Citation Nr: 18147258 Decision Date: 11/05/18 Archive Date: 11/02/18 DOCKET NO. 15-16 575 DATE: November 5, 2018 ORDER Entitlement to a disability rating of 30 percent, but no higher, prior to March 4, 2015, for service-connected degenerative joint disease, right knee, limitation of flexion, is granted. Entitlement to a compensable disability rating from March 4, 2015 to October 10, 2016; entitlement to a disability rating in excess of 40 percent from October 11, 2016 to February 28, 2018; and entitlement to a compensable disability rating since March 1, 2018, for service-connected degenerative joint disease, right knee, limitation of flexion, is denied. Entitlement to a disability rating of 30 percent, but no higher, prior to March 4, 2015, for service-connected degenerative joint disease, left knee, limitation of flexion, is granted. Entitlement to a disability rating in excess of 10 percent from March 4, 2015 to January 27, 2017, and entitlement to a compensable disability rating since January 28, 2017, for service-connected degenerative joint disease, left knee, limitation of flexion, is denied. Entitlement to a disability rating in excess of 10 percent for service-connected degenerative joint disease, right knee, instability, is denied. Entitlement to a disability rating in excess of 10 percent for service-connected degenerative joint disease, left knee, instability, is denied. Entitlement to a disability rating in excess of 30 percent from March 4, 2015 to October 10, 2016, and in excess of 40 percent since October 11, 2016, for service-connected degenerative joint disease, right knee, limitation of extension, is denied. Entitlement to a disability rating in excess of 40 percent since March 4, 2015 for service-connected degenerative joint disease, left knee, limitation of extension, is denied. Entitlement to an effective date earlier than March 4, 2015, for the award of a separate disability rating for service-connected degenerative joint disease, right knee, limitation of extension, is denied. Entitlement to an effective date earlier than March 4, 2015, for the award of a separate disability rating for service-connected degenerative joint disease, left knee, limitation of extension, is denied. FINDINGS OF FACT 1. Prior to March 4, 2015, the most probative evidence establishes that flexion of the Veteran’s right knee was limited to 5 degrees. 2. From March 4, 2015 to October 10, 2016, the most probative evidence establishes that flexion of the Veteran’s right knee was greater than 60 degrees. 3. From October 11, 2016 to February 28, 2018, the Veteran was mistakenly assigned a 40 percent disability rating, in excess of the schedular rating criteria. In a July 2017 rating decision, the Veteran was notified of this clear and unmistakable error. The Board will not disturb this favorable finding. 4. Since March 1, 2018, the most probative evidence establishes that flexion of the Veteran’s right knee has been greater than 60 degrees. 5. Prior to March 4, 2015, the most probative evidence establishes that flexion of the Veteran’s left knee was limited to 5 degrees. 6. From March 4, 2015 to January 27, 2017, the most probative evidence establishes that flexion of the Veteran’s left knee was not limited to 30 degrees or less. 7. Since January 28, 2017, the most probative evidence establishes that flexion of the Veteran’s left knee has been greater than 60 degrees. 8. Throughout the appellate period, the Veteran has experienced slight instability in the right knee. 9. Throughout the appellate period, the Veteran has experienced slight instability in the left knee. 10. From March 4, 2015 to October 10, 2016, the most probative evidence establishes that extension of the Veteran’s right knee was limited to 20 degrees. 11. Since October 11, 2016, the most probative evidence establishes that extension of the Veteran’s right knee was limited to 30 degrees. 12. Since March 4, 2015, the most probative evidence establishes that extension of the Veteran’s left knee was limited to 40 degrees. 13. The Veteran’s service-connected degenerative joint disease, right knee, did not increase in severity sufficient to warrant a separate compensable rating for limitation of extension until March 4, 2015. 14. The Veteran’s service-connected degenerative joint disease, left knee, did not increase in severity sufficient to warrant a separate compensable rating for limitation of extension until March 4, 2015. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating of 30 percent, but no higher, prior to March 4, 2015, for service-connected degenerative joint disease, right knee, limitation of flexion, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Code 5260. 2. The criteria for entitlement to a compensable disability rating from March 4, 2015 to October 10, 2016; a disability rating in excess of 40 percent from October 11, 2016 to February 28, 2018; and a compensable disability rating since March 1, 2018, for service-connected degenerative joint disease, right knee, limitation of flexion, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Code 5260. 3. The criteria for entitlement to a disability rating of 30 percent, but no higher, prior to March 4, 2015, for service-connected degenerative joint disease, left knee, limitation of flexion, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Code 5260. 4. The criteria for entitlement to a disability rating in excess of 10 percent from March 4, 2015 to January 27, 2017, and a compensable rating since January 28, 2017, for service-connected degenerative joint disease, left knee, limitation of flexion, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Code 5260. 5. Throughout the appellate period, the criteria for entitlement to a disability rating in excess of 10 percent for service-connected degenerative joint disease, right knee, instability, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Code 5257. 6. Throughout the appellate period, the criteria for entitlement to a disability rating in excess of 10 percent for service-connected degenerative joint disease, left knee, instability, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Code 5257. 7. The criteria for entitlement to a disability rating in excess of 30 percent from March 4, 2015 to October 10, 2016, and in excess of 40 percent since October 11, 2016, for service-connected degenerative joint disease, right knee, limitation of extension, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Code 5261. 8. The criteria for entitlement to a disability rating in excess of 40 percent since March 4, 2015 for service-connected degenerative joint disease, left knee, limitation of extension, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Code 5261. 9. The criteria for entitlement to an effective date earlier than March 4, 2015 for the award of a separate compensable rating for service-connected degenerative joint disease, right knee, limitation of extension, have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(o). 10. The criteria for entitlement to an effective date earlier than March 4, 2015 for the award of a separate compensable rating for service-connected degenerative joint disease, left knee, limitation of extension, have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(o). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1968 to August 1970, from December 1990 to April 1991, and from August 1993 to December 1994, as well as over 20 years of inactive service. These matters come before the Board of Veterans’ Appeals on appeal from an October 2014 rating decision issued by a Regional Office (RO) of the United States Department of Veterans Affairs (VA). In November 2016, the Veteran testified before the undersigned Veterans Law Judge at a Travel Board hearing. A copy of the hearing transcript has been associated with the electronic claims file. The Veteran has waived initial RO consideration of evidence received since the January 2016 Supplemental Statement of the Case. See August 10 and September 6, 2018 correspondence; see also 38 C.F.R. § 20.1304(c). Neither the Veteran nor his representative has raised any issues with the duty to notify, the duty to assist, or the conduct of his Board hearing as to the duties discussed in Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); See also Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Thus, the Board need not discuss any potential issues in this regard. The regulations pertinent to this decision were most recently provided to the Veteran in the March 2015 and August 2015 Statements of the Case, as well as the January 2016 Supplemental Statement of the Case. Since the Veteran has had adequate notice of the pertinent laws governing this appeal, they will not be repeated here unless deemed appropriate to do so by the Board. The Veteran’s rating codesheet appears to have a clerical error with regard to some of the staged ratings assigned for bilateral knee extension and flexion. Specifically, the stages that are labeled as beginning on March 31, 2015 on the codesheet should be modified to reflect to correct effective date of March 4, 2015. See March 2015 rating decision. Accordingly, this clerical error is REFERRED to the RO for corrective action. 38 C.F.R. § 19.9(b). Increased Rating Claims The Veteran seeks higher disability ratings for his service-connected degenerative joint disease of the bilateral knees. As an initial matter, the evidence unequivocally demonstrates that the Veteran has never experienced ankylosis; dislocation or removal of the semilunar cartilage; impairment of the tibia and fibula; or genu recurvatum in either knee. Thus, he is ineligible for ratings under the corresponding Diagnostic Codes of 5256, 5258, 5259, 5262, and 5263 throughout the appellate period. See 38 C.F.R. § 4.71a. The Board shall now examine whether the Veteran is eligible for disability ratings higher than those currently assessed for his bilateral knees within the appellate period. 1. Increased ratings for right knee limitation of flexion The Veteran has been in receipt of a 20 percent rating prior to March 4, 2015, a noncompensable rating from March 4, 2015 to October 10, 2016, a 40 percent rating from October 11, 2016 to February 28, 2018, and a noncompensable rating since March 1, 2018 for service-connected degenerative joint disease, right knee, limitation of flexion. He seeks a higher disability rating for all stages. A. Prior to March 4, 2015 At the time of the October 2014 rating decision, the Veteran’s right knee limitation of flexion had been rated as 20 percent disabling since 2008. The RO denied a higher rating. To warrant a higher disability rating, the evidence must demonstrate right knee flexion limited to 15 degrees or less. At the June 2014 VA examination, the VA examiner documented right knee flexion ending at 70 degrees; however, there was evidence of painful motion at 5 degrees. Painful motion can equate to limitation of motion. See VAOPGCPREC 9-98 (“Under section 4.59, painful motion is considered limited motion even though a range of motion is possible beyond the point when pain sets in.”) (citing Hicks v Brown, 8 Vet. App. 417, 421 (1995)). Resolving reasonable doubt in the Veteran’s favor, and utilizing the point where painful motion began as indicative of his limitation of flexion, the Board finds that June 2014 VA examination findings demonstrate right knee flexion limited to 5 degrees, sufficient to warrant a higher disability rating of 30 percent prior to March 4, 2015. The Veteran contends that the June 2014 VA examiner hyperflexed his right knee to 70 degrees disregarding the Veteran’s request to stop range of motion testing due to severe pain. The Veteran indicated that the examiner’s actions caused him to suffer residual right knee pain for days after the examination. The Board regrets the Veteran’s negative experience with the June 2014 VA examiner. These credible lay assertions further support the Board’s assignment of a disability rating based on where painful motion began during right knee flexion testing at the June 2014 VA examination, which has resulted in an award of the highest schedular rating available under Diagnostic Code 5260, prior to March 4, 2015. Given this favorable finding, the Board concludes there is no prejudice to the Veteran in relying on the June 2014 VA examination results. For the period on appeal prior to March 4, 2015, the Board shall grant a higher disability rating of 30 percent under Diagnostic Code 5260, 38 C.F.R. § 4.71a for right knee limitation of flexion. To this extent, the Veteran’s appeal is granted. B. From March 4, 2015 to October 10, 2016 In a March 2015 rating decision, the Veteran’s disability rating for right knee flexion was reduced to a noncompensable rating, effective March 4, 2015. The Veteran did not challenge the propriety of this reduction by filing a notice of disagreement within one year of the rating decision’s mailing. Thus, the only issue before the Board is whether the Veteran is entitled to a higher disability rating during the staged period of March 4, 2015 to October 10, 2016. At the March 4, 2015 VA examination, range of motion testing was conducted. The examiner noted that right knee flexion ended at 110 degrees and that painful motion began at 85 degrees. Repetitive use testing was not conducted due to the Veteran’s subjective reports of pain. The examiner further opined that factors such as pain, weakness, fatiguability, and/or incoordination due to flare ups or repeated use over time would result in flexion limited to 55 degrees in the right knee. Under Diagnostic Code 5260, knee flexion limited to 45 degrees must be shown to warrant a compensable 10 percent disability rating. The results of the March 4, 2015 VA examination do not show limitation of right knee flexion of such a severity to warrant a higher disability rating during the staged period, even accepting the reported limitations following repetitive use. Under Diagnostic Code 5003, a compensable 10 percent disability rating may be warranted where there is x-ray evidence of arthritis, evidence of swelling, muscle spasm, or painful motion, and limitation of motion is otherwise noncompensable under the appropriate diagnostic codes. While the Veteran experienced painful motion in the right knee and did not demonstrate compensable limitation of flexion in the right knee during this staged period, he is ineligible for a compensable disability rating under Diagnostic Code 5003 because he is already in receipt of a compensable disability rating for limitation of extension of the right knee from March 4, 2015 to October 10, 2016. The provisions of Diagnostic Code 5003 would apply only where the limitation of motion shown is not compensable under the appropriate diagnostic codes; here, he has compensable limitation of extension. The Board finds no other objective medical evidence in the appellate record documenting range of motion findings from March 4, 2015 to October 10, 2016 sufficient to warrant a higher compensable disability rating for right knee flexion. Accordingly, the Veteran’s appeal is denied. C. From October 11, 2016 to March 1, 2018 In a February 2017 rating decision, the RO increased the Veteran’s right knee flexion rating to 40 percent, effective on October 11, 2016—the date the Veteran filed an application seeking entitlement to a total disability rating based on individual unemployability (TDIU), which the RO interpreted as a request for an increase. The RO mistakenly awarded the increased rating for right knee flexion based on range of motion findings regarding right knee extension, as obtained at a January 2017 VA examination. In July 2017, the RO recognized its mistake and issued a rating decision finding clear and unmistakable error in the February 2017 rating decision’s assignment of a 40 percent evaluation for right knee flexion. While the Board will not disturb the 40 percent rating for right knee flexion that was in effect from October 11, 2016 to March 1, 2018, this rating is in excess of the highest schedular rating (30 percent) authorized under Diagnostic Code 5260, 38 C.F.R. § 4.71a. Moreover, the results of the January 2017 VA examination demonstrate that the Veteran’s right knee flexion, including painful motion, ended at 80 degrees, which would typically warrant a noncompensable disability rating. In August 2017, the Veteran submitted a disability benefits questionnaire completed by physician, J.C.E., assessing his bilateral knees. There is no indication on the questionnaire that J.C.E. has treated the Veteran, is familiar with the Veteran’s medical history, or reviewed the Veteran’s past medical records. There is no mention of J.C.E. or other outside medical care for the Veteran’s knees anywhere in the Veteran’s VA treatment records. The Veteran did not identify J.C.E. as a medical provider for his knees in response to any of the VCAA letters and never provided a signed VA Form 4142 requesting and authorizing VA to obtain medical records from J.C.E. on his behalf. Despite these evidentiary concerns, the range of motion test results listed in the questionnaire document right knee flexion limited to 110 degrees, well above the threshold necessary for a compensable disability rating. In light of the above, there is no basis upon which to award a higher rating under Diagnostic Code 5260 for right knee limitation of flexion during this timeframe and the Veteran’s appeal is denied. D. Since March 1, 2018 In the July 2017 rating decision, the RO proposed to reduce the Veteran’s disability rating to a noncompensable rating in light of the clear and unmistakable error issued in the February 2017 rating decision. A December 2017 rating decision effectuated the reduction proposed in the July 2017 rating decision, effective March 1, 2018. Review of the record shows that there is no objective medical evidence since March 1, 2018 documenting compensable limitation of flexion in the right knee. As the Veteran is already in receipt of a compensable disability rating for right knee limitation of extension during this timeframe, the Veteran is not entitled to a compensable rating under Diagnostic Code 5003. See discussion supra. Having failed to establish entitlement to a compensable disability rating for right knee limitation of flexion since March 1, 2018, the Veteran’s appeal is denied. 2. Increased ratings for left knee limitation of flexion The Veteran has been in receipt of a 20 percent rating prior to March 4, 2015, a 10 percent rating from March 4, 2015 to January 27, 2017, and a noncompensable rating since January 28, 2017 for service-connected degenerative joint disease, left knee, limitation of flexion. He seeks a higher disability rating for all stages. A. Prior to March 4, 2015 At the time of October 2014 rating decision, the Veteran’s left knee limitation of flexion had been rated at 20 percent since 2008. The RO denied a higher disability rating. To warrant a higher disability rating, the evidence must demonstrate left knee flexion limited to 15 degrees of less. At the June 2014 VA examination, the VA examiner documented left knee flexion ending at 95 degrees; however, there was evidence of painful motion at 5 degrees. Painful motion can equate to limitation of motion. See VAOPGCPREC 9-98 (“Under section 4.59, painful motion is considered limited motion even though a range of motion is possible beyond the point when pain sets in.”) (citing Hicks, 8 Vet. App. at 421). Resolving reasonable doubt in the Veteran’s favor, and utilizing the point where painful motion began as indicative of his limitation of flexion, the Board finds that June 2014 VA examination findings demonstrate left knee flexion limited to 5 degrees, sufficient to warrant a higher disability rating of 30 percent prior to March 4, 2015. Again, the Board acknowledges the Veteran’s contentions that the June 2014 VA examiner hyperflexed his left knee during flexion testing while ignoring his reports of severe pain. However, given that the examiner noted that left knee pain began at 5 degrees, sufficient to warrant the highest schedular rating available prior to March 4, 2015, there is no prejudice to the Veteran in relying upon the June 2014 VA examination results. For the period on appeal prior to March 4, 2015, the Board shall grant a higher disability rating of 30 percent under Diagnostic Code 5260, 38 C.F.R. § 4.71a for right knee limitation of flexion. To this extent, the Veteran’s appeal is granted. B. From March 4, 2015 to January 27, 2017 In a March 2015 rating decision, the Veteran’s disability rating for left knee limitation of flexion was reduced to a 10 percent rating, effective March 4, 2015. The Veteran did not challenge the propriety of this reduction by filing a notice of disagreement within one year of the rating decision’s mailing. Thus, the issue currently before the Board is whether the Veteran is entitled to a higher disability rating during the staged period of March 4, 2015 to January 27, 2017 for left knee limitation of flexion. At the March 4, 2015 VA examination, range of motion testing was conducted. The examiner noted that left knee flexion ended at 95 degrees and that painful motion began at 80 degrees. Repetitive use testing was not conducted due to the Veteran’s subjective reports of pain. The examiner further opined that factors such as pain, weakness, fatiguability, and/or incoordination due to flare ups or repeated use over time would result in flexion limited to 45 degrees in the left knee. Under Diagnostic Code 5260, knee flexion limited to 30 degrees or less must be shown to warrant a disability rating higher than the currently assessed 10 percent evaluation. The results of the March 4, 2015 VA examination do not show limitation of left knee flexion of such a severity to warrant a higher disability rating. VA treatment records during this time frame simply list the Veteran’s knees as a continuing active problem and indicate that the Veteran’s pain was stable and he was experiencing no falls. These records do not provide any meaningful information in evaluating the Veteran’s disability rating under the rating criteria in Diagnostic Code 5260. As the evidence between March 4, 2015 and January 27, 2017 fails to demonstrate left knee flexion limited to 30 degrees or less, the Veteran’s appeal for a disability rating in excess of 10 percent for left knee flexion during this timeframe must be denied. C. Since January 28, 2017 In a February 2017 rating decision, the RO reduced the Veteran’s disability for left knee flexion from 10 percent to noncompensable, effective the date of the January 28, 2017 VA examination. Range of motion testing at this VA examination demonstrated that left knee flexion, including painful motion, was limited to 85 degrees, which would warrant a noncompensable rating. VA treatment records since January 28, 2017 do not contain range of motion findings and are of little relevance in evaluating whether the Veteran has experienced compensable limitation of left knee flexion since January 28, 2017. The Veteran is not eligible for a 10 percent disability rating under Diagnostic Code 5003 because he is already in receipt of a compensable rating for limitation of motion (extension) in the left knee during this time frame. The Board has also considered the August 2017 disability benefits questionnaire completed by J.E.C. which documented left knee flexion limited to 120 degrees, well above the threshold necessary for a compensable disability rating. In light of the above, there is no basis upon which to award a higher rating under Diagnostic Code 5260 for left knee limitation of flexion during this timeframe and the Veteran’s appeal is denied. 3. Increased ratings for bilateral knee instability In the October 2014 rating decision, the RO denied disability ratings in excess of 10 percent for each knee under Diagnostic Code 5257, 38 C.F.R. § 4.71a. The Veteran seeks a higher disability rating under this diagnostic code for each knee. Diagnostic Code 5257 provides for 10, 20, or 30 percent ratings for recurrent subluxation or lateral instability that is, respectively, “slight,” “moderate,” or “severe.” The words “slight,” “moderate,” and “severe,” as used in Diagnostic Code 5257 are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence for “equitable and just decisions.” 38 C.F.R. § 4.6. Here, the Veteran has been assigned a 10 percent rating for each knee due to slight instability throughout the appellate period. At the November 2016 Board hearing, the Veteran testified that he has experienced consistent bilateral knee instability for several years, and the frequency and severity of his subjectively perceived instability has worsened over the years. He testified that his left knee was worse than his right knee with respect to instability. He further indicated that he had fallen three times in the last month and a half due to the bilateral knee instability. Regarding competency of the Veteran’s testimony, he is competent to generally describe experiences of falling, or knees buckling, as these are within the Veteran’s realm of personal knowledge. However, feeling unstable and having lateral instability or recurrent subluxation of the knee are not the same thing. Lateral instability and recurrent subluxation of the knee can be observed and quantified by testing, such as varus/valgus, posterior drawer, or Lachman testing. Furthermore, the medical evidence of records calls into question the credibility of the Veteran’s testimony, as VA treatment records throughout the appellate period consistently document “no falls.” For these reasons, the Veteran’s lay reports of bilateral knee instability have been afforded minimal evidentiary weight in this determination.   At the June 2014 VA examination, anterior, posterior, and medial-lateral instability testing was normal. These objective findings documenting normal joint stability do not demonstrate moderate or severe instability sufficient to warrant an evaluation higher than the Veteran’s current 10 percent disability rating. At the March 2015 and January 2017 VA examinations, joint stability testing was not conducted due to the Veteran’s subjective complaints of pain. This fact neither weighs in favor or against the Veteran’s request for an increased rating; however, it is noteworthy that both VA examiners found that the Veteran did not use assistive devices, such as knee bracing, a cane, a walker, or crutches. As discussed above, it is unclear of the context in which the August 2017 disability benefits questionnaire was procured. Evidentiary issues aside, even if the Board were to view the results of this disability questionnaire in the light most favorable to the Veteran, the documented joint stability testing results noted a history of slight recurrent subluxation (not elsewhere supported in the record), no evidence of a history of lateral instability, and no presence of current joint instability (although the boxes used to assess anterior, posterior, and medial-lateral instability were not completed). These findings, if valid, would not support a rating higher than the Veteran’s currently assessed 10 percent disability rating. The Veteran’s VA treatment records for the period on appeal consistently indicate that the Veteran’s bilateral knee pain is “stable” and that the Veteran has not experienced falls. See February 2015, May 2016, July 2017, January 2018 VA treatment records. There are no VA examination findings or VA treatment records within the appellate period affirmatively establishing the presence of clinically diagnosable recurrent subluxation or lateral instability, as set forth in Diagnostic Code 5257. Given that the Veteran’s VA treatment records consistently report that the Veteran has not experienced falls during the appellate period, the lack of an affirmative diagnosis of lateral instability or recurrent subluxation within the appellate period, and the fact that the Veteran does not require assistive devices to stabilize his knee joints, the Board cannot find that the Veteran experienced moderate or severe recurrent subluxation or lateral instability during the appellate period to support a higher disability rating than the current 10 percent evaluation for each knee. To this end, the Veteran’s appeal must be denied. 4. Increased ratings for right knee limitation of extension The Veteran is currently in receipt of a 30 percent rating from March 4, 2015 to October 10, 2016, and a 40 percent rating since October 11, 2016, for right knee limitation of extension under Diagnostic Code 5261, 38 C.F.R. § 4.71a. See discussion regarding effective date, infra. The Veteran seeks a higher disability rating. For the period of March 4, 2015 to October 10, 2016, the evidence must establish right knee extension limited to 30 degrees or greater to warrant a disability rating higher than his currently assessed 30 percent evaluation. Since October 11, 2016, the evidence must establish right knee extension limited to 45 degrees or greater to warrant a disability rating higher than his currently assessed 40 percent evaluation. At the March 4, 2015 VA examination, the Veteran’s right knee extension was limited to 20 degrees, and painful motion began at 20 degrees. Repetitive use testing was not completed due to the Veteran’s reports of pain. The examiner noted that the Veteran experienced additional functional loss due to pain in his right knee; however, this additional limitation of motion was attributed to flexion, not extension. As the Veteran’s right knee extension was not limited to 30 degrees or greater, this examination does not support a disability rating higher than the Veteran’s current 30 percent during the applicable period. Furthermore, the appellate record is devoid of any other medical evidence establishing right knee limitation of extension sufficient to warrant higher rating during the period of March 4, 2015 to October 10, 2016. The Veteran was afforded another VA examination in January 2017 to assess the severity of his service-connected knee disabilities. The examiner noted right knee extension limited to 30 degrees. While the examiner noted that range of motion testing exhibited pain (and pain during flare ups), it did not result in any additional limitation of extension in the right knee. Repetitive use testing was not conducted due to the Veteran’s reports of pain. Applying this range of motion finding to the schedular criteria in Diagnostic Code 5261, limitation of knee extension to 30 degrees warrants a 40 percent disability. This examination did not contain objective evidence establishing that the Veteran’s right knee extension was limited to 45 degrees sufficient to warrant a higher 50 percent disability rating. Based on the January 2017 VA examination results the RO assigned a 40 percent disability rating effective October 11, 2016, the date that the Veteran filed a formal application seeking entitlement to a TDIU, which the RO treated as a request for an increased disability rating. Since October 11, 2016, the appellate record is devoid of competent medical evidence establishing that the Veteran experienced right knee extension limited to 45 degrees to warrant a higher 50 percent disability rating. Likewise, at no time prior to October 11, 2016 did the objective medical evidence contain range of motion findings showing right knee extension limited 30 degrees or greater sufficient to warrant a 40 percent disability rating. In August 2017, the Veteran submitted a disability benefits questionnaire completed by physician J.C.E. who documented that the Veteran’s right knee extension ended at 0 degrees (no limitation of extension). Evidentiary issues aside, even if the Board were to view the results of this disability questionnaire in the light most favorable to the Veteran, the documented range of motion findings would not result in a higher 50 percent rating for limitation of right knee extension. Regarding VA treatment records, this evidence fails to contain range of motion evidence documenting right knee extension limited to 30 degrees or greater from March 4, 2015 to October 10, 2016, or right knee extension limited to 45 degrees or greater since October 11, 2016 to warrant higher disability ratings for these discrete time periods. For these reasons, the Veteran’s request for a disability rating higher than the currently assessed 30 percent evaluation prior to October 11, 2016, and 40 percent evaluation thereafter, for right knee limitation of extension is denied.   5. Increased ratings for left knee limitation of extension The Veteran is currently in receipt of a 40 percent disability rating for limitation of extension in the left knee, effective March 4, 2015. See 38 C.F.R. § 4.71a; Diagnostic Code 5261; see also discussion regarding effective date, infra. The Veteran seeks a higher disability rating. To warrant a higher disability rating of 50 percent, the evidence must demonstrate extension limited to 45 degrees or greater. At the March 4, 2015 VA examination, the Veteran exhibited left knee extension limited to 30 degrees, and painful motion began at 30 degrees of extension. The Veteran was unable to perform repetitive use testing due to pain, and he asked that his knee not be extended fully. Relevant to this analysis, the examiner found that the Veteran exhibited functional impairment characterized by less movement than normal, weakened movement, and pain on movement. However, any additional limitation of motion as a result of pain or flare ups was attributed to reduced flexion, not extension. The results of the March 4, 2015 VA examination simply do not contain range of motion findings sufficient to substantiate a higher 50 percent evaluation under Diagnostic Code 5261, 38 C.F.R. § 4.71a. The Veteran was afforded another VA examination in January 2017, where extension was limited to 40 degrees. The examiner noted that the Veteran exhibited pain during extension testing; however, the examiner found that this pain (and pain during flare ups) did not result in any additional limitations of extension in the left knee. Repetitive use testing was not conducted due to the Veteran’s reports of pain. Applying these range of motion findings to the schedular criteria in Diagnostic Code 5261, limitation of knee extension to 40 degrees warrants a 40 percent disability rating. As the Veteran’s left knee did not exhibit extension limited to 45 degrees during this VA examination, a higher 50 percent disability rating is not warranted. In August 2017, the Veteran submitted a disability benefits questionnaire completed by physician J.C.E. who documented that the Veteran’s left knee extension ended at 0 degrees (no limitation of extension). Evidentiary issues aside, even if the Board were to view the results of this disability questionnaire in the light most favorable to the Veteran, the documented range of motion findings would not result in a higher 50 percent rating for limitation of left knee extension. Additionally, the Veteran’s VA treatment records throughout the appellate period fail to document range of motion findings exhibiting left knee extension limited to 45 degrees or greater, sufficient to warrant a higher 50 percent disability rating. For these reasons, the Veteran’s request for a disability rating higher than the currently assessed 40 percent evaluation for left knee limitation of extension is denied for the entire appellate period. 6. Additional considerations In evaluating the Veteran’s increased rating claims, particularly those seeking higher ratings for bilateral knee limitation of flexion and extension, the Board has considered the various lay statements of record, including the Veteran’s November 2016 hearing testimony, where the Veteran subjectively reported pain, limitation of motion, and physical deficits in his bilateral knees. The Board finds these statements to be credible and competent to the extent that they relay the Veteran’s own experiences and personal observations. Layno v. Brown, 6 Vet. App. 465 (1994). However, the Veteran is not competent to opine on the severity of complex musculoskeletal or orthopedic conditions or detailed range of motion findings, as these issues require medical expertise to appropriately evaluate. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Since determining the degree of the Veteran’s impairment hinges on evaluation of the clinically significant symptoms and objectively measurable criteria under the rating schedule (such as range of motion testing verified by goniometer measurements), the Board affords greater evidentiary weight to the contemporaneous medical records and objective examinations by competent medical professionals over the non-competent subjective lay statements offered by the Veteran. The Board further finds that there is no basis for the assignment of ratings in excess of those upheld or awarded herein based on consideration of any of the factors addressed in 38 C.F.R. §§ 4.40, 4.45 and DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). The Court has held that “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). 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. To the extent that the Veteran has experienced functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness, these symptoms have been fully contemplated by the Veteran’s assigned ratings as discussed in the analysis above. Earlier Effective Date Claims At the outset, the Board acknowledges that the August 2015 Statement of the Case and the January 2016 Supplemental Statement of the Case indicate that the Veteran seeks an earlier effective date for the reduction of the bilateral knee limitation of flexion ratings as set forth in the March 2015 rating decision. This is unmistakably an administrative error, as it is nonsensical that the Veteran would request his rating to be reduced earlier than the date assigned in the rating decision. Accordingly, the Board will disregard these issues, as their certification to the Board was clearly an administrative error. In the March 2015 rating decision, the RO granted separate ratings for bilateral knee limitation of extension and assigned an effective date of March 4, 2015. In a notice of disagreement received in May 2015, the Veteran challenged the effective date of his assigned ratings for bilateral knee limitation of extension. He argued that these rating should be assigned an effective date of February 6, 2008. It is clear, then, that this was the issue he meant to pursue, not the one as phrased by the RO. See also Board hearing transcript. In general, except as otherwise provided, the effective date of an evaluation an award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. The effective date of an award of increased disability compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if application is received within one year from such date; otherwise, the effective date will be the date of VA receipt of the claim for increase, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a), (b)(2); 38 C.F.R. § 3.400(o); Harper v. Brown, 10 Vet. App. 125 (1997). After a comprehensive review of the appellate record, the Board finds that the Veteran first experienced compensable limitation of extension in the bilateral knees at the March 4, 2015 VA examination. Evidence within the appellate period and prior to March 4, 2015 failed to demonstrate that the Veteran experienced compensable limitation of extension in either knee under Diagnostic Code 5261, 38 C.F.R. § 4.71a. VA outpatient treatment records from the start of the appellate period through March 4, 2015 do not contain range of motion findings or other competent evidence demonstrating that the Veteran experienced limitation of extension in the bilateral knees to warrant a compensable rating. In fact, VA treatment records dated in July 2014 and February 2015 indicate that the Veteran exhibited “good ROM in …lower extremities,” with no suggestion the Veteran’s extension was limited. At the June 2014 VA examination, the Veteran’s right and left knee extension ended at 0 degrees (demonstrating no limitation of extension) without painful motion. At the November 2016 hearing, the Veteran testified that his limitation of extension in the bilateral knees began approximately 6 or 7 years prior to the hearing, i.e., earlier than March 4, 2015. The Veteran is competent to describe his observable symptoms, including bilateral knee pain and knee joint limitations. Layno, 6 Vet. App. at 470. However, the Veteran is not competent to provide detailed range of motion findings as measured by a goniometer or to assess the severity of a complex musculoskeletal or orthopedic condition. See Jandreau, 492 F.3d at 1377. Moreover, the competent objective medical evidence of record, documenting normal bilateral knee extension during the time frame described by the Veteran, is afforded more probative weight than the Veteran’s non-competent lay assertions. In sum, the Board finds that the RO correctly assigned an effective date of March 4, 2015 for the award of separate compensable ratings for limitation of extension in the bilateral knees, as the Veteran did not experience compensable limitation of extension in either knee within the criteria under Diagnostic Code 5261, 38 C.F.R. § 4.71a, at any time during the appellate period prior to March 4, 2015. To this end, the Veteran’s appeal for an effective date earlier than March 4, 2015 for the assignment of separate ratings for limitation of extension in the bilateral knees is denied. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Galante, Associate Counsel