Citation Nr: 20008375 Decision Date: 01/31/20 Archive Date: 01/31/20 DOCKET NO. 16-07 607 DATE: January 31, 2020 ORDER Entitlement to an initial rating in excess of 10 percent for left knee disability is denied. Entitlement to an initial rating in excess of 10 percent for right knee disability is denied. Entitlement to a separate initial rating of 10 percent rating for right knee status post meniscal tear surgery, under DC 5259, is granted. FINDINGS OF FACT 1. The Veteran’s bilateral knee disability has been manifested primarily by pain, decreased flexion no less than 110 degrees, and full extension to zero degrees. 2. The evidence demonstrates a history of right knee meniscal tear surgery with symptoms of locking, pain, and effusion. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for right knee disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.7, 4.40, 4.45, 4.71a, Diagnostic Code (DC) 5260 and 5261. 2. The criteria for an initial rating in excess of 10 percent for left knee disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.7, 4.40, 4.45, 4.71a, DC 5260 and 5261. 3. The criteria for an initial 10 percent rating for right knee status post meniscal surgery have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DC 5259. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1988 to May 2009. In February 2019, the Board remanded the claim for further development. Increased Rating Disability evaluations are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Court has held that a veteran may not be compensated twice for the same symptomatology as “such a result would over compensate the claimant for the actual impairment of his earning capacity.” Brady v. Brown, 4 Vet. App. 203, 206 (1993). This would result in pyramiding, contrary to the provisions of 38 C.F.R. § 4.14. The Court has acknowledged, however, that when a veteran has separate and distinct manifestations attributable to the same injury, he should be compensated under different DCs. Esteban v. Brown, 6 Vet. App. 259 (1994); Fanning v. Brown, 4 Vet. App. 225 (1993). Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be “staged.” Hart v. Mansfield, 21 Vet. App. 505 (2007) (staged ratings are appropriate when the factual findings show distinct period where the service-connected disability exhibits symptoms that would warrant different ratings.); see also Fenderson v. West, 12 Vet. App. 119, 126 (2001). A disability may require re-evaluation in accordance with changes in a veteran’s condition. It is thus essential, in determining the level of current impairment, that the disability be considered in the context of the entire recorded history. 38 C.F.R. § 4.1. The Veteran’s right knee disability is rated under DC 5003-5260 and his left knee under DC 5260. Diagnostic Code 5003 (arthritis, degenerative) provides that if degenerative arthritis is established by X-rays, then the disability is rated under the appropriate diagnostic code for the specific joint limitation of motion. When the rating of a specific joint is noncompensable under the codes pertaining to limitation of motion, a rating of 10 percent is for application for each major joint 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. See 38 C.F.R. § 4.71a, DC 5003. Under DC 5257, slight recurrent subluxation or lateral instability warrants a 10 percent rating, moderate recurrent subluxation or lateral instability warrants a 20 percent rating, and severe recurrent subluxation or lateral instability warrants a 30 percent rating. 38 C.F.R. § 4.71a. The words “slight,” “moderate,” and “severe” as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. Under Diagnostic Code 5258, a 20 percent rating is assigned for a knee with dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint. 38 C.F.R. § 4.71a. DC 5259 provides a 10 percent evaluation for symptomatic removal of semilunar cartilage. Id. Diagnostic Code 5260 evaluates limitation of flexion as follows: flexion limited to 60 degrees warrants a noncompensable rating; flexion limited to 45 degrees warrants a 10 percent rating; flexion limited to 30 degrees warrants a 20 percent rating; and flexion limited to 15 degrees warrants a 30 percent rating. See 38 C.F.R. § 4.71a, DC 5260. Diagnostic Code 5261 evaluates limitation of extension as follows: extension limited to 5 degrees warrants a noncompensable rating; extension limited to 10 degrees warrants a 10 percent rating; extension limited to 15 degrees warrants a 20 percent rating; extension limited to 20 degrees warrants a 30 percent rating; extension limited to 30 degrees warrants a 40 percent rating; and extension limited to 45 degrees warrants a 50 percent rating. See 38 C.F.R. § 4.71a, DC 5261. Separate evaluations may be assigned for limitation of flexion and extension of the same joint. See VAOPGCPREC 09-04 (September 17, 2004). Specifically, when a Veteran has both a compensable level of limitation of flexion and a compensable level of limitation of extension of the same leg, the limitations must be rated separately to adequately compensate for functional loss associated with injury to the leg. Id. A claimant who has arthritis or limitation of motion and instability of a knee, may be rated separately under DCs 5003 and 5257. Any separate rating must be based on additional disabling symptomatology that meets the criteria for a compensable rating. VAOPGCPREC 23-97 (1997); VAOPGCPREC 9-98 (1998). Separate ratings under DC 5260 for limitation of flexion and DC 5261 for limitation of extension, may be assigned for disability of the same knee; however, any separate rating must be based on additional disabling symptomatology that meets the criteria for a compensable rating. VAOGCPREC 9-2004. Compensating a claimant under DC 5257 and DC 5258 (dislocated cartilage with locking pain and effusion) also does not constitute pyramiding. See Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that ratings under DC 5257 and 5260 and 5261 do not necessarily preclude ratings under DCs 5258 and 5259). The normal range of motion of the knee is 0 degrees of extension and 140 degrees of flexion. See 38 C.F.R. § 4.7, Plate II. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of “the normal working movements of the body,” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40). 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158 (2016). Associated objective neurologic abnormalities are evaluated separately under an appropriate diagnostic code. See 38 C.F.R. § 4.71a (General Formula, Note 1). Analysis The Veteran contends that his bilateral knee disability is more severe than the ratings depict. In September 2009, the Veteran was afforded a VA examination to determine the nature and etiology of his bilateral knee disability. The Veteran stated that he strained his right knee in 1998. Then, in 2000, he underwent a field reconstruction, and, in 2003, he had another reconstruction with debridement. At the time of the exam, the Veteran reported discomfort in the right knee, especially when climbing, kneeling, and squatting. The examiner noted no sign of instability. The Veteran denied any impairment of the left knee. The examiner stated that there was no evidence of adverse impact on activities of daily living or the Veteran’s current occupation. The examiner diagnosed the Veteran with degenerative joint disease (DJD) and internal derangement, right knee, status post anterior cruciate ligament (ACL) reconstruction and left knee chondromalacia. The examiner noted no signs of inflammation, flare-ups, or functional limitation on standing or walking. On examination, the Veteran walked briskly in the hallway without assistive device, and his gait and posture were normal. The Veteran’s bilateral knee forward flexion was to 135 degrees and extension was to zero degree. There was no pain in range of motion (ROM) and no loss of motion on repeated maneuver after three repetitions. The Veteran had crepitation on ROM in his right knee. He did not have mediolateral instability. There was no anterior-posterior drawer sign, and McMurray and Lachman tests were negative. There was no localized tenderness, swelling, deformity, or instability present in the left knee. Bilaterally, there was no evidence of uneven weightbearing of the joint or callosity. There was also no ankylosis, leg length discrepancy, inflammatory arthritis, or prosthesis. Regarding Deluca assessment, the examiner stated there was no evidence of additional loss of ROM after repetitive use due to pain, weakness, fatigue, lack of endurance, or incoordination. In May 2011, the Veteran was seen at the orthopedic clinic for left knee instability and pain. The Veteran stated that he suffered an acute injury in March 2011. At the time of the evaluation, the Veteran denied any significant pain and instability in his knee. The Veteran reported a sensation that his knee gave out on him when walking at times. He denied any significant pain under the kneecap and significant medial or lateral pain. He also denied numbness, paresthesias, or weakness in his left lower extremity. The Veteran’s forward flexion was from zero to 130 degrees and extension from 130 degrees to zero. His knee was stable to varus and valgus stress testing. McMurray’s test was negative. He had 1A Lachman, and he had a pivot glide. He had no significant medial or lateral joint line tenderness and no tenderness with motion of his patella. His talar grind and dial test were negative. His neurovascularly was intact, distally, with palpable dorsalis pedis and posterior tibialis pulses. Sensation was intact to light touch to sural, saphenous, superficial peroneal, deep peroneal, and tibial nerve distributions. He had 5/5 EHL, FHL, tibialis anterior, and gastrosoleus function and mild weakness of the left quadriceps muscle. In his February 2016 Substantive Appeal, the Veteran stated that he only suffered from pain in his left knee, so, the ROM should have been within proper limits. However, he suffered two right knee ligament repairs. He stated that various activities caused swelling and locking, and he was unable to be in a bent position requiring adverse knee flexion for more than a couple of minutes without causing aggravation and severe pain. He stated during his last VA examination, his flexion may have been within the proper ROM; however, his knees were manually forced into the measured position and not achieved naturally. Additionally, the record incorrectly identified the left knee as the knee with the meniscus removal. In November 2016, the Veteran was afforded a VA examination to determine the severity of his bilateral knee disability. The Veteran stated that he injured his knees in 2000. In 2000 and 2003, he had surgery on his right knee. At the time of the exam, he stated that his knees hurt on and off. The examiner confirmed the Veteran’s right knee arthritis with internal derangement and status post anterior cruciate ligament (ACL) reconstruction and left knee chondromalacia with degenerative arthritis diagnoses. The Veteran reported flare-ups, to include knee pain. He did not report functional loss or impairment. The Veteran’s bilateral knee ROM was all normal, i.e., forward flexion was from zero to 140 degrees and extension from 140 to zero degrees. Pain was noted on flexion but did not result in/cause functional loss. There was no evidence of pain with weight bearing, no objective evidence of crepitus, and no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive use testing with at least three repetitions. There was no additional loss of function or ROM after three repetitions. The Veteran was not examined immediately after repetitive use over time or during a flare-up; as such, the examination was neither medically consistent or inconsistent with the Veteran’s statements describing functional loss with repetitive use over time or during a flare-up. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time or during a flare-up. There were no additional contributing factors of the disability. Muscle strength testing was normal with no reduction in muscle strength or muscle atrophy. He did not have ankylosis. The Veteran did not have recurrent subluxation or a history of lateral instability. Joint stability testing was normal. The Veteran did not have a history of recurrent effusion, and he did not have or ever had recurrent patellar dislocation, “shin splints” (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome or any other tibial or fibular impairment. He did not now have or had ever had a meniscus condition. In 2000 and 2003, the Veteran had meniscectomy with residuals of the surgery to include pain and scars. The scar was 6 x 0.2 cm and 4 x 0.2 cm. There were no pertinent physical findings, complications, conditions, signs, or symptoms related to his condition. He did not use any assistive devices as a normal mode of locomotion, and functioning was no so diminished that amputation with prothesis would equally serve the Veteran. The Veteran’s condition did not impact his ability to work. In May 2019, the Veteran was afforded another VA examination to determine the severity of his bilateral knee disability. The Veteran stated that he injured his knees playing soccer. He did not report any specific trauma or injury to the left knee, only multiple strains. However, he tore his right knee ACL and had surgical repair in 2003. Since service, the Veteran reported constant pain which was worse with squatting, bending, kneeling, descending stairs, and with prolonged standing and walking. His bilateral knees buckled approximately one to two times a week. Increase walking caused his knees to swell, intermittently. The Veteran used Advil and Aleve to relieve the pain and ice and elevation for swelling. The examiner diagnosed the Veteran with right knee meniscal tear with arthritis with internal derangement and status post-ACL reconstruction and meniscectomy. The Veteran was also diagnosed with left knee instability, degenerative arthritis with history of ACL tear and instability. He reported flare-ups. He also reported functional loss or functional impairment of his knees, to include pain with prolonged standing. The Veteran’s bilateral knee flexion was from zero to 110 degrees and extension from 110 to zero. LROM made prolonged walking and standing difficult. Pain was noted on flexion and caused functional loss. 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 but objective evidence of pain with weight bearing. The Veteran was able to perform repetitive-use testing with at least three repetitions. There was no additional loss of function or ROM after three repetitions. The Veteran was not examined immediately after repetitive use over time; as such, the examination was medically consistent with the Veteran’s statements describing functional loss with repetitive use over time. Pain, weakness, fatigability, and incoordination did not significantly limit functional ability with repeated use over a period of time. The examiner stated, following further review of the Veteran’s records and considering the Veteran’s subjective complaints and objective exam findings, and given the examiner’s clinical knowledge and medical expertise, there remained no rational basis to make a notation regarding any additional losses of function or motion with repeated use over time since the Veteran was not examined immediately after repetitive use over time. The examination was not conducted during a flare-up; therefore, the examination was neither medically consistent or inconsistent with the Veteran’s statements describing functional loss during a flare up. There were no additional contributing factors of the disability. The Veteran’s bilateral knee muscle strength testing revealed active movement against some resistance. There was reduction in muscle strength, and the reduction was due entirely to his bilateral knee disabilities. There was no muscle atrophy, ankylosis, or recurrent subluxation. The Veteran had lateral instability (referring only to the knee joint itself (tibio-femoral). He had slight lateral instability in the right knee and moderate instability in his left knee. The Veteran had a history of recurrent effusion which caused intermittent swelling that was reduced with ice and elevation. His right knee joint instability testing was normal. His left knee joint stability testing revealed 1+ in the anterior instability (Lachman test). The Veteran had shin splints (medical tibial stress syndrome), but the condition did not affect his knee or ankle ROM. At the time of the exam, the Veteran denied shin splints. The Veteran had right knee meniscal tear (semilunar cartilage) condition with frequent episodes of joint pain and effusion. He had right knee surgery, meniscectomy, in 2000 and 2004. Residue of the meniscectomy included constant pain which was worse with squatting, bending, kneeling, descending stairs, and prolonged standing and walking. He also had frequent episodes of joint pain and effusion in his left knee. His bilateral knees buckled approximately one to two times a week. Increase walking caused his knees to swell intermittently. There were no other pertinent findings, complications, condition, signs, or symptoms related to the Veteran’s bilateral knee conditions. The Veteran had a 5 cm X 0.5 cm right knee distal scar. He also had a 4.5 cm X 0.5 cm right knee medical scar and 1 cm X 0.5 cm scar on his right knee proximal. The scars were not painful or unstable or had a total area equal to or greater than 39 square cm (6 sq. inches), or located on his head, face, or neck. The Veteran did not use an assistive device as a normal mode of locomotion, and functioning was not so diminished that amputation with prosthesis would equally serve the Veteran. Imaging revealed bilateral degenerative or traumatic arthritis. Bilaterally, there was objective evidence of pain on passive ROM testing and objective evidence of pain when the joint was used in non-weight bearing. The Veteran’s November 2016 right knee X-ray revealed a small metal plate on the lateral distal surface of the femur, a screw in the proximal tibia, and evidence of a pull-through operation. Otherwise, the Veteran’s right knee was negative. His left knee X-ray revealed moderate narrowing in the lateral compartment that probably represented degenerative change. Otherwise, his left knee was negative. An April 2011 left knee MRI revealed a complete tear of the ACL. Bilaterally, the Veteran’s disability affected his ability to work. In the past 12 months, he lost between zero to one week of work. The Veteran’s left knee degenerative arthritis with history of ACL tear and instability, and his right knee arthritis and status post ACL and meniscectomy repair caused difficulty with prolonged walking and standing. Based on the evidence of record, the Board finds that a rating in excess of 10 percent for the Veteran’s bilateral knee condition is not warranted. There is no evidence that the Veteran has had limitation of bilateral knee flexion to 30 degrees or less or limitation of extension to 15 degrees or more. The record shows that, at worse, his bilateral knee flexion was to no less than 110 degrees. As such, the criteria for a disability rating in excess of 10 percent under DC 5260 are not met. The Board also notes that the Veteran’s extension was normal; therefore, a separate rating under 5261 is not warranted. The Board recognizes that, under DeLuca v. Brown, 8 Vet. App. 202 (1995), VA must consider “functional loss” of a musculoskeletal disability separately from consideration under the DCs. “Functional loss” may occur as a result of weakness or pain on motion. Here, the evidence shows that pain has been a constant and predominant symptom. The Board notes that the May 2019 VA examiner noted objective evidence of pain with weight bearing, objective evidence of pain on passive ROM testing, and objective evidence of pain when the joint was used in non-weight bearing. Pain was noted on flexion and caused functional loss. However, given the extent of bilateral knee motion, there is no evidence of a disability picture that is commensurate to a limitation of flexion to the extent necessary to establish entitlement to a higher disability rating, even after taking his reported pain into full consideration. See DeLuca, 8 Vet. App. at 204 -07; 38 C.F.R. §§ 4.40, 4.45, 4.71a, DC 5260 and 5261. In this regard, the Board emphasizes that a 10 percent disability rating under DC 5260 already contemplates an otherwise non-compensable degree of limitation of motion verified by objective evidence of symptoms such as painful motion. Further, the Board has considered the potential application of the other provisions of 38 C.F.R., Parts 3 and 4. Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The Board notes that other criteria for rating knee disabilities are provided under DCs 5256 (for ankylosis) and 5262 (for impairment of the tibia and fibula). The evidence does not show that the Veteran’s bilateral knee disability manifestations has included ankylosis. The Board notes that the May 2019 VA examiner stated that the Veteran had shin splints. However, the condition did not affect the Veteran’s knee or ankle ROM, and at the time of the exam, the Veteran denied shin splints. Therefore, the Board finds that separate or higher ratings under DCs 5256 and 5262 are not warranted. The Board notes that the Veteran had right knee meniscal repair surgery in 2000 and 2003/04. The Veteran’s right knee disability was manifested by frequent episodes of joint pain, swelling, and effusion. Under DC 5259, a maximum 10 percent rating is warranted for removal of the semilunar cartilage (meniscus), which is not encompassed by the rating criteria under DC 5260 (limitation of flexion). See Lyles v. Shulkin, 29 Vet. App. 107 (2017). Therefore, granting separate ratings under both DC 5259 and DC 5260 would not violate the rule against pyramiding. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261 (1994) (the critical element is that none of the symptomatology for any condition is duplicative of or overlapping with the symptomatology of the other condition). Accordingly, the Board finds the Veteran is entitled to a separate rating under DC 5259 (cartilage, semilunar, removal of, symptomatic). As the Veteran has been granted a separate rating for his right knee meniscal condition under DC 5259, a rating under DC 5258 is precluded. The Board notes that some potential symptoms related to meniscal impairment are listed in DC 5258, which pertains to a dislocated (or torn) meniscus and provides for a 20 percent rating based on frequent symptoms of locking, pain, and effusion into the joint. In this case, however, because the Veteran’s right knee meniscus was removed during the 2000 and 2003/04 meniscectomy, and the Veteran has had continued symptoms related to the meniscus, his meniscal condition is properly rated under DC 5259. Thus, a rating under DC 5258 is not warranted. Additionally, the Veteran has scars related to his right knee condition; however, there was no objective evidence that the scars were painful, unstable, or had a total area equal to or greater than 39 square cm (6 square inches). Therefore, separate ratings under DC 7800-7805 are not warranted. On March 8, 2011, the Veteran was granted service connection for left knee instability and assigned a 10 percent rating under DC 5257, and in May 2019, the rating was increased to 20 percent. Additionally, in May 2019, he was granted service connection for right knee instability and assigned a 10 percent rating under DC 5257. As noted above, a rating in excess of 10 percent (20 percent) under DC 5257 requires “slight” symptoms of instability, a moderate recurrent subluxation or lateral instability warrants a 20 percent rating, and severe recurrent subluxation or lateral instability warrants a 30 percent rating. 38 C.F.R. § 4.71a. Regarding the Veteran’s left knee, during his May 2011 evaluation, the Veteran reported left knee instability and pain. At the time of the evaluation, the Veteran denied any significant instability. During his November 2016 VA examination, his joint stability tests were normal. There was also no clinical evidence of recurrent subluxation or lateral instability at the examination. Additionally, muscle strength testing was normal with no reduction in muscle strength or muscle atrophy. The Board notes that although the joint stability tests have been negative, the Veteran’s statement regarding the sensation that his knee gave out on him when walking, is competent and credible. As such, from May 8, 2011, the Board finds that the Veteran’s left knee instability was slight in severity, and a rating in excess of 10 percent is not warranted. Turning to whether a disability rating in excess of 10 percent for right knee instability and in excess of 20 percent for left disability instability is warranted, the Board finds that the objective medical evidence does not warrant a disability rating in excess of 10 percent for right knee instability and 20 percent for the left instability. Here, the evidence does not indicate that the Veteran suffered from a moderate right knee instability or severe left knee instability. The May 2019 VA examiner indicated there was slight lateral instability in the right knee and moderate instability in the left knee. Thus, from May 29, 2019, a disability rating in excess of 10 percent for the right knee instability and 20 percent for the left knee instability under DC 5257 is not warranted. Under DC 5003, degenerative arthritis established by X-ray findings is rated on the basis of limitation of motion under the appropriate DCs for the specific joint or joints involved. The Veteran has a current diagnosis of bilateral knee arthritis, as confirmed by X-ray evidence. However, the Veteran has already received a compensable rating under the appropriate DC. Assigning a separate rating under DC 5003 would constitute pyramiding, as DC 5260 rates based on limitation of motion, including limitation of motion caused by pain, and this includes arthritic pain. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Further, the rating criteria under DC 5003 specifically directs that degenerative arthritis be rated on the basis of limitation of motion under the appropriate DCs for the specific joint or joints involved. See 38 C.F.R. § 4.71a DC 5003. The Board has considered the Veteran and his representative’s statements regarding the severity of the Veteran’s bilateral knee disabilities. However, as lay persons, they do not have the training or expertise to render a competent opinion which is more probative than the VA examiners’ opinions on this issue, as this is a medical determination that is complex. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994)). Thus, the lay opinions by themselves are outweighed by the VA examiners’ findings and the other evidence of record. See id.; see also King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (affirming the Court’s conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert’s opinion more probative on the issue of medical causation). In sum, the preponderance of the evidence is against the assignment of increased ratings for the Veteran’s bilateral knee disabilities. As such, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Moore 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.