Citation Nr: 18146469 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-41 441 DATE: October 31, 2018 ORDER Entitlement to a rating in excess of 20 percent disabling for patellofemoral pain syndrome with symptomatic chondromalacia of the patella with synovitis, right knee, status post arthroscopic resection, from November 26, 2014 is denied. Entitlement to a rating in excess of 10 percent disabling for patellofemoral pain syndrome left knee, from November 26, 2014 is denied. FINDINGS OF FACT 1. The Veteran’s patellofemoral pain syndrome with symptomatic chondromalacia of the patella with synovitis, right knee, status post arthroscopic resection has manifested with limitation of flexion at most to 120 degrees and extension to zero degrees, even considering painful motion and other factors. 2. The Veteran’s patellofemoral pain syndrome left knee has manifested with limitation of flexion at most to 125 degrees and extension to zero degrees, even considering painful motion and other factors. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent disabling for patellofemoral pain syndrome with symptomatic chondromalacia of the patella with synovitis, right knee, status post arthroscopic resection have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.103, 3.321, 4.1, 4.3, 4.7, 4.21, 4.97, Diagnostic Codes (DCs) 5020-5260. 2. The criteria for a rating in excess of 10 percent disabling for patellofemoral pain syndrome, left knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.103, 3.321, 4.1, 4.3, 4.7, 4.21, 4.97, DC 5260. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If there is a question as to which of two evaluations should apply, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. Entitlement to a rating in excess of 20 percent disabling for patellofemoral pain syndrome with symptomatic chondromalacia of the patella with synovitis, right knee, status post arthroscopic resection, from November 26, 2014 The Veteran’s right knee disorder has been rated as 20 percent disabling under DC 5020-5260. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. DC 5020 provides synovitis will be rated based on the limitation of motion of affected parts, and DC 5260 provides ratings for limited flexion of the leg. 38 C.F.R. § 4.71a. Normal range of motion of the knee is to zero degrees extension and to 140 degrees flexion. See 38 C.F.R. § 4.71a, Plate II. Under DC 5260 a noncompensable rating is assigned when flexion is limited to 60 degrees, a 10 percent rating is assigned when flexion is limited to 45 degrees, a higher 20 percent rating is assigned when flexion is limited to 30 degrees, and a maximum 30 percent rating is assigned if flexion is limited to 15 degrees. 38 C.F.R. § 4.71a. The Veteran contends that his right knee warrants a higher disability rating. Specifically, in his Notice of Disagreement, he indicates that “knee locking” was not considered during his previous VA examination along with daily instability. In March 2015, the Veteran attended a VA Knee and Lower Leg Conditions Disability Benefits Questionnaire (DBQ) examination. The Veteran indicated that his right knee has gotten progressively worse with daily pain and giving way when going down stairs. He also noted swelling, stiffness, and difficulty with prolonged sitting. Upon examination, the examiner noted range of motion (ROM) for the right knee as flexion to 130 degrees with functional loss noted as pain with limited range of motion. No additional loss of ROM after repetitive testing was noted. Joint stability testing indicated normal stability in the right knee. No ankylosis was noted as well. An August 2015 VA treatment record indicated full ROM in the right knee for the Veteran. In February 2017, the Veteran attended another VA Knee and Lower Leg Conditions DBQ examination. The Veteran indicated that his right knee has gotten progressively worse with daily pain and giving way when going down stairs. Upon examination, the examiner noted ROM for the right knee as flexion to 120 degrees with functional loss noted as pain with limited range of motion. No additional loss of ROM after repetitive testing was noted. Joint stability testing indicated normal stability in the right knee. No ankylosis was noted as well. A VA July 2018 MRI impression was that of chondromalacia of the medial compartment but otherwise unremarkable. In August 2018, the Veteran attended another VA Knee and Lower Leg Conditions DBQ examination. The Veteran indicated that his right knee is unstable and buckles. Upon examination, the examiner noted ROM for the right knee as flexion to 135 degrees with functional loss noted as pain with limited range of motion. No additional loss of ROM after repetitive testing was noted. Joint stability testing indicated normal stability in the right knee. No ankylosis was noted as well. Based on the foregoing evidence of record, the Board finds that the Veteran’s right knee disability does not warrant a higher rating. Indeed, the evidence of record during the appeal period is completely silent for any indication that the Veteran’s right knee flexion was limited to 15 degrees. Further, throughout the appeal period, his right knee flexion at its worst was limited to 120 degrees. Accordingly, a higher 30 percent rating is not warranted for the entire appeal period. Entitlement to a rating in excess of 10 percent disabling for patellofemoral pain syndrome left knee, from November 26, 2014 The Veteran’s left knee disorder has been rated as 10 percent disabling under DC 5260. DC 5260 provides ratings for limited flexion of the leg. 38 C.F.R. § 4.71a. Normal range of motion of the knee is to zero degrees extension and to 140 degrees flexion. See 38 C.F.R. § 4.71a, Plate II. Under DC 5260 a noncompensable rating is assigned when flexion is limited to 60 degrees, a 10 percent rating is assigned when flexion is limited to 45 degrees, a higher 20 percent rating is assigned when flexion is limited to 30 degrees, and a maximum 30 percent rating is assigned if flexion is limited to 15 degrees. 38 C.F.R. § 4.71a. The Veteran contends that his left knee warrants a higher disability rating. Specifically, in his Notice of Disagreement, he indicates that “knee locking” was not considered during his previous VA examination along with daily instability. In March 2015, the Veteran attended a VA Knee and Lower Leg Conditions Disability Benefits Questionnaire (DBQ) examination. The Veteran indicated that his left knee has gotten progressively worse with daily pain and giving way when going down stairs. He also noted swelling, stiffness, and difficulty with prolonged sitting. Upon examination, the examiner noted range of motion (ROM) for the left knee as flexion to 130 degrees with functional loss noted as pain with limited range of motion. No additional loss of ROM after repetitive testing was noted. Joint stability testing indicated normal stability in the left knee. No ankylosis was noted as well. An August 2015 VA treatment record indicated full ROM in the right knee for the Veteran. In February 2017, the Veteran attended another VA Knee and Lower Leg Conditions DBQ examination. The Veteran indicated that his right knee has gotten progressively worse with daily pain and giving way when going down stairs. Upon examination, the examiner noted ROM for the right knee as flexion to 125 degrees with functional loss noted as pain with limited range of motion. No additional loss of ROM after repetitive testing was noted. Joint stability testing indicated normal stability in the left knee. No ankylosis was noted as well. In August 2018, the Veteran attended another VA Knee and Lower Leg Conditions DBQ examination. The Veteran indicated that his right knee is unstable and buckles. Upon examination, the examiner noted normal ROM for the left knee. No additional loss of ROM after repetitive testing was noted. Joint stability testing indicated normal stability in the left knee. No ankylosis was noted as well. Based on the foregoing evidence of record, the Board finds that the Veteran’s left knee disability does not warrant a higher rating. Indeed, the evidence of record during the appeal period is completely silent for any indication that the Veteran’s left knee flexion was limited to 30 degrees. Further, throughout the appeal period, his left knee flexion at its worst was limited to 125 degrees. Accordingly, a higher 20 percent rating is not warranted for the entire appeal period. N. RIPPEL Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R.A. Elliott II, Associate Counsel