POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The Veteran, a veteran who served from August 1997 to April 2007, appeals the denial of increased ratings for his cervical spine, right shoulder, and left knee conditions, and the initial grant of a 70 percent rating for PTSD. The Board granted a 70 percent rating for PTSD, effective March 28, 2014, finding that the Veteran's symptoms throughout the appeal period demonstrated occupational and social impairment with deficiencies in most areas, consistent with the 70 percent criteria. The Board cited the Veteran's difficulty adapting to stressful circumstances, impaired impulse control, and continuous depression as evidence supporting this rating. The Board also considered the Veteran's contention that his disability was more severe than currently rated but found insufficient evidence of worsening during the relevant periods for the cervical spine, right shoulder, and left knee conditions to warrant higher ratings. For the cervical spine, the Board found the evidence against ratings higher than 10 percent prior to March 2020, 20 percent prior to May 2024, and 30 percent thereafter, citing normal range of motion and lack of severe spasm or ankylosis. For the right shoulder, the Board found flexion and abduction limited to 80 degrees or greater during flare-ups, insufficient for a rating above 30 percent. For the left knee, the Board found flexion limited to 80 degrees or greater and extension to zero degrees, also insufficient for a rating above 10 percent. The Board noted the Veteran's use of pain medication but found insufficient evidence that this substantially altered the range of motion findings. The Board denied increased ratings for the cervical spine, right shoulder, and left knee. The claim for a left knee disability other than arthroscopy residuals with scar was remanded for a medical opinion to determine if the left knee strain may be caused or aggravated by the service-connected arthroscopy residuals.

Rationale

Combat service in Iraq; Occupational and social impairment with deficiencies in most areas; Impaired impulse control and difficulty adapting to stressful circumstances

Full Decision Text

Citation Nr: 26005008
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 16-42 820
DATE: April 28, 2026

ORDER

Effective March 28, 2014, a 70 percent rating for posttraumatic stress disorder (PTSD) is granted.

A rating in excess of 10 percent prior to March 10, 2020; a rating in excess 20 percent prior to May 15, 2024; and a rating in excess of 30 percent thereafter for a cervical spine disability is denied.

A rating in excess of 30 percent for a right shoulder disability is denied.

A rating in excess of 10 percent for left knee arthroscopy residuals is denied.

REMANDED

Service connection for a left knee disability other than arthroscopy residuals with scar.

?

FINDINGS OF FACT

1. Since March 28, 2014, the Veteran's PTSD has resulted in occupational and social impairment with deficiencies in most areas.

2. Prior to March 10, 2020, the Veteran's cervical spine disability has not resulted in forward flexion of the cervical spine to 30 degrees or less; combined range of motion of the cervical spine of 170 degrees or less; or muscle spasm or guarding.  Prior to May 15, 2024, the Veteran's cervical spine disability has not resulted in forward flexion of the cervical spine limited to 15 degrees or less or favorable ankylosis of the entire cervical spine.  Since May 15, 2024, the Veteran's cervical spine disability has not resulted in unfavorable ankylosis of the entire cervical spine.

3. The Veteran's right shoulder disability has not resulted in limitation of motion of the arm to 25 degrees from side.

4. The Veteran's left knee arthroscopy residuals have not resulted in flexion limited to 60 degrees or less nor extension limited to 10 degrees or greater.

CONCLUSIONS OF LAW

1. Effective March 28, 2014, the criteria for a 70 percent rating for PTSD have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.130, Diagnostic Code (DC) 9411.

2. The criteria for a rating in excess of 10 percent prior to March 10, 2020; a rating in excess 20 percent prior to May 15, 2024; and a rating in excess of 30 percent thereafter for a cervical spine disability have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.71a, DC 5242.

3. The criteria for a rating in excess of 30 percent for a right shoulder disability have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.71a, DC 5201.

4. The criteria for a rating in excess of 10 percent for left knee arthroscopy residuals have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.71a, DC 5260.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1997 to April 2007.

The case is on appeal from an April 2015 rating decision.

Most recently, in a September 2024 decision, the Board adjudicated the traumatic brain injury appeal and remanded the remaining claims for additional development. 

The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record.  See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008).

General Legal Criteria

Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries.  The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations
The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record.  See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008).

General Legal Criteria

Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries.  The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations.  38 U.S.C. § 1155.  Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability.  38 C.F.R. § 4.1.

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.  When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant.  38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing.  38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement.  See DeLuca v. Brown, 8 Vet. App. 202 (1995).  Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate.  See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

1. A rating in excess of 50 percent for PTSD prior to December 3, 2021, and a rating in excess of 70 percent thereafter.

Specific Rating Criteria

The Veteran's PTSD has been evaluated under the General Rating Formula for Mental Disorders (General Formula).  38 C.F.R. § 4.130, DC 9411.  Under the General Formula, a noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning.

A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment.

A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation).

A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity.

A 70 percent evaluation is warranted where there is objective evidence demonstrating 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
 behavior, self-care, and normal conversation).

A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity.

A 70 percent evaluation is warranted where there is objective evidence demonstrating 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, or 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; and the inability to establish and maintain effective relationships.

A 100 percent disability evaluation is warranted when there is 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; and memory loss for names of close relatives, own occupation, or own name.

The symptoms listed under the General Formula are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating.  Mauerhan v. Principi, 16 Vet. App. 436 (2002); see also Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013) (explaining that the symptoms that could give rise to a given rating are those in like kind, i.e., of similar duration, severity, and frequency, to those provided in the non-exhaustive lists).

Analysis

The Veteran suffers from PTSD as a result of combat service in Iraq.  He is currently in receipt of a 50 rating for PTSD prior to December 3, 2021, and a 70 percent rating thereafter.  The Veteran contends his disability is more severe than what is contemplated by the currently assigned rating. 

After reviewing the available evidence, the Board finds that the Veteran's PTSD has resulted in occupational and social impairment with deficiencies in most areas throughout the appeal period.  During a December 2021 VA examination, the examiner noted the Veteran's difficulty in establishing and maintaining effective work and social relationships and difficulty adapting to stressful circumstances.  The examiner concluded that these and other manifestations of the Veteran's PTSD result in occupational and social impairment with deficiencies in most areas.  Notably, this level of impairment is reflected in the record prior to the date of this examination.  See Swain v. McDonald, 27 Vet. App. 219, 224 (2015).  

The Veteran has experienced symptoms associated with a high level of social and occupational impairment throughout the review period.  The Veteran has experienced ongoing impaired impulse control, as described in the Veteran's spouse's March 2014 statement.  Additionally, a November 2012 VA treatment note contains the Veteran's recollection of being "triggered" by a smell at work which the Veteran was concerned would provoke him to violence, demonstrating his difficulty adapting to stressful circumstances.  The Veteran immediately sought VA treatment following the incident.  Also, VA treatment notes reflect continuous depression throughout the review period which has undoubtedly impacted the Veteran's ability to function effectively at work and as a member of his family.  Accordingly, considering this level of impairment throughout the review period, a 70 percent rating, effective March 28, 2014, for PTSD is warranted.

The Board considered whether a 70 percent rating is warranted during the one-year period preceding the date of the Veteran's March 2014 increased rating claim.  However, there is insufficient evidence that an increase in disability occurred during that one-year period.  Rather, evidence such as the aforementioned November 2012 VA treatment note suggest the Veteran's disability had worsened well-before the one-year "lookback" period.  Accordingly, the award must be assigned based on the date of claim.  See 38 U.S.C. § 5110(b)(3); 38 C.F.R. § 3.400(o)(2).

The Board also considered whether the Veteran's symptoms and impairment warrant a 100 percent rating at any point during the review period.  However, the Veteran has been employed and married throughout this time
 date of the Veteran's March 2014 increased rating claim.  However, there is insufficient evidence that an increase in disability occurred during that one-year period.  Rather, evidence such as the aforementioned November 2012 VA treatment note suggest the Veteran's disability had worsened well-before the one-year "lookback" period.  Accordingly, the award must be assigned based on the date of claim.  See 38 U.S.C. § 5110(b)(3); 38 C.F.R. § 3.400(o)(2).

The Board also considered whether the Veteran's symptoms and impairment warrant a 100 percent rating at any point during the review period.  However, the Veteran has been employed and married throughout this time.  See June 2024 VA examination.  The Board thus cannot properly conclude that he has experienced total occupational and social impairment, as required for a higher rating.  

Therefore, for the reasons articulated above the Board finds that the Veteran's PTSD has resulted in occupational and social impairment with deficiencies in most areas throughout the appeal period.  This is particularly so when reasonable doubt is resolved in the Veteran's favor.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.   Accordingly, effective March 28, 2014, a 70 percent rating for PTSD is warranted.

2. A rating in excess of 10 percent prior to March 10, 2020; a rating in excess 20 percent prior to May 15, 2024; and a rating in excess of 30 percent thereafter for a cervical spine disability.

Specific Legal Criteria

The Veteran's cervical spine disability is rated under The General Rating Formula for evaluating the spine.  38 C.F.R. § 4.71a.  The General Rating Formula provides a 10 percent disability rating for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height.  A 20 percent disability rating is assigned for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; the combined range of motion of the cervical spine not greater than 170 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.  A 30 percent disability rating is assigned for forward flexion of the cervical spine to 15 degrees or less or favorable ankylosis of the entire cervical spine.  A 40 percent disability rating is assigned for unfavorable ankylosis of the entire cervical spine.  A 100 percent rating is warranted for unfavorable ankylosis of the entire spine.

Following the rating criteria, Note 1 states: evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate DC.

Note 2 explains that the "combined range of motion" refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation.

Note 5 specifies that, for VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

Effective February 7, 2021, VA amended the rating criteria for musculoskeletal conditions.  However, the changes were not substantive for cervical spine conditions as relevant to the present appeal.

Analysis

The Veteran's cervical spine disability is currently rated 10 percent prior to March 10, 2020; 20 percent prior to May 15, 2024; and 30 percent thereafter.  The Veteran contends his disability is more severe than what is contemplated by the currently assigned ratings. 

Regarding the period prior to March 10, 2020, a rating in excess of 10 percent requires evidence of forward flexion of the cervical spine not greater than 30 degrees; combined range of motion of the cervical spine not greater
Effective February 7, 2021, VA amended the rating criteria for musculoskeletal conditions.  However, the changes were not substantive for cervical spine conditions as relevant to the present appeal.

Analysis

The Veteran's cervical spine disability is currently rated 10 percent prior to March 10, 2020; 20 percent prior to May 15, 2024; and 30 percent thereafter.  The Veteran contends his disability is more severe than what is contemplated by the currently assigned ratings. 

Regarding the period prior to March 10, 2020, a rating in excess of 10 percent requires evidence of forward flexion of the cervical spine not greater than 30 degrees; combined range of motion of the cervical spine not greater than 170 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.  The Veteran underwent a VA examination in February 2015.  The Veteran's cervical spine range of motion was recorded as normal, and the examiner indicated that the Veteran did not experience additional loss of range of motion after repeated use over time or flare-ups.  The examiner also indicated that the Veteran does not experience localized tenderness, guarding, or muscle spasm.  Contemporaneous treatment notes contain insufficient evidence of impairment more severe than that recorded during the VA examination.  Additionally, while available treatment records reflect ongoing treatment for neck pain during this period, there is insufficient evidence of worsening of the disability prior to March 2020.  See Swain, 27 Vet. App. at 224.  Accordingly, a rating in excess of 10 percent prior to March 2020 is not warranted.

Regarding the period prior to May 15, 2024, a rating in excess of 20 percent requires evidence of forward flexion of the cervical spine limited to 15 degrees or less or favorable ankylosis of the entire cervical spine.  The latter criterion may be satisfied by severe limitation of motion during flare ups constituting "functional" ankylosis.  See Chavis v. McDonough, 34 Vet. App. 1 (2021).  The Veteran attended an additional VA examination in March 2020.  The examiner estimated that the Veteran's cervical spine forward flexion is, at worst, limited to 30 degrees during flare ups.  The examiner indicated that there was no evidence of favorable or unfavorable ankylosis of the cervical spine.  Contemporaneous treatment notes contain insufficient evidence of impairment more severe than that recorded during the VA examination.  The Board notes that, even during flare ups, the Veteran was recorded as maintaining some range of motion of his cervical spine, and a finding of "functional" ankylosis is thus not appropriate.  Lastly, while available treatment records reflect ongoing treatment for neck pain during this period, there is insufficient evidence of worsening of the disability prior to May 2024.  See Swain, 27 Vet. App. at 224.  Accordingly, a rating in excess of 20 percent prior to May 2024 is not warranted.

Regarding the period starting May 15, 2024, a rating in excess of 30 percent requires evidence of unfavorable ankylosis of the entire cervical spine.  During a June 2024 VA examination, the examiner indicated that the Veteran does not have favorable or unfavorable ankylosis of the cervical spine.   The examiner estimated that the Veteran's cervical spine forward flexion is limited to 10 degrees during flare ups.  Therefore, even during flare ups, the Veteran was recorded as maintaining some range of motion of his cervical spine, and a finding of "functional" ankylosis is thus not appropriate.  Moreover, the examiner estimated that the Veteran's range of motion during flare ups includes the neutral position (zero degrees).  Therefore, even if the Veteran's limitation of motion constituted functional ankylosis, it is not "unfavorable" as defined in the rating criteria.  See 38 C.F.R. § 4.71a, Note 5.  Accordingly, a rating in excess of 30 percent is not warranted.

The Board notes that the Veteran uses pain medication to treat his neck pain, including lidocaine ointment.  See March 2022 VA treatment note.   However, there is insufficient evidence that the Veteran's cervical spine limitation of motion would be substantially different absent medication.  See Ingram v. Collins, 38 Vet. App. 130, 132 (2025).   The presence of painful motion was recorded during the aforementioned VA examinations.  

Finally, the Board considered whether higher or separate ratings were appropriate under separate DCs.  See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). 
, a rating in excess of 30 percent is not warranted.

The Board notes that the Veteran uses pain medication to treat his neck pain, including lidocaine ointment.  See March 2022 VA treatment note.   However, there is insufficient evidence that the Veteran's cervical spine limitation of motion would be substantially different absent medication.  See Ingram v. Collins, 38 Vet. App. 130, 132 (2025).   The presence of painful motion was recorded during the aforementioned VA examinations.  

Finally, the Board considered whether higher or separate ratings were appropriate under separate DCs.  See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991).  The Veteran's upper extremity radiculopathy has been rated separately and is not part of the present appeal.  Additionally, there is insufficient evidence of intervertebral disc syndrome to implicate DC 5243.

Accordingly, the evidence is persuasively against the claim.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable.  See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102.  An increased rating for the Veteran's cervical spine disability is not warranted.

3. A rating in excess of 30 percent for right shoulder osteoarthritis.

Specific Legal Criteria

The Veteran's right shoulder disability is rated under 38 C.F.R. § 4.71a, DC 5201, for limitation of motion of the arm.  Under DC 5201, limitation of motion of the arm at shoulder level warrants a 20 percent rating for both the major and minor extremity.  Limitation of motion of the arm midway between side and shoulder warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity.  Limitation of motion of the arm to 25 degrees from side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint.  See 38 C.F.R. § 4.71, Plate I.

Effective February 7, 2021, VA amended DC 5201 to reflect that limitation of motion may be shown by flexion and/or abduction and clarified the degrees of limitation of motion that correspond to each rating.  Now, limitation of motion at the shoulder level (flexion and/or abduction limited to 90 degrees) warrants a 20 percent rating for both the major and minor extremity.  Limitation of motion of the arm midway between side and shoulder level (flexion and/or abduction limited to 45 degrees) warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity.  Flexion and/or abduction limited to 25 degrees from the side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint.  38 C.F.R. § 4.71a, DC 5201.

The Board notes that, as the February 7, 2021, rating criteria changes did not specify that it was to have a retroactive effect, the prior criteria and the new criteria will both be considered for the later rating period and the rating assigned based on the criteria most favorable to the Veteran.  An award warranted under the revised criteria cannot be effective prior to February 7, 2021. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003).  However, the criteria for both DCs for both periods are the same with the exception of the addition of degrees of ranges of motion to clarify the degrees of flexion and/or abduction for each level of limitation.

DC 5201 "does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of the arm."  Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013).

Analysis

The Veteran is currently in receipt of a 30 rating for his right shoulder disability.  He contends his disability is more severe than what is contemplated by the currently assigned rating. 

The Veteran is right-handed.  Under both the original and revised criteria of DC 5201, a 40 percent rating for the major extremity requires evidence of flexion or abduction limited to 25 degrees or less.  The Veteran's shoulder disability was evaluated four times during the appeal period.  During a February 2015 VA examination, the Veteran's right shoulder range of motion was normal, although pain was observed during flexion.  During a March 2020 VA examination, the examiner estimated that the
Fed. Cir. 2013).

Analysis

The Veteran is currently in receipt of a 30 rating for his right shoulder disability.  He contends his disability is more severe than what is contemplated by the currently assigned rating. 

The Veteran is right-handed.  Under both the original and revised criteria of DC 5201, a 40 percent rating for the major extremity requires evidence of flexion or abduction limited to 25 degrees or less.  The Veteran's shoulder disability was evaluated four times during the appeal period.  During a February 2015 VA examination, the Veteran's right shoulder range of motion was normal, although pain was observed during flexion.  During a March 2020 VA examination, the examiner estimated that the Veteran's right shoulder flexion is limited to 120 degrees and abduction is limited to 90 degrees during flare ups.  During a January 2022 VA examination, the examiner estimated that the Veteran's flexion and abduction are limited to 150 degrees after repeated use over time.  During the most recent June 2020 VA examination, the examiner estimated the Veteran's flexion is limited to 80 degrees and abduction is limited to 100 degrees during flare ups.  

A careful review of the Veteran's treatment records and lay statements during the appeal period identified insufficient evidence of any symptoms or functional impairment pertaining to the Veteran's right shoulder condition substantially different or more severe than those noted during the aforementioned VA examinations.  

Accordingly, the foregoing evidence contains insufficient indication that the Veteran has experienced flexion or abduction limited to 25 degrees or less during the review period.  The Board notes that the Veteran uses pain medication to manage his right shoulder pain.  See June 2024 VA examination.  Notably, though, the Veteran's right shoulder range of motion has been consistently recorded as flexion and abduction limited to 80 degrees or greater, a level of impairment associated with a 20 percent rating, and there is insufficient evidence that the Veteran's range of motion would be vastly different absent pain medication.  See Ingram, 38 Vet. App. at 132.   

Additionally, all potentially applicable DCs have been considered.  See Schafrath, 1 Vet. App. at 593.  There is insufficient evidence of ankylosis of scapulohumeral articulation or impairment of the humorous to implicate DCs 5200 or 5202.  Additionally, the Veteran has already been assigned a 40 percent rating under DC 8511 for right upper extremity radiculopathy, which is a separate disability.  

Accordingly, the evidence is persuasively against a higher rating during this period.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable.  See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3.  A rating in excess of 30 percent for a right shoulder disability is not warranted. 

4. A rating in excess of 10 percent for left knee arthroscopy residuals.

Specific Legal Criteria

Limitation of motion of the knee is contemplated within DCs 5260 (flexion) and 5261 (extension).  Separate ratings under DCs 5260 and 5261 may be assigned for disability of the same knee joint.  See VAOPGCPREC 9-2004.  

Under DC 5260, a noncompensable rating will be assigned for limitation of flexion of the leg to 60 degrees; a 10 percent rating will be assigned for limitation of flexion of the leg to 45 degrees; a 20 percent rating will be assigned for limitation of flexion of the leg to 30 degrees; and a 30 percent rating will be assigned for limitation of flexion of the leg to 15 degrees.  38 C.F.R. § 4.71a, DC 5260.

Limitation of extension of the knee is rated under DC 5261.  Limitation of extension of a leg to 5 degrees warrants a noncompensable rating.  A 10 percent rating requires that extension be limited to 10 degrees.  A 20 percent rating requires that extension be limited to 15 degrees.  A 30 percent rating requires that extension be limited to 20 degrees.  A 40 percent rating requires that extension be limited to 30 degrees.  A 50 percent rating requires that extension be limited to 45 degrees.  38 C.F.R. § 4.71a, DC 5261.

Analysis

The Veteran is currently in receipt of a 10 rating for his left knee disability due to painful motion.  He contends his disability is more severe than what is contemplated by the currently assigned rating. 

A rating in excess of 
able rating.  A 10 percent rating requires that extension be limited to 10 degrees.  A 20 percent rating requires that extension be limited to 15 degrees.  A 30 percent rating requires that extension be limited to 20 degrees.  A 40 percent rating requires that extension be limited to 30 degrees.  A 50 percent rating requires that extension be limited to 45 degrees.  38 C.F.R. § 4.71a, DC 5261.

Analysis

The Veteran is currently in receipt of a 10 rating for his left knee disability due to painful motion.  He contends his disability is more severe than what is contemplated by the currently assigned rating. 

A rating in excess of 10 percent for knee limitation of motion requires evidence of flexion limited to 30 degrees or less or evidence of extension limited to 15 degrees or more.  The Veteran's left knee disability was evaluated during February 2015, March 2020, and June 2024 VA examinations.  The most severe impairment was recorded during the final examination, during which the examiner estimated that the Veteran's left knee flexion was limited to 80 degrees during flare ups.  Extension to zero degrees was consistently recorded throughout the review period.  Additionally, the Veteran's treatment records and lay statements during the appeal period contain insufficient evidence of functional impairment pertaining to the Veteran's left knee condition different or more severe than those noted in the VA examinations.  

The Board notes that the Veteran uses pain medication to manage his knee pain.  See June 2024 VA examination.  Notably, though, the Veteran's left knee range of motion has been consistently recorded as flexion limited to 80 degrees or greater and extension limited to zero degrees, a level of impairment associated with noncompensable ratings, and there is insufficient evidence that the Veteran's left knee range of motion would be vastly different absent pain medication.  See Ingram, 38 Vet. App. at 132.   

Therefore, the Veteran's left knee limitation of motion does not warrant a rating in excess of 10 percent under DC 5260 or 5261.  Likewise, this level of impairment is not sufficient to warrant two separate 10 percent ratings under both DC 5260 and 5261.  

The Board considered other DCs pertaining to the knee and leg.  However, the Veteran does not have ankylosis or functional ankylosis as applicable to DC 5256.  DCs 5258 and 5259 also do not apply, as there is no evidence of a semilunar cartilage condition or episodes of knee "locking." Additionally, there is insufficient evidence of impairment of the tibia and fibula or genu recurvatum to implicate DCs 5262 or 5263.  

Accordingly, the evidence is persuasively against the claim.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable, and a rating in excess of 10 percent rating for left knee arthroscopy residuals is not warranted.  See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3.

REASONS FOR REMAND

Service connection for a left knee disability other than arthroscopy residuals with scar.

In his March 2014 claim, the Veteran sought service connection for arthritis, secondary to his left knee arthroscopy.  This claim may be broadly construed to encompass any left knee disability other than the Veteran's service-connected left knee arthroscopy residuals with scar.  See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009).  While there is insufficient evidence at this time that the Veteran has been diagnosed with left knee arthritis, the Veteran was diagnosed with left knee strain, separate from arthroscopy residuals, during a June 2024 VA examination.  The examiner noted that the Veteran's knee pain has worsened since his arthroscopy during service.  Particularly considering that the diagnoses affect the same joint, this evidence is sufficient to suggest that the Veteran's left knee strain may be caused or aggravated by his arthroscopy residuals.  Accordingly, VA has a duty to order a medical opinion addressing this topic, and remand for this development is thus warranted.  See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006).   

The matters are REMANDED for the following action:

Obtain a medical opinion from an appropriate VA examiner to determine the nature and etiology of the Veteran's left knee disabilities.  If an examination is deemed necessary, it shall be provided.  The entire claims file, to include a copy of this remand, must be provided to the examiner and reviewed in full.

The examiner should state
 to suggest that the Veteran's left knee strain may be caused or aggravated by his arthroscopy residuals.  Accordingly, VA has a duty to order a medical opinion addressing this topic, and remand for this development is thus warranted.  See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006).   

The matters are REMANDED for the following action:

Obtain a medical opinion from an appropriate VA examiner to determine the nature and etiology of the Veteran's left knee disabilities.  If an examination is deemed necessary, it shall be provided.  The entire claims file, to include a copy of this remand, must be provided to the examiner and reviewed in full.

The examiner should state whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any left knee disability (other than arthroscopy residuals) is caused by, or aggravated by, the Veteran's service-connected left knee arthroscopy residuals. 

The examiner must include a well-reasoned rationale in support of the opinions offered.  If an intercurrent cause of the Veteran's disability is suspected, it should be identified, and any medical literature consulted should be cited.

 

 

RYAN T. KESSEL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	B. Hayes, Associate Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.