Citation Nr: 18150206
Decision Date: 11/14/18	Archive Date: 11/14/18

DOCKET NO. 16-10 094
DATE:	November 14, 2018
ORDER
A rating in excess of 30 percent for status post total right knee replacement, effective July 1, 2012 is denied.
FINDING OF FACT
During the period on appeal, the Veteran’s status post total right knee replacement has been characterized by no more than range of motion measurements including flexion from 0 to 115 degrees, extension from 115 to 0 degrees, no joint instability, and intermediate pain and stiffness. 
CONCLUSION OF LAW
The criteria for a rating more than 30 percent, since July 1, 2012, for status post total right knee replacement have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.10, 4.14, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5055, 5260 (2017).
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran had active duty service from July 1975 to August 1979. 
A rating more than 30 percent for status post total right knee replacement, effective July 1, 2012
Disability evaluations are determined by comparing the Veteran’s current symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155 (West 2014); 38 C.F.R. Part 4 (2017). 
Diagnostic Code 5055 provides the rating criteria for a prosthetic replacement of a knee joint. A 100 percent rating is warranted for one year following implantation of the prosthesis. (The one-year total rating commences after a one-month convalescent rating under 38 C.F.R. § 4.30). Thereafter, chronic residuals consisting of severe painful motion or weakness in the affected extremity warrant a 60 percent rating. Intermediate degrees of residual weakness, pain, or limitation of motion are rated by analogy to Diagnostic Codes 5256, 5260, 5261, or 5262. The minimum rating following replacement of a knee joint is 30 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5055 (2017). 
Diagnostic Code 5260 provides ratings based on limitation of flexion of the leg. Limitation of flexion to 60 degrees warrants a noncompensable rating. Limitation of flexion to 45 degrees warrants a 10 percent rating. Flexion limited to 30 degrees warrants a 20 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5260 (2017). 
Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59.
Where there is a question as to which of two disability evaluations should be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. 
The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided. Separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of, or overlapping with, the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). 
In a June 2011 post-operative assessment, the Veteran was noted to have right knee flexion from 0 to between 90 and 99 degrees. 
In an August 2012 lay statement, the Veteran reported that he had continued right knee pain, has trouble sleeping, and can’t walk more than a mile without a cane. 
In November 2015, the Veteran was afforded a VA examination. The examiner noted a previous right knee total arthroplasty. Upon examination, the Veteran’s range of motion measurements included flexion from 0 to 115 degrees and extension from 115 to 0 degrees. The examiner also noted intermediate residual weakness, pain, and stiffness. The Veteran reported that sometimes his knees “give out,” however, the examiner performed stability testing and concluded that the Veteran had no right knee instability. 
During the period on appeal, the Veteran’s status-post total right knee replacement has been characterized by no more than range of motion measurements including flexion from 0 to 115 degrees, extension from 115 to 0 degrees, no joint instability, and intermediate pain and stiffness. 
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The preponderance of the evidence is against the claim for a higher rating under Diagnostic Code 5055. A 60 percent rating is not warranted under Diagnostic Code 5055 because the Veteran is not experiencing severe painful motion. 
 
Vito A. Clementi
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Joshua Wozniak