Citation Nr: 22008022 Decision Date: 02/11/22 Archive Date: 02/11/22 DOCKET NO. 10-49 721 DATE: February 11, 2022 ORDER Entitlement to an initial rating in excess of 20 percent disabling for service-connected ankylosing spondylitis of the right shoulder is denied. Entitlement to an initial rating in excess of 20 percent disabling for service-connected ankylosing spondylitis of the left shoulder is denied. Entitlement to an initial rating in excess of 10 percent disabling for service-connected ankylosing spondylitis of the right hip is denied. Entitlement to an initial compensable rating for service-connected limitation of extension of the right thigh associated with ankylosing spondylitis of the right hip, is denied. Entitlement to an initial compensable rating for service-connected impairment of the right thigh associated with ankylosing spondylitis of the right hip, is denied. Entitlement to an initial rating in excess of 10 percent disabling for service-connected ankylosing spondylitis of the left hip is denied. Entitlement to an initial compensable rating for service-connected limitation of flexion of the left thigh associated with ankylosing spondylitis of the left hip, is denied. Entitlement to an initial rating in excess of 10 percent disabling for service-connected thoracolumbar spine disability is denied. FINDINGS OF FACT 1. The Veteran's right shoulder ankylosing spondylitis is manifested by loss of range of motion of the arm, but not flexion and/or abduction limited to 45 degrees (midway between side and shoulder level), even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis of the scapulohumeral articulation, impairment of the humerus, or impairment of the clavicle or scapula. 2. The Veteran's left shoulder ankylosing spondylitis is manifested by loss of range of motion of the arm, but not flexion and/or abduction limited to 25 degrees from side, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis of the scapulohumeral articulation, impairment of the humerus, or impairment of the clavicle or scapula. 3. The Veteran's service-connected ankylosing spondylitis of the right hip is manifested by limitation of flexion, but is not productive of flexion limited to 30 degrees. 4. The Veteran's service-connected limitation of extension of the right hip associated with ankylosing spondylitis of the right hip is not productive of extension limited to 5 degrees. 5. The Veteran's service-connected ankylosing spondylitis of the right hip is not productive of limitation of rotation the right leg, (cannot toe-out) more than 15 degrees, ankylosis, or impairment of the femur. 6. The Veteran's service-connected ankylosing spondylitis of the left hip is not productive of abduction limited beyond 10 degrees, ankylosis, or impairment of the femur. 7. The Veteran's service-connected limitation of flexion of the left hip associated with ankylosing spondylitis of the left hip is not productive of flexion limited to 45 degrees. 8. The Veteran's service-connected thoracolumbar spine disability has manifested with painful motion and corresponding functional impairment, and more nearly approximate limitation of flexion of greater than 60 degrees but not greater than 85 degrees; a combined range of motion of the thoracolumbar spine not greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height; without more severe manifestations; there is no evidence of ankylosis or incapacitating episodes having a total duration of 2 weeks but less than 4 weeks during the past 12 months. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 20 percent disabling for service-connected ankylosing spondylitis of the right shoulder have not been met. 38 U.S.C. §§ 1155, 5107; 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. 2. The criteria for an initial rating in excess of 20 percent disabling for service-connected ankylosing spondylitis of the left shoulder have not been met. 38 U.S.C. §§ 1155, 5107; 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. 3. The criteria for an initial rating in excess of 10 percent disabling for service-connected ankylosing spondylitis of the right hip have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.7, 4.71a, Diagnostic Code 5252. 4. The criteria for an initial compensable rating for service-connected limitation of extension of the right hip associated with ankylosing spondylitis of the right hip have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.7, 4.71a, Diagnostic Code 5251. 5. The criteria for an initial compensable rating for service-connected impairment of the right thigh associated with ankylosing spondylitis of the right hip have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.7, 4.71a, Diagnostic Code 5253. 6. The criteria for an initial rating in excess of 10 percent disabling for service-connected ankylosing spondylitis of the left hip have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.7, 4.71a, Diagnostic Code 5253. 7. The criteria for an initial compensable rating for service-connected limitation of flexion of the left hip associated with ankylosing spondylitis of the left hip have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.7, 4.71a, Diagnostic Code 5252. 8. The criteria for an initial rating in excess of 10 percent disabling for service-connected for thoracolumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.20, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from May 2000 to May 2009. In an October 2009 rating decision, the RO granted service connection and assigned initial ratings to the Veteran's right and left shoulder, right and left hip, and low back disabilities. During the course of the Veteran's appeal, in a December 2016 rating decision and an August 2021 supplemental statement of the case, the RO granted increased initial and separate ratings for these disabilities. However, because a claimant will generally be presumed to be seeking the maximum benefit allowed by law and regulation, a claim remains in controversy where less than the maximum available benefit is awarded. AB v. Brown, 6 Vet. App. 35, 38 (1993). Since the December 2016 rating decision and August 2021 supplemental statement of the case did not award the Veteran the maximum ratings for the disabilities on appeal, the issues remain in appellate status. In his December 2010 substantive appeal, the Veteran requested a Board hearing in Washington, D.C. A March 2012 hearing was scheduled, but the Veteran cancelled the hearing prior to the scheduled date. Accordingly, the hearing request is considered withdrawn. 38C.F.R. §20.704(d). In July 2016 and April 2017, the Board remanded the claims on appeal for further development and adjudication. The Board finds that there was substantial compliance with its July 2016 and April 2017 remand directives. A remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand order. Stegall v. West, 11 Vet. App. 268 (1998). Nonetheless, it is only substantial compliance, rather than strict compliance, with the terms of a remand that is required. See D'Aries v. Peake, 22 Vet. App. 97, 104 (2008) (finding substantial compliance where an opinion was provided by a neurologist as opposed to an internal medicine specialist requested by the Board); Dyment v. West, 13 Vet. App. 141 (1999). Increased Rating 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 rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). While the Veteran's entire history is reviewed when making a disability determination, where service connection has already been established and an increase in the disability rating is at issue, it is a present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). The Court has held that, in determining the present level of a disability for any increased evaluation claim, the Board must consider the application of staged ratings. See 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. Consideration is given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they are raised by the Veteran, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, are expected in all instances. 38 C.F.R. § 4.21. 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 evaluation 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 disability. 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. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the degree of limitation of motion, the provisions of 38 C.F.R. §§ 4.10, 4.40, and 4.45 are for consideration. See DeLuca v. Brown, 8 Vet. App. 202 (1995). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. 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. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. When 38 C.F.R. § 4.59 is raised by the claimant or reasonably raised by the record, even in non-arthritis contexts, the Board should address its applicability. Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). The Board notes that recently, the United States Court of Appeals for Veterans Claims (Court) held that "to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of" 38 C.F.R. § 4.59. See Correia v. McDonald, 28 Vet. App. 158 (2016). Specifically the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. In this regard, review of the VA examinations, which are discussed above, showed that joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and with range of motion measurements of the opposite undamaged joint was done at the various examinations in compliance with Correia. Importantly, the most recent VA examination found that all range of motion testing was normal and there was no pain on weight-bearing. The Board notes for sake of reference that ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. See Shipwash v. Brown, 8 Vet. App. 218, 221 (1995) (citing DORLAND'S ILLUSTRATED MEDICAL DICTIONARY (27th ed. 1988) at 91). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Entitlement to initial ratings in excess of 20 percent disabling for service-connected ankylosing spondylitis of the right and left shoulders are denied. The Veteran contends that his bilateral shoulder ankylosing spondylitis is worse than is reflected by his currently assigned ratings. The Veteran's bilateral shoulder ankylosing spondylitis is rated under Diagnostic Code 5201. The Veteran's disabilities are rated as 20 percent disabling effective June 1, 2009, pursuant to Diagnostic Code 5201. The Board notes that the record, including all the VA examinations, indicates that the Veteran is right hand dominant. However, as the Veteran is service connected for both his right and left shoulders, both the minor and major ratings apply. Under Diagnostic Code 5201, limitation of arm motion that is limited to shoulder level (flexion and/or abduction limited to 90 degrees) warrants a 20 percent rating in the minor and major extremity. Such limitation that is limited midway between the side and shoulder level also warrants a 20 percent rating in the minor extremity but a 30 percent rating in the major extremity. Such limitation to 25 degrees from the side warrants a 30 percent rating in the minor extremity and a 40 percent rating in the major extremity. 38 C.F.R. § 4.71a. Normal range of motion in the shoulder is from zero to 180 degrees of forward elevation (flexion) and zero to 180 degrees of shoulder abduction. 38 C.F.R. § 4.71a, Plate I. Turning to the evidence of record, the Board notes that the Veteran underwent two VA examinations throughout the appeal period, to include in November 2008 and July 2021. In November 2008 the Veteran underwent a VA General Medical Examination. The Veteran reported that he began experiencing pain in his shoulders in 1999 and was diagnosed with ankylosing spondylitis in 2006. The Veteran reported that he underwent physical therapy and had injections but they did not help. However, after he started on a different medication, the pain improved but he still suffered from stiffness. Upon examination, the examiner noted that stiffness was precipitated by lifting 20 pounds overhead. The examiner found no evidence of swelling, heat, weakness, instability, giving-out, locking, or lacking endurance. The examiner noted that the Veteran did not use any assistive devices and that bilateral range of motion testing revealed flexion 0 to 180 degrees, abduction 0 to 180 degrees, external rotation 0 to 90 degrees with pain on motion, and internal rotation 0 to 90 degrees. The examiner noted that as far as Deluca factors, it would be speculative to comment further on range of motion, fatigability, in-coordination, pain, or flare-ups beyond the noted range of motion testing. X-rays showed unremarkable shoulders with no bony or soft tissue abnormalities. The acromioclavicular and humeroglenoid joints were also unremarkable. In July 2021 the Veteran underwent a VA Shoulder and Arm Conditions examination with an accompanying disability benefits questionnaire (DBQ). The examiner noted that he reviewed the Veteran's records and that the Veteran was right hand dominant. The examiner noted that the Veteran suffered from bilateral rotator cuff tendonitis and ankylosing spondylitis. The Veteran contends that he suffers from daily pain and stiffness as well as flare-ups of his conditions. The Veteran contends that more than half the year he experiences flare-ups which are worse in his right shoulder than his left. The Veteran also contends that he suffers from functional loss or functional impairment in that he has increased pain with lifting and carrying and increased pain and difficulty with throwing motions. Furthermore, the Veteran reported that he was previously on a medication that helped with his pain, however, such caused an immune system reaction and he had to stop taking the medication. Upon examination, the examiner noted that the Veteran's range of motion was abnormal and that it did contribute to functional loss. Right shoulder flexion endpoint was 110 degrees, abduction 120 degrees, internal rotation 90 degrees, and external rotation 60 degrees. Left shoulder flexion endpoint was 140 degrees, abduction 110 degrees, internal rotation 90 degrees, and external rotation 45 degrees. Pain was exhibited in flexion, abduction, and external rotation. Passive range of motion testing was the same as active motion. Pain was noted in active and passive motion and caused some functional loss in that the Veteran was unable to lift more than 10 pounds and had difficulty working with his arms over his head. The examiner found evidence of crepitus but no evidence of localized tenderness or pain on palpation. The Veteran was able to perform repetitive use and repeated use over time testing without any additional loss of range of motion in the right shoulder. However, the left shoulder revealed flexion endpoint was 120, abduction was 110, internal rotation 90 and external rotation was 45. The examiner noted that fatigability, lack of endurance and pain were all factors in the functional loss. Finally, the examiner noted additional bilateral range of motion loss during flare-ups due to fatiguability, lack of endurance and pain. Right shoulder flexion endpoint was 105 degrees, abduction 110 degrees, internal rotation 90 degrees, external rotation 50 degrees. Left shoulder flexion endpoint was 110 degrees, abduction 110 degrees, internal rotation 90 degrees, and external rotation 45 degrees. Rotator cuff testing revealed positive Hawkins Impingement test, but negative results for all additional testing. The examiner found no evidence of muscle atrophy, ankylosis, shoulder instability, dislocation or labral pathology, clavicle, scapula, acromioclavicular join or sternoclavicular joint conditions, or any impairment of the humerus. Finally, the examiner noted that the Veteran did not use any assistive devices and that his conditions did impact his ability to work by limiting his ability to carry and lift. While the Veteran consistently sought treatment for his bilateral shoulder complaints, to include pain, during the appeal period, such do not reflect any additional findings pertinent to the rating criteria that were not documented at the aforementioned VA examinations. Finally, throughout the appeal the Veteran has submitted lay statements indicating his belief that his shoulder conditions are more disabling than is reflected by his assigned ratings. Specifically, the Veteran contends that he suffers from daily pain and stiffness as well as flare-ups of his conditions. The Veteran contends that more than half the year he experiences flare-ups which are worse in his right shoulder than his left. Based on the foregoing, the Board finds that ratings in excess of 20 percent are not warranted for the Veteran's bilateral shoulder disabilities under Diagnostic Code 5201. In this regard, while such disabilities result in the loss of range of motion of the arms, they do not result in restrictions severe enough to warrant ratings in excess of 20 percent disabling. For the Veteran's minor joint, his left shoulder, such is not limited to flexion and/or abduction limited to 25 degrees from his side, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. For the Veteran's major joint, his right shoulder, such is not limited to midway between his side and shoulder (flexion and/or abduction limited to 45 degrees). In this regard, the most restrictive testing results were those obtained during the July 2021 VA examination. During the examination it was noted that the Veteran's flexion and abduction of the right shoulder were 110 and 120 degrees and his left shoulder was 140 and 110 degrees. Furthermore, while the Veteran reported additional pain and functional loss after repeated use and use over time and/or on flare-ups, the examiner noted no change in the Veteran's right shoulder range of motion with repeated use or use over time and only minimal decrease in the left shoulder with flexion of 120 and abduction of 110. And while the range did change in both shoulders during flare-ups, again it was a minimal decrease with right shoulder flexion endpoint at 105 and abduction 110 and left shoulder flexion endpoint at 110 and abduction 110. Therefore, as there is no objective evidence that the Veteran's bilateral shoulder disabilities resulted in flexion and/or abduction limited to 25 degrees from his side or flexion and/or abduction limited to 45 degrees, the Veteran is not entitled to ratings in excess of 20 percent under Diagnostic Code 5201 for limitation of motion. The Board further finds that separate or higher ratings are not warranted under any other potentially applicable Diagnostic Codes related to the shoulders. In this regard, the evidence, to include VA examination reports and treatment records, does not show, nor did the Veteran contend, that his bilateral shoulder disabilities resulted in ankylosis of the scapulohumeral articulation, impairment of the humerus, or impairment of the clavicle or scapula. Consequently, higher, or separate ratings are not warranted under Diagnostic Codes 5200, 5202, and 5203, respectively. Again, the Board acknowledges that the Veteran has chronic bilateral shoulder pain and thus, recognizes the application of 38 C.F.R. §§ 4.40 and 4.45, and DeLuca, supra. However, a higher compensation is not warranted under these provisions because there is no persuasive evidence of additional functional loss due to pain, weakness, fatigue, or incoordination which would limit motion to such a degree so as to warrant higher ratings. As previously noted, while the July 2021 examiner did note some additional limitation following repeated use, use over time and/or on flare-ups, the decrease in function was minimal. Therefore, the Board finds that this additional loss still does not meet the criteria for ratings in excess of 20 percent under Diagnostic Code 5201. Moreover, even though the examiners observed pain in both of the Veteran's shoulders, pain alone is not sufficient to warrant a higher rating, as pain may cause a functional loss, but pain itself does not constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Rather, pain must affect some aspect of "the normal working movements of the body" such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. Id.; see 38 C.F.R. § 4.40. In this case, it does not. Therefore, ratings in excess of 20 percent under Diagnostic Code 5201, are not warranted. Consequently, the Board finds that higher ratings for the Veteran's service-connected bilateral shoulder ankylosing spondylitis are not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the evidence of record is against the claims. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal and the increased rating claims must be denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Entitlement to an initial rating in excess of 10 percent disabling for service-connected ankylosing spondylitis of the right hip, and to initial compensable ratings for service-connected limitation of extension of the right thigh and impairment of the right thigh associated with ankylosing spondylitis of the right hip and entitlement to an initial rating in excess of 10 percent disabling for service-connected ankylosing spondylitis of the left hip and an initial compensable rating for service-connected limitation of flexion of the left thigh associated with ankylosing spondylitis of the left hip, are denied. The Veteran contends that his bilateral hip disabilities are worse than is reflected by his currently assigned ratings. The Veteran's bilateral hip disabilities are rated under Diagnostic Codes 5251, 5252, and 5253. The Veteran's ankylosing spondylitis of the right hip is rated as 10 percent disabling effective June 1, 2009 under Diagnostic Code 5252. The Veteran's limitation of extension of the right thigh associated with ankylosing spondylitis of the right hip is rated as noncompensable effective July 28, 2021 under Diagnostic Code 5251, and his impairment of the right thigh associated with ankylosing spondylitis of the right hip is also rated as noncompensable effective July 28, 2021 under Diagnostic Code 5253. The Veteran's ankylosing spondylitis of the left hip is rated as 10 percent disabling effective June 1, 2009 under Diagnostic Code 5253 and his limitation of flexion of the left thigh associated with ankylosing spondylitis of the left hip is rated as noncompensable effective July 28, 2021 under Diagnostic Code 5252. The Board notes that the Veteran's 10 percent ratings for his bilateral hip ankylosing spondylitis are based on the Veteran's reports of painful motion. 38 C.F.R. § 4.59 allows consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating for a particular joint. Under Diagnostic Code 5251, limitation of extension of the thigh to 5 degrees warrants assignment of a 10 percent evaluation. There is no higher rating available under this code section. Under Diagnostic Code 5252, limitation of flexion of the thigh, where limitation is limited to 45 degrees, a 10 percent evaluation is warranted; where limitation is limited to 30 degrees, a 20 percent evaluation is contemplated, and a 30 percent evaluation is assigned where flexion is limited to 20 degrees. Where flexion is limited to 10 degrees, a 40 percent evaluation is contemplated. Under Diagnostic Code 5253, where there is limitation of rotation of the thigh (cannot toe-out more than 15 degrees), a 10 percent evaluation is assigned. Assignment of a 20 percent evaluation, the highest available rating under Diagnostic Code 5253, is warranted where there is limitation of abduction of the thigh, or motion lost beyond 10 degrees. Other relevant Diagnostic Codes pertaining to the hip and thigh are Diagnostic Code 5250 which provides for ankylosis of the hip, Diagnostic Code 5254 which is applicable when there is a flail joint, and Diagnostic 5255 which applies to impairment of the femur. Turning to the evidence of record, the Board notes that the Veteran underwent two VA examinations throughout the appeal period, to include in November 2008 and July 2021. In November 2008 the Veteran underwent a VA General Medical Examination. The Veteran reported that he began experiencing pain in his shoulders in 1999 and was diagnosed with ankylosing spondylitis in 2006. The Veteran reported that he underwent physical therapy and had injections but they did not help. The pain then spread to other joints, to include his hips. However, after he started on a different medication, the pain improved but he still suffered from stiffness. The Veteran reported that he had pain with stiffness when he woke in the morning, but that it improved throughout the day with movement. He reported no swelling, heat, redness, instability, giving out, locking, or lack of endurance. Upon examination, the examiner noted no evidence of swelling, tenderness, guarding, redness, heat, instability, weakness, abnormal movement, spasm, or pain on motion. Bilateral range of motion testing revealed flexion 0 to 125 degrees, extension 0 to 30 degrees, abduction 0 to 45 degrees, adduction 0 to 25 degrees, external rotation 0 to 60 degrees, and internal rotation 0 to 40 degrees. The examiner noted that as far as Deluca factors, it would be speculative to comment further on range of motion, fatigability, in-coordination, pain, or flare-ups beyond the noted range of motion testing. X-rays showed bilateral unremarkable hip joints. The examiner noted the articular surface of the femoral head and femoroacetabular joints were also unremarkable. In July 2021 the Veteran underwent a VA Hip and Thigh Conditions examination with an accompanying DBQ. The examiner noted that he reviewed the Veteran's records and that the Veteran suffered from bilateral hip ankylosing spondylitis. The Veteran reported that he suffered chronic daily bilateral pain and stiffness. In addition, he noted that his pain was worse in the mornings and caused him to limp. The Veteran also contended that he suffered from functional loss or functional impairment in that he had increased pain after sitting or driving for 1-2 hours and that he required rest after standing or walking for 30-45 minutes. Furthermore, the Veteran reported that he was previously on a medication that helped with his pain, however, such caused an immune system reaction and he had to stop taking the medication. Upon examination, the examiner noted that the Veteran's range of motion was abnormal and that it did contribute to functional loss. Range of motion testing of the right hip revealed flexion endpoint was 100 degrees, extension 20 degrees, abduction 45 degrees, adduction 25 degrees, external rotation 45 degrees, internal rotation 40 degrees. Pain was noted with all motion. Left hip testing revealed flexion endpoint was 100 degrees, extension 30 degrees, abduction 45 degrees, adduction 25 degrees, external rotation 50 degrees, and internal rotation 40 degrees. Pain was noted with extension, abduction, adduction, and internal rotation. The examiner noted that limitation in adduction did not prevent the Veteran from crossing his legs and that passive testing was the same as active motion. Furthermore, the examiner noted pain with active and passive motion that caused functional loss in that the Veteran had difficulty squatting and that his hips "popped" when flexed. The examiner found objective evidence of crepitus, but no evidence of localized tenderness or pain with palpation. The examiner noted that the Veteran was able to perform repetitive use and repeated use over time testing, and that such did result in additional loss of function or range of motion. Right hip testing revealed flexion endpoint was 100 degrees, extension 20 degrees, abduction 35 degrees, adduction 25 degrees, external rotation 45 degrees, and internal rotation 40 degrees. Left hip testing revealed flexion endpoint was 100 degrees, extension 30 degrees, abduction 35 degrees, adduction 25 degrees, external rotation 50 degrees, and internal rotation 30 degrees. Pain, fatigability, and lack of endurance were contributing factors for both repetitive and repeated use over time. Furthermore, while the Veteran reported increased pain with lateral movement and popping if he "lifts his knee or sits up," the examiner noted that the Veteran denied flare-ups. Therefore, range of motion testing in relation to flare-ups was deemed irrelevant and not conducted. The examiner found no evidence of muscle atrophy, ankylosis, or femur or flail hip joint impairment. The examiner noted that the Veteran did not use any assistive devices but that his hip disabilities impacted his ability to work as he had difficulty squatting. Furthermore, while the Veteran consistently sought treatment for his bilateral hip and thigh complaints, to include pain, during the appeal period, such do not reflect any additional findings pertinent to the rating criteria that were not documented at the aforementioned VA examinations. Finally, throughout the appeal the Veteran has submitted lay statements indicating his belief that his bilateral hip conditions are more disabling than is reflected by his assigned ratings. The Veteran specifically notes that he suffers chronic daily bilateral pain and stiffness. In addition, he notes that his pain is worse in the mornings and causes him to limp. Right Hip Based on the foregoing, the Board finds that an initial rating in excess of 10 percent is not warranted. As previously noted, the Veteran's 10 percent rating for his ankylosing spondylitis of the right hip is based on the Veteran's reports of painful motion. (38 C.F.R. § 4.59 allows consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating for a particular joint.) However, there is no evidence of flexion of the thigh being limited to 30 degrees. The most restrictive flexion documented at the July 2021 VA examination was to 100 degrees. Therefore a higher rating under Diagnostic Code 5252 is not warranted. Furthermore, there are no objective findings that extension has been limited to 5 degrees to warrant a compensable rating under Diagnostic Code 5251. The most restrictive extension documented was at the July 2021 VA examination, but such was still to 20 degrees. There are no objective findings showing limitation of rotation of the thigh (cannot toe-out more than 15 degrees) or limitation of adduction of the thigh (cannot cross legs) to warrant a 10 percent rating under Diagnostic Code 5253. On VA examination, rotation (external and internal) was to 45 and 40 degrees and adduction was always at least 25 degrees. Furthermore, it was noted that adduction did not inhibit the Veteran from crossing his legs. Finally, there is no evidence of ankylosis, a flail joint or impairment of the femur to warrant additional separate or a higher rating under Diagnostic Codes 5250, 5254 and 5255. Again, the Board acknowledges that the Veteran has chronic right hip pain and thus, recognizes the application of 38 C.F.R. §§ 4.40 and 4.45, and DeLuca, supra. However, a higher compensation is not warranted under these provisions because there is no persuasive evidence of additional functional loss due to pain, weakness, fatigue, or incoordination which would limit motion to such a degree so as to warrant higher ratings. In this regard, at the July 2021 VA examination, the examiner found additional loss after repetitive use and repeated use over time due to pain, fatigability, and lack of endurance; however such did not significantly limit functional ability. The examiner noted flexion was 100 degrees, extension 20 degrees, abduction 35 degrees, adduction 25 degrees, external rotation 45 degrees, and internal rotation 40 degrees. The Board notes that this additional loss still does not meet the criteria for a rating in excess of 10 percent under Diagnostic Code 5252 or compensable ratings under Diagnostic Codes 5251 or 5253. There was also no significant limitation of functional ability during any expected flare-up. The most recent VA examination found that the Veteran explicitly denied flare-ups. Moreover, even though the examiners observed pain in the right hip, pain alone is not sufficient to warrant a higher rating, as pain may cause a functional loss, but pain itself does not constitute functional loss. Mitchell, 25 Vet. App. at 32. Rather, pain must affect some aspect of "the normal working movements of the body" such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. Id.; see 38 C.F.R. § 4.40. In this case, it does not. Therefore, a rating in excess of 10 percent under Diagnostic Code 5252, as well as compensable ratings under Diagnostic Codes 5251 and 5253 are not warranted. Consequently, the Board finds that higher ratings for the Veteran's service-connected right hip disabilities are not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the evidence of record is against the claims. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal and the increased and compensable rating claims must be denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Left Hip Based on the foregoing, the Board finds that an initial rating in excess of 10 percent is not warranted. As previously noted, the Veteran's 10 percent rating for his ankylosing spondylitis of the left hip is based on the Veteran's reports of painful motion. (38 C.F.R. § 4.59 allows consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating for a particular joint.) There are no objective findings showing limitation of abduction of the left thigh, specifically motion lost beyond 10 degrees to warrant a 20 percent rating under Diagnostic Code 5253. The most restrictive range of motion was on the July 2021 VA examination, and abduction was 45 degrees. Furthermore, there is no objective evidence of flexion being limited to 45 degrees. The most restrictive flexion documented at the July 2021 VA examination was to 100 degrees. Therefore a compensable rating under Diagnostic Code 5252 is also not warranted. Finally, there is no evidence of any limitation of extension, ankylosis, a flail joint or impairment of the femur to warrant additional separate or higher ratings under Diagnostic Codes 5250, 5251, 5254 and 5255. Again, the Board acknowledges that the Veteran has chronic left hip pain and thus, recognizes the application of 38 C.F.R. §§ 4.40 and 4.45, and DeLuca, supra. However, higher compensation is not warranted under these provisions because there is no persuasive evidence of additional functional loss due to pain, weakness, fatigue, or incoordination which would limit motion to such a degree so as to warrant higher ratings. In this regard, at the July 2021 VA examination, the examiner found additional loss after repetitive use and repeated use over time due to pain, fatigability, and lack of endurance; however such did not significantly limit functional ability. The examiner noted flexion was 100 degrees, extension 30 degrees, abduction 35 degrees, adduction 25 degrees, external rotation 50 degrees, and internal rotation 30 degrees. The Board notes that this additional loss still does not meet the criteria for a rating in excess of 10 percent under Diagnostic Code 5253 or a compensable rating under Diagnostic Codes 5252. There was also no significant limitation of functional ability during any expected flare-up. The most recent VA examination found that the Veteran explicitly denied flare-ups. Moreover, even though the examiners observed pain in the left hip, pain alone is not sufficient to warrant a higher rating, as pain may cause a functional loss, but pain itself does not constitute functional loss. Mitchell, 25 Vet. App. at 32. Rather, pain must affect some aspect of "the normal working movements of the body" such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. Id.; see 38 C.F.R. § 4.40. In this case, it does not. Therefore, a rating in excess of 10 percent under Diagnostic Code 5253, as well as a compensable rating under Diagnostic Code 5252 are not warranted. Consequently, the Board finds that higher ratings for the Veteran's service-connected left hip disabilities are not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the evidence of record is against the claims. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal and the increased and compensable rating claims must be denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Entitlement to an initial rating in excess of 10 percent disabling for service-connected thoracolumbar spine disability is denied. The Veteran contends that his thoracolumbar spine disability is worse than is reflected by his currently assigned rating. The Veteran's service-connected thoracolumbar spine disability is rated under Diagnostic Code 5242 for degenerative arthritis of the spine, which is evaluated under the General Rating Formula for Rating Diseases and Injuries of the Spine. The Veteran's thoracolumbar spine disability is rated as 10 percent disabling effective June 1, 2009 pursuant to Diagnostic Code 5242. Under the General Rating Formula for Rating Diseases and Injuries of the Spine, with or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings will apply: a 10 percent rating is warranted if forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees, the combined range of motion of the thoracolumbar spine was greater than 235 degrees or that muscle spasms or guarding not resulting in an abnormal gait or abnormal spinal contour. A 20 percent rating is warranted if forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees, the combined range of motion of the thoracolumbar spine was not greater than 120 degrees or that muscle spasms or guarding were 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 warranted if forward flexion of the thoracolumbar spine is to 30 degrees or less or if there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine and a 100 percent rating is warranted for ankylosis of the entire spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. The criteria also include the following provisions: Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2): For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. 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 normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. Under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, a 10 percent rating is warranted for incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months. A 20 percent rating is warranted for incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent rating is warranted for incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months and a 60 percent rating is warranted for incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. An incapacitating episode is defined as a period of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician. An evaluation can be had either on the total duration of incapacitating episodes over the past 12 months or by combining separate evaluations of the chronic orthopedic and neurologic manifestations along with evaluations for all other disabilities under 38 C.F.R. § 4.25, whichever method resulted in the higher evaluation. Turning to the evidence of record, the Board notes that the Veteran underwent two VA examinations throughout the appeal period, to include in November 2008 and July 2021. In November 2008 the Veteran underwent a VA General Medical Examination. The Veteran reported that he began experiencing pain in his shoulders in 1999 and was diagnosed with ankylosing spondylitis in 2006. The Veteran reported that he underwent physical therapy and had injections but they did not help. The pain then spread to other joints, to include his back. However, after he was started on a different medication, the pain improved but he still suffered from stiffness. The Veteran reported no bowel or bladder problems and he was able to do straight leg raises without any radiating pain. Upon examination, the examiner noted that the Veteran had a normal gait and noted no evidence of edema, tenderness, guarding, redness, heat, instability, weakness or abnormal movement, spasm, or pain on motion. Range of motion testing of the thoracic spine revealed active/passive forward rotation of the upper trunk 0 to 30 degrees and active/passive back rotation of the upper trunk 0 to 30 degrees. In addition lumbar spine range of motion revealed flexion 0 to 95 degrees, extension 0 to 30 degrees, left lateral flexion 0 to 40 degrees, right lateral flexion 0 to 40 degrees, left lateral rotation 0 to 35 degrees, and right lateral rotation 0 to 35 degrees. The examiner noted that as far as Deluca factors, it would be speculative to comment further on range of motion, fatigability, in-coordination, pain, or flare-ups beyond the noted range of motion testing. X-rays of the lumbar spine revealed possible spina bifida occulta at the level of SI. However, the remainder of the x-rays showed that the pedicles, intervertebral spaces, and height of the vertebral bodies were unremarkable. X-rays of the dorsal spine revealed mild degenerative changes of the lower dorsal spine. Otherwise the x-rays were unremarkable. In July 2021 the Veteran underwent a VA Back Conditions examination with an accompanying DBQ. The examiner noted that he reviewed the Veteran's records and that he suffered from degenerative changes of the thoracolumbar spine. The Veteran reported that he suffered from constant daily pain and spasms approximately 2-3 times a week as well as occasional sciatica. The Veteran also contended that he suffered from functional loss or functional impairment in that he had increased pain with standing and walking, laying flat also increased his pain so he had to sleep in a sitting position, and he could not sit for more than an hour or lift more than 10 pounds. Furthermore, the Veteran reported that he was previously on a medication that helped with his pain, however, such caused an immune system reaction and he had to stop taking the medication. Upon examination the examiner noted that the Veteran's active range of motion resulted in forward flexion endpoint of 75 degrees, extension 25 degrees, right lateral flexion 30 degrees, left lateral flexion 30 degrees, right lateral rotation 30 degrees, and left lateral rotation 30 degrees. Passive range of motion testing was the same as active, and pain was noted in all types of motion. The examiner noted objective evidence of crepitus as well as localized tenderness and pain on palpation. The examiner further conducted repetitive use testing and repeated use over time. The examiner noted that forward flexion endpoint was 65 degrees, extension 20 degrees, right lateral flexion 25 degrees, left lateral flexion 25 degrees, right lateral rotation 30 degrees, and left lateral rotation 30 degrees. The examiner noted that pain, fatigability, and lack of endurance contributed to functional loss. The examiner noted that the Veteran denied flare-ups and therefore range of motion testing during a flare up was not conducted. The examiner noted localized tenderness and muscle spasms, but such did not result in abnormal gait or spinal contour, and the examiner found no evidence of guarding. Muscle strength, sensory, and reflex testing were normal. Straight leg testing was negative. While the examiner noted that the Veteran suffered from radiculopathy, he found no other neurological abnormalities. In addition, the examiner found no evidence of ankylosis or IVDS. The examiner noted that the Veteran did not use assistive devices, but that his condition did impact his ability to work as he was limited in the time which he could sit or stand and he was not able to lift more than 10 pounds. Furthermore, while the Veteran consistently sought treatment for his back complaints, to include pain, during the appeal period, such do not reflect any additional findings pertinent to the rating criteria that were not documented at the aforementioned VA examinations. Finally, Throughout the appeal, the Veteran has submitted statements in which he has indicated his belief that his back disability warrants a rating higher than that which has been assigned. The Veteran specifically contends that he suffers from constant daily pain and spasms approximately 2-3 times a week as well as occasional sciatica. The Board finds that, when applying the General Rating Formula to the Veteran's thoracolumbar spine disability, the evidence does not warrant a rating in excess of 10 percent disabling. There have been no findings of forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or combined range 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; or any ankylosis of the thoracolumbar spine. The most restrictive range of motion found was 75 degrees of forward flexion documented on the July 2021 VA examination. The Veteran has reported chronic low back pain, and, thus, the Board recognizes the application of 38 C.F.R. §§ 4.40, 4.45, and Deluca. However, a higher compensation is not warranted under these provisions because there is no persuasive evidence of additional functional loss due to pain, weakness, fatigue, or incoordination which would limit motion to such a degree so as to warrant a rating in excess of 10 percent. In the range of motion testing of record, pain was elicited during forward flexion, however it was noted that the pain itself did not result in or cause significant functional loss. The examiner further noted that the Veteran could do repetitive motion testing and there was only minor additional loss of function or range of motion after repetition. In sum, there is no objective evidence that repetitive use, repeated use over time, or flare-ups result in loss of range of motion meeting the criteria for a rating in excess of 10 percent. Again, pain alone is not sufficient to warrant a higher rating, as pain may cause a functional loss but does not itself constitute functional loss. See Mitchell, supra. Therefore, a rating in excess of 10 percent is not warranted based on limitation of motion. The Board has also considered whether it may be appropriate to rate the Veteran's thoracolumbar spine disability under other diagnostic codes, but finds that no higher ratings are warranted. A rating is not warranted based on incapacitating episodes. See 38 C.F.R. § 4,81a, Diagnostic Code 5243. The evidence of record shows the Veteran has not experienced incapacitating episodes and the July 2021 VA examiner specifically found that the Veteran did not have IVDS of the thoracolumbar spine. There is no evidence showing that the Veteran suffered incapacitating episodes lasting a total of at least two weeks but less than four weeks during the past 12 months to warrant a 20 percent rating for IVDS. In this regard, the Board finds a higher rating based on IVDS with incapacitating episodes is not warranted. The Board finds that a higher rating is not assignable under any other potentially applicable rating criteria. With respect to neurological abnormalities pursuant to Note (1) of the General Rating Formula for Disease and Injuries of the Spine, the Board notes that there has been no objective finding of neurological abnormalities associated with the Veteran's thoracolumbar spine disability, other than the radiculopathy of the Veteran's bilateral lower extremities. The Board notes that the Veteran is already separately service connected for his radiculopathy and he has not expressed disagreement with the separate ratings already assigned nor does the evidence of record indicate that an increase is warranted. Furthermore, there is no evidence of bowel or bladder dysfunction, and the Veteran has expressly denied such problems during his examinations. Significantly, all the VA examinations of record have found no associated neurological abnormalities, other than radiculopathy. Thus, an additional separate compensable rating is not warranted for any neurological symptoms, and the Veteran's symptoms are adequately contemplated under the assigned disability ratings discussed above. Consequently, the Board finds that a higher rating for the Veteran's service-connected thoracolumbar spine disability is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the evidence of record is against the claim. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal and the increased rating claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Other Considerations The Board has considered whether staged ratings under Fenderson, supra and Hart, supra, are appropriate for the Veteran's service-connected disabilities; however, the Board finds that his symptomatology has been stable for each of his disabilities throughout the appeal. Therefore, assigning staged ratings for his disabilities is not warranted. Furthermore, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claims adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). In assessing the severity of the disabilities under consideration, the Board has considered the Veteran's assertions regarding his symptoms, which he is certainly competent to provide. See, e.g. Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). However, the criteria needed to support higher ratings require medical findings that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134 (1994). As such, the lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher or separate ratings pursuant to any applicable criteria at any point pertinent to this appeal. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the evidence of record is against the claims, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Unger, 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.