Citation Nr: 19166409 Decision Date: 08/27/19 Archive Date: 08/27/19 DOCKET NO. 14-06 240A DATE: August 27, 2019 ORDER Entitlement to an initial rating in excess of 10 percent for service-connected patellofemoral syndrome of the left knee is denied. Entitlement to an initial rating in excess of 10 percent for service-connected patellofemoral syndrome of the right knee is denied. FINDINGS OF FACT 1. For the entire appeal period, the Veteran’s service-connected patellofemoral syndrome of the left knee has been manifested by, at worst, full extension and flexion functionally limited to 125 degrees with pain, but not ankylosis or frequent episodes of locking, pain, and effusion. 2. For the entire appeal period, the Veteran’s service-connected patellofemoral syndrome of the right knee has been manifested by, at worst, full extension and flexion functionally limited to 125 degrees with pain, but not ankylosis or frequent episodes of locking, pain, and effusion. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial rating in excess of 10 percent for service-connected patellofemoral syndrome of the left knee have not been met. 38 U.S.C. § 1155; 38 C.F.R. § §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 2. The criteria for entitlement to an initial rating in excess of 10 percent for service-connected patellofemoral syndrome of the right knee have not been met. 38 U.S.C. § 1155; 38 C.F.R. § §§ 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from December 1977 to November 1981, and from November 1982 to November 1998. An August 2019 rating decision granted an initial rating of 10 percent for both service-connected patellofemoral knee disabilities. Increased Rating Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § Part 4. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § § 4.3. A veteran’s entire history is to be considered when making disability evaluations. See 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). In initial-rating cases, where the appeal stems from a granted claim of service connection with respect to the initial evaluation assigned, VA assesses the level of disability from the effective date of service connection. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian life. Generally, the degree of disability specified is considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § § 4.1. When all the evidence is assembled, a determination will be made on the claim. Reasonable doubt will be resolved in favor of the Veteran. If there is a preponderance of the evidence against the claim, the claim will be denied. If the evidence supports the claim or is in relative equipoise, the Veteran will prevail. 38 U.S.C. § 5107 (b); 38 C.F.R. § §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 1. Entitlement to an initial rating in excess of 10 percent for service-connected patellofemoral syndrome of the left knee. 2. Entitlement to an initial rating in excess of 10 percent for service-connected patellofemoral syndrome of the right knee. The Veteran asserts that his service-connected bilateral knee disability is more severe than his initial ratings reflect. His right and left knee disabilities are currently rated at 10 percent under Diagnostic Codes 5260 for pain with limitation of motion. Normal ranges of motion of the knee are to 0 degrees in extension, and to 140 degrees in flexion. 38 C.F.R. § § 4.71, Plate II. Diagnostic Code 5260 evaluates limitation of knee flexion. A noncompensable rating is assigned for flexion limited to 60 degrees. A 10 percent rating is assigned for flexion limited to 45 degrees. A 20 percent rating is assigned for flexion limited to 30 degrees. A 30 percent rating is assigned for flexion limited to 15 degrees. Diagnostic Code 5261 evaluates limitation of knee extension. A noncompensable rating is assigned for extension limited to 5 degrees. A 10 percent rating is assigned for extension limited to 10 degrees. A 20 percent rating is assigned for extension limited to 15 degrees. A 30 percent rating is assigned for extension limited to 20 degrees. A 40 percent rating is assigned for extension limited to 30 degrees. A 50 percent rating is assigned for extension limited to 45 degrees. Of note, separate compensable ratings may be assigned for limitation of flexion and for limitation of extension, without violating the rule against pyramiding. See 38 C.F.R. § § 4.14. In considering range of motion ratings, it is important to consider whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. § §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202 (1995). A minimum compensable evaluation for a joint disability is warranted for painful motion under 38 C.F.R. § § 4.59. However, a rating in excess of the minimum compensable rating must be based on demonstrated functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). A May 2012 VA examination report reflects the Veteran’s complaints of bilateral knee pain which he treated with over the counter medication. His right and left knee extension measured 0 degrees and flexion measured to 140 degrees. There was no loss of range of motion after repetitive testing for either knee. The examiner noted no instability or subluxation and no ankylosis. An April 2019 VA examination report again reflects the Veteran’s complaints of bilateral knee pain which he treated with over the counter medication. His right and left knee extension measured 0 degrees and flexion measured to 125 degrees. Pain was noted on flexion and extension. Muscle strength measured 4/5 in right and left knee flexion and extension. A 2011 bilateral medial meniscus tear was noted without subsequent surgery or removal. The examiner noted no instability or subluxation and no ankylosis. Here, neither the Veteran’s right knee or left knee condition warrants a compensable rating under either Diagnostic Code 5260 or Diagnostic Code 5261. A 10 percent rating for limitation of flexion requires flexion to be limited to 45 degrees and 10 percent rating for limitation of extension requires extension to be limited to 10 degrees. Here, the most recent VA examinations show that repetitive motion only reduced range of flexion for both knees to 125 degrees at worst, and he had no knee extension reduction of motion. As such, a compensable rating under Diagnostic Code 5260 and 5261 is not warranted. Here, the evidence shows that Veteran has painful motion in his bilateral knees. As such, a minimum compensable rating for both knees has been assigned. As 10 percent rating is already assigned for the bilateral knees to compensate for the pain, a rating in excess of 10 percent for the bilateral knees is not warranted in the absence of evidence showing that the limitation of range of motion has reached the level of the 20 percent rating. See Mitchell. The Board considered whether the Veteran is entitled to a separate rating under Diagnostic Code 5257 based on his complaints of giving way and instability and finds that the evidence does not warrant a 10 percent rating under Diagnostic Code 5257 as no instability or subluxation was found in medical treatment records or VA examination reports during the appeal period. The Board also considered whether the Veteran was entitled to a separate rating based on the findings of a torn meniscus and related symptoms, including snapping, pain and tenderness. The Board finds, however, that a separate rating is not warranted under Diagnostic Codes 5258 or 5259. Regarding entitlement to a separate rating under Diagnostic Code 5258, neither the medical nor lay evidence documents recurrent effusion nor locking. The evidence overwhelmingly shows that he did not experience recurrent effusion or locking during the period on appeal as there was no evidence of recurrent effusion or locking at either VA examinations. While pain has been related to the Veteran’s right and left knee disabilities, these symptoms are not sufficient to warrant a separate rating under Diagnostic Code 5258 and are contemplated by his 10 percent rating based on painful limitation of motion. Accordingly, the Board finds that a separate rating is not warranted under Diagnostic Code 5258. The Board further finds that a separate rating is not warranted under Diagnostic Code 5259 because although the April 2019 VA examination report reflect the Veteran has a meniscal tear, the Veteran has not undergone meniscal surgery or removal. The Board additionally considered whether the Veteran is entitled to a higher rating due to functional impairment under the provisions of 38 C.F.R. § §§ 4.40 and 4.45. DeLuca, 8 Vet. App. 202. In making this determination, the Board considered the Veteran’s lay statements about his symptoms, VA examination reports, and VA treatment records. While the record shows knee pain, the evidence does not show that his symptoms produce functional loss that is manifested by adequate evidence of disabling pathology for higher ratings. See 38 C.F.R. § § 4.40; Mitchell, 25 Vet. App. at 38. Indeed, the Veteran did not experience additional limitation of motion after repetitive use testing and his disability ratings are already based on the extent to which his symptoms reduce range of motion and cause pain. In light of the Veteran’s reported symptoms and the medical evidence, the Board finds that the Veteran is not entitled to higher ratings for his bilateral knee disabilities. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Peden, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § § 20.1303.