Citation Nr: 0828134 Decision Date: 08/20/08 Archive Date: 08/28/08 DOCKET NO. 00-04 191A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES 1. Entitlement to an initial rating greater than 20 percent for degenerative joint disease of the acromioclavicular joint of the right shoulder. 2. Entitlement to an initial rating greater than 20 percent for degenerative joint disease of the acromioclavicular joint of the left shoulder. 3. Entitlement to an initial rating greater than 10 percent for chronic right hip strain. 4. Whether new and material evidence has been received to reopen a claim of service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis. 5. Entitlement to service connection for post-traumatic osteoarthritis of the knees, ankles, cervical spine, and left hip. 6. Entitlement to service connection for ischemic heart disease. REPRESENTATION Appellant represented by: Theodore C. Jarvi, Attorney at Law WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Michael T. Osborne, Counsel INTRODUCTION The veteran had active service from August 1957 to June 1960. This matter comes before the Board of Veterans' Appeals (Board) on appeal of June and July 1999 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona, which denied the benefits sought on appeal. An RO hearing was held on the veteran's claims in March 2000. In August 1988, the Board denied the veteran's claim of service connection for a back disorder. The veteran did not appeal this decision, and it became final. See 38 U.S.C.A. § 7104 (West 2002 & Supp. 2008). In a September 2001 Supplemental Statement of the Case, the RO essentially reopened the veteran's previously denied claim of service connection for a back disorder (characterized as degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis) and denied this claim on the merits. The Board does not have jurisdiction to consider a claim that has been previously adjudicated unless new and material evidence is presented. See Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). Therefore, although the RO has reviewed the veteran's service connection claim for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis on a de novo basis, this issue is as stated on the title page. Regardless of the RO's reopening of the claim for service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis, the Board must make its own determination as to whether new and material evidence has been received to reopen this claim. That is, the Board has a jurisdictional responsibility to consider whether a claim should be reopened, regardless of the RO's finding. See Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). In a May 2004 rating decision, the RO granted the veteran's claims of service connection for degenerative joint disease of the acromioclavicular joint of the right shoulder, assigning a 20 percent rating effective December 14, 1998, for degenerative joint disease of the acromioclavicular joint of the left shoulder, assigning a 20 percent rating effective December 14, 1998, and for chronic right hip strain, assigning a 10 percent rating effective December 14, 1998. The veteran continued to disagree with the disability ratings assigned to his service-connected bilateral shoulder and right hip disabilities. It appears that the veteran filed a claim of entitlement to a total disability rating based on individual unemployability (TDIU) in October 2004. To date, however, this claim has not been adjudicated by the RO. Accordingly, the veteran's TDIU claim is referred back to the RO for adjudication. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. The veteran's right shoulder disability is manifested by, at most, limitation of motion of the right (dominant) arm at shoulder level. 3. The veteran's left shoulder disability is manifested by, at most, limitation of motion of the left (non-dominant) arm to midway between the side and shoulder level. 4. The veteran's right hip disability is not manifested by limitation of motion on hip flexion to 30 degrees or less. 5. In August 1988, the Board denied the veteran's claim of service connection for a back disorder. 6. New and material evidence has been received since August 1988 in support of the veteran's claim of service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis. 7. The veteran's degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis is a congenital or development defect and is not a disability for VA compensation purposes. There has been no superimposed disability incurred or aggravated in service. 8. The medical evidence shows that the veteran's post- traumatic osteoarthritis of the knees, ankles, cervical spine, and left hip is not related to service. 9. The medical evidence shows that the veteran's ischemic heart disease is not related to service. CONCLUSIONS OF LAW 1. The criteria for an initial rating greater than 20 percent for degenerative joint disease of the acromioclavicular joint of the right shoulder have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2008); 38 C.F.R. §§ 4.1, 4.2., 4.7, 4.71a, Diagnostic Code (DC) 5003-5201 (2007). 2. The criteria for an initial rating greater than 20 percent for degenerative joint disease of the acromioclavicular joint of the left shoulder have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2008); 38 C.F.R. §§ 4.1, 4.2., 4.7, 4.71a, DC 5003-5201 (2007). 3. The criteria for an initial rating greater than 10 percent for chronic right hip strain have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2008); 38 C.F.R. §§ 4.1, 4.2., 4.7, 4.71a, DC 5252 (2007). 4. The August 1988 Board decision, which denied the veteran's claim of service connection for a back disorder, is final. 38 U.S.C.A. § 7104 (West 2002 & Supp. 2008); 38 C.F.R. § 3.104 (2007). 5. Evidence received since the August 1988 Board decision in support of the claim of service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis is new and material; accordingly, this claim is reopened. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2001). 6. The veteran's degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis was not incurred in service nor may it be so presumed. 38 U.S.C.A. §§ 1101, 1112, 1131, 1137, 5103, 5103A, 5107 (West 2002 & Supp. 2008); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 4.9 (2007). 7. The veteran's post-traumatic osteoarthritis of the knees, ankles, cervical spine, and left hip was not incurred in service nor may it be so presumed. 38 U.S.C.A. §§ 1101, 1112, 1131, 1137, 5103, 5103A, 5107 (West 2002 & Supp. 2008); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2007). 8. The veteran's ischemic heart disease was not incurred in service nor may it be so presumed. 38 U.S.C.A. §§ 1101, 1112, 1131, 1137, 5103, 5103A, 5107 (West 2002 & Supp. 2008); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Before assessing the merits of the appeal, VA's duties under the Veterans Claims Assistance Act of 2000 (VCAA) must be examined. The VCAA provides that VA shall apprise a claimant of the evidence necessary to substantiate his claim for benefits and that VA shall make reasonable efforts to assist a claimant in obtaining evidence unless no reasonable possibility exists that such assistance will aid in substantiating the claim. In an April 2001 letter, VA notified the veteran of the information and evidence needed to substantiate and complete his claims, including what part of that evidence he was to provide and what part VA would attempt to obtain for him. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). This letter informed the veteran to submit medical evidence relating his disabilities to active service and noted other types of evidence the veteran could submit in support of his claims. The veteran was informed of when and where to send the evidence. After consideration of the contents of this letter, the Board finds that VA has substantially satisfied the requirement that the veteran be advised to submit any additional information in support of his claims. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). As will be explained below in greater detail, the evidence does not support granting service connection for any of the veteran's claimed disabilities. Thus, any failure to notify and/or develop these claims under the VCAA cannot be considered prejudicial to the veteran. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). The claimant also has had the opportunity to submit additional argument and evidence and to participate meaningfully in the adjudication process. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). Letters issued in January and September 1999 also defined new and material evidence, advised the veteran of the reasons for the prior denial of the claim of service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis, and noted the evidence needed to substantiate the underlying claim. That correspondence satisfied the notice requirements as defined in Kent v. Nicholson, 20 Vet. App. 1 (2006). Additional notice of the five elements of a service- connection claim was provided in March 2006, as is now required by Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Thus, the Board finds that VA met its duty to notify the appellant of his rights and responsibilities under the VCAA. The veteran's higher initial rating claims for degenerative joint disease of the acromioclavicular joint of both shoulders and for chronic right hip strain are "downstream" elements of the RO's grant of service connection for these disabilities in the currently appealed rating decision issued in May 2004. For such downstream issues, notice under 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159 is not required in cases where such notice was afforded for the originating issue of service connection. See VAOPGCPREC 8-2003 (Dec. 22, 2003). For an increased compensation claim, section § 5103(a) requires, at a minimum, that the Secretary notify the claimant that, to substantiate a claim, the claimant must provide, or ask the Secretary to obtain, medical or lay evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on the claimant's employment and daily life. Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008). In November 2003, VA notified the veteran of the information and evidence needed to substantiate and complete this claim, including what part of that evidence he was to provide and what part VA would attempt to obtain for him. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio, 16 Vet. App. at 187. To the extent that Dingess requires more extensive notice as to potential downstream issues such as disability rating and effective date, because the May 2004 rating decision was fully favorable to the veteran on the issues of service connection for degenerative joint disease of the acromioclavicular joint of each shoulder and for chronic right hip strain, and because the veteran's higher initial rating claims for degenerative joint disease of the acromioclavicular joint of each shoulder and for chronic right hip strain are being denied in this decision, the Board finds no prejudice to the veteran in proceeding with the present decision and any defect with respect to that aspect of the notice requirement is rendered moot. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993); see also Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In Dingess, the United States Court of Appeals for Veterans Claims (Veterans Court) held that, in cases where service connection has been granted and an initial disability rating and effective date have been assigned, the typical service-connection claim has been more than substantiated, it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. See Dingess, 19 Vet. App. at 490-91. The Board notes that the Veterans Court, in Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008) clarified VA's notice obligations in increased rating claims. The appeal for higher initial ratings for degenerative joint disease of the acromioclavicular joint of each shoulder and for chronic right hip strain originates, however, from the grant of service connection for these disabilities. Consequently, Vazquez-Flores is inapplicable. With respect to the timing of the notice, the Board points out that the Veterans Court held that a VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction decision on a claim for VA benefits. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). In this case, the RO could not have provided pre-adjudication VCAA notice because the June and July 1999 rating decision were issued prior to the VCAA's enactment. There has been no prejudice to the appellant and any defect in the timing or content of the notices has not affected the fairness of the adjudication. See Mayfield, 444 F.3d at 1328; see also Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). The Board also finds that VA has complied with the VCAA's duty to assist by aiding the veteran in obtaining evidence and affording him the opportunity to give testimony before the RO. It appears that all known and available records relevant to the issues here on appeal have been obtained and are associated with the veteran's claims file; the veteran does not contend otherwise. As to any duty to provide an examination and/or seek a medical opinion, the Board notes that in the case of a claim for disability compensation, the assistance provided to the claimant shall include providing a medical examination or obtaining a medical opinion when such examination or opinion is necessary to make a decision on the claim. An examination or opinion shall be treated as being necessary to make a decision on the claim if the evidence of record, taking into consideration all information and lay or medical evidence (including statements of the claimant) contains competent evidence that the claimant has a current disability, or persistent or recurring symptoms of disability; and indicates that the disability or symptoms may be associated with the claimant's act of service; but does not contain sufficient medical evidence for VA to make a decision on the claim. 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The veteran has been provided with VA examinations which address the contended causal relationships between his claimed back disability, post-traumatic arthritis, ischemic heart disease and active service. The veteran also has provided with VA examinations which address the current nature and severity of his service-connected degenerative joint disease of the acromioclavicular joint of each shoulder and his service- connected chronic right hip strain. In summary, the Board finds that VA has done everything reasonably possible to notify and to assist the veteran and no further action is necessary to meet the requirements of the VCAA. In August 1988, the Board denied the veteran's claim of service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis (characterized as a back disorder). A finally adjudicated claim is an application which has been allowed or disallowed by the agency of original jurisdiction, the action having become final by the expiration of one year after the date of notice of an award or disallowance, or by denial on appellate review, whichever is the earlier. 38 U.S.C.A. §§ 7104, 7105 (West 2002 & Supp. 2008); 38 C.F.R. §§ 3.160(d), 20.302, 20.1103 (2007). Because the veteran did not appeal this decision, the August 1988 Board decision became final. The claim of entitlement to service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis may be reopened if new and material evidence is submitted. Manio v. Derwinski, 1 Vet. App. 140 (1991). The veteran filed this application to reopen his previously denied service connection claim for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis on a VA Form 21-4138 that was received at the RO on December 14, 1998. New and material evidence is defined by regulation, see 38 C.F.R. § 3.156, which VA amended in 2001. See 66 Fed. Reg. 45620- 45632 (August 29, 2001). The amended version of 38 C.F.R. § 3.156(a), however, is applicable only to claims filed on or after August 29, 2001. Because the veteran filed this application to reopen his claims of service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis on December 14, 1998, the earlier version of 38 C.F.R. § 3.156(a) is applicable to this case. Under the applicable provisions, new and material evidence means evidence not previously submitted which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with the evidence previously assembled is so significant that it must be considered in order to decide fairly the merits of the claim. 38 C.F.R. § 3.156(a) (2001). In determining whether evidence is new and material, the credibility of the new evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). With respect to the veteran's application to reopen a claim of service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis, the evidence before VA at the time of the prior final Board decision in August 1988 consisted of the veteran's service medical records, post- service treatment records, and lay statements. In this decision, the Board reviewed all of the evidence then of record and concluded that, although the newly submitted evidence concerned the veteran's contention of an in-service parachute jump injury which he alleged had led to his current back disorder, this evidence still did not show that any in- service injury "resulted in chronic residuals or that arthritis of the veteran's spine developed within a year of his discharge from active service." See Board decision dated August 8, 1988, at pp. 5-6. Because there was no medical evidence of a causal relationship between the veteran's reported in-service back injury and his current back disability, the reopened claim of service connection for a back disability was denied on the merits. The newly submitted evidence consists of additional private treatment records, the veteran's Social Security Administration (SSA) records, and a report of VA examination dated in January 2003. The newly submitted private treatment records show that the veteran continued to receive treatment for variously diagnosed back problems. X-rays of the veteran's lumbar spine in December 1993 showed Grade I L5-S1 spondylolisthesis with probable bilateral spondylolysis. On private outpatient treatment in July 1996, the veteran complained of hip pain and pain in his buttock and sciatica. He reported having a bad parachute landing fall and severely injuring his back. He was diagnosed with spondylolisthesis "shortly after that." He was a retired butcher. Physical examination showed back pain in the lumbosacral area and some mild tenderness but an excellent range of motion and no neurologic signs. X-rays showed a Grad II spondylolisthesis L5 on S1 with a severely degenerative L5-S1 disk. The diagnosis was Grade II spondylolisthesis with degenerative disc disease. The veteran was awarded SSA disability benefits in October 1998 due to degenerative disc disease. In February 1999, the veteran complained of low back pain "for years" related to a bad parachute landing fall in 1958. Neurological examination was normal. The veteran's intermittent symptoms "are suggestive or nerve root irritation." X-rays showed a grade II spondylolisthesis, L5 on S1 with a degenerative disk. The private examiner stated that the veteran "is really not that symptomatic." The diagnosis was degenerative disc disease at the lumbosacral spine with a grade II spondylolisthesis, L5 on S1. A magnetic resonance imaging (MRI) scan of the veteran's lumbar spine in March 1999 showed bilateral spondylolysis at L5 with a Grade II spondylolisthesis of L5-S1 and a mildly to moderately bulging L4-L5 intervertebral disk. On private outpatient treatment in May 1999, the veteran's complaints included arthritis. X-rays showed spondylolisthesis Grade II at L5-S1. The impressions included osteoarthritis in the lower back. In December 1999, the veteran complained of chronic low back pain "for many years." He stated that, while on active service, he was involved in a parachute jump where he suffered a back injury. He did not seek medical treatment at that time but later developed chronic low back pain. He worked primarily as a butcher after active service. He re- injured his back in 1970 and was told that he had a genetic spondylolisthesis. He described his pain as primarily in the lumbar region radiating down his right buttock and leg and over the right thigh. Physical examination showed a normal gait on heel walking but a little difficulty with toe walking. An MRI was reviewed and appeared to show scoliosis. The impressions included lumbar radiculopathy with possible herniated disc at L4,5 and spinal stenosis. On VA examination in January 2003, the veteran's complaints included low back pain. The VA examiner reviewed the veteran's claims file, including his service medical records. The veteran's history included an in-service back injury following a parachute jump in 1958, a post-service work- related back injury, and a back injury following a post- service motor vehicle accident. Physical examination showed a normal gait, tenderness to palpation in the right and left paralumbar muscles, no muscle pain, and some complaint of pain on midline percussion of the lumbar spine. X-rays of the lumbar spine showed anterolisthesis of L5 on S1 compromising greater than 30 percent of the vertebral body length with associated intervertebral disk space narrowing and marginal osteophytes. X-rays of the thoracic spine demonstrated marginal osteophyte formation throughout with confluent anterior osteophytes in the mid-thoracic spine and degenerative disc disease. The VA examiner opined that the veteran's thoracic and lumbar spine problems were not likely related to active service because lumbar arthrolisthosis was a developmental or congenital condition. The impressions included thoracic spine with degenerative disc disease/degenerative joint disease and lumbar spine with anterolisthesis L5-S1 with associated degenerative disc disease/degenerative joint disease. In a March 2003 letter, C.N.B., M.D., stated that he had reviewed the veteran's medical records "for the purpose of making a medical opinion concerning [his] spine problems." Dr. C.B. stated that he had reviewed the veteran's service medical records and post-service medical records. He opined that the veteran's current lumbar radiculopathy, spinal stenosis, and degenerative changes and associated neurological sequelae all were caused by his "paratrooper accident." On private outpatient treatment in October 2004, the veteran's complaints included low back pain. The private examiner conducting this examination, B.S., M.D., noted that the purpose of this evaluation was to determine a causal relationship between active service and the veteran's current orthopedic complaints. Dr. B.S. stated that he had reviewed "voluminous medical records." The veteran reported that he had injured his low back following a parachute jump in April 1958. Physical examination showed difficulty sitting during the course of the interview, changing position intermittently, difficulty undressing, requiring assistance from the examiner in the course of changing positions on the examining table, slow ambulation with a component of a waddling gait, difficulty balancing, complaints of low back pain when standing on his heels, a loss of lumbar lordosis, complaints of moderate low back pain throughout the low back range of motion, and marked tenderness to palpation in the midline paravertebral area of the lumbosacral area. Dr. B.S. opined that it was more likely than not that the veteran's post-traumatic arthritis of the lumbar spine was related to active service. The diagnoses included chronic lumbosacral sprain/strain and Grade II spondylolisthesis L5-S1 with degenerative disc disease and intervertebral disc space narrowing at L5-S1 and osteophyte formation. With respect to the veteran's application to reopen a claim of service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis, the Board observes that the evidence that was of record in August 1988 did not show any causal relationship between the veteran's acknowledged in- service parachute jump injury and his back disorder (now diagnosed as degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis). The veteran now has submitted such evidence. Such information must be presumed credible for the purposes of reopening the veteran's service connection claim for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis. See Justus, 3 Vet. App. at 513. Because the newly submitted evidence raises a reasonable possibility that the veteran's degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis may be related to active service, the Board finds that this evidence is new and material. This evidence was not previously submitted to agency decision makers, relates to an unestablished fact necessary to substantiate the claim of service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis, and is neither cumulative nor redundant of the evidence of record at the time of the last prior final denial. New evidence is sufficient to reopen a claim if it contributes to a more complete picture of the circumstances surrounding the origin of a veteran's disability, even where it may not convince the Board to grant the claim. Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). Accordingly, the claim for service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis is reopened. Having determined that new and material evidence has been received to reopen the veteran's claim of service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis, the Board must adjudicate this claim on the merits. The veteran also contends that he incurred post-traumatic osteoarthritis of the knees, ankles, cervical spine, and left hip, and ischemic heart disease during active service. Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic diseases, including arthritis and cardiovascular disease (including ischemic heart disease), are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Mere congenital or development defects are not considered diseases or injuries for VA compensation purposes. 38 C.F.R. § 4.9. If there is no evidence of a chronic condition during service or an applicable presumptive period, then a showing of continuity of symptomatology after service may serve as an alternative method of establishing the second and/or third element of a service connection claim. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488 (1997). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Evidence of a chronic condition must be medical, unless it relates to a condition to which lay observation is competent. If service connection is established by continuity of symptomatology, there must be medical evidence that relates a current condition to that symptomatology. See Savage, 10 Vet. App. at 495-498. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 C.F.R. § 3.102. A review of the veteran's service medical records indicates that, at his enlistment physical examination in August 1957, he denied any relevant medical history. Clinical evaluation was normal except for a scar. The veteran's history and clinical evaluation was unchanged on periodic physical examination in January 1958, when he was found qualified for airborne training. In December 1959, the veteran was treated for a right knee contusion after falling from a rock pile. This injury was incurred in the line of duty. The veteran was hospitalized for four days. On admission, x-rays were negative and a cylinder cast was applied. After four days of complete bed rest in a hospital, the veteran returned to full duty. He had no complaints after his cast was removed in January 1960. The veteran's clinical evaluation was normal at his separation physical examination in April 1960, except for a tattoo on his arm. The veteran's DD Form 214 shows that he was awarded the Parachutist Badge. His military occupational specialty (MOS) was light weapons infantry. The post-service medical evidence shows that, in a November 1970 letter, H.R.B., M.D., stated that he had seen the veteran in October 1970. At that time, the veteran reported that he first injured his low back while at work in September 1970. He then reported a brief hospital stay for bed rest and physical therapy. The veteran's complaints included constant low back pain which radiated into his left buttock. Physical examination showed a straight low back, segmental but guarded lumbosacral motions, tight lumbar muscles, and no muscle spasm. X-rays showed grade I spondylolisthesis of the lumbosacral level. Dr. H.B. stated that it was "not an uncommon orthopedic experience for previously asymptomatic spondylolisthesis (and this patient has no history of any previous back difficulty) to continue to have disabling symptoms for varying periods of time and sometimes indefinitely." Dr. H.B. opined that the veteran continued to experience disabling symptoms from his September 1970 on- the-job injury which consisted of lumbosacral strain superimposed on a spondylolisthesis which was developmental in nature. In an April 1976 letter, Dr. H.B. stated that he had seen the veteran in April 1975 following a December 1974 motor vehicle accident in which the veteran's vehicle was struck from behind. The veteran complained of low back pain since that accident. Physical examination showed smooth, segmental, and complete lumbar motion in all directions. X-rays showed spondylolisthesis at L5-S1. Dr. H.B. opined that, as a result of the veteran's motor vehicle accident, he had sustained an acute lumbosacral musculo-ligamentous strain superimposed upon a pre-existing area of spondylolisthesis. In an October 1984 statement, the veteran described his severe in-service back injury following a parachute jump on April 23, 1958. In a December 1984 letter, B.L.R., D.C., stated that he had seen the veteran in December 1981 for recurring upper back pain resulting in muscle spasms and painful motion. Dr. B.R. reviewed x-rays of the veteran's lumbar spine and noted a grade I spondylolisthesis at the L5-S1. The diagnoses included chronic thoracic strain. In a December 1985 letter, V.A.D, M.D., stated that he had been in practice from 1951 to 1979 and remembered that the veteran had complained of a back problem at that time "but I do not remember any specific diagnosis." The relevant medical records had been destroyed. "I remember that you believed the back to have been injured while you were in military service." The veteran also submitted a barely legible copy of a "jump log" in which it appears in the "Remarks" section that the veteran injured his back following a parachute jump on April 23, 1958. As noted above, the recently submitted medical evidence shows continuing treatment for a variety of back problems (including Grade I and Grade II spondylolisthesis with degenerative disc disease, lumbar radiculopathy with possible herniated disc at L4,5 and spinal stenosis, and osteoarthritis of the lower back). On private disability evaluation by D.S., D.O., in March 1997, the veteran complained of daily chest pain three times a day without shortness of breath, nausea, or vomiting. His history included a myocardial infarction in 1991. Physical examination showed a regular heart rate and rhythm without murmurs, rubs, or gallops, no reproducible chest wall tenderness. An electrocardiogram was normal. A stress test was normal except for alleged chest pain and decreased work capacity. Dr. D.S. stated that, on the basis of the veteran's cardiovascular examination and history, he was reluctant to classify the veteran as being "disabled" because there was no proven coronary ischemia. The impressions included coronary artery disease which was "probably stable," status-post myocardial infarction and stenting. On private outpatient treatment in May 1999, the veteran complained of arthritis. Physical examination showed no synovitis in the metacarpophalangeal joints in the wrists, elbows, or knees. There was a decreased range of motion in the hips and crepitus bilaterally in both knees. X-rays showed mild osteoarthritis involving both knees. The impressions included osteoarthritis involving the knees and hips. On VA examination in December 2002, the veteran complained that his ischemic heart disease was related to his parachute jumping during service. The VA examiner reviewed the veteran's claims file, including his service medical records. The veteran's history included coronary artery disease diagnosed in 1991. The VA examiner concluded that there was no nexus between active service and the veteran's ischemic heart disease. On VA examination in January 2003, the veteran's complaints included multiple joint trauma from an in-service parachute jump. The VA examiner reviewed the veteran's claims file, including his service medical records. Physical examination showed tenderness to palpation in the left trapeizus/supraspinatus area but no other tenderness about the neck, no muscle spasm in the cervical spine, tenderness to palpation in the bilateral biceps and coracoids and the lateral upper humerus, no swelling or tenderness to palpation in either ankle or either knee, and no effusion or crepitation in either knee. The VA examiner opined that the veteran's cervical, thoracic, and lumbar spine problems were not likely related to active service because lumbar arthrolisthosis was a developmental or congenital condition. This examiner also opined that the veteran's bilateral knee disability and bilateral ankle disability were not related to active service. This examiner opined further that the veteran's left shoulder disability was at least as likely as not related to active service. The impressions included thoracic spine with degenerative disc disease/degenerative joint disease and lumbar spine with anterolisthesis L5-S1 with associated degenerative disc disease/degenerative joint disease, a bilateral patellar spur of the knees, mild chronic strain of the ankles, cervical spine with multilevel spondylosis, and degenerative joint disease of the acromioclavicular joint of the left shoulder. In March 2003, after a review of the veteran's medical records, Dr. C.B. opined that the veteran's current lumbar radiculopathy, spinal stenosis, and degenerative changes and associated neurological sequelae all were caused by his "paratrooper accident." Dr. C.B. also opined that, due to the veteran's "severe spine degenerative disease and his superimposed inability to exercise, which was caused by his paratrooper accident," he had developed ischemic heart disease. Finally, Dr. C.B. concluded that it also was likely that the veteran's current hip and knee problems were due to excessive weight gain. When examined by Dr. B.S. in October 2004, the veteran's complaints included pain in the knees, ankles, left hip, and neck. Physical examination showed normal alignment in the cervical spine, complaints of pain in the neck throughout range of motion testing of the cervical spine, tenderness to palpation in the midline paravertebral area of the cervical spine with no evidence of muscle spasm, complaints of pain throughout range of motion testing of the left hip, no evidence of swelling in either knee, complaints of pain on range of motion testing of the right knee, generalized tenderness in both knees, no ligamentous instability in either knee, no evidence of swelling in the ankles, generalized tenderness to palpation in both ankles, no instability, and complaints of moderate pain throughout range of motion testing of the ankles. The diagnoses included chronic left hip pain, chondromalacia patella with associated chronic limitation of motion and osteoarthritic changes confined to the medial compartment of the left knee, chronic bilateral ankle pain with painful and limited motion, chronic cervical sprain/strain, and multilevel cervical spondylolysis. Dr. B.S. opined that it was more likely than not that the veteran's current post-traumatic osteoarthritis of the knees, left ankle condition, cervical spine, and left hip were related to service. After reviewing "voluminous" medical records, Dr. B.S. also opined that it was more likely than not that the veteran's post-traumatic arthritis of the lumbar spine was related to active service. A private magnetic resonance imaging (MRI) scan of the veteran's right knee in April 2005 showed a high T-2 signal in the medial femoral epicondyle and medial tibial plateau which likely represented edema in the bone marrow and "could be secondary to contusion if there is a history of trauma. This could also represent acute degenerative change," a degenerative change in the posterior horn of the medial meniscus, and a small joint effusion. The Board finds that the preponderance of the evidence is against the veteran's claims of service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis. The veteran was not treated for any back problems during active service or within the first post-service year; accordingly, service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis on a presumptive service connection basis is precluded. See 38 C.F.R. §§ 3.307, 3.309. A review of the veteran's DD Form 214 indicates that he was awarded the Parachutist's Badge. As the Board previously noted in its August 1988 decision, the veteran also participated in a mass parachute jump in April 1958 when he apparently injured his back. As the veteran himself has conceded, however, he did not seek medical treatment for any injuries he experienced in April 1958 or subsequently while on active service. Instead, it appears that he first was treated for his multiple orthopedic complaints in October 1970, or more than 10 years after his service separation in June 1960, following an on-the-job back injury. With respect to negative evidence, the fact that there was no record of any complaint, let alone treatment, involving the veteran's condition for many years is significant. See Maxson v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that it was proper to consider the veteran's entire medical history, including a lengthy period of absence of complaints). Dr. H.B. concluded in November 1970 that the veteran's back problems were related to his on-the-job back injury in September 1970. At that time, the veteran himself reported that his back problems had begun after he injured his back at work. He did not report any history of in-service back problems or that he had suffered a back injury while participating in a parachute jump during active service. Dr. H.B. also concluded that the veteran's spondylolisthesis was superimposed on his on-the-job lumbosacral strain and was a developmental defect. Similarly, after reviewing the veteran's complete claims file, the VA examiner concluded in January 2003 that the veteran's thoracic and lumbar spine problems were not likely related to active service because lumbar arthrolisthosis was a developmental or congenital condition. As noted above, congenital or developmental defects are not considered disabilities for VA compensation purposes. See 38 C.F.R. § 4.9 (2007). The veteran relies heavily on the opinions rendered by Dr. V.D. in December 1985, Dr. C.B. in March 2003, and Dr. B.S. in October 2003 as support for his service connection claim for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis. As noted, Dr. V.D. recalled in December 1985 that the veteran "believed the back to have been injured while you were in military service" but did not provide any opinion concerning the etiology of the veteran's back disability. Dr. C.B. opined in March 2003 that the veteran's lumbar radiculopathy, spinal stenosis, and degenerative changes were caused by his "paratrooper accident." The veteran's report that he was a paratrooper during service is consistent with the parachute jump log he submitted and his receipt of the Parachutist's Badge during active service. It appears, however, that Dr. C.B. based his March 2003 opinion solely on the history provided by the veteran which is not totally supported by the record. For example, the veteran reported injuring his back after a parachute jump during active service; however, as noted, the veteran's service medical records are completely silent for any complaints of or treatment for back problems at any time during active service. The basis for Dr. B.S.'s October 2003 opinion also is not clear because he referred only to "voluminous" medical records; it is not clear whether he had access to or reviewed the veteran's complete claims file prior to offering his opinion. Thus, it is clear that the December 1985 and March and October 2003 opinions merely are a recitation of the veteran's own contention; there is no indication that Dr. V.D., Dr. C.B., or Dr. B.S. was rendering a medical opinion as to the date of onset based on the clinical or objective evidence. See Kowalski v. Nicholson, 19 Vet. App. 171 (2005). The opinions by Dr. C.B. and Dr. B.S. also are less probative than the opinions provided by Dr. H.B. in November 1970 and in April 1976. Dr. H.B.'s opinions are much closer in time to the veteran's period of active service and discuss both the veteran's on-the-job back injury in September 1970 and his motor vehicle accident in December 1974. The Board notes that neither Dr. C.B. nor Dr. B.S. discussed the veteran's post-service back injury in September 1970 or his post- service motor vehicle accident in December 1974 when they provided their opinions in March and October 2003, respectively. The Board also finds that the preponderance of the evidence is against the veteran's claims of service connection for post-traumatic osteoarthritis of the knees, ankles, cervical spine, and left hip. With the exception of in-service treatment for a right knee contusion, which appears to have resolved during service because it was not noted at the veteran's separation physical examination, the veteran's service medical records show no complaints of or treatment for any of these claimed disabilities during active service or within the first post-service year. Accordingly, service connection for post-traumatic osteoarthritis of the knees, ankles, cervical spine, and left hip is precluded. See 38 C.F.R. §§ 3.307, 3.309. It appears that the veteran first was treated for osteoarthritis in May 1999, or almost 39 years after his separation from service in June 1960, when he was diagnosed as having osteoarthritis of the knees and hips. See Maxson, 230 F.3d at 1333. The remaining post-service evidence shows that, following comprehensive physical examination and a review of the veteran's complete claims file in January 2003, the VA examiner opined that the veteran's bilateral knee disability and bilateral ankle disability were not related to active service and the veteran's left shoulder disability was at least as likely as not related to active service. Again, the veteran relies heavily on the opinions provided by Dr. C.B. and Dr. B.S. in support of his service connection claims for post-traumatic osteoarthritis of the knees, ankles, cervical spine, and left hip. As noted above, however, the opinions provided by Dr. C.B. and by Dr. B.S. are less than probative on the issue of whether the veteran's osteoarthritis in multiple joints is related to active service because these opinions merely are a recitation of the veteran's own contention and there is no indication that either Dr. C.B. or Dr. B.S. was rendering a medical opinion as to the date of onset based on the clinical or objective evidence. See Kowalski v. Nicholson, 19 Vet. App. 171 (2005). By contrast, following a review of the veteran's complete claims file and a thorough physical examination of the veteran, the VA examiner concluded in January 2003 that the veteran's cervical spine problems, bilateral knee disability, bilateral ankle disability, and left shoulder disability were not related to active service. Because the bases for the opinions by Dr. C.B. and Dr. B.S. purporting to relate the veteran's multiple joint osteoarthritis to active service are not clear, as discussed above, and because the VA examiner reviewed the veteran's complete claims file, including his service medical records, prior to examining him and offering his opinion concerning the claimed medical nexus relationship between osteoarthritis and active service, the Board find the January 2003 VA examiner's opinion more probative than the opinions by Dr. C.B. and Dr. B.S. on the issue of whether the veteran's multiple joint osteoarthritis is related to active service. The Board observes that, following an MRI scan of the veteran's right knee in April 2005, a private radiologist concluded that the veteran's right knee edema in the bone marrow "could be secondary to contusion if there is a history of trauma. This could also represent acute degenerative change." Current regulations provide that service connection may not be based on a resort to speculation or even remote possibility. See 38 C.F.R. § 3.102 (2006); Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992); and Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). Accordingly, even if the veteran's right knee MRI scan in April 2005 is viewed in the light most favorable to the veteran, this evidence does not establish service connection for osteoarthritis of the right knee. The Board further finds that the preponderance of the evidence is against the veteran's claim of service connection for ischemic heart disease. The veteran's service medical records show no complaints of or treatment for ischemic heart disease during active service or within the first post- service year. Thus, service connection for ischemic heart disease is not warranted on a presumptive service connection basis. See 38 C.F.R. § 3.307, 3.309. It appears that the veteran first was treated for ischemic heart disease in March 1997, or almost 37 years after his service separation, when Dr. D.S. found no proven coronary ischemia. See Maxson, 230 F.3d at 1333. Dr. D.S. concluded that the veteran's coronary artery disease probably was stable and was reluctant to classify the veteran as disabled given his lack of coronary ischemia. The remaining post-service medical evidence shows that, following VA examination in December 2002, the VA examiner concluded that there was no nexus between active service and the veteran's ischemic heart disease. Absent evidence of a medical nexus between the veteran's ischemic heart disease and active service, the Board finds that service connection for ischemic heart disease is not warranted. The veteran also contends that his service-connected degenerative joint disease of the acromioclavicular joint of each shoulder and his service-connected chronic strain of the right hip are more disabling than currently evaluated. In general, disability evaluations are assigned by applying a schedule of ratings that represent, as far as can be determined, the average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (2007). Separate diagnostic codes identify the various disabilities and the criteria that must be met for specific ratings. The regulations require that, in evaluating a given disability, the disability be viewed in relation to its whole recorded history. 38 C.F.R. § 4.2 (2007); see also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. Separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. See Fenderson v. West, 12 Vet. App. 119 (1999). The veteran's service-connected degenerative joint disease of the acromioclavicular joint currently is evaluated as 20 percent disabling in each shoulder by analogy to 38 C.F.R. § 4.71a, DC 5003-5201. See 38 C.F.R. § 4.71a, DC 5003-5201 (2007). The veteran's service-connected chronic right hip strain currently is evaluated as 10 percent disabling under 38 C.F.R. § 4.71a, DC 5252. See 38 C.F.R. § 4.71a, DC 5252 (2007). The veteran is right-handed so his right side is his major (dominant) side. Arthritis due to trauma and substantiated by x-ray findings is rated as degenerative arthritis under DC 5003. DC 5003 indicates that degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate DC for the specific joint involved. When, however, the limitation of motion of the specific joint involved is non-compensable under the appropriate DC, a rating of 10 percent is applicable for each such major joint or group of minor joints affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling muscle, spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, DC 5003 provides a 10 percent evaluation for degenerative arthritis with x-rays evidence of the involvement of 2 or more major joints or 2 or more minor joint groups. The maximum evaluation of 20 percent is available under DC 5003 for degenerative arthritis with x-ray evidence of the involvement of 2 or more major joints or 2 or more minor joint groups with occasional incapacitating exacerbations. See 38 C.F.R. § 4.71, DC 5003 (2007). For the purpose of rating disability from arthritis, the shoulders and hips are considered major joints. See 38 C.F.R. § 4.45(f) (2007). DC 5201 provides a 20 percent rating for limitation of motion of the arm at the shoulder level for the major (dominant) side. DC 5201 also provides a 20 percent rating for limitation of motion of the arm midway between the minor (non-dominant) side and shoulder level. A maximum 30 percent rating is warranted for limitation of motion of the arm to 25 degrees from the minor (non-dominant) side. A 30 percent rating is warranted for limitation of motion of the arm midway between the major (dominant) side and shoulder level. A maximum 40 percent rating is warranted for limitation of motion of the arm to 25 degrees from the major (dominant) side. See 38 C.F.R. § 4.71a, DC 5201 (2007). DC 5252 provides a 10 percent rating for limitation of rotation of the thigh, an inability to toe-out more than 15 degrees, in the affected leg. Limitation of adduction of the thigh and an inability to cross the legs also warrants a 10 percent rating. A maximum 20 percent rating is assigned for limitation of abduction of the thigh with motion los beyond 10 degrees. See 38 C.F.R. § 4.71a, DC 5252 (2007). If a veteran has separate and distinct manifestations relating to the same injury, he or she should be compensated under different diagnostic codes. Esteban v. Brown, 6 Vet. App. 259 (1994); Fanning v. Brown, 4 Vet. App. 225 (1993). The evaluation, however, of the same manifestation under different diagnostic codes is to be avoided. 38 C.F.R. § 4.14 (2006). The Rating Schedule may not be employed as a vehicle for compensating a claimant twice or more for the same symptomatology, since such a result would overcompensate the claimant for the actual impairment of his earning capacity and would constitute pyramiding. See Esteban, citing Brady v. Brown, 4 Vet. App. 203 (1993). The basis of disability evaluations is the ability of the body as a whole to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10 (2007). Disability of the musculoskeletal system is primarily the inability to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. 38 C.F.R. § 4.40 (2007). Consideration is to be given to whether there is less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse, instability of station, or interference with standing, sitting, or weight bearing. 38 C.F.R. § 4.45 (2007). VA must consider "functional loss" of a musculoskeletal disability separately from consideration under the diagnostic codes; "functional loss" may occur as a result of weakness, fatigability, incoordination or pain on motion. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). VA must consider any part of the musculoskeletal system that becomes painful on use to be "seriously disabled." A review of the veteran's service medical records indicates that the veteran was not treated for any shoulder or right hip problems during active service. As noted elsewhere, the veteran was normal clinically at his entrance and separation physical examinations. The post-service medical evidence shows that, on private outpatient treatment in April 1999, the veteran complained of left shoulder pain "for years . . . ever since he was on active duty in the military." Objective examination showed a full range of motion of the left shoulder, a negative drop- arm test, and some subacromial crepitus. X-rays showed some mild to moderate degenerative changes in the glenohumeral joint and mild degenerative changes in the acromioclavicular joint. The assessment was left shoulder degenerative joint disease and impingement syndrome. Following private outpatient treatment in May 1999, the impressions included osteoarthritis involving the left shoulder. On VA examination in January 2003, the veteran's complaints included bilateral shoulder and right hip pain. The VA examiner reviewed the veteran's claims file, including his service medical records. The veteran reported that these injuries were related to a parachute jump in 1958. Physical examination of both shoulders showed tenderness to palpation in the bilateral biceps and coracoids and lateral upper humerus. Range of motion testing of the right shoulder showed flexion to 110 degrees, extension to 45 degrees, abduction to 100 degrees, external rotation to 90 degrees, and internal rotation to 85 degrees. Range of motion testing of the left shoulder showed flexion to 90 degrees, extension to 45 degrees, abduction to 80 degrees, external rotation to 70 degrees, and internal rotation to 65 degrees. The veteran complained of pain at the terminal degrees of bilateral motion. Physical examination of the right hip showed tenderness to palpation about the trochanteric bursa region plus the anterior superior iliac spine region on the right. Range of motion testing of the right hip showed flexion to 65 degrees. The VA examiner opined that the veteran's right hip strain and both shoulders were at least as likely as not related to active service. The impressions included right shoulder with degenerative joint disease of the acromioclavicular joint, left shoulder with degenerative joint disease of the acromioclavicular joint, and right hip with chronic strain and a normal x-ray. On examination by Dr. B.S. in October 2004, the left and right shoulder showed normal appendicular and articular alignment. Range of motion testing of the right shoulder showed flexion to 110 degrees, extension to 40 degrees, abduction to 100 degrees, external rotation to 85 degrees, and internal rotation to 75 degrees. Range of motion testing of the left shoulder showed flexion to 110 degrees, extension to 45 degrees, abduction to 95 degrees, external rotation to 85 degrees, and internal rotation to 70 degrees. The veteran complained of pain throughout range of motion testing of each shoulder. There was generalized tenderness over the anterior aspect of each shoulder in the subacromial arch and biceps groove. There was bilateral tenderness over the acromioclavicular joint with slight crepitation. Range of motion testing of the right hip showed flexion to 65 degrees with complaints of pain in the right hip at the extreme range of motion localized over the anterior proximal right thigh and right groin. The diagnoses included chronic degenerative joint disease of the acromioclavicular joints in each shoulder manifested by significant limitation of motion, rotator cuff weakness, and chronic moderate to severe pain, and chronic right hip pain with limitation of motion. The Board finds that the preponderance of the evidence is against the veteran's claims for initial disability ratings greater than 20 percent for service-connected degenerative joint disease of the acromioclavicular joint in each shoulder. Initially, the Board notes that the veteran was not treated for any shoulder disabilities during active service. It appears that he first was treated for shoulder complaints in April 1999, when he complained of left shoulder pain since active service. The medical evidence shows that the veteran's service-connected degenerative joint disease of the acromioclavicular joint in each shoulder is manifested by, at most, limitation of motion of each arm at shoulder level. There was a full range of motion in the left shoulder on private outpatient treatment in April 1999. Although the veteran complained of bilateral shoulder pain in January 2003, right shoulder range of motion testing showed flexion to 110 degrees, extension to 45 degrees, abduction to 100 degrees, external rotation to 90 degrees, and internal rotation to 85 degrees. Range of motion testing of the left shoulder showed flexion to 90 degrees, extension to 45 degrees, abduction to 80 degrees, external rotation to 70 degrees, and internal rotation to 65 degrees. The veteran again complained of pain throughout range of motion testing of each shoulder in October 2004. Range of motion testing of the right shoulder showed flexion to 110 degrees, extension to 40 degrees, abduction to 100 degrees, external rotation to 85 degrees, and internal rotation to 75 degrees. Range of motion testing of the left shoulder showed flexion to 110 degrees, extension to 45 degrees, abduction to 95 degrees, external rotation to 85 degrees, and internal rotation to 70 degrees. Absent objective medical evidence that either of the veteran's arms had limited motion to midway between the side and shoulder level (or to approximately 45 degrees of flexion) or was limited to 25 degrees (of flexion) from the side, the veteran's service- connected degenerative joint disease of the acromioclavicular joint in the right (dominant) shoulder warrants, at most, a 20 percent rating under DC 5003-5201. Similarly, the veteran's service-connected degenerative joint disease of the acromioclavicular joint in the left (non-dominant) shoulder warrants, at most , a 20 percent rating under DC 5003-5201. See 38 C.F.R. § 4.71a, DC 5003-5201 (2007). The Board also finds that the preponderance of the evidence is against an initial rating greater than 10 percent for chronic right hip strain. Again, the Board notes initially that the veteran was not treated for right hip problems during active service. It appears that he first was treated for right hip complaints in January 2003 when he reported injuring his right hip during a parachute jump in April 1958. Range of motion testing of the right hip in January 2003 showed flexion to 65 degrees. X-rays of the right hip also were normal. On private outpatient treatment in October 2004 with Dr. B.S., range of motion testing of the right hip showed flexion to 65 degrees with complaints of pain in the right hip at the extreme range of motion localized over the anterior proximal right thigh and right groin. Absent evidence of right hip flexion limited to 30 degrees, an initial rating greater than 10 percent for service-connected chronic right hip strain is not warranted under DC 5252. See 38 C.F.R. § 4.71a, DC 5252 (2007). There is no evidence that the disability ratings assigned to the veteran's service-connected degenerative joint disease of the acromioclavicular joint in each shoulder or to his service-connected chronic right hip strain should be increased for any other separate period based on the facts found during the whole appeal period. The evidence of record from the day the veteran filed the claim to the present supports the conclusion that the veteran is not entitled to additional increased compensation during any time within the appeal period. There is no evidence of any additional disability due to functional loss as a result of weakness, fatigability, incoordination or pain on motion. See DeLuca v. Brown, 8 Vet. App. 202. As the preponderance of the evidence is against the veteran's claims, the benefit-of- the-doubt doctrine does not apply. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App 49, 55-57 (1990). (CONTINUED ON NEXT PAGE) ORDER Entitlement to an initial rating greater than 20 percent for degenerative joint disease of the acromioclavicular joint of the right shoulder is denied. Entitlement to an initial rating greater than 20 percent for degenerative joint disease of the acromioclavicular joint of the left shoulder is denied. Entitlement to an initial rating greater than 10 percent for chronic right hip strain is denied. As new and material evidence has been received, the claim of service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis is reopened; to this extent only, the appeal is granted. Entitlement to service connection for degenerative disc disease/degenerative joint disease of the thoracic and lumbar spine with anterolisthesis is denied. Entitlement to service connection for post-traumatic osteoarthritis of the knees, ankles, cervical spine, and left hip is denied. Entitlement to service connection for ischemic heart disease is denied. ____________________________________________ JAMES L. MARCH Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs