Citation Nr: 18158200 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 16-52 426 DATE: December 14, 2018 ORDER Entitlement to an initial compensable rating for left knee patella femoral pain syndrome, extension, is denied. Entitlement to an initial compensable rating for right knee patella femoral pain syndrome, extension, is denied. FINDINGS OF FACT 1. The Veteran’s left knee patella femoral pain syndrome most nearly approximates extension limited to 5 degrees or better without dislocated semilunar cartilage, recurrent subluxation, or lateral instability 2. The Veteran’s right knee patella femoral pain syndrome most nearly approximates extension limited to 5 degrees or better without dislocated semilunar cartilage, recurrent subluxation, or lateral instability CONCLUSIONS OF LAW 1. The criteria for an initial compensable rating for left knee patella femoral pain syndrome, extension have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261 (2018). 2. The criteria for an initial compensable rating for right knee patella femoral pain syndrome, extension have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Airforce from November 1988 to December 2005. He is a Persian Gulf Veteran. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon. Duty to Assist The Veterans Claims Assistance Act of 2000 (VCAA), codified in pertinent part at 38 U.S.C. §§ 5103, 5103A (2012), and the pertinent implementing regulation, codified at 38 C.F.R. § 3.159 (2017), provide that VA will assist a claimant in obtaining evidence necessary to substantiate a claim but is not required to provide assistance to a claimant if there is no reasonable possibility that such assistance would aid in substantiating the claim. The Board finds VA has complied with its duty to assist the Veteran in the development of the claims decided herein. In this respect, the Veteran’s service treatment records (STRs) have been obtained. Additionally, all available post-service medical evidence identified by the Veteran has been obtained. The Veteran was afforded an opportunity for a hearing before a Decision Review Officer or before the Board, but declined to do so. Neither the Veteran nor his representative have identified any outstanding, existing evidence that could be obtained to substantiate the claims; the Board is also unaware of any such evidence. Therefore, the Board is satisfied that VA has complied with its duty to assist the Veteran in the development of the claims decided herein. Accordingly, the Board will address the merits of the Veteran’s claims. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In both initial rating claims and normal increased rating claims, the Board must discuss whether “staged ratings” are warranted, and if not, why not. See generally Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Where there is a question as to which of the two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise the lower rating will be assigned. See 38 C.F.R. § 4.7. Diagnostic Code 5261, limitation of extension, of the leg provides a non-compensable rating if extension is limited to 5 degrees, a 10 percent rating if limited to 10 degrees, a 20 percent rating if limited to 15 degrees, a 30 percent rating if limited to 20 degrees, a 40 percent rating if limited to 30 degrees, and a 50 percent rating if limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261; see also 38 C.F.R. § 4.71, Plate II (2015) (showing normal flexion and extension as between 0 degrees and 140 degrees). Normal extension is a fully straightened leg, or 0 degrees. For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40 and 4.45, pertaining to functional impairment. The Court of Appeals of Veterans Claims has instructed that in applying these regulations VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, or pain. DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Johnston v. Brown, 10 Vet. App. 80, 84-85 (1997); 38 C.F.R. § 4.59. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must weigh against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996) (citing Gilbert, 1 Vet. App. at 54). The Board has reviewed all of the evidence of record, with an emphasis on the evidence relevant to the Veteran’s claims. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). The Board will summarize the relevant evidence where appropriate and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the Veteran’s claims. In a December 2014 VA examination, the VA examiner found the Veteran’s left and right knee extension went to 5 degrees. The examiner noted that the Veteran exhibited pain on extension, pain on weight bearing, and that there was objective evidence of localized tenderness or pain on palpitation of the knee joints. A December 2014 VA rating decision granted service connection for limitation of right and left knee extension. A noncompensable (or 0 percent) evaluation was assigned effective December 18, 2014, for both the Veteran’s knees. Symptoms at that time supported a noncompensable evaluation for the Veteran’s left and right knee femoral pain syndrome based on a limitation of extension of 5 to 9 degrees. The Veteran was given a July 2016 VA examination; the examiner found that the Veteran’s extension was to 0 degrees for both his left knee and his right knee. The examiner noted that the Veteran had decreased motion due to pain and found that there was objective evidence of pain with eight bearing, moderate pain on palpitation of all peripatellar structures, and objective evidence of crepitus. The examiner also noted that the examination was medically consistent with the Veteran’s statements describing functional loss during a flare-up. Additionally, the examiner stated that pain during the Veteran’s flare-ups would limit the range of motion on extension of the Veteran’s knees to 5 degrees. Finally, the examiner noted that there is no ankylosis, no history of recurrent subluxation, no history of lateral instability, and no history of recurrent effusion. The Veteran has objected to the 2014 and 2016 VA examination findings, stating that the examiners were rude, inattentive, rushed, or otherwise not competent. However, both reports include all findings necessary to application of the rating criteria, and both are markedly similar. Further, the examiners are presumed competent in the performance of their duties. Rizzo v. Shinseki, 580 F.3d 1288 (Fed.Cir.2009). With respect to the Veteran’s left and right knee extension the examination results are not much different than the findings of the December 2014 VA examination that concluded the Veteran’s left and right knees did not exhibit significant functional limitations with extension. It is clear from the July 2016 examination report that the examiner reviewed the Veteran’s claims file, considered his subjective complaints of pain, and completed a comprehensive examination of the Veteran’s knees. Because the July 2016 examiner engaged in a comprehensive physical examination relevant to the Veteran’s claim and considered his medical history and contentions on appeal, the Board concludes that this examination is adequate for adjudicative purposes. With respect to the DeLuca factors, it is clear that the Veteran’s left and right knee extension is limited to, at most 5 degrees. Extension is the movement beginning with the leg bent at the knee and then straightening the leg with normal extension being a fully straightened leg, or 0 degrees. An extension of 5 degrees means that the Veteran can almost completely straighten his legs, except for those last 5 degrees of movement. Extension limited to 5 degrees is noncompensable under DC 5261. 38 C.F.R. § 4.71a. A higher evaluation of 10 percent is not warranted for limitation of extension of the knee unless there is extension limited to 10 to 14 degrees. A higher evaluation of 20 percent is not warranted unless extension is limited to 15 to 19 degrees. The competent medical evidence of record shows that the Veteran’s left and right knee extension is limited to 5 degrees or better. Based on a review of the evidence of record, an evaluation for left and right knee patellofemoral pain syndrome, extension higher than 0 percent, is denied. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Gresham