Citation Nr: 22046509 Decision Date: 08/16/22 Archive Date: 08/16/22 DOCKET NO. 17-56 959 DATE: August 16, 2022 ORDER Entitlement to a 100 percent disability rating for service-connected posttraumatic stress disorder (PTSD) with depression, alcohol dependence, and cocaine dependence prior to November 26, 2019, is granted. Entitlement to a disability rating higher than 20 percent for service-connected subacromial bursitis, right shoulder, is denied. Entitlement to a disability rating higher than 10 percent for service-connected degenerative joint disease of the first metatarsal with left foot strain is denied. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran's service-connected psychiatric symptoms and overall impairment more nearly approximated total occupational and social impairment. 2. Throughout the appeal period, the symptoms and functional impairment of the Veteran's service-connected subacromial bursitis of the right shoulder most nearly approximated limitation of motion of the arm to 60 degrees from the side after consideration of limitation due to pain; it did not more nearly approximate unfavorable ankylosis (or its functional equivalent) and did not involve a fibrous union of the humerus, nonunion of the humerus (false flail joint), or loss of head of the humerus (flail shoulder). 3. Throughout the appeal period, the Veteran's service-connected degenerative joint disease of the first metatarsal with left foot strain most nearly approximates a mild foot injury, manifested by aching pain, without incapacitating or non-incapacitating exacerbations, symptom combinations productive of definite or severe impairment of health, or manifestations that more nearly approximate a moderately severe or severe foot injury. CONCLUSIONS OF LAW 1. The criteria for a 100 percent disability rating for PTSD with depression, alcohol dependence, and cocaine dependence have been met throughout the appeal period. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.130, Diagnostic Code 9411. 2. The criteria for a disability rating in excess of 20 percent for service-connected subacromial bursitis of the right shoulder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321(b), 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201. 3. The criteria for a disability rating in excess of 10 percent for service-connected degenerative joint disease of the first metatarsal with left foot strain have not been met. 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 5010-5284. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 2008 to November 2008, and from March 2009 to April 2010. These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2015 Rating Decision of a Department of Veterans Affairs (VA) Regional Office (RO). Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found, a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. 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. 1. Entitlement to a disability rating higher than 70 percent for service-connected PTSD with depression, alcohol dependence, and cocaine dependence prior to November 26, 2019 The Veteran seeks entitlement to a higher disability rating for his service-connected PTSD with depression, alcohol dependence, and cocaine dependence. The Board's June 2019 decision remanded the issue of entitlement to a disability rating higher than 70 percent for service-connected PTSD for additional development. The Veteran was then provided with a VA PTSD examination on November 26, 2019, and an August 2020 Rating Decision granted entitlement to a 100 percent disability rating effective November 26, 2019, based on the results of that examination. As such, the Veteran now seeks a disability rating in excess of 70 percent prior to November 26, 2019. Prior to November 26, 2019, the Veteran's PTSD was rated as 70 percent disabling pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411. All acquired psychiatric disorders, with the exception of eating disorders, are evaluated under the General Rating Formula for Mental Disorders. A 70 percent rating is assigned when there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. 38 C.F.R. § § 4.130, Diagnostic Code 9411. A 100 percent rating is assigned when there is evidence of total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time and place; memory loss for names of close relatives, own occupation or name. Id. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. The rating agency shall assign a rating based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126 (a). When evaluating the level of disability from a mental disorder, VA will also consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). Under the General Rating Formula, the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. On the other hand, if the evidence shows that the Veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating will be assigned. Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004); Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). The appeal period for the increased rating claim for PTSD begins on June 25, 2015, when the Veteran filed his claim of entitlement to increased compensation benefits. For the following reasons, a disability rating of 100 percent for PTSD prior to November 26, 2019, is warranted. Crucially, the November 2019 VA PTSD examination report that formed the basis of the Veteran's increased 100 percent rating found that his psychiatric diagnoses resulted in total occupational and social impairment due to symptoms such as depressed mood; anxiety; suspiciousness; panic attacks more than once a week; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; difficulty in understanding complex commands; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work like setting; impaired impulse control, such as unprovoked irritability with periods of violence; spatial disorientation; persistent delusions or hallucinations; grossly inappropriate behavior; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. However, medical treatment records dated prior to November 26, 2019, also documented the psychiatric symptomatology contemplated by the criteria for a 100 percent disability rating pursuant to Diagnostic Code 9411. For instance, the report of an October 2012 VA PTSD examination report indicated that the Veteran's psychiatric diagnoses resulted in inability to establish and maintain effective relationships; suicidal ideation; and impaired impulse control, such as unprovoked irritability with periods of violence. VA treatment records dated from the Atlanta VA Medical Center in Atlanta, Georgia, dated in March 2013 indicated that the Veteran was both suicidal and homicidal. VA treatment records from the Anniston-Oxford VA Clinic in Oxford, Alabama, dated in August 2014 indicated that the Veteran had been admitted to the in-patient unit at the Tuscaloosa VA Medical Center in Tuscaloosa, Alabama, for psychiatric symptomatology such as homicidal thoughts. Additionally, the report of a December 2015 VA PTSD examination indicated that the Veteran's psychiatric diagnoses resulted in intrusive thoughts; impaired judgment; difficulty in establishing and maintaining effective work and social relationships; and impaired impulse control, such as unprovoked irritability with periods of violence. Indeed, the evidence indicates that the Veteran reported homicidal ideation as well as suicidal ideation just prior to the appeal period, and was even hospitalized for this symptomatology in 2014. See Bankhead v. Shulkin, 29 Vet. App. 10, 20 (2017) (stating the language of 38 C.F.R. § 4.130 "indicates that the presence of suicidal ideation alone, that is, a veteran's thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment in most areas."). A review of the Veteran's Social Security Administration (SSA) records also suggests total occupational and social impairment due to service-connected psychiatric symptomatology throughout the period on appeal. For example, an October 2014 SSA Decision found that the Veteran had been disabled under the Social Security Act due to major depressive disorder and PTSD since January 2010. In reaching this conclusion, the Administrative Law Judge found the Veteran's allegations that he was unable to work due to nightmares, anxiety issues in relating to people, and controlled emotional outbursts to be credible, and agreed with the post-hearing consultative psychological evaluator that the Veteran would have considerable difficulty coping with supervisors, coworkers, and members of the public in the work setting. In sum, the Veteran's PTSD has resulted in symptoms of similar severity, frequency, and duration to the symptoms associated with a 100 percent rating and have more nearly approximated total occupational and social impairment throughout the period on appeal. Resolving any remaining reasonable doubt in the Veteran's favor (as required under 38 C.F.R. § 4.3), the Board finds that a 100 percent rating for PTSD with depression, alcohol dependence, and cocaine dependence is warranted throughout the period on appeal. 2. Entitlement to rating higher than 20 percent for service-connected subacromial bursitis, right shoulder The Veteran also seeks a higher disability rating for his service-connected subacromial bursitis of the right shoulder. 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, 44 (2011), the United States Court of Appeals for Veterans Claims (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; DeLuca v. Brown, 8 Vet. App. 202 (1995). 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, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The Veteran's right shoulder disability has been evaluated as 20 percent disabling pursuant to Diagnostic Code 5201, which outlines the rating criteria for limitation of arm motion. The VA examination reports of record reflect that the Veteran is right-hand dominant, meaning that his right shoulder disability affects his dominant arm. Per Diagnostic Code 5019, which outlines the rating criteria for bursitis, bursitis is to be evaluated based on limitation of the affected part per the rating criteria for degenerative arthritis. Pursuant to Diagnostic Code 5003, degenerative arthritis established by X-ray findings is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. However, when limitation of motion due to degenerative arthritis is noncompensable under the appropriate diagnostic code, 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. A 20 percent rating under Diagnostic Code 5003 requires involvement of two or more major joints or two or more minor joint groups with occasional incapacitating exacerbations. For the purpose of rating disability from arthritis, the shoulder is considered a major joint. See 38 C.F.R. § 4.45. Per Diagnostic Code 5201, a 20 percent rating (the minimum rating available for both the dominant and non-dominant arm pursuant to this Diagnostic Code) is assigned when the range of arm motion is limited to shoulder level for the dominant arm. The next higher rating of 30 percent rating requires that shoulder motion for the dominant arm be limited to the midway point between the side and shoulder level. 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. While Diagnostic Code 5201 was amended as of February 7, 2021, such amendments did not intend to alter the rating criteria; rather, they simply clarified the specific ranges of motion that qualified as limitations to promote consistency among ratings. As noted in the clarification, a 30 percent rating for a major joint where motion is limited to "midway between side and shoulder level," was clarified as being flexion and/or abduction limited to 45 degrees or less. Additionally, a 40 percent rating for a major joint where motion is limited "to 25 degrees from side" was clarified as being flexion and/or abduction limited to 25 degrees from side. Here, the Veteran was provided with a VA Shoulder and Arm Conditions examination in July 2014, at which time he was diagnosed as having subacromial bursitis with degenerative joint disease of the acromioclavicular joint. At that time, the Veteran reported limited motion and chronic pain; however, he denied that flare-ups impacted the function of his shoulder and/or arm. Range of motion testing revealed right shoulder flexion limited to 90 degrees (with pain at 60 degrees), and right shoulder abduction limited to 80 degrees (with pain at 60 degrees). The Veteran was able to perform repetitive-use testing with 3 repetitions, and exhibited right shoulder flexion limited to 90 degrees and right shoulder abduction limited to 85 degrees after repetitive-use testing. There was no additional limitation in range of motion of the shoulder and arm following repetitive-use testing. However, the Veteran did have functional loss and/or functional impairment of the shoulder and arm after repetitive use due to less movement than normal, excess fatiguability, and pain on movement. The Veteran also exhibited localized tenderness or pain on palpation of joints/soft tissue/biceps tendon of the right shoulder. Muscle strength testing revealed normal strength. There was no evidence of ankylosis. Hawkins' Impingement testing (possibly signifying rotator cuff tendinopathy or tear), empty-can testing (possibly signifying rotator cuff pathology), and lift-off subscapularis testing (possibly signifying infraspinatus tendinopathy or tear) were positive in the right shoulder. There was no evidence of instability/dislocation/labral pathology; clavicle, scapula, acromioclavicular joint, and sternoclavicular joint conditions; or joint replacement and/or other surgical procedures. The examiner indicated that the Veteran's shoulder condition impacted his ability to work in that he would have difficulty with overhead activities and lifting over 50 pounds. The Veteran was next provided with a VA Shoulder and Arm Conditions examination in December 2015, at which time he was diagnosed as having right shoulder bursitis. At that time, the Veteran reported no pain with usual use but increased pain with attempts to perform overhead tasks and repeated weight bearing; however, he denied that flare-ups impacted the function of his shoulder and/or arm. Range of motion testing revealed right shoulder flexion limited to 125 degrees, right shoulder abduction limited to 110 degrees, external rotation limited to 80 degrees, and internal rotation limited to 45 degrees, with pain that did not result in/cause functional loss noted in all ranges of motion. Although there was evidence of pain with weightbearing, there was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was not able to perform repetitive-use testing with 3 repetitions, and the examiner noted that pain significantly limited functional ability with repeated use over a period of time (although the examiner was unable to describe this in terms of additional loss of range of motion). Muscle strength testing revealed normal strength. There was no evidence of ankylosis. Hawkins' Impingement testing (possibly signifying rotator cuff tendinopathy or tear) and empty-can testing (possibly signifying rotator cuff pathology) were positive in the right shoulder. There was no evidence of instability/dislocation/labral pathology or joint replacement and/or other surgical procedures. However, a positive cross-body adduction test caused he examiner to suspect acromioclavicular joint pathology. Nonetheless, the examiner opined that he Veteran's right shoulder disorder did not impact his ability to perform any type of occupational task. The Veteran was most recently provided with a VA Shoulder and Arm Conditions examination in January 2020, at which time he was diagnosed as having subacromial bursitis of the right shoulder. At that time, the Veteran reported right shoulder pain and limitation of motion; however, he denied that flare-ups impacted the function of his shoulder and/or arm as well as any functional loss or functional impairment of the right upper extremity. Range of motion testing revealed right shoulder flexion to 180 degrees, right shoulder abduction to 180 degrees, external rotation to 90 degrees, and internal rotation to 90 degrees, with pain noted on rest/non-movement. There was no evidence of pain with weightbearing, although there was objective evidence of localized tenderness or pain on palpation of the right anterolateral shoulder. There was no evidence of pain on passive range of motion testing or pain on non-weight bearing testing of the right shoulder. The Veteran was able to perform repetitive-use testing with at least three repetitions, with no additional loss of function or range of motion after three repetitions. Although the Veteran was not being examined immediately after repetitive use over time, the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Moreover, pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. Muscle strength testing revealed normal strength, with no evidence of muscle atrophy. There was no evidence of ankylosis; a rotator cuff condition; shoulder instability, dislocation or labral pathology; a clavicle, scapula, acromioclavicular joint or sternoclavicular joint condition; or condition or impairment of the humerus. There was no evidence of joint replacement and/or other surgical procedures. The examiner concluded that the Veteran's right shoulder disorder did not impact his ability to perform any type of occupational task. Based on the above evidence, the Veteran's right shoulder flexion and abduction were, at worst, limited to 60 degrees (considering the onset of painful movement) during the period on appeal, to include the one-year "look back" period. 38 C.F.R. § 3.400(o); see Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). This does not meet the criteria for a higher evaluation under Diagnostic Code 5201, as shoulder motion for the dominant arm has not been limited to the midway point between the side and shoulder level (i.e., flexion and/or abduction limited to 45 degrees or less). The Board has considered whether other Codes apply such that the Veteran could receive a still higher rating. There are two Codes applicable to the shoulder and arm that reflect symptoms warranting an evaluation higher than 20 percent for the non-dominant shoulder. First, pursuant to Code 5200, the Veteran would need to have unfavorable ankylosis of the scapulohumeral articulation. 38 C.F.R. § 4.71a. There is no evidence, including lay statements, that the Veteran has unfavorable ankylosis of the scapular-humoral joint or that his right shoulder is stuck in one position. The Board acknowledges the notation on the December 2015 VA examination report of, "Less movement than normal due to ankylosis, adhesions, etc.;" however, the same examination report, in addition to the July 2014 and January 2020 examination reports, explicitly indicated that there was no evidence of ankylosis. Furthermore, that generalized statement, in addition to being inconsistent with the remainder of the December 2015 examination report and the other lay and medical evidence of record, does not indicate unfavorable ankylosis at a position of 25 or fewer degrees of abduction. VA treatment records and the Veteran's statements confirm he can move his right arm, albeit with a limited range of motion. Finally, there is no evidence of "functional ankylosis" such that the Veteran is prevented from moving his shoulder from an unfavorable position at all due to pain. See Chavis v. McDonough, 34 Vet. App. 1 (2021). As indicated above, at worst, the Veteran's right shoulder flexion and abduction has been limited to 60 degrees due to pain. Therefore, the Board finds that the lay and medical evidence of record persuasively establishes that the Veteran does not have unfavorable ankylosis of the right shoulder or its functional equivalent. Thus, Diagnostic Code 5200 does not apply. Second, pursuant to Diagnostic Code 5202, the Veteran would need to have impairment of the humerus, to include fibrous union, nonunion, or loss of head, to be assigned a rating higher than 20 percent. There is no evidence, including lay evidence, of fibrous union, nonunion, or loss of head of the humerus. Thus, Diagnostic Code 5202 does not apply. Moreover, a separate rating cannot be assigned pursuant to Diagnostic Code 5203, because the Veteran's pain and limited motion are compensated pursuant to Diagnostic Code 5201; thus, assigning a separate evaluation pursuant to Diagnostic Code 5203 would result in impermissible pyramiding. See 38 C.F.R. § 4.14; see also 38 C.F.R. § 4.71a. directing that clavicle or scapula impairment be rated on based on function of the contiguous joint (shoulder). In summary, the Veteran is rated pursuant to the correct Diagnostic Code, and a disability rating higher than 20 percent is not warranted. 3. Entitlement to rating higher than 10 percent for service-connected degenerative joint disease of the first metatarsal with left foot strain The Veteran also seeks a rating higher than 10 percent for his service-connected degenerative joint disease of the first metatarsal with left foot strain. This disability is currently rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5010-5284. Hyphenated Diagnostic Codes are used when a rating under one Diagnostic Code requires use of an additional Diagnostic Code to identify the specific basis for the evaluation assigned. 38 C.F.R. § 4.27. Regarding foot injuries, applicable regulatory criteria are set forth in Diagnostic Code 5284. 38 C.F.R. § 4.71a, Diagnostic Code 5284. Under Diagnostic Code 5284, a 10 percent rating is warranted for moderate disability. A 20 percent rating is warranted for moderately severe disability. A 30 percent rating is warranted for severe disability. Note: With actual loss of use of the foot, rate 40 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5284. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, this diagnostic code was not changed. The words "moderate," "moderately severe," and "severe" are not defined by Diagnostic Code 5284. Rather than applying a mechanical formula, the Board must instead evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. One possible source for such definitions would be the dictionary. Webster's II New College Dictionary defines "moderate" to include "of average or medium quantity, quality, or extent." Id. at 704. Definitions for "severe" include "extremely intense." Id. at 1012. It is also noted that the term "moderately severe" includes impairment that is considered more than "moderate" but not to the extent as to be considered "severe." Here, the Veteran was provided with a VA Foot Conditions examination in December 2015, at which time the examiner diagnosed him as having "left foot pain." Subjectively, the Veteran described pain in his fifth toe; however, he denied any flare-ups that impacted the function of the foot as well as any functional loss or functional impairment of the foot. There was no evidence of flatfoot (pes planus), Morton's neuroma (Morton's disease) and metatarsalgia, hammer toe, hallux valgus, hallux rigidus, acquired pes cavus (clawfoot), or malunion / nonunion of tarsal or metatarsal bones. There was no history of foot surgery. The examiner indicated that pain was only present upon forced flexion and extension of the left fifth toe. There was no evidence of functional loss of the left lower extremity attributable to the left foot condition. There was no pain, weakness, fatigability, or incoordination that significantly limited functional ability during flare-ups or when the foot was used repeatedly over a period of time. There was no other functional loss during flare-ups or when the foot was used repeatedly over a period of time. Although imaging studies of the foot were available, the examiner indicated that there was no degenerative or traumatic arthritis documented. The examiner opined that the Veteran's left foot symptomatology did not impact his ability to perform any type of occupational task. The Veteran was next provided with a VA Foot conditions examination in January 2020, at which time the examiner diagnosed him as having degenerative arthritis of the left foot as well as left foot strain. Subjectively, the Veteran described an aching sensation in his left foot; however, he denied any flare-ups that impacted the function of the foot as well as any functional loss or functional impairment of the foot. There was no evidence of flatfoot (pes planus), Morton's neuroma (Morton's disease) and metatarsalgia, hammer toe, hallux valgus, hallux rigidus, acquired pes cavus (clawfoot), or malunion / nonunion of tarsal or metatarsal bones. There was no history of foot surgery. Rather, the examiner reiterated that the only diagnoses were degenerative joint disease of the left first metatarsal with left foot strain, which he described as being merely "mild" in nature. The foot condition did not chronically compromise weight bearing, nor did it require arch supports, custom orthotic inserts, or shoe modifications. There was no evidence of functional loss for left lower extremity attributable to the left foot condition. There was no pain, weakness, fatigability, or incoordination that significantly limited functional ability during flare-ups or when the foot was used repeatedly over a period of time. There was no other functional loss during flare-ups or when the foot was used repeatedly over a period of time. The examiner opined that the Veteran's left foot symptomatology did not impact his ability to perform any type of occupational task. The examiner additionally commented that there was no evidence of pain on active range of motion testing of the left foot, that there was no evidence of pain on passive range of motion testing of the left foot, that there was no evidence of pain on weight bearing testing of the left foot, that there was no evidence of pain on non-weight bearing testing of the left foot, and that the Veteran's subjective complaints were not supported by objective findings. Based on the above evidence, at no point during the appeal period is a disability rating in excess of 10 percent warranted under Diagnostic Code 5284, as the evidence does not show that the Veteran's degenerative joint disease of the left first metatarsal with left foot strain more nearly approximates a moderately severe or severe foot injury. In this regard, while he has pain, this pain is limited to a mild aching pain that does not impact function of the left foot or the left lower extremity. Moreover, the January 2020 VA examiner explicitly found this disability to be merely "mild" in nature. In light of such characterization of his disability by a competent medical professional, which is further supported by the Veteran's treatment records, the Board finds his left foot/toe symptomatology results in no more than a moderate foot injury. Additionally, there is no X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations, to warrant a higher rating for arthritis under Diagnostic Code 5010. Thus, a rating in excess of 10 percent for such disability is not warranted. In reaching the foregoing conclusions, the Board acknowledges the Veteran's belief that his degenerative joint disease of the first metatarsal with left foot strain as well as his subacromial bursitis of the right shoulder are more severe than as reflected by the currently assigned disability ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disability in light of the rating criteria to be more persuasive than his own reports. In conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, insofar as the Board has denied a higher rating for such disability, the weight of the probative evidence is against such aspect of the Veteran's claim. Therefore, the benefit of the doubt doctrine is not applicable in such regard and his increased rating claim must otherwise be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Anthony M. Flamini 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.