Citation Nr: 1328356 Decision Date: 09/05/13 Archive Date: 09/16/13 DOCKET NO. 07-39 435 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Manchester, New Hampshire THE ISSUES 1. Entitlement to a rating in excess of 10 percent for degenerative changes of the right knee with meniscal tear prior to March 7, 2011, and in excess of 30 percent from that date. 2. Entitlement to a rating in excess of 30 percent for anterior cruciate deficiency, right knee, status-post anterior cruciate ligament reconstruction. 3. Entitlement to a rating excess of 10 percent for unfavorable ankylosis of the left middle (long) finger of the minor hand, residuals of dislocation and also of the ring finger prior to March 12, 2007, and in excess of 20 percent from that date. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD J. Andrew Ahlberg, Counsel INTRODUCTION The Veteran served on active duty from December 1976 to June 1989. This case comes before the Board of Veterans' Appeals (Board) on appeal from June 2007 and May 2008 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Manchester, New Hampshire, which, in pertinent part, granted an increased rating of 10 percent for anterior cruciate deficiency, right knee, effective November 1, 2006 (June 2007 rating decision), denied entitlement to an increased rating in excess of 10 percent for degenerative changes of the right knee (June 2007 rating decision), and denied entitlement to a rating in excess of 10 percent for unfavorable ankylosis of the left middle (long) finger of the minor hand, residuals of dislocation (May 2008 rating decision). The Veteran provided testimony before a Decision Review Officer (DRO) at the RO in November 2008 and before the Board in a videoconference hearing in March 2010. Transcripts of both hearings are of record. During the March 2010 hearing, the Veteran withdrew the appeal with respect to the issue of entitlement to extension of a temporary total rating based on surgical treatment necessitating convalescence beyond October 31, 2006. Therefore, this issue is no longer before the Board. 38 C.F.R. § 20.204 (2012). The case was remanded by the Board for further development in January 2011, and following this remand, a June 2012 rating decision increased the rating for the degenerative changes of the right knee with meniscal tear to 30 percent effective from March 7, 2011, and the rating for anterior cruciate deficiency of the right knee, status-post anterior cruciate ligament reconstruction to 30 percent effective from November 1, 2006. This rating decision also added disability of the ring finger to that assigned for the service connected unfavorable ankylosis of the left middle finger, and increased the rating for such disability to 20 percent effective from March 12, 2007. The Veteran remains in disagreement with the ratings assigned for the disabilities at issue despite the increased ratings assigned by the June 2012 rating decision. AB v. Brown, 6 Vet. App. 35 (1993). As the increases for the service connected degenerative changes of the right knee with meniscal tear and unfavorable ankylosis of the left middle finger, residuals of dislocation and also of the ring finger were not assigned effective from the date of the claims for increased rating for these disabilities, there is for consideration, as the issues are listed on the title page, entitlement to an increased rating in excess of 10 percent for degenerative changes of the right knee with meniscal tear prior to March 7, 2011, and in excess of 30 percent from that date; and entitlement to a rating in excess of 10 percent of unfavorable ankylosis of the left long finger, residuals of dislocation and also of the ring finger prior to March 12, 2007, and in excess of 20 percent from that date. Id. FINDINGS OF FACT 1. Prior to March 7, 2011, extension of the right knee was full and flexion was limited to, at worst, 125 degrees; from March 7, 2011, motion is limited to, at worst, 20 degrees of extension after repetitive motion and 115 degrees of flexion. 2. The rating for disability attributed to anterior cruciate deficiency (severe recurrent instability) of the right knee is the highest assignable schedular rating for such symptomatology; disability in the right knee does not at any time during the appeal period include ankylosis or impairment of the tibia or fibula with nonunion and loose motion necessitating a brace. 3. The Veteran is right handed. 4. It is at least as likely as not that ankylosis of the middle and ring fingers has been present since receipt of the claim for increase, January 3, 2007; at no time during the appeal period has there been ankylosis of more than two fingers. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for degenerative changes of the right knee with meniscal tear prior to March 7, 2011, and in excess of 30 percent from that date are not met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes (DCs) 5003, 5010, 5258, 5260, 5261 (2012). 2. The criteria for a rating in excess of excess of 30 percent for anterior cruciate deficiency, right knee, status-post anterior cruciate ligament reconstruction are not met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a, DC 5257 (2012). 3. Resolving all reasonable doubt in favor of the Veteran, the criteria for a 20 percent rating, but no higher, for unfavorable ankylosis of the left long finger of the minor hand, residuals of dislocation and also of the ring finger are met from January 3, 2007. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a, DC 5219 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. VA's Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107; 38 C.F.R §§ 3.102, 3.156(a), 3.159, 3.326(a). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1). In Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), the United States Court of Appeals for Veterans Claims (Court) held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) Veteran status; 2) existence of a disability; 3) a connection between the Veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. In Pelegrini v. Principi, 18 Vet. App. 112 (2004), the Court held that VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable AOJ decision on the claim for VA benefits. Regarding claims for increased ratings such as those on appeal in the instant case, the VCAA requirement is generic notice, that is, the type of evidence needed to substantiate the claim, namely, evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on employment, as well as general notice regarding how disability ratings and effective dates are assigned. Vazquez-Flores v. Shinseki, 580 F.3d 1270 (Fed. Cir. Sept. 4, 2009). The Board finds that VA has satisfied its duty to notify under the VCAA with respect to the claims for increased ratings on appeal. Specifically, preadjudication letters were provided to the Veteran in November 2006 and October 2007. with specific information, including relevant rating criteria, concerning the evidence and information necessary to substantiate the increased rating claims on appeal, as well as his and VA's respective responsibilities in obtaining such evidence and information. Additionally, the October 2007 letter advised him of the information and evidence necessary to establish a disability rating and an effective date in accordance with Dingess/Hartman, supra. Next, VA has a duty to assist the Veteran in the development of the claims. This duty includes assisting him in the procurement of service treatment records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). The claims file contains the Veteran's service treatment records and post-service treatment records. Moreover, the Veteran's statements in support of the claims are of record. The Board has carefully reviewed such statements and concludes no available outstanding evidence has been identified. The Board has also perused the medical records for references to additional treatment reports not of record, but has found nothing to suggest that there is any outstanding evidence with respect to the Veteran's claims. Additionally, the Veteran was afforded VA examinations in March 2007, March 2008, and March 2011 to evaluate the severity of the service-connected disabilities on appeal. Neither the Veteran nor his representative has alleged that such are inadequate for rating purposes. Moreover, the Board finds that the examinations are adequate in order to evaluate the Veteran's service-connected disabilities as they include an interview with the Veteran, a review of the record, and a full physical examination, addressing the relevant rating criteria. Therefore, the Board finds that the examination reports of record are adequate to adjudicate the Veteran's increased rating claims and no further examination is necessary. In this regard, the March 2011 VA examination reflects compliance with the instructions of the January 2011 remand. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order); see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Also as requested in this remand, reports from the Social Security Administration (SSA) contained in a CD-ROM were printed and associated with the claims file and are documented to have been reviewed by the RO in the June 2012 Supplemental Statement of the Case and rating decision. Id. With regard to the Board hearing in March 2010, the Veteran was provided an opportunity to set forth his contentions during the hearing before the undersigned. In Bryant v. Shinseki, the United States Court of Appeals for Veterans Claims (Court) held that 38 C.F.R. § 3.103(c)(2) requires that the RO Decision Review Officer or Veterans Law Judge who chairs a hearing to fulfill two duties: (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Bryant v. Shinseki, 23 Vet. App. 488 (2010). During both hearings, the issues remaining on appeal were enumerated. Also, information was solicited regarding the nature and severity, or frequency, as appropriate, of the Veteran's right knee and left middle and ring finger symptoms, as well as concerning his current treatment providers. Therefore, not only were the issues "explained . . . in terms of the scope of the claims for benefits," but "the outstanding issues material to substantiating the claims," were also fully explained. Id. at 497. As such, the Board finds that, consistent with Bryant, the DRO and Board complied with the duties set forth in 38 C.F.R. 3.103(c)(2), and that both hearings were legally sufficient. For the above reasons, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd, 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). II. Analysis Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence as appropriate and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claims. In this regard, the Board notes that it has reviewed all of the evidence of record, to include in the Veteran's paper claims file and virtual record (Virtual VA and Veterans Benefits Management System), with an emphasis on the evidence relevant to this appeal. The virtual record contains no additional correspondence or evidence not physically associated with the paper claims folder. When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail. The Court has also stated, "It is clear that to deny a claim on its merits, the evidence must preponderate against the claim." Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Ratings Schedule) found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the appellant's favor. 38 C.F.R. § 4.3. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating an appellant's service-connected disabilities. 38 C.F.R. § 4.14. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Staged ratings are appropriate for an increased rating claim whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). 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 of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). 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 enervation, 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 that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45. The Court has held that VA must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss under 38 C.F.R. § 4.40, which requires VA to regard as "seriously disabled" any part of the musculoskeletal system that becomes painful on use. See DeLuca v. Brown, 8 Vet. App. 202 (1995). In Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 38 C.F.R. § 4.40. Furthermore, the intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Thus, actually painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimum compensable rating for the joint. The joints should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59. In Burton v. Shinseki, 25 Vet. App. 1, 5 (2011), the Court found that, when 38 C.F.R. § 4.59 is raised by the claimant or reasonably raised by the record, even in non-arthritis context, the Board should address its applicability. DC 5003 provides that degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic code(s) for the specific joint(s) involved. When, however, the limitation of motion of the specific joint(s) involved is noncompensable under the appropriate diagnostic code(s), a 10 percent rating is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. 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, a 10 percent evaluation is warranted if there is X- ray evidence of involvement of two or more major joints or two or more minor joint groups and a 20 percent evaluation is authorized if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. Traumatic arthritis is rated as for degenerative arthritis. 38 C.F.R. § 4.71a, DC 5010. A. Right Knee A 20 percent rating is warranted for dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint. DC 5258. The only rating for assignment under DC 5258 is a 20 percent rating. Under DC 5260, a 10 percent rating is warranted for knee flexion limited to 45 degrees. A 20 percent rating under DC 5260 requires flexion to be limited to 30 degrees, and a 30 percent evaluation is warranted when flexion is limited to 15 degrees. Under DC 5261, a 10 percent rating is warranted for limitation of extension to 10 degrees. A 20 percent rating requires extension to be limited to 15 degrees, and a 30 percent evaluation is warranted when extension is limited to 20 degrees. The normal range of motion of the knee is from 140 degrees flexion to 0 degrees extension. 38 C.F.R. § 4.71, Plate II. In the event of a disability manifesting both limitation of flexion and limitation of extension, VA is to provide two separate ratings under DCs 5260 and 5261. See VAOPGCPREC 9- 04, 69 Fed. Reg. 59990 (2004). Slight recurrent subluxation or lateral instability of a knee warrants a 10 percent rating under DC 5257. A 20 percent rating requires moderate recurrent subluxation or lateral instability, and a 30 percent evaluation is warranted for severe recurrent subluxation or lateral instability. VA's General Counsel has held that a claimant who has arthritis and instability of the knee may be rated separately under DCs 5003/5010 and 5257, respectively. VAOPGCPREC 23-97; 62 Fed. Reg. 63,604(1997). In VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998), the VA General Counsel further explained that, to warrant a separate rating, the limitation of motion need not be compensable under DC 5260 or 5261; rather, such limited motion must at least meet the criteria for a zero (0) percent rating. By way of background, the Veteran was treated during service for right knee problems, to include anterior cruciate ligament deficiency, and service connection for anterior cruciate deficiency of the right knee was granted by a February 1990 rating decision. A noncompensable rating was assigned under DC 5257. This rating was continued until September 2005, at which time a rating decision increased the rating assigned under DC 5257 to 10 percent based on a determination that slight recurrent subluxation was shown. This decision also assigned a separate 10 percent rating for degenerative changes of the right knee with a meniscal tear under DCs 5258-5010 based on a determination that painful motion of a major joint was demonstrated and the fact that separate ratings may be assigned for instability and limitation of motion due to arthritis as provided by VAOPGCPREC 23-97. (Hyphenated Diagnostic Code numbers reflect the assignment of a rating under the first Diagnostic Code number using the criteria of the second Diagnostic Code. See 38 C.F.R. § 4.20.). These ratings were based upon clinical findings to include those from a September 2004 VA examination that showed range of motion from full extension to 120 degrees of flexion with pain on extension and some laxity in the right knee compared to the left knee. Thereafter, the Veteran underwent surgery of the right knee, to include an anterior cruciate ligament reconstruction and partial lateral meniscectomy, at a private medical facility in September 2006, and a February 2007 rating decision assigned a temporary 100 percent rating for convalescence following this surgery under 38 C.F.R. § 4.30 for the knee disability rated under DC 5257 from September 15, 2006, to October 31, 2006. Following the expiration of this rating, a noncompensable rating was assigned under DC 5257 effective from November 1, 2006. The rating under DC 5257 was increased to 10 percent effective from November 1, 2006, by a June 2007 rating decision after a March 2007 VA examination showed the Veteran describing instability in the right knee and evidence of anterior drawer laxity. This examination also included range of motion findings in the right knee showing full extension and 125 degrees of flexion with pain. Repetitive motion showed no loss of motion. Additional findings with respect to the right knee at the March 2007 VA examination included no ankylosis, Osgood-Schlatter's disease, crepitation, masses behind the knees, clicks or snaps, grinding, patellar abnormality, effusion, dislocation, or locking. The examiner commented that the right knee prevented the Veteran from being able to participate in sports and resulted in moderate impairment in his ability to shop, exercise, and dress. At a March 2008 VA examination, the Veteran was said to have denied any flareups in the right knee as contemplated by DeLuca but he did state that this knee was unstable. He reported that he wears a brace, ambulates with a cane, and uses corrective shoes due to his knee disability. He asserted that there had been no improvement in the right knee since the September 2006 surgery and that his daily activities were extremely limited due to his right knee disability. The Veteran stated that he was only able to stand for 5 minutes before severe pain occurs and that climbing stars caused severe pain. He also reported that he must use a scooter when shopping. Upon physical examination in March 2008, the Veteran was observed to walk with an antalgic gait favoring the right knee. There was an abnormal shoe wear pattern with increased wear on the outside of the heel. The right knee was "exquisitely" tender to palpation across the Allograft (surgical) scar but there was no painful motion from full extension to 130 degrees of flexion. Three repetitions of motion resulted in no additional loss of motion or pain. There was no evidence of fatigue or weakness and motor strength was 5/5 on extension and flexion. The Veteran did not exhibit lack of endurance or incoordination. There was mild effusion and no instability; the McMurray's test was negative; and there was no weakness. There was tenderness along the medial and lateral joint lines and also along the scar over the patella area. The examiner noted that there was no redness, heat, abnormal movement, guarding or laxity. The ligaments were stable. Following the examination, the diagnosis was Allograft anterior cruciate ligament repair with suboptimal results. Summarizing the testimony with respect to the right knee presented at the November 2008 hearing before the DRO and to the Board at the March 2010 hearing, the Veteran described flareups, incapacitating episodes, weakness, fatigue, and instability that limited his ability to walk, kneel, squat, and dress. At the March 2010 hearing (see Transcript, page 4), the Veteran reported that he was receiving private, and not VA, treatment for his right knee disability. At the most recent VA examination of the right knee in March 2011, the Veteran reported that he took Tramadol every day for arthritis pain, to include in the right knee. Upon physical examination, the Veteran was observed to again walk with an antalgic gait and to display evidence of an abnormal shoe wear pattern. Findings in the right knee included tenderness, instability, and guarding of movement. There was no Osgood-Schlatter's disease, crepitation, snaps, or grinding. The meniscus was surgically absent with no evidence of locking, effusion, dislocation, abnormal tendons or bursae, or other knee abnormalities. Range of motion was from a 15 degree loss of extension to 115 degrees of flexion. Repetitive motion resulted in pain and an additional extension loss to 20 degrees. The Veteran reported pain throughout active right knee motion, and the Veteran's right knee disability was said by the examiner to prevent the Veteran from being able to participate in sports and resulted in severe impairment in his ability to complete chores, shop, exercise, engage in recreation, bathe, and dress. In summarizing the severity of the Veteran's service connected disabilities and their impact on occupational functioning separate and apart from non-service connected disabilities, the conclusion following the March 2011 VA examination was that the service connected disabilities were "significant" and had a severe impact on physical and sedentary employment, with sitting more than one hour and standing more than 30 minutes precluded by service connected disability, to include that caused by the right knee. In addition to the reports from the VA examinations set forth above, the undersigned has also reviewed the VA outpatient treatment reports of record dated during the appeal period through July 2009 which almost entirely reflect treatment for non related disabilities (as indicated above, the Veteran testified that he was not receiving VA treatment for his right knee) and otherwise contain no clinical findings pertaining to the right knee demonstrating a disability that significantly differs in nature or severity from that described on the reports from the VA examinations set forth above. The SSA reports printed from the CD-ROM have also been reviewed, and these records include an August 2007 determination by SSA that the Veteran was disabled pursuant to the Social Security Act, as amended, due to bilateral degenerative joint disease of the knees and depression. (The Board emphasizes that it is not bound by the decisions of the SSA in its determinations as to the proper rating to be assigned for a disability). The clinical records printed from the CD-ROM from the appeal period otherwise also do not demonstrate a disability that significantly differs in nature or severity from that described on the reports from the VA examinations set forth above. In this regard, a private treatment report dated in January 2008 reflected full extension and 130 degrees in the right knee with stable ligaments. It was the examiner's opinion that the Veteran did not have a "great" knee but that it was not "trashed." Applying the pertinent rating criteria to the facts summarized above, it was not until the March 7, 2011, VA examination that there was any limitation of extension, much less the limited extension to 15 degrees, and 20 degrees on repeated testing, shown at this examination. As set forth above, a 30 percent rating may be assigned under DC 5261 if extension is limited to 20 degrees. The RO's grant of a 30 percent rating for degenerative changes of the right knee with meniscal tear in its June 2012 rating decision reflects consideration of this fact as the diagnostic codes for rating such disability were listed therein as 5003-5261, and the 30 percent rating was assigned effective from March 7, 2011, based on limitation of extension being shown to 20 degrees on the examination of that date, and not before this examination. As for a rating degenerative changes of the right knee with meniscal tear in excess of 10 percent prior to March 7, 2011, on the basis of limitation of flexion, prior to the March 2011 examination, flexion was limited to, at worst, 125 degrees. Thus, as rating in excess of 10 percent for limitation of flexion under DC 5260 requires flexion to be limited to 30 degrees, a rating in excess of 10 percent prior to March 7, 2011, cannot be assigned on the basis of limitation of flexion. In short therefore, a rating greater than 10 percent for degenerative changes of the right knee prior to March 7, 2011, cannot be assigned. Having determined that the criteria for a rating in excess of 10 percent for degenerative changes of the right knee with meniscal tear prior to March 7, 2011, on the basis of limitation of flexion or extension are not met, the next matter for consideration is whether a rating may be assigned in excess of 30 percent from March 7, 2011, for such disability. As rating in excess of 30 percent on the basis of limitation of extension under DC 5261 would require extension to be limited to 30 degrees, and the extension was only limited to 20 degrees at the March 7, 2011, VA examination, a rating greater than 30 percent cannot be assigned under DC 5261 based on these findings. There is otherwise no evidence demonstrating that extension in the right knee has been limited to 30 degrees for the period beginning March 7, 2011. As for flexion, the highest assignable rating under DC 5260 is 30 percent. Nonetheless, as flexion was to 115 degrees at the March 7, 2011, and the criteria for a 0 percent evaluation under DC 5260 requires flexion to be limited to 60 degrees, a separate rating under DC 5260 on the basis of limitation of flexion from March 7, 2011, also cannot be assigned. See VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998). Turning to the rating of 30 percent assigned from November 1, 2006, under DC 5257 for the 30 percent rating for the aspect of service connected right knee disability listed by the RO as anterior cruciate deficiency, status-post anterior cruciate ligament reconstruction, at the time the Veteran's claim for an increased rating for his right knee disability was received in October 2006, the temporary 100 percent rating assigned under 38 C.F.R. § 4.30 from September 15, 2006 was still in effect; as such, and because the June 2012 rating decision assigned the 30 percent rating under DC 5257 effective immediately after the expiration of this temporary 100 percent rating, there is only for consideration whether the criteria for a rating in excess of 30 percent are met for this disability, and not whether an increased or "staged" rating is warranted for an earlier period of time during the appeal period as with respect to the analysis above. The 30 percent rating assigned under DC 5257 reflects "severe" recurrent subluxation or lateral instability; as such, a rating in excess of 30 percent cannot be assigned under DC 5257. As for a rating in excess of 30 percent under another code pertaining to the rating of knee disabilities, the only such codes that provide for a rating in excess of 30 percent (aside from DC 5261 for limitation of extension contemplated by the rating assigned for the aspect of the service connected right knee disability addressed above) are DC 5256 (ankylosis) and DC 5262 (impairment of the tibia and fibula). Ankylosis is not demonstrated or claimed and a 40 percent rating under DC 5262 requires non union of the tibia and fibula with loss of motion requiring a brace-such manifestations are also not shown or claimed. As such, the rating criteria for an evaluation in excess of 30 percent for anterior cruciate deficiency, status-post anterior cruciate ligament reconstruction of the right knee are not met under any potentially applicable diagnostic code. B. Finger Ankylosis Under DC 5226, a 10 percent rating is warranted for unfavorable or favorable ankylosis of the long finger of the dominant (major) or non-dominant (minor) hand. A note following DC 5226 provides that VA should also consider whether an evaluation for amputation is warranted and whether an additional evaluation is warranted for resulting limitation of motion of other digits or interference with overall function of the hand. Under DC 5219, a 20 percent rating is the only, and maximum, rating for unfavorable ankylosis of the middle and ring fingers of the hand, regardless of whether the hand is dominant or non-dominant. A note following DC 5219 also provides that VA should consider whether an evaluation for amputation is warranted. Note (1) under the criteria for Evaluation of Ankylosis or Limitation of Motion of Single or Multiple Digits of the Hand indicates that, for digits 2 through 5, zero degrees of flexion represents the fingers fully extended, making a straight line with the rest of the hand. The position of function of the hand is with the metacarpophalangeal and proximal interphalangeal joints flexed to 30 degrees; only joints in these positions are considered to be in favorable position. For digits 2 through 5, the metacarpophalangeal joint has a range of 0 to 90 degrees of flexion, the proximal interphalangeal joint has a range of 0 to 100 degrees of flexion, and the distal interphalangeal joint has a range of 0 to 70 or 80 degrees of flexion. Note (2) indicates that, when two or more digits of the same hand are affected by any combination of amputation, ankylosis, or limitation of motion that is not otherwise specified in the rating schedule, the evaluation level assigned will be that which best represents the overall disability (i.e., amputation, unfavorable or favorable ankylosis, or limitation of motion), assigning the higher level of evaluation when the level of disability is equally balanced between one level and the next higher level. Note (3) indicates that if both the metacarpophalangeal and proximate interphalangeal joints of a digit are ankylosed, and either is in extension or full flexion, or there is rotation or angulation of a bone, it should be evaluated as amputation without metacarpal resection, at the proximal interphalangeal joint or proximal thereto. If both the metacarpophalangeal and proximal interphalangeal joints of a digit are ankylosed, it should be evaluated as unfavorable ankylosis, even if each joint is individually fixed in a favorable position. If only the metacarpophalangeal or proximal interphalangeal joint is ankylosed, and there is a gap of more than two inches between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, it should be evaluated as unfavorable ankylosis. If only the metacarpophalangeal or proximal interphalangeal joint is ankylosed, and there is a gap of two inches or less between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, it should be evaluated as favorable ankylosis. DC 5149 addresses amputation of the middle and ring fingers, and provides for a 30 percent rating for the major hand and a 20 percent rating for the minor hand. The rating for multiple finger amputations applies to amputations at the proximal interphalangeal joints or through proximal phalanges. See Note (a). Summarizing the pertinent evidence with the above criteria in mind, the Veteran sustained fractures of the middle and ring fingers during service, and a VA examiner in May 2005 found that a deformity in the middle finger wherein this finger was in a flexed position was due to an in-service accident. Following this examination, a July 2005 rating decision granted service connection for favorable ankylosis of the left long finger, residuals of dislocation, and assigned a 10 percent rating for such disability under DC 5226 effective from February 7, 2005. With respect to the nature of the finger disability at issue described at the May 2005 VA examination, the long finger was flexed at approximately 30 degrees; there was pain with palpation of the metacarpal joint of mostly the middle finger and some, but less, pain with palpation of the ring finger; and normal range of metacarpophalangeal joint motion of all fingers of the left hand to 90 degrees with two to three repetitions except the long finger wherein the Veteran could not perform any flexion due to the flexion deformity. The Veteran could move all the fingers of his left hand and flex them to the first palmar crease and could accomplish thumb to finger opposition with all the fingers. It was also difficult for the Veteran to move the ring finger due to stiffness and pain. Left handgrip strength was decreased when compared with the right hand. Following the May 2005 VA examination, the diagnoses also included a deformity of the left ring finger which the examiner also thought was etiologically related to service, and the July 2005 rating decision granted service connection for the additional disability of residuals of a left ring finger dislocation with limitation of motion. A noncompensable rating was assigned for the left ringer finger disability under DC 5230 (limitation of motion of the ring or little finger) effective from February 7, 2005. Also with respect to the left ring finger, a private clinical report dated December 2004 noted a deformity with flexion of the proximal interphalangeal (PIP) joints, hyperextension, and synovitis due to an increasing deformity of the middle, and to a lesser extent, ring finger. The impression by this examiner was history of traumatic dislocation at the PIP joints of the long and ring fingers with progressive pain, swelling, and deformity of the PIP joint of the long and ring finger. Additional evidence includes private clinical reports from a fusion of the interphalangeal joint of the left long finger due to post traumatic arthritis of the left hand at the PIP joint in June 2005. Also of record are reports from private surgery in April 2006 to remove the hardware installed in the left long finger during the June 2005 surgery. Thereafter, the Veteran filed a claim for an increased rating for the service connected disability of the long finger of the left hand, and related disability, that was received on January 3, 2007. A VA examination conducted in conjunction with this claim in March 2007 documented that the Veteran was right handed and showed him complaining about decreased strength and dexterity in the left hand. Also described by the Veteran were pain, limited motion, swelling, weakness, and stiffness in the left long and ring fingers. Upon physical examination March 2007, there was ankylosis of the left long finger with this finger flexed at 20 degrees that was said to not interfere with functioning of the left hand or motion of the other digits of this hand. Ankylosis was also shown in the left ring finger with this finger flexed at 5 degrees. This ankylosis was also said to not interfere with functioning of the left hand or motion of other digits of this hand. Also demonstrated was an angulation deformity in the left long finger at the PIP joint of 5 degrees of ulnar deviation, as well as enlargement as this joint. There was no gap between the thumb pad and tips of the fingers on attempted opposition of the thumb to the fingers. There was a gap of less than one inch between the left long finger and the proximale transverse crease of the left hand on maximal flexion of this, but no other, finger. Left hand grip strength was reduced when compared to that of the right and it was indicated that there was diminished dexterity in the left hand of the left and long fingers along with limited motion and strength. Range of motion testing conducted at the March 2007 VA examination showed 20 degrees of extension to 60 degrees of flexion in the PIP joint without pain and 0 degrees of extension to 90 degrees of flexion in the distal interphalangeal (DIP) joint without pain. The physician who examined the Veteran reported no additional loss in range of motion of the PIP and DIP joints of the left long finger or pain following repetitive use. The left long finger disability was said to result in severe impairment in the ability to complete chores and engage in sports or recreation and to mildly impact the ability to shop, eat, and bathe. After refracturing his left long finger after the hardware was removed from the fusion site, the Veteran underwent another fusion at the PIP joint of the left long finger at a private medical facility in December 2007. These reports also reveal that the Veteran had a hyperextension deformity of the PIP joint of the left ring finger, and the surgery accomplished in December 2007 included a tenodesis and volar plate advance of the PIP joint of the left ring finger. At a March 2008 VA examination, the Veteran reported symptoms of left middle finger pain graded as 2/10 and decreased strength and manual dexterity. He also described weakness, stiffness, swelling, heat, instability, fatigue, and lack of endurance. He reported no flareups as contemplated by the DeLuca decision (discussed herein above), but described difficulty carrying objects with his left hand with an inability to carry a gallon of milk. The Veteran denied the use of assistive devices for the left hand. The examiner observed that the left long finger was fused in extension with ankylosis of the metacarpophalangeal (MCP), PIP, and DIP joints. Ankylosis of the MCP, PIP, and DIP joints of the left middle finger was in full extension at 0 degrees with no movement possible in flexion. The left middle finger PIP joint was swollen and erythematous but the Veteran could touch the tip of his left thumb to the tip of the long finger. There was decreased left hand grip strength when compared with the right hand and it was indicated that the Veteran was unable to push or pull with the left hand without causing pain in the fused middle finger. Twisting against resistance was also said to be painful and there was decreased sensation to monofilament testing over the entire dorsal aspect of the left middle finger. The diagnosis following the March 2008 VA examination was fusion of the left middle finger in December 2007 with suboptimal result. The examiner stated that the combination of the suboptimal left middle finger ankylosis and limited strength and range of motion of the left ring finger made manual labor impossible. He stated that sedentary employment and retraining of the left hand to use a compute keyboard would be possible. After the March 2008 VA examination, a May 2008 rating decision continued the 10 percent rating for ankylosis of the left long finger (but listed such service-connected disability therein as unfavorable, rather than favorable, ankylosis) and, based on the loss of sensation shown at the March 2008 examination, granted service connection for incomplete paralysis of the left long finger by analogy to DC 8515 (paralysis of the median nerve). A 10 percent rating for such disability was assigned. Summarizing the testimony with respect to the finger disability presented at the November 2008 DRO hearing and at the March 2010 Board hearing, the Veteran described pain, limitation of motion, swelling, weakness, limited motion, and difficulty holding onto objects. He reported flareups at the November 2008 hearing but not at the March 2010 hearing. The Veteran did not report being treated by VA for his finger disability at either hearing, and testified at the March 2010 Board hearing that he had last been treated for such disability by a private physician in 2008. See March 2010 hearing transcript, page 11. He also testified to the undersigned that he could reach the left thumb with his left middle finger. Id., page 14. At the most recent VA examination in March 2011, the Veteran reported that he had problems with his left ring and long fingers and indicated that it was difficult for him to type on a keyboard. Upon physical examination, extension of the long finger was normal with objective evidence of pain. There was a gap of one to two inches between the left long finger and the proximale transverse crease of the left hand on maximal flexion of this finger. Repetitive motion elicited pain but no additional limitation of motion. Ankylosis of the left long finger was noted at the PIP joint with 0 degrees of flexion and five degrees of ulnar angulation at the PIP joint was again noted. This ankylosis was again said to not interfere with function of the left hand or motion of the other digits of this hand. "Severe" decreased strength for pushing, pulling, and twisting was described and there was said to be decreased dexterity such as with grabbing objects. Additional findings from the March 2011 VA examination included the ability of the Veteran to touch the tips of the thumb and left long finger; motion at the DIP joint from 0 to 45 degrees; motion in the MCP joint from 0 to 75 degrees; and no reduction with repetitive motion but pain with all motion. The diagnosis following the examination was unfavorable ankylosis of the left middle finger and incomplete paralysis that was said to severely impact the Veteran's ability to engage in sports and dress and moderately impair his ability to complete chores, engage in recreation, bathe, and use the bathroom. As noted, in summarizing the severity of the Veteran's service connected disabilities and their impact on occupational and social functioning apart from non-service connected disabilities, the conclusion following the March 2011 VA examination was that the service connected disabilities were "significant" and had a severe impact on physical and sedentary employment. Specifically in this regard with respect to the service connected finger disability at issue, it was reported that the Veteran could not perform repetitive hand motion. As for additional evidence, reports from the SSA reports include a February 2008 determination by SSA that the Veteran was disabled pursuant to the regulations of this agency due to disabilities that included the fingers. (Again, the Board emphasizes that it is not bound by the determinations of the SSA in its determinations as to the proper rating to be assigned for a disability). With respect to the VA outpatient treatment reports of record dated during the appeal period through July 2009, these reports contain no clinical findings pertaining to the finger disability at issue demonstrating a disability that significantly differs in nature or severity from that described on the reports from the VA examinations set forth above. Again and as with respect to the right knee, the Veteran himself has not identified VA as having played a significant, if any, role in the treatment for the finger disability at issue during the appeal period. Applying the pertinent legal criteria to the facts summarized above, the June 2012 rating decision, as previously indicated, added the ring finger to the service connected unfavorable ankylosis of the left long finger. Based on the inclusion of ankylosis of the left ring finger, this decision increased the rating for the finger disability at issue to 20 percent under DC 5219 effective from March 12, 2007, which was the date of the March 2007 VA examination discussed above. As set forth above, the only, and maximum, rating for ankylosis of the long and ring finger under DC 5219 is 20 percent. A higher evaluation of 30 percent is not warranted (given that the affected hand in the instant case if that of the minor hand) unless there is favorable ankylosis involving the thumb and any two fingers (DC 5222); or, favorable ankylosis involving the index, long, ring and little fingers (DC 5221); or, unfavorable ankylosis involving the thumb and any finger (DC 5219); or, unfavorable ankylosis involving the index finger and any other two fingers (DC 5218) or for amputations of multiple fingers (DCs 5126-5148). It is simply not shown, or contended, that any of the manifestations required for an increased rating under any of these diagnostic codes are demonstrated. As such, a schedular rating in excess of 20 percent for unfavorable ankylosis of the left long finger of the minor hand cannot be assigned. Notwithstanding the above, with respect to the effective date assigned for the 20 percent rating, the Board finds that there is an approximate balance of the negative and positive evidence as to whether the criteria for a 20 percent rating under DC 5219; namely, unfavorable ankylosis of the long and ring fingers, was demonstrated from the time of the filing of the claim for increase (January 3, 2007). As support for this determination, evidence of record dated prior to January 3, 2007, indentified relevant symptomatology and pathology in the left ring finger (if not ankylosis, per se), to include the private clinical report dated in December 2004 that noted a deformity with flexion of the PIP joint of the ring finger and the pain and stiffness described in the ring finger at the May 2005 VA examination. As such, and after resolving all reasonable doubt in this regard as required by the controlling legal authority, the Board finds that the criteria for a 20 percent rating for unfavorable ankylosis of the left middle (long) finger of the minor hand, residuals of dislocation and also of the ring finger are met from January 3, 2007. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert, supra. C. Other Considerations First, with regard to giving proper consideration to the effects of pain in assigning a disability rating, as well as the provisions of 38 C.F.R. § 4.45 and the holdings in DeLuca and Mitchell, supra, the reports from the examinations conducted above document consideration of these principles, and there is no indication that increased compensation would be warranted under these principles. The Board further finds that staged ratings for the Veteran's disabilities beyond those already assigned, or granted herein, are not warranted as his symptomatology has otherwise remained stable throughout each time period during the appeal. See Hart, supra. In making its determinations in this case, the Board has carefully considered the Veteran's contentions with respect to the nature of his service-connected disabilities at issue and notes that his lay testimony is competent to describe certain symptoms associated with these disabilities. The Veteran's history and symptom reports have been considered, including as presented in the medical evidence discussed above, and have been contemplated by the disability ratings that have been assigned. Moreover, the competent medical evidence offering detailed specific findings pertinent to the rating criteria is the most probative evidence with regard to evaluating the pertinent symptoms of the service-connected disabilities at issue. As such, while the Board accepts the Veteran's testimony with regard to the matters he is competent to address, the Board relies upon the competent medical evidence with regard to the specialized evaluation of functional impairment, symptom severity, and details of clinical features of the service- connected conditions at issue. The Board has also contemplated whether the case should be referred for extra-schedular consideration for the disabilities at issue. An extra-schedular disability rating is warranted if the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that application of the regular schedular standards would be impracticable. 38 C.F.R. § 3.321(b)(1). In Thun v. Peake, 22 Vet. App. 111, 115-16 (2008), the Court explained how the provisions of 38 C.F.R. § 3.321 are applied. Specifically, the Court stated that the determination of whether a claimant is entitled to an extra- schedular rating under 3.321 is a three-step inquiry. First, it must be determined whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. In this regard, the Court indicated that there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. Under the approach prescribed by VA, if the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. Second, if the schedular evaluation does not contemplate the claimant's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as "marked interference with employment" and "frequent periods of hospitalization." Third, when an analysis of the first two steps reveals that the rating schedule is inadequate to evaluate a claimant's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the claimant's disability picture requires the assignment of an extra- schedular rating. Id. The Board has carefully compared the level of severity and symptomatology of the Veteran's service-connected disabilities at issue with the established criteria found in the rating schedule. The Board finds that the disabilities at issue are fully addressed by the rating criteria under which each such disability is rated. In this regard, the specific diagnostic criteria adequately address the whole of the Veteran's symptoms referable to his service-connected knee and finger disabilities. There are no additional symptoms of the service-connected disabilities at issue. In this regard, a wide range of signs and symptoms are contemplated in the applicable rating criteria for the Veteran's knee and finger disabilities. These disabilities require application of the holding in Deluca, supra, and Mitchell, supra, which, in turn, requires consideration of 38 C.F.R. §§ 4.40 and 4.45. 38 C.F.R. § 4.40 requires consideration of functional loss, including the ability to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance, pain, weakness, and atrophy. Likewise, 38 C.F.R. § 4.45 requires consideration of, in part, incoordination, impaired ability to execute skilled movements, painful motion, swelling, deformity, disuse atrophy, instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing. Also, 38 C.F.R. § 4.59 requires consideration of such matters as unstable or mal- aligned joints, and crepitation as well as any painful arthritic motion. Therefore, the Board finds that the rating criteria reasonably describe the Veteran's disability level and symptomatology associated with the service-connected disabilities addressed above. As such, the Board need not proceed to consider the second factor, viz., whether there are attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization. Consequently, the Board concludes that referral of this case for consideration of an extra- schedular rating for either of the service-connected disabilities addressed above is not warranted. Id.; Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996). "Because the VA disability rating schedule is designed to consider the disabling effect of disabilities separately, no single DC provision will adequately assess the variety of symptoms involved with multiple service-connected disabilities." Johnson v. Shinseki, No. 10-1785, slip op. at 10 (Vet. App. Mar. 27, 2013) (en banc). Thus, as to the question of "whether [38 C.F.R.] § 3.321(b)(1) requires VA to consider multiple service-connected disabilities on a collective basis" the Court held that it did not. Johnson v. Shinseki, No. 10-1785, slip op. at 4 (Vet. App. Mar. 27, 2013) (en banc) (noting that a concurring opinion in Brambley v. Principi, 17 Vet. App. 20, 27 (2003) that there should have been a determination of "whether the appellant's service-connected disabilities as a whole [sic] entitled [a Veteran] to [an extraschedular rating] under § 3.321(b)(1)" had never been adopted by the Court and concurring opinions are not binding on the Court" (citing Maryland v. Wilson, 519 U.S. 408, 412-13). Stated in other terms, an extraschedular rating may not be assigned for the cumulative impact of the service-connected disabilities herein at issue. Finally, the Board acknowledges the holding in Rice v. Shinseki, 22 Vet. App. 447 (2009) that a total rating based on individual unemployability due to service-connected disability (TDIU) claim is part of a claim for a higher rating when such claim is raised by the record or asserted by the Veteran. The Board observes that the Court has also noted that VA has a "well-established" duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); see also Bradley v. Peake, 22 Vet. App. 280 (2008). This duty to maximize benefits requires VA to assess all of a claimant's disabilities to determine whether any combination of disabilities establishes entitlement to special monthly compensation (SMC) under 38 U.S.C.A § 1114. See Bradley, 22 Vet. App. 280, 294 (2008) (finding that SMC "benefits are to be accorded when a Veteran becomes eligible without need for a separate claim"). Subsection 1114(s) requires that a disabled Veteran whose disability level is determined by the ratings schedule must have at least one disability that is rated at 100 percent in order to qualify for the special monthly compensation provided by that statute. Under the law, subsection 1114(s) benefits are not available to a Veteran whose 100 percent disability rating is based on multiple disabilities, none of which is rated at 100 percent disabling. The record reflects that the Veteran was awarded TDIU, based on disabilities in addition to those addressed herein, effective from September 11, 2007, by a December 2008 rating decision. This award remained effective thru March 21, 2010, as by way of the increased ratings assigned by the June 2012 rating decision, the service connected disabilities combined to be 100 percent disabling effective from March 22, 2010 (under 38 C.F.R. § 4.16a, TDIU is only for assignment when the schedular rating is "less than total"). In light of the above, and the fact that this appeal stems initially from a claim for an increased rating for service connected right knee disability filed in October 2006, the Board has considered whether the issue of entitlement to a TDIU during the appeal period prior to September 11, 2007, has been raised. In this regard, while the Veteran was said to not be employed at the March 2007 VA examination of the disabilities at issue, there is no indication therein that this was due solely to the service connected disabilities on appeal. Moreover, the award of the TDIU by the December 2008 rating decision was based, in addition to his knee and finger disabilities, his service connected back and psychiatric disorders, and it was only the psychiatric examination conducted in March 2008 that resulted in the conclusion that even sedentary work could be precluded due to his psychiatric problems (the examination of the finger disability in March 2008,while containing a conclusion that the finger disability precluded manual labor, resulted in the conclusion that such disability would not preclude sedentary employment). It was specially noted at the March 2007 VA examination that the Veteran's ability to write would not be affected by his service connected finger disability in the minor hand given that he is right-handed, and there is otherwise no indication that the service connected right knee or finger disabilities on appeal, by themselves, rendered the Veteran unemployable during the appeal period prior to September 11, 2007. Therefore, the issue of entitlement to a TDIU is not raised in the instant appeal and further consideration of such is not necessary. Finally, as the 100 percent rating is based on multiple disabilities, none of which is rated at 100 percent disabling, consideration of entitlement to SMC under the holding in Bradley is not indicated. In sum, the Board finds that the preponderance of the evidence is against the assignment of ratings in excess of 10 percent for degenerative changes of the right knee with meniscal tear prior to March 7, 2011, and in excess of 30 percent from that date as well as for a rating in excess of 30 percent for anterior cruciate deficiency, right knee, status-post anterior cruciate ligament reconstruction. Therefore, the benefit of the doubt doctrine is not applicable, and these claims must be denied. 38 U.S.C.A. § 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7; Gilbert, supra. The Board also finds that while the criteria are met for a 20 percent for unfavorable ankylosis of the left long finger of the minor hand, residuals of dislocation and also of the ring finger from January 3, 2007, the preponderance of the evidence is against the assignment of a rating in excess of 20 percent for this disability; as such entitlement to a rating in excess of 20 percent for unfavorable ankylosis of the left long finger of the minor hand, residuals of dislocation and also of the ring finger must be denied. Id. ORDER Entitlement to a rating in excess of 10 percent for degenerative changes of the right knee with meniscal tear prior to March 7, 2011, and in excess of 30 percent from that date is denied. Entitlement to a rating in excess of 30 percent for anterior cruciate deficiency, right knee, status-post anterior cruciate ligament reconstruction is denied. Entitlement to a 20 percent rating for unfavorable ankylosis of the left long finger of the minor hand, residuals of dislocation and also of the ring finger from January 3, 2007 is granted, subject to regulations governing the payment of monetary awards. Entitlement to a rating in excess 20 percent rating for unfavorable ankylosis of the left long finger of the minor hand, residuals of dislocation and also of the ring finger is denied. ____________________________________________ K. L. WALLIN Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs