Citation Nr: 1002183 Decision Date: 01/13/10 Archive Date: 01/22/10 DOCKET NO. 05-41 309 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to an increased disability evaluation for bilateral plantar fasciitis, currently evaluated as 10 percent disabling. 2. Entitlement to a temporary total disability rating for bilateral plantar fasciitis under the provisions of 38 C.F.R. § 4.30 based upon convalescence following September 20, 2004, Department of Veterans Affairs orthopedic treatment. 3. Entitlement to an increased disability evaluation for right knee patellofemoral syndrome, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARINGS ON APPEAL The Veteran/Appellant ATTORNEY FOR THE BOARD J. T. Hutcheson, Counsel INTRODUCTION The Veteran had active service from May 1979 to June 1992 and from February 2003 to January 2004. This matter came before the Board of Veterans' Appeals (Board) on appeal from a June 2005 rating decision of the Jackson, Mississippi, Regional Office (RO) which, in pertinent part, denied increased disability evaluations for the Veteran's bilateral plantar fasciitis and right knee patellofemoral syndrome and a total disability rating for her bilateral plantar fasciitis under the provisions of 38 C.F.R. § 4.30 based upon convalescence following September 20, 2004, Department of Veterans Affairs (VA) orthopedic treatment. In August 2007, the Veteran was afforded a hearing before the undersigned sitting at the RO. A transcript of that hearing is contained in the claims folder. In November 2007, the Board remanded the Veteran's appeal to the RO for additional action. The matter is now properly returned for additional appellate consideration. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the Veteran's appeal has been obtained. 2. The Veteran's post-operative bilateral plantar fasciitis alone has been objectively shown to be productive of no more than chronic bilateral foot pain and swelling; well-healed surgical scars; an antalgic gait; the daily use of 3D boots; and an impaired ability to be on her feet for prolonged periods of time. The foot disability is severe. 3. The September 20, 2004, VA orthopedic treatment of the Veteran's bilateral plantar fasciitis encompassed immobilization of the Veteran's left foot in a cast and required a period of convalescence until October 21, 2004. 4. The Veteran's right knee patellofemoral syndrome has been objectively shown to be manifest by no more than a range of motion of 0 to 100 degrees with pain and crepitus; joint line tenderness; mild degenerative joint disease; and no recurrent joint subluxation or lateral instability. CONCLUSIONS OF LAW 1. Criteria for a 30 percent evaluation for the Veteran's bilateral plantar fasciitis have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.10, 4.40, 4.45, 4.71a, Diagnostic Code 5284 (2009). 2. Criteria for a temporary total disability rating under the provisions of 38 C.F.R. § 4.30 based upon convalescence following September 20, 2004, VA orthopedic treatment have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R §§ 3.102, 3.159, 3.326(a), 4.30(a)(3), 4.45(f) (2009). 3. Criteria for an evaluation in excess of 10 percent for the Veteran's right knee patellofemoral syndrome have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Assist In Pelegrini v. Principi, 18 Vet. App. 112 (2004), the United States Court of Appeals for Veterans Claims (Court) held that a Veterans Claims Assistance Act of 2000 (VCAA) notice, as required by 38 U.S.C.A. § 5103(a), must (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that the VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. The notice must be provided to a claimant before the initial unfavorable RO decision on a claim for VA benefits. In reviewing the Veteran's claims of entitlement to both increased evaluations for her bilateral plantar fasciitis and right knee patellofemoral syndrome and for a total disability rating under 38 C.F.R. § 4.30, the Board observes that the RO issued VCAA notices to the Veteran in January 2005, March 2006, and January 2008 which informed her of the evidence generally needed to support a claim of entitlement to an increased evaluation and a total disability rating; what actions she needed to undertake; and how the VA would assist her in developing her claims. The January 2005 VCAA notice was issued prior to the June 2005 rating decision from which the instant appeal arises. The VA has attempted to secure all relevant documentation to the extent possible. The Veteran was afforded multiple VA examinations for compensation purposes. The examination reports are of record. The Veteran was afforded hearings before both a VA hearing officer and the Board. The hearing transcripts are of record. In November 2007, the Board remanded the Veteran's claims to the RO for additional action including affording the Veteran further evaluation which encompassed her feet and right knee. The Veteran was afforded a February 2008 VA orthopedic examination for compensation purposes. To that end, when the VA undertakes to either provide an examination or to obtain an opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). While not a model of clarity, the February 2008 examination report reflects that all relevant orthopedic evaluation and tests were performed. The examiner also noted reviewing the claims folder extensively and provided opinions regarding limitation due to pain. Although the examiner did not provide supporting rationale for the opinion that foot pain is more likely due to plantar fasciitis than neuropathy, the Board finds that the lack of reasoning is not detrimental to the Veteran as the claim will be resolved in her favor, as discussed more fully below, in a finding that the foot disability is severe and a result of service-connected plantar fasciitis. As such, the Board finds that there has been substantial compliance with its November 2007 remand instructions and additional remand is not required. D'Aries v. Peake, 22 Vet. App. 97 (2008) (noting that substantial rather than strict compliance with the terms of a Board remand is required pursuant to Stegall v. West, 11 Vet. App. 268 (1998)). There remains no issue as to the substantial completeness of the Veteran's claims. All relevant facts have been developed to the extent possible. 38 U.S.C.A. §§ 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R §§ 3.102, 3.159, 3.326(a) (2009). Any duty imposed on the VA, including the duty to assist and to provide notification, has been met as set forth above. Quartuccio v. Principi, 16 Vet. App. 183 (2002); Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, No. 05-7157 (Fed. Cir. Apr. 5, 2006); Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); Shinseki v. Sanders, 556 U.S. ___ (2009). Consequently, the Board now turns to the merits of the Veteran's claims. II. Bilateral Plantar Fasciitis A. Historical Review A November 2003 Army physical evaluation board report indicates that the Veteran was diagnosed as having chronic bilateral plantar fasciitis which rendered her unfit for continued military service. In August 2004, the RO established service connection for bilateral plantar fasciitis; assigned a 10 percent evaluation for that disability under the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5284; and effectuated the award as of January 17, 2004. B. Increased Evaluation Disability evaluations are determined by comparing the Veteran's current symptomatology with the criteria set forth in the Schedule For Rating Disabilities. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4 (2009). Moderate residuals of foot injuries warrant a 10 percent evaluation. A 20 percent evaluation requires moderately severe residuals. A 30 percent evaluation requires severe residuals. 38 C.F.R. § 4.71a, Diagnostic Code 5284 (2009). Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7 (2009). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45 (2009). With any form of arthritis, painful motion is an important factor of disability, the facial expression, wincing, etc., on pressure or manipulation, should be carefully noted and definitely related to affected joints. Muscle spasm will greatly assist the identification. Sciatic neuritis is not uncommonly caused by arthritis of the spine. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight bearing and non-weight bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59 (2009). Evaluations shall be based as far as practicable, upon the average impairments of earning capacity with the additional proviso that the Secretary shall from time to time readjust this schedule of ratings in accordance with experience. To accord justice, therefore, to the exceptional case where the schedular evaluations are found to be inadequate, the Under Secretary for Benefits or the Director, Compensation and Pension Service, upon field station submission, is authorized to approve on the basis of the criteria set forth in this paragraph an extra-schedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities. The governing norm in these exceptional cases is: A finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b) (1) (2009). A March 2004 VA podiatric evaluation reflects that the Veteran complained of chronic bilateral foot burning pain and aching. She presented a history of bilateral plantar fascial fibromatosis and 2002 right and left plantar fasciotomies. On examination, the Veteran exhibited bilateral foot pronation and lower extremity ranges of motion "within normal limits." VA clinical documentation dated in September 2004 and October 2004 indicate that her feet were placed in casts and 3D boots in an attempt to ameliorate her bilateral foot pain. The VA treatment record states that the Veteran's bilateral foot disorder necessitated that she be "off work" for a six week period. In her November 2004 claim for an increased evaluation, the Veteran advanced that: her feet had been "in [a] walking cast or [a] regular cast since September 2004; her bilateral foot disorder had increased in severity; and she was unable to hold a job. At a February 2005 VA examination for compensation purposes, the Veteran complained of progressively worsening chronic bilateral foot pain which was exacerbated by walking. She reported that she had been treated with bilateral lower extremity casts, 3D boots, and night splints. The Veteran stated that she was not currently working and was limited in her ability to perform her activities of daily living. It was difficult for her to be on her feet for "any length of time due to" her chronic foot pain. The Veteran was observed to have a bilateral antalgic gait. On examination of the feet, the Veteran exhibited bilateral third web space tenderness to palpation; well-healed bilateral plantar fascial release scars; "significant flat foot deformity," bilaterally; full ranges of motion of the ankles, the subtalar joints, and the toes; normal foot muscle strength and sensation; and no callosities. Contemporaneous X-ray studies of the feet revealed no abnormalities. Assessments of bilateral plantar fasciitis and significant bilateral pes planus deformity were advanced. The examiner commented that "it is conceivable that pain could further limit function as described particularly after being on her feet all day." At a March 2006 hearing before a VA hearing officer, the Veteran testified that she experienced chronic bilateral foot pain and intermittent bilateral foot swelling. She stated that her bilateral foot disorder necessitated that she wear 3D boots on a daily basis; impaired her ability to walk and to stand for prolonged periods of time; and prevented her from finding suitable work. At an April 2006 VA examination for compensation purposes, the Veteran complained of chronic bilateral plantar foot pain which radiated into her calves. She reported that she took pain medication; wore 3D boots and "night splints;" and used a cane for ambulation. The Veteran stated that she was "unable to find work that does not include prolonged standing." On examination of the feet, the Veteran exhibited "exquisite tenderness" and soft tissue swelling at the insertion of the plantar fascia, bilaterally; well-healed scars on the medial aspects of the feet; ranges of motion of the ankles of dorsiflexion of 0 to 20 degrees and plantar flexion of 0 to 20 degrees; ranges of motion of the toes of dorsiflexion of 0 to 40 degrees and plantar flexion of 0 to 40 degrees; mild bilateral pes planus; and no abnormal weight-bearing or callosities. Assessments of bilateral plantar fasciitis and bilateral pes planus were advanced. The examiner commented that the Veteran "obviously is somewhat disabled from plantar fasciitis;" "is having problems with employment;" and "would likely be able to work only in a seated job." At the August 2007 hearing before the undersigned, the Veteran testified that her bilateral foot disorder was productive of chronic foot pain and swelling; impaired her ability to walk and to stand; and necessitated the daily use of 3D boots. She clarified that she had not worked since 2004. At a February 2008 VA examination for compensation purposes, the Veteran complained of chronic bilateral foot pain. She reported that she did not drive a car or work due to her bilateral foot and right knee pain. She was observed to walk with a shuffling gait. On examination of the feet, the Veteran exhibited tenderness to palpation of the entire dorsal aspect of the right foot; bilateral flexible pes planus; intact sensation; no callosities or other evidence of abnormal weight-bearing; normal sensation; and no painful motion of her ankles, feet, or toes. Contemporaneous X-ray studies of the feet were reported to show no bony abnormalities. An assessment of bilateral plantar fasciitis was advanced. The examiner observed that "it is conceivable that pain could further limit function as described particularly after being on her feet all day." It is important to point out at this juncture that 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. § 4.3. The Board has reviewed the probative evidence of record including the Veteran's testimony and written statements on appeal. The Veteran's post-operative bilateral plantar fasciitis alone has been objectively shown to be manifest by no more the severe chronic bilateral foot pain and swelling; well-healed post-operative scars; and the use of 3D boots and night splints. The Veteran's chronic bilateral foot pain significantly restricts her ability to be on her feet for prolonged periods of time and prevents her from taking employment which requires prolonged standing and walking. Repeated examinations of the feet have failed to reveal either painful or limited motion of any lower extremity joint; abnormal weight-bearing; or sensory impairment associated with the Veteran's post-operative bilateral plantar fasciitis. The Board finds that the Veteran's testimony as to her severe bilateral foot pain and associated functional impairment to be credible. Therefore, the Board concludes, when resolving all reasonable doubt in favor of the Veteran, that her post-operative bilateral plantar fasciitis warrants assignment of a 30 percent evaluation under the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5284 (2009) as the foot disability is deemed to be severe. This represents the maximum schedular evaluation under Diagnostic Code 5284. The Board observes that the Veteran has advanced contentions on appeal that her bilateral plantar fasciitis renders her unable to secure employment requiring prolonged periods of being on her feet. The Court has directed that when entitlement to a total rating for compensation purposes based on individual unemployability is raised during the adjudicatory process of evaluating the underlying disability, it is part of the claim for benefits for the underlying disability. Rice v. Shinseki, 22 Vet. App. 447, 454 (2009). In reviewing the record, the Board observes that a total rating for compensation purposes based on individual unemployability was denied in October 2006 during the pendency of the instant appeal. The Veteran did not submit a notice of disagreement with that decision. Further, the evidence of record does not establish that the Veteran's service-connected bilateral foot disorder renders her unable to secure and follow any form of substantially gainful employment. Indeed, the Veteran's bilateral foot disorder alone appears not to impact her ability to secure and follow such employment as does not require prolonged periods of standing and/or walking. Consequently, the Board finds that the total rating aspect of this claim has been adjudicated and is not properly on appeal at this time. Because the evidence of record does not show that the Veteran is unemployable solely due to her severe foot disability, additional consideration under 38 C.F.R. § 4.16 is not required, or appropriate, at this time. The clinical findings with respect to the Veteran's severe foot disability fall within the criteria for a 30 percent evaluation under the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5284 (2009). See Thun v. Peake, 22 Vet. App. 111 (2008). Although the Veteran asserts that she is totally unemployable because of her foot and knee disabilities, she has not identified any specific factors which may be considered to be exceptional or unusual in light of VA's schedule of ratings, and the Board has been similarly unsuccessful. The Veteran has not required frequent periods of hospitalization for her foot disability and treatment records are void of any finding of exceptional limitation due to the foot disability beyond that contemplated by the schedule of ratings. The Board does not doubt that limitation caused by foot pain and fatigue has an adverse impact on employability; however, loss of industrial capacity is the principal factor in assigning schedular disability ratings. See 38 C.F.R. §§ 3.321(a) and 4.1. 38 C.F.R. Section 4.1 specifically states: "[g]enerally, 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." See also Moyer v. Derwinski, 2 Vet. App. 289, 293 (1992) and Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) [noting that the disability rating itself is recognition that industrial capabilities are impaired]. Thus, the Board finds that referral for consideration of assignment of an evaluation on an extra-schedular basis is not warranted. 38 C.F.R. § 3.321(b)(1) (2009). Following a review of the entirety of the record, the Board finds that a schedular evaluation of 30 percent is warranted for all periods considered except as discussed below for the period of convalescence. A rating in excess of 30 percent is not warranted and the only need for staged ratings is as discussed below. Hart v. Mansfield, 21 Vet. App. 505 (2007). C. 38 C.F.R. § 4.30 The provisions of 38 C.F.R. § 4.30 (2009) direct, in pertinent part, that: A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established by report at hospital discharge (regular discharge or release to non-bed care) or outpatient release that entitlement is warranted under paragraph (a) (1), (2) or (3) of this section effective the date of hospital admission or outpatient treatment and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge or outpatient release. The termination of these total ratings will not be subject to § 3.105(e) of this chapter. Such total rating will be followed by appropriate schedular evaluations. When the evidence is inadequate to assign a schedular evaluation, a physical examination will be scheduled and considered prior to the termination of a total rating under this section. (a) Total ratings will be assigned under this section if treatment of a service-connected disability resulted in: (1) Surgery necessitating at least one month of convalescence. (2) Surgery with severe post-operative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited). (3) Immobilization by cast, without surgery, of one major joint or more. The shoulder, elbow, wrist, hip, knee, and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae, are considered groups of minor joints, ratable on a parity with major joints. 38 C.F.R. § 4.45(f) (2009). A September 20, 2004, VA orthopedic treatment record states that the Veteran complained of chronic bilateral foot pain; diffuse numbness and tingling; and progressive loss of her arches. An assessment of "bilateral plantar fasciitis status post release of continued pain" was advanced. The treating VA physician directed that: We will place her in a cast on her left and 3D boot at night on her right. We will do this for six weeks and see if this cools her symptoms. A September 22, 2004, VA treatment record states that: [The Veteran] must be off work for 6 weeks as a result of the surgery she required to both her feet at the VA hospital. She is unable to meet the physical requirements of her job in reference to physical holds on patients and the need for mobility to assist transitions to the floor. An October 1, 2004, VA orthopedic treatment record states that the Veteran complained of continued right heel pain and requested a right short leg cast. The Veteran was directed to be put into a right short leg cast. VA clinical documentation dated on October 13, 2004, states that the Veteran requested to be and was subsequently placed in bilateral 3D boots. A treating VA physician directed that the Veteran could return to limited employment on October 21, 2004. In her November 2004 claim, the Veteran advanced that she had been "in [a] walking cast or [a] regular cast since September 2004." At the March 2006 hearing before a VA hearing officer, the Veteran testified that she had been give a "hard cast" in March 2004 which she wore for eight weeks and used a "walking cast" between September 2004 and June or July 2005. She clarified that she had been unable to work during this period of convalescence. At the August 2007 hearing before the Board, the Veteran clarified that she was seeking a temporary total rating for her bilateral plantar fasciitis under the provisions of § 4.30 for the period following the September 20, 2004, VA orthopedic treatment. The Veteran's left foot was placed in a cast for treatment of her plantar fasciitis on September 20, 2004. Her right foot was subsequently placed in a cast on October 1, 2004. A treating VA physician determined that the Veteran's plantar fasciitis treatment necessitated immobilization of the left foot with a cast and a subsequent period of convalescence from September 20, 2004, to October 21, 2004. Therefore, the Board concludes that a temporary total disability rating for the Veteran's bilateral plantar fasciitis following VA orthopedic treatment on September 20, 2004, is warranted. 38 C.F.R. § 4.30(a)(3) (2009). III. Right Knee Patellofemoral Syndrome A. Historical Review The Veteran's service treatment records convey that she was treated for right knee complaints. The report of an October 1992 VA examination for compensation purposes states that the Veteran was diagnosed as having right knee patellofemoral syndrome. In March 1996, the Board granted service connection for right knee patellofemoral syndrome. In April 1996, the RO effectuated the grant of service connection for right knee patellofemoral syndrome; assigned a 10 percent evaluation for that disability; and assigned the effective date of the award as July 1, 1992. B. Increased Evaluation Limitation of flexion of either leg to 45 degrees warrants a 10 percent evaluation. A 20 percent evaluation requires that flexion be limited to 30 degrees. A 30 percent evaluation requires limitation to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260 (2009). Limitation of extension of either leg to 10 degrees warrants a 10 percent evaluation. A 20 percent evaluation requires that extension be limited to 15 degrees. A 30 percent evaluation requires that extension be limited to 20 degrees. A 40 percent evaluation requires that extension be limited to 30 degrees. A 50 percent evaluation requires that extension be limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261 (2009). The average normal range of motion of the knees is from 0 to 140 degrees. 38 C.F.R. § 4.71 (2009). Slight impairment of either knee, including recurrent subluxation or lateral instability, warrants a 10 percent disability evaluation. A 20 percent evaluation requires moderate impairment. A 30 percent evaluation requires severe impairment. 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2009). Degenerative arthritis (degenerative joint disease) established by X-ray findings will be rated on the basis of limitation of motion of the specific joint or joints involved. When the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, an evaluation of 10 percent is applied for each major joint or group of minor joints affected by the limitation of motion. These 10 percent evaluations are combined and not added. 38 C.F.R. § 4.71a, Diagnostic Code 5003 (2009). At a June 2004 VA examination for compensation purposes, the Veteran complained of chronic right knee pain, discomfort, and cracking. She reported that she had difficulty rising from a seated position and climbing stairs. The Veteran denied right knee catching or locking. She was observed to walk with a non-antalgic gait. On examination of the right knee, the Veteran exhibited a range of motion of 0 to "approximately 127 degrees" with pain beyond 115 degrees; medial joint line tenderness; and a stable knee. Contemporaneous X-ray studies of the knee revealed no significant abnormalities. An assessment of patellofemoral syndrome was advanced. The examiner commented that "it is conceivable that pain could further limit function as described, particularly after being on her feet all day." At the February 2005 VA examination for compensation purposes, the Veteran complained of intermittent right knee pain and swelling. On examination of the right knee, the Veteran exhibited a range of motion of 0 to 135 degrees; mild medial joint line tenderness to palpation; and no joint instability. Contemporaneous X-ray studies of the right knee revealed no abnormalities. An assessment of minimally symptomatic right patellofemoral syndrome was advanced. At the April 2006 VA examination for compensation purposes, the Veteran complained of anterior right knee pain which was exacerbated by both rising from a seated position and using stairs. She denied experiencing right knee locking, catching, giving way, or instability. On examination of the right knee, the Veteran exhibited a range of motion of 0 to 125 degrees with "some" patellofemoral crepitus and no joint instability. Contemporaneous X-ray studies of the right knee revealed mild degenerative changes. Assessments of right knee patellofemoral syndrome and mild right knee medial compartment arthritis were advanced. The examiner clarified that the Veteran exhibited "minimal loss of motion." At the March 2006 hearing before a VA hearing officer, the Veteran testified that her right knee disorder was productive of intermittent right knee pain and swelling and limitation of motion. At the August 2007 hearing before the Board, the Veteran testified that her chronic right knee disorder was manifest by pain and limitation of motion. She has been diagnosed as having right knee arthritis. The Veteran clarified that her right knee disability, in combination with her bilateral foot disorder, significantly impaired her vocational activities. She has not put forth any assertion that she is totally unemployable because of her knee disability. At the February 2008 VA examination for compensation purposes, the Veteran complained of chronic right knee pain and an occasional feeling of giving way. On examination of the right knee, the Veteran exhibited a range of motion of 0 to approximately 100 degrees with "a lot of pain" and no joint instability. Contemporaneous X-ray studies of the right knee revealed findings consistent with mild degenerative changes. An assessment of mild right knee/patellofemoral degenerative joint disease was advanced. The examiner commented that "it is feasible that patient (sic) can have functional limitations during flare-ups however and this is most likely secondary to pain." The Veteran's right knee disability has been shown to be objectively manifest by no more than chronic knee pain; a range of motion of the knee of 0 to 100 degrees with pain and crepitus; medial joint line tenderness; degenerative joint disease; and no ligamental instability or recurrent subluxation. While the Veteran presented a subjective history of right knee giving way, the joint has been shown to be stable on repeated physical evaluation. Therefore, the provisions of 38 C.F.R. § 4.71a, Diagnostic Code 5257, are not for application. In the absence of objective evidence of either actual or functional limitation of right knee flexion to 30 degrees or actual or functional limitation of extension to 15 degrees, the Board concludes that at an evaluation in excess of 10 percent evaluation is not warranted for the Veteran's right knee patellofemoral syndrome at any time during the relevant period. Furthermore, as the Veteran's right knee symptomatology falls squarely within the criteria of 38 C.F.R. § 4.71a, Diagnostic Codes 5003 and 5260, the Board finds that referral for an evaluation on an extra- schedular basis is not warranted. 38 C.F.R. § 3.321(b)(1) (2009). Hart v. Mansfield, 21 Vet. App. 505 (2007). ORDER A 30 percent evaluation for the Veteran's bilateral plantar fasciitis is granted subject to the law and regulations governing the award of monetary benefits. A temporary total disability rating for the Veteran's bilateral plantar fasciitis under the provisions of 38 C.F.R. § 4.30 based upon convalescence following September 20, 2004, VA orthopedic treatment is granted subject to the law and regulations governing the award of monetary benefits. An increased evaluation for the Veteran's right knee patellofemoral syndrome is denied. ____________________________________________ Kristi Barlow Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs