Citation Nr: 1333696 Decision Date: 10/24/13 Archive Date: 10/24/13 DOCKET NO. 10-21 304 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to a rating in excess of 10 percent for service-connected left knee disorder. REPRESENTATION Appellant represented by: Oklahoma Department of Veterans Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD John Kitlas, Counsel INTRODUCTION The Veteran served on active duty from January 1980 to November 1981. This matter is before the Board of Veterans' Appeals (Board) on appeal from an October 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma, which confirmed and continued the noncompensable (zero percent) rating for the Veteran's service-connected left knee disorder. A subsequent August 2013 rating decision assigned a 10 percent rating for the left knee disorder, effective April 30, 2009 (date of claim). However, the case remains in appellate status pursuant to AB v. Brown, 6 Vet. App. 35 (1993). The Veteran provided testimony at a hearing before the undersigned Veterans Law Judge (VLJ) in November 2011. A transcript of this hearing has been associated with the Veteran's VA claims folder. This case was previously before the Board in March 2013, at which time it was remanded for further development to include obtaining any outstanding treatment records and according the Veteran a new examination to evaluate the nature and severity of his service-connected left knee disorder. Additional treatment records were obtained, and the Veteran was accorded a new VA examination of his left knee in July 2013. All other development directed by the Board's remand appears to have been substantially completed. Accordingly, a new remand is not required in order to comply with the holding of Stegall v. West, 11 Vet. App. 268 (1998). See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (Remand not required under Stegall where the Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (2002). This appeal was processed using the Virtual VA paperless claims processing system. Accordingly, any future consideration of this appellant's case should take into consideration the existence of this electronic record. FINDINGS OF FACT 1. The Veteran's service-connected left knee disorder is manifested by painful motion. 2. The Veteran's service-connected left knee disorder is not manifested by ankylosis, dislocation or removal of the semilunar cartilage, impairment of the tibia or fibula, genu recurvatum, recurrent subluxation and/or lateral instability, flexion limited to 30 degrees or less, or limitation of extension. CONCLUSION OF LAW The criteria for a rating in excess of 10 percent for the Veteran's service-connected left knee disorder are not met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5256 to 5263 (2013). REASONS AND BASES FOR FINDINGS AND CONCLUSION Preliminary Matters The Board notes at the outset that VA has an obligation to notify claimants what information or evidence is needed in order to substantiate a claim, as well as a duty to assist claimants by making reasonable efforts to get the evidence needed. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A and 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2013); see also Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). Under the law, VA is required to notify the Veteran of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, VA will attempt to obtain. 38 C.F.R. § 3.159(b). The United States Court of Appeals for Veterans Claims (Court) has indicated that VA must provide a claimant notice before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); see also Pelegrini v. Principi, 18 Vet. App. 112 (2004). In this case, the Veteran was sent pre-adjudication notification via letters dated in May and June 2009, which is clearly prior to the October 2009 rating decision that is the subject of this appeal. He was also sent additional notification via an April 2013 letter, followed by readjudication of the appeal by an August 2013 Supplemental Statement of the Case which "cures" the timing problem associated with inadequate notice or the lack of notice prior to the initial adjudication. Mayfield v. Nicholson, 20 Vet. App. 537 (2006) (Mayfield III), citing Mayfield II, 444 F.3d at 1333-34. These letters, in pertinent part, informed the Veteran of what was necessary to substantiate his current appellate claim, to include the information and evidence used by VA to determine disability rating(s) and effective date(s); what information and evidence he must submit; and what information and evidence will be obtained by VA. In view of the foregoing, the Board finds that the Veteran was notified and aware of the evidence needed to substantiate his current appellate claim and the avenues through which he might obtain such evidence, and of the allocation of responsibilities between himself and VA in obtaining such evidence. Accordingly, there is no further duty to notify. In any event, the Veteran has not demonstrated any prejudice with regard to the content or timing of any notice. See Shinseki v. Sanders, 129 S.Ct.1696 (2009) (Reversing prior case law imposing a presumption of prejudice on any notice deficiency, and clarifying that the burden of showing that an error is harmful, or prejudicial, normally falls upon the party attacking the agency's determination). In addition, the Board finds that the duty to assist a claimant in the development of his or her case has been satisfied. The Veteran's service treatment records are on file, as are various post-service medical records. Further, the Veteran has had the opportunity to present evidence and argument in support of his left knee claim, to include at the November 2011 Board hearing. Nothing indicates he has identified the existence of any relevant evidence that has not been obtained or requested. For example, he has not identified outstanding evidence which documents symptoms of his service-connected left knee disorder that is not reflected by the evidence already of record. In fact, the Veteran reported in August 2013 that he had no other information or evidence to submit regarding his appeal. With respect to the November 2011 hearing, the Board is cognizant of the fact the Court held in Bryant v. Shinseki, 23 Vet. App. 488 (2010), that 38 C.F.R. 3.103(c)(2) requires that the RO official or VLJ who conducts a hearing fulfill two duties to comply with the above the regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. Here, during the hearing, the VLJ accurately noted the appellate issue, asked questions to clarify the Veteran's contentions and treatment history, and explained that the purpose of the hearing was to describe how the knee was affecting the Veteran and the symptoms that it produces. Moreover, the testimony of the Veteran, to include the questions posed by his accredited representative, focused on the elements necessary to substantiate the appellate claim; i.e., the Veteran, through his testimony, demonstrated that he had actual knowledge of the elements necessary to substantiate his claim. Finally, neither the Veteran nor his representative has asserted that VA failed to comply with 38 C.F.R. 3.103(c)(2), nor has he identified any prejudice in the conduct of either hearing. As such, the Board finds that, consistent with Bryant, the duties set forth in 38 C.F.R. 3.103(c)(2) have been satisfied. The Board further notes the Veteran was accorded VA medical examinations in June 2009 and July 2013 which made findings regarding the symptomatology of the service-connected left knee disorder that are consistent with the treatment records and relevant rating criteria. No inaccuracies or prejudice is demonstrated with respect to these examinations, nor has the Veteran indicated his left knee has increased in severity since the most recent examination. Accordingly, the Board finds that these examinations are adequate for resolution of this case. In view of the foregoing, the Board finds that the duty to assist the Veteran has been satisfied in this case. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the appellant or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (The Board must review the entire record, but does not have to discuss each piece of evidence). Rather, the Board's analysis below will focus specifically on what the evidence shows, or fails to show, on the claims. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (Noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C.A. § 7104(a). Moreover, the Court has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C.A. § 5107(b). When a reasonable doubt arises regarding service origin, such doubt will be resolved in the favor of the claimant. Reasonable doubt is doubt which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. The question is whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which event the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). Legal Criteria and Analysis Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a question as to which of two evaluations applies, assigning the higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person's ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Thus, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011). The degree of impairment resulting from a disability is a factual determination and generally the Board's primary focus in such cases is upon the current severity of the disability. However, staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). The criteria for disabilities of the knee and leg are found at 38 C.F.R. § 4.71a, Diagnostic Codes 5256 to 5263. Diagnostic Code 5256 provides for ankylosis of the knee. Under this Code, favorable ankylosis of either knee warrants a 30 percent evaluation. Ankylosis is considered to be favorable when the knee is fixed in full extension, or in slight flexion at an angle between 0 degrees and 10 degrees. A 40 percent evaluation requires that the knee be fixed in flexion at an angle between 10 degrees and 20 degrees. When the knee is fixed in flexion between 20 degrees and 45 degrees, a 50 percent rating is assigned. A 60 percent rating is warranted for extremely unfavorable ankylosis, with the knee fixed in flexion at an angle of 45 degrees or more. 38 C.F.R. § 4.71a. Under Diagnostic Code 5257, slight impairment of either knee, including recurrent subluxation or lateral instability, warrants a 10 percent evaluation. A 20 percent evaluation requires moderate impairment, while a 30 percent evaluation requires severe impairment. 38 C.F.R. § 4.71a. Under Diagnostic Code 5258, when there is cartilage, semilunar, dislocated, with frequent episodes of "locking," pain, and effusion into the joint, a 20 percent is assignable. 38 C.F.R. § 4.71a. Under Diagnostic Code 5259, a 10 percent rating is assigned for cartilage, semilunar, removal of, symptomatic. This Code does not provide for a disability rating in excess of 10 percent. 38 C.F.R. § 4.71a. Diagnostic Code 5260 provides for limitation of flexion of the leg. Where flexion is limited to 60 degrees, a 0 percent rating is provided; when flexion is limited to 45 degrees, 10 percent is assigned; when flexion is limited to 30 degrees, 20 percent is assigned; and when flexion is limited to 15 degrees, 30 percent is assigned. 38 C.F.R. § 4.71a. Diagnostic Code 5261 provides for limitation of the extension of the leg. When there is limitation of extension of the leg to 5 degrees, a zero percent rating is assigned; when the limitation is to 10 degrees, a 10 percent rating is assignable; when the limitation is to 15 degrees, 20 percent is assigned; when extension is limited to 20 degrees, 30 percent is assigned; when extension is limited to 30 degrees, 40 percent is assigned; and when it is limited to 45 degrees, 50 percent is assigned. 38 C.F.R. § 4.71a. The Board notes that full range of motion of the knee consists of 0 degrees extension and 140 degrees flexion. 38 C.F.R. § 4.71, Plate II. Diagnostic Code 5262 provides criteria for impairment of the tibia and fibula. With malunion and slight knee or ankle disability, a 10 percent rating is assigned. Moderate knee or ankle disability warrants a 20 percent rating. A 30 percent rating is assigned when there is marked knee or ankle disability. When there is nonunion with loose motion, requiring brace, a 40 percent rating is warranted. 38 C.F.R. § 4.71a. Under Diagnostic Code 5263, when there is genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated), a 10 percent rating is warranted. This Code does not provide for a disability rating in excess of 10 percent. 38 C.F.R. § 4.71a. Initially, the Board notes that the required manifestations for evaluation under Diagnostic Codes 5256 (knee, ankylosis), 5258 (cartilage, dislocated, semilunar), 5259 (symptomatic removal of semilunar cartilage), 5262 (tibia and fibula, impairment of), and 5263 (genu recurvatum) are not applicable, as the presence of ankylosis of the left knee, dislocation or removal of the semilunar cartilage, impairment of the tibia or fibula, or genu recurvatum have not been demonstrated. The Board also observes that Diagnostic Codes 5259 and 5263 provide for a maximum rating of 10 percent, which is the current evaluation of the Veteran's service-connected left knee disorder. As such, they do not provide a basis for the benefit currently sought on appeal. The Board acknowledges that the Veteran has complained of painful left knee motion, and that such complaints were noted on the VA medical examinations and in the treatment records. As such, the provisions of 38 C.F.R. §§ 4.40, 4.45, and 4.59 are for consideration in this case. Further, repetitive motion testing was conducted on the VA examinations in an effort to simulate the extent of impairment during flare-ups. Nevertheless, even when taking into account the Veteran's complaints of pain, the record does not reflect he has flexion limited to 30 degrees or less, nor limitation of extension. For example, the June 2009 VA examination showed the left knee to have flexion to 140 degrees, and extension to zero degrees. In addition, the left knee was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. The more recent July 2013 VA examination found the left knee to have flexion to 130 degrees, with pain noted at 90 degrees. After repetitive motion testing he had flexion to 125 degrees. He did not have any limitation of extension or evidence of painful extension, to include after repetitive testing. The Board also acknowledges that the Veteran reported at the July 2013 VA examination that, with his condition, there could be additional limitation of range of motion due to pain, weakness, and fatigability; and that he reported an estimated 40 degrees lost flexion of the knee with flare-up of the knee pain, or approximately 30 percent loss of range of motion. However, this still does not satisfy the criteria for a rating in excess of 10 percent for limitation of flexion under Diagnostic Code 5260. Nothing in the other evidence of record indicates such limitation, nor limitation of extension. The Board acknowledges that VA's Office of General Counsel held in VAOPGCPREC 9-2004 that separate ratings under Diagnostic Codes 5260 and 5261 may be assigned for disability of the same joint. However, in this case, the record does not reflect the Veteran has limitation of extension. In other words, he would not qualify for a compensable rating under Diagnostic Code 5261. Therefore, such separate ratings are not warranted in this case. With respect to Diagnostic Code 5257, the Board notes that the Veteran reported giving way of his left knee, to include at his November 2011 hearing. He also reported wearing a brace on his left knee as result thereof at this hearing, as well as at the July 2013 VA examination. Moreover, VA's Office of General Counsel held in VAOPGCPREC 23-97 that a claimant who has arthritis and instability of the knee may be rated separately under Diagnostic Codes 5003 and 5257. General Counsel stated that when a knee disorder is already rated under Diagnostic Code 5257, the veteran must also have limitation of motion which at least meets the criteria for a zero-percent rating under Diagnostic Code 5260 (flexion limited to 60 degrees or less) or 5261 (extension limited to 5 degrees or more) in order to obtain a separate rating for arthritis. General Counsel subsequently held in VAOPGCPREC 9-98 that a separate rating for arthritis could also be based on X-ray findings and painful motion under 38 C.F.R. § 4.59; see also Degmetich v. Brown, 104 F.3d 1328, 1331 (Fed. Cir. 1997). Where additionally disability is shown, a veteran rated under 5257 can also be compensated under 5003 and vice versa. Despite the foregoing, the Board finds that the Veteran does not experience recurrent subluxation or lateral instability of the left knee. For example, the June 2009 VA examination concluded that the anterior and posterior cruciate ligaments stability test, the medial and lateral collateral ligaments stability test, and the medial and lateral meniscus test of the left knee were all within normal limits. Similarly, all joint stability tests were normal for the left knee on the July 2013 VA examination, and it was stated there was no evidence or history of recurrent patellar subluxation/dislocation. Nothing in the treatment records on file support such a finding either. Therefore, the Board finds that the Veteran is not entitled to a compensable rating under Diagnostic Code 5257, to include assignment of a separate rating pursuant to VAOPGCPRECs 23-97 and 9-98. For these reasons, the Board finds that the Veteran does not meet or nearly approximate the schedular criteria for a rating in excess of 10 percent for his service-connected left knee disorder under any of the potentially applicable Diagnostic Codes. Therefore, the preponderance of the evidence is against this claim. In making this determination, the Board took into consideration the applicability of "staged" rating(s) pursuant to Fenderson, supra, and Hart, supra. However, a thorough review of the record does not indicate any distinctive period(s) where the Veteran met or nearly approximated the criteria for a rating in excess of 10 percent. Therefore, no such "staged" rating(s) are warranted in this case. Further, as the preponderance of the evidence is against the claim for a higher schedular rating, the benefit of the doubt doctrine is not for application in the instant case. See generally Gilbert, supra; Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). In exceptional cases an extraschedular rating may be provided. 38 C.F.R. § 3.321. The Court has set out a three-part test, based on the language of 38 C.F.R. § 3.321(b)(1), for determining whether a Veteran is entitled to an extraschedular rating: (1) the established schedular criteria must be inadequate to describe the severity and symptoms of the claimant's disability; (2) the case must present other indicia of an exceptional or unusual disability picture, such as marked interference with employment or frequent periods of hospitalization; and (3) the award of an extraschedular disability rating must be in the interest of justice. Thun v. Peake, 22 Vet. App. 111 (2008), aff'd, Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). In this case, the Board finds that the rating criteria contemplate the symptomatology of the Veteran's service-connected left knee disorder. The Board notes that the treatment records and VA medical examinations on file, as well as the Veteran's own statements and hearing testimony, reflect that his left knee is primarily manifested by pain and resulting functional impairment. However, pursuant to the provisions of 38 C.F.R. §§ 4.40, 4.45, and 4.59, the Board was required to take into account such impairment when evaluating whether a higher rating was warranted under the schedular criteria. Therefore, to then find that such complaints warrant an extraschedular rating would be in violation of the prohibition against pyramiding of disabilities found in 38 C.F.R. § 4.14. A thorough review of the record does not otherwise indicate any exceptional or unusual disability picture not contemplated by the schedular criteria. Consequently, the Board concludes that the rating criteria are adequate to evaluate the Veteran's service-connected left knee disorder and referral for consideration of extraschedular rating is not warranted. Lastly, the Board notes that notes that, in Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court held that a claim of entitlement to a total rating based upon individual unemployability (TDIU) is part of an increased rating claim when such claim is expressly raised by the Veteran or reasonably raised by the record. In this case, the Board acknowledges that the Veteran has reported problems performing his work as a welder due to the service-connected left knee disorder, and that he has missed days from work as a result thereof. However, the record also reflects that he remains gainfully employed in this occupation. Based on these facts, as well as a review of the other evidence of record, the Board is of the opinion that the Veteran's level of occupational impairment from his left knee has been adequately compensated by the current schedular rating. Loss of industrial capacity is the principal factor in assigning schedular disability ratings. See 38 C.F.R. §§ 3.321(a), 4.1. Indeed, 38 C.F.R. § 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 Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (Noting that the disability rating itself is recognition that industrial capabilities are impaired). Therefore, this case does not warrant consideration of a TDIU. ORDER A rating in excess of 10 percent for service-connected left knee disorder is denied. ____________________________________________ MICHAEL E. KILCOYNE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs