Citation Nr: 21000899 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 11-04 915 DATE: January 6, 2021 ORDER From October 5, 2010 to June 3, 2015, entitlement to a disability rating in excess of 10 percent for right knee instability is denied. From June 4, 2015, entitlement to a disability rating in excess of 20 percent for right knee instability is denied. Entitlement to a disability rating in excess of 30 percent for right knee injury with degenerative arthritis is denied. Entitlement to a disability rating in excess of 30 percent for degenerative arthritis of the left knee is denied. From October 5, 2010 to June 3, 2015, entitlement to a disability rating in excess of 10 percent for left knee instability is denied. From June 4, 2015, entitlement to a disability rating in excess of 20 percent for left knee instability is denied. Entitlement to a disability rating in excess of 20 percent for left knee meniscal tear is denied. FINDINGS OF FACT 1. For the period from October 5, 2010 to June 3, 2015, moderate right knee instability is not shown. 2. For the period from June 4, 2015, severe moderate right knee instability is not shown. 3. The Veteran’s arthritis of the right knee is manifested by extension limited to 20 degrees with pain, but not limited to 30 degrees, and flexion is not limited to 45 degrees or less. 4. The Veteran’s arthritis of the left knee is manifested by extension limited to 20 degrees with pain, but not limited to 30 degrees, and flexion is not limited to 45 degrees or less. 5. For the period from October 5, 2010 to June 3, 2015, moderate left knee instability is not shown. 6. For the period from June 4, 2015, severe left knee instability is not shown. 7. The Veteran is in receipt of the maximum assignable rating for meniscal tear of the left knee. CONCLUSIONS OF LAW 1. For the period from October 5, 2010 to June 3, 2015, the criteria for entitlement to a disability rating in excess of 10 percent for instability, right knee, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Part 4, Diagnostic Code 5257. 2. For the period from June 4, 2015, the criteria for entitlement to a disability rating in excess of 20 percent for instability, right knee, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Part 4, Diagnostic Code 5257. 3. The criteria for entitlement to a disability rating in excess of 30 percent for arthritis, right knee, with limitation of extension, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Part 4, Diagnostic Codes 5003, 5261. 3. The criteria for entitlement to a disability rating in excess of 30 percent for arthritis, left knee, with limitation of extension, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Part 4, Diagnostic Codes 5003, 5261. 4. For the period from October 5, 2010 to June 3, 2015, the criteria for entitlement to a disability rating in excess of 10 percent for instability, left knee, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Part 4, Diagnostic Code 5257. 5. For the period from June 4, 2015, the criteria for entitlement to a disability rating in excess of 20 percent for instability, left knee, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Part 4, Diagnostic Code 5257. 6. The criteria for entitlement to a disability rating in excess of 20 percent for meniscal tear, left knee, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Part 4, Diagnostic Code 5258. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty from July 1976 to June 1983. These matters came before the Board of Veterans’ Appeals (Board) on appeal from a February 2010 rating decision. In June 2014, the Board granted a 30 percent rating for arthritis of the right knee based on limitation of extension, and a 30 percent rating for arthritis of the left knee, also based on limitation of extension. The issues of entitlement to a rating in excess of 30 percent for arthritis of the right knee; a rating in excess of 30 percent for arthritis of the left knee; and a rating in excess of 10 percent for left knee instability were remanded for additional development. In an October 2016 rating decision, a 20 percent rating was assigned to left knee instability, effective June 4, 2015; and, service connection was granted for right knee instability, rated 10 percent disabling, effective June 30, 2014, and rated 20 percent disabling, effective June 4, 2015. In August 2017, the Board remanded the issues for further development. In a March 2019 rating decision, service connection for left knee meniscal tear was granted and a 20 percent rating was assigned effective May 21, 2016. In a September 2019 decision, the Board granted an earlier effective date of October 5, 2010 for the award of service connection and the 10 percent ratings for instability of the right and left knees. The remaining issues were remanded for further development. Increased Ratings Disability evaluations are determined by the application of the Schedule For Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. The Board has reviewed all the evidence in the Virtual folders, which includes: his contentions, treatment records, and C&P examination reports. Although there is an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). For purposes of this decision, the Board notes that normal range of motion for the knee is flexion to 140 degrees and extension to 0 degrees. 38 C.F.R. § 4.71a, Plate II. Diagnostic Codes 5260 and 5261 provide for rating based on limitation of motion. Evaluations for limitation of flexion of a knee are assigned as follows: flexion limited to 45 degrees is 10 percent; flexion limited to 30 degrees is 20 percent; and flexion limited to 15 degrees is 30 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Evaluation for cartilage, semilunar, dislocated knee with frequent episodes of locking, pain, and effusion into the joint warrants a 20 percent disability rating. 38 C.F.R. § 4.71, Diagnostic Code 5258. Evaluations for limitation of extension of the knee are assigned as follows: extension limited to 10 degrees is 10 percent; extension limited to 15 degrees is 20 percent; extension limited to 20 degrees is 30 percent; extension limited to 30 degrees is 40 percent; and extension limited to 45 degrees is 50 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5261. The rating schedule provides for a 10 percent rating for slight recurrent subluxation or lateral instability, a 20 percent rating for moderate recurrent subluxation or lateral instability, and a 30 percent rating for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Pursuant to Diagnostic Code 5003, arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic code(s) 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 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 2 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 2 or more major joints or 2 or more minor joints warrants a 10 percent evaluation. See 38 C.F.R. § 4,71a, Diagnostic Code 5003. 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. The intent of the rating 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. 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 evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. However, § 4.14 does not preclude the assignment of separate evaluations for separate and distinct symptomatology where none of the symptomatology justifying an evaluation under one diagnostic code is duplicative of or overlapping with the symptomatology justifying an evaluation under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259, 262 (1994). The VA General Counsel has held that a claimant who has arthritis and instability of a knee may be rated separately under Codes 5003 and 5257, while cautioning that any such separate rating must be based on additional disabling symptomatology. VAOPGCPREC 23-97 (July 1997); VAOPGCPREC 9-98 (Aug. 1998). Moreover, the General Counsel also held more recently that separate ratings under 38 C.F.R. § 4.71a, Diagnostic Code 5260 (limitation of flexion of the leg) and under Diagnostic Code 5261 (limitation of extension of the leg), may be assigned for disability of the same joint. VAOGCPREC 9-2004 (Sept. 2004). Right knee A 30 percent disability rating is in effect for limitation of extension of the right knee pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5261, effective November 18, 2009, which corresponds to the date of his increased rating claim. A separate 10 percent disability rating is in effect for instability of the right knee, rated 10 percent disabling, effective October 5, 2010, and 20 percent disabling, effective June 4, 2015, pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5257. With regard to the limitation of motion criteria, a disability rating in excess of 30 percent is not warranted for limitation of extension, as extension limited to 30 degrees is not shown, and a separate compensable rating is not warranted for limitation of flexion as flexion limited to 45 degrees is not shown. Review of the February 2010 examination report reflects extension limited to 20 degrees with pain, and flexion to 120 degrees. The April 2011 examination report reflects extension limited to 10 degrees with pain, with normal flexion. The June 2014 Board decision assigned a 30 percent rating based on the February 2010 objective finding of limitation of extension to 20 degrees, with consideration of reports of functional loss with pain. Thereafter, medical evidence associated with the record does not reflect limitation of extension to 30 degrees nor flexion limited to 45 degrees. On examination in July 2014, extension was normal, and flexion was to 130 degrees, reduced to 120 degrees on repetitive motion testing and in consideration of functional limitations. On examination in June 2015, extension was normal, and flexion was to 100 degrees, reduced to 90 degrees on repetitive motion testing and in consideration of functional limitations. On examination in August 2018, extension was normal, and flexion was to 90 degrees. Additionally, review of VA outpatient orthopedic evaluations do not reflect extension to 30 degrees nor flexion to 45 degrees. Based on the objective medical evidence and lay assertions of the Veteran, the evidence of record does not support that the Veteran has had limitation of extension to 30 degrees or less at any time, nor compensable flexion. Thus, a higher evaluation based on limitation of extension per Diagnostic Code 5261 is not warranted. Per a VA General Counsel opinion, separate ratings may be granted based on limitation of flexion (DC 5260) and limitation of extension (DC 5261) of the same knee joint. VAOPGCPREC 09-04, 69 Fed. Reg. 59990 (2004). However, there is no evidence of compensable limitation of flexion; thus, separate ratings are not warranted for any period contemplated by this appeal. With regard to Diagnostic Code 5257, the evidence of record does not support a disability rating in excess of 10 percent for the period prior to June 4, 2015, nor a disability rating in excess of 20 percent for the period from June 4, 2015. With regard to the period prior to June 4, 2015, an October 5, 2010 VA treatment record reflects anterior positive Lachman’s test and positive for valgus laxity. Prior to October 5, 2010, instability is not shown by objective examination; stability testing was normal at the February 2010 examination. On October 21, 2010, he was referred for a knee brace for ligament instability of the knees. On December 6, 2010, there were objective findings of ligament laxity of the right knee. There was positive Lachman's and anterior drawer and varus instability of the right knee. On December 16, 2010, he had possible ligamentous laxity of the right knee. In April 2011, the medial/lateral collateral ligaments stability test, the anterior/posterior cruciate ligaments stability test and the medial/lateral meniscus stability test were all within normal limits for the right knee. The June 2014 VA examination reflects that on joint stability testing, anterior stability test was normal, as was posterior stability test. On medial-lateral stability testing, there was a finding of +1 (0-5 millimeters). There was no evidence or history of recurrent patellar subluxation/dislocation. On examination in March 2015, there was no ligamentous instability on anterior and posterior testing and valgus/varus stress testing. 05/01/2015 VAMC Other Output/Reports at 2. Based on the objective findings, the 10 percent rating in effect compensates the Veteran for slight lateral instability. The objective findings detailed above do not provide support for a finding of moderate or severe lateral instability as at times examination reports have not reflected any objective findings of lateral instability, and the June 2014 examination report reflected medial-lateral instability +1 but did not reflect findings of +2 (5-10 millimeters) or +3 (10-15 millimeters) which would have been indicative of worse symptomatology. Thus, the objective findings of record prior to June 4, 2015 provide support for a finding of slight lateral instability but not a rating in excess of 10 percent. For the period from June 4, 2015, a disability rating in excess of 20 percent is not warranted as severe lateral instability is not shown. The June 4, 2015 C&P examination reflects no finding of recurrent subluxation with the examiner characterizing his lateral instability as slight. Anterior stability testing was +1, posterior stability testing was +1, medial stability testing was +2, and lateral stability testing was +2. A March 2016 orthopedic evaluation reflects occasional swelling and frequent clicking and instability. 07/22/2020 CAPRI at 14. A June 2016 outpatient record reflects complaints of occasional locking, catching, and buckling. Id. at 7. A July 2016 orthopedic evaluation reflects 1A Lachman’s and negative posterior drawer. Id. at 3. The August 2018 C&P examination reflects an objective finding of slight lateral instability and no history of recurrent subluxation or effusion. Joint stability testing was normal. Orthopedic evaluations in October 2018, January 2019, April 2019, July 2019, October 2019 and February 2020 reflect objective findings of no instability. 07/22/2020 CAPRI at 16, 55; 11/22/2019 CAPRI at 53, 69, 83, 89. The 20 percent rating in effect contemplates his moderate instability of the right knee which was shown on objective examination in June 2015. Severe lateral instability is not shown as objective findings did not reflect findings of +2 of anterior stability or posterior stability, and +3 of medial stability and lateral stability which would have been indicative of worse symptomatology. Moreover, subsequent orthopedic evaluations have not shown objective findings of instability. Thus, the objective findings of record from June 4, 2015 provide support for a finding of moderate lateral instability but not a rating in excess of 20 percent. A separate 20 percent rating is also not warranted pursuant to Diagnostic Code 5258 contemplating dislocated, semilunar cartilage, as locking and effusion have not been shown. While the Veteran has complained of locking, the objective medical evidence does not reflect dislocated, semilunar cartilage. With regard to the other potentially applicable rating codes, Diagnostic Code 5256 provides a higher rating for ankylosis of the knee; however, ankylosis of the knee joint has not been shown. Diagnostic Code 5262 allows for evaluations ranging from 10 to 40 percent for tibia and fibular impairment when there is nonunion with loose motion requiring a brace or malunion with knee or ankle disability; however, tibia and fibular impairment has not been shown in either knee. The Board must also consider whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See DeLuca v. Brown, 8 Vet. App. 202, 205-08 (1995). In finding that a higher evaluation is not warranted for any period, the Board has considered the Veteran’s subjective complaints, as well as whether there is additional functional loss due to lack of endurance, weakness, fatigue, and pain per 38 C.F.R. §§ 4.40 and 4.45. DeLuca, 8 Vet. App. at 206-07. These factors have been taken into consideration in awarding the 30 percent rating pursuant to Diagnostic Code 5261. While the examination reports and evaluations reflect the Veteran’s complaints of pain and swelling, difficulty ascending/descending stairs, and inference with sitting and standing which cause functional limitations. The Board notes that pain alone is not sufficient to warrant a higher rating, as pain may cause a functional loss but does not itself constitute functional loss. Mitchell, 25 Vet. App. at 38. Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id.; 38 C.F.R. § 4.40. The findings reflected in the C&P examination reports and treatment records do not support a rating in excess of the rating already in effect. The rating contemplates his limitation of motion during flare-ups and due to functional limitations. In consideration of the DeLuca factors, while it is clear that the Veteran experiences pain and limitations due to his right knee disability, the respective disability rating in effect takes into consideration the Veteran’s functional loss and limitations associated with his right knee disability. The Board finds that 38 C.F.R. § 4.40, 4.45 and 4.59 do not provide the basis for a higher rating for any period contemplated by this appeal. The Board has considered whether additional ratings for neurological manifestations are warranted. However, because no such manifestations have been diagnosed, additional ratings for neurological manifestations are inapplicable in this case. 38 C.F.R. § 4.124a. Applying all of the appropriate diagnostic codes to the facts of this case, the objective assessment of the Veteran’s impairment of the right knee prior does not suggest that he has sufficient symptoms at any time during the pendency of this appeal, so as to warrant the assignment of increased evaluations from the respective 30 percent (for arthritis and limitation of extension), and 10 and 20 percent (for instability) evaluations in effect. Hart v. Mansfield, 21 Vet. App. 505 (2007). Left knee A 30 percent disability rating is in effect for limitation of extension of the left knee pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5261, effective November 18, 2009. A separate 10 percent disability rating is in effect for instability, left knee, rated 10 percent disabling, effective October 5, 2010, and 20 percent disabling, effective June 4, 2015, pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5257. A separate 20 percent disability rating is in effect for meniscal tear, left knee, effective May 21, 2016. With regard to the limitation of motion criteria, a disability rating in excess of 30 percent is not warranted for limitation of extension, as extension limited to 30 degrees is not shown, and a separate compensable rating is not warranted for limitation of flexion as flexion limited to 45 degrees is not shown. Review of the February 2010 examination report reflects extension limited to 20 degrees with pain, and flexion to 120 degrees. The April 2011 examination report reflects extension limited to 10 degrees with pain, with normal flexion. The June 2014 Board assigned a 30 percent rating based on the February 2010 objective finding of limitation of extension to 20 degrees, and due to reports of functional loss with pain. Thereafter, medical evidence associated with the record does not reflect limitation of extension to 30 degrees nor flexion limited to 45 degrees. On examination in July 2014, extension was normal, and flexion was to 140 degrees, reduced to 130 degrees on repetitive motion testing and in consideration of functional limitations. On examination in June 2015, extension was normal, and flexion was to 105 degrees, reduced to 95 degrees on repetitive motion testing and in consideration of functional limitations. On examination in August 2018, extension was normal and flexion was to 120 degrees. Review of VA outpatient orthopedic evaluations do not reflect extension to 30 degrees nor flexion to 45 degrees. Based on the objective medical evidence and lay assertions of the Veteran, the evidence of record does not support that the Veteran has had limitation of extension to 30 degrees or less at any time, nor compensable flexion. Thus, a higher evaluation based on limitation of extension per Diagnostic Code 5261 is not warranted. Per a VA General Counsel opinion, separate ratings may be granted based on limitation of flexion (DC 5260) and limitation of extension (DC 5261) of the same knee joint. VAOPGCPREC 09-04, 69 Fed. Reg. 59990 (2004). However, there is no evidence of compensable limitation of flexion; thus, separate ratings are not warranted for any period contemplated by this appeal. With regard to Diagnostic Code 5257, the evidence of record does not support a disability rating in excess of 10 percent for the period prior to June 4, 2015, nor a disability rating in excess of 20 percent for the period from June 4, 2015. With regard to the period prior to June 4, 2015, an October 5, 2010 VA treatment record reflects anterior positive Lachman’s test and positive for valgus laxity. Prior to October 5, 2010, instability is not shown by objective examination; stability testing was normal at the February 2010 examination. On October 21, 2010, he was referred for a knee brace for ligament instability of the knees. On December 6, 2010, there were objective findings of possible ligament laxity of the left knee. There was slight positive Lachman’s, negative anterior drawer, and slight valgus instability of the left knee. On December 16, 2010, he had possible ligamentous laxity of the left knee. In April 2011, the medial/lateral collateral ligaments stability test, the anterior/posterior cruciate ligaments stability test and the medial/lateral meniscus stability test were all within normal limits for the left knee. The June 2014 VA examination reflects normal joint stability testing. There was no evidence or history of recurrent patellar subluxation/dislocation. On examination in March 2015, there was no ligamentous instability on anterior and posterior testing and valgus/varus stress testing. 05/01/2015 VAMC Other Output/Reports at 2. Based on the objective findings, the 10 percent rating in effect compensates the Veteran for slight lateral instability. The objective findings do not provide support for a finding of moderate or severe lateral instability as at times examination reports have not reflected any objective findings of lateral instability. The objective findings of record prior to June 4, 2015 provide support for a finding of slight lateral instability but not a rating in excess of 10 percent. For the period from June 4, 2015, a disability rating in excess of 20 percent is not warranted as severe lateral instability is not shown. The June 4, 2015 C&P examination reflects no finding of recurrent subluxation with the examiner characterizing his lateral instability as slight. Anterior stability testing was +1, posterior stability testing was +1, medial stability testing was +2, and lateral stability testing was +2. A March 2016 orthopedic evaluation reflects occasional swelling and frequent clicking and instability. 07/22/2020 CAPRI at 14. A June 2016 outpatient record reflects complaints of occasional locking, catching, and buckling. Id. at 7. A July 2016 orthopedic evaluation reflects 1A Lachman’s and negative posterior drawer. Id. at 3. The August 2018 C&P examination reflects an objective finding of slight lateral instability and no history of recurrent subluxation or effusion. Joint stability testing was normal. Orthopedic evaluations in October 2018, January 2019, April 2019, July 2019, October 2019 and February 2020 reflect objective findings of no instability. 07/22/2020 CAPRI at 16, 55; 11/22/2019 CAPRI at 53, 69, 83, 89. The 20 percent rating in effect contemplates the moderate instability of the left knee shown on objective examination in June 2015. Severe lateral instability is not shown, as objective findings did not reflect findings of +2 of anterior stability or posterior stability, and +3 of medial stability and lateral stability which would have been indicative of worse symptomatology. Moreover, subsequent orthopedic evaluations have not shown objective findings of instability. Thus, the objective findings of record from June 4, 2015 provide support for a finding of moderate lateral instability but not a rating in excess of 20 percent. As detailed above, a separate 20 percent rating is in effect per Diagnostic Code 5258 contemplating dislocated, semilunar cartilage, with locking and effusion. This constitutes the highest rating assignable for dislocated, semilunar cartilage. The effective date corresponds to the date of a MRI which showed bucket-handle tear posterior horn of medial meniscus with flipped meniscus in the anterior horn. 07/22/2020 CAPRI at 3. With regard to the other potentially applicable rating codes, Diagnostic Code 5256 provides a higher rating for ankylosis of the knee; however, ankylosis of the knee joint has not been shown. Diagnostic Code 5262 allows for evaluations ranging from 10 to 40 percent for tibia and fibular impairment when there is nonunion with loose motion requiring a brace or malunion with knee or ankle disability; however, tibia and fibular impairment has not been shown in either knee. The Board must also consider whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See DeLuca v. Brown, 8 Vet. App. 202, 205-08 (1995). In finding that a higher evaluation is not warranted for any period, the Board has considered the Veteran’s subjective complaints, as well as whether there is additional functional loss due to lack of endurance, weakness, fatigue, and pain per 38 C.F.R. §§ 4.40 and 4.45. DeLuca, 8 Vet. App. at 206-07. These factors have been taken into consideration in awarding the 30 percent rating pursuant to Diagnostic Code 5261. While the examination reports and evaluations reflect the Veteran’s complaints of pain and swelling, difficulty ascending/descending stairs, and inference with sitting and standing which cause functional limitations. The Board notes that pain alone is not sufficient to warrant a higher rating, as pain may cause a functional loss but does not itself constitute functional loss. Mitchell, 25 Vet. App. at 38. Rather, pain must affect some aspect of “the normal working movements of the body” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Id.; 38 C.F.R. § 4.40. The findings reflected in the C&P examination reports and treatment records do not support a rating in excess of the rating already in effect. The rating contemplates his limitation of motion during flare-ups and due to functional limitations. In consideration of the DeLuca factors, while it is clear that the Veteran experiences pain and limitations due to his left knee disability, the respective disability rating in effect takes into consideration the Veteran’s functional loss and limitations associated with his left knee disability. The Board finds that 38 C.F.R. § 4.40, 4.45 and 4.59 do not provide the basis for a higher rating for any period contemplated by this appeal. The Board has considered whether additional ratings for neurological manifestations are warranted. However, because no such manifestations have been diagnosed, additional ratings for neurological manifestations are inapplicable in this case. 38 C.F.R. § 4.124a. (Continued on the next page)   Applying all of the appropriate diagnostic codes to the facts of this case, the objective assessment of the Veteran’s impairment of the left knee prior does not suggest that he has sufficient symptoms at any time during the pendency of this appeal, so as to warrant the assignment of increased evaluations from the respective 30 percent (for arthritis and limitation of extension), 10 and 20 percent (for instability) evaluations in effect, and the 20 percent rating in effect for meniscal tear, left knee. Hart v. Mansfield, 21 Vet. App. 505 (2007). Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.W. Kreindler, 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.