Citation Nr: 20046903 Decision Date: 07/14/20 Archive Date: 07/14/20 DOCKET NO. 13-30 160 DATE: July 14, 2020 ORDER Disability ratings greater than 30 percent (instability) and 10 percent (loss of extension) prior to February 10, 2016 and greater than 60 percent thereafter for left total knee arthroplasty (previously characterized as left knee patellectomy with degenerative joint disease), irrespective of temporary total ratings due to convalescence from August 26, 2011 to December 31, 2011, February 10, 2016 to March 30, 2017, and November 27, 2017 to February 28, 2018, are denied. FINDINGS OF FACT 1. Prior to February 10, 2016, the Veteran’s left knee disability was manifested by subjective complaints of pain and instability and objective findings of extension limited to no more than10 degrees and flexion limited to no more than 75 degrees, even in contemplation of functional loss due to pain and other factors, or as a result of repetitive motion or flare-ups. 2. Beginning February 10, 2016, the Veteran’s left knee disability was recharacterized as left total knee arthroplasty, to reflect a total knee replacement, and has been manifested by post-prosthesis placement with chronic residuals of severe painful motion and weakness. CONCLUSIONS OF LAW 1. Prior to February 10, 2016, the criteria for disability ratings greater than 30 percent (instability) and 10 percent (loss of extension) for left knee patellectomy with degenerative joint disease were not met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5257 and 5261. 2. Beginning February 10, 2016, the criteria for a disability rating greater than 60 percent for right knee status post arthroplasty with history of degenerative joint disease have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5055. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1977 to January 1984. These matters come before the Board of Veterans’ Appeals (Board) from a January 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. Notably, the Veteran requested a Board videoconference hearing in his September 2013 substantive appeal but withdrew this request in August 2017 correspondence. The January 2012 rating decision granted a temporary total rating for the left knee based on convalescence following surgery for a service-connected disability, pursuant to 38 C.F.R. § 4.30 effective August 26, 2011, continued a 30 percent disability rating for the left knee effective October 1, 2011 under Diagnostic Code (DC) 5257 for instability. Subsequently, by rating decision dated in July 2013, the RO extended the temporary total rating for the left knee through December 31, 2011 and continued a 30 percent disability rating effective January 1, 2012. In a November 2015 rating decision, the RO granted a separate 10 percent rating for loss of extension of the left knee (under DC 5261), effective October 16, 2015 and decreased the Veteran’s disability rating for instability (DC 5257) from 30 to 20 percent disabling effective October 16, 2015. In an April 2016 rating decision, the RO recharacterized the Veteran’s knee disability to left total knee arthroplasty, and granted a total rating pursuant to 38 C.F.R. § 4.71a, DC 5055 for total knee replacement, effective February 10, 2016, and a 30 percent thereafter, beginning April 1, 2017. Notably, the ratings under DCs 5257 and 5261 were ended, effective the date of his total rating post replacement. In a December 2017 rating decision, the RO granted a temporary total rating for the left knee effective November 27, 2017 due to additional surgery, and continued a 30 percent disability rating under DC 5055 effective March 1, 2018. In a March 2020 rating decision, however, the RO increased the disability rating for the Veteran’s left knee from 30 to 60 percent disabling effective April 1, 2017, assigned a 60 percent disability rating effective March 1, 2018, and increased the disability rating for the Veteran’s left knee from 20 to 30 percent disabling from January 1, 2012 to February 10, 2016. In summary – the Veteran raised his claim for an increased rating in April 2011. Apart from the several temporary total ratings based on surgeries throughout the appeal, the Veteran’s left knee is rated as follows: For the first period on appeal, which is from his claim to February 2016, the Veteran has a 30 percent rating based on instability (DC 5257) and a 10 percent rating based on limitation of extension (DC 5261) from October 2015 to February 2016. These ratings were discontinued for the second period on appeal, which is from his total knee replacement forward, pursuant to the rating criteria when a joint has been replaced. His rating was changed to DC 5055, and is rated at 100 percent from February 2016, and 60 percent from April 2017 forward (with an additional total 100 percent rating period from November 2017 through February 2018 for surgery). This decision does not disturb the 100 percent ratings. As an aside, by way of history, in October 2018, the Board, in part, denied service connection for a right knee disorder. The Veteran appealed the Board’s denial of service connection to the U.S. Court of Appeals for Veterans Claims (Court). In September 2019, on joint motion for partial remand (JMPR), the Court vacated this decision, and returned it to the Board for further consideration. In March 2020, the Board remanded the right knee claim for additional development pursuant to the JMPR. The remand directives for that claim are still being undertaken, and the claim has not yet been readjudicated. Accordingly, the Board currently does not have jurisdiction of that issue and it will be decided at a later time. Disability ratings greater than 30 percent (instability) and 10 percent (loss of extension) prior to February 10, 2016 and greater than 60 percent thereafter for left total knee arthroplasty (previously characterized as left knee patellectomy with degenerative joint disease), irrespective of temporary total ratings from August 26, 2011 to December 31, 2011, February 10, 2016 to March 30, 2017, and November 27, 2017 to February 28, 2018, are denied. Rating Criteria Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities (Schedule). 38 C.F.R. Part 4. The percentage ratings contained in the 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 the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Separate diagnostic codes identify the various disabilities. Turning to the rating criteria, knee disabilities are unique in the rating code, as they are one of a few orthopedic disabilities in which a Veteran may receive multiple ratings based on separate symptoms in the same joint. While the law generally prevents considering the same symptoms under various diagnoses to support separate ratings, some of the relevant DCs for the knee have been interpreted to apply to different functions of the knee, therefore warranting separate consideration. Specifically, the evidence may warrant separate ratings for limitation of flexion of the knee, limitation of extension of the knee, and lateral instability and recurrent subluxation of the knee. When there has been a total knee replacement, a different set of regulations applies, which are described below. Prior to February 2016, when the Veteran had his knee replaced, the disability was rated at 30 percent pursuant to Diagnostic Code (DC) 5257 which pertains to recurrent subluxation or lateral instability and is found at 38 C.F.R. § 4.71a. Under that code, slight impairment is assigned a 10 percent rating, moderate impairment a 20 percent rating, and severe impairment a 30 percent rating. The terms “mild,” “moderate,” and “severe” are not defined in the Schedule. 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. It should also be noted that use of terminology such as “mild” or “moderate” by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding a higher rating. 38 C.F.R. §§ 4.2, 4.6.DC Other DCs relevant to the knee prior to February 2016 include DC 5260 and DC 5261. 5260 rates based on limitation of flexion. When flexion of the leg is limited to 60 degrees, a noncompensable rating is warranted. When flexion is limited to 45 degrees, a 10 percent rating is warranted. Flexion limited to 30 degrees warrants a 20 percent rating, while flexion limited to 15 degrees warrants the maximum 30 percent rating. DC 5261 rates based on limitation of extension. That code provides that when extension is limited to 5 degrees, a noncompensable rating is assigned. Extension limited to 10 degrees warrants a 10 percent rating. When limitation of extension is at 15 degrees, a 20 percent rating is warranted. Extension limited to 20 degrees warrants a 30 percent rating. Extension limited to 30 degrees warrants a 40 percent rating. Lastly, extension limited to 45 degrees warrants the maximum, 50 percent rating. Since February 2016, however, when the Veteran had his knee replaced, the disability rating (and diagnostic code) changed, because his disability changed. It is now characterized as left total knee arthroplasty, and is rated pursuant to 38 C.F.R. § 4.71a, DC 5055. Under DC 5055, prosthetic replacement of a knee joint is rated 100 percent for one year following implantation of the prosthesis. The one-year total rating commences after a one-month convalescent rating under 38 C.F.R. § 4.30. Thereafter, chronic residuals consisting of severe painful motion or weakness in the affected extremity warrant a 60 percent rating. Intermediate degrees of residual weakness, pain, or limitation of motion are rated by analogy to DCs 5256, 5260, 5261, or 5262. The minimum rating following replacement of a knee joint is 30 percent. 38 C.F.R. § 4.71a. DC 5256 rates based on degrees of ankylosis, meaning a situation in which the knee joint is fixed in place and immovable. DC 5261 is described above. DC 5262 rates based on nonunion or malunion of the tibia and fibula. As will be discussed fully below, the Veteran’s knee is not fixed in place; there is no finding of ankylosis of record. Therefore, DC 5256 does not apply. Likewise, there is no evidence of malunion or nonunion of the Veteran’s leg bones. Therefore, DC 5262 does not apply. Medical Evidence Evidence relevant to the current level of severity of the Veteran’s left knee disability during the appeal period beginning April 2011 includes VA examination reports dated in January 2012, October 2015, April 2017, May 2019, and June 2019. During the January 2012 VA examination, the examiner noted diagnoses of left patellectomy and left degenerative joint disease. At that time, the Veteran noted his history regarding the left knee, to include his most recent surgery in October 2011 and stated that he experienced constant pain in the left knee with weakness and giving way. He had pain with prolonged standing and sitting and also had difficulty climbing stairs. He treated his left knee pain with a brace, a cane, and pain medication. He also used alternating ice and heat. He denied flare-ups of the knee Range of motion testing revealed flexion to 120 degrees and extension to 0 degrees with no objective evidence of painful motion. The Veteran was able to perform repetitive-use testing with three repetitions and no additional loss of motion. The examiner noted that the Veteran did experience functional loss and/or functional impairment of the left knee, described as less movement than normal. There was tenderness or pain to palpation for joint line or soft tissues. Muscle strength and joint stability testing were normal. There was no evidence or history of recurrent patellar subluxation/dislocation. There was also no evidence or history of “shin splints” (medial tibial stress syndrome), stress fracture, chronic exertional compartment syndrome, or any other tibial and/or fibular impairment. There was a history of meniscal tear with meniscectomy along with frequent episodes of joint pain but no residual signs and/or symptoms due to a meniscectomy. There had been no total knee joint replacement. There were surgical scars pertaining to the left knee but none of these scars were painful and/or unstable, nor did they have a total area greater than 39 square centimeters. There were no other pertinent physical findings. The Veteran constantly used a brace and/or a cane as an assistive device to aid with locomotion. There was no functional impairment of an extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. Imaging studies revealed traumatic arthritis of the left knee but there was no x-ray evidence of patellar subluxation. The impression was 1) remote patellectomy, 2) probable contusion versus impingement versus postsurgical changes in the superior aspect of the Hoffa’s fat pad adjacent to the postsurgical site, clinical correlation suggested, 3) subtle, nonspecific patchy foci of marrow edema versus contusion involving the tibial plateau, 4) tears of the posterior horn of the medial meniscus, 5) probable quadriceps tendinopathy; the visualized well corticated ossicles adjacent to the anterior aspect of the distal quadriceps tendon appear stable, and 6) probable mild strain versus partial tear of the distal one-third of the patellar tendon. During the October 2015 VA examination, the examiner continued a diagnosis of left knee patellectomy with degenerative joint disease. The Veteran reported experiencing loss of range of motion, sharp pain daily, poor balance, and severe instability. He ambulated with a cane due to instability, used pain medication regularly, and wore a brace on the left knee. The Veteran reported experiencing weekly flare-ups of the left knee resulting in swelling and increased pain. He had difficulty standing longer than 5 to 10 minutes due to severe pain as well as difficulty walking over 20 yards without rest. On range of motion testing of the left knee, the Veteran had flexion to 75 degrees and extension to 10 degrees. This loss of motion contributed to a functional loss, specifically difficulty climbing or going down stairs. There was objective evidence of moderate localized tenderness or pain on palpation of the anterior joint/associated soft tissue which was described as wincing. There was evidence of pain with weight bearing as well as objective evidence of crepitus. The Veteran was unable to perform repetitive-use testing with at least three repetitions. Specifically, the examiner noted that the Veteran reported an onset of severe pain after completing initial range of motion testing. The Veteran was not examined immediately after repetitive use over time, and the examiner indicated that it was medically consistent with the Veteran’s statements describing functional loss with repetitive use over time. The examiner also noted that pain, weakness, fatigability, and lack of endurance significantly limited functional ability with repeated use over a period of time. However, the examiner was unable to describe this in terms of range of motion as the Veteran was not being examined immediately following repetitive use. The examiner noted that the examination was conducted during a flare up and was medically consistent with the Veteran’s statements describing functional loss during a flare up. The examiner also noted that pain, weakness, fatigability, and lack of endurance significantly limited functional ability with flare ups. However, the examiner was unable to describe this in terms of range of motion as the Veteran was not examined during a flare up. Additional factors contributing to disability included less movement than normal, weakened movement, swelling, instability of station, disturbance of locomotion, interference with sitting, and interference with standing. Muscle strength testing was slightly abnormal, described as “active movement against some resistance,” and there was a reduction in muscle strength which was found to be entirely due to the left knee disability. There was no muscle atrophy and no ankylosis. There was no evidence of recurrent subluxation but there was a history of moderate lateral instability and recurrent effusion of moderate severity on a daily basis on the left side. Joint stability testing was indicated but the examiner was unable to perform this due to an onset of severe pain when attempting during physical examination. There was objective evidence of moderate effusion and warmth on examination. There was no evidence of patellar dislocation, “shin splints” (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome, or any other tibial or fibular impairment. There was also no evidence of a meniscal condition. There were no other pertinent physical findings other than scars of the left knee which were not painful or unstable and did not have a total area equal to or greater than 39 square centimeters. With regard to assistive devices, it was noted that the Veteran constantly used a brace and cane to assist with locomotion. The examiner noted that there was no functional impairment of an extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. The examiner noted that the Veteran’s left knee condition required him to change positions as needed, avoid walking over 100 yards without rest, and avoid heavy lifting. During the April 2017 VA examination, the examiner continued a diagnosis of left knee arthroplasty, status post total knee replacement, residuals. The Veteran reported a history of total knee replacement in February 2016. The left knee was still unstable and he was still having pain with decreased flexibility. The Veteran reported experiencing flare-ups of the left knee, specifically while walking up stairs. He denied experiencing functional loss. On range of motion testing of the left knee, the Veteran’s flexion was limited to 90 degrees and he had full extension to 0 degrees. This loss of motion caused a functional loss. There was evidence of pain with weight bearing. There was also objective evidence of localized tenderness or pain on palpation of the left knee, described as medial and lateral tenderness with palpation. There was no objective evidence of crepitus. The Veteran was able to perform repetitive-use testing with at least three repetitions with no additional loss range of motion after three repetitions. The Veteran’s left knee was examined immediately after repetitive use over time, but the examiner noted that pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time. The Veteran’s left knee was not examined during a flare-up, but the examiner indicated that it was medically consistent with the Veteran’s statements describing functional loss during a flare-up. The examiner was unable to say without mere speculation whether pain, weakness, fatigability, or incoordination significantly limit functional ability with flare-ups as the Veteran was not examined during a flare-up. Additional factors contributing to the Veteran’s left knee disability included deformity, disturbance of locomotion, and interference with standing. The Veteran had more than one surgery on the left knee which gave a look of deformity to the knee itself and he reported experiencing difficulty with prolonged walking/standing. Muscle strength testing was abnormal for the left knee, described as “active movement against gravity” and there was reduction in muscle strength which was entirely due to the left knee condition. There was muscle atrophy but no ankylosis. Joint stability testing was performed and was normal. There was no evidence of patellar dislocation, “shin splints” (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome, or any other tibial or fibular impairment. There was also no evidence of a meniscal condition. With regard to surgical procedures, it was noted that the Veteran underwent left total knee replacement in February 2016 resulting in chronic residuals consisting of severe painful motion or weakness. Other pertinent physical findings included that the Veteran’s left knee was larger than the right knee and that the Veteran had notable clicking in the posterior left knee during passive range of motion felt by the examiner. There were also scars of the left knee which were not painful or unstable and did not have a total area greater than 39 square centimeters. With regard to assistive devices, it was noted that the Veteran regularly used a brace and cane to assist with ambulation. The examiner noted that there was no functional impairment of an extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. Imaging studies revealed traumatic arthritis but there were no other significant diagnostic test findings and/or results. The examiner wrote that the Veteran’s left knee disability impacted his ability to perform occupational tasks, noting that the Veteran’s left knee condition prevented prolonged walking or standing as such aggravated the knee. The examiner included range of motion findings for the right knee and noted that there was evidence of pain on passive range of motion testing and evidence of pain when the joint is used in non-weight bearing. During the May 2019 VA examination, the examiner continued a diagnosis of left knee disability, to include a left total knee replacement and left total knee arthroplasty. However, the examination was concluded before any physical findings could be given following an argument between the Veteran and the examiner. During the June 2019 VA examination, the examiner continued a diagnosis of left total knee arthroplasty but also noted diagnoses of left knee instability and degenerative arthritis. The Veteran reported a history of a significant ongoing worsening left knee condition with multiple unsuccessful surgeries offering no effective relief. This significantly impacted his day to day activities and mobility. He had difficulty walking, standing, squatting, constant pain, instability, falls and near falls, buckling, and giving out. He treated his left knee symptoms with pain medication as needed. The Veteran denied experiencing flare-ups of the left knee but did report experiencing functional loss of the left knee, specifically difficulties with prolonged standing, walking, and climbing stairs. On range of motion testing of the left knee, the Veteran’s flexion was limited to 110 degrees and he had full extension to 0 degrees. This loss of motion caused a functional loss in that it limited the Veteran’s movement (walking, bending, and standing). There was objective evidence of localized tenderness or pain on palpation of the left knee, described as mild tenderness of the medial lateral aspect of the left knee. There was also evidence of pain with weight bearing as well as objective evidence of crepitus. The Veteran was unable to perform repetitive-use testing with at least three repetitions. The Veteran was not examined immediately after repetitive use over time but the examiner found that the examination was medically consistent with the Veteran’s statements describing functional loss with repetitive use over time. The examiner noted that neither pain, weakness, fatigability, nor incoordination significantly limit functional ability with repeated use over a period of time. The Veteran’s left knee was not examined during a flare-up, and the examiner indicated that it was neither medically consistent nor inconsistent with the Veteran’s statements describing functional loss during a flare-up. The examiner noted that neither pain, weakness, fatigability, nor incoordination significantly limit functional ability with flare-ups. Additional factors contributing to the Veteran’s left knee disability included less movement than normal, interference with sitting, and interference with standing. Muscle strength testing was abnormal for the left knee, described as “active movement against some resistance” as well as a reduction in muscle strength which was entirely due to the left knee condition. There was no muscle atrophy and no ankylosis. There was a history of slight recurrent subluxation, slight lateral instability, as well as recurrent effusion. Joint stability testing was performed and showed lateral instability of the left knee measured at 2+. There was no evidence of patellar dislocation, “shin splints” (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome, or any other tibial or fibular impairment. There was also no evidence of a meniscal condition. With regard to assistive devices, it was noted that the Veteran constantly used a brace to assist with ambulation. The examiner noted that there was no functional impairment of an extremity such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. Imaging studies revealed traumatic arthritis but there were no other significant diagnostic test findings and/or results. The examiner wrote that the Veteran’s left knee disability impacted his ability to perform occupational tasks, noting that the Veteran previously worked as a housekeeper but was unable to stand for a prolonged period, walk, bend, or squat due to left knee degenerative joint disease, left knee instability, and residual left total knee arthroplasty. The examiner included range of motion findings for the right knee and noted that there was evidence of pain on passive range of motion testing and evidence of pain when the joint is used in non-weight bearing regarding the left knee. Also of record are VA treatment records dated through May 2020 as well as private treatment records dated through May 2018. These records show range of motion findings similar to those noted above with the exception of a private May 2017 disability benefits questionnaire which shows left knee flexion to 40 degrees and extension to 20 degrees. Prior to the Knee Replacement For the period prior to February 10, 2016, the Board finds that a disability rating greater than 30 percent under DC 5257 for the Veteran’s left knee disability is not warranted. Evidence relevant to the level of severity of the Veteran’s left knee disability prior to February 10, 2016 includes the January 2012 and October 2015 VA examination reports. Notably, the January 2012 VA examination report is negative for instability. While the October 2015 VA examination report shows probable instability of the left knee, the Board notes that the Veteran’s disability rating of 30 percent pursuant to DC 5257 prior to February 10, 2016 contemplates this instability. Significantly, 30 percent is the maximum rating under this diagnostic code, and contemplates severe instability. So, despite the objective findings on examination that showed no measurable instability, the Veteran’s lay statements of instability allow for the application of the benefit of the doubt, and the maximum 30 percent rating stands. As for the potential for separate ratings for the left knee, the Board notes that the Veteran is in receipt of a separate 10 percent rating under DC 5261 from October 16, 2015 due to the loss of extension to 10 degrees demonstrated in the October 2015 VA examination report. Prior to that examination, the Veteran had full extension (to zero degrees), even on repetition, which is non-compensable. For the next higher rating, extension would need to be limited to 15 degrees or more. Examinations prior to February 2016 do not reveal such limitation of extension. Therefore, the 10 percent rating for the period from October 2015 to February 2016 stands. A higher rating is not warranted. As for the potential for additional separate rating under DC 5260 for loss of flexion, the January 2012 VA examination report shows that the Veteran had 120 degrees of flexion and the October 2015 VA examination report which shows that the Veteran had 75 degrees of flexion. A compensable evaluation is only warranted pursuant to DC 5260, if flexion is limited to 45 degrees or less. Significantly, the January 2012 VA examiner indicated that there were no flare-ups and there was no additional limitation of motion after at least three repetitions. There was also no indication of pain, weakness, fatigue, nor incoordination significantly limiting functional ability with repeated use over a period of time. While the October 2015 VA examination report shows a history of flare-ups and an inability to perform repetitive-use testing with at least three repetitions, the examiner also indicated that the examination was conducted during a flareup. Therefore, the range of motion found at that time is indicative of limitation during such flareups. Yet, it was not so severe as to further limit flexion to a degree of 45 or less; therefore, a separate rating for flexion is not warranted during this period. With regard to a higher rating under another diagnostic code, as there was no evidence of ankylosis (i.e., where the joint fixed in place), impairment of the tibia or fibula, or genu recurvatum, DCs 5256, 5262, and 5263 are not for application. While the Veteran’s left knee disability obviously fluctuated in severity during the appeal period given the August 2011 surgery, the Board notes that a temporary total rating was awarded following the August 2011 surgery. As such, for the period prior to February 10, 2016, the appropriate rating for the Veteran’s left knee disability is in fact two, separate ratings (30 percent under DC 5257 and 10 percent under DC 5261) and no higher, based on limitation of extension and on laxity. [Again, the Board does not disturb the total, 100 percent rating in effect during this period]. Since the Knee Replacement For the period beginning February 10, 2016, the Board finds that a disability rating higher than 60 percent is not warranted for the left knee. During the April 2017 and June 2017 VA examinations, it was noted that the Veteran underwent total left knee replacement in February 2016 resulting in chronic residuals consisting of severe painful motion or weakness which is in line with the Veteran’s 60 percent rating (notably the maximum rating under regulation for total knee replacements, after the initial 100 percent is granted immediately following surgery). Furthermore, the Veteran did not have his knee replaced again after the February 2016 surgery. As such, a 100 percent rating under DC 5055 is not warranted. There are no other applicable diagnostic codes that would afford him a schedular rating in excess of 60 percent. Notably, DCs 5256, 5261, and 5262 do not provide for ratings higher than 50 percent. As such, for the period beginning February 10, 2016, the appropriate rating for the Veteran’s left knee disability is 60 percent pursuant to DC 5055 and no higher. [Again, the Board does not disturb the total, 100 percent ratings in effect during this period]. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board April Maddox, 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.