Citation NR: 9636077 Decision Date: 12/20/96 Archive Date: 12/24/96 DOCKET NO. 94-40 095 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUES 1. Entitlement to an increased (compensable) evaluation for arthralgia of the left knee, to include restoration of a previously-assigned 10 percent disability rating. 2. Entitlement to an increased (compensable) evaluation for arthralgia of the right knee, to include restoration of a previously-assigned 10 percent disability rating. 3. Entitlement to an increased evaluation for arthralgia of the left hand, currently rated as 10 percent disabling. 4. Entitlement to an increased evaluation for arthralgia of the right hand, currently rated as 10 percent disabling. 5. Entitlement to an increased (compensable) evaluation for arthralgia of the right elbow. 6. Entitlement to an increased (compensable) evaluation for arthralgia of the left ankle. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD William L. Puchnick, Associate Counsel INTRODUCTION The veteran served on active duty from June 1948 to March 1952. This case is currently before the Board of Veterans’ Appeals (BVA or Board) on appeal from a May 1992 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan, which proposed to reduce the disability evaluation for arthralgia of each knee from 10 percent to noncompensible. The 10 percent evaluation for the right knee had been in effect since March 1973, while that for the left knee had been in effect since February 1976. A subsequent September 1992 rating decision did reduce the disability evaluation for service-connected arthralgia of the right and left knee from 10 percent to noncompensable, effective December 1, 1992. The combined service-connected disability evaluation was reduced to 20 percent. These evaluations, as well as a 10 percent disability evaluation for service-connected arthralgia of the right and left hand, and a noncompensable disability evaluation for service- connected arthralgia of the right elbow and left ankle, remain in effect. The Board notes that the veteran’s current service-connected arthralgia of multiple joints has, in each instance, been rated by analogy pursuant to Diagnostic Code 5002 (rheumatoid arthritis), despite the fact that there are not current residuals of this disorder. Hence, in each instance, the Board will evaluate the subject joint under the appropriate Diagnostic Code sections for that joint. CONTENTIONS OF APPELLANT ON APPEAL Basically, the appellant contends that his service-connected disabilities are more disabling than their current evaluations suggest. He claims to suffer from ongoing exacerbations which necessitate continued treatment, including constant pain which limits his daily activities. He states that medications have been of little help. Specifically, he complains of a pain in his right hand radiating up his right arm into the right shoulder area, which is aggravated by lifting and results in difficulty in writing or handling small objects. He claims a loss of grip in his right hand, in addition to an inability to take the tops off pill bottles with his left hand. With respect to his knees, the veteran contends that his left knee sometimes gives out while walking and bothers him while squatting or sleeping. He avers that both knees get “ketches” in them. The veteran also complains of pain and loss of motion of the right elbow. Finally, he states that his left ankle gives out on uneven ground, and that he is required to wear a brace. The veteran treats these afflictions with Salsalate and Tylenol. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1996), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence supports the restoration of a 10 percent evaluation for arthralgia of the left and right knee. The Board further finds that the preponderance of the evidence is against the claims of entitlement for an increased evaluations for arthralgia of the left hand, right hand, and right elbow. Finally, the evidence supports the assignment of a 10 percent evaluation for arthralgia of the left ankle. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran’s appeal has been obtained by the RO. 2. The veteran’s arthralgia of multiple joints is manifested by subjective complaints of pain and loss of grip in his hands, “ketching” and giving out of the knees, pain and loss of motion of the right elbow, and giving out of the left ankle on uneven ground. 3. The veteran’s left knee arthralgia is productive of slight functional impairment. 4. The veteran’s right knee arthralgia is productive of slight functional impairment. 5. There is no current evidence that the veteran suffers from limitation of motion of the left hand, or that left hand arthralgia is productive of more than slight functional impairment. 6. There is no current evidence that the veteran suffers from limitation of motion of the right hand, or that right hand arthralgia is productive of more than slight functional impairment. 7. There is no current evidence that the veteran’s right elbow arthralgia manifests limitation of motion, or is productive of any other functional impairment. 8. There is current evidence that the veteran’s left ankle arthralgia is productive of moderate functional impairment. CONCLUSIONS OF LAW 1. The schedular criteria for a 10 percent evaluation for arthralgia of the left knee have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.344(a), 4.1-4.14, 4.40-4.46, 4.71a, Diagnostic Codes 5002-5257 (1995). 2. The schedular criteria for a 10 percent evaluation for arthralgia of the right knee have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.344(a), 4.1-4.14, 4.40-4.46, 4.71a, Diagnostic Codes 5002-5257 (1995). 3. The schedular criteria for an evaluation in excess of 10 percent for arthralgia of the left hand have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1-4.14, 4.40-4.46, 4.73, Diagnostic Codes 5002-5309 (1995). 4. The schedular criteria for an evaluation in excess of 10 percent for arthralgia of the right hand have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1- 4.14, 4.40-4.46, 4.73, Diagnostic Codes 5002-5309 (1995). 5. The schedular criteria for a compensable evaluation for arthralgia of the right elbow have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1-4.14, 4.31, 4.40- 4.46, 4.71a, Diagnostic Codes 5002-5209 (1995). 6. The schedular criteria for a 10 percent evaluation for arthralgia of the left ankle have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1-4.14, 4.40-4.46, 4.71a, Diagnostic Codes 5002-5271 (1995). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As a preliminary matter, the Board finds that the veteran’s claims are plausible and capable of substantiation and thus are well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). The Board is satisfied that all relevant facts have been properly developed. No further assistance to the veteran is required in order to comply with the duty to assist as mandated by 38 U.S.C.A. § 5107 (a). Disability ratings are based upon the average impairment of earning capacity resulting from disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.1 (1995). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet.App. 55, 58 (1994). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1995). In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31 (1995). The record contains lay testimony by the veteran during his September 1993 personal hearing that he can not take the tops off of pill bottles with his left hand and has lost his grip in the right hand. He also testified that he suffers from pain in his hands and fingers. He also testified that his left knee bothers him when squatting or sleeping, and is productive of severe pain. He also testified as to pain and loss of motion of the right elbow, and of his left ankle giving out on uneven ground. Finally, he testified that the aforementioned disabilities have hampered him on the job (at the U.S. Post Office) and while he does carpentry work. While the veteran, as a lay person, is competent to testify as to symptoms which are in the realm of his personal knowledge, such testimony is not competent to prove a matter requiring medical expertise. Grottveit v. Brown, 5 Vet.App. 91, 92-93 (1993). In the same manner, a September 1993 lay statement from the veteran’s employer observing that the veteran had been having difficulty during the preceding year performing certain duties requiring that he bend at the knees (squatting, climbing stairs, climbing ladders, and bending) is not competent to prove medical causation. Id. Thus, the Board is constrained to review the medical records for evidence of medical causation. Upon VA examination in December 1970, the veteran complained of difficulty in stair climbing. Examination of the knees revealed no swelling and no specific tenderness, but loud cracking on squatting with normal range of motion. X-ray examination of the right knee revealed minimal osteoarthritis. The left knee was normal. Diagnosis was X- ray finding of minimal osteoarthritis of the right knee. In June 1972, the veteran reported for a VA examination complaining of pain in the right knee. He could not walk for extended periods, or move heavy loads on the job. Examination showed normal tone and motion of the quadriceps, no visible pathology of the knees, no swelling, no excessive mobility, normal range of motion, and loud crepitus on squatting. X-ray examination of the knees was negative. The diagnosis was bilateral arthralgia of the knees. At the time of his April 1973 VA examination, the veteran complained of knee pain and weakness, along with reduced wages from lost time on the job. Examination revealed the veteran walked with no limp, squatted fully but had difficulty rising, walked on heels and toes, had equal deep tendon reflexes, and no swelling or dislocation of extremities. Shoulders, cervical and lumbar spine, hips, knees, and ankles exhibited normal range of motion. Examination of the knees showed bilateral crepitus on extreme flexion, no effusion or tenderness, normal range of motion, good joint stability, negative Drawer’s and McMurray’s, and no gross neurological defects. X-ray study was of radiographically normal knees bilaterally with no evidence of fracture, subluxation, or degenerative arthritic change. The diagnosis was bilateral arthralgia of the knees, with no arthritis of the knees found on examination. October 1975 VA examination found no swelling, tenderness, or effusion of the knees, and bilateral crepitus with flexion. Drawer’s and McMurrays’s were negative. Range of motion was normal. Joint stability was good, with no increased joint mobility and no atrophy of the leg or thigh. Deep tendon reflexes and pedal pulses were positive bilaterally. There was no calf tenderness or swelling. Range of motion of the hips and ankles was normal. X-ray examination of the knee showed no acute bony injury or bony destruction. The diagnosis was bilateral arthralgia of the knees. In June 1976, the veteran reported for a VA examination complaining that he could not stand on his feet for any length of time, and experienced pain in right knee, right hand, and right elbow. He claimed that the pain was mostly in his knees, but “jumped around” from one joint to another. Examination of the knee revealed the right knee to be more painful than the left, bilateral extension to 5 degrees, bilateral flexion to 110 degrees, and instability to medial and lateral pressure on extension. The right elbow showed no limitation of motion, while the right hand produced pain on manipulation of the metatarsal phalangeal joint of the middle finger. Index finger grip was weak. X-rays of the right hand, right elbow, and knees were negative for any evidence of significant abnormality. The diagnosis was arthralgia of the right elbow, right hand, and knees. In September 1991, the veteran was afforded a VA examination, at which time he complained of pain in the knees, elbows, hands, hips, left ankle, right shoulder, and back. Examination of the knees revealed no swelling, effusion, or instability, with flexion to 140 degrees bilaterally. Left ankle eversion and erosion were within normal range, and neither swelling nor effusion were noted. The right elbow showed a full range of motion, with no effusion, swelling, or olecranon bursa. Supination, pronation, flexion, and extension were within the normal range. Concerning the hands, there were small rheumatoid nodules on the metacarpal joints. There was full range of motion of the fingers, with no wasting of the thenar, hyperthenar, or smaller muscles of the hand. Diagnosis was rheumatoid arthritis with arthralgia of the knees, ankle, and right elbow, with no specific findings or injuries, and a full range of motion of all joints without any swelling or effusion. X-ray examination of the right hand revealed early arthritic changes involving proximal and distal interphalangeal joints of all fingers, more marked involving the second, third, and fourth finger. The impression was osteoarthritis. X-ray examination of the left ankle, right elbow, and bilateral knees was negative. The veteran reported for another VA examination in March 1994 complaining of pain in the knees, as well as a left ankle prone to dislocation, resulting in an everted foot. Bilateral knee pain was evidenced on the grind test, although not of a severe nature. The left ankle was in an splint, with no pain and with normal range of motion. The veteran had bilateral first metacarpophalangeal joint pains which bothered him in the morning, as did his proximal interphalangeal joints. Grip strength was termed “good.” There was no swelling or deformity or other impairment of the knee. Flexion of the right knee was to 115 degrees, left knee flexion was to 110 degrees. Extension was normal. The other joints were said to move “normally.” The diagnosis was that the veteran had one half-hour to one hour of pain which would go away with aspirin. There was no polymyalgia, but more of an “osteoarthritic or wear and tear process” over most joints. Degenerative joint disease or tendonitis was ruled out in the bilateral metacarpophalangeal joints and proximal interphalangeal joints of the hands and knees. The veteran’s most recent VA examination was given in June 1994. At that time, he complained of difficulty in squatting, and of being unable to sleep at night with his knees flexed up. He further complained of mild numbness of the first metacarpophalangeal joint of the right index finger. Examination revealed no swelling of the aforementioned joints, and no deformity. There was no subluxation, lateral instability, or crepitation of the knee joints or left ankle. Range of motion of the knees was flexion to 140 degrees bilaterally. Concerning the left ankle, plantar flexion was to 45 degrees, and dorsiflexion was to 10 degrees. The diagnosis was possible osteoarthritis and rheumatoid arthritis. The rheumatoid factor was listed as negative. X-ray impressions of the left ankle and bilateral knees were negative, revealing no significant abnormalities. Private medical records from December 1994 show that the veteran complained of his left knee “catching,” made worse when going up and down stairs. Examination revealed pain with palpitation along the medial joint space, slight crepitus with motion, collateral ligaments intact, negative Drawer’s and Lachman’s signs, no swelling, and normal range of motion. The assessment was a torn meniscus of the medial left knee. X-rays were prescribed. An X-ray report later in December 1994 revealed hypertrophic spurring of the intracondylar tibial spine. The articular cartilage was well-maintained. No traumatic or destructive lesion was seen. The impression was of early hypertrophic osteoarthritis of the left knee. A private orthopedic examination administered in January 1995 indicated that the veteran presented with bilateral knee and hand pain. His main complaint, however, was bilateral knee pain in the parapatellar aspects of his knees. Examination of the lower extremities revealed excellent quadriceps function throughout, bilateral parapatellar crepitance, mild synovial effusions bilaterally, medial jointline tenderness which was minimal, no ligamentous instability, good hip and ankle motion, excellent pulses, and good tendon reflexes. The impression was of bilateral chondromalacia patella with degenerative arthritis of both knees, with trauma possibly playing a role. The use of Lodeine was recommended. I. Entitlement to an Increased Evaluation for Arthralgia of the Knees, to Include Restoration of a Previously-Assigned Rating As stated, the veteran’s disability evaluation for the knees was reduced to noncompensable in a September 1992 rating decision, effective December 1, 1992. Arthralgia of the knees has been rated under Diagnostic Code 5257 (severe recurrent subluxation or lateral instability). The 10 percent evaluation for the right knee had been in effect since March 1973, while that for the left knee had been in effect since February 1976. Ratings which have been in effect for five or more years are subject to the provisions of 38 C.F.R. § 3.344 (1995), which sets forth certain regulatory requirements which must be complied with before these evaluations may be reduced. Brown v. Brown, 5 Vet.App. 413, 417 (1993). In that decision, the United States Court of Veterans Appeals (Court) identified general regulatory requirements which are applicable to all rating reductions, including those which have been in effect for five years or more. Pursuant to 38 C.F.R. § 4.1, it is essential, both in the examination and in the evaluation of the disability, that each disability be viewed in relation to its history. Brown, 5 Vet.App. at 420. Similarly, 38 C.F.R. § 4.2 (1995) establishes that “[i]t is the responsibility of the rating specialist to interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of the disability present.” The Court has held that these provisions “impose a clear requirement” that rating reductions be based on the entire history of the veteran’s disability. Furthermore, 38 C.F.R. § 4.13 (1995) provides that when any change in an evaluation is to be made, “the rating agency should assure itself that there has been an actual change in the condition, for better or worse, and not merely a difference in the thoroughness of the examination or in use of descriptive terms.” Id., 5 Vet.App. at 420-421. In light of these provisions, ...the RO and Board are required in any rating-reduction case to ascertain, based on the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Id., 5 Vet.App. at 421 (citation omitted). Finally, under the provisions of 38 C.F.R. §§ 4.2 and 4.10 (1995), a rating reduction may not be based solely on the fact that an improvement has actually occurred, but also on whether the improvement actually reflects an improvement in the veteran’s ability to function under the ordinary conditions of life and work. Id. As noted, the veteran was previously rated as 10 percent disabled for each knee under Diagnostic Code 5257. That evaluation contemplated not more than slight recurrent subluxation or lateral instability of each knee. In other words, no matter how classified, the veteran was previously considered to be experiencing slight bilateral knee impairment. The current noncompensable evaluation contemplates a situation in which there are no residuals of his bilateral knee arthralgia. 38 C.F.R. § 4.31. However, this is not the veteran’s case. The Board finds no significant difference in the medical status of the veteran’s knees at the time of the June 1972, October 1975, and September 1991 VA examinations, which resulted in disability evaluations of 10 percent for the right knee, 10 percent for the left knee, and 0 percent for both knees, respectively. Indeed, the examinations are consistent in their findings of no swelling, no effusion, normal range of motion, and negative X-ray of the knees, in addition to a diagnosis of bilateral arthralgia of the knees. The Board would note, however, that at least one recent VA examination did show some limitation of motion in each knee. Moreover, the veteran continues to experience disabling pain and weakness in his knees, resulting in a source of functional impairment. 38 C.F.R. § 4.40 (1995). The Board finds no medical basis on which to conclude that there has been any improvement in the veteran’s bilateral knee arthralgia which can reasonably be expected to be maintained under the ordinary conditions of life. 38 C.F.R. § 3.321(b)(1) (1995). Because the veteran continues to experience slight impairment in both knees, evidenced by continuing symptomatology, as contemplated by the previous 10 percent evaluations under Diagnostic Code 5257, the Board is of the opinion that the prior 10 percent evaluations should be restored. For an assignment of a disability evaluation greater than 10 percent for the knees, the relevant Diagnostic Code sections are 5257, 5258, 5260, 5261, and 5262. An increased rating of 20 percent under Diagnostic Code 5257 requires moderate recurrent subluxation or lateral instability, which has not been shown on examination. Nor has dislocated semilunar cartilage been shown to permit a rating of 20 percent under Diagnostic Code 5258. Nor have limitation of flexion to 30 degrees or limitation of extension to 15 degrees been shown to warrant the award of a 20 percent disability rating pursuant to Diagnostic Codes 5260 and 5261, respectively. Indeed, the March 1994 VA examination revealed right knee flexion to 115 degrees, left knee flexion to 110 degrees, and normal extension. Bilateral knee flexion to 140 degrees was evidenced at the June 1994 VA examination. Finally, malunion of the tibia and fibula with moderate knee or ankle disability has not been evidenced to allow a 20 percent rating under Diagnostic Code 5262. The Board also acknowledges that the veteran’s left and right knee disabilities have been reported to be productive of subjective complaints of pain both on appeal and during his VA examinations. These claims have been taken into consideration in restoration of the prior 10 percent evaluations. In this regard, there is no basis for a finding of functional loss due to pain sufficient to warrant an increased rating over and above this restoration. Thus, in view of the evidence of record, an increased evaluation under 38 C.F.R. §§ 4.40, 4.45, is not warranted. See DeLuca v. Brown, 8 Vet.App. 202, 205 (1995). The Board has also considered the provisions of 38 C.F.R. § 4.7, but finds that there is no question presented as to which of two or more evaluations would more properly classify the severity of the veteran’s left and right knee disabilities. Finally, the Board finds that the evidence does not present such “an exceptional or unusual disability picture as to render impractical the application of the regular rating schedule standards.” 38 C.F.R. § 3.321(b)(1). In this regard, there is no indication that the veteran’s left and right knee disabilities have markedly interfered with his earning capacity, employment status, or have necessitated frequent periods of hospitalization. In the absence of such factors, the Board finds that the criteria for consideration of an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, No. 95-238, slip op. at 4 (U.S. Vet.App. July 3, 1996); Shipwash v. Brown, 8 Vet.App. 218, 227 (1995). II. Entitlement to an Increased Evaluation for Arthralgia of the Hands The veteran’s service-connected right hand arthralgia was assigned a 10 percent disability rating effective February 1976, in a September 1976 rating decision. His service- connected left hand arthralgia was assigned a 10 percent disability rating effective December 1992. Both hands are currently rated pursuant to Diagnostic Code 5309 (Group IX, intrinsic muscles of the hand). Evaluation of muscle injuries usually turns on the type of injury and the objective findings relating to symptoms of muscle disabilities such as weakness, pain, fatigue, uncertainty of movement, or impairment of coordination. See 38 C.F.R. § 4.54 (1995). Under Diagnostic Code 5309, it is recognized that the hand is so compact a structure that isolated muscle injuries are rare. Consequently, disability evaluations are based on functional impairment, as measured by limitation of motion, with a minimum evaluation of 10 percent. It is therefore necessary to examine the Diagnostic Code sections concerning the hand which permit the assignment of a disability evaluation greater than 10 percent. In this case, those sections would be 5218, 5219, 5222, and 5223, and 5224. Because unfavorable ankylosis of three fingers of one hand has not been shown, an increased evaluation of 20 percent for either the right or left hand is not warranted under Diagnostic Code 5218. In the same manner, a 20 percent evaluation for either hand is not warranted under Diagnostic Code 5219 (unfavorable ankylosis of two digits of one hand), 5222 (favorable ankylosis of three fingers of one hand), 5223 (favorable ankylosis of two digits of one hand) or 5224 (ankylosis of the thumb). In light of these criteria, examination results, and X-ray findings, the current evaluations of 10 percent for the right and left hands are warranted under Diagnostic Code 5309. The veteran’s complaints of pain have been taken into consideration in assigning the aforementioned evaluations under 38 C.F.R. §§ 4.40 and 4.45. DeLuca, 8 Vet.App. at 205. 38 C.F.R. § 4.40 requires that with respect to the musculoskeletal system, any findings of pain must be supported by adequate pathology and evidenced by the visible behavior of the individual undertaking the examination on which the rating is based. See Johnson v. Brown, 9 Vet.App. 7, 10 (1996). In this instance, the examiner did not find objective evidence of pain during any examination. Id.; 38 C.F.R. § 4.45. There exists no underlying pathology to substantiate the claims of the veteran with respect to pain. Thus, in view of the evidence of record, an increased evaluation under 38 C.F.R. §§ 4.40 and 4.45 is not warranted. See DeLuca, 8 Vet.App. at 205. The Board has once again considered the provisions of 38 C.F.R. § 4.7, but finds that there is no question presented as to which of two or more evaluations would more properly classify the severity of the veteran’s left and right hand arthralgia. Finally, the Board finds that the criteria for submission for consideration of an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met. Bagwell, No. 95-238, slip op. at 4; Shipwash, 8 Vet.App. at 227. III. Entitlement to an Increased (Compensable) Evaluation for Arthralgia of the Right Elbow The veteran’s service-connected arthralgia of the right elbow is rated as noncompensable effective December 1992, pursuant to Diagnostic Code 5209 (elbow, other impairment of). The Board observes that the veteran does not meet the Diagnostic Code criteria for the minimum 20% evaluation under section 5209 as his medical records do not indicate a joint fracture, with marked cubitus varus or cubitus valgus deformity, or with ununited fracture of head of radius. Nor does the veteran suffer from ankylosis of the elbow necessary for a compensable evaluation under Diagnostic Code 5205. There is also no evidence that the veteran suffers from limitation of flexion of the forearm (Diagnostic Code 5206), limitation of extension of the forearm (Diagnostic Code 5207), or limitation of both flexion and extension of the forearm (Diagnostic Code 5208). Hence, a compensable rating for arthralgia of the right elbow is not warranted. The veteran’s complaints of pain and impairment have been taken into consideration in assigning the aforementioned evaluation under 38 C.F.R. §§ 4.40 and 4.45. DeLuca, 8 Vet.App. at 205 However, upon consideration of the veteran’s medical history and the recent examination results, a compensable rating must be denied. In considering the provisions of 38 C.F.R. § 4.7, the Board finds that there is no question presented as to which of two or more evaluations would more properly classify the severity of the veteran’s right elbow arthralgia. Finally, the criteria for submission for consideration of an extraschedular rating for right elbow arthralgia pursuant to 38 C.F.R. § 3.321(b)(1) are not met. Bagwell, No. 95-238, slip op. at 4; Shipwash, 8 Vet.App. at 227. IV. Entitlement to an Increased (Compensable) Evaluation for Arthralgia of the Left Ankle Service-connected arthralgia of the veteran’s left ankle is rated noncompensable effective December 1992, pursuant to Diagnostic Code 5271 (ankle, limited motion of). The applicable Diagnostic Code sections concerning the ankle are 5270, 5271, 5272, 5273, and 5274. Because ankylosis of the left ankle has not been shown, a compensable evaluation is not warranted under Diagnostic Code 5270. In the same fashion, there is no indication of subastragalar or tarsal joint ankylosis to permit a compensable evaluation pursuant to Diagnostic Code 5272. Additionally, there is no objective evidence of malunion of os calcis or astragalus, or of astragalectomy, required by Diagnostic Code 5273 and 5274 respectively. As noted, the veteran’s service-connected left ankle arthralgia is currently evaluated as noncompensable under Diagnostic Code 5271. A compensable rating of 10 percent requires “moderate” limited ankle motion under 5271. In the instant case, the veteran’s limitation of motion was limited by 10 degrees in dorsiflexion of the left ankle at the time of his most recent VA examination in June 1994. Additionally, the veteran has complained of pain and a proclivity to dislocation of the left ankle. These factors raise the question of functional loss of the left ankle considered by 38 U.S.C.A. § 4.40. Given that the veteran does have some active loss of motion and complaints of pain, a 10 percent disability evaluation, as equivalent to moderately limited motion, but not rising to the level of “marked” limitation of motion, is warranted pursuant to Diagnostic Code 5271. Complaints of pain and impairment have been taken into consideration in the assignment of a compensable disability evaluation for arthralgia of the left ankle. 38 C.F.R. §§ 4.40 and 4.45. DeLuca, 8 Vet.App. at 205. The Board has also considered 38 C.F.R. § 4.7, but finds that there is not a question as to which of two or more disability ratings more properly evaluates the severity of the veteran’s left ankle arthralgia. Finally, the Board finds that the criteria for submission for consideration of an extraschedular rating for left ankle arthralgia pursuant to 38 C.F.R. § 3.321(b)(1) are not met. Bagwell, No. 95-238, slip op. at 4; Shipwash, 8 Vet.App. at 227. ORDER Subject to the provisions governing the award of monetary benefits, a 10 percent evaluation for arthralgia of the left knee is granted. Subject to the provisions governing the award of monetary benefits, a 10 percent evaluation for arthralgia of the right knee is granted. An evaluation in excess of 10 percent for arthralgia of the left hand is denied. An evaluation in excess of 10 percent for arthralgia of the right hand is denied. A compensable evaluation for arthralgia of the right elbow is denied. Subject to the provisions governing the award of monetary benefits, a 10 percent evaluation for arthralgia of the left ankle is granted. RAYMOND F. FERNER Acting Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741 (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1995), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals. - 2 -