Citation Nr: 20050100 Decision Date: 07/28/20 Archive Date: 07/28/20 DOCKET NO. 19-08 813 DATE: July 28, 2020 ORDER A rating in excess of 20 percent for a low back strain with degenerative disc disease of the lumbar spine is denied. A rating in excess of 10 percent for right knee chondromalacia with degenerative changes is denied. An increased rating of 20 percent, from March 24, 2017 to the present, for right knee lateral instability, is granted. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran's low back strain has not manifested by forward flexion of 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine, or unfavorable ankylosis of the entire thoracolumbar spine, or unfavorable ankylosis of the entire spine. 2. Throughout the period on appeal, the evidence shows right knee chondromalacia with degenerative changes with painful motion but not a compensable level of limitation of motion. 3. From March 24, 2017 to the present, the evidence shows moderate lateral instability of the right knee. CONCLUSIONS OF LAW 1. Throughout the period on appeal, the criteria for entitlement to a rating in excess of 20 percent for a low back strain have been not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.10, 4.71a, Diagnostic Code (DC) 5242. 2. Throughout the period on appeal, the criteria for a rating in excess of 10 percent for right knee chondromalacia with degenerative changes have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, DC 5260-5010. 3. From March 24, 2017 to the present, the criteria for a 20 percent rating for right knee lateral instability have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.10, 4.71a, DC 5257. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 1967 to May 1994. Increased Rating Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. While a veteran's entire history is reviewed when assigning a disability rating, where service connection has already been established and an increase in the rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). In rating disabilities of the musculoskeletal system, it is necessary to consider, subject to the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant 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. Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). In determining the present level of a disability for any increased rating claim, the Board must consider the application of staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509 (2007). In other words, where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings is necessary. 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 veteran. 38 C.F.R. § 4.3. 1. A rating in excess of 20 percent for a low back strain with degenerative disc disease of the lumbar spine is denied. The Veteran contends that his service-connected lumbar spine condition is more severe than that which is currently contemplated by his 20 percent rating. The Veteran's degenerative disc disease of the lumbar spine is rated under the General Rating Formula for Disease and Injuries of the Spine at 38 C.F.R. § 4.71a. Such formula provides a 10 percent rating for forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees, or the combined range of motion of the thoracolumbar spine is greater than 120 degrees but not greater than 235 degrees; or when there exists muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal contour; or, a vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is assigned when there is forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or, when there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for limitation of forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted if there is unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. Any associated objective neurologic abnormalities are rated separately under relevant diagnostic codes. Id. at Note (1). Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (IVDS), a 10 percent disability rating is warranted for IVDS with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months; a 20 percent disability rating is warranted for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent disability rating is warranted for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a 60 percent disability rating is warranted for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a. Note (1) to DC 5243 provides that, for purposes of ratings under DC 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. Note (2) provides that, if intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, each segment is to be rated on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. 38 C.F.R. § 4.71a. In a May 2015 VA examination, the examiner noted that the Veteran has a diagnosis of degenerative disc disease with degenerative joint disease of the thoracic spine. No flare-ups were reported. Initial range of motion (ROM) measurements were recorded as: forward flexion to 60 degrees, extension to 30 degrees or greater, bilateral flexion to 10 degrees, right lateral rotation to 30 degrees or greater, and left lateral rotation to 20 degrees. Pain was indicated on forward flexion, extension, bilateral flexion, and bilateral rotation. The examiner noted that the Veteran was able to perform repetitive-use testing with three repetitions. Post-test ROM measurements were recorded as: forward flexion to 80 degrees, extension to 30 degrees or greater, right lateral flexion to 10 degrees, left lateral flexion to 5 degrees, right lateral rotation to 30 degrees or greater, and left lateral rotation to 20 degrees. The examiner noted that the Veteran had additional limitation in ROM following repetitive-use testing. The examiner also indicated that the Veteran has functional loss or impairment of his thoracolumbar spine. Contributing factors were noted as: less movement than normal, pain on movement, and interference with sitting, standing, and/or weight-bearing. The examiner noted localized tenderness or pain to palpation of the joint and/or soft tissue of the lower back bilaterally. No guarding or muscle spasm was indicated. Muscle strength was noted as normal, five out of five. No muscle atrophy was indicated. Reflexes were noted as hypoactive. Sensation to light touch was noted as normal. Straight leg raising testing yielded normal results. Moderate right side paresthesias and/or dysesthesias and numbness were noted. No neurologic abnormalities were noted. Ankylosis was not indicated. IVDS was denied. The use of assistive devices was denied. The examiner noted that the Veteran’s condition impacts his ability to work. The examiner estimated that pain causes an additional five-degree loss of ROM on left lateral flexion. The examiner stated that the Veteran can lift up to 25 pounds, can walk up to one fourth of a mile at a time, can walk one hour per 8 hour day, can stand/sit up to 20 minutes at a time, and can sit/stand up to 8 hours daily, but that the Veteran must get up from a seating position and move around at least hourly. In a September 2019 VA examination, the examiner noted a diagnosis of degenerative arthritis of the spine. No flare-ups were reported. The Veteran reported functional loss or impairment when as being unable to walk as fast as he used to, that he is unable to run, and that he must use a handrail when climbing stairs. Initial ROM measurements were recorded as: forward flexion to 50 degrees, extension to 20 degrees, bilateral flexion to 10 degrees, and bilateral rotation to 10 degrees. ROM itself was not noted to cause functional loss. However, the examiner noted that pain on bilateral flexion and bilateral rotation causes functional loss. Evidence of pain on weight bearing was indicated. The examiner noted sharp and stabbing pain, five out of ten in severity, in the right lower lumbar spine. The examiner noted that the Veteran was not able to perform repetitive use testing with at least three repetitions due to fear of pain. The examiner also noted that the Veteran was not examined immediately after repetitive use over time. The examiner indicated that pain, weakness, fatigability or incoordination significantly limit functional ability with repeating use over a period of time. Described in terms of ROM, the examiner noted that forward flexion is limited to 45 degrees, extension to 15 degrees, bilateral flexion to 10 degrees, and bilateral rotation to 5 degrees. The examination was not conducted during a flare-up. No guarding or muscle spasm was indicated. Disturbance of locomotion and interference with sitting and standing were noted as additional factors contributing to the Veteran’s disability. Muscle strength was noted as four out of five on the right side and five out of five on the left side. No muscle atrophy was indicated. Bilateral knee reflexes were noted as hypoactive. Sensation to light touch was noted as normal. Straight leg raising testing yielded normal results. Mild intermittent pain and numbness in the bilateral lower extremity was noted. Ankylosis was denied. IVDS was denied. The Veteran endorsed regular use of a cane. The examiner noted that the Veteran’s condition impacts his ability to work. In particular, the Veteran reported pain when climbing stairs and pain when standing or walking over five minutes. The criteria for a rating in excess of 20 percent for a low back strain have not been met. 38 C.F.R. §§ 4.1, 4.7, 4.71a, DC 5242. At worst, the evidence shows that the Veteran manifested forward flexion limited to 45 degrees. Therefore, the Veteran has manifested forward flexion limited to 45 degrees, but not less than 30 degrees during the rating period on appeal, which is representative of a 20 percent disability rating. See 38 C.F.R. §§ 4.71a, DC 5242. Accordingly, considering the overall level of functional impairment, a rating in excess of 20 percent is not warranted for the Veteran's lumbar spine. See 38 C.F.R. § 4.45; DeLuca, 8 Vet. App. at 202. The record does not reflect that forward flexion of the thoracolumbar spine is limited to 30 degrees or less; favorable or unfavorable ankylosis of the entire thoracolumbar spine; or unfavorable ankylosis of the entire spine. See 38 C.F.R. § 4.7 ("where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned"). Consideration has been given as to whether a higher rating may be assigned under the criteria for IVDS. However, the May 2015 and September 2019 VA examiners noted that the Veteran does not have IVDS. Accordingly, the rating schedule for IVDS would not result in an increased disability rating. See 38 C.F.R. § 4.71a, DC 5243, Note 1. In conclusion, the criteria for a rating in excess of 20 percent for a lumbar spine condition have not been met. See 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71, DC 5242. Consideration has been given to the benefit of the doubt doctrine under 38 U.S.C. § 5107 and 38 C.F.R. § 3.102, but the evidence is not of such approximate balance to warrant its application. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 2. A rating in excess of 10 percent for right knee chondromalacia with degenerative changes is denied. 3. An increased rating of 20 percent, from March 24, 2017 to the present, for right knee lateral instability, is granted. The Veteran contends that his right knee condition is worse than that which is contemplated by his current 10 percent disability ratings under DCs 5260-5010 and 5257 for chondromalacia with degenerative changes and lateral instability. DC 5010 represents arthritis due to trauma, substantiated by x-ray findings, which in turn is to be rated under DC 5003 as degenerative arthritis (hypertrophic or osteoarthritis). 38 C.F.R. § 4.71a. Pursuant to DC 5003, 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) and Note (2) provide that the 20 percent and 10 percent ratings based on X-ray findings will not be combined with ratings based on limitation of motion, and are not to be utilized in rating conditions listed under DCs 5013 to 5024. Id. For the purpose of rating disability from arthritis, the knee is considered a major joint. See 38 C.F.R. § 4.45. Standard motion of a knee joint is from 0 degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71, Plate II. Limitation of leg motion is governed by DCs 5260 and 5261. DC 5260 concerns limitation of leg flexion. DC 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. DC 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 DC 5260 (limitation of flexion of the leg) and DC 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). The Veteran was afforded a VA examination in May 2015. The examiner noted diagnoses of right knee chondromalacia with degenerative changes and right meniscus surgical trimming. Flare-ups were reported and were noted to cause a functional loss or impairment in that the Veteran is unable to exercise, to include swimming. Initial ROM testing revealed flexion from 0 to 110 degrees and extension from 110 to 0 degrees. ROM itself was noted to contribute to functional loss due to pain. In particular, pain was noted on flexion. Evidence of pain with weight bearing was indicated. No objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue was indicated. The examiner noted objective evidence of crepitus. The examiner noted that the Veteran was able to perform repetitive use testing with at least three repetitions, and additional functional loss or ROM was indicated after three repetitions, which was recorded as flexion from 0 to 100 degrees and extension from 100 to 0 degrees. Pain was noted to cause the additional loss of ROM. The examiner noted that the Veteran was not examined immediately after repetitive use over time or during a flare-up. However, the Veteran reported that severe flare-ups occur several times weekly and last for a few hours. Additional factors contributing to the Veteran’s disability were noted as disturbance of locomotion and interference with sitting and standing. Muscle strength was noted as five out of five. No muscle atrophy was indicated. No ankylosis was indicated. Recurrent subluxation, lateral instability, and recurrent effusion were denied. No instability was indicated. Recurrent patellar dislocation, “shin splints,” stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibular impairment was denied. The examiner noted that the Veteran reported meniscus trimming in 1992 and 1994. Residual symptoms of pain were noted. The use of assistive devices was denied. In terms of functional impact, the examiner noted that the Veteran’s condition impacts his ability to perform occupational tasks in that he has difficulty walking. The Veteran was afforded a VA examination in March 2017. The examiner indicated that an in-person examination was conducted and that the Veteran’s CPRS file was reviewed in conjunction with the examination. The examiner noted a diagnosis of right knee degenerative arthritis. No flare-ups were reported. The Veteran did not report any functional loss or impairment. Initial ROM testing revealed flexion from 0 to 110 degrees and extension from 110 to 0 degrees. ROM itself was noted not to contribute to functional loss. Pain was noted with flexion and extension but was noted not to result in or cause functional loss. Evidence of pain with weight bearing was indicated. Mild medial tenderness to palpation was indicated. Objective evidence of crepitus was noted. The examiner noted that the Veteran was able to perform repetitive use testing with at least three repetitions, but no additional functional loss or ROM after three repetitions was noted. The Veteran was not examined immediately after repetitive use over time. The examiner noted that pain, weakness, fatigability or incoordination does not significantly limit functional ability with repeated use over a period of time. Muscle strength was noted as five out of five on flexion and four out of five on extension. The examiner noted that the reduction in muscle strength is due to the Veteran’s diagnosed knee condition. Muscle atrophy was denied. Ankylosis was denied. Moderate lateral instability was indicated. Joint stability testing revealed normal results, but for the lateral instability test, which revealed 1+ instability. The examiner noted that the Veteran has had a meniscus condition resulting in frequent episodes of joint pain. The examiner noted that the Veteran’s most recent arthroscopic surgery was in 2016. The Veteran endorsed regular use of a knee brace. The examiner noted no functional impact on the Veteran’s ability to perform any type of occupational task. The Veteran was afforded a further VA examination in September 2019. The examiner indicated that an in-person examination was conducted and that the Veteran’s VA e-folder was reviewed in conjunction with the examination. The examiner noted diagnoses of right knee degenerative arthritis, chondromalacia with degenerative changes, right meniscus surgical trimming, and instability. No flare-ups were reported. The Veteran reported having functional loss or impairment in that he has difficulty climbing and descending stairs, difficulty with balance, knee locking, and difficulty with lateral movement. Initial ROM testing revealed flexion from 0 to 100 degrees and extension from 100 to 0 degrees. ROM itself was noted not to contribute to a functional loss. However, pain on flexion was noted to cause functional loss. The examiner noted moderate aching and throbbing to the lateral aspect of the knee. No evidence of pain with weight bearing was indicated. Objective evidence of crepitus was indicated. The examiner noted that the Veteran was not able to perform repetitive-use testing with at least three repetitions due to fear of pain. The examination was not conducted immediately after repetitive use over time. However, the examiner noted that pain, weakness, and lack of endurance significantly limit functional ability with repeated use over a period of time. Described in terms of ROM, the examiner recorded flexion from 0 to 95 degrees and extension from 95 to 0 degrees. The examination was not conducted during a flare-up. Disturbance with locomotion and interference with standing were noted as additional factors that contribute to the Veteran’s disability. Muscle strength was noted as five out of five on flexion and four out of five on extension. No muscle atrophy was indicated. Ankylosis was denied. Recurrent subluxation, lateral instability, and recurrent effusion were denied. Joint stability testing revealed normal results, but for the lateral instability test, which revealed 1+ instability. Recurrent patellar dislocation, “shin splints,” stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibular impairment was denied. A right knee meniscus tear was noted with a history of repair in 1994, 1997, and 2008. Residual symptoms of frequent episodes of joint pain were noted. The Veteran endorsed the constant use of a knee brace. In terms of functional impact, the examiner noted that the Veteran’s diagnoses impact his ability to perform occupational tasks. Specifically, the examiner noted difficulty ascending and descending stairs, standing, and walking. Throughout the period on appeal, the evidence of record does not support an increased rating above the 10 percent rating assigned for the Veteran's right knee limitation of extension under DC 5260. Under DC 5260, a 20 percent rating will be assigned for limitation of flexion of the leg to 30 degrees. Throughout the period on appeal, the Veteran’s limitation of flexion was, at worst, limited to 95 degrees. Therefore, a rating in excess of 10 percent under DC 5260 is not warranted. Under DC 5261, a noncompensable rating is assigned when extension of the leg is limited to 5 degrees; a 10 percent rating is assigned when extension of the leg is limited to 10 degrees; and a 20 percent rating is assigned when extension is limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5261. Of note, it must be considered whether the Veteran is entitled to separate ratings under DC 5261 (limitation of extension of the leg). VAOPGCPREC 9-04 (September 17, 2004), published at 69 Fed. Reg. 59,990 (2004). Specifically, where a Veteran has both a limitation of flexion and a limitation of extension of the same leg, the limitations must be rated separately to adequately compensate for functional loss associated with injury to the leg. Id. Throughout the period on appeal, the evidence of record does not support a separate or higher rating under DC 5261. Under DC 5261, a 10 percent rating is assigned when extension of the leg is limited to 10 degrees; and a 20 percent rating is assigned when extension is limited to 15 degrees. Throughout the period on appeal, the Veteran’s limitation of extension was, at worst, limited to 0 degrees. Therefore, a separate or higher rating under DC 5261 is not warranted. The Veteran has a separate rating of 10 percent under DC 5257 for right lateral instability. Under DC 5257, a 10 percent rating is warranted for slight impairment from subluxation or lateral instability. A 20 percent rating is warranted for moderate impairment from subluxation or lateral instability. A maximum, 30 percent rating is warranted for severe impairment from recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, DC 5257. In the March 2017 VA examination, the examiner characterized the Veteran’s level of instability as moderate lateral instability of the right knee. Upon joint stability testing, the examiner recorded right knee lateral instability as 1+ instability. The September 2019 VA examiner also noted right knee lateral instability as 1+ instability. Further, the March 2017 examiner noted the regular use of a knee brace and the September 2019 examiner noted the constant use of a knee brace. Thus, the evidence shows moderate impairment from lateral instability of the right knee. Therefore, a 20 percent rating is warranted for moderate impairment from lateral instability of the right knee, from March 24, 2017 to the present. In light of the presence of meniscal symptomatology and surgical repairs noted throughout the record, DCs 5258 and 5259 are potentially applicable to the Veteran's claims. In this regard, pursuant to DC 5258, a 20 percent rating is assigned based on evidence of dislocated semilunar cartilage with locking episodes and effusion into the joint. Under DC 5259, a 10 percent rating is assigned based on symptomatic removal of semilunar cartilage. However, a rating higher than 10 percent is not available under DC 5259 since a 10 percent rating is the maximum under DC 5259. Furthermore, a higher rating is not warranted under DC 5258 since recurrent effusion is denied throughout the record. The record indicates that the Veteran has, at worst, limitation of flexion to 95 degrees and limitation of extension to 0 degrees. Therefore, if strictly rated under range-of-motion diagnostic codes, the Veteran's right knee disability would be rated as noncompensable. As noted above, limitation of flexion with evidence of degenerative arthritis of the right knee is rated at 10 percent under DC 5260-5010. The Veteran's complaints have been considered, but there is no evidence that his right knee disability suffers significant or additional functional loss beyond that contemplated by the assigned 10 rating for limitation of flexion under DC 5260-5010, and separate 20 rating under DC 5257, from March 24, 2017 to the present. See 38 C.F.R. § 4.71, DCs 5260-5010 and 5257; 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, Mitchell, Correia, and Sharp, all supra. In short, the preponderance of the evidence is against the claim for an increased rating for the right knee for limitation of flexion under DC 5260. See 38 C.F.R. § 4.71a, DC 5260. As discussed above, the Veteran has been assigned a 20 percent rating for right knee lateral instability, from March 24, 2017 to the present, under DC 5257. In considering whether higher or separate ratings might be assigned for the service-connected right knee disability under other diagnostic codes, ankylosis has been denied, there is no indication of recurrent effusion into the joint associated with dislocated semilunar cartilage, and there is no indication of malunion of the tibia and fibula. Thus, separate rating under DCs 5256, 5258, and 5262 are not warranted. Lastly, there is no evidence of genu recurvatum to warrant a higher or separate rating under DC 5263. In conclusion, a rating in excess of 10 percent for the service-connected right knee limitation of flexion is not warranted; a 20 percent rating for right knee moderate impairment from lateral instability, from March 24, 2017 to the present, is warranted; and separate ratings are not warranted. To the extent that the Veteran contends entitlement to such, the preponderance of the evidence is against the claim; there is no reasonable doubt to be resolved; and any further increased rating is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Timothy T. Emmart 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.