Citation Nr: 18151547 Decision Date: 11/19/18 Archive Date: 11/19/18 DOCKET NO. 14-27 499 DATE: November 19, 2018 ORDER Entitlement to a rating in excess of 20 percent prior to July 12, 2016 for lateral instability for residuals of a right knee injury, status-post meniscectomy and total right knee replacement, with degenerative joint disease (DJD) (right knee disability) under DC 5257 is denied. Entitlement to a rating in excess of 30 percent from September 1, 2017 forward for the service-connected right knee disability under DC 5055 is denied. Entitlement to a separate increased rating of 10 percent from August 13, 2013 to July 30, 2015 and of 30 percent from July 30, 2015 to December 28, 2015 for limited motion under DC 5261 for the service-connected right knee disability is granted. Entitlement to an initial compensable rating for right knee surgical scar is denied. Entitlement to an earlier effective date prior to July 12, 2016 for right knee surgical scar is denied. FINDINGS OF FACT 1. The Veteran’s original right knee 20 percent rating, in effect prior to this present appeal, was more nearly approximated under DC 5257 reflecting a moderate finding of recurrent subluxation or lateral instability. 2. The Veteran’s right knee has not been manifested by severe lateral instability or recurrent subluxation during the appellate period. 3. The Veteran’s right knee disability at worse, was productive of flexion at 90 degrees. 4. From August 13, 2013 to July 30, 2015 the Veteran’s right knee exhibited extension limited to 10 degrees. 5. From July 30, 2015 to December 28, 2015 the Veteran’s right knee exhibited extension limited to 20 degrees. 6. From September 1, 2017, the post-operative residuals of the total right knee replacement have not reflected severe painful motion or weakness. 7. The Veteran’s right knee surgical scar does not involve an area or areas of at least 6 square inches (39 square centimeters), one or more painful scars, or produce other disabling effects. 8. The Veteran was service connected for his right knee surgical scar effective July 12, 2016, the date of the right knee surgery which caused the scar. CONCLUSIONS OF LAW 1. The criteria for an increased rating in excess of 20 percent prior to July 12, 2016 for residuals of a right knee injury, status-post meniscectomy and total right knee replacement, with degenerative joint disease (DJD) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.321, 4.71a Diagnostic Codes 5010, 5257. 2. The criteria for an evaluation in excess of 30 degrees from September 1, 2017 forward for residuals of a right knee injury, status-post meniscectomy and total right knee replacement, with degenerative joint disease (DJD) have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.321, 4.71a Diagnostic Codes 5010, 5055, 5256 -5263. 3. The criteria for a separate 10 percent evaluation from August 13, 2013 to July 30, 2015 and 30 percent evaluation from July 30, 2015 to December 28, 2015 for residuals of a right knee injury, status-post meniscectomy and total right knee replacement, with degenerative joint disease (DJD) have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.321, 4.71a Diagnostic Codes 5010, 5261. 4. The criteria for an initial compensable rating for a right knee surgical scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.3, 4.118, Diagnostic Codes 7801, 7802, 7804, 7805. 5. The criteria for the assignment of an earlier effective date than July 12, 2016, for a right knee surgical scar have not been met. 38 U.S.C. §§ 1155, 5110; 38 C.F.R. §§ 3.155, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1981 to April 1984. Increased Rating VA has adopted a Schedule for Rating Disabilities to evaluate service-connected disabilities. See 38 U.S.C. § 1155; 38 C.F.R., Part IV. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. The evaluation of the same disability or its manifestation under various diagnoses, which is known as pyramiding, is to be avoided. Id. Because the level of disability may have varied over the course of the claim, the rating may be “staged” higher or lower for segments of time during the period under review in accordance with such variations, to the extent they are sufficient to warrant changes in the evaluations assignable under the applicable rating criteria. In evaluating disabilities of the musculoskeletal system, consideration must be given to functional loss, including due to weakness and pain, affecting the normal working movements of the body in terms of excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40. With respect to disabilities of the joints, consideration is given as to whether there is less movement or more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement, as well as swelling, deformity, or atrophy of disuse. 38 C.F.R. § 4.45. The provisions of § 4.40 and § 4.45 thus require a determination of whether a higher rating may be assigned based on functional loss of the affected joint on repeated use as a result of the above factors beyond any limitation reflected on one-time measurements of range of motion. DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). However, a higher rating based on functional loss may not exceed the highest rating available under the applicable diagnostic code(s) pertaining to range of motion. See Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Additionally, with any form of arthritis, painful motion is an important factor of disability. 38 C.F.R. § 4.59. Joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. 1. Entitlement to an increased rating in excess of 20 percent prior to July 12, 2016 and in excess of 30 percent from September 1, 2017 forward for residuals of a right knee injury, status-post meniscectomy and total right knee replacement, with degenerative joint disease (DJD) The Veteran asserts that his right knee disability is more severe than currently rated under the applicable diagnostic criteria. Diagnostic Codes (DCs) relevant to knee disabilities include 5003, 5010, and 5256 through 5263. Under DCs 5003 and 5010, arthritis established by x-ray findings is rated on the basis of limitation of motion of the affected joints. When however, the limited motion of the specific joint or joints involved would be non-compensable under the appropriate diagnostic codes, a 10 percent rating is assigned for each involved major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. 38 C.F.R. § 4.71a. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. DC 5256 provides for a 30 percent rating (and even higher ratings) for ankyloses of a knee in a favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees. Ankylosis is immobility and consolidation of a joint due to disease, injury, surgical procedure. Nix v. Brown, 4 Vet. App. 462, 465 (1993); and Shipwash v. Brown, 8 Vet. App. 218, 221 (1995). Under DC 5257, other knee impairment is evaluated based upon recurrent subluxation and/or lateral instability. This DC provides that a 10 percent disability rating is warranted for slight disability, a 20 percent rating is warranted for moderate disability, and a maximum 30 percent evaluation is warranted for severe disability. 38 C.F.R. § 4.71a. See also Johnson v. Brown, 9 Vet. App. 7, 11 (1996) (holding that DC 5257 is not predicated on loss of range of motion). The words “slight,” “moderate,” and “severe” as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. It should also be noted that use of terminology such as “severe” by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. DC 5258 provides for assignment of a 20 percent rating for dislocation of the semilunar cartilage, with frequent episodes of “locking,” pain, and effusion into the joint. 38 C.F.R. § 4.71a. DC 5259 provides for a 10 percent rating for symptomatic residuals of removal of a semilunar cartilage. Ratings under DC 5259 require consideration of 38 C.F.R. §§ 4.40 and 4.45 because removal of a semilunar cartilage may result in complications producing loss of motion. VAOGCPREC 9-98. DC 5260 pertains to limitation of leg flexion, and provides for a noncompensable rating when flexion is limited to 60 degrees. A 10 percent rating requires flexion limited to 45 degrees; a 20 percent rating requires flexion limited to 30 degrees; and the highest available 30 percent rating requires flexion limited to 15 degrees. Id. DC 5261 provides that limitation of motion of the knee will be assigned a noncompensable rating when extension is limited to 5 degrees. A 10 percent evaluation requires extension limited to 10 degrees; a 20 percent rating requires extension limited to 15 degrees; a 30 percent rating requires extension limited to 20 degrees; a 40 percent rating requires extension limited to 30 degrees; and a maximum 50 percent rating is assigned when extension is limited to 45 degrees. Id. DC 5262 provides for evaluation of impairment of the tibia and fibula. With malunion and slight knee or ankle disability a 10 percent rating is warranted; with moderate knee or ankle disability a 20 percent rating is warranted; and with marked knee or ankle disability a 30 percent rating is warranted. For a 40 percent rating there must be nonunion of the tibia or fibula with loose motion, requiring a brace. DC 5263 provides for a 10 percent rating for genu recurvatum, when acquired, traumatic, with weakness and insecurity in weight-bearing which is objectively demonstrated. Under 38 C.F.R. § 4.71a, DC 5055 a 100 percent total rating is assigned for 1 year following implantation of a prosthesis. Thereafter, a minimum 30 percent rating is assigned. With chronic residuals consisting of severe painful motion or weakness in the affected extremity a 60 percent rating is warranted. With intermediate degrees of residual weakness, pain or limitation of motion, a rating is assigned analogously under DCs 5256 (ankylosis), 5261 (limitation of extension), or 5262 (tibial or fibular impairment). Normal range of motion for the knee is from 0 degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II. Separate disability ratings may be assigned for limitation of knee flexion and of knee extension without violation of the rule against pyramiding (at 38 C.F.R. § 4.14), regardless of whether the limited motions are from the same or different causes. VAOPGCPREC 9-04 (September 17, 2004), 69 Fed. Reg. 59,990 (2004). Moreover, it has been held that a claimant may receive separate disability ratings for arthritis and instability of the knee, under DCs 5003 and 5257, respectively. See VAOPGCPREC 23-97 (July 1, 1997), 62 Fed. Reg. 63,604 (1997). In order for a knee disability rated under DC 5257 to warrant a separate rating for arthritis based on X-ray findings and limitation of motion, limitation of motion under DCs 5260 or 5261 does not have to be compensable, but must meet the criteria for a zero-percent rating. VAOPGCPREC 9-98 (August 14, 1998), 63 Fed. Reg. 56,704 (1998). The Veteran was rated a 20 percent rating prior to July 12, 2016 under DC 5099-5010. From July 12, 2016 to September 1, 2017, the Veteran was in receipt of a 100 percent rating under DC 5055 for knee replacement. Thereafter, the Veteran was granted a 30% rating under the same DC. Careful review of the record reveals confusion as to the basis of the original 20 percent rating for the right knee disability. See February 1998 Rating Decision (noting the Veteran was given a 20 percent rating for malunion of the tibia and fibula with moderate knee or ankle disability); September 2013 Rating Decision (reflecting the 20 percent rating was assigned due to x-ray evidence showing two or more major joints or two or more joint groups with occasional incapacitating exacerbations); June 2014 Statement of the Case (reflecting the 20 percent rating as due to symptomatic residuals of semilunar cartilage removal and extension limited to 10-14 degrees). Further, the diagnostic code for this rating was changed since its original grant in December 1997. See February 1998 Rating Decision (reflecting a DC of 5010-5262); August 2007 Rating Decision (reflecting a DC of 5099-5010). Due to the contradictory evidence, the Board cannot rely on the descriptions provided by the regional office and has done a retrospective look at the evidence of record. The Veteran originally filed an increased rating claim for his right knee in August 1997. The Veteran reported his knee swells, gives out, and sounds like the bones are rubbing together. See August 1997 Medical Record (reflecting the Veteran underwent a right knee arthroscopy in July 1997); November 1997 Report of Medical Examination. He also reported that it is difficult to stand for long periods and he supports his knee with a brace. See November 1997 Report of Medical Examination. The Veteran was given a VA examination in December 1997. The Veteran reported a history of right knee locking, swelling, and unpredictable buckling. The Veteran also reported that while he had a surgery in 1984 for his knee locking, he had a recurrence of knee locking due to a bone spur lodged behind the knee and underwent a bone extraction surgery. See December 1997 VA C&P Examination Report. See generally, July 1997 Operative Report (reflecting the Veteran’s history of right knee recurrent giving way and locking). Further, the record reveals that the lateral meniscus was surgically absent, instead of dislocated (see DC 5258). Id. The examiner noted that the Veteran had crepitus upon manipulation and incomplete extension. The Veteran also had atrophy of the right quadriceps, poor muscle tone, and poor power. The examiner found the Veteran to have a right lateral meniscus tear with residual intermittent pain, swelling, recurrent buckling, and osteoarthritis. After this review, the Board finds that the 20 percent rating in effect prior to this present appeal represented a moderate finding of recurrent subluxation or lateral instability under DC 5257. See 38 C.F.R. § 4.20. Thus, with the clarified diagnostic code, the Board will consider the evidence from this current appeal period to determine whether a higher rating under DC 5257 is warranted, or whether separate ratings are warranted under other diagnostic codes, to include DC 5259, 5260, 5261. The Board will consider the rating in two separate periods, one from the period prior to total knee replacement and the other after the total knee replacement (DC 5055). On VA examination in August 2013, the Veteran was found to exhibit right knee flexion to 80 degrees and extension to 10 degrees, with no change in range of motion testing after repetitive testing and muscle strength as 4/5. There was objective evidence of painful motion on both flexion and extension. The Veteran reported symptoms of swelling, pain, locking up, and giving out. The Veteran exhibited functional loss in terms of pain, less movement than normal, weakened movement, pain on movement, atrophy of disuse, disturbance of locomotion, and interference with sitting, standing, and weightbearing. The Veteran was also reported to use a knee brace on a constant basis and a cane when walking outside the house. A July 2014 medical note reflected the Veteran feels his knee is giving away and was waiting to hear back from an orthopedic specialist. See July 2014 Primary Care Note. A July 2015 Orthopedic Consultation note reflects the Veteran as having an active extension at 20 degrees and a passive extension to -5 degrees. The Veteran was noted to have flexion to 90 degrees and good muscle strength. See July 2015 Orthopedic Consultation note. Another orthopedic medical note found the Veteran to have full range of motion. See December 2015 Orthopedic Surgery Note. On a private evaluation in April 2016, the Veteran complained of his right knee giving way and had right knee range of motion from 0 to 120 degrees. See April 2016 Clinic Note. On his October 2016 VA C&P Examination Report the Veteran was found to exhibit right knee flexion to 110 degrees and extension to 0 degrees, with muscle strength as 4/5. The examiner stated that with repeated use over time, pain, fatigue, and lack of endurance would further limit functional ability. The examiner also noted that the Veteran did not have any joint instability, effusion, recurrent subluxation, or lateral instability. The Veteran’s claim for an increased rating for his right knee was remanded by the Board in August 2016 and April 2018 for new VA examinations. Both Board decisions ordered a new examination to ensure compliance with the U.S. Court of Appeals for Veterans Claims (Court) precedential decision holding that for VA examinations to be adequate for rating musculoskeletal disabilities, they must record range of motion testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of motion of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158, 169-70 (2016) (citing 38 C.F.R. § 4.59 (2016)). The Veteran was scheduled for a VA examination in July 2018 however he did not attend it. See June 2018 VA C&P Examination Report. See also 38 C.F.R. 3.655 (requiring a showing of good cause for failure to appear before a VA examination is rescheduled). The probative evidence of record, including the private and VA medical records and the August 2013 and October 2016 VA examinations, demonstrates that the Veteran’s right knee at worst, is productive of moderate lateral instability. Throughout the record the Veteran has complained of right knee instability which is contemplated by his 20 percent evaluation. However, the Veteran’s medical physicians have not characterized his symptoms as severe. Further, based on the October 2016 VA examination, the Veteran was not found to have any lateral instability or recurrent subluxation. The Board finds that the Veteran’s right knee degenerative disc disease is entitled to a separate rating under DC 5261 for limited extension. The Veteran’s right knee disability warrants a 10 percent rating from August 13, 2013 to July 30, 2015 for extension limited to 10 degrees and a 30 percent rating from July 30, 2015 to December 28, 2015 for extension limited to 20 degrees. See August 2013 VA C&P Examination Report (reflecting extension limited to 10 degrees); July 2015 Orthopedic Consultation Note (reporting extension of 20 degrees); December 2015 Orthopedic Surgery Note (reflecting the Veteran has full range of motion). The Veteran is entitled to a noncompensable rating from December 28, 2015 forward as his medical records show him to have full range of motion of his knee. See December 2015 Orthopedic Surgery Note; April 2016 Clinic Note; October 2016 VA C&P Examination Report. In his August 2013 VA C&P examination, the Veteran asserted that his right knee disability is also productive of locking up. The Board finds that the Veteran is competent and credible to establish the symptoms of his right knee condition. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (holding that a layperson is competent to report a contemporaneous medical diagnosis); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007) (lay testimony is competent as to matters capable of lay observation). However, the Veteran’s medical treatment records do not reflect semilunar cartilage dislocation with complaints or treatments for frequent episodes of locking, pain, and joint effusion. The Board is also cognizant that the Court has clarified that separate ratings can be warranted. Here, with multiple ratings in effect that contemplate the Veteran’s symptoms, the Board finds that the Veteran is not competent to attribute a lay symptom to a specific cause. Therefore, the Board does not find that the Veteran is entitled to a separate rating under Diagnostic Code 5259. Here, the record shows that cartilage has been removed, but the record does not reflect that this aspect of prior surgeries is the cause of separate symptomatology. The Board notes that symptoms associated with the Veteran’s degenerative joint disease, do not necessarily overlap with the painful and limited motion currently rated under DC 5261. See VAOPGCPREC 23-97 (July 1997) and VAOPGCPREC 9- 98, (August 1998) (holding that separate ratings may be assigned for arthritis of the knee with limited motion and instability of the knee and/or cartilage impairment with associated locking and effusion); Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994) (separate ratings are permissible so long as the symptomatology for one condition is not “duplicative or overlapping with the symptomatology” of the other condition). As the Veteran’s arthritic symptoms do not necessarily overlap with his limited motion, a separate rating under DC 5261 does not violate the rule against pyramiding. See 38 C.F.R. § 4.14. Further the Veteran’s right knee has not been diagnosed with ankylosis, non-union of the tibia and fibula, or genu recurvatum, and his right knee limitation has at worse, been reported at 90 degrees. As such, the Veteran which does not warrant a separate or increased rating under DC 5256, 5261, 5262, or 5263. As the Veteran did not attend the July 2018 VA examination, the Board must consider the current rating warranted under DC 5055 based on the evidence of record. There is no VA examination from this period of time. Review of this record, does not reflect that the right knee disability results in severe painful motion or weakness for the period from September 1, 2017 forward or that a rating in excess of 30 percent is warranted by analogy under DC 5256, 5261, or 5262. Under this alternative DC codes, the record does not show that the knee has had ankylosis, significant loss of extension or non-union of the knee with loss motion requiring a brace. Accordingly, the preponderance of the evidence weighs in the Veteran’s favor and the Board finds he is entitled to a separate 10 percent rating from August 13, 2013 to July 30, 2015 and a 30 percent rating from July 30, 2015 to December 28, 2015 under DC 5261. However, the Board finds that a rating in excess of 30 percent after September 1, 2017 is not warranted under any applicable diagnostic code. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 2. Entitlement to an initial compensable rating for right knee surgical scar The Veteran’s right knee scar has been assigned a noncompensable rating under 38 C.F.R. § 4.118, DC 7804. Diagnostic Code 7804 pertains to scars that are unstable or painful. Id. Under DC 7804, a 10 percent rating is assigned for one or two scars that are unstable or painful; a 20 percent rating is assigned for three or four scars that are unstable or painful; a maximum 30 percent rating is assigned for five or more scars that are unstable or painful. Id. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. Note (1). If one or more scars are both unstable and painful, 10 percent is to be added to the evaluation that is based on the total number of unstable or painful scars. Id. Note (2). On July 12, 2016 the Veteran underwent total knee replacement surgery. The October 2016 VA C&P examiner reported that the Veteran had a linear scar measuring 6 cm by 3 cm resulting from that surgery. The scar was not painful or unstable on examination. In addition, the scar was not found to cause any disfigurement or limitation of motion. See October 2016 VA C&P Examination Report. The evidence shows that the Veteran does not have one or two scars that are painful or unstable associated with his right knee. Accordingly, the criteria for a compensable rating percent under DC 7804 is not more nearly approximated. See Id. The Board has considered other potentially applicable diagnostic codes. The evidence of record, shows that the Veteran’s right knee scar does not involve an area or areas of at least 6 square inches (39 square centimeters). Thus, DC 7801, which pertains to scars that are deep and nonlinear, and DC 7802, which pertains to scars that are superficial and nonlinear, do not apply. See 38 C.F.R. § 4.118. The scar does not involve the head, face, or neck. Thus, DC 7800 does not apply. See 38 C.F.R. § 4.118. The evidence does not show any other disabling effects of the Veteran’s scar. Thus, no other diagnostic code is applicable. See 38 C.F.R. § 4.118, DC 7805 (providing that disabling effects of scars not considered in a diagnostic code applicable to scarring (i.e. DC’s 7800, 7801, 7802, and 7804) are to be evaluated under an appropriate diagnostic code). In sum, the preponderance of the evidence shows that the Veteran’s right knee scar has not more nearly approximated the criteria for a compensable or separate rating during the pendency of this claim. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). Therefore, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Effective Date 3. Entitlement to an earlier effective date prior to July 12, 2016 for right knee surgical scar Except as otherwise provided, the effective date of an evaluation and award of 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 later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The effective date of an evaluation and an award of compensation based on a reopened claim is the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(q)(2). If a claim for disability compensation is received within one year after separation from service, the effective date of entitlement is the day following separation or the date entitlement arose. 38 C.F.R. § 3.400 (b)(2). Otherwise, it is the date of receipt of claim or the date entitlement arose, whichever is later. See 38 C.F.R. § 3.400. With respect to the date of claim, a specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid to any individual under VA law. 38 U.S.C. §§ 501, 5101 (2012); 38 C.F.R. § 3.151 (2017). The Veteran contends that he is entitled to the earlier effective date than July 12, 2016 for his right knee scar. See May 2017 Notice of Disagreement. In a January 2017 Rating Decision, the Veteran was granted a non-compensable rating for his right knee scar due to his right knee replacement surgery. See January 2017 Rating Decision. The rating decision noted the effective date for the scar as July 12, 2016, the date of the right knee replacement surgery. See July 2016 Operative Report. Based on the evidence of record, the Board finds that the Veteran is not entitled to an earlier effective date for his right knee surgical scar. The RO granted the Veteran service connection for his right knee surgical scar effective on the date of the right total knee replacement surgery. There is no theory of entitlement that would allow the Veteran to obtain an effective date earlier than the date the injury occurred. Accordingly, as a matter of law, an earlier effective date for service connection for a right knee earlier than July 12, 2016 cannot be established. Brannon v. West, 12 Vet. App. 33, 34-5 (1998). Because the outcome of this issue is determined by the application of law to facts that are not in dispute, the benefit-of-the-doubt rule does not apply. See Sabonis v. West, 6 Vet. App. 426, 430 (1994); see also 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Sinckler, Associate Counsel