Citation Nr: 21044997 Decision Date: 07/22/21 Archive Date: 07/22/21 DOCKET NO. 19-22 460 DATE: July 22, 2021 ORDER Service connection for prostate cancer, to include claimed as due to herbicide exposure, is denied. Service connection for hypertension, to include claimed as due to herbicide exposure, is denied. Service connection for diabetes mellitus, to include claimed as due to herbicide exposure, is denied. Service connection for restless leg syndrome, to include claimed as due to herbicide exposure, is denied. Service connection for residuals of a hemorrhagic cerebral vascular accident (CVA), claimed as a stroke, is denied. Service connection for supraventricular arrhythmia, to include claimed as due to herbicide exposure, is denied. Service connection for a coronary artery bypass graft, to include claimed as due to herbicide exposure, is denied. Secondary service connection for diplopia as due to a heart disorder is denied. Service connection for post-traumatic stress disorder (PTSD) is denied. Service connection for sleep apnea is denied. Service connection for allergic sinusitis is denied. Service connection for asthma is denied. Service connection for ear drum replacement is denied. A disability rating in excess of 10 percent for lumbar spine arthritis is denied. A disability rating in excess of 20 percent for right shoulder strain is denied. A disability rating in excess of 20 percent for left shoulder rotator cuff tear residuals is denied. FINDINGS OF FACT 1. During his lifetime, the Veteran served in Japan, Turkey, and Iran while on active duty and was not exposed to Agent Orange or herbicides. 2. Prior to his death, the Veteran was diagnosed with prostate cancer, hypertension, diabetes, restless leg syndrome (RLS), supraventricular arrhythmia, a coronary artery bypass graft, and had a CVA in 2003. 3. There was no prostate cancer, cardiovascular, endocrine, heart, lower leg neurological, or cerebral vascular injury, disease, or event during service. 4. Symptoms of prostate cancer, hypertension, diabetes, RLS, and a CVA were not chronic in service, were not continuous after service separation, and did not manifest to a compensable degree within one year of separation from service. 5. Prostate cancer, hypertension, diabetes, RLS, a CVA, supraventricular arrhythmia, and a coronary artery bypass graft did not have their onset during service and are not otherwise related to service. 6. There is no service-connected heart disorder on which secondary service connection for diplopia may be granted. 7. The Veteran did not have, nor did he have at any time proximate to or during the course of this appeal, PTSD, sleep apnea, sinusitis, asthma, and/or an ear drum replacement disorder. 8. For the rating period on appeal, the lumbar spine disability did not manifest limitation of flexion greater than 30 degrees but not greater than 60 degrees, combined range of motion to 120 degrees or less, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, or incapacitating episodes requiring physician ordered bed rest having a total duration of at least two weeks during a 12-month period. 9. For the rating period on appeal, the right and left shoulder disabilities did not more nearly approximate arm motion limited to 25 degrees from the side. CONCLUSIONS OF LAW 1. Prostate cancer was not incurred in active service and may not be presumed to have been incurred therein, including as due to herbicide exposure. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326. 2. Hypertension was not incurred in active service and may not be presumed to have been incurred therein, including as due to herbicide exposure. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326. 3. Diabetes mellitus was not incurred in active service and may not be presumed to have been incurred therein, including as due to herbicide exposure. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326. 4. RLS was not incurred in active service and may not be presumed to have been incurred therein, including as due to herbicide exposure. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326. 5. A CVA, along with any associated residuals, was not incurred in active service and may not be presumed to have been incurred therein, including as due to herbicide exposure. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326. 6. The criteria for service connection for supraventricular arrhythmia, including as due to herbicide exposure, have not been met. 38 U.S.C. §§ 1110, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326. 7. The criteria for service connection for coronary artery bypass graft, including as due to herbicide exposure, have not been met. 38 U.S.C. §§ 1110, 1113, 1116, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326. 8. The criteria for secondary service connection for diplopia have not been met. 38 U.S.C. §§ 1110, 5103, 5103A; 38 C.F.R. §§ 3.159, 3.310. 9. The criteria for service connection for PTSD have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.326(a). 10. The criteria for service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.326(a). 11. The criteria for service connection for sinusitis have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.326(a). 12. The criteria for service connection for asthma have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.326(a). 13. The criteria for service connection for ear drum replacement have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.326(a). 14. The criteria for a disability rating in excess of 10 percent for lumbar spine arthritis have not been met or more nearly approximated for any part of the rating period. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 15. The criteria for a disability rating in excess of 20 percent for the right shoulder disability have not been met or more nearly approximated for any part of the rating period. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. 16. The criteria for a disability rating in excess of 20 percent for the left shoulder disability have not been met or more nearly approximated for any part of the rating period. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1961 to December 1964. The Veteran died in August 2020, and the appellant is the Veteran's surviving spouse. The appellant has been substituted as for purposes of processing the appeal to completion. See 38 U.S.C. § 5121A; 38 C.F.R. § 3.1010. This case was previously before the Board in September 2020, where the Board dismissed the issues on appeal for lack of jurisdiction; however, subsequently the Veteran's surviving spouse was granted substitution to continue the Veteran's appeal. 1. Service Connection for Prostate Cancer 2. Service Connection for Hypertension 3. Service Connection for Diabetes 4. Service Connection for Restless Leg Syndrome 5. Service Connection for a CVA 6. Service Connection for Supraventricular Arrhythmia 7. Service Connection for Coronary Artery Bypass Graft Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Prostate cancer (as a malignant tumor), hypertension, diabetes mellitus, RLS (as an organic disease of the nervous system), and a CVA (as a brain hemorrhage) are considered chronic diseases under 38 C.F.R. § 3.309(a). As such, the presumptive service connection provisions under 38 C.F.R. § 3.303(b) for service connection based on "chronic" symptoms in service and "continuous" symptoms since service are applicable. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). In addition, the law provides that, where a veteran served 90 days or more of active service, and certain chronic diseases become manifest to a degree of ten percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. The appellant contends that various disorders, to include the Veteran's prostate cancer, hypertension, diabetes, RLS, a CVA, supraventricular arrhythmia, and a coronary artery bypass graft, are due to service. The contention is that the Veteran was exposed to herbicides (Agent Orange) during service. During his lifetime, the Veteran asserted that he was exposed to Agent Orange while on active duty during service in Thailand. Prior to his death, the Veteran was diagnosed with prostate cancer, hypertension, diabetes, RLS, supraventricular arrhythmia, and a coronary artery bypass graft, and had a CVA in 2003. See private treatment records. After a review of all the lay and medical evidence of record, the Board finds that the weight of the evidence is against a finding that the Veteran was exposed to herbicide agents during service, to include alleged service in Thailand. Under the facts of this case, where there are no specific details or indicia of herbicide exposure or opportunity for observation, the appellant's general assertions that the Veteran was exposed to Agent Orange during service are outweighed by the other evidence that weighs against exposure. With respect to the assertion of in-service herbicide exposure, the Board has placed greater probative value on the service personnel records that document service in Japan, Turkey, and Iran during the Vietnam Conflict, and do not indicate exposure to herbicides, to include any exposure in Thailand. The service personnel records, to include the service treatment records and DD Form 214, do not suggest exposure to herbicide during service and do not reflect service in Thailand. Exposure to herbicides is also not shown in the Department of Defense documentation. See also June 2018 Defense Personnel Records Information Retrieval System response. After review of all the lay and medical evidence of record, the Board finds that the weight of the evidence is against finding that a prostate cancer, cardiovascular, endocrine, neurological, heart, or CVA injury or disease occurred during service, or that chronic symptoms of prostate cancer, hypertension, diabetes, RLS, or a CVA were manifested during service. The service treatment records, which are complete, show no complaints, findings, diagnoses, or treatment related to prostate cancer, hypertension, diabetes, RLS, a CVA, and/or a heart disorder. Further, the November 1964 service separation examination report reflects the Veteran was clinically evaluated as normal, to include the cardiovascular, endocrine, and neurological systems. Because the service treatment records are complete, and the Veteran sought treatment for various other symptoms during service, and clinical testing including blood tests, pulse, and blood pressure monitoring were conducted during service, the Board finds that symptoms of prostate cancer, hypertension, diabetes, RLS, a CVA, and a heart disorder are conditions that would have ordinarily been recorded during service had they been present during service. In this case, the service treatment records reflect that the Veteran sought treatment for a hernia, to include epigastric hernia surgery, stomach pain, and external otitis. As the service treatment records are complete and show complaints and treatment for other disorders, the Veteran similarly would have reported or complained of prostate, cardiovascular, endocrine, cerebral vascular, or neurological disability symptoms, had such occurred during service. Additionally, routine blood tests and blood pressure testing, which includes physical pressing on the pulse and indicators of cardiovascular irregularity, would have noted such irregularities had they been present during service. For these reasons, the lay and medical evidence generated contemporaneous to service, which showed no in-service prostate, cardiovascular, endocrine, cerebral vascular, neurological, or heart injury or disease and no chronic symptoms of prostate cancer, hypertension, diabetes, RLS, or a CVA, is likely to reflect accurately the Veteran's physical condition, so is of significant probative value and provides evidence against a finding of prostate, cardiovascular, endocrine, cerebral vascular, neurological, or heart disorder symptoms during service. Accordingly, the criteria for presumptive service connection under 38 C.F.R. § 3.303(b) based on "chronic" symptoms in service are not met. The Board next finds that the weight of the evidence shows that symptoms of prostate cancer, hypertension, diabetes, RLS, and/or a CVA were not continuous since service, including not to a degree of 10 percent within one year of service separation. The numerous private treatment records reflect that prostate cancer was not manifested until approximately 2007, over 43 years after service separation. See private treatment records. A February 2015 private treatment record reflects treatment for diabetes since 2009, over 45 years after service separation and that the Veteran underwent a coronary artery bypass in 2003, over 39 years after service separation. A November 2013 private treatment record also reflets a CVA in 2003, over 39 years after service separation. In addition, the private and VA treatment records do not reflect an RLS or hypertension diagnosis until years after service separation. See private treatment records. Regarding the theory of direct service connection, the weight of the evidence shows that prostate cancer, hypertension, diabetes, RLS, a CVA, and a heart disorder, to include a coronary artery bypass graft, are not related service because the weight of the evidence demonstrates no in-service injury or disease or even event to which the disorders could be related. As discussed above, while the appellant has contended that the claimed disorders were due in-service herbicide exposure during service in Thailand, the service personnel records reflect the Veteran served in Japan, Iran, and Turkey and was not exposed to Agent Orange or herbicides during service. Further, service treatment records reflect no injury or disease to the prostate, cardiovascular, endocrine, cerebral vascular, or neurological system, and/or the heart. For these reasons, prostate cancer, hypertension, diabetes, RLS, a CVA, and a heart disorder, to include a coronary artery bypass graft, which began many years after service, are not related to service. While, during his lifetime, the Veteran was competent to relate symptoms of prostate cancer, hypertension, diabetes, RLS, a CVA, and a heart disorder experienced at any time, he was not competent to opine on whether there is a link between these disorders and active service, including to the alleged exposure to herbicides, because such a conclusion regarding causation requires specific, highly specialized, medical knowledge and training regarding the unseen and complex processes of the cardiovascular, endocrine, cerebral vascular, and neurological systems and the development of prostate cancer, knowledge of the various risk factors and causes of hypertension, diabetes, RLS, and a stroke, specific clinical testing for hypertension, diabetes and cancer that indicate onset, and knowledge of the incubation period or ranges of such disorders that the Veteran was not shown to possess, especially in the context of this case where there was no exposure to herbicides during service. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997) (stating that a lay person is not competent to diagnose or make a competent nexus opinion about a disorder as complex as cancer). Finally, the Board notes that the medical evidence of record has suggested a possible post-service cause for numerous disorders, to include hypertension, a heart disorder, and the CVA. Per the record, a potential cause of various disorders includes the Veteran's long history of "ongoing significant tobacco abuse," to include a 50-year history of smoking. See private treatment records. The death certificate lists the immediate cause of death as a bilateral pneumonia with the underlying causes of death listed as chronic obstructive pulmonary disease and lung cancer. For these reasons, the Board finds that the preponderance of the lay and medical evidence that is of record weighs against the claim of service connection for prostate cancer, hypertension, diabetes, RLS, a CVA, and a heart disorder; consequently; therefore, the appeal on these issues must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 8. Secondary Service Connection for Diplopia The appellant contends that during his lifetime the Veteran developed diplopia due to a heart disorder. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. See 38 C.F.R. § 3.310. In the instant decision, the Board is denying service connection for a heart disorder, to include supraventricular arrhythmia, as well as diabetes, hypertension, a CVA, and prostate cancer. As such, secondary service connection (See 38 C.F.R. § 3.310) for a vision disorder is not warranted as a matter of law, whether or not the disorder was caused by a heart disorder (or diabetes, hypertension, a CVA, and prostate cancer) as there is no primary service-connected disability upon which secondary service connection may be granted. As such, service connection on a secondary basis must be denied as a matter of law. See 38 C.F.R. § 3.310(a); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). 9. Service Connection for PTSD 10. Service Connection for Sleep Apnea 11. Service Connection for Allergic Sinusitis 12. Service Connection for Asthma 13. Service Connection for Ear Drum Replacement With any claim for service connection (under any theory of entitlement), it is necessary for a current disability to be present. See Brammer v. Derwinski, 3 Vet. App. 223 (1992); see also McClain v. Nicholson, 21 Vet. App. 319 (2007) (service connection may be warranted if there was a disability present at any point during the claim period, even if it is not currently present); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (when the record contains a recent diagnosis of disability immediately prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency). The appellant contends that the claimed PTSD, sleep apnea, sinusitis, asthma, and ear drum replacement are related to the Veteran's service. After a review of the evidence, the weight of the evidence demonstrates that during the Veteran's lifetime he did not have a current diagnosis or functionally impairing disabilities of PTSD, sleep apnea, sinusitis, asthma, and/or an ear drum replacement. As to the claimed PTSD, a February 2015 VA PTSD examination reports reflect the VA examiner specifically assessed that the Veteran did not have PTSD. The VA and private treatment records also do not contain a confirmed PTSD diagnosis. See 38 C.F.R. § 4.125. The February 2015 VA PTSD examination report and VA medical opinion is highly probative and are adequately based on objective findings as shown by the record. The VA examiner considered a complete and accurate history of the claimed psychiatric disorder as provided through review of the record. As to the claimed sleep apnea, sinusitis, asthma, and ear drum replacement, the Board finds that the weight of the evidence is against the finding that the Veteran had a current sleep apnea, sinusitis, asthma, or ear drum replacement, either by diagnosis or by functional impairment, including based on lay evidence reports. See VA and private treatment records; Saunders v. Wilkie, 886 F.3d, 1356, 1368 (Fed. Cir. 2018). The competent evidence of record does not demonstrate that the Veteran has a current diagnosis of sleep apnea, sinusitis, asthma, and ear drum replacement. Based on the foregoing, the Board finds the weight of the evidence demonstrates that the Veteran did not have a current PTSD, sleep apnea, sinusitis, asthma, and/or and ear drum replacement disabilities; therefore, the claims for service connection must be denied. 14. Rating Lumbar Spine Arthritis Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the rating of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran's service-connected disabilities. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits compensating a veteran twice for the same symptoms or functional impairment). Disabilities of the spine are rated under the General Rating Formula for Diseases and Injuries of the Spine (Diagnostic Codes 5235 to 5243). Ratings under the General Rating Formula 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. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees, but not greater than 85 degrees; combined range of motion of the thoracolumbar spine greater than 120 degrees, but not greater than 235 degrees; 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 is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; combined range of motion of the thoracolumbar spine not greater than 120 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 40 percent rating is assigned for forward flexion of the thoracolumbar spine at 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees; extension is zero to 30 degrees; left and right lateral flexion are zero to 30 degrees; and left and right lateral rotation are zero to 30 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 combined normal range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of the spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Under Diagnostic Code 5243 (Intervertebral Disc Syndrome), a 20 percent disability rating is assigned with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent disability rating is assigned with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a maximum 60 percent disability rating is assigned with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. For the rating period on appeal, the Veteran is in receipt of a 10 percent disability rating for the lumbar spine disability under Diagnostic Code 5237. After a review of all the evidence, lay and medical, the Board finds that, during the Veteran's lifetime, the lumbar spine disability was not manifested by limitation of flexion greater than 30 degrees but not greater than 60 degrees, combined range of motion of the thoracolumbar spine to 120 degrees or less, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. The February 2015 VA examination report reflects forward flexion to 80 degrees, to include pain, and combined range of motion greater than 120 degrees, to include pain. The February 2015 VA examiner also did not discern muscle spasm, weakened movement, incoordination, swelling, instability, or disturbance of locomotion. Similarly, no examiner, VA or private, assessed that the lumbar spine disability was manifested by limitation of flexion greater than 30 degrees but not greater than 60 degrees, combined range of motion of the thoracolumbar spine to 120 degrees or less, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. See VA and private treatment records. The evidence of record, as it reflects on the appeal period, does not show the Veteran had any incapacitating episodes for at least two weeks during a 12-month period. See February 2015 VA examination report, VA and private treatment records. Additionally, the Board has considered whether there was additional functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40, 4.45, and 4.59. See also DeLuca. Evidence including the VA examination report and VA and private treatment records indicate, at worst, forward flexion to 80 degrees and combined range of motion greater than 120 degrees, which does not warrant a higher rating based on additional limitation of motion of function. For these reasons, the Board finds that the disability picture more nearly approximates the criteria described for a 10 percent rating for the lumbar spine disability. See 38 C.F.R. §§ 4.3, 4.7, 4.71a. 15. Rating Right Shoulder Strain 16. Rating Left Shoulder Rotator Cuff Tear Residuals For the rating period on appeal, the right and left shoulder disabilities have each been rated as 20 percent disabling under Diagnostic Code 5201. Under Diagnostic Code 5201, limitation of an arm at the shoulder level warrants a 10 rating whether it is the major or minor extremity. When motion is limited to midway between the side and shoulder level, a 20 percent rating is warranted for the minor extremity. When motion is limited to 25 degrees from the side, a 30 percent rating is warranted for the minor extremity. 38 C.F.R. § 4.71a. Normal ranges of shoulder flexion and abduction are from 0 to 180 degrees, and external and internal rotation are from 0 to 90 degrees. See 38 C.F.R. § 4.71, Plate I. After a review of all the evidence, lay and medical, the Board finds that, for the rating period on appeal, the right and left shoulder disabilities have not more nearly approximated arm motion limited to 25 degrees from the side as required for a higher rating under Diagnostic Code 5201. As to the right shoulder, the February 2015 VA examination report reflects right shoulder flexion to 130 degrees, abduction to 110 degrees, and bilateral rotation to 90 degrees, to include pain, weakness, and incoordination. The February 2015 VA examiner also did not discern additional loss of function or range after repetitive-use testing, which the Board finds does not more nearly approximate limitation of motion of the right shoulder limited to 25 degrees from the side (as needed for the next higher (30 percent) rating). As to the left shoulder, the February 2015 VA examination report reflects flexion to 90 degrees, abduction to 80 degrees, and bilateral rotation to 80 degrees, to include pain, weakness, and incoordination during a flare-up. The VA examiner also noted that the Veteran experienced less movement, weakened movement, and pain on movement, which the Board finds does not more nearly approximate limitation of motion of the left shoulder limited to 25 degrees from the side (as needed for the next higher (30 percent) rating). No examiner has assessed that the right or left shoulder disability has more nearly approximated limitation of motion of the left shoulder limited to 25 degrees from the side as required for a higher rating under Diagnostic Code 5201, and the appellant has not alleged otherwise. See VA and private treatment records. Similarly, the lay descriptions of limitations of motion and function do not describe limitations of motion that more nearly approximate limitation to 25 degrees from the side. Based on the evidence of record, the Board finds that for this period the right and left shoulder disabilities did not more closely approximate limitation of motion to 25 degrees from side, as contemplated by the 30 percent disability rating under Diagnostic Code 5201. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Tenney, 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.