Citation Nr: 20041981 Decision Date: 06/19/20 Archive Date: 06/19/20 DOCKET NO. 16-22 980 DATE: June 19, 2020 ORDER Entitlement to a higher initial disability rating in excess 10 percent for the right knee strain limitation of flexion disability, hereinafter referred to as a right knee flexion disability, from July 8, 2011 to December 13, 2019 is denied. Entitlement to a higher initial disability rating in excess 10 percent for the left knee strain limitation of flexion disability, hereinafter referred to as a left knee flexion disability, from July 8, 2011 to December 13, 2019 is denied. Entitlement to a higher (compensable) initial disability rating for the right knee strain limitation of extension disability, hereinafter referred to as a right knee extension disability, from July 8, 2011 to December 13, 2019 is denied. Entitlement to a higher (compensable) initial disability rating for the left knee strain limitation of extension disability, hereinafter referred to as a left knee extension disability, from July 8, 2011 to December 13, 2019 is denied. Entitlement to a higher (compensable) initial disability rating for the right knee flexion disability from December 13, 2019 to March 4, 2020 is denied. Entitlement to a higher (compensable) initial disability rating for the left knee flexion disability from December 13, 2019 to March 4, 2020 is denied. Entitlement to a higher initial disability rating in excess 40 percent for the right knee extension disability, from December 13, 2019 is denied. Entitlement to a higher initial disability rating in excess 40 percent for the left knee extension disability, from December 13, 2019 is denied. Entitlement to a higher initial disability rating in excess of 10 percent for the right knee flexion disability from March 4, 2020 is denied. Entitlement to a higher initial disability rating in excess of 10 percent for the right knee flexion disability from March 4, 2020 is denied. FINDINGS OF FACT 1. From July 8, 2011 to December 13, 2019, the right and left knee flexion disabilities manifested in limited flexion to at worse 90 degrees, and the right and left knee extension disabilities manifested in limited extension to 0 degrees; without ankylosis, recurrent subluxation or lateral instability, dislocated semilunar cartilage with frequent episodes of locking with effusion into the joint, symptomatic removal of semilunar cartilage, nonunion or malunion of the tibia and fibula, or genu recurvatum. 2. From December 13, 2019 to March 4, 2020, the right and left knee flexion disabilities manifested in limited flexion to at worse to 100 degrees with compensable limitation of extension in both knees; without ankylosis, recurrent subluxation or lateral instability, dislocated semilunar cartilage with frequent episodes of locking with effusion into the joint, symptomatic removal of semilunar cartilage, nonunion or malunion of the tibia and fibula, or genu recurvatum. 3. From December 13, 2019, the right and left knee extension disabilities manifested in limited extension to at worse 30 degrees; without compensable limitation in flexion in both knees, ankylosis, recurrent subluxation or lateral instability, dislocated semilunar cartilage with frequent episodes of locking with effusion into the joint, symptomatic removal of semilunar cartilage, nonunion or malunion of the tibia and fibula, or genu recurvatum. 4. From March 4, 2020, the right and left knee flexion disabilities manifested in limited flexion to at worse 40 degrees with compensable extension disabilities in both knees; without ankylosis, recurrent subluxation or lateral instability, dislocated semilunar cartilage with frequent episodes of locking with effusion into the joint, symptomatic removal of semilunar cartilage, nonunion or malunion of the tibia and fibula, or genu recurvatum. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating in excess of 10 percent for the right knee flexion disability from July 8, 2011 to December 13, 2019 are not met or more nearly approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 2. The criteria for an initial disability rating in excess of 10 percent for the left knee flexion disability from July 8, 2011 to December 13, 2019 are not met or more nearly approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 3. The criteria for an initial (compensable) disability rating for the right knee extension disability from July 8, 2011 to December 13, 2019 are not met or more nearly approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261. 4. The criteria for an initial (compensable) disability rating for the left knee extension disability from July 8, 2011 to December 13, 2019 are not met or more nearly approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261. 5. The criteria for an initial (compensable) disability rating for the right knee flexion disability from December 13, 2019 to March 4, 2020 are not met or more nearly approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 6. The criteria for an initial (compensable) disability rating for the left knee flexion disability from December 13, 2019 to March 4, 2020 are not met or more nearly approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 7. The criteria for an initial disability rating in excess of 40 percent for the right knee extension disability from December 13, 2019 are not met or more nearly approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261. 8. The criteria for an initial disability rating in excess of 40 percent for the left knee extension disability from December 13, 2019 are not met or more nearly approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261. 9. The criteria for an initial disability rating in excess of 10 percent for the right knee flexion disability from March 4, 2020 are not met or more nearly approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 10. The criteria for an initial disability rating in excess of 10 percent for the left knee flexion disability from March 4, 2020 are not met or more nearly approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1994 to December 1998 and from February 2008 to May 2008. These matters are on appeal from an August 2013 rating decision issued by the Regional Office (RO). These maters have a long procedural history. These matters were before the Board in May 2017 and then remanded for a VA examination. A supplemental statement of the case was issued in January 2018. The Veteran appealed the matters to the U.S. Court of Appeals for Veterans Claims (CAVC). In April 2018, the Court clerk adopted a Joint Motion for Partial Remand (JMPR) filed by the parties in April 2018. The JMPR was amended by the parties in September 2018. In January 2019, the Board remanded the matters again in January 2019 for another VA examination. The Board remanded the matters again for a Stegall violation. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Duties to Notify and Assist In March 2020 correspondence, the Veteran contends that the March 2020 VA examination was inadequate, specifically the VA examiners opinion on the right and left knee functional impairment during a flare up. Even though he did not endorse flareups during the examination and the examination was not conducted during a flare up, the Veteran contends that he previously endorsed flare ups and that the VA examiner should have estimated functional loss during flareups. The Veteran also contends that the VA examiner in the July 2014 VA examination did not account for functional loss with repeated use over time. See March 2020 Correspondence. In this case, the Veteran’s general assertions are insufficient to establish that the VA examinations were inadequately conducted. In the March 2020 VA examination, the VA examiner filled out the functional loss section, including the subsection about flareups. In the July 2014 VA examination, the VA examiner filled out the functional loss section, including the subsection about repeated use over time. These examinations were specifically designed for the purpose of evaluating the knee disabilities and, more specifically, functional impairment. For these reasons, the Board finds that the March 2020 and July 2014 VA examinations are adequate for the purpose of rating the service-connected right and left knee disabilities, and remand for a new VA examination is not warranted. Based on the foregoing, the duties to notify and assist have been met. 38 U.S.C. §§ 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.326. Legal Authority for Knee Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. 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 rating 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 disabilities. 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. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (double “compensation” for the same symptom or impairment is prohibited). When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. When evaluating disabilities of the musculoskeletal system, 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Further, 38 C.F.R. § 4.45 provides that consideration also be given to decreased movement, weakened movement, excess fatigability, incoordination, and pain on movement, swelling, and deformity or atrophy of disuse. Painful motion is considered limited motion at the point that pain actually sets in. See VAOPGCPREC 9-98. With any form of arthritis, painful motion is an important factor of disability, the facial expression, wincing, etc., on pressure or manipulation, should be carefully noted and definitely related to affected joints. Muscle spasm will greatly assist the identification. Sciatic neuritis is not uncommonly caused by arthritis of the spine. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59. The appropriate diagnostic codes for rating limitation of motion of the knees are Diagnostic Codes 5260 and 5261. 38 C.F.R. § 4.71a. Normal range of motion of the knee is from 0 degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II. In VAOPGCPREC 9-2004, the VA General Counsel interpreted that when considering Diagnostic Codes 5260 and 5261 together with 38 C.F.R. § 4.71, a veteran may receive a rating for limitation in flexion only, limitation of extension only, or, if the 10 percent criteria are met for both limitations of flexion and extension, separate ratings for limitations in flexion under Diagnostic Code 5260 (leg, limitation of flexion) and extension under Diagnostic Code 5261 (leg, limitation of extension). Under Diagnostic Code 5260, limitation of knee flexion is rated 30 percent disabling where flexion is limited to 15 degrees; 20 percent disabling where flexion is limited to 30 degrees; 10 percent disabling where flexion is limited to 45 degrees; and noncompensable where flexion is limited to 60 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5261, limitation of knee extension is rated 50 percent disabling where extension is limited to 45 degrees; 40 percent disabling where extension is limited to 30 degrees; 30 percent disabling where extension is limited to 20 degrees; 20 percent disabling where extension is limited to 15 degrees; 10 percent disabling where extension is limited to 10 degrees; and noncompensable where extension is limited to 5 degrees. 38 C.F.R. § 4.71a. Diagnostic Code 5257 contemplates “other impairment” of the knee including recurrent subluxation or lateral instability. Under Diagnostic Code 5257, where impairment is severe, moderate or slight, disability evaluations of 30, 20, and 10 percent are assigned, respectively. 38 C.F.R. § 4.71a. Id. Diagnostic Code 5262 contemplates impairment of the tibia and fibula, assigning a 40 percent rating for nonunion of the tibia and fibula, and 10, 20, and 30 percent ratings for slight, moderate or marked knee or ankle disabilities. Id. The words “slight,” “moderate,” “severe,” and “marked” as used in the various diagnostic codes are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence for “equitable and just decisions.” Id. Under Diagnostic Code 5256, disability ratings are assigned when ankylosis is present. Id. Diagnostic Code 5258 provides a 20 percent disability rating when a dislocated semilunar cartilage is present with frequent episodes of “locking,” pain, and effusion into the joint. Id. Diagnostic Code 5259 provides for a 10 percent disability rating when semilunar cartilage has been removed and related symptoms are present. Id. A 10 percent disability rating is assigned under Diagnostic Code 5263 when genu recurvatum is identified. Id. Diagnostic Code 5003 provides that degenerative arthritis established by X-ray findings is to be evaluated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic code, an evaluation of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. 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, a 10 percent evaluation is assignable for X-ray evidence of involvement of arthritis of two or more major joints or two or more minor joint groups. A 20 percent evaluation is assignable for X-ray evidence of involvement of arthritis of two or more major joints or two or more minor joint groups, with occasional incapacitating episodes. 38 C.F.R. § 4.71a. Notes (1) and (2) under Diagnostic Code 5003 provides the following: Note (1) provides that the 20 percent and 10 per cent ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion. Note (2) provides that the 20 percent and 10 percent ratings based on X-rays findings, above, will not be utilized in rating conditions listed under Diagnostic Codes 5013 to 5024, inclusive. VA’s Office of General Counsel has provided guidance concerning increased rating claims for knee disorders. VA’s General Counsel interpreted that compensating a claimant for separate functional impairment under Diagnostic Code (DC) 5257 and 5003 does not constitute pyramiding. See VAOPGCPREC 23-97. Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition was not “duplicative of or overlapping with the symptomatology” of the other condition. See Esteban, 6 Vet. App. 259, 262; Lyles, 29 Vet. App. 107. In VAOPGCPREC 9-98, VA’s General Counsel reiterated that, if a veteran has a disability rating under Diagnostic Code 5257 for instability of the knee, and there is also X-ray evidence of arthritis, a separate rating for arthritis could also be based on painful motion under 38 C.F.R. § 4.59. In addition, the General Counsel considered a hypothetical situation in which a knee disability was evaluated under Diagnostic Code 5259 that was productive of pain, tenderness, friction, osteoarthritis established by X-rays, and a slight loss of motion. For the purposes of the hypothetical, it was assumed that Diagnostic Code 5259 did not involve limitation of motion. Given the findings of osteoarthritis, the General Counsel stated that the availability of a separate evaluation under Diagnostic Code 5003 in light of sections 4.40, 4.45, 4.59 must be considered. See Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991). Absent X-ray findings of arthritis, limitation of motion should be considered under Diagnostic Codes 5260 and 5261. The claimant’s painful motion may add to the actual limitation of motion so as to warrant a rating under Diagnostic Codes 5260 or 5261. The VA General Counsel further noted in VAOPGCPREC 9-98 that the removal of the semilunar cartilage may involve restriction of movement caused by tears and displacements of the menisci, but that the procedure may result in complications such as reflex sympathetic dystrophy, which can produce loss of motion. Therefore, limitation of motion is a relevant consideration under Diagnostic Code 5259, and the provisions of 4.40, 4.45, and 4.59 must be considered. The Veteran generally contends that the symptoms associated with the right and left knee disabilities warrant higher initial disability ratings for all periods on appeal. 1. Initial Disability Rating for the Right Knee Flexion Disability From July 8, 2011 to December 13, 2019 2. Initial Disability Rating for the Left Knee Flexion Disability From July 8, 2011 to December 13, 2019 3. Initial Disability Rating for the Right Knee Extension Disability From July 8, 2011 to December 13, 2019 4. Initial Disability Rating for the Left Knee Extension Disability From July 8, 2011 to December 13, 2019 From July 8, 2011 to December 13, 2019, the Veteran was in receipt of an initial 10 percent rating for the right knee flexion disability, an initial 10 percent rating for the left knee flexion disability, a noncompensable initial rating for the right knee extension disability, and a noncompensable initial rating for the left knee extension disability, rated under DC 5260 and DC 5261 respectively. After a review of all the evidence, both lay and medical, the Board finds that higher initial disability ratings for the bilateral flexion and extension disabilities are not warranted from July 8, 2011 to December 13, 2019. The right and left knees manifested in limitation of flexion to 120, 140, and 90 degrees. See February 2013 VA Treatment Records (measuring right and left knee flexion to 120 degrees); July 2014 VA Examination (measuring right and left knee flexion to 140 degrees); June 2017 VA Examination (measuring right and left knee flexion to 90 degrees). The right and left knees manifested in limitation of extension to 0 degrees. See February 2013 VA Treatment Records; July 2014 VA Examination; June 2017 VA Examination. The weight of the evidence is against finding that from July 8, 2011 to December 13, 2019 the right and left knees manifested in arthritis, ankylosis, recurrent subluxation or lateral instability, dislocated semilunar cartilage with frequent episodes of locking with effusion into the joint, symptomatic removal of semilunar cartilage, nonunion or malunion of the tibia and fibula, or genu recurvatum. See July 2014 VA Examination; June 2017 VA Examination. For this period on appeal, VA examiners found some functional loss in both knees manifesting in pain, fatiguability, weakness, and lack of endurance with repetitive use over time and during flare ups. See July 2014 VA Examination; June 2017 VA Examination. The evidence of record weighs against finding a higher initial disability rating in excess 10 percent for the right and left knee flexion disabilities from July 8, 2011 to December 13, 2019 and against finding a higher (compensable) initial disability rating for the right and left knee disabilities from July 8, 2011 to December 13, 2019. The evidence does not show that, even with painful functional limitations, there is limitation of flexion or extension in the right or left knees that warrant higher initial disability ratings, under DC 5260 and DC 5261. For these reasons, the Board finds that the criteria for the above-mentioned higher initial disability rating claims have not been met. 38 C.F.R. §§ 4.3, 4.7. 5. Initial Disability Rating for the Right Knee Flexion Disability from December 13, 2019 to March 4, 2020 6. Initial Disability Rating for the Left Knee Flexion Disability from December 13, 2019 to March 4, 2020 From December 13, 2019 to March 4, 2020, the Veteran was in receipt of an initial 0 percent rating for the right and left knee flexion disabilities, rated under DC 5260. After a review of all the evidence, both lay and medical, the Board finds that higher (compensable) initial disability ratings for the right and left flexion disabilities are not warranted from December 13, 2019 to March 4, 2020. The right and left knees manifested in limitation of flexion to 100 degrees. The Board notes that during this period on appeal the Veteran had compensable limitation of extension in both knees. See December 2019 VA Examination. The weight of the evidence is against finding that from December 13, 2019 to March 4, 2020 the right and left knees manifested in ankylosis, recurrent subluxation or lateral instability, dislocated semilunar cartilage with frequent episodes of locking with effusion into the joint, symptomatic removal of semilunar cartilage, nonunion or malunion of the tibia and fibula, or genu recurvatum. See December 2019 VA Examination. For this period on appeal, VA examiners found some functional loss in both knees manifesting in pain with repetitive use and during flareups. See December 2019 VA Examination. The evidence of record weighs against finding a higher (compensable) initial disability rating for the right and left knee flexion disabilities from December 13, 2019 to March 4, 2020. The evidence does not show that, even with painful functional limitations, there is limitation of flexion in the right or left knees that warrant higher initial disability ratings, under DC 5260. For these reasons, the Board finds that the criteria for the above-mentioned higher (compensable) initial disability rating claims have not been met. 38 C.F.R. §§ 4.3, 4.7. 7. Initial Disability Rating for the Right Knee Extension Disability from December 13, 2019 8. Initial Disability Rating for the Left Knee Extension Disability from December 13, 2019 From December 13, 2019, the Veteran is in receipt of an initial 40 percent rating each for the right and left knee extension disabilities, rated under DC 5261. After a review of all the evidence, both lay and medical, the Board finds that higher initial disability ratings in excess of 40 percent for the right and left extension disabilities are not warranted from December 13, 2019. The right and left knees manifested in limitation of extension to 30 degrees at worst. See December 2019 VA Examination (measuring right and left knee extension to 30 degrees); March 2020 VA Examination (measuring right and left knee extension to 20 degrees). The weight of the evidence is against finding that from December 13, 2019 the right and left knees manifested in ankylosis, recurrent subluxation or lateral instability, dislocated semilunar cartilage with frequent episodes of locking with effusion into the joint, symptomatic removal of semilunar cartilage, nonunion or malunion of the tibia and fibula, or genu recurvatum. See December 2019 VA Examination; March 2020 VA Examination. For this period on appeal, VA examiners found some functional loss in both knees manifesting in pain with repetitive use and during flareups. See December 2019 VA Examination; March 2020 VA Examination. The evidence of record weighs against finding a higher initial disability rating in excess of 40 percent for the right and left knee extension disabilities from December 13, 2019. The evidence does not show that, even with painful functional limitations, there is limitation of extension in the right or left knees that warrant higher initial disability ratings, under DC 5261. For these reasons, the Board finds that the criteria for the above-mentioned higher initial disability rating claims have not been met. 38 C.F.R. §§ 4.3, 4.7. 9. Initial Disability Rating for the Right Knee Flexion Disability from March 4, 2020 10. Initial Disability Rating for the Left Knee Flexion Disability from March 4, 2020 From March 4, 2020, the Veteran is in receipt of an initial 10 percent rating for the right and left knee flexion disabilities, rated under DC 5260. After a review of all the evidence, both lay and medical, the Board finds that higher initial disability ratings in excess of 10 percent for the right and left flexion disabilities are not warranted from March 4, 2020. The right and left knees manifested in limitation of flexion to 40 degrees at worst. The VA examiner also found some functional loss in both knees manifesting in pain with repetitive use. The Board notes that the Veteran is in receipt of a compensable disability rating for limitation of extension in both knees. See March 2020 VA Examination. The weight of the evidence is against finding that from March 4, 2020 the right and left knees manifested in arthritis, ankylosis, recurrent subluxation or lateral instability, dislocated semilunar cartilage with frequent episodes of locking with effusion into the joint, symptomatic removal of semilunar cartilage, nonunion or malunion of the tibia and fibula, or genu recurvatum. See March 2020 VA Examination. The evidence of record weighs against finding a higher initial disability rating in excess of 10 percent for the right and left knee flexion disabilities from March 4, 2020. The evidence indicates that the painful functional limitations warrant the existing rating under DC 5261 based on limitations of motion caused by the pain. For these reasons, the Board finds that the criteria for the above-mentioned higher or separate initial disability rating claims have not been met. 38 C.F.R. §§ 4.3, 4.7. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Costantino, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.