent rating). In December 2018, the Board remanded the Veteran's appeal to the RO for further evidentiary development. The Board directed the RO to obtain any outstanding treatment records and arrange examinations to determine the current severity of the Veteran's degenerative joint disease of her left knee with patellofemoral pain syndrome and chondromalacia, bilateral pes planus with plantar fascitis and bilateral heel spurs, and bursitis of her right shoulder. Because the above-referenced development has been completed, the RO substantially complied with the remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). On remand, the RO increased the Veteran's rating for bilateral pes planus with plantar fasciitis and bilateral heel spurs to 50 percent, effective December 16, 2019. The Board has characterized the issue accordingly. In a June 2020 Supplemental Statement of the Case, the RO denied higher initial ratings for degenerative joint disease of the left knee with patellofemoral pain syndrome and chondromalacia and for bursitis of the right shoulder. Disability Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, 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. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. This regulation also requires that, whenever possible, the joints involved are tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). 1. Entitlement to a compensable rating prior to June 27, 2014, and in excess of 10 percent from June 27, 2014, for degenerative joint changes of the left knee with patellofemoral pain syndrome and chondromalacia On June 27, 2014, the Veteran filed the present claim for an increased rating. The Veteran is service-connected for degenerative joint changes to the left knee with patellofemoral pain syndrome and chondromalacia under Diagnostic Code 5260 (limitation of flexion of the leg). The Veteran's left knee degenerative joint changes with patellofemoral pain syndrome and chondromalacia have been rated under the criteria of Diagnostic Code 5260 for limitation of flexion of the knee. Diagnostic Code 5260 provides a noncompensable rating for flexion limited to 60 degrees, a 10 percent rating for flexion limited to 45 degrees, a 20 percent rating for flexion limited to 30 degrees, and a maximum 30 percent rating for flexion limited to 15 degrees. See 38 C.F.R. § 4.71a, DC 5260. During the pendency of the appeal, the criteria for rating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. However, the regulatory changes did not affect Diagnostic Codes 5260 and 5261. Turning to the evidence, an April 2013 Disability Benefits Questionnaire (DBQ) for Knee Conditions diagnosed bilateral chondromalacia patella and knee osteoarthritis. The Veteran reported constant knee pain, swelling, and difficulty getting in and out of cars. Initial range of motion testing of the left knee showed full flexion and extension 0 to 140 degrees and back with no evidence of pain. There was no change after three repetitions. The left knee did not show additional factors such as weakened movement or swelling, and it had normal muscle strength in flexion and extension. Stability testing was normal and there was no history of recurrent patellar subluxation or dislocation or a meniscal condition. The Veteran reported using a knee brace regularly and a cane constantly. May 2012 imaging showed degenerative or arthritic changes in both knees. A private treatment record dated June 2014 states that the Veteran reported pain in the bilateral knees. On examination, she had mild varus, no medial lateral laxity, negative Lachman's and negative anterior drawer and negative pivot shift. Sensation was grossly normal. X-rays showed some degenerative disease and the doctor diagnosed osteoarthritis of the knees. The Veteran underwent a DBQ for Knee and Lower Leg Conditions in October 2014. The examiner diagnosed osteoarthritis of the left knee. Initial range of motion testing showed flexion from 0 to pain at 90 degrees, and extension was full to 0 degrees. There was no change of range of motion after three repetitions. The examiner noted reduced movement and pain on movement. There was pain on palpation of the knees. Muscle strength was normal on flexion and extension, instability testing was normal, and the Veteran had no patellar subluxation or dislocation. The Veteran said that she used bilateral knee braces when walking for extended periods. In the July 2015 Notice of Disagreement, the Veteran reported a worsening of the left knee. Private treatment records include an April 2016 imaging of the left knee which identified moderate degenerative arthropathy, degenerated medial meniscus without acute tear, and large joint effusion. An August 2016 DBQ for knee conditions found left knee flexion 0 to 75 degrees and extension 75 to 0 degrees. There was pain on flexion but not on weight-bearing or palpation. Additional factors included disturbance of locomotion. The left knee was normal on stability testing and the examiner found no meniscal conditions in the left knee. A December 2019 DBQ for Knee Conditions diagnosed degenerative joint disease with patellofemoral pain syndrome and chondromalacia. The Veteran reported onset in the 2000s and had worsened since then. She reported a deep aching pain worsened by long periods of walking and standing. The Veteran reported increased difficulty with stairs and said that her knee sometimes gives out. The Veteran reported daily flare ups depending on how active she is. Initial range of motion testing showed flexion 0 to 110 degrees and extension 110 to 0 degrees. There was pain on flexion but not on extension of the knee. The examiner found moderate localized tenderness in the left knee, pain on weight-bearing, and evidence of crepitus. There was no change in the range of motion after three repetitions. The Veteran's range of motion with repeated use over time and during flare ups was flexion 0 to 100 degrees, extension 100 to 0 degrees. The Veteran was limited by pain and fatigue during flare ups but there were no additional factors such as swelling or deformity. Muscle strength was normal on flexion and extension and the knee had normal stability. The Veteran reported using the knee brace regularly. The examiner noted that there was no objective evidence of pain on non-weight-bearing testing, and the passive range of motion was the same as the active range of motion. Prior to June 27, 2014 Applying the criteria for Diagnostic Code 5260, the Veteran's limitation of flexion of the left knee from June 27, 2013 to June 27, 2014, does not warrant a compensable rating. The evidence does not indicate that the Veteran's left knee was limited in flexion to 45 degrees or less during this period, and therefore a higher 10 percent rating is not warranted under the criteria for Diagnostic Code 5260. 38 C.F.R. § 4.71a. The Board must consider the disability factors listed in 38 C.F.R. § 4.40 and 4.45 in assigning a disability rating. However, the evidence did not show any of these factors during this period and, therefore, the Veteran's condition did not more nearly approximate limitation of flexion to 45 degrees or less. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). The Board has considered other potentially applicable Diagnostic Codes relating to the knee, but this disability does not warrant an evaluation under any other provisions of the rating schedule. The record does not contain evidence of ankylosis of the right knee, instability of the knee, dislocation of cartilage of the knee, limitation of extension of the knee, impairment of the tibia and fibula, or genu recurvatum. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5257, 5258, 5261, 5262, 5263. From June 27, 2014 Applying the criteria for Diagnostic Code 5260 to the evidence after June 27, 2014, the evidence does not warrant a rating in excess of the 10 percent currently assigned. The evidence does not indicate that her knee was limited in flexion to 30 degrees or less even during flare ups, and therefore a rating greater than 10 percent cannot be assigned under the criteria for Diagnostic Code 5260. 38 C.F.R. § 4.71a. Considering the additional factors of disability under 38 C.F.R. § 4.40 and 4.45, the October 2014 DBQ listed reduced movement, pain on movement, and pain on palpation of the knees. The examiner noted disturbance of locomotion in the August 2016 DBQ, and the Veteran reported pain on flexion, moderate localized tenderness, pain on weight-bearing, and that the knee sometimes gives out in the December 2019 DBQ. These factors have been considered; however, the Veteran's range of flexion was limited to no less than 100 degrees during this period, even during flare ups. Considering the large range of motion of 0 to 100 degrees, the additional factors listed herein do not show that the condition more nearly approximates limitation of flexion of only 30 degrees or less. The Board has considered other potentially applicable Diagnostic Codes relating to the knee, but this disability does not warrant an evaluation under any other provisions of the rating schedule. The record does not contain evidence of ankylosis of the right knee, instability of the knee, dislocation of cartilage of the knee, limitation of extension of the knee, impairment of the tibia and fibula, or genu recurvatum. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5257, 5258, 5261, 5262, 5263. Accordingly, the Board finds that the preponderance of the evidence is against the Veteran's claim. Consequently, the benefit-of-the-doubt rule is not applicable, and the claim for entitlement to a compensable disability rating for degenerative joint changes of the left knee with patellofemoral pain syndrome and chondromalacia prior to June 27, 2014, or to a rating in excess of 10 percent from June 27, 2014, must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 2. Entitlement to an increased rating in excess of 10 percent from June 27, 2013, and in excess of 50 percent from December 16, 2019, for bilateral pes planus with plantar fasciitis and bilateral heel spurs On June 27, 2014, the Veteran filed the claim at hand for an increased rating. On remand, the RO increased the rating to 50 percent, effective December 16, 2019. The Veteran's bilateral pes planus with plantar fasciitis and bilateral heel spurs has been evaluated under 38 C.F.R. § 4.71a, Diagnostic Code 5276, for bilateral flat foot, as the rating criteria effective prior to February 7, 2021, did not contain a specific Diagnostic Code to evaluate bilateral plantar fasciitis. The disability rating criteria for bilateral flatfoot, acquired, are as follows. A 50 percent rating is warranted in cases of pronounced disability, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the Tendo Achilles on manipulation, not improved by orthopedic shoes or appliances. A 30 percent rating is warranted for severe cases, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic calluses. A 10 percent rating is to be assigned in cases of moderate symptoms, such as the weight-bearing line over to medial the great toe, inward bowing of the Tendo Achilles, pain on manipulation and use of the feet. A noncompensable 0 percent rating is to be assigned in cases of mild symptoms which are relieved by built-up shoe or arch support. 38 C.F.R. § 4.71a, Diagnostic Code 5276. The Board has also considered other potentially applicable Diagnostic Codes. However, the evidence of record does not show that the Veteran has diagnoses of or symptoms more nearly approximating weak foot, hallux valgus, hallux rigidus, malunion or nonunion of tarsal or metatarsal bones, or other foot injuries during the appeal period. The Veteran is separately service connected for hammer toe. As such, ratings under 38 C.F.R. § 4.71a, Diagnostic Codes 5277, 5280, 5281, 5282, 5283, and 5284 will not be further considered. The rating criteria for evaluating the musculoskeletal system were revised during the Veteran's appeal, effective February 7, 2021. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76,453 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a). These revisions added Diagnostic Code 5269 for plantar fasciitis and provide a 10 percent rating for unilateral or bilateral plantar fasciitis; a 20 percent rating for unilateral plantar fasciitis where there is no relief from both non-surgical and surgical treatment; and a 30 percent rating for bilateral plantar fasciitis where there is no relief from both non-surgical and surgical treatment. A 40 percent rating is warranted where there is actual loss of use of the foot. Turning to the evidence, an April 2013 DBQ for foot conditions diagnosed plantar fasciitis, which was moderate and bilateral. Diagnostic testing showed bilateral pes planus and calcaneal spurs. The Veteran was functionally impaired with difficulty getting into and out of cars due to foot pain. An April 2013 DBQ for flatfoot/ pes planus diagnosed bilateral pes planus. Since separation from service in 2009, the Veteran reported pain and deformity in her feet. She had pain on use of the feet and her pain was accentuated on manipulation of the feet. There was swelling of the feet but no characteristic calluses. Her symptoms were not relieved by arch supports and she did not have extreme tenderness of plantar surfaces of either foot. There was decreased longitudinal arch height when weight-bearing in both feet but no marked deformity or marked pronation. The weight-bearing line did not fall over the medial to great toe. There was no inward bowing or marked inward displacement or severe spasms of the Achilles tendons. The Veteran always used custom molded orthotics in her shoes. A September 2013 VA podiatry note stated that the Veteran had pain and burning in the arches of both feet. Her muscle strength was normal and there was pain on palpation bilaterally, with great pain on palpation of the medial tubercle calcaneus, bilaterally. There was decreased range of motion of the ankles when the knees were extended. The clinician assessed plantar fasciitis, pes planus, and gastro soleal equinus. An August 2014 VA treatment record indicates that the Veteran was treated at that time for plantar fasciitis with injections to her heels. The October 2014 DBQ for foot conditions diagnosed flat foot, hammer toes, and plantar fasciitis, all bilateral. The Veteran complained of constant burning pain in her bilateral plantar surfaces. She stated that it is difficult to walk even a few steps during flare ups. There was pain on the use of both feet and pain on manipulation of the right foot there was no accentuated pain. She had no swelling or characteristic calluses. The Veteran said that she used a left arch support. There was no extreme tenderness of plantar surfaces, but she had decreased longitudinal arch height of both feet when weight-bearing. There was no marked deformity or marked pronation. There was pain on examination of both feet and the examiner said that it causes a functional loss. The Veteran also had pain on weight-bearing and non-weight-bearing. During flare ups, the Veteran reported that she has difficulty standing and walking proportional to the amount of time she is on her feet. A March 2017 VA treatment record indicated that the Veteran had heel pain which was six on a scale of ten and the VA clinician found tenderness to palpation along the medial plantar fascial band bilaterally and mild tenderness at the medial calcaneal tubercle, gastrocnemius equinus. A January 2018 VA treatment record noted that the Veteran reported aching pains in the bottoms of both feet. The Veteran underwent a DBQ for foot conditions in December 2019. The examiner diagnosed flat foot/ pes planus, plantar fasciitis, and bilateral heel spurs. The Veteran said that she was in constant pain in both feet and that she cannot walk or stand for long periods of time without frequent rest breaks. The Veteran described sharp pains in the bottoms of both feet in the arches and heels. The flat foot condition resulted in pain in both feet on use, the pain was accentuated on use, and there was pain on manipulation of the feet. There was no swelling or characteristic calluses and the Veteran was no longer using arch supports or orthotics. There was extreme tenderness of the plantar surfaces on both feet which was not improved by orthopedic shoes or appliances and there was decreased longitudinal arch height of both feet, but no marked deformity of the feet. The Veteran's weight-bearing line did not fall over the medial to great toe, and there was no inward bowing, inward displacement, or severe spasm of the Achilles tendons. The Veteran's bilateral heel spurs were of moderate severity as they did not chronically compromise the Veteran's weight-bearing or require arch supports or orthotics. The Veteran had bilateral foot pain on examination which contributes to functional loss, which was pain on movement, pain on weight-bearing and non-weight-bearing. There were no other factors of disability such as weakened movement. The Veteran reported pain on weight-bearing and movement of feet and on waking up in the morning. In terms of functional impact, the examiner stated that the Veteran is limited in running, jumping, prolonged ambulation, prolonged standing, and high-impact activities. Prior to March 29, 2017 The evidence during this period does not call for an increase in the currently assigned 10 percent rating. Applying the criteria for Diagnostic Code 5276, the evidence does not show that the Veteran's condition was severe during this period, with severe symptoms such as objective evidence of marked deformity (pronation, abduction, etc.), indication of swelling on use, or characteristic calluses. The 2013 examiner stated that the Veteran's pain was accentuated but the 2014 examiner did not. Altogether, the Veteran's disability symptoms during this period are more characteristic of the moderate symptoms described in DC 5276 and therefore do not warrant an increase above the currently-assigned 10 percent. 38 C.F.R. § 4.71A. The Veteran's symptoms during this period (pain and swelling at times) are contemplated by the rating criteria and do not call for an increase under 38 C.F.R. § 4.40 or 4.45. DeLuca v. Brown, 8 Vet. App. 202 (1995). Diagnostic Code 5269 cannot be applied for this time period because it did not become effective until February 7, 2021. 38 U.S.C. § 5110(g); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). From March 29, 2017 The Veteran was previously assigned a 50 percent rating for this disability effective December 16, 2019, the date of a VA examination for foot conditions. An effective date for an increased rating should not be assigned mechanically based on the date of a diagnosis. Rather, all of the facts should be examined to determine the date that the disability first manifested. Accordingly, the effective date for an increased ratingas well as for an initial rating or for staged ratingsis predicated on when the increase in the level of disability can be ascertained. Swain v. McDonald, 27 Vet. App. 219, 224 (2015); accord Young v. McDonald, 766 F.3d 1348 (Fed. Cir. 2014). Here, the VA treatment record of March 29, 2017, shows a worsening of the Veteran's condition. The pain of six on a scale of ten and the tenderness to palpation along the medial plantar fascial band bilaterally and mild tenderness at the medial calcaneal tubercle, gastrocnemius equinus had not been previously identified and they are likely evidence of the worsening which was detailed in the next VA examination of December 16, 2019. As this is the earliest date when the worsening can be factually ascertained, an increase to the 50 percent evaluation effective March 29, 2017, is warranted. A 50 percent rating is the maximum schedular rating under Diagnostic Code 5276. Diagnostic Code 5269 cannot be applied for this time period because it did not become effective until February 7, 2021. 38 U.S.C. § 5110(g); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). From December 16, 2019 The Veteran has already been granted the maximum schedular rating for pes planus. There is no higher schedular rating that can be assigned for pes planus by regulation. See 38 C.F.R. § 4.71a, Diagnostic Code 5276, Flatfoot, acquired. There is also no higher rating available under Diagnostic Code 5269 for plantar fasciitis. In a case such as this one where the law and not the evidence is dispositive, entitlement to a higher schedular rating is denied because there is a lack of entitlement as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). 3. Entitlement to an initial rating in excess of 20 percent for bursitis of the right shoulder The Veteran appeals the November 2015 rating decision which granted service connection for bursitis of the right shoulder at a 20 percent rating. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. 38 C.F.R. § 4.27. Here, the hyphenated diagnostic code 5019-5201 indicates that the Veteran's degenerative arthritis (DC 5003) is rated by analogy under the criteria for limitation of motion of the arm under Diagnostic Code 5201. 38 C.F.R. § 4.71a. VA examinations during the appeal period reflect that the Veteran is right hand dominant. Therefore, his right shoulder is considered her major shoulder. 38 C.F.R. § 4.69. Diagnostic Code 5201 provides that limitation of motion of the arm at the shoulder level is rated 20 percent for the major shoulder; limitation of motion of the arm midway between the side and shoulder level is rated as 30 percent for the major shoulder; and limitation of motion of the arm to 25 degrees from the side is rated as 40 percent for the major shoulder. 38 C.F.R. § 4.71(a). Diagnostic Code 5201 does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of' the arm. Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013). The rating criteria for degenerative arthritis (DC 5003) call for a 20 percent rating to be assigned in cases of X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. A rating of 10 percent is to be assigned in cases of involvement of 2 or more major joints or 2 or more minor joint groups. Note 1 indicates that the 20 and 10 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. 38 C.F.R. § 4.71a. Turning to the evidence, the Veteran underwent a DBQ for shoulder and arm conditions in November 2015. The examiner diagnosed bursitis of the right shoulder and noted that the Veteran is right-hand-dominant. The Veteran said that her right shoulder pain had become more frequent and was now limiting her range of motion. On initial range of motion testing, forward flexion was 0 to 125 degrees (of 180), abduction 0 to 90 degrees (of 180), external rotation 0 to 90 (of 90) and internal rotation 0 to 20 (of 90). The examiner concluded that the Veteran had functional loss due to restricted motion. There was distal deltoid tenderness but no crepitus. The Veteran was unwilling to perform range of motion testing after three repetitions due to severe pain, and repeated use over time was also not tested. The Veteran's muscle strength on forward flexion and abduction was normal and there was no muscle atrophy. The examiner suspected a rotator cuff condition, but tests were negative. There was no instability or dislocation or conditions involving the clavicle, scapula, AC joint, sternoclavicular joint, or humerus. A November 2015 X-ray showed findings of no acute fracture or dislocation. "No acute bony pathology is seen. Normal bone mineralization alignment. Only minimal age-appropriate degenerative changes." A December 2015 MRI showed a full-thickness tear of the supraspinatus tendon at its anterior insertion. In her December 2016 VA Form 9 Substantive Appeal, the Veteran reported the tear of the supraspinatus tendon and stated that fluid tends to painfully build up in the subacromial. In December 2019 a Compensation and Pension Examination for shoulder and arm conditions was completed. The examiner diagnosed right shoulder impingement syndrome and bursitis of the right shoulder. The Veteran reported pain in the shoulder at times, with difficulty reaching for things overhead and behind her back. She denied any popping of the shoulder. The Veteran reported flare ups a few times a week. Initial range of motion testing was flexion 0 to 130 degrees, abduction 0 to 90 degrees, external rotation 0 to 20 and internal rotation 0 to 50 degrees. She reported pain in the anterior shoulder on all movements and pain when weight-bearing. There was no crepitus. The range of motion did not change after three repetitions. With repeated use over time and during flare ups, flexion was reduced to 0 to 120 degrees, abduction 0 to 85 degrees, external rotation 0 to 10 degrees and internal rotation 0 to 40 degrees. The examiner noted no additional factors contributing to the disability. Muscle strength testing was normal on forward flexion and abduction. The examiner suspected a rotator cuff condition and a Hawkins' Impingement Test was positive. There was no instability and no conditions involving the clavicle, scapula, AC joint or sternoclavicular joint or the humerus. The examiner stated that there was no objective evidence of pain when not weight-bearing and that passive range of motion testing was the same as active. Applying the criteria of DC 5201, the Veteran's condition warrants a disability rating of 30 percent, as the Veteran is able to raise the right arm to no less than 85 degrees from her side. 38 C.F.R. § 4.71a. The right shoulder is also limited in its internal and external rotation and, in November 2015, the examiner noted tenderness of the shoulder and the Veteran was unable to complete three repetitions due to the severe pain on movement. Considering these additional factors, the Veteran's disability more nearly approximates an inability to raise the arm higher than 45 degrees from her side and an evaluation of 30 percent is therefore warranted. The condition does not more nearly approximate movement limited to 25 degrees from the side, which would warrant a 40 percent evaluation. 38 C.F.R. § 4.40, 4.45, 4.71a DC 5201. In addition, the Board has considered whether a higher rating is warranted under any other potentially applicable diagnostic code related to the shoulders. The highest rating provided under Diagnostic Code 5203 is 20 percent; therefore, rating under this Diagnostic Code would not provide her with a higher rating. Additionally, the Veteran does not have ankylosis of the scapulohumeral articulation or impairment of the humerus, as documented in the VA examination reports and treatment records. Consideration of Diagnostic Codes 5200 and 5202 is therefore not warranted. Diagnostic Code 5003 for degenerative arthritis similarly does not provide a higher rating, as the maximum rating under its criteria is 20 percent. Therefore, a 30 percent rating, but no higher, is warranted for bursitis of the right shoulder. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Dean, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.