Citation Nr: 18147137 Decision Date: 11/05/18 Archive Date: 11/02/18 DOCKET NO. 12-18 746 DATE: November 5, 2018 ORDER Entitlement to an initial disability rating in excess of 10 percent for degenerative disc disease (DDD) of the lumbar spine is denied. Entitlement to an initial compensable disability rating prior to October 6, 2016 and in excess of 10 percent thereafter for right hip bursitis is denied. Entitlement to an initial compensable disability rating prior to October 6, 2016 and in excess of 10 percent for left hip bursitis is denied. Entitlement to an initial compensable disability rating prior to April 13, 2015 and in excess of 10 percent for right knee bursitis with chondromalacia (right knee disability) is denied. FINDINGS OF FACT 1. During the entire course of the appeal, the Veteran’s DDD of the lumbar spine was not manifested by flexion limited to 60 degrees; no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour was noted. 2. For the period prior to and after October 6, 2016, the Veteran’s bilateral hip disabilities were not manifested by flexion limited to 45 degrees or extension limited to 5 degrees. 3. For the period prior to and after April 13, 2015, the Veteran’s right knee disability was not manifested by flexion limited to 45 degrees; extension was to 0 degrees. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for DDD of the lumbar spine were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.71a, Diagnostic Codes (DCs) 5242-5243. 2. The criteria for an initial compensable disability rating for right hip bursitis prior to October 6, 2016 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DCs 5252-5024. 3. The criteria for a disability rating in excess of 10 percent for left hip bursitis after October 6, 2016 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DCs 5019-5251. 4. The criteria for an initial compensable rating prior to April 13, 2015 and a rating in excess of 10 percent thereafter for right knee disability have not been met.38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DCs 5260-5024. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1988 to January 2010. These matters come to the Board of Veterans’ Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In September 2014, the Veteran testified before the undersigned at a formal hearing; a transcript of which has been associated with the claims file. In January 2015 and June 2017, the Board, in pertinent part, remanded the issues on appeal. The Board notes that with regard to the disabilities decided herein, there has been substantial compliance with the previous Board remands. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during active military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two evaluations shall be applied, the higher rating 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. When there is an approximate balance of positive and negative 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. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. In both initial rating claims and normal increased rating claims, the Board must discuss whether “staged ratings” are warranted, and if not, why not. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board notes that it has reviewed all of the evidence in the Veteran’s claims file, with an emphasis on the evidence relevant to the appeal. 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) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. Disabilities of the spine are currently rated under the General Rating Formula for Diseases and Injuries of the Spine (for DCs 5235 to 5243, unless 5243 is evaluated under the Formula for Rating IVDS Based on Incapacitating Episodes). Ratings under the General Rating Formula for Diseases and Injuries of the Spine are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. The General Rating Formula for Diseases and Injuries of the Spine provides a 10 percent disability rating for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, the combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent disability rating for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent disability rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. Finally, a 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a. Note (2) provides that, for VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The normal combined range of motion of the thoracolumbar spine is 240 degrees. See also Plate V, 38 C.F.R. § 4.71a. When rating degenerative arthritis of the spine (DC 5242), in addition to consideration of rating under the General Rating Formula for Diseases and Injuries of the Spine, rating for degenerative arthritis under DC 5003 should also be considered. 38 C.F.R. § 4.71a. DC 5243 provides that intervertebral disc syndrome (IVDS) is to be rated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes provides a 20 percent disability rating for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent disability rating for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a 60 percent disability rating for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a. Note (1) to DC 5243 provides that, for purposes of ratings under DC 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Note (2) provides that, if IVDS is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, each segment is to be rated on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. 38 C.F.R. § 4.71a. With regard to knee disabilities, DC 5024 states that tenosynovitis will be rated on limitation of motion of affected parts, as arthritis, degenerative. DC 5019 states that bursitis will be rated on limitation of motion of affected parts. Normal ranges of motion of the hip are hip flexion from 0 degrees to 125 degrees, and hip abduction from 0 degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II. Disabilities of the hip and thigh are rated under the criteria of 38 C.F.R. § 4.71a, DCs 5250 through 5255. DCs 5250 (ankylosis of the hip), 5254 (flail joint) and 5255 (impairment of the femur) are not shown in the Veteran’s case. Under DC 5251, a 10 percent rating is warranted for extension limited to 5 degrees. Under DC 5252, a 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 20 degrees, and a 40 percent rating is warranted for flexion limited to 10 degrees. Normal range of motion of the hip and thigh is flexion from 0 to 125 degrees and abduction from 0 to 45 degrees. 38 C.F.R. § 4.71a, Plate II (2016). Under DC 5253, a rating of 10 percent is assigned for limitation of rotation (cannot toe-out more than 15 degrees for the affected leg) or for limitation of adduction (cannot cross legs). A rating of 20 percent is assigned for limitation of abduction when motion is lost beyond 10 degrees. DCs 5256 through 5263 set forth the relevant provisions for disabilities of the knee. DC 5256 governs ankylosis of the knee, and provides a 30 percent rating for knee ankylosis in a favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees. A 40 percent rating is provided for knee ankylosis in flexion between 10 and 20 degrees. A 50 percent rating is provided for knee ankylosis in flexion between 20 degrees and 45 degrees. A 60 percent rating is provided for knee ankylosis that is extremely unfavorable, in flexion at an angle of 45 degrees or more. The Schedule provides that the normal range of motion of the knee is from zero degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II. DC 5257 governs other impairment of the knee, providing respective ratings of 10, 20, and 30 percent for slight, moderate, or severe recurrent subluxation or lateral instability of the knee. 38 C.F.R. § 4.71a. DC 5258 provides for a maximum 20 percent rating for dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint. Id. DC 5259 provides a maximum 10 percent rating for removal of semilunar cartilage that is symptomatic. Id. DC 5260, which governs limitation of leg flexion, provides a zero percent rating for flexion limited to 60 degrees, 10 percent for flexion limited to 45 degrees, 20 percent for flexion limited to 30 degrees, and a maximum of 30 percent for flexion limited to 15 degrees. Id. DC 5261, which governs limitation of leg extension, provides a zero percent rating for extension limited to 5 degrees, 10 percent for extension limited to 10 degrees, 20 percent for extension limited to 15 degrees, 30 percent for extension limited to 20 degrees, 40 percent for extension limited to 30 degrees, and a maximum of 50 percent for extension limited to 45 degrees. Id. DC 5262 provides that impairment of the tibia and fibula characterized by malunion with slight knee or ankle disability warrants a 10 percent evaluation, malunion with moderate knee or ankle disability warrants a 20 percent evaluation, and malunion with marked knee or ankle disability warrants a 30 percent rating. Impairment of the tibia and fibula manifested by nonunion with loose motion, requiring a brace, warrants a maximum 40 percent rating. Id. DC 5263 provides a maximum 10 percent rating for genu recurvatum that is acquired and traumatic, with weakness and insecurity in weight-bearing objectively demonstrated. Id. More generally, disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in 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. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. In addition, the intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. This regulation also provides that the intent of the Rating Schedule is to recognize painful motion with joint or periarticular pathology as productive of disability, and that crepitation should be noted carefully as points of contact which are diseased. Thus, when assessing the severity of a musculoskeletal disability that, as here, is at least partly rated on the basis of limitation of motion, VA must also consider the extent that the veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent (“flare-ups”) due to the extent of his pain (and painful motion), weakness, premature or excess fatigability, and incoordination-assuming these factors are not already contemplated by the governing rating criteria. DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997). And although VA is required to apply 38 C.F.R. §§ 4.40 and 4.45, pertaining to functional impairment for disabilities evaluated on the basis of limitation of motion, where the Veteran is in receipt of the maximum schedular evaluation based on limitation of motion and a higher rating requires ankylosis, these regulations are not for application. Johnston, 10 Vet. App. at 84-85. Moreover, pain itself does not constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id.; see 38 C.F.R. § 4.40. DDD of the Lumbar Spine Prior to October 6, 2016, the Veteran’s DDD of the lumbar spine is assigned a 10 percent disability rating under DC 5243 and assigned a 10 percent disability rating under DCs 5242-5243 thereafter. Turning to the evidence, a September 2009 MRI of the Veteran’s lumbar spine revealed mild lower DDD and facet changes, synovitis L4-L5, and mild left foraminal disc extrusion at L5-S1 with encroachment on an exiting nerve. A December 2010 VA examination showed forward flexion to 110 degrees with pain, extension to 30 degrees with pain, and no loss of motion with repetition. No weakness, fatigue, or lack of coordination was noted. The Veteran reported flare-ups when carrying heavy objects or with prolonged sitting, standing, sit-ups, and running in cold weather. No radiation of pain was reported. He was diagnosed with DDD, synovitis, and foraminal disc extrusion at L5-S1. During a June 2011 VA examination, the Veteran reported constant lower back pain, no additional functional impairments with flare-ups, radiating pain to the right foot with some tingling of the right leg, no weakness, or bowel or bladder incontinence. On physical examination, the Veteran had a normal gait, no list or scoliosis, or spasm or tenderness. Flexion was to 90 degrees with pain and extension to 0 degrees without pain. A neurological examination revealed heel and toe gait were intact but unstable. Straight leg testing was negative, deep tendon reflexes were 2+, and peripheral sensation and pulses were normal. March 2015 VA treatment notes indicate a diagnosis for lumbar radiculopathy. A November 2016 VA examination diagnosed the Veteran with degenerative arthritis of the spine and IVDS. The Veteran had no episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by or treated by a physician in the past 12 months. The Veteran reported flare-ups with bending, lifting, and prolonged sitting over an hour. The examiner was unable to say without mere speculation if pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over time or flare-ups. Flexion was to 80 degrees and extension to 20 degrees. The Veteran was unable to perform repetitive use testing due to his reported pain level. No guarding or muscle spasm, muscle atrophy, radiculopathy, ankylosis, or other neurologic abnormalities were noted. During a December 2017 VA examination, the Veteran reported that his pain was manageable and that he had flare-ups four to six times a month. He denied radiculopathy. Flexion was to 80 degrees. The Veteran was unable to perform extension due to pain and was only able to perform one round of flexion due to pain. Localized tenderness or pain on palpation of the joints or associated soft tissue of the lumbar spine were noted. The examiner was unable to say without mere speculation if pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use or with flare-ups. Muscle spasm and guarding were noted but did not result in abnormal gait or abnormal spinal contour. No muscle atrophy, abnormal sensation, radiculopathy, or ankylosis were noted. Upon review of the record, the Board finds that a disability rating in excess of 10 percent for the Veteran’s DDD of the lumbar spine is not warranted during any time during the period on appeal. To obtain a higher rating for the Veteran’s spine disability, it is necessary to show forward flexion of no greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Here, however, the Veteran’s forward flexion was shown to be no worse than 80 degrees, even when pain on motion was considered, and no abnormal gait, scoliosis, reversed lordosis, or abnormal kyphosis was shown. Further, there is no evidence that the Veteran experienced incapacitating episodes at any time during the periods on appeal. Thus, the Board finds that a higher rating is not warranted for the Veteran’s spine. There is no basis for the assignment of additional disability due to pain, weakness, fatigability, or incoordination. See 38 C.F.R. §§ 4.40 and 4.45 and DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). The December 2010 VA examination shows no loss of motion following repetition. However, during the November 2016 VA examination, the Veteran was unable to perform repetitive motion due to his pain level. He was also unable to perform extension due to pain and was only able to do one round of flexion due to pain during the December 2017 VA examination. In addition, the November 2016 and December 2017 VA examiners were unable to say without mere speculation if pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use or with flare-ups. However, both examinations indicate that the Veteran’s muscle strength was normal and he had no muscle atrophy. Thus, the Board finds that if any functional loss manifested by pain and weakness on movement and additional limited motion after repetitive testing is present, such is contemplated in the 10 percent rating currently assigned. Based on the objective medical evidence of record, there is no basis for the assignment of additional disability due to pain, weakness, fatigability, or incoordination, and the Board finds that the assignment of additional disability pursuant to 38 C.F.R. §§ 4.40 and 4.45 is not warranted. The Board notes that although the Veteran was diagnosed with lumbar radiculopathy in March 2015, the Veteran denied radiculopathy during his December 2017 VA examination. Although the December 2010 VA examination indicates that the Veteran reported no radiation of pain and no radiculopathy in November 2016, he did so during the June 2011 VA examination; however, the Veteran’s deep tendon reflexes and peripheral sensation and pulses were normal. Lastly, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, because the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990) Bilateral Hip Disabilities The Board notes that prior to October 6, 2016, the Veteran’s bilateral hip disabilities were assigned a noncompensable rating under DC 5252-5024. However, after October 6, 2016, the Veteran’s bilateral hip disabilities were assigned a 10 percent rating under DC 5019-5251 on the basis of limitation of extension of the thigh. Under DC 5251, 10 percent is the maximum rating for extension of the thigh limited to 5 degrees. However, the Veteran’s bilateral thigh extension at worst was 15 degrees during his April 2015 VA examination. Thus, a 10 percent rating under DC 5251 is not warranted prior to October 6, 2016. Under DC 5252, a 10 percent rating can be assigned if there is flexion of the thigh limited to 45 degrees. However, a 10 percent rating is not warranted under that diagnostic code prior to October 6, 2016, because the December 2009 and April 2015 VA examination reports show that the Veteran had bilateral flexion of the thigh to 115 degrees, at worst, and the April 2015 VA examination showed normal hip flexor strength. Higher ratings cannot be assigned under other diagnostic codes in 38 C.F.R. § 4.71a pertaining to the hip, because the criteria for them are not alleged or shown to be present. For example, the 2009 VA examination report shows that bilateral thigh abduction was 40 degrees. The 2015 VA examination report shows that bilateral thigh abduction was to 45 degrees and adduction was to 25 degrees. More impairment than this would need to be shown for additional compensation under other diagnostic codes in 38 C.F.R. § 4.71a The Veteran is already in receipt of the maximum rating of 10 percent under DC 5251 after October 6, 2016. Under DC 5252, a 10 percent rating can be assigned if there is thigh flexion limited to 45 degrees. However, a 10 percent rating is not warranted under that diagnostic code after October 6, 2016, because the November 2016 and December 2017 VA examination reports show that the Veteran had bilateral thigh flexion to 100 degrees, at worst, and normal hip flexor strength. Higher ratings cannot be assigned under other diagnostic codes in 38 C.F.R. § 4.71a pertaining to the hip, because the criteria for them are not alleged or shown to be present. For example, the 2016 VA examination report shows that bilateral thigh abduction was 40 degrees and thigh adduction was 20 degrees. The 2017 VA examination report shows that bilateral thigh abduction was to 40 degrees and adduction was to 20 degrees. More impairment than this would need to be shown for additional compensation under other DCs in 38 C.F.R. § 4.71a. There is no evidence of unemployability due to the disabilities at issue. To the contrary, the Veteran was noted as working full time as an analyst for the U.S. Department of Defense for the previous eight years at the time of the 2017 VA examination. In light of the above, the Board concludes that the benefits sought on appeal cannot be granted. The preponderance of the evidence is against the claims and there is no doubt to be resolved. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1991). Right Knee Disability The Veteran’s right knee disability is rated as noncompensable prior to April 13, 2015 and at 10 percent disabling under DC 5260-5024 on the basis of limitation of extension of leg flexion. Turning to the evidence, a December 2009 VA examination showed right knee flexion to 135 degrees and extension to 0 degrees. The Veteran reported right knee discomfort and pain, however no pain on range of motion or loss of motion on repeated use was noted. There was no tenderness, swelling, deformity, ankylosis, or instability noted. The Veteran was diagnosed with right knee bursitis with chondromalacia. In April 2015, the Veteran’s right knee flexion was to 130 degrees and extension to 0 degrees. No pain was noted on examination despite the Veteran’s reports. The examiner noted no additional functional loss or range of motion after repetitive use testing. The examiner was unable to estimate loss of range of motion due to pain, weakness, fatigability, or incoordination during flare ups or when the joint was used repeatedly over a period of time. No crepitus, tenderness, muscle atrophy, ankylosis, previous or current meniscus condition, or instability were noted. The examiner reported that the Veteran’s knee disability had no functional impact. A December 2017 VA examination showed right knee flexion to 130 degrees and extension to 0 degrees. No pain was noted on examination. No crepitus, muscle atrophy, ankylosis, or instability were noted. The examiner noted no additional functional loss or range of motion after repetitive use testing. The examiner was unable to estimate loss of range of motion due to pain, weakness, fatigability, or incoordination during flare ups or when the joint was used repeatedly over a period of time. The Veteran had not missed worked due to his right knee pain. After reviewing the evidence of record, the Board finds that higher ratings under DC 5260 are not warranted for the Veteran’s right knee disability prior to or after April 13, 2015. The evidence demonstrates that flexion, at worst, was limited to 135 degrees prior to April 13, 2015 and 130 degrees thereafter. There is no evidence of extension limited to 10 degrees or more to warrant a compensable rating under DC 5261 prior to or after April 13, 2015. As such, higher ratings under DCs 5260 or 5261 are not warranted for limitation of range of motion of the left knee prior to or after April 13, 2015. The Board has considered whether higher disability ratings are warranted based on functional loss due to pain or weakness, fatigability, incoordination, or pain on movement of a joint. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see also Mitchell, Burton, and DeLuca, supra. However, the ratings for the right knee disability contemplate the effects of any complaints of pain, fatigue, swelling, weakness, or lack of endurance. VA examiners specifically performed repetitive testing and no examiner found additional functional limitation after repeated use over time. In other words, even factoring the effect of pain and repetitive motion, the functional limitation does not more nearly approximate limitation of flexion to 30 degrees to warrant a higher rating. Accordingly, consideration of other factors of functional limitation does not support the grant of higher ratings than already assigned. See 38 C.F.R. §§ 4.40, 4.45; DeLuca, supra. The Board has also considered whether separate or increased ratings may be assigned under other diagnostic codes for the periods on appeal, and finds that the Veteran clearly does not have ankylosis to warrant a separate rating under DC 5256 (ankylosis), and there is no evidence of dislocated cartilage with frequent episodes of locking and effusion, removal of cartilage, extension limited to 5 degrees, malunion of the tibia and fibula, or genu recurvatum to warrant separate ratings under DCs 5257 (instability), 5258 (dislocated cartilage), 5259 (removal of cartilage), 5262 (malunion of the tibia and fibula), or 5263 (genu recurvatum). In light of the above, the Board concludes that the benefits sought on appeal cannot be granted. The preponderance of the evidence is against the claims and there is no doubt to be resolved. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1991). M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Norwood, Associate Counsel