Citation Nr: 22018141 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 15-15 432 DATE: March 28, 2022 ORDER A disability rating in excess of 10 percent for service-connected left knee injury with limitation of flexion, status post arthroscopy, is denied. A compensable disability rating for service-connected left knee injury with limitation of extension, status post arthroscopy, is denied. A disability rating in excess of 20 percent for service-connected left shoulder disability is denied. A disability rating in excess of 10 percent for service-connected left ankle disability is denied. FINDINGS OF FACT 1. The Veteran's service-connected left knee injury with limitation of flexion, status post arthroscopy is manifested by complaints of pain and limitation of flexion to no less than 85 degrees. 2. The Veteran's service-connected left knee injury with limitation of extension, status post arthroscopy is manifested by complaints of pain and limitation of extension to no more than 5 degrees. 3. The Veteran's service-connected left shoulder disability is manifested by complaints of pain with limitation of abduction to 80 degrees. 4. The Veteran's service-connected left ankle disability is manifested by complaints of pain and limitation of left ankle dorsiflexion to no greater than 10 degrees and plantar flexion to no less than 30 degrees. CONCLUSIONS OF LAW 1. The criteria for entitlement to an evaluation in excess of 10 percent for service-connected left knee injury with limitation of flexion, status post arthroscopy have not been met. See 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.159, 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260 (2020); Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a). 2. The criteria for entitlement to a compensable evaluation for service-connected left knee injury with limitation of extension, status post arthroscopy have not been met. See 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.159, 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261 (2020); Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a). 3. The criteria for entitlement to an evaluation in excess of 20 percent rating for service-connected left shoulder disability have not been met. See 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.159, 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201 (2020); Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a). 4. The criteria for entitlement to an evaluation in excess of 10 percent for service-connected left ankle disability have not been met. See 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.159, 3.321, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271 (2020); Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from February 1969 to September 1991. This appeal to the Board of Veterans' Appeals (Board) arose from August 2012 and March 2014 rating decisions issued by the Department of Veterans Affairs (VA). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran requested a hearing before the Board, but later withdrew the request. See April 2015 VA Form 9; June 2017 Hearing request correspondence. The Veteran has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Thus, the Board need not discuss any potential issues in this regard. Increased Rating In reviewing the Veteran's appeals for increased ratings, the Board has not overlooked the holding of the United States Court of Appeals for Veterans Claims in Rice v. Shinseki, 22 Vet. App. 447 (2009)(holding that claims for higher evaluations also include a claim for entitlement to individual unemployability (TDIU) when the appellant claims he is unable to work due to a service-connected disability). However, the evidence of record does not suggest that the Veteran is unemployable due specifically to his service-connected disabilities on appeal. As such, the Board finds that Rice is not applicable to the current appeal, and the issue of entitlement to TDIU should not be construed as being on appeal. See Rice, 22 Vet. App. 447, citing Comer v. Peake, 552 F.3d 1362 (Fed. Cir. 2009). Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. The Veteran's entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1. Where the Veteran timely appealed the rating initially assigned for the service-connected disability within one year of the notice of the establishment of service connection for it, VA must consider whether the Veteran is entitled to "staged" ratings to compensate him for times since filing his claim when his disability may have been more severe than at other times during the course of his appeal. See Fenderson v. West, 12 Vet. App. 119 (1999). But where service connection has already been established, and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, in such cases, when the factual findings show distinct time periods during which a claimant exhibits symptoms of the disability at issue and such symptoms warrant different evaluations, staged evaluations may also be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). Here, such staged ratings have not been assigned. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disabilities in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. 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 disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261- 62 (1994). When evaluating musculoskeletal disabilities, VA may, in addition to applying schedular criteria, consider granting a higher rating in cases in which the claimant experiences additional functional loss due to pain, weakness, excess fatigability, or incoordination, to include with repeated use or during flare-ups, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996). 1. Entitlement to a rating in excess of 10 percent for service-connected left knee injury with limitation of flexion, status post arthroscopy, is denied. 2. Entitlement to a compensable rating for service-connected left knee injury with limitation of extension, status post arthroscopy, is denied. In a March 2014 rating decision, the Regional Office (RO) continued a 10 percent evaluation for service-connected left knee injury with limitation of flexion, status post arthroscopy under Diagnostic Code 5260. The RO also separately assigned a noncompensable evaluation for this disability under Diagnostic Code 5261, effective February 11, 2013. The Board notes that the RO appeared to recharacterize this issue as a left knee injury with arthroscopy with limitation of extension and assign an earlier effective date of February 6, 2013, in a March 2019 rating decision. The Veteran is seeking entitlement to increased evaluations. As an initial matter, the Board notes that, during the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended, effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110 (g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110 (g) can be no earlier than the effective date of that change. As the period of time on appeal extends to the present, the Board will consider the Veteran's knee claims under the old criteria prior to February 7, 2021, and under the new rating criteria from February 7, 2021, to the present, where applicable. The criteria that is more favorable to the Veteran will be applied. The Board has reviewed all relevant post-service medical records, as well as the Veteran's statements. The Board notes that the Veteran reported chronic knee pain throughout his VA treatment records. Additionally, the Veteran underwent VA knee examinations in March 2013, December 2019, and August 2020, which are of record. According to Diagnostic Code 5260, a 10 percent disability rating is warranted for flexion limited to 45 degrees; a 20 percent disability rating is assigned for flexion limited to 30 degrees; and a 30 percent disability rating is assigned for flexion limited to 15 degrees. See 38 C.F.R. § 4.71a. Under Diagnostic Code 5261, a 10 percent disability rating is warranted for extension limited to 10 degrees; a 20 percent disability rating is assigned for extension limited to 15 degrees; a 30 percent disability rating is assigned for extension limited to 20 degrees; a 40 percent disability rating is assigned for extension limited to 30 degrees; and a 50 percent disability rating is assigned for extension limited to 45 degrees. See 38 C.F.R. § 4.71a. Normal range of motion of the knee is to 0 degrees extension and to 140 degrees flexion. See 38 C.F.R. § 4.71a, Plate II. Separate ratings under Diagnostic Code 5260 (leg, limitation of flexion) and Diagnostic Code 5261 (leg, limitation of extension), both currently codified under 38 C.F.R. § 4.71a, may be assigned for disability of the same joint. See VAOPGCPREC 9-04 (2004). The Board notes that no changes were made to Diagnostic Codes 5260 or 5261 via the February 7, 2021, regulatory revisions. With regard to the possibility of assigning an evaluation in excess of 10 percent for the Veteran's service-connected left knee disability under Diagnostic Code 5260, the Board notes that there is no evidence of record demonstrating that the Veteran's left knee was limited in flexion to 30 degrees or less. Specifically, the March 2013 and the December 2019 VA Disability Benefits Questionnaires (DBQs) noted a range of motion of the left knee from 0 to 120 degrees with no additional limitations after 3 repetitions of range of motion. The August 2020 DBQ noted a range of motion of the left knee from +5 to 95 degrees with additional limitations of +5 to 85 degrees after 3 repetitions of range of motion. There is no medical evidence of record recording limitation of motion to a greater degree. As such, an increased rating is not warranted based on limitation of flexion for the Veteran's left knee for any period of time on appeal under Diagnostic Code 5260. With regard to the possibility of assigning an increased evaluation for the Veteran's service-connected left knee disability under Diagnostic Code 5261, the Board finds there is no evidence of record demonstrating that the Veteran's left knee was limited in extension to 10 degrees or more at any period of time on appeal. As noted, the Veteran's extension was recorded at zero degrees bilaterally at both the March 2013 and December 2019 DBQs and at 5 degrees at the August 2020 DBQ. There is no medical evidence of record demonstrating a more severe limitation of extension. As such, an increased rating is not warranted based on limitation of extension for the Veteran's left knee for any period of time on appeal under Diagnostic Code 5261. The Board has reviewed alternative diagnostic codes under which the Veteran could receive increased ratings for his service-connected left knee disabilities. Specifically, there is no evidence of record showing that the Veteran has ankylosis; impairment of the tibia and fibula; or acquired, traumatic genu recurvatum. As such, Diagnostic Codes 5256, 5262, and 5263 are not applicable for any period of time on appeal under either the old or the new diagnostic criteria. Diagnostic Code 5010 addresses the issue of arthritis due to trauma, substantiated by x-ray findings, which is to be rated as degenerative arthritis under Diagnostic Code 5003. See 38 C.F.R. § 4.71a, Diagnostic Code 5010. Degenerative arthritis, or osteoarthritis, when established by x-ray findings, will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. The Veteran is not service connected for arthritis of the left knee, so those diagnostic codes are not applicable. Moreover, the Veteran is already assigned a 10 percent rating for the left knee for the entire period of time on appeal for noncompensable limitation of motion with pain. As such, considering the service-connected disabilities under Diagnostic Codes 5003 or 5010 would not afford him any higher ratings. With regard to Diagnostic Codes 5258 and 5259, the Veteran is not service connected for symptomatic removal of semilunar cartilage or for a disability relating to dislocated, semilunar cartilage. Moreover, while the evidence of record documents knee pain and the August 2020 DBQ noted a history of recurrent effusion, the medical evidence of record does not reveal frequent episodes of locking related to his service-connected knee disabilities. As such, an increased or separate compensable evaluation is not available under Diagnostic Code 5258 or 5259 for the Veteran's service-connected left knee disabilities. With regard to Diagnostic Code 5257, the Board notes that, throughout the course of this appeal, the Veteran has been granted service connection separately for impairment of the left knee and assigned a 20 percent evaluation, effective August 25, 2020, under Diagnostic Code 5257. While the Veteran has given no indication that he disagrees with this disability rating or the assigned effective date, the Board will still consider whether the Veteran's service-connected left knee disabilities on appeal warrant a higher or an earlier assigned evaluation under Diagnostic Code 5257 for any period of time on appeal. Prior to the February 7, 2021, regulatory change, Diagnostic Code 5257 addresses impairment of the knee in the form of recurrent subluxation or lateral instability. A 10 percent evaluation is warranted for slight recurrent subluxation or lateral instability, a 20 percent is warranted for moderate recurrent subluxation or lateral instability, and a 30 percent is warranted for severe recurrent subluxation or lateral instability. As of February 7, 2021, under the amended criteria, Diagnostic Code 5257 addresses knee, other impairment. With regard to recurrent subluxation or lateral instability, a 10 percent evaluation is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent evaluation is warranted for one of the following: (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device for ambulation, (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device or bracing for ambulation. A 30 percent evaluation is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device and bracing for ambulation. With regard to patellar instability, a 10 percent evaluation is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent evaluation is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A 30 percent evaluation is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. According to note (1), for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. According to note (2), a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). With regard to the criteria in effect prior to February 7, 2021, the Board finds no medical evidence of record reflecting that the Veteran's service-connected disability of either knee has manifested with recurrent subluxation or lateral instability prior to August 25, 2020. The December 2019 VA examiner noted no history of recurrent subluxation or lateral instability. The March 2013 VA examiner also noted no history of recurrent subluxation and documented normal testing related to anterior instability, posterior instability, and medial-lateral instability. As such, a separate or increased evaluation is not warranted for the Veteran's left knee disabilities prior to August 25, 2020, under the Diagnostic Code 5257 criteria in effect prior to February 7, 2021. For the period of August 25, 2020, to the present, the Board finds the evidence of record does reflect that the Veteran's service-connected left knee disability manifests with recurrent subluxation or lateral instability that is more than moderate in severity. The August 2020 DBQ specifically noted no history of recurrent subluxation of the left knee, and the Veteran's lateral instability was noted as moderate in nature. As such, an evaluation in excess of 20 percent is not warranted for the Veteran's left knee, effective August 25, 2020, under the Diagnostic Code 5257 criteria in effect prior to February 7, 2021. With regard to the Diagnostic Code 5257 criteria in effect as of February 7, 2021, the Board acknowledges that the 20 percent disability rating was assigned to compensate the Veteran for moderate instability. The medical evidence of record, to include the August 2020 DBQ, does not reflect that the Veteran's service-connected disability relates to a condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker, Moreover, the Veteran's service-connected left knee disability has not manifested with an unrepaired or failed repair of complete ligament tear causing persistent instability, or the need of a prescription from a medical provider for both an assistive device and bracing for ambulation. The Board acknowledges that the Veteran indicated in the August 2020 DBQ that he uses a cane regularly, but the DBQ does not indicate that he uses a brace as well. Moreover, he is not service connected for a ligament tear of the left knee. As such, the Board finds that an evaluation in excess of 20 percent is not warranted for the Veteran's left knee disabilities under the Diagnostic Code 5257 criteria in effect as of February 7, 2021. With respect to the possibility of assigning higher ratings for any period of time on appeal under 38 C.F.R. §§ 4.40 and 4.45, there is no indication in the medical evidence of record, to include the March 2013, December 2019, and August 2020VA knee examination reports, that any subjective complaints, such as pain, fatigue, incoordination, or weakness, result in additional limitation of function so as to meet the criteria for higher evaluations than have already been assigned or for any further separate evaluations for any period of time on appeal. As noted above, the March 2013, December 2019, and August 2020 VA examiner noted that there were no additional limitations after 3 repetitions of range of motion so significant as to meet the criteria for a higher evaluation. Moreover, the August 2020 VA examiner noted that the examination was medically consistent with the Veteran's statements describing function loss during flare up. In conclusion, the Board finds that the preponderance of the evidence is against the appeal for a rating in excess of 10 percent for the Veteran's service-connected left knee injury with limitation of flexion, status post arthroscopy, and a compensable rating for his service-connected left knee injury with limitation of extension, status post arthroscopy for any period of time on appeal. The benefit of the doubt rule enunciated in 38 U.S.C. § 5107 (b) is not for application. See generally Gilbert, supra; Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). Assignment of staged ratings is not for application. The Veteran has not raised the issue of an extraschedular evaluation through his statements, and the evidence of record does not raise the issue through documentation of symptoms not contemplated by the rating criteria. 3. Entitlement to a rating in excess of 20 percent for service-connected left shoulder disability is denied. In an August 2012 rating decision, the RO continued a 20 percent evaluation for service-connected residuals of a left shoulder injury (minor), under Diagnostic Codes 5299-5201. The Veteran is seeking an increased rating. As noted, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended during the pendency of the appeal, effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). As the period of time on appeal extends to the present, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021, and under the new rating criteria from February 7, 2021, to the present, where applicable. The criteria that is more favorable to the Veteran will be applied. Prior to February 7, 2021, Diagnostic Code 5201 provides for ratings based on limitation of motion of the arm. Specifically, Diagnostic Code 5201 provides a 20 percent rating for limitation of motion of the minor arm at shoulder level or midway between side and shoulder level. A 30 percent evaluation is warranted for limitation of motion of the minor arm to 25 degrees from side. 38 C.F.R. § 4.74a, Diagnostic Code 5201 (2020). Effective February 7, 2021, Diagnostic Code 5201 was altered to clarify that midway between the side and shoulder level would be considered flexion and/or abduction limited to 45 degrees and shoulder level would be considered flexion and/or abduction limited to 90 degrees. Normal ranges of upper extremity motion are defined by VA regulation as follows: forward elevation (flexion) from zero to 180 degrees; abduction from zero to 180 degrees; and internal and external rotation to 90 degrees. Lifting the arm to shoulder level is lifting it to 90 degrees. See 38 C.F.R. § 4.71, Plate I (2020). The Board has reviewed all relevant post-service medical records, as well as the Veteran's statements. The Board notes that the Veteran reported chronic shoulder pain throughout his VA treatment records. Additionally, the Veteran underwent VA shoulder examinations in May 2012, March 2013, November 2019, and August 2020, which are of record. The Board finds the criteria for a rating higher than 20 percent were not met under Diagnostic Code 5201 for any period of time on appeal. Specifically, there is no evidence from this time period reflecting limitation of motion of the minor arm to 25 degrees from the side. The May 2012 VA examination noted an abduction and flexion to 180 degrees with no additional limitations after 3 repetitions of range of motion. A January 2013 VA treatment record noted a forward flexion of 0 to 90 degrees with mild discomfort. The March 2013 VA examination noted a limitation of abduction and flexion to 140 degrees with no additional limitations after 3 repetitions of range of motion. The November 2019 VA examination noted a limitation of abduction and flexion to 140 degrees with no additional limitations after 3 repetitions of range of motion. The August 2020 VA examination noted right shoulder limitation of abduction to 80 degrees and flexion to 85 degrees with no additional limitation of abduction after 3 repetitions of range of motion and limitation of flexion to 80 degrees after 3 repetitions of range of motion. Therefore, as the evidence of record does not reflect that the Veteran's left shoulder is limited to 25 degrees from the side, an increased evaluation is not available under Diagnostic Code 5201 under the criteria in effect prior to and as of February 7, 2021. The Board has reviewed the remaining diagnostic codes relating to shoulder disabilities but finds that they do not provide for an increased or separate rating under the circumstances. See 38 C.F.R. § 4.71a, Diagnostic Codes 5200, 5202, and 5203. As there is no evidence of ankylosis of the scapulohumeral articulation, flail shoulder, false flail shoulder, fibrous nonunion of the humerus, malunion of the humerus with moderate or marked deformity, recurrent dislocation of the scapulohumeral joint, or impairment of the clavicle or scapula, an increased or separate rating is not warranted under Diagnostic Codes 5200, 5202, or 5203 under the criteria in effect prior to and as of February 7, 2021. As such, the Board finds that the symptoms associated with this service-connected disability are most appropriately rated under Diagnostic Code 5201, and an increased or separate rating cannot be granted under other diagnostic codes. In rendering this determination, the Board has considered Diagnostic Codes 5003 and 5010 addressing arthritis. However, as the Veteran is already assigned a 20 percent rating for his left shoulder disability for the entire period of time on appeal for limitation of motion with pain, considering the service-connected disability under Diagnostic Codes 5003 or 5010 would not afford him any higher rating. With respect to the possibility of assigning higher ratings for any period of time on appeal under 38 C.F.R. §§ 4.40 and 4.45, there is no indication in the medical evidence of record, to include the March 2013, November 2019, and August 2020 VA shoulder examination reports, that any subjective complaints, such as pain, fatigue, incoordination, or weakness, result in additional limitation of function so as to meet the criteria for a higher evaluations than have already been assigned or for any separate evaluations for any period of time on appeal. As noted above, the March 2013, November 2019, and August 2020 VA examiners noted that there were no additional limitations after 3 repetitions of range of motion so significant as to meet the criteria for a higher evaluation. Moreover, the August 2020 VA examiner noted that the examination was medically consistent with the Veteran's statements describing function loss during flare up. In summary, for the reasons and bases set forth above, the Board concludes that the preponderance of the evidence is against the claim for an increased rating, and the benefit of the doubt rule enunciated in 38 U.S.C. § 5107 (b) is not for application. See generally Gilbert, supra; Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). Assignment of staged ratings is not for application. The Veteran has not raised the issue of an extraschedular evaluation through his statements, and the evidence of record does not raise the issue through documentation of symptoms not contemplated by the rating criteria. 4. Entitlement to a rating in excess of 10 percent for service-connected left ankle disability is denied. In a March 2014 rating decision, the RO continued a 10 percent evaluation for service-connected left ankle sprain under Diagnostic Code 5271. The Veteran is seeking a higher evaluation. Diagnostic Code 5271 applies when there is limited motion of the ankle. A 10 percent evaluation is assigned where the limitation of motion is "moderate." A 20 percent evaluation is assigned where the limitation of motion is "marked." This is the maximum evaluation available under this diagnostic code. As noted, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended during the pendency of the appeal, effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). As the period of time on appeal extends to the present, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021, and new rating criteria from February 7, 2021, to the present, where applicable. The criteria that is more favorable to the Veteran will be applied. Diagnostic Code 5271 contemplates disability of the ankle manifested by limitation of motion. Under this code, prior to February 7, 2021, a 10 percent rating is assigned when limitation of motion is moderate, and a 20 percent rating is assigned when limitation of motion is marked. Effective February 7, 2021, moderate limitation of motion is described as less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion; and marked limitation of motion is described as less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. Normal range of motion of the ankle includes plantar flexion from 0 degrees to 45 degrees and dorsiflexion (extension) from 0 degrees to 20 degrees. 38 C.F.R. § 4.71a, Plate II. The Board notes that words such as 'mild,' 'moderate,' 'severe', and 'marked' are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are 'equitable and just'. 38 C.F.R. 4.6. It should also be noted that use of terminology such as 'mild' and 'severe' by VA examiners and others, although evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 U.S.C.A. § 7104 (West 2014); 38 C.F.R. §§ 4.2, 4.6 (2020). The Board has reviewed all relevant post-service medical records, as well as the Veteran's statements. The Board notes that the Veteran reported chronic ankle pain throughout his VA treatment records. Additionally, the Veteran underwent VA ankle examinations in March 2013, November 2019, and August 2020, which are of record. With regard to granting an evaluation in excess of 10 percent under Diagnostic Code 5271, the Board finds that the Veteran's left ankle does not meet the criteria of marked limitation of motion and does not manifest with less than 5 degrees of dorsiflexion or less than 10 degrees of plantar flexion. The Board acknowledges that the March 2013, November 2019, and August 2020 all reveal some limitation of motion. Specifically, the Veteran's left ankle plantar flexion was noted at 45 degrees or greater and his left ankle dorsiflexion was noted at 15 degrees in the March 2013 VA examination. No additional limitation was noted upon repetitive testing. In the November 2019 VA examination report, the Veteran's dorsiflexion was noted at 20 degrees and his plantar flexion was noted at 40 degrees with no additional limitation of motion after 3 repetitions. In the August 2020 VA examination report, the Veteran's dorsiflexion was noted at 15 degrees and his plantar flexion was noted at 35 degrees. Upon repetitive testing, the Veteran's left ankle dorsiflexion was noted at 10 degrees and his plantar flexion as noted at 30 degrees. While the Board has considered these limitations of motion, the Board does not find that a plantar flexion of 30 degrees and a dorsiflexion of 10 degrees would be considered more than moderate limitation of motion, given that normal plantar flexion ranges are from 0 to 45 degrees and normal dorsiflexion ranges are from 0 to 20 degrees. Moreover, the evidence of record clearly does not demonstrate less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. As such, an increased rating is not available under the criteria of Diagnostic Code 5271 in effect as of February 7, 2021, or prior to February 7, 2021. The Board has reviewed alternative diagnostic codes under which the Veteran could receive increased ratings for his service-connected left ankle disability. However, the Board them to be inapplicable in this case. See 38 C.F.R. § 4.71a, Diagnostic Codes 5270-5274. Specifically, the Veteran's service-connected left ankle disability does not manifest with ankylosis of the ankle (Diagnostic Code 5270), ankylosis of the subastragalar or tarsal joint (Diagnostic Code 5272), malunion of os calcis or astragalus (Diagnostic Code 5273), or astragalectomy (Diagnostic Code 5274). As such, increased or separate evaluations are not available for this disability under these diagnostic codes. In rendering this determination, the Board has considered Diagnostic Codes 5003 and 5010 addressing arthritis. However, as the Veteran is already assigned a 10 percent rating for the left ankle for the entire period of time on appeal for limitation of motion with pain, considering the service-connected disability under Diagnostic Codes 5003 or 5010 would not afford him any higher rating. With respect to the possibility of assigning higher ratings for any period of time on appeal under 38 C.F.R. §§ 4.40 and 4.45, there is no indication in the medical evidence of record, to include the March 2013, November 2019, and August 2020 VA ankle examination reports, that any subjective complaints, such as pain, fatigue, incoordination, or weakness, result in additional limitation of function so as to meet the criteria for a higher evaluation than has already been assigned or for any separate evaluations for any period of time on appeal. As noted above, the March 2013, November 2019, and August 2020 VA examiners noted that there were no additional limitations after 3 repetitions of range of motion so significant as to meet the criteria for a higher evaluation. Moreover, the August 2020 VA examiner noted that the examination was medically consistent with the Veteran's statements describing function loss during flare up. In summary, for the reasons and bases set forth above, the Board concludes that the preponderance of the evidence is against the claim for an increased rating, and the benefit of the doubt rule enunciated in 38 U.S.C. § 5107 (b) is not for application. See generally Gilbert, supra; Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). Assignment of staged ratings is not for application. The Veteran has not raised the issue of an extraschedular evaluation through his statements, and the evidence of record does not raise the issue through documentation of symptoms not contemplated by the rating criteria. JEREMY J. OLSEN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Durham, 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.