Citation Nr: 18159171 Decision Date: 12/19/18 Archive Date: 12/18/18 DOCKET NO. 12-26 004 DATE: December 19, 2018 ORDER An evaluation in excess of 10 percent for osteoarthritis of the left knee is denied. An evaluation in excess of 10 percent for osteoarthritis of the right knee is denied. A separate 20 percent evaluation for residuals of a meniscal repair of the right knee throughout the appeal period is granted. A 20 percent evaluation, but no higher, for posttraumatic arthritis of the left ankle throughout the appeal period is granted. A 20 percent evaluation, but no higher, for posttraumatic arthritis of the right ankle throughout the appeal period is granted. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran’s left knee is not shown to have flexion to 60 degrees or less, any limitation of extension, any subluxation or lateral instability of the knee joint, or any evidence of ankylosis, impairment of the tibia and fibula, genu recurvatum, or meniscal impairment. 2. Throughout the appeal period, the Veteran’s right knee is not shown to have flexion to 60 degrees or less, any limitation of extension, any subluxation or lateral instability of the knee joint, or any evidence of ankylosis, impairment of the tibia and fibula, or genu recurvatum. 3. Throughout the appeal period, the Veteran’s right knee is shown to have residual of a meniscal repair that most closely approximated to pain, locking, and effusion. 4. The Veteran’s bilateral ankles are shown to have marked limitation of motion, although there is no evidence of ankylosis of the bilateral ankles throughout the appeal period. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 10 percent for osteoarthritis of the left knee are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5010, 5256-5263. 2. The criteria for an evaluation in excess of 10 percent for osteoarthritis of the right knee are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5010, 5256, 5257, 5260-5263. 3. The criteria for a separate 20 percent evaluation for residuals of a right knee meniscal repair throughout the appeal period are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5258, 5259. 4. The criteria for an evaluation of 20 percent, but no higher, for posttraumatic arthritis of the left ankle throughout the appeal period are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5270-5274. 5. The criteria for an evaluation of 20 percent, but no higher, for posttraumatic arthritis of the right ankle throughout the appeal period are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5270-5274. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Air Force from December 1980 to December 2000. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), in which the Agency of Original Jurisdiction (AOJ) increased the Veteran’s bilateral ankle and knee disabilities to 10 percent disabling, respectively. The Veteran timely appealed that decision; the case was previously before the Board in October 2017, at which time it was remanded for additional development. Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1. The basis of disability evaluations 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. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as “staging the ratings.” See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008). In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology, and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45, but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). Bilateral Knee Disabilities As noted above, the Veteran filed his claim for increased evaluation of his bilateral knee disabilities on April 15, 2009. In conjunction with this claim for increase, the Board has considered the relevant evidence since April 15, 2008. See 38 C.F.R. § 3.400(o). Throughout the appeal period, the Veteran’s bilateral knee disabilities have been assigned 10 percent evaluations, respectively, under Diagnostic Code 5010-5260. Initially, the Board reflects that as each knee is a single major joint, a higher evaluation under Diagnostic Codes 5003 and/or 5010 for arthritis is not applicable in this case. See 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010. Normal range of motion of the knee is to 0 degrees (full extension) to 140 degrees (full flexion). 38 C.F.R. § 4.71a, Plate II. When flexion of the knee is limited to 45 degrees, a 10 percent rating may be assigned. When flexion is limited to 30 degrees, a 20 percent disability rating may be assigned. A 30 percent rating may be assigned when flexion of the leg is limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. When extension of the knee is limited to 10 degrees, a 10 percent disability rating may be assigned. When extension is limited to 15 degrees, a 20 percent disability rating may be assigned. When limited to 20 degrees, a 30 percent rating may be assigned. When extension is limited to 30 degrees, a 40 percent disability rating is assignable. A 50 percent disability rating may be assigned when extension of the leg is limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Slight recurrent subluxation or lateral instability warrants a 10 percent disability rating. A 20 percent rating requires moderate recurrent subluxation or lateral instability. A 30 percent rating requires severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Dislocation of the semilunar cartilage of the knee with frequent episodes of “locking,” pain and effusion into the joint warrants a 20 percent disability rating. 38 C.F.R. § 4.71a, Diagnostic Code 5258. Symptomatic removal of semilunar cartilage warrants a 10 percent evaluation. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Turning to the evidence of record, during an August 2009 VA examination, the Veteran reported the following symptoms for his left knee: weakness, stiffness, swelling, giving way, locking, tenderness, and pain. He reported that he did not experience pain. He indicated that he did not experience heat, redness, lack of endurance, fatigability, deformity, drainage, effusion, subluxation, and dislocation. The Veteran reported that he experienced flare-ups as often as 24 times per day and each time would last for one hour. He reported the severity of his pain as 8 out of 10. He reported that the flare-ups were precipitated by physical activity. He stated that it is alleviated by rest and over the counter medication. He reported that during the flare-ups, he experienced functional impairment described as the inability to run or walk fast, inability to lift heavy thing, and limitation of motion of the joint (difficulty flexing, locking in place, and pain). He reported difficulty with standing/walking. The Veteran reported that he could not walk fast or run. He reported that his condition has not resulted in any incapacitation. As to his right knee, the Veteran reported the following symptoms: weakness, stiffness, swelling, giving way, lack of endurance, fatigability, tenderness, and pain. He reported that he did not experience heat, redness, locking, deformity, drainage, effusion, subluxation, and dislocation. He reported that he experienced flare-ups as often as 24 times per day and each time lasted for one hour. He reported that his pain was a 10 out of 10. The flare-ups were precipitated by physical activity. He reported that it was alleviated by rest and medicine. He stated that during the flare-ups, he experienced functional impairment described as the inability to run, stand long, flex fully and limitation of motion of the joint which he reported could not be flexed fully. He reported difficulty with standing and walking. The Veteran reported that he could not run, stand long, or flex fully. He reported residual pain and decreased function following his meniscal repair. He reported that his condition did not result in incapacitation. He reported that his overall functional impairment was the inability to run or stand for a long period of time. On examination, on the right knee, there was abnormal movement, weakness, tenderness, and guarding of movement. The right knee showed no signs of edema, instability, effusion, redness, heat, deformity, malalignment, and drainage. There was no subluxation. On the left knee, there was abnormal movement, weakness, tenderness, and guarding of movement. The left knee showed no signs of edema, instability, effusion, redness, heat, deformity, malalignment, and drainage. There was no subluxation. Examination of the right knee revealed locking pain. There was no genu recurvatum and crepitus. Examination of the left knee revealed locking pain. There was no genu recurvatum and crepitus. Initial range of motion testing of the left knee revealed flexion to 85 degrees with pain beginning at 70 degrees and extension to 0 degrees. Range of motion testing of the right knee revealed flexion to 85 degrees with pain beginning at 70 degrees and extension to 0 degrees. On the left knee, the joint function was additionally limited by the following after repetitive use: pain, fatigue, weakness, lack of endurance, and pain had the major functional impact. The joint function on the left was not additionally limited by the following after repetitive use: incoordination. The medial/lateral collateral ligaments stability test, the anterior/posterior cruciate ligaments stability test and the medial/lateral meniscus stability tests are all within normal limits for the right knee. The medial/lateral collateral ligaments stability test, the anterior/posterior cruciate ligaments stability test and the medial/lateral meniscus ligaments stability test are all within normal limits of the left knee. On the right knee, the joint function was additionally limited by the following after repetitive use: pain, fatigue, weakness, lack of endurance, and pain was had the major functional impact. The joint function on the right is not additionally limited by the following after repetitive use: incoordination. During the October 2017 VA examination, the Veteran reported challenges walking, running, and exercising. He reported that he had difficulty going up and down stairs. The Veteran reported that his pain was located in the medical aspect of both knees at the joint level with the right knee in more pain than the left. The Veteran did not report any flare-ups of the knees. The Veteran reported functional loss/functional impairment of the joints described as pain and stiffness which interfered with mobility. The initial range of motion for the Veteran’s left knee was abnormal or outside of the normal range with flexion to 105 degrees and extension to 0 degrees. There was knee pain and stiffness interfered with mobility. There was pain on flexion. There was evidence of pain with weight-bearing. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was objective evidence of crepitus. Initial range of motion reflected that the right knee was abnormal with flexion to 90 degrees and extension to 0 degrees. There was knee pain and stiffness that interfered with mobility. There was pain on flexion. There was evidence of pain with a weight bearing. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was no objective evidence of crepitus. The Veteran was able to perform repetitive use testing, bilaterally, with at least three repetitions with no additional functional loss or range of motion after three repetitions. The Veteran was examined immediately after repetitive use, bilaterally, over time with no pain, weakness, fatigability or incoordination that significantly limited functional ability with repeated use over a period of time. There was no recurrent subluxation, no lateral instability, and no recurrent effusion, bilaterally. There was no joint instability, no muscle atrophy, and no ankylosis, bilaterally. The Veteran has had a meniscus (semilunar cartilage) condition on the right with frequent episodes of joint pain. Bilaterally, there was no evidence of pain on massive motion testing and there was no evidence of pain when the joint was used in non-weightbearing. The Veteran regularly used a brace and cane as an assistive device. VA treatment records reflect continued treatment for the Veteran’s bilateral knee disabilities, with substantially similar findings to those noted above in the VA examination reports with respect to the Veteran’s bilateral knee disabilities. Based on the foregoing evidence, the Board reflects that Diagnostic Codes 5256, 5262, and 5263 are not applicable in this case, as there is no evidence of ankylosis, tibia or fibula, or genu recurvatum of either of the Veteran’s bilateral knees at any time during the appeal period. See 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5262, 5263. With regards to the Veteran’s flexion and extension of his bilateral knees, the Board has contemplated whether higher evaluations and separate evaluations are warranted under Diagnostic Codes 5260 and 5261 in this case. The Board reflects, however, that the Veteran’s flexion of his bilateral knees is not shown to be limited to 60 degrees or less at any time during the appeal period, nor is there any evidence of a limitation of extension of either knee. Consequently, the Board reflects that the application of a 10 percent evaluation for noncompensable limitation of motion with arthritis and painful motion has been appropriately applied in this case under Diagnostic Code 5010; higher evaluations under Diagnostic Codes 5260 and 5261 are not warranted based on the evidence of record at this time. See 38 C.F.R. § 4.71a, Diagnostic Code 5003, 5010, 5260, 5261. The Board has additionally contemplated whether a separate evaluation for lateral subluxation or instability is warranted throughout the appeal period for either of the Veteran’s knee disabilities under Diagnostic Code 5257. However, throughout the appeal period, the evidence of record demonstrates that the Veteran’s knees did not have any subluxation or instability on examination, nor did he report any problems with subluxation, instability, or giving way/out of his knees at any time during the appeal period. Consequently, the Board finds that a separate compensable evaluation under Diagnostic Code 5257 is not warranted for either of the Veteran’s bilateral knee disabilities based on the evidence of record at this time. See 38 C.F.R. § 4.71a, Diagnostic Code 5257. Finally, the Board has contemplated whether a separate evaluation is warranted under either Diagnostic Codes 5258 or 5259 in this case for either of his knee disabilities. Initially, the Board reflects that the Veteran’s left knee disability is not shown to have any meniscal condition throughout the appeal period; thus, despite the Veteran’s reports of meniscal symptoms such as locking noted in the August 2009 VA examination, as there is no evidence of a meniscal condition associated with the Veteran’s left knee disability, the Board finds that Diagnostic Codes 5258 and 5259 are not applicable in this case respecting the left knee disability. However, the Veteran’s right knee is clearly shown to have a meniscal condition throughout the appeal period. The Veteran is noted to have pain, and complaints of locking in the August 2009 VA examination. Although the Veteran was only noted to have frequent episodes of pain related to his meniscal condition in the October 2017 VA examination, by resolving reasonable doubt in his favor, the Board finds that a separate 20 percent evaluation under Diagnostic Code 5258 is warranted for the Veteran’s right knee meniscal problems throughout the appeal period. As Diagnostic Code 5258 contemplates the same and additional symptomatology as Diagnostic Code 5259, the Board finds that any further award under that 5259 in this case would be impermissible pyramiding. Accordingly, throughout the appeal period, the Board finds that a separate 20 percent evaluation for the Veteran’s residuals of a right knee meniscal repair is warranted based on the evidence of record at this time. See 38 C.F.R. §§ 4.7, 4.14, 4.71a, Diagnostic Code 5258, 5259; Lyles v. Shulkin, 29 Vet. App. 107 (2017). In so reaching the above conclusions, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Bilateral Ankle Disabilities As noted above, the Veteran filed his claim for increased evaluation of his bilateral ankle disabilities on April 15, 2009. In conjunction with this claim for increase, the Board has considered the relevant evidence since April 15, 2008. See 38 C.F.R. § 3.400(o). Throughout the appeal period, the Veteran’s bilateral ankle disabilities have been assigned 10 percent evaluations, respectively, under Diagnostic Code 5010-5271. Initially, the Board reflects that as each ankle is a single major joint, a higher evaluation under Diagnostic Codes 5003 and/or 5010 for arthritis is not applicable in this case. See 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010. Under Diagnostic Code 5271, moderate limitation of motion of the ankle is assigned a 10 percent evaluation, and marked limitation of motion of the ankle is assigned a 20 percent evaluation. See 38 C.F.R. § 4.71a, Diagnostic Code 5271. Standard range of ankle dorsiflexion is from 0 to 20 degrees, and plantar flexion from 0 to 45 degrees. See 38 C.F.R. § 4.71, Plate II. The terms “slight,” “moderate,” and “marked” are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just,” and all evidence must be evaluated in deciding rating claims. 38 C.F.R. § 4.6. Other alternative Diagnostic Codes include Diagnostic Code 5270, which provides a 20 percent evaluation for ankylosis of the ankle in plantar flexion less than 30 degrees warrants a 20 percent rating. If ankylosed in plantar flexion between 30 degrees and 40 degrees, or in dorsiflexion between 0 degrees and 10 degrees, a 30 percent rating is warranted. If ankylosed in plantar flexion at more than 40 degrees, or in dorsiflexion at more than 10 degrees, or with abduction, adduction, inversion or eversion deformity, a 40 percent rating is warranted. See 38 C.F.R. § 4.71a, Diagnostic Code 5270. Finally, as will be discussed below, there is no evidence of ankylosis of his subastragalar or tarsal joints, malunion of the os calcis or astragalus bilaterally, nor is there evidence that he has underwent an astragalectomy of either ankle in this case. Moreover, the highest possible evaluation for any of those disabilities is 20 percent disabling, which as will be discussed below will be assigned in this case. See 38 C.F.R. § 4.71a, Diagnostic Codes 5272-5274. Consequently, the Board will not further contemplate Diagnostic Codes 5272 through 5274 in this decision. During an August 2009 VA examination, the Veteran reported the following symptoms: weakness, giving way, lack of endurance, tenderness and pain. He indicated that he did not experience stiffness, swelling, heat, redness, locking, fatigability, deformity, drainage, effusion, subluxation, and dislocation. The Veteran reported that he experienced flare-ups as often as 24 times per day and each would last for an hour. He reported pain that was 10 out of 10. The flare-ups were precipitated by physical activity and walking and resolved with rest and over the counter medication. The Veteran reported that during the flare-ups, he experienced functional impairment described as slow walking, the inability to run, and limitation of the joint (stiffness). He reported difficulty with standing/walking. He reported that he could not walk or walk long. He reported that his condition did not result in any incapacitation. On examination, the Veteran walked with a normal gait. The Veteran’s walk was normal. The Veteran had difficulty with weight bearing knee and ankle weakness and decreased range of motion. He had no difficulty with ambulation. On the right ankle, there is weakness, tenderness, and guarding of movement. The right ankle showed no signs of edema, instability, abnormal movement, effusion, redness, heat, deformity, malalignment, and drainage. There was no subluxation. On the left ankle there was no weakness, tenderness, and guarding of movement. The left showed no signs of edema, instability, abnormal movement, effusion, redness, heat, deformity, malalignment, and drainage. There was no subluxation. An examination of the ankles did not reveal any deformity and there was no ankylosis. Range of motion of the left ankle revealed dorsiflexion to 15 degrees with pain beginning at 15 degrees. His plantar flexion was to 40 degrees with pain beginning at 35 degrees. Range of motion of the right ankle revealed dorsiflexion to 15 degrees with pain beginning at 15 degrees. His plantar flexion was to 40 degrees with pain beginning at 35 degrees. On the left ankle, the joint function was additionally limited by the following after repetitive use: pain, fatigue, weakness, lack of endurance, and pain had the major functional impact. The joint function on the left was not additionally limited by the following after repetitive use: incoordination. On the right ankle, the joint function was additionally limited by the following after repetitive use: pain, fatigue, weakness, lack of endurance, and pain had the major functional impact. The joint function on the right ankle was not additionally limited by the following after repetitive use: incoordination. During an October 2017 VA examination, the Veteran reported he had pain in the ankles located over the Achilles bilaterally. He could not run and walking became a chore. He could not exercise like he used to. The Veteran did not report any flare-ups on the ankle. The Veteran did not report any functional loss or functional impairment of the joint or extremity. On examination, initial range of motion of the left ankle was normal with dorsiflexion to 20 degrees and plantar flexion to 45 degrees. There was no pain on examination. There was no evidence of pain with weight bearing. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was no objective evidence of crepitus. Initial range of motion of the right ankle was noted as normal with dorsiflexion to 20 degrees and plantar flexion to 45 degrees. There was no pain noted on examination. There was no evidence of pain with weight bearing. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was no objective evidence of crepitus. On the left ankle, the Veteran was able to perform repetitive use testing with at least three repetitions. There was no additional loss of function or range of motion after three repetitions. On the right ankle, the Veteran was able to perform repetitive use testing with at least three repetitions. There was no additional loss of function or range of motion after three repetitions. The Veteran was examined immediately after repetitive use over time. Pain, weakness and fatigability or incoordination did not significantly limit functional ability bilaterally with repeated use over a period of time. There was no muscle atrophy, no ankylosis, and no joint instability bilaterally. There was no evidence of pain on passive motion testing and no evidence of pain when the joint was used in non-weight bearing, bilaterally. The Veteran regularly used a can as an assistive device. VA treatment records reflect continued treatment and complaint of pain in the Veteran’s ankles, with substantially similar findings to those noted above in the VA examination reports throughout the appeal period. Upon review of the evidence of record, the Board finds that the Veteran’s bilateral posttraumatic ankle arthritis more nearly approximates marked limitation of motion. The August 2009 VA examination report reflects joint function was additionally limited by pain, fatigue, weakness, and lack of endurance causing major functional impact bilaterally. While the October 2017 VA examination noted improvement, the Veteran continued to report pain and difficulty with running and walking. He continued to use an assistive device and he could not exercise. Thus, the Board finds that the overall disability picture of the Veteran’s posttraumatic arthritis of the left ankle and posttraumatic arthritis of the right ankle more nearly approximated marked limitation of motion of each ankle. Accordingly, the Board finds that a 20 percent evaluation under Diagnostic Code 5271 is warranted for each ankle disability throughout the appeal period based on the evidence of record at this time. See 38 C.F.R. § 4.71a, Diagnostic Code 5271. The Board reflects that in order for a higher evaluation to be assigned in this case, the evidence must demonstrate ankylosis of the ankles either between 30 and 40 degrees in plantar flexion or in between 0 and 10 degrees in dorsiflexion. As the evidence clearly demonstrates during the appeal period, the Veteran’s ankles are shown to have some range of motion during that appeal period and that there is no evidence of ankylosis or fixation of the Veteran’s ankles. Accordingly, an evaluation in excess of 20 percent for either ankle disability in this case is not warranted based on the evidence of record in this case. Thus, the Board finds that a 20 percent evaluation, but no higher, is warranted for the Veteran’s bilateral ankle disabilities throughout the appeal period. See 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5270, 5271. In so reaching the above conclusions, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Laroche, N.