Citation Nr: 20076972 Decision Date: 12/03/20 Archive Date: 12/03/20 DOCKET NO. 17-52 797 DATE: December 3, 2020 ORDER An initial evaluation in excess of 10 percent for right knee arthritis is denied. A separate 20 percent evaluation for right knee meniscal tear for the period beginning January 9, 2016, but no earlier, is granted, subject to the laws and regulations governing the payment of monetary awards. A separate 10 percent evaluation for right knee instability prior to June 20, 2019, is granted. An evaluation in excess of 20 percent for right knee instability for the period beginning June 20, 2019, is denied. A compensable evaluation for a right knee scar prior to June 20, 2019, and in excess of 10 percent thereafter, is denied. FINDING OF FACT 1. For the entire appeal period, the Veteran’s right knee meniscal tear is manifested by subjective complaints of pain, with flexion limited to 120 degrees and extension limited to 5 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, did not result in ankylosis, impairment of the tibia or fibula, or genu recurvatum. 2. As of January 9, 2016, the Veteran’s right knee meniscal tear was manifested by dislocation of semilunar cartilage with frequent episodes of locking, pain, and effusion. 3. For the appeal period prior to June 20, 2019, the Veteran’s right knee instability resulted in slight recurrent subluxation or lateral instability. 4. As of June 20, 2019, the Veteran’s right knee instability resulted in moderate recurrent subluxation or lateral instability; at no time during the appeal period does the evidence demonstrate severe recurrent subluxation or lateral instability of the right knee. 5. As of August 26, 2014, the Veteran had one scar of the right knee that was not painful. 6. As of June 20, 2019, the Veteran had one scar of the right knee, which was painful. 7. For the entire appeal period, the Veteran’s scar of the right knee was not unstable, did not affect an area of at least 6 square inches (929 square cms), or result in any disabling effects. CONCLUSION OF LAW 1. The criteria for an initial evaluation in excess of 10 percent for right knee arthritis 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 Code 5003-5261. 2. Beginning January 9, 2016, but no earlier, the criteria for a 20 percent rating for right knee meniscal tear 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 Code 5258. 3. For the period prior to June 20, 2019, the criteria for a separate 10 percent evaluation for right knee instability 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 Code 5257. 4. For the period beginning June 20, 2019, the criteria for an evaluation in excess of 20 percent for right knee instability 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 Code 5257. 5. The criteria for an initial compensable evaluation for the period prior to June 20, 2019, and in excess of 10 percent thereafter, for scar 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, 4.118, Diagnostic Code 7802, 7804. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1961 to August 1965. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in September 2015 by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2018, the Board remanded the claim for an initial rating in excess of 10 percent for right knee meniscal tear for further development. While on remand, in an August 2020 rating decision, the Agency of Original Jurisdiction (AOJ) awarded a separate rating for instability of the right knee evaluated as 20 percent disabling, effective June 20, 2019; a separate raring for a scar of the right knee evaluated as 0 percent disabling, effective August 26, 2014; and a separate rating for a painful scar of the right knee evaluated as 10 percent disabling, effective June 20, 2019. While the Veteran did not enter a notice of disagreement with regard to the propriety of the separate ratings for right knee instability and scar of the right knee, such issues are part and parcel of his claim for an increased rating for his right knee meniscal tear disability. The claim now returns for additional development. The Board notes that additional evidence, to include a medical opinion, was added to the claims file subsequent to the August 2020 supplemental statement of the case. However, as the evidence is not pertinent to the instant claims on appeal, a waiver or remand for RO consideration of the evidence is not necessary. See 38 C.F.R. § 20.1304(c). Disability ratings are determined by applying a schedule of ratings that 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 the limitation of activity imposed by the disabling condition should be emphasized. 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 veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation 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. Right Knee Disability Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weightbearing and non-weightbearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). By way of background, the Veteran’s right knee meniscal tear has been assigned a 10 percent rating based on evidence of painful motion, pursuant to Diagnostic Code 5257. Thereafter, in an August 2020 rating decision, the AOJ recharacterized the Veteran’s disability as right knee degenerative arthritis with a history of patellectomy, pursuant to Diagnostic Code 5261. Additionally, the AOJ awarded a separate rating of 20 percent for the right knee instability, pursuant to Diagnostic Code 5257, which will be discussed below. In this regard, the assignment of a particular diagnostic code is “completely dependent on the facts of a particular case” and the Board can choose the diagnostic code to apply so long as it is supported by reasons and bases as well as the evidence. Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, diagnosis, and demonstrated symptomatology. Any change in diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). It is permissible to switch diagnostic codes to reflect more accurately a claimant’s current symptoms. See also Read v. Shinseki, 651 F. 3d 1296, 1302 (Fed. Cir. 2011) (holding that service connection for a disability is not severed when the diagnostic code associated with it is changed to determine more accurately the benefit to which a veteran may be entitled). In the instant case, while the Veteran’s right knee meniscal tear with degenerative arthritis was originally rated pursuant to Diagnostic Code 5257, which pertains to impairment of the knee. A June 2017 rating decision notes that such rating is based on painful motion of the knee. Subsequent to the initial award of service connection, the June 2019 VA examination reflects a diagnosis of degenerative arthritis of the right knee, which is evaluated under Diagnostic Code 5003, which, as will be discussed below, provides that degenerative arthritis is rated on the basis of limitation of motion of the specific joint involved. Accordingly, in the August 2020 supplemental statement of the case, the AOJ recharacterized the Veteran’s disability as right knee arthritis with history of patellectomy pursuant to Diagnostic Code 5261, which pertains to limitation of extension of the leg. The AOJ continued the 10 percent rating based on evidence of painful motion of the knee as provided by 38 C.F.R. § 4.59, rather than evidence of compensable limitation of extension. Thus, the Board finds that it is appropriate to change the diagnostic code under which the Veteran’s right knee degenerative arthritis with history of patellectomy is rated from Diagnostic Code 5261 to Diagnostic Code 5003-5261. VA’s General Counsel has stated that when a knee disorder is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5257, and an appellant also has limitation of knee motion which at least meets the criteria for a noncompensable evaluation under 38 C.F.R. § 4.71a, Diagnostic Code 5260 or 5261, separate evaluations may be assigned for arthritis with limitation of motion and for instability. However, General Counsel stated that if an appellant does not meet the criteria for a noncompensable rating under either Diagnostic Code 5260 or 5261, there is no additional disability for which a separate rating for arthritis may be assigned. VAOPGCPREC 23-97 (July 1, 1997), published at 62 Fed. Reg. 63,604 (1997). If a rating is assigned under the provisions for other knee impairment (38 C.F.R. § 4.71a, Diagnostic Code 5257) a separate 10 percent rating may be assigned where some limitation of motion, albeit noncompensable, has been demonstrated. See VAOPGCPREC 9-98, 63 Fed. Reg. 56,704 (1998). In this regard, pursuant to Diagnostic Code 5003, degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion of the specific joint involved. When, however, the limitation of motion of the specific joint involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints 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. In the absence of limitation of motion, x-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations warrants a 20 percent evaluation. X-ray evidence of involvement of two or more major joints or two or more minor joints warrants a 10 percent evaluation. 38 C.F.R. § 4.71a. Note (1) provides that the 20 percent and 10 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion. Id. For the purpose of rating disability from arthritis, the knee is considered a major joint. See 38 C.F.R. § 4.45. Normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II. Limitation of motion of the knee is contemplated in 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261. Diagnostic Code 5260 provides for a zero percent rating where flexion of the leg is only limited to 60 degrees. For a 10 percent rating, flexion must be limited to 45 degrees. A 20 percent rating is warranted where flexion is limited to 30 degrees. A 30 percent rating may be assigned where flexion is limited to 15 degrees. Diagnostic Code 5261 provides for a zero percent rating where extension of the leg is limited to five degrees. A 10 percent rating requires extension limited to 10 degrees. A 20 percent rating is warranted where extension is limited to 15 degrees. A 30 percent rating may be assigned where extension is limited to 20 degrees. For a 40 percent rating, extension must be limited to 30 degrees. Finally, where extension is limited to 45 degrees a 50 percent rating may be assigned. VA’s General Counsel has stated that separate ratings under Diagnostic Code 5260 (limitation of flexion of the leg) and Diagnostic Code 5261 (limitation of extension of the leg) may be assigned for disability of the same joint. VAOPGCPREC 9-04 (September 17, 2004), published at 69 Fed. Reg. 59,990 2004). In addition, the United States Court of Appeals for Veterans Claims has held that evaluation of a knee disability under Diagnostic Codes 5257 or 5261, or both, does not as a matter of law, preclude a separate evaluation of a meniscal disability of the same knee pursuant to Diagnostic Codes 5258 or 5259 as long as the same symptoms are not used to assign those separate evaluations (i.e., pyramiding). See Lyles v. Shulkin, 29 Vet. App. 107 (2017). Pursuant to Diagnostic Code 5258, a 20 percent rating is assigned based on evidence of dislocated semilunar cartilage with locking episodes and effusion into the joint. Also, under Diagnostic Code 5259, a 10 percent rating is assigned based on symptomatic removal of semilunar cartilage. Ratings are also available pursuant to Diagnostic Codes 5256, 5262, and 5263 when there is evidence of ankylosis, impairment of the tibia and fibula, and genu recurvatum, respectively. Turning to the evidence of record, the Veteran underwent a VA examination in June 2015 in connection with his claim for service connection. At the time, the examiner noted that the Veteran had a patellectomy on his right knee in 1963, and he currently experienced pain and giving way on occasion. He further noted a 2014 MRI that revealed a meniscal tear, but on physical examination, there was no pain on motion or on weight bearing, the joint was stable, and the Veteran denied flare-ups. Upon examination, the Veteran had range of motion from zero to 140 degrees, without pain or objective evidence of localized tenderness or pain on palpitation of the joint or associated soft tissue. There was no evidence of pain with weight bearing, evidence of crepitus, or ankylosis. Stability testing and muscle strength testing was normal. In statements dated January 9, 2016—received with the Veteran’s January 2016 notice of disagreement—the Veteran and his spouse reported that the Veteran’s leg gives way causing him to frequently lose his balance, that he has extreme pain, and that his knee locks up all the time. These statements were reiterated in May 2016 statements. However, a subsequent March 2016 private treatment record indicated that the right knee showed mild swelling, and the medial and lateral joint had tenderness. Moreover, in March 2018, the Veteran’s private physician indicated that his meniscal pathology was related directedly to instability of his right knee. Based on such evidence, the Board found, in October 2018, a remand necessary to afford the Veteran a VA examination to assess the current nature and severity of his service connected disability. Accordingly, the Veteran was afforded a VA examination in June 2019. At the time, the examiner diagnosed the Veteran with a meniscal tear, knee instability, and degenerative arthritis. The Veteran reported that his condition has persisted and worsened over time, he has constant pain and increased pain with certain activities, to include driving a car, prolonged walking, prolonged standing, and prolonged standing. He also reported that he his right leg gives out without warning, he has fallen multiple times, has to walk near walls or use arm rails to get in out of chairs, and has swelling in both knees at night. Additionally, he reported that he has to wear a brace at all times, uses a cane to walk short distances and a mobile chair for longer distances. Finally, the Veteran reported daily flare-ups which cause increase pain and occurs for up to two hours after stopping activities, such as driving and prolonged walking, standing and sitting. Upon examination, the Veteran’s range of motion testing showed flexion to 120 degrees and extension to 5 degrees, with pain that caused functional loss. Evidence of pain with weight bearing and objective evidence of crepitus was noted. The Veteran was able to perform repetitive-use testing without additional loss of function or range of motion. Additionally, while the Veteran was not examined after repetitive use or during flare-ups, the examiner noted that pain, weakness, fatigability or incoordination does not significantly limit functional ability with repetitive use and/or during flare-ups. Additionally, it was noted that the examination was neither medically consistent or inconsistent with the Veteran’s statements describing functional loss with repetitive use over time and during flare-ups. The examiner described that after a review of the record, he had no basis to offer additional losses of function or motion with repeated use over time or during flare-ups. Sharp v. Shulkin, 29 Vet. App. 26 (2017); Jones v. Shinseki, 23 Vet. App. 382 (2010). Muscle strength testing was 4/5 reflecting active movement against some resistance with right knee flexion and extension, but there was no atrophy. Joint stability was normal upon testing for anterior and lateral instability. Slight recurrent subluxation and moderate lateral instability was also noted on the examination report. There was no ankylosis noted. The Veteran’s meniscal condition resulted in frequent episodes of joint “locking,” joint pain, and joint effusions. It was also noted that the Veteran has surgical scars as a result of his 1963 patellectomy, which will be discussed below. Upon review of the foregoing, the Board finds that an initial rating in excess of 10 percent, based on painful motion, for the Veteran’s right knee degenerative arthritis with meniscal tear, is not warranted under Diagnostic Codes 5003-5261. In this regard, as noted previously, such rating contemplates arthritis with painful, limited motion resulting in extension limited to, at most, 10 degrees. With respect to Diagnostic Code 5003, such provides that arthritis established by x-ray findings will be rated on the basis of limitation of motion of the specific joint involved. In this regard, the Veteran revealed did not reveal limitation of extension to a compensable degree at the June 2015 or June 2019 VA examinations. Notably, at the June 2015 VA examination, the Veteran had full extension and at the June 2019 VA examination, extension was limited to 5 degrees. Although the Veteran reported flare-ups at the June 2019 VA examination, no range of motion findings were provided, and the examiner opined that the there was no functional loss with flare-ups. Here, the evidence does not reflect extension limited to 15 degrees or more at any time during the appeal period; consequently, a rating in excess of 10 percent under Diagnostic Code 5003- 5261 is not warranted. Furthermore, a higher or separate rating is not warranted under Diagnostic Code 5260 pertinent to the limitation of flexion. In this regard, in order to warrant a compensable, i.e., 10 percent, rating under such Diagnostic Code, flexion must be limited to 45 degrees. In this regard, the Veteran’s right knee flexion was limited to, at most, 140 degrees at the June 2015 VA examination; and limited to, at most 120 degrees at the June 2019 VA examination. Therefore, at no point during the appeal period has the Veteran’s flexion has been limited to more than 60 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. Thus, a higher or separate rating under Diagnostic Code 5260 is not warranted. However, the Board finds that a separate rating under Diagnostic Code 5258 is warranted. In this regard, the Veteran had a meniscal tear throughout the appeal period. While the meniscal tear was noted during the June 2015 VA examination, the Veteran did not endorse episodes of joint locking or joint effusion at the time. The Board notes the Veteran’s spouse wrote in a January 2016 statement that the Veteran’s knee locks up all the time. Thereafter, a March 2018 MRI study confirmed the presence of torn lateral meniscus of the right knee. The June 2019 VA examination report noted the Veteran experienced frequent episodes of joint locking and frequent episodes of joint effusion. At the time, the Veteran reported popping, locking and swelling to both knees, and that his knee was still symptomatic following his patellectomy in 1963. Based on the foregoing, and resolving all reasonable doubt in the Veteran’s favor, the Board finds that he had a lateral meniscal tear, also referred to as dislocated semilunar cartilage, with locking episodes and effusion into the joint for the appeal period as of January 9, 2016, the date such symptoms were first reported by his spouse in the record. Accordingly, a separate 20 percent evaluation under Diagnostic Code 5258 is warranted beginning January 9, 2016, but no earlier. See 38 C.F.R. § 4.71a, Diagnostic Code 5258. With regards to Diagnostic Code 5259, the Board reflects that any assignment under that Diagnostic Code after January 9, 2016, is impermissible as it would be pyramiding. See 38 C.F.R. § 4.14. Additionally, prior to that date, the Board notes that no meniscal symptomatology is noted during the 2015 VA examination or in any of the lay reports by the Veteran or his spouse. Accordingly, although pain is noted, such is already contemplated under the Veteran’s rating under Diagnostic Code 5003-5261, as discussed above. Thus, as there is no other meniscal symptomatology that is unaccounted for by other ratings, the Board cannot find that a separate 10 percent evaluation under Diagnostic Code 5259 is warranted for the period prior to January 9, 2016. See 38 C.F.R. §§ 4.14, 4.71a, Diagnostic Code 5259; Estaban v. Brown, 6 Vet. App. 259 (1994) (in cases where separate and distinct manifestations have arisen from the same injury, separate disability ratings may be assigned where none of the symptomatology of the conditions overlaps). Finally, there is no indication that the Veteran’s left knee is manifested by ankylosis, impairment of the tibia and fibula, or genu recurvatum. Accordingly, higher or separate ratings under Diagnostic Codes 5256, 5262, and 5263 are not warranted. Next, as to the Veteran’s right knee instability, as noted above, in the August 2020 rating decision, the AOJ awarded a separate rating for the Veteran’s right knee instability, as 20 percent disabling, effective June 20, 2019, pursuant to Diagnostic Code 5257. In this regard, such Diagnostic Code provides for the assignment of a 10 percent rating where there is slight recurrent subluxation or lateral instability, a 20 percent rating where there is moderate recurrent subluxation or lateral instability, and a 30 percent rating is assigned where there is severe recurrent subluxation or lateral instability. Descriptive 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 for “equitable and just decisions.” 38 C.F.R. § 4.6. The Board finds than a separate 10 percent for right knee instability for the appeal period prior to June 20, 2019 is warranted. In this regard, while VA examinations reflects no objective evidence of right knee instability prior to June 20, 2019, the Veteran and his wife reported instability of the right knee. Specifically, at the June 2015 VA examination, objective stability testing resulted in normal findings. However, at the time, the Veteran reported that his right knee would give out occasionally. Furthermore, subsequent statements by the Veteran and his spouse indicates instability of the right knee and lose of balance. Specifically, in January 2016, the Veteran wrote that at the time of the VA examination he stumbled when he got out of the chair in the waiting room due to his knee giving out. Additionally, the Veteran’s spouse wrote in January 2016 and May 2016 that the Veteran loses his balance a lot and his right knee is unstable. Consequently, the Board resolves all doubt in favor of the Veteran and finds that, for the appeal period prior to June 20, 2019, the right knee disability results in slight recurrent subluxation or lateral instability of the right knee. Therefore, a separate 10 percent rating under Diagnostic Code 5257 is warranted for that period. However, the Board finds that a rating in excess of 20 percent as of June 20, 2019 is not warranted. The June 2019 VA examination revealed slight recurrent subluxation and moderate lateral instability. Consequently, a 20 percent rating for the Veteran’s right knee instability was awarded, effective June 20, 2019. Thus, in order to warrant a higher rating, there must be severe lateral instability or recurrent subluxation. However, there is no indication of severe lateral instability or recurrent subluxation, a rating in excess of 20 percent is not warranted. Thus, the assignment of a 20 percent rating as of June 20, 2019, for right knee instability is proper. Scar of the Right Knee As previously noted, in an August 2020 rating decision, the AOJ granted a separate noncompensable rating for the Veteran’s surgical scar of the right knee, effective August 26, 2014, the date of service connection for the right knee disability; and a rating of 10 percent, effective June 20, 2019. In this regard, scars are rated under 38 C.F.R. § 4.118, Diagnostic Codes 7800 through 7805. As Diagnostic Code 7800 pertains to scars of the head, face, or neck, such is inapplicable to the evaluation of the Veteran’s left lower leg scars. Burn scars or scars due to other causes, not of the head, face, or neck, that are deep and nonlinear are awarded a compensable rating when they have an area or areas of at least 6 square inches (929 square cms) pursuant to Diagnostic Code 7801. Note (1) provides that a deep scar is on associated with underlying soft tissue damage. Burn scars or scars due to other causes not of the head, face, or neck, that are superficial and nonlinear are awarded a 10 percent rating only when they have an area or areas of 144 square inches (929 square cms) or greater pursuant to Diagnostic Code 7802. Note (1) provides that a superficial scar is one not associated with underlying soft tissue damage. Diagnostic Code 7804 provides that one or two scars that are unstable or painful warrant a 10 percent rating. Three or four scars that are unstable or painful warrant a 20 percent rating. Five or more scars that are unstable or painful warrant a 30 percent rating. Note (1) provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that, if one or more scars are both unstable and painful, 10 percent is to be added to the evaluation that is based on the total number of unstable or painful scars. Note (3) provides that scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under Diagnostic Code 7804, when applicable. Diagnostic Code 7805 is relevant to other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804. It provides that any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 should be evaluated under an appropriate diagnostic code. Although the examiner reflected in the June 2015 VA examination that the Veteran had no scars related to his knee condition, the examiner also noted a scar on the right knee that measured 14.5 centimeters in length and 0.5 centimeters in width. There was no evidence that such was painful, unstable, or had a total area equal to or greater than 39 square cm at that time. A June 2019 VA examination revealed that the Veteran had one linear right knee scar as a result of his patellectomy. The Veteran reported that the scar was tender and painful, and that he could not wear certain clothes because the seams rub against the scar. The examiner noted that the Veteran winced and pulled away with the slightest pressure to the scar line. The scar of the right knee was measured to be 22 cm in length by 1 cm in width. The scar was not unstable, did not have underlying soft tissue damage and did not result in limitation of function, to include limitation of motion. Upon review of the foregoing, the Board finds that an initial compensable rating for the Veteran’s right knee scar prior to June 20, 2019, and in excess of 10 percent thereafter is not warranted. Specifically, the evidence shows that prior to the June 20, 2019 VA examination, the Veteran had one scar of the right knee that was not painful. Therefore, service connection for the right knee scar, effective August 26, 2014, the date of service connection for the associated right knee disability, is proper. Thereafter, at the June 20, 2019 VA examination, the Veteran’s right knee scar was tender to palpitation and painful. Consequently, the Board finds that a 10 percent rating for the painful scar as of such date is proper. However, at no time during the appeal period has the Veteran’s scars been unstable, of a size to warrant a compensable rating, or resulted in disabling effects. Thus, a compensable rating prior to June 20, 2019 and 10 percent thereafter, for his scar of the right knee is not warranted. In reaching its conclusions in the instant case, the Board acknowledges the Veteran’s belief that his symptoms associated with his right knee are more severe than as reflected by the current assigned disability ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disability. The Board has considered whether staged ratings under Fenderson, supra, and Hart, supra, are appropriate for the Veteran’s service-connected right knee meniscal tear with degenerative arthritis, right knee instability and associated right knee scar; however, the Board finds that his symptomatology had been stable throughout the appeal period. Therefore, assigning staged ratings is not warranted. Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, in regard to the initial and increased rating claims adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Therefore, while the Board finds that a separate rating of 20 percent for right knee meniscal tear and a separate rating of 10 percent for right knee instability prior to June 20, 2019 is warranted; an initial rating higher than 10 percent for the right knee meniscal tear with degenerative arthritis is, a rating in excess of 20 percent for right knee instability as of June 20, 2019, and a compensable rating prior to June 20, 2019 for right knee scar, and in excess of 10 percent thereafter is not warranted. In adjudicating the Veteran’s increased rating claims herein, the Board has resolved all doubt in his favor, which has resulted in an award of 20 percent for right knee meniscal tear as of June 20, 2019 and a 10 percent for right knee instability prior to June 20, 2019. However, to the extent that higher or additional separate ratings are denied herein, the Board finds that the preponderance of the evidence is against such ratings. Consequently, the benefit of the doubt doctrine is not applicable in such regard, and his initial and increased rating claims must otherwise be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Waite 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.