Citation Nr: 19141413 Decision Date: 05/29/19 Archive Date: 05/29/19 DOCKET NO. 17-56 182 DATE: May 29, 2019 ORDER Entitlement to service connection for a hernia condition, status-post surgery with testicular pain, is denied. Entitlement to an initial rating in excess of 10 percent for right wrist sprain is denied. Entitlement to an initial rating in excess of 20 percent, prior to July 6, 2017, for degenerative disc disease (DDD) with low back strain, is denied. Entitlement to a rating in excess of 40 percent, effective from July 6, 2017, for DDD with low back strain, is denied. Entitlement to an initial rating in excess of 10 percent for status post right knee medial meniscal repair with patellofemoral syndrome and degenerative arthritis, based on pain, tenderness, and limitation of motion, is denied. A separate 10 percent rating for the service-connected right knee disability, based on symptomatic removal of semilunar cartilage, is granted, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to an initial compensable rating for erectile dysfunction is denied. Entitlement to an initial compensable rating for scars right knee, status post right knee arthroscopic medial meniscectomy, is denied. Entitlement to a compensable rating for restless leg syndrome of the right lower extremity is denied. Entitlement to an initial compensable rating for restless leg syndrome, left lower extremity is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had a current hernia disability or any disability related to hernia surgery or manifested by testicular pain at any time during or approximate to the pendency of the claim. 2. The Veteran’s right wrist sprain has been manifested by painful and limited motion without ankylosis 3. Prior to July 6, 2017, the Veteran’s DDD with low back strain was manifested by pain and objective evidence of limitation of with pain; but did not result in forward flexion of 30 degrees or less, favorable ankylosis, or incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the previous 12 months. 4. Effective from July 6, 2017, the Veteran’s DDD with low back strain has been manifested by painful limitation of motion, but has not resulted in unfavorable lumbar ankylosis; incapacitating episodes, or comparable functional impairment; or objective evidence of any related neurological abnormalities. 5. The Veteran’s status post right knee medial meniscal repair with patellofemoral syndrome and degenerative arthritis has been manifested by chronic pain, arthritis, tenderness, swelling, limitation of motion with pain on motion, antalgic gait, pain on weight-bearing, as well as reports of flare-ups with pain and functional loss, and limitations on activities including walking and standing. 6. Resolving reasonable doubt in favor of the Veteran, his service-connected right knee disability has been manifested by symptoms related to removal of semilunar cartilage including episodes of locking and swelling/effusion into the joint 7. The Veteran’s erectile dysfunction has resulted in loss of erectile power, but has not been manifested by penile deformity 8. The Veteran’s scars, right knee status post right knee arthroscopic medial meniscectomy, are linear, not painful or unstable, each measure 1 centimeters (cm.) by 0.3 cm., and do not result in limitation of function 9. The Veteran’s restless leg syndrome, right lower extremity, has been manifested by subjective symptoms of tossing and turning all night and being tired and exhausted the next day, but no objective clinical findings consistent with or approximating mild incomplete neuralgia. 10. The Veteran’s restless leg syndrome, left lower extremity, has been manifested by subjective symptoms of tossing and turning all night and being tired and exhausted the next day, but no objective clinical findings consistent with or approximating mild incomplete neuralgia. CONCLUSIONS OF LAW 1. The criteria for service connection for hernia condition status-post surgery with bilateral testicular pain have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for an initial rating in excess of 20 percent, prior to July 6, 2017, for DDD with low back strain, have not been met. 38 U.S.C. §§ 1155, 5107 38 C.F.R. §§ 4.1, 4.2, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5243. 3. The criteria for a rating in excess of 40 percent for, effective from July 6, 2017, for DDD with low back strain, have not been met. 38 U.S.C. §§ 1155, 5107 38 C.F.R. §§ 4.1, 4.2, 4.40, 4.45, 4.59, 4.71a, DC 5243. 4. The criteria for an inital rating in excess of 10 percent for right wrist sprain have not been met. 38 U.S.C. §§ 1155, 5107 38 C.F.R. §§ 4.1, 4.2, 4.40, 4.45, 4.59, 4.71a, DCs 5024-5215. 5. The criteria for an initial rating in excess of 10 percent for status post right knee medial meniscal repair, with patellofemoral syndrome and degenerative arthritis, based on pain, tenderness, and limitation of motion, have not been met. 38 U.S.C. §§ 1155, 5107 38 C.F.R. §§ 4.1, 4.2, 4.40, 4.45, 4.59, 4.71a, DC 5003, 5260. 6. The criteria for a separate 10 percent rating for the service-connected right knee disability, based on symptoms related to removal of semilunar cartilage, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.71a, DC 5259. 7. The criteria for an initial compensable for erectile dysfunction have not been met. 38 U.S.C. §§ 1155, 5107 38 C.F.R. §§ 4.1, 4.2, 4.115b, DC 7522. 8. The criteria for an initial compensable rating for restless leg syndrome, right lower extremity, have not been met. 38 U.S.C. §§ 1155, 5107 38 C.F.R. §§ 4.1, 4.2, 4.124a, DC 8721. 9. The criteria for an initial compensable for restless leg syndrome, left lower extremity, have not been met. 38 U.S.C. §§ 1155, 5107 38 C.F.R. §§ 4.1, 4.2, 4.124a, DC 8721. 10. The criteria for an initial compensable for scars, right knee status post right knee arthroscopic medial meniscectomy, have not been met. 38 U.S.C. §§ 1155, 5107 38 C.F.R. §§ 4.1, 4.2, 4.40, 4.45, 4.59, 4.118, DC 7805. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from November 1988 to November 2011. 1. Entitlement to service connection for a hernia condition status post surgery with testicular pain. The Veteran contends he has been experiencing testicular and groin pain since his hernia surgery in service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1113; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. Service connection has already been granted for a related scar, right lower abdomen, status post surgery. However, in view of the foregoing, and lacking a current diagnosis, the cornerstone element of service connection has not been met, and service connection for a hernia condition is not warranted. Brammer v. Derwinski, 3 Vet. App. 223 (1992). The Board concludes that the Veteran does not have a current diagnosis of a hernia disability, nor has recurrence of a hernia been shown, at any time during the pendency of the claim or recent to the filing of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Review of the record includes STRs showing that on a discharge examination in 2011, it was noted that the Veteran had chronic pain in the right groin due to inguinal repair. At that time, he reported he had hernia repair surgery in 2002, and still had pain at the surgery site. On a VA pre-discharge examination in July 2011, the Veteran reported being diagnosed with status right herniorrhaphy after having hernia surgery in 2002. He reported pain in the testicles, at the surgery site, during intercourse, and when pressure was applied to the area. The diagnosis was status post right herniorrhaphy with residual scar. The subjective factors included occasional pain with sex, and the objective factors included well-healed scar. In a statement submitted with his October 2017 substantive appeal (VA Form 9), the Veteran reported having hernia repair surgery in 2002 and dealing with groin pain since then. He was told by hospital personnel that they used wire mesh during the hernia repair surgery, but had had no luck getting records of that. He reported constant pain in the testicles and lower/upper groin. The Board acknowledges that the Veteran has described symptoms of groin and testicular pain, which he relates to the hernia surgery in service; however, no current disability is shown. There is also no evidence of persistent or recurrent symptoms of a hernia condition, other than pain, and no evidence showing that this groin and/or testicular pain has caused functional impairment. Subjective complaints of pain, in the absence of functional impairment, are insufficient to establish a current disability. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). While the Veteran is competent to report the pain symptoms he has experienced, he is not competent to provide a diagnosis in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Increased Rating Disability ratings are determined by application of the VA Schedule for Rating Disabilities, which 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 there must be emphasis upon the limitation of activity imposed by the disabling condition. 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 appellant working or seeking work. 38 C.F.R. § 4.2. 2. Entitlement to an initial rating in excess of 10 percent for right wrist sprain. The Veteran contends that he should be entitled to a rating in excess of 10 percent for his right wrist sprain which has been rated under DCs 5024-5215. Pursuant to DC 5024, tenosynovitis is rated based on limitation of the affected part as degenerative arthritis, which is evaluated under DC 5003. DC 5003 provides that arthritis established by x-ray findings will be rated on the basis of limitation of motion of the specific joint involved. When the limitation of motion of the specific joint involved is, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion. 38 C.F.R. § 4.71a. DC 5215 provides for a maximum 10 percent rating for both the major and minor extremity where there is limitation of motion of the wrist with dorsiflexion to less than 15 degrees or palmar flexion limited in line with the forearm. In order to warrant a rating in excess of 10 percent, ankylosis of the wrist must be shown. DC 5214 provides that where there is ankylosis of the wrist that is favorable in 20 degrees to 30 degrees of dorsiflexion, a 30 percent rating for the major extremity and a 20 percent rating for the minor extremity is warranted. Based upon a review of the record, the Board finds that a rating in excess of 10 percent for the Veteran’s right wrist strain is not warranted, as there has been no finding or indication of ankylosis. In that regard, on a VA examination in July 2011, the Veteran reported gradual right wrist pain, with weakness, stiffness, locking, tenderness, and pain. He denied swelling, heat, lack of endurance, fatigability, deformity, effusion, subluxation, or dislocation. He reported flare-ups up to 5 times per day, lasting an hour, at a severity level of 3 out of 10. He reported flare-ups were precipitated by physical activity and alleviated by rest, and that during flare-ups he experienced pain when pushing, lifting, and twisting, and limitation of motion when twisting or pushing. He also reported that his wrist condition had not resulted in any incapacitation in the past 12 months. Examination of the right wrist revealed tenderness, and range of right wrist motion was normal, with pain, and repetitive range of motion was possible, with no additional degree of limitation of motion or function. In a statement submitted with his October 2017 substantive appeal (VA Form 9), the Veteran reported he had limited painful motion of the right wrist and that the pain continued to worsen over the years. He reported the right wrist pain was unbearable and that it was hard to do everyday activities, including writing, because of severe pain, loss of movement, and flexibility of the right wrist. Review of the record shows complaints of right wrist pain, but is negative for any indication of ankylosis. Moreover, at the VA examination in 2011, although right wrist range of motion was normal, as there was pain on dorsiflexion with resulting functional impairment, a 10 percent rating was assigned despite the fact that the Veteran did not meet the criteria for such a rating under DC 5215. 3. Entitlement to an initial rating in excess of 20 percent, prior to July 6, 2017, and a rating in excess of 40 percent, effective from July 6, 2017, for DDD with low back strain. The Veteran contends he should be entitled to higher ratings prior to July 6, 2017, and effective from July 6, 2017, for his DDD with low back strain, which has been rated under DC 5243, for intervertebral disc syndrome (IVDS). In a statement received in October 2017, the Veteran stated that since service he had experienced severe daily low back pain and did not have any strength in his low back, despite having physical therapy, seeing specialists, and undergoing various procedures. He contended that because of the low back pain he struggled every day to play with his children and grandchildren, noting that he had sharp pains in his lower back that caused balance issues and for him to drop to his knees unexpectedly at times. DC 5243 provides that IVDS is to be rated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. The Formula for Rating IVDS Based on Incapacitating Episodes provides that a 20 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes. Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Prior to July 6, 2017 The Veteran contends that he should be entitled to an initial rating in excess of 20 percent prior to July 6, 2017, for his service-connected DDD with low back strain. On a VA examination in July 2011, the Veteran reported he could walk without limitation and had not experienced falls, fatigue, or paresthesias due to his spinal condition, but did report having stiffness, weakness, spasms, decreased motion, and numbness. He denied related bowel or bladder problems. He reported constant moderate low back pain since 2004, which traveled down the back of his legs, was exacerbated by activity, and was relieved by rest and pain medicine. He reported that during times of pain, he could function with medication. He also reported that during flare-ups, he experienced constant pain, weakness, and limitation of the joint, including an inability to lift objects, bend over, lean over, stand for extended periods of time, or run. He reported that in the past 12 months, his condition had not resulted in any incapacitation. Examination revealed no radiating pain on movement and no muscle spasm. There was tenderness at the lumbar sacral junction. There was no guarding of movement, weakness, atrophy, or ankylosis noted. Range of motion testing revealed flexion to 60 degrees with pain at 40 degrees, and extension to 20 degrees with pain at 10 degrees. Repetitive range of motion was possible, with no additional limitations including by pain, fatigue, weakness, lack of endurance, or incoordination. After reviewing the record prior to July 16, 2017, the Board finds that an initial rating excess of 20 percent for the Veteran’s service-connected low back disability is not warranted. The competent evidence of record does not show or approximate flexion of the thoracolumbar spine of 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine, or incapacitating episodes having a total duration of least four weeks, at any time during the appeal period. Rather, the Veteran’s low back has demonstrated flexion no worse than 60 degrees, with pain limiting range of motion to 40 degrees, and he denied any incapacitating episodes. With regard to limitation of motion, the Board notes that the objective findings for flexion do not approximate the criteria for a 40 percent rating, even considering the effects of pain and pain on motion. In that regard, the Board has considered the Veteran’s complaints of back pain and weakness, and flare-ups, as well as additional limitation of functioning resulting therefrom, including problems with lifting objects, bending/leaning over, standing for extended periods of time, and running. However, on the VA examination, repetitive range of motion was possible, with no additional limitations including by pain, fatigue, weakness, lack of endurance, or incoordination. In light of the foregoing, the Board finds that there is insufficient objective evidence to conclude that the Veteran’s back pain, limited motion, weakness, and other symptoms have been associated with such additional functional limitation as to warrant a rating in excess of 20 percent. 38 C.F.R. §§ 4. 40, 4.45, 4.59. The Board also notes that there has been no objective evidence of related neurological abnormalities during this period. Effective from July 6, 2017 The Veteran contends he should be entitled to a rating in excess of 40 percent effective from July 6, 2017, for his service-connected DDD with low back strain. On a VA examination in July 2017, the Veteran reported he used a back brace and cane to stay upright. It was noted that his condition was getting worse, and that he currently experienced constant sharp pain and dull deep pain at times. He reported having flare-ups and that when in bed he had to move in slow motion. He described the functional impairment of the thoracolumbar spine as inability to bend over without losing his balance, and inability to pick up grandkids due to no muscle strength. Range of motion testing (passive and active) revealed flexion to 30 degrees, extension to 5 degrees, with pain, and no additional loss of function or range of motion after three repetitions. There was no tenderness or guarding resulting in abnormal gait or abnormal spinal contour shown, as well as no ankylosis. He used a cane and brace constantly and walked with antalgic gait. It was noted that his back condition impacted his ability to work, because he cannot bend over without losing balance, needed a cane and back brace to stay up right, and he had a guarded antalgic gait. It was also noted that there was no objective evidence of pain when his back was used in a non-weight bearing position, After reviewing the record effective from July 16, 2017, the Board finds that the evidence does not support a higher rating for the Veteran’s service-connected low back disability. In that regard, the lay and objective evidence of record does not support a finding of ankylosis. Rather, when the Veteran was examined in 2017, he was able to demonstrate forward flexion of 30 degrees, with pain. His lay statements similarly do not indicate that there has been ankylosis. Moreover, while VA must in some circumstances consider functional impairment in addition to limitation of motion due to factors such as pain, weakness, premature or excess fatigability, and incoordination, this rule does not apply where, as here, the Veteran is receiving the maximum schedular evaluation based on limitation of motion and a higher rating requires ankylosis. Johnston v. Brown, 10 Vet. App. 8 (1997). A higher rating is therefore not warranted for the orthopedic manifestations of this service-connected low back disability. Even considering additional functional loss, however, the Board finds that the effects do not more nearly approximate ankylosis of the lumbar spine. The Board also notes that the Veteran does not assert, and the evidence does not show, he been prescribed bed rest or experienced incapacitating episodes of at least 6 weeks during a 12 month period. Recognition is given to the Veteran’s reports of having flare ups as well as limitations in activities due to his low back pain, however, he has not been prescribed bed rest by a physician, which is a requirement for VA purposes. Finally, the Board notes that the neurological examination in 2017 was normal and the record does not otherwise show that a separate rating is warranted for any neurological component of the Veteran’s low back disability. 4. Entitlement to an initial rating in excess of 10 percent for status post right knee medial meniscal repair with patellofemoral syndrome and degenerative arthritis. The Veteran contends he should be entitled to a higher rating for his service-connected right knee medial meniscal repair with patellofemoral syndrome and degenerative arthritis, which has been rated as 10 percent disabling rating, pursuant to DCs 5003-5260. After reviewing the record, which includes VA examinations, as well as VA treatment records, the Board concludes that the preponderance of the competent evidence does not support the grant of a rating in excess of 10 percent pursuant to DC 5003 or DC 5260, but that a separate 10 percent rating is warranted pursuant to DC 5258. 38 C.F.R. § 4.71a. Full range of motion of the knee is from 0 degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71, Plate II. DC 5260 provides a 10 percent rating when flexion of the leg is limited to 45 degrees. A 20 percent rating is warranted when flexion of the leg is limited to 30 degrees. 38 C.F.R. § 4.71a. DC 5261 provides a 10 percent rating when extension of the leg is limited to 10 degrees. A 20 percent rating is warranted when extension is limited to 15 degrees. Id. Review of the records shows that on a VA examination in July 2011, the Veteran reported right knee pain, stiffness, swelling, giving way, lack of endurance, locking, and tenderness. He denied heat redness, fatigability, deformity, effusion, subluxation, and dislocation. He reported having flare-ups as often as four times a week, lasting one hour, and precipitated by physical activity and alleviated by rest and pain medications. During flare-ups, he experienced pain when standing and weight bearing and limitation of motion, including pain when bending and extending the leg. He reported difficulty with standing or walking for long periods of time without stiffness and pain, and that it hurt when walking stairs, exercising, or attempting to run. He also reported being unable to perform day to day activities such as playing with his children, lifting and moving things, and weight bearing. Examination of the right knee revealed tenderness and pain, but no edema, instability, abnormal movement, effusion, weakness, redness, deformity, guarding of movement, malalignment, or subluxation. There was also no locking pain, genu recurvatum, or crepitus. Range of right motion was assessed as normal, and repetitive range of motion did not cause additional limitation of motion or function. Joint stability testing was within normal limits for the right knee. An x-ray of the right knee was normal. The diagnosis was status post right knee medial meniscus with residual scar and patellofemoral syndrome. On a VA examination in February 2017, it was noted that right knee degenerative arthritis was diagnosed in 2014. The Veteran reported constant right knee pain, especially if he stood or walked for too long. Since service he had steroid injections and physical therapy, but no real relief. He denied flare-ups, but described functional impairment as pain with walking too long or climbing too many steps. Range of right knee motion testing revealed normal flexion and extension, with pain. Pain was noted on examination but did not result in or cause functional loss, and there was no tenderness on palpation, and no objective evidence of crepitus. He was able to perform repetitive use testing with no additional functional loss or range of motion. The examiner was unable to say, without mere speculation, whether pain, weakness, fatigability, or incoordination, significantly limited right knee functional ability with repeated use over a period of time, noting an inability to assess this. Right knee muscle strength was normal, and no atrophy noted. There was no history of recurrent subluxation or lateral instability, but the right knee swelled occasionally. Joint stability testing was normal. It was also noted that he had right knee meniscal tear with frequent episodes of joint pain. He occasionally used a right knee brace for pain. The examiner opined that the Veteran’s knee conditions impacted his ability to work, noting he could walk or stand for about 15-20 minutes, climb one flight of steps, and had pain with carrying heavy loads. An MRI of the right knee in 2014 showed a complex tear of the medial meniscus. It was noted he had right knee pain with weight-bearing, which limited motion to 110 degrees, but this did not result in functional loss. In a statement submitted with his October 2017 substantive appeal (VA Form 9), the Veteran reported having constant right knee pain, swelling for years before and after the torn meniscus surgery in service, balance issues due to right knee problems, being unable to stand for long periods without using a cane, issues with walking long distance or walking up and down stairs, and being unable to run because of right knee problems. He also reported that his last MRI showed a meniscal tear and that he thought that was why he had severe pain, swelling, limitation, and little flexibility. On review of the record, the Board notes that although the Veteran has complained of chronic knee pain, the limitation of right knee motion findings recorded do not meet the requirements for the next higher rating under DC 5260 or DC 5261, as flexion and extension were assessed as normal at the VA examinations in 2011 and 2017. Moreover, his right pain and additional functional limitations were considered in the assignment of the current 10 percent rating pursuant to DCs 5003-5260, in the absence of compensable limitation of motion. See 38 C.F.R. § 4.59. In that regard, the competent evidence of record shows that the Veteran’s service-connected right knee disability has been manifested by chronic pain, tenderness, swelling, limitation of motion, pain on motion, pain on weight-bearing, as well as flare-ups with pain and functional limitations, and limitations on daily activities including walking and standing. However, even with consideration of pain and functional limits, the manifestations of the service-connected right knee disability have not been associated with such additional functional limitation as to warrant increased compensation pursuant to provisions of 38 C.F.R. §§ 4.40, 4.45, or the holding in DeLuca v. Brown, 8 Vet. App. 202 (1995). Rather, his complaints of pain, swelling, and tenderness, and functional limitations are contemplated in the current 10 percent rating assigned under DCs 5003-5260. The Board has also considered whether additional separate ratings are warranted for the Veteran’s service-connected right knee disability. A separate rating for instability or subluxation of the right knee is not warranted pursuant to DC 5257. Although the Veteran occasionally wore a knee brace for pain, and at the VA examination in 2011 reported his right knee giving way, he denied subluxation or dislocation, and objective stability testing on VA examinations in 2011 and 2017 revealed normal findings. The Board notes that the Veteran has reported having locking in his knee but there was no indication this was frequent. While he reported swelling of the right knee, he denied effusion, and on objective examinations in February 2014 and on the VA examination in 2014, no effusion was shown objectively. Moreover, although it was noted at the VA examination in 2017 that the Veteran had a right knee meniscal tear with frequent episodes of joint pain, the record shows his knee pain has already been considered in the separate rating assigned under DCs 5003-5260. Therefore, the Board concludes there has not been competent evidence of or approximating frequent episodes of locking, pain, and effusion into the knee joint, and a separate rating under DC 5258 is not warranted. Finally, the Board also finds that the competent evidence of record reveals that the Veteran underwent right knee meniscectomy in service, and that his right knee remained symptomatic, to include findings of swelling, crepitus, and locking; thus resolving any reasonable doubt in his favor, a separate 10 percent rating is warranted under DC 5259, which provides for a maximum 10 percent rating when semilunar cartilage has been removed, but remains symptomatic. 5. Entitlement to an initial compensable rating for erectile dysfunction. The Veteran contends he should be entitled to a compensable rating for his erectile dysfunction. Erectile dysfunction is rated by analogy under 38 C.F.R. § 4.115b, DC 7522, which provides that deformity of the penis with loss of erectile power is rated as 20 percent disabling. While the record shows that the Veteran has experienced loss of erectile power, for which he takes medication, the record, which includes a VA examination in July 2011 and VA treatment records, does not show any finding of penile deformity. Thus, although he experiences loss of erectile power, as no penile deformity has been shown, a compensable rating under DC 7522 is not warranted. The Board also notes that although a compensable rating for his service-connected erectile dysfunction has been denied, the Veteran has been separately granted entitlement to special monthly compensation based on the loss of use of a creative organ. 38 U.S.C. § 1114(k); 38 C.F.R. § 3.350(a). 6. Entitlement to an initial compensable rating for scars right knee, status post right knee arthroscopic medial meniscectomy. The Veteran contends he should be entitled to a compensable rating for his right knee scars, status post right knee arthroscopic medial meniscectomy, which have been assigned a non-compensable rating pursuant to 38 U.S.C. § 4.118, DC 7805. Under DC 7805, which rates scars and other effects of scars evaluated under DCs 7800, 7801, 7802, and 7804, disabling effects not considered in a rating provided under the aforementioned diagnostic codes are to be evaluated under an appropriate diagnostic code. DC 7801 provides ratings for scars, other than the head, face, or neck that are deep and nonlinear. DC 7802 provides ratings for scars, other than the head, face, or neck that are superficial and nonlinear. DC 7804 provides ratings for one or more superficial scars that are painful or unstable on examination. On a VA examination in July 2011, the Veteran reported a right knee scar caused by surgery in February 2011, but indicated the scar was not painful, and he did not experience skin breakdown. He reported no other symptoms, and did not experience functional impairment due to the scar. Examination revealed three arthroscopic portal scars, all similar in size and description. It was noted the scars were linear, 1 cm. by.3 cm. in size, and not painful on examination. There was no skin breakdown, and it was noted this was a superficial scar with no underlying tissue damage. There was no inflammation or edema, and no keloid formation, and the scar was not disfiguring, and did not limit his motion or function. In considering the Veteran’s claim, the Board finds that as the Veteran’s arthroscopic scars of the right knee are linear, superficial, stable, and not painful, such scars do not warrant compensable ratings under DC 7801, 7802, 7804, 7805. Thus, the Veteran is not entitled to a compensable rating for surgical scars of the right knee, status post right knee arthroscopic medial meniscectomy, under any of the potentially applicable Diagnostic Code. 7. Entitlement to compensable ratings for restless leg syndrome of the right lower extremity and the left lower extremity. The Veteran contends he should be entitled to compensable ratings for restless leg syndrome of the right and left lower extremities. Based on a review of the record, however, the Board concludes that a compensable rating is not warranted for either restless leg syndrome, right lower extremity or the left lower extremity. The Veteran’s restless leg syndrome of the right and left lower extremities have been assigned 0 percent ratings by analogy under DCs 8799-8721. Hyphenated diagnostic codes indicate that a condition of the peripheral nerves (DC 8799) is rated under the criteria for neuralgia of the external popliteal nerve (DC 8721). DC 8721, concerning neuralgia of the external popliteal nerve, is subject to rating provisions of DC 8521, which provides that mild, incomplete paralysis warrants a 10 percent rating. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to a varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, moderate degree. 38 C.F.R. § 4.124a, DCs 8521, 8621, 8721. Neuralgia characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum rating equal to moderate incomplete paralysis. 38 C.F.R. § 4.124. On a VA examination in July 2011, it was noted that the Veteran had restless leg syndrome for 4 or 5 years, but had no tingling or numbness, abnormal sensation, loss of sensation, pain, weakness, or paralysis of the affected body parts. He reported nocturnal leg movement, and that functional impairment included tiredness and inability to stay awake or alert at times. In a statement submitted with his October 2017 substantive appeal (VA Form 9), the Veteran reported he had been dealing with restless leg syndrome since service because of different sleep patterns. He reported he tosses and turns all night, and as a result is tired and exhausted throughout the day. He stated that several medications has been prescribed, but none worked effectively (Continued on the next page)   After reviewing the record, the Board concludes that compensable ratings for restless leg syndrome, right and left lower extremities, are not warranted. Although the Veteran reported his restless leg syndrome affects his sleep, on the VA examination, he denied tingling or numbness, abnormal sensation, loss of sensation, pain, weakness, or paralysis of the affected body parts. Additionally, on neurological examination of the lower extremities, motor function was within normal limits, sensory examination was intact, reflexes were normal, and peripheral nerve involvement was not evident. Accordingly, a compensable rating is not warranted under DC 8721 as there has been no showing of any objective clinical findings consistent with or approximating mild incomplete neuralgia. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Casula, 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.