Citation Nr: 22015196 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 17-54 556 DATE: March 16, 2022 ORDER Entitlement to service connection for a skin disability is denied. Beginning April 16, 2019, entitlement to an initial disability rating greater than 20 percent for service-connected left shoulder strain is denied. Beginning April 16, 2019, entitlement to an initial disability rating greater than 20 percent for service-connected lumbar strain is denied. FINDINGS OF FACT 1. The evidence of record is against finding that the Veteran has had a skin disability at any time during, or approximate to, the pendency of the claim. 2. Beginning April 16, 2019, the Veteran's service-connected left shoulder strain does not manifest limitation of motion to at least 45 degrees. 3. Beginning April 16, 2019, the Veteran's service-connected lumbar strain does not manifest limitation of forward flexion to at least 30 degrees; or any form of ankylosis or its functional equivalent. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a skin disability are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a). 2. Beginning April 16, 2019, the criteria for entitlement to an initial disability rating greater than 20 percent for service-connected left shoulder strain are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5201. 3. Beginning April 16, 2019, the criteria for entitlement to an initial disability rating greater than 20 percent for service-connected lumbar strain are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DCs) 52355243. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1962 to March 1965. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2014 Rating Decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. A Board hearing was conducted via videoconference with the RO in Philadelphia, Pennsylvania. A transcript of this hearing is contained within the electronic claims file. These claims last were addressed by a July 2021 Board Decision. There, the Board granted the appeal to reopen the claim for entitlement to service connection for a skin disability and denied increased ratings for the shoulder and back prior to April 16, 2019. The Board then remanded entitlement to service connection for a skin disability and entitlement to increased ratings for the shoulder and back beginning April 16, 2019 (the date of the Veteran's hearing at which point he alleged a worsening of his conditions). For the former, the agency of original jurisdiction was to consider the Veteran's new and material evidencenamely his hearing testimony. For the latter, it was instructed to afford the Veteran new examinations for his back and left shoulder to determine whether an increase in severity had occurred. In August 2021, the Veteran was provided the requisite examinations. Thus, the AOJ substantially has complied with the Board's prior remand instructions permitting readjudication of this appeal. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). In rendering a decision on appeal, the Board must analyze the competency, credibility, and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Buchanan v. Nicholson, 451 F.3d 1331, 133537 (Fed. Cir. 2006). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall resolve all reasonable doubt in favor of the claimant. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 C.F.R. § 3.102. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1380 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008), aff'd sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009). Service Connection For his alleged skin disability, the Veteran avers that he has been diagnosed with vitiligo. April 16, 2019, Hr'g Tr. (Tr.) at 19. He relates that diagnosis back to his time in Vietnam when he had to "rub all kinds of chemicals on [his] bod[y]," including "Agent Orange." Id. He claims that, during service and as a result, he experienced rashes and little bumps. Id. For disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during a period of war, the United States will pay to any veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation as provided in this subchapter, but no compensation shall be paid if the disability is a result of the veteran's own willful misconduct or abuse of alcohol or drugs. 38 U.S.C. § 1110. To establish service connection, there must exist medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013); 38 C.F.R. § 3.303(a). Where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service treatment records (STRs) do not contain complaints of, treatment for, or diagnosis of any skin disability. The Veteran's December 1964 separation examination showed no abnormalities relating to his skin. Post-service private treatment records from August 2010 note that the Veteran's skin was normal without any lesions or rashes. A February 2012 VA medical center (VMAC) entry documents that the Veteran's skin is supple and intact without suspicious lesions. He also denied any rashes. There is no other evidence concerning any possible skin condition. The Veteran indeed is competent to report any skin disability, as one would manifest in lay, observable symptoms. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board, however, does not find credible his assertion that he has vitiligo. There is no medical evidence confirming diagnosis of any skin conditionvitiligo or otherwise. There are no medical records documenting any complaints for any skin condition. To be sure, the Veteran testified that "[t]hey say I've got vitiligo." Tr. at 19. This, at the very least, indicates that the Veteran is relaying a past diagnosis from his medical providers. But, as just noted, there is no such diagnosis of any skin conditionnor treatment for any symptomsin his records. Thus, while he also is competent to report a contemporaneous medical diagnosis, see Jandreau, 492 F. 3d at 1377, the Board likewise does not find such evidence credible when reviewing the other evidence of record. Thus, the Board finds that the first element of service connection has not been established. See Romanowsky, 26 Vet. App. 289, 293 (2013); 38 C.F.R. § 3.303(a). The Board further notes that the Veteran never has been provided a VA examination for this condition, nor is he entitled to one. VA's duty to assist includes providing a medical examination or obtaining a medical opinion when necessary to make a decision on a claim, as defined by law. 38 C.F.R. § 3.159(c)(4). In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained, there are four factors that must be met: (1) whether there is competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is insufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); 38 C.F.R. § 3.159(c)(4). The facts do not satisfy the first element under the McLendon framework. At the very least, McLendon requires persistent or recurrent symptoms of disability. Those are not present. The Veteran has asserted that he was diagnosed with vitiligo, but, for the reasons stated above, the Board has found that statement to lack credibility, as there is neither any competent and credible documented diagnosis or persistent or recurrent symptoms of a disability. Absent the Veteran's allegations at his hearing, the record contains nothing more than fleeting references to the fact that his skin is normalfacts that cut against him. Even at the hearing, he never discusses any recurrent symptoms; he merely parrots an alleged diagnosis of vitiligo, and he gives nothing more than that. He does not indicate when, where, or by whom he was diagnosed. He does not address any symptoms this condition has caused or for how long he allegedly has experienced them. He gives the Board virtually no information. That is not enough to satisfy McLendon's first element. See 20 Vet. App. at 81; 38 C.F.R. § 3.159(c)(4). Thus, VA owes him no duty to provide an examination. Because the evidence of record does not support the Veteran's claim for entitlement to service connection for a skin disability, his appeal on this issue is denied. The Board is unable to find an approximate balance of the positive and negative evidence submitted to warrant for the Veteran a favorable decision. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53; 38 C.F.R. §§ 3.102, 3.303(a). Increased Rating Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. 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. Fenderson v. West, 12 Vet. App. 119, 126 (1999). "The relevant temporal focus for adjudicating an increased-rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim." Hart v. Mansfield, 21 Vet. App. 505, 509 (2007) (discussing 38 U.S.C. § 5110 and 38 C.F.R. § 3.400(o)). In determining the present level of a disability for any increased rating claim, the Board must consider the application of staged ratings. 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 is necessary. Id. When assessing the severity of musculoskeletal disabilities that are, at least partly, rated on the basis of limitation of motion, VA also must consider the extent that a veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when a veteran's symptoms are most prevalent ("flare-ups") due to the extent of his or her pain (and painful motion), weakness, premature or excess fatigability, and incoordination, assuming these factors are not already contemplated by the governing rating criteria. DeLuca v. Brown, 8 Vet. App. 202, 20407 (1995); 38 C.F.R. §§ 4.40, 4.45, 4.59. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the veteran. 38 C.F.R. § 4.3. 1. Beginning April 16, 2019, entitlement to an initial disability rating greater than 20 percent for service-connected left shoulder strain is denied. At his hearing, the Veteran argued that his left shoulder condition had worsened since his last VA examination, resulting in the Board's staged rating. He claims entitlement to a rating greater than 20 percent. The February 2014 Rating Decision on appeal awarded the Veteran service connection for his left shoulder; he was assigned a 10 percent disability rating effective August 31, 2012. A subsequent September 2017 Rating Decision increased that rating to 20 percent effective the same date. Under DC 5200, ankylosis of scapulohumeral articulation, favorable ankylosis with unfavorable abduction limited to 25 degrees from the side warrants a 50 percent disability rating for the dominant arm and 40 percent for the nondominant arm. Intermediated between unfavorable and favorable ankylosis warrants a 40 percent disability rating for the dominant arm and 30 percent for the nondominant arm. Unfavorable ankylosis with abduction limited to 25 degrees from the side warrants a 30 percent disability rating for the dominant arm and 20 percent for the nondominant arm. Under DC 5201, limitation of motion of the arm to 25 degrees from the side is rated as 40 percent disabling for the dominant arm and 30 percent disabling for the nondominant arm. Midway between the side and shoulder level warrants a 30 percent rating for the dominant arm and 20 percent for the nondominant arm. Limitation of motion to the shoulder level warrants a 20 percent disability rating for either arm. Plate I shows that normal range of motion for shoulder flexion and abduction is 0180 degrees, and external and internal rotation is 090 degrees. Shoulder level for both flexion and abduction is the 90 degree mark, while shoulder level for external and internal rotation is 0 degrees. Notably, DC 5201 does not provide separate ratings for limitations on flexion, extension, abduction and rotation; rather, DC 5201 permits only a single rating for limitation of motion of an arm. Yonek v. Shinseki, 722 F.3d 1355, 1359 (Fed. Cir. 2013). DC 5202 pertains to impairment of the humerus and recurrent dislocation of the shoulder at the scapulohumeral joint. Loss of head (flail shoulder) warrants an 80 percent disability rating for the dominant arm and 70 percent for the nondominant arm. Nonunion of the humerus (false flail joint) warrants a 60 percent disability rating for the dominant arm and 50 percent for the nondominant arm. Fibrous union of the humerus warrants a 50 percent disability rating for the dominant arm and 40 percent for the nondominant arm. Recurrent dislocation of the shoulder at the scapulohumeral joint with frequent episodes and guarding of all arm movements warrants a 30 percent disability rating for the dominant arm and 20 percent for the nondominant arm. Recurrent dislocation of the shoulder at the scapulohumeral joint with infrequent episodes and guarding movement only at shoulder level warrants a 20 percent rating for either arm. DC 5203 pertains to impairment of the clavicle or scapula. Dislocation of either joint for either arm warrants a 20 percent rating. Nonunion of either joint with loose movement also warrants a 20 percent rating for either arm; without loose movement warrants a 10 percent rating. The Board notes that, during the pendency of this appeal, VA has amended the rating criteria for the musculoskeletal system contained in 38 C.F.R. § 4.71a. These changes take effect February 7, 2021, and cannot be applied prior to that date. Beginning that date, however, the Board will apply the rating criteria that is more favorable to the Veteran: either the old or the new criteria. 85 Fed. Reg. 76,453, 76,469 (Nov. 30, 2020). The new criteria simply clarify three points regarding what the old criteria meant in discussing its ranges of motion: (1) Under DC 5201, limitation of motion midway between side and shoulder level means flexion and/or abduction limited to 45 degrees; (2) Under DC 5201, limitation of motion at shoulder level means flexion and/or abduction limited to 90 degrees; and (3) Under DC 5202, recurrent dislocation of the shoulder at the scapulohumeral joint with infrequent episodes and guarding movement only at shoulder level means flexion and/or abduction limited to 90 degrees. Other than these clarifications, there are no substantive changes to the rating criteria for the shoulders. Id. at 76,462. The only evidence associated with the claims file since the Board's last remand was the August 2021 VA examination provided to the Veteran. It noted physical examination of the Veteran and review of the claims file and recited the Veteran's complaints and medical history. He reported intermittent flare-ups of varying duration characterized by aching pain that does not cease. Precipitating factors were noted as increased activities, and the only alleviating factor is rest. The severity is mild. The Veteran characterized his functional loss as an inability to perform tasks involving overhead lifting. Initial active ranges of motion were as follows: flexion 090 degrees; abduction: 085 degrees; external and internal rotation: 075 degrees. There was pain on all variations. All the same was true for passive ranges of motion. There was pain on both weight bearing and non-weight bearing, but there was no crepitus. The Veteran could not perform repetitive-use testing due to increased pain. He was not observed immediately after repeated use over time, but the examiner noted that pain would contribute to functional loss and would reduce range of motion to the following: flexion: 080 degrees; abduction: 075 degrees; external and internal rotation: 065 degrees. The same was true for flare-ups. There was no atrophy or ankylosis. The report indicates that, for the rotator cuff, the left shoulder tested negative for the Empty Can and External Rotation/Infraspinatus Strength Tests; the Hawkin's Impingement and Lift-off Subscapularis Tests could not be performed. The examiner could not perform the Crank Apprehension and Relocation Test, but shoulder instability, dislocation or labral pathology was not suspected. The Veteran test negative for the Crossbody Adduction Test, but there was noted mild degenerative changes in the left acromioclavicular (AC) joint. There were no impairments of the humerus or required assistive devices. The Veteran's occupational impact was described as follows: "Veteran requires accommodations to allow for performance of tasks involving use of left shoulder only as tolerated and at own pace; he is not able to perform overhead tasks and will require significant limitations as a result; he is capable of performing light, sedentary activities as tolerated." The applicable DC here is 5201. To receive a rating greater than 20 percent, the Veteran's left shoulder must exhibit limitation of motion to at least midway between his side and shoulder level, i.e., 45 degrees. The August 2021 VA examination discussed above verifies that the Veteran does not meet this criterion. Even when considering the Veteran's additional pain and functional loss due to repeated use over time and flare-ups, his shoulder flexion has been limited to no more than 80 degrees. Thus, the Board is satisfied that the pertinent additional factors laid out within the regulations have been considered. See DeLuca, 8 Vet. App. at 20407; 38 C.F.R. §§ 4.40, 4.45, 4.59. Because the Veteran does not satisfy the range-of-motion requirement for an increased rating, and because there are no other shoulder conditions for which he may be compensated, his appeal on this issue must be denied. See 38 C.F.R. § 4.71a, DC 5201. 2. Beginning April 16, 2019, entitlement to an initial disability rating greater than 20 percent for service-connected lumbar strain is denied. At his hearing, the Veteran argued that his back condition has worsened since his last VA examination, resulting in the Board's staged rating. He claims entitlement to a higher rating. The February 2014 Rating Decision on appeal awarded the Veteran service connection for his back; he was assigned a 10 percent disability rating effective August 31, 2012. A September 2021 Rating Decision increased that rating to 20 percent, effective April 16, 2019. DCs 5235 through 5242 pertain to various disease and injuries of the spine. Invertebral disc syndrome based on incapacitating episodes (IVDS) (DC 5243), however, is rated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. 38 C.F.R. § 4.71a at Note (6). Under 38 C.F.R. § 4.71a, DCs 52355242, a 100 percent rating is warranted if there is unfavorable ankylosis of the entire spine. A 50 percent rating is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine. A 40 percent rating is warranted for limitation of forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 30 percent rating is warranted for forward flexion of the cervical spine 15 degrees or less; or favorable ankylosis of the entire cervical spine. The thoracolumbar spine encompasses forward flexion of 090 degrees; extension of 030 degrees; and bilateral lateral flexion and bilateral rotation of 030 degrees. The normal combined range of motion of the thoracolumbar spine is 240 degrees. All record ranges of motion are to be rounded to the nearest five degrees. Id. at Notes (2), (4), Plate V. 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. Id. at Note (5). Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are rated separately under an appropriate diagnostic code. Id. at Note (1). The United States Court of Appeals for Veterans Claims (CAVC) held that, while in the past the focus of applying the factors contained in 38 C.F.R. §§ 4.40 and 4.45 were limited to that of range of motion, nothing "suggests that those factors should not apply in the context of ankylosis, particularly as ankylosis is, in essence, a complete limitation of motion." Chavis v. McDonough, 34 Vet. App. 1, 19 (2021). Thus, the CAVC held, "application of §§ 4.40 and 4.45 permits consideration under the General Rating Formula of an evaluation based on ankylosis if a claimant's functional loss is consistent with that contemplated by ankylosisin other words, if it is the functional equivalent of ankylosis." Id. at 20. Under DC 5243, incapacitating episodes of IVDS having a total duration of at least six weeks during the past twelve months warrants a 60 percent rating. Incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past twelve months yields a 40 percent rating. Incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past twelve months warrants a 20 percent rating. Incapacitating episodes having a total duration of at least one week but less than two weeks during the past twelve months is rated as 10 percent disabling. For purposes of evaluations under DC 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. If IVDS is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. Id. at Notes (1) and (2). During the pendency of this appeal, VA has amended the rating criteria for the musculoskeletal system contained in 38 C.F.R. § 4.71a. These changes take effect February 7, 2021, and cannot be applied prior to that date. Beginning that date, however, the Board will apply the rating criteria that is more favorable to the Veteran: either the old or the new criteria. 85 Fed. Reg. 76,453, 76,469 (Nov. 30, 2020). The rating criteria for the spine also did not undergo any substantive changes. Rather, the rating schedule merely reflects updated DCs. DC 5242 now is assigned for degenerative arthritis and degenerative disc disease other than IVDS. DC 5243IVDSnow will be assigned only where there is disc herniation with compression and/or irritation of the adjacent nerve root; DC 5242 should be assigned for all other disc diagnoses. DC 5244 is created for complete, traumatic paralysis; if it does not cause loss of use of both hands or feet, then it is incomplete paralysis, and the residuals thereof should be rated under the appropriate DCs for the peripheral nerves. Paraplegia is to be rated under DC 5110. 85 Fed. Reg. 76,453, 76,463, 76,469 (Nov. 30, 2020). The only evidence associated with the claims file since the Board's last remand was the August 2021 VA examination provided to the Veteran. It noted physical examination of the Veteran and review of the claims file and recited the Veteran's complaints and medical history. The report indicated that Veteran suffers from a lumbosacral strain. He reported intermittent flare-ups of varying duration characterized by aching pain. Precipitating factors were noted as increased activities, and the only alleviating factor is rest. The severity is mild. Functional impact was noted as difficulty with heavy lifting (more than twenty-five pounds), walking, and bending over. Initial active ranges of motion were recorded as follows: forward flexion: 045 degrees; extension: 010 degrees; right lateral flexion: 015 degrees; left lateral flexion: 010 degrees; right lateral rotation: 020 degrees; and left lateral rotation: 015 degrees. Pain was noted for all ranges of motion. All the same was true for passive range of motion. There was pain on weight bearing and non-weight bearing, but there was no crepitus. Repetitive use testing was not performed due to increased pain. While the Veteran was not observed immediately after repeated use over time, the examiner opined that pain would cause loss of range of motion as follows: forward flexion: 040 degrees; extension: 05 degrees; right lateral flexion: 010 degrees; left lateral flexion: 05 degrees; right lateral rotation: 015 degrees; and left lateral rotation: 010 degrees. The exact same was noted for flare-ups. The Veteran did not experience guarding or muscle spasm of the thoracolumbar spine. Muscle strength was normal. There was no muscle atrophy, ankylosis, IVDS or radiculopathy. No assistive devices were noted. The Veteran's occupational limitations were noted as requiring accommodations to allow performance of prolonged or strenuous activities at his own pace and tolerance. He cannot lift more than twenty-five pounds or engage in repetitive bending or prolonged walking. He can perform light, sedentary activities at his own pace and tolerance. The evidence of record does not show that the Veteran is entitled to a rating greater than 20 percent. First, he does not experienceeven considering additional pain due to repeated use over time and flare-upslimitation of forward flexion to at least 30 degrees. See DeLuca, 8 Vet. App. at 20407; 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, DC 52355242. Second, there is no evidence that the Veteran experiences ankylosis of any formeither diagnosed or its functional equivalent. There is no evidence to suggest that the Veteran's spine is fixed in any position even at its worst during a flare-up. Thus, the Board does not find that ankylosis is present. See Chavis, 34 Vet. App. at 19; 38 C.F.R. § 4.71a, DC 52355242. The Veteran has not been diagnosed with IVDS, so those criteria are inapplicable in this case. There also are no other neurological symptoms that can be assigned separate ratings. Thus, the Board finds that, beginning April 16, 2019, the Veteran's current 20 percent captures his current disability and that a rating greater than that is not warranted. See 38 C.F.R. § 4.71a, DC 52355242. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Trevor T. Bernard, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.