Citation Nr: 18152342 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 15-45 954 DATE: November 21, 2018 ORDER A rating in excess of 10 percent for degenerative arthritis of the left knee is denied. A rating in excess of 10 percent for degenerative arthritis of the right knee is denied. FINDINGS OF FACT 1. For the entire appeal period, the Veteran’s degenerative arthritis of the left knee was manifested by flexion limited to no more than 135 degrees and extension limited to no more than zero degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, lateral instability or recurrent subluxation, removal or dislocation of semilunar cartilage, impairment of the tibia or fibula, or genu recurvatum. 2. For the entire appeal period, the Veteran’s degenerative arthritis of the right knee was manifested by flexion limited to no more than 135 degrees and extension limited to no more than zero degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, lateral instability or recurrent subluxation, removal or dislocation of semilunar cartilage, impairment of the tibia or fibula, or genu recurvatum. CONCLUSIONS OF LAW 1. The criteria for rating in excess of 10 percent for degenerative arthritis of the left knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5003-5260. 2. The criteria for rating in excess of 10 percent degenerative arthritis of the right knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5003-5260. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1997 to June 2001. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. In July 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. 1. Entitlement to a rating in excess of 10 percent for degenerative arthritis of the left knee. 2. Entitlement to a rating in excess of 10 percent for degenerative arthritis of the right knee. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. 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. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” 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. 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; DeLuca v. Brown, 8 Vet. App. 202 (1995). 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, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The Veteran’s service-connected degenerative arthritis of the left and right knees are each evaluated as 10 percent disabling pursuant to Diagnostic Code 5003-5260. 38 C.F.R. § 4.71a. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. In the instant case, degenerative arthritis, evaluated under Diagnostic Code 5003, is rated pursuant to limitation of flexion, evaluated under Diagnostic Code 5260. The Veteran filed a claim in February 2013 seeking an increased rating for such disabilities as he believed that they are more severe than as reflected by the currently assigned ratings. As an initial matter, the Board notes that, in the April 2014 rating decision on appeal, the Agency of Original Jurisdiction (AOJ) changed the Diagnostic Code under which the Veteran’s bilateral knee disabilities are rated. By way of background, service connection for such disabilities was originally established in a March 2002 rating decision, at which time they were assigned noncompensable ratings pursuant to Diagnostic Code 5257, which pertains to recurrent subluxation or lateral instability, effective June 26, 2001. Thereafter, in an August 2006 rating decision, the AOJ awarded 10 percent ratings for the Veteran’s left and right knee disabilities pursuant to Diagnostic Code 5257, effective February 15, 2006, and March 28, 2006, respectively; however, such award was based on findings of painful, limited motion rather than recurrent subluxation or lateral instability. An August 2010 rating decision continued the 10 percent ratings for the Veteran’s bilateral knee disabilities under Diagnostic Code 5257. Finally, in the April 2014 rating decision on appeal, the AOJ likewise continued the 10 percent ratings, but changed the Diagnostic Code to 5003-5260. In light of the change in Diagnostic Code during the pendency of the appeal, the Board has considered the Court’s and the United States Court of Appeals for the Federal Circuit’s (Federal Circuit’s) holdings in Murray v. Shinseki, 24 Vet. App. 420 (2011), and Read v. Shinseki, 651 F. 3d 1296 (Fed. Cir. 2011), respectively. In this regard, in June 2011, both the Court, in Murray, and Federal Circuit, in Read, considered the issue of whether severance of a particular diagnostic code was indeed severance of a service-connected disability. In Murray, the Court held that a VA medical examination showing that the symptoms upon which a disability rating was based are no longer present cannot act to reduce that disability rating if it has been in effect for more than 20 years, and thus protected by regulation. 38 C.F.R. § 3.951(b). Additionally, the Court held that the change of Diagnostic Codes under which veteran’s disability was rated was error where the change effectively reduced to a zero percent disability rating which had been in effect for more than 20 years, and thus protected by regulation. Id. However, days after the Murray decision, the Federal Circuit addressed a similar issue in Read. In Read, the veteran had been service-connected for residuals of a gunshot wound and a compensable rating had been assigned regarding a particular muscle group. Over 10 years after the initial assignment of the rating, a VA examiner determined that, in fact, a different muscle group had been affected by the gunshot wound and not the muscle group to which the initial diagnostic code applied. Notably, when the disability was initially granted service connection, no diagnosis of a particular muscle group had been identified. Following the VA examiner’s report, the Diagnostic Code was changed to reflect the affected muscle group. The Veteran appealed and the Board denied the appeal, finding that the diagnostic codes contained the same criteria and that, because the disability still enjoyed the same rating, there had been no harm in changing the Diagnostic Code. The Court affirmed the Board’s decision and the Veteran appealed to the Federal Circuit. The Federal Circuit identified the issue on appeal as whether the service connection for a disability protected under 38 U.S.C. § 1159 is severed when VA assigns to an injury a different Diagnostic Code than originally noted. In reaching its conclusion that the protected disability is not severed, the Federal Circuit considered the rationale behind 38 U.S.C. § 1159, as well as other relevant statutory definitions, and determined that 38 U.S.C. § 1159 only protects service connection of the disability, not the specific Diagnostic Code. Upon review of the definition of service connection under 38 U.S.C. § 101(16), the Federal Circuit determined that “to sever service connection is to conclude that a particular disability previously determined to have been incurred in the line of duty was incurred otherwise.” Id. The Federal Circuit noted that § 1159 “does not protect the fact of a disability, and therefore, the change in the determination of the applicable Diagnostic Code likewise is unprotected.” Id. Specifically regarding the facts in Read, the Federal Circuit agreed with the government’s argument that, because the same disability was involved in both the initial disability determination and the later specific identification of the particular muscle group that was affected, the change in the Diagnostic Code did not sever anything. His disability was still service-connected even though the Diagnostic Code may have changed. Id. Moreover, the Federal Circuit found that the purpose of 38 U.S.C. § 1159 was to “protect Veterans with long-standing determinations of service connection from suddenly having the determination of service connection stripped.” Id. The Federal Circuit noted that “there is nothing in the legislative history that manifests any concern about the situs of the disability or the Diagnostic Code associated with it, and expanding the protection of § 1159 to such situs determinations or Diagnostic Codes does nothing to advance Congress’ intention.” Id., citing VAOPGCPREC 50-91 (Mar. 29, 1991) (precedential opinion of the VA General Counsel) (noting that it would be “beyond the legislative purpose” to allow a Veteran to be service connected for two disabilities because of the protection of the statute where only one is shown by the medical evidence). Further, the Federal Circuit noted that VA had not changed its determination that the Veteran’s gunshot wound was incurred in connection with his military service, or that he was entitled to compensation for the disability he incurred as a result. Thus, the Federal Circuit found that “to determine that the change of the situs of the disability - or the Diagnostic Code associated with it - was a severance of one service-connected disability and an establishment of another, where the cause of the disability and the resultant functional impairment are the same, would ill-serve the purpose of the statute.” The Federal Circuit also noted that the issue of reassignment of a diagnostic code was not a novel concept. Referencing Gifford v. Brown, 6 Vet. App. 269 (1994), the Court was noted to have held that the correction of the situs of the injury was not a violation of § 1159 because the Veteran remained service-connected for the disability at issue. Thus, based on the foregoing, the Federal Circuit held that service connection for a “disability” is not severed simply because the situs of a disability - or the Diagnostic Code associated with it - is corrected to more accurately determine the benefit to which a Veteran may be entitled for a service-connected disability. The Board recognizes a distinction between Murray and Read in that, in Murray, the diagnostic codes for arthritis and limitation of motion do not evaluate the same symptoms as the Diagnostic Code for instability. See VAOGCPREC 23-97 (July 1, 1997; revised July 24, 1997) and VAOGCPREC 9-98 (August 14, 1998). Whereas in situations such as Read, the differing Diagnostic Codes regarding muscle groups do consider the same symptoms. However, to narrowly construe Read as only applying to muscle groups or similar Diagnostic Code groupings that only consider exactly the same symptoms would fall short of the holding in Read. Again, in Read, the Federal Circuit considered the broader picture of § 1159 and carefully examined exactly what is protected - service connection for the disability, not the specific Diagnostic Code. Upon careful consideration, the Federal Circuit determined that the specific Diagnostic Code was not protected even though service connection for the disability was protected. In the present case, the Board finds that service connection for the Veteran’s bilateral knee disabilities had not been in effect for 20 years at the time of the April 2014 rating decision that changed the Diagnostic Code and, thus, it is not protected under 38 U.S.C. § 110 and 38 C.F.R. § 3.951(b). Nonetheless, here, as in Read, the same disability is involved in both the March 2002 rating decision that initially established service connection and the April 2014 rating decision. The Board has not concluded that the Veteran’s bilateral knee disabilities previously determined to have been incurred in the line of duty were incurred otherwise. Based on the holding in Read, the Board finds that the change in the Diagnostic Code here does not result in a severance. Furthermore, per Murray, the Veteran’s rating for his bilateral knee disabilities was not reduced. In this regard, such disabilities have remained service-connected since June 26, 2001, at which time noncompensable ratings were assigned, and he has been in receipt of a 10 percent rating for his left and right knee disabilities since February 15, 2006, and March 28, 2006, respectively. Therefore, the reassignment of the DC for his service-connected bilateral knee disabilities did not sever service connection or act to reduce his disability ratings and, thus, was not improper. In this regard, pursuant to Diagnostic Code 5003, arthritis established by x-ray findings will be rated on the basis of limitation of motion of the specific joint involved. When, however, the limitation of motion of the specific joint involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, x-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations warrants a 20 percent evaluation. X-ray evidence of involvement of two or more major joints or two or more minor joints warrants a 10 percent evaluation. Normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II. Limitation of motion of the knee is contemplated in 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261. Diagnostic Code 5260 provides for a zero percent rating where flexion of the leg is only limited to 60 degrees. For a 10 percent rating, flexion must be limited to 45 degrees. A 20 percent rating is warranted where flexion is limited to 30 degrees. A 30 percent rating may be assigned where flexion is limited to 15 degrees. Diagnostic Code 5261 provides for a zero percent rating where extension of the leg is limited to five degrees. A 10 percent rating requires extension limited to 10 degrees. A 20 percent rating is warranted where extension is limited to 15 degrees. A 30 percent rating may be assigned where extension is limited to 20 degrees. For a 40 percent rating, extension must be limited to 30 degrees. And finally, where extension is limited to 45 degrees a 50 percent rating may be assigned. Diagnostic Code 5257 provides for assignment of a 10 percent rating when there is slight recurrent subluxation or lateral instability, a 20 percent rating when there is moderate recurrent subluxation or lateral instability, and a 30 percent evaluation for severe recurrent subluxation or lateral instability. VA’s General Counsel has stated that when a knee disorder is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5257 and an appellant also has limitation of knee motion which at least meets the criteria for a noncompensable evaluation under 38 C.F.R. § 4.71a, Diagnostic Code 5260 or 5261, separate evaluations may be assigned for arthritis with limitation of motion and for instability. However, General Counsel stated that, if an appellant does not meet the criteria for a noncompensable rating under either Diagnostic Code 5260 or Diagnostic Code 5261, there is no additional disability for which a separate rating for arthritis may be assigned. VAOPGCPREC 23-97 (July 1, 1997), published at 62 Fed. Reg. 63,604 (1997). If a rating is assigned under the provisions for other knee impairment (38 C.F.R. § 4.71a, Diagnostic Code 5257) a separate 10 percent rating may be assigned where some limitation of motion, albeit noncompensable, has been demonstrated. See VAOPGCPREC 9-98, 63 Fed. Reg. 56,704 (1998). Specifically, 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 Diagnostic Code 5260 or Diagnostic Code 5261 need not be compensable, but must at least meet the criteria for a zero-percent rating. Id. VA’s General Counsel has also stated that separate ratings under Diagnostic Code 5260 (limitation of flexion of the leg) and Diagnostic Code 5261 (limitation of extension of the leg) may be assigned for disability of the same joint. VAOPGCPREC 9-04 (September 17, 2004), published at 69 Fed. Reg. 59,990 2004). The evidence referable to the Veteran’s claims for increased ratings consists of his own statements, including those made at the July 2018 Board hearing, VA treatment records, and VA examination reports dated in December 2013, with a March 2014 addendum, and December 2017. In this regard, in documents of record and at the July 2018 Board hearing, the Veteran reported experiencing consistent bilateral knee pain during daily activities, to include while walking, driving, at work, and when participating in outdoor activities such as hiking. He indicated that he has reduced range of motion, stiffening, locking, and giving way of his knees, which was more severe on the right, with occasional flare-ups. VA treatment records dated throughout the appeal period reflect the Veteran’s reports of bilateral knee pain and an October 2017 X-ray revealed minimal degenerative changes without joint effusion. At the December 2013 VA examination, the Veteran complained of bilateral knee pain. He reported daily discomfort and worsening pain after weight bearing. The Veteran also indicated that he had flare-ups of his bilateral knee disabilities. In this regard, the examiner noted that pain, weakness, or fatigability could limit his function after repeated use of his knees, and the Veteran reported his belief that stiffness may limit his range of motion (ROM) to 90 degrees bilaterally during a flare-up. Upon ROM testing, the Veteran has bilateral knee flexion to 140 degrees or greater, with pain beginning at such point, and extension to zero degrees without pain. Following repetitive use testing, the Veteran’s ROM of his bilateral knees remained the same, and the examiner indicated that he did not have any additional limitation of ROM following such repetitive-use testing. He further reported that the Veteran had functional loss and/or impairment of the bilateral knees as a result of pain on movement. Muscle strength and joint stability testing were both normal bilaterally. There was no evidence or history of recurrent patellar subluxation/ dislocation, or any meniscal conditions. The examiner found that the Veteran’s bilateral knee disabilities did not impact his ability to work. In a March 2014 addendum, the examiner indicated that there was insufficient evidence or objective examination findings that would provide a reliable prediction of decreased functional ability during flare-ups or with repetitive use over a period of time. In this regard, he reported that, based on the available evidence and examination findings, it was not possible, without resorting to speculation, to predict within a reasonable degree of medical certainty, a potential loss of range of motion manifested as a consequent of a flare-up or exacerbation outside the clinical setting. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). At a December 2017 VA examination, the Veteran reported that his bilateral knee disabilities had worsened in chronicity and intensity. He also indicated that he had flare-ups as a result of prolonged standing that are manifested by aching pain and sometimes sharp pain that can persist for hours to days. However, he denied having any functional loss or impairment, to include due to repeated use over time. Upon ROM testing, the Veteran has bilateral knee flexion to 135 degrees, with pain that did not result in or cause functional loss, and extension to zero degrees without pain. There was pain on passive ROM as well as non- and weight-bearing, medial line joint tenderness, and crepitus. See Correia, supra. Following repetitive use testing, the Veteran’s ROM of his bilateral knees remained the same, and the examiner indicated that he did not have any additional limitation of ROM following such repetitive-use testing. It was further noted that the examination was being conducted during a flare-up. See Sharp, supra. However, he noted that the Veteran provided a reasonable and credible account of increased symptoms with repetitive use or exertional use activity, and flare-ups, to include pain and fatigue; however, he provided no specific information regarding increased disability in terms of ROM. Consequently, the examiner found that, without additional and specific information, a reasonable and prudent clinician cannot, without resorting to speculation or conjecture, describe additional disability in terms of ROM, particularly when the proposed activity or flare-up occurs outside the clinical environment. Id. Muscle strength and joint stability testing were both normal bilaterally. There was no evidence or history of recurrent patellar subluxation/ dislocation, or any meniscal conditions. The examiner found that the Veteran’s bilateral knee disabilities would adversely affect his ability to perform occupational tasks requiring physical work such as lifting, pushing, pulling, bending, standing, kneeling, squatting, climbing, and carrying; however, such would not adversely affect sedentary occupational activities. Based on the foregoing, the Board finds that ratings in excess of 10 percent for the Veteran’s bilateral knee disabilities are not warranted. In this regard, he has shown only a limitation of flexion, at its worst, to 135 degrees with pain, but such does not result in additional functional loss more nearly approximating limitation of flexion to 30 degrees, which is required for a higher rating of 20 percent under Diagnostic Code 5260, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. In fact, at his December 2013 VA examination, the Veteran himself estimated that his flexion was limited to, at most, 90 degrees during a flare-up. Further, the Veteran is in receipt of the minimal compensable rating pursuant to Diagnostic Code 5003 for limitation of motion due to arthritis that is not otherwise compensable. Thus, ratings in excess of 10 percent for the Veteran’s bilateral knee disabilities pursuant to Diagnostic Code 5260 are not warranted. Moreover, a higher or separate rating is not warranted pursuant to Diagnostic Code 5261 as the Veteran’s left or right knee extension has not been shown to be limited to 5 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. The Board further notes that, while the Veteran has reported instability manifested by locking and giving way, such was not found on examinations conducted during the appeal period. In this regard, while he is competent describe feelings of locking and giving way, he is not competent to relate such symptoms to a diagnosis of lateral instability. In this regard, there is no indication that he possesses the requisite knowledge to administer or interpret specialized testing that would reveal instability as such is not immediately observable by a lay person. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). In this regard, the VA examiners, who have the training to conduct and interpret ligament testing, found that there was no laxity in the left or right knee. Consequently, the Board finds that a higher or separate rating under Diagnostic Code 5257 is not warranted. Finally, as the evidence does not show ankylosis, dislocation or removal of semilunar cartilage, impairment of the tibia or fibula, or genu recurvatum, higher or separate ratings under Diagnostic Codes 5256, 5258, 5259, 5262, and 5263, respectively, are not warranted. In reaching its conclusions in the instant case, the Board acknowledges the Veteran’s belief that his bilateral knee symptoms are more severe than as reflected by the current assigned disability ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert, supra. Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disabilities. The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran’s service-connected bilateral knee disabilities; however, the Board finds that his symptomatology has been stable throughout the period on appeal. Therefore, assigning staged ratings for such disabilities is not warranted. Further, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claims adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). Therefore, the Board finds that ratings in excess of 10 percent for the Veteran’s bilateral knee disabilities is not warranted. In reaching such determination, the Board considered the benefit of the doubt doctrine; however, as the preponderance of the evidence is against his increased rating claims, such is not applicable and the claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Tiffany Alston, Associate Counsel